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Mitigation or even elimination of adverse effects caused by ionizing radiation is the main scope of the radiation protection discipline. The interaction of radiation with living matter is quantified and correlated with biological effects by dose. The Sievert is the most well-known quantity, and it is used with the equivalent and effective dose to minimize stochastic effects. However, Gray is the reference quantity for sizing tissue reactions that could occur under high-exposure conditions such as in a radiation emergency. The topics addressed in this review are the choice to move from Sievert to Gray, how the operational quantities for environmental and individual monitoring of the detectors should consider such a change of units, and why reference levels substitute dose levels in emergency exposure.
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Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Humanos , Radiación IonizanteRESUMEN
INTRODUCTION/PURPOSE: Postmortem computed tomography (PMCT) is a valuable tool for analyzing the death of patients with SARS-CoV-2 infection. The purpose of this study was to investigate the correlation between PMCT lung findings in autopsy cadavers positive for SARS-CoV-2 infection and the severity of COVID-19 lung disease by histopathological analysis. MATERIALS AND METHODS: We reviewed chest PMCT findings, paying particular attention to the lung parenchyma, in 8 autopsy cases positive for SARS-CoV-2. Correlations between chest PMCT and histopathological findings were assessed. Clinical conditions and comorbidities were also recorded and discussed. The primary cause of death was finally considered. RESULTS: In 6/8 cases, pulmonary PMCT findings were massive consolidation (4/8) and bilateral diffuse mixed densities with a crazy-paving pattern (2/8). These cases showed severe pulmonary signs of COVID-19 at histopathological analysis. In the remaining 2/8 cases, pulmonary PMCT findings were scant antideclive ground-glass opacities in prevalent gradient densities attributed to hypostasis. In 4/8 cases with massive consolidations, important comorbidities were noted. In 6/8 cases with severe pulmonary histopathological signs of lung COVID-19, autopsy found that the cause of death was cardiorespiratory failure. In the remaining 2/8 cases, histopathological analysis revealed lung alterations due to edema and some signs of SARS-CoV-2 infection; the cause of death was not attributed to SARS-CoV-2 infection (Table 1). DISCUSSION AND CONCLUSION: Chest PMCT findings correlate with the severity of COVID-19 lung disease at histopathology examination. According to our results, there may also be a relationship between cause of death and PMCT findings in COVID-19, which must be critically analyzed considering clinical antemortem data.
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COVID-19 , SARS-CoV-2 , Autopsia , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To evaluate the role of dual-energy computed tomography (DECT) in the management of vertebral compression fractures in clinical practice. MATERIALS AND METHODS: This retrospective IRB-approved study included 497 consecutive patients with suspected acute vertebral fractures, imaged either by DECT (group 1) or MRI (group 2) before vertebroplasty. The site, number and type of fractures at imaging findings, and clinical outcome based on any change in pain (DELTA-VAS), before (VAS-pre) and after treatment (VAS-post), were determined and compared. Two radiologists evaluated DECT and MRI images (15 and 5 years of experience, respectively), and inter-observer and intra-observer agreement were calculated using k statistics. RESULTS: Both in the control group (n = 124) and in the group of patients treated by vertebroplasty (n = 373), the clinical outcome was not influenced by the imaging approach adopted, with a DELTA-VAS of 5.45 and 6.42 in the DECT group and 5.12 and 6.65 in the MRI group (p = 0.326; p = 0.44). In the group of treated patients, sex, age, lumbar fractures, multiple fractures, previous fractures, Genant grade, involvement of anterior apex or superior endplates, and increased spinal curvatures were similar (p = ns); however, dorsal fractures were more prevalent in group 1 (p = 0.0197). Before treatment, the mean VAS-pre was 8.74 in group 1 (DECT) and 8.65 in group 2 (MRI) (p = 0.301), whereas after treatment, the mean VAS-post value was 2.32 in group 1 (p = 0.0001), and 2.00 in group 2 (p = 0.0001). The DELTA-VAS was 6.42 in the group of patients imaged using DECT and 6.65 in the group imaged using MRI (p = 0.326). Inter-observer and intra-observer agreement were 0.85 and 0.89 for DECT, and 0.88 and 0.91 for MRI, respectively. CONCLUSION: The outcome of vertebral compression fracture management was no different between the two groups of patients studied.
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Enfermedades Óseas Metabólicas , Fracturas por Compresión , Fracturas Osteoporóticas , Fracturas de la Columna Vertebral , Vertebroplastia , Fracturas por Compresión/diagnóstico por imagen , Fracturas por Compresión/cirugía , Humanos , Fracturas Osteoporóticas/etiología , Fracturas Osteoporóticas/cirugía , Estudios Retrospectivos , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/cirugía , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Vertebroplastia/métodosRESUMEN
In December 2019, a new coronavirus, SARS-COV-2, caused a cluster of cases of pneumonia in China, and rapidly spread across the globe. It was declared a pandemic by the World Health Organization on March 11th, 2020. Virtual autopsy by post-mortem CT (PMCT) and its ancillary techniques are currently applied in post-mortem examinations as minimally or non-invasive techniques with promising results. In this narrative review, we speculate on the potentials of PMCT and its ancillary techniques, as a viable investigation technique for analysis of suspected or confirmed SARS-COV-2 deaths. An online literature search was performed by using three prefix search terms (postmortem, post-mortem, post mortem) individually combined with the suffix radiology, imaging, computed tomography, CT and with the search terms 'SARS-CoV-2' and 'COVID-19' to identify papers about PMCT and its ancillary techniques in SARS-COV-2 positive cadavers. PMCT findings suggestive for pulmonary COVID-19 in deceased positive SARS-COV-2 infection are reported in the literature. PMCT ancillary techniques were never applied in such cases. PMCT imaging of the lungs has been proposed as a pre-autopsy screening method for SARS-COV-2 infection. Further studies are needed to ascertain the value of PMCT in determining COVID-19 as the cause of death without autopsy histopathological confirmation. We advocate the application of PMCT techniques in the study of ascertained or suspected SARS-COV-2 infected deceased individuals as a screening technique and as a method of post-mortem investigation, to augment the numbers of case examined and significantly reducing infection risk for the operators.
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COVID-19 , SARS-CoV-2 , Autopsia/métodos , Humanos , Pandemias , Tomografía Computarizada por Rayos X/métodosRESUMEN
In a foreign country, a religious terrorist group raided a restaurant, using pipe bombs, sharp-edged weapons, and various types of firearms (handguns, submachine guns, and AK-47 assault rifles) loaded with normal and prohibited bullets to kill foreigner customers, some of whom were Italian tourists. Local pathologists performed forensic autopsies on the bodies, but we were asked to perform additional external examinations, postmortem computed tomography (PMCT) scans, and then a second round of complete autopsies on nine victims (5 females and 4 males). Four victims had slash wounds inflicted by sharp-edged weapons, mostly localized in the head and neck. All but two victims had gunshot wounds. Finally, three casualties had injuries caused by the explosion of improvised explosive devices. In all cases, PMCT was a reliable source of information and provided strategic guide during autopsies, helping identify and describe the injuries and thus reconstruct the events. Therefore, in these cases, we suggest integrating the autopsy findings with the postmortem radiological data.
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Víctimas de Crimen , Patologia Forense/métodos , Terrorismo , Heridas y Lesiones/diagnóstico por imagen , Heridas y Lesiones/patología , Adulto , Autopsia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
Bone marrow edema (BME) is defined as an area of low signal intensity on T1-weighted (T1W) MRI images and associated with intermediate or high signal intensity findings on T2-weighted (T2W) MRI images. BME represents a typical imaging finding that characterizes common stress-related bone injuries of professional and amateur athletes. The etiology of stress-related injuries is influenced by numerous factors, including the initiation of a new sports activity or changes in an existing training protocol. The clinical significance of BME remains unclear. However, a correlation between the imaging pattern of BME, the clinical history of the patient and the type of sports activity practiced is essential for correct diagnosis and adequate therapeutic treatment. It is also important to clarify whether there is a specific threshold beyond which exercise can adversely affect the bone remodeling process, as the clinical picture may degenerate into the presence of BME, pain and, in the most severe cases, bone loss. In our review, we summarize the current knowledge on the etiopathogenesis and treatment options for BME and highlight the main aspects that make it difficult to formulate a correct diagnosis and establish an adequate therapeutic treatment.
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Enfermedades de la Médula Ósea , Médula Ósea , Atletas , Médula Ósea/diagnóstico por imagen , Enfermedades de la Médula Ósea/diagnóstico por imagen , Edema/diagnóstico por imagen , Edema/etiología , Humanos , Imagen por Resonancia MagnéticaAsunto(s)
COVID-19 , Humanos , Niño , SARS-CoV-2 , Autopsia , Tomografía Computarizada por Rayos X , Causas de MuerteRESUMEN
PURPOSE: Repeatedly negative prostate biopsies in individuals with elevated prostate-specific antigen (PSA) levels can be frustrating for both the patient and the urologist. This study was performed to investigate if magnetic resonance imaging (MRI)-guided transrectal biopsy (MRGB) increases diagnostic performance in individuals with suspected prostate cancer (PCa). MATERIALS AND METHODS: Twenty-three consecutive men with a total PSA >4 ng/mL, PSA density >0.15, PSA velocity >0.75 ng/mL/year and suspicious MRI findings were included (average age 64 years; age range 53-75 years; total PSA levels ranging from 4.7 to 54 ng/mL; median 9 ng/mL). MRGB was performed with a closed unit at 1.5 Tesla, an MRI compatible biopsy device, a needle guide, and a titanium double-shoot biopsy gun. RESULT: At prebiopsy MRI, in the 23 patients, a total of 26 suspicious areas to which the MRGB should be directed were found, 23 of them in the peripheral zone and three in the transitional zone. The needle guide was depicted and could be positioned with MRI guidance in all 23 patients. The duration of the procedure ranged from 35 to 55 min (mean 40 min). MRGB was well tolerated by all patients, and no major complications were observed. The detection rate for the diagnosis of PCa was 80, and 90 % of detected PCa were of intermediate aggressiveness. CONCLUSION: MRGB has the potential to improve cancer detection rates in men with suspected PCa to deliver the relevant treatment as soon as possible.
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Biopsia/métodos , Imagen por Resonancia Magnética , Próstata/patología , Anciano , Humanos , Masculino , Persona de Mediana Edad , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/patologíaRESUMEN
The aim of this paper is to underline the importance of the role of general practitioners (GPs) in distributing vital information about prevention to citizens, to highlight the importance of the so-called voluntary prevention programmes, both for conditions for which no organised screening programmes exist and for those for which they do exist but may well be obsolete or inefficient. Nowadays, voluntary prevention is made more effective thanks to the new sophisticated diagnostic technologies applied worldwide by diagnostic imaging. Epidemiological data about the incidence and causes of death among the Italian population have shown that screening programmes should be aimed first at fighting the following diseases: prostatic carcinoma, lung cancer, colorectal carcinoma, breast cancer, cardiovascular disease, cerebrovascular disease, aortic and peripheral vascular disease. GPs do not generally give good or adequate instructions concerning voluntary prevention programmes; GPs may not even be aware of this type of prevention which could represent a valuable option together with the existing mass screening programmes. Therefore, in the following analysis, we aim to outline the correct diagnostic pathway for the prevention of diseases having the highest incidence in our country and which represent the most frequent causes of death. If used correctly, these screening programmes may contribute to the success of secondary prevention, limiting the use of tertiary prevention and thus producing savings for the Italian National Health System.
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Diagnóstico por Imagen , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/prevención & control , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Cardiovasculares/prevención & control , Neoplasias Colorrectales/diagnóstico por imagen , Neoplasias Colorrectales/prevención & control , Femenino , Medicina General , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/prevención & control , Masculino , Rol del Médico , Medicina Preventiva , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/prevención & control , Radiografía , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/prevención & controlRESUMEN
The aim of this paper is to critically review the literature documenting the imaging approach in adult Femoral Head Avascular Necrosis (FHAVN). For this purpose we described and evaluated different radiological techniques, such as X-ray, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Nuclear Medicine. Plain films are considered the first line imaging technique due to its ability to depict femoral head morphological changes, to its low costs and high availability. CT is not a routinely performed technique, but is useful to rule out the presence of a subchondral fracture when MRI is doubtful or contraindicated. MRI is unanimously considered the gold standard technique in the early stages, being capable to detect bone marrow changes such as edema and sclerosis. It may be useful also to guide treatment and, as CT, it is a validated technique in follow-up of patients with FHAVN. Nuclear medicine imaging is mostly applied in post-operative period to detect graft viability or infective complications. More advanced techniques may be useful in particular conditions but still need to be validated; thus new research trials are desirable. In conclusion, X-ray examination is the first line approach, but lacks of sensitivity in early stage whereas MRI is indicated. CT easily depicts late stage deformation and may decrease MRI false positive results in detecting the subchondral fracture. However, the role of both Nuclear Medicine Imaging and advanced MR techniques in FHAVN still need to be investigated.
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PURPOSE: This study was undertaken to assess the feasibility of real-time elastosonography (RTE) of Achilles tendon in the clinical evaluation of a cohort of children affected by unilateral clubfoot, not surgically treated. MATERIALS AND METHODS: Twenty patients affected by unilateral clubfoot were evaluated. The study group consisted of 8 males and 12 females (mean age, 16 ± 7.3 months), all treated with the Ponseti method. Children were divided into two groups according to age: group 1 aged 0-18 months, and group 2 aged 18-60 months. Any further systemic pathological conditions were considered exclusion criteria. For each subject, RTE examination of the Achilles tendons was performed bilaterally, and then regions of interest (ROIs) were positioned. RESULTS: In children aged 0-18 months, the mean value ROI 1/mean value ROI 2 ratio was 2.0 ± 0.18 and it showed a statistically significant difference if compared to the same ratio from healthy tendons, 2.5 ± 0.17 (p < 0.05). In group 2 (children aged 18-60 months) the mean ROI 1/mean value ROI 2 ratio value was 1.8 ± 0.27, compared to a 2.04 ± 0.21 (p < 0.05) ratio in healthy tendons. CONCLUSION: RTE is a feasible, reliable and easily performed technique that allows an accurate study of the mechanical properties of Achilles tendon in children with clubfoot.
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Pie Equinovaro/diagnóstico por imagen , Diagnóstico por Imagen de Elasticidad , Preescolar , Sistemas de Computación , Estudios de Factibilidad , Femenino , Humanos , Lactante , Recién Nacido , MasculinoRESUMEN
Historically, non-cancer diseases have not been considered a health risk following low-dose exposure to ionizing radiation. However, it is now well known that high-dose ionizing radiation causes cardiovascular disease, and emerging epidemiological evidence suggests an excess risk of non-cancer diseases even following exposure to lower doses of ionizing radiation than previously thought. In fact, the evidence is strongest for cardiovascular disease (CVD). The aim of this review was to report the most representative studies and data on the risk of CVD from low-dose radiation in people with occupational exposure. We reported the results of 27 articles selected from a database search of 1151 studies. The results show a complex evidence landscape on the relationship between radiation exposure and cardiovascular disease. In general, published papers show a positive association between ionizing radiation exposure and dermal microcirculation damage, ischemic heart disease, and cerebrovascular disease. Overall, they highlight the need for comprehensive and detailed research to clarify this relationship. Due to limited statistical power, the dose-risk relationship below 0.5 Gy is inconclusive, but if this relationship is found to have no threshold, it could have a significant impact on current estimates of health risks at low doses.
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INTRODUCTION AND OBJECTIVES: To evaluate the oncological and functional outcomes of transperineal laser ablation (TPLA) as the focal therapy for localized prostate cancer (PCa) after a 12-month follow-up. MATERIALS AND METHODS: Patients with low- and intermediate-risk localized PCa were prospectively treated with focal TPLA between July 2021 and December 2022. The inclusion criteria were the following: clinical stage < T2b; PSA < 20 ng/mL; International Society of Urological Pathology (ISUP) grade ≤ 2; MRI-fusion biopsy-confirmed lesion classified as PI-RADS v2.1 ≥ 3. Intra-, peri-, and post-operative data were collected. Variables including age, PSA, prostate volume (PVol), Charlson's Comorbidity Index (CCI), International Prostate Symptom Score (IPSS) with QoL score, International Index of Erectile Function (IIEF-5), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Male Sexual Health Questionnaire-Ejaculatory Dysfunction Short Form (MSHQ-EjD) were collected at baseline and at 3, 6 and 12 months after TPLA. Post-operative mpMRI was performed at 3 and 12 months. Finally, all patients underwent prostatic re-biopsy under fusion guidance at 12 months. The success of this technique was defined as no recurrence in the target treated lesion at the 12-month follow up. RESULTS: Twenty-four patients underwent focal TPLA. Baseline features were age [median 67 years (IQR 12)], PSA [5.7 ng/mL (3.9)], PVol [49 mL (27)], CCI [0 (0)], IPSS [11 (9)], IPSS-QoL [2 (2)], IIEF-5 [21 (6)], ICIQ-SF [0 (7)], MSHQ-EjD ejaculation domain [14 (4)] and bother score [0 (2)]. Median operative time was 34 min (IQR 12). Median visual analogue scale (VAS) 6 h after TPLA was 0 (IQR 1). The post-operative course was regular for all patients, who were discharged on the second post-operative day and underwent catheter removal on the seventh post-operative day. No patient had incontinence at catheter removal. A significant reduction in PSA (p = 0.01) and an improvement in IPSS (p = 0.009), IPSS-QoL (p = 0.02) and ICIQ-SF scores (p = 0.04) compared to baseline were observed at the 3-month follow-up. Erectile and ejaculatory functions did not show any significant variation during the follow-up. No intra- and peri-operative complications were recorded. Three Clavien-Dindo post-operative complications were recorded (12%): grade 1 (two cases of urinary retention) and grade 2 (one case of urinary tract infection). At the 12-month follow-up, eight patients showed mpMRI images referable to suspicious recurrent disease (PIRADS v2.1 ≥ 3). After re-biopsy, 7/24 patients' (29%) results were histologically confirmed as PCa, 3 of which were recurrences in the treated lesion (12.5%). The success rate was 87.5%. CONCLUSIONS: The focal TPLA oncological and functional results seemed to be encouraging. TPLA is a safe, painless, and effective technique with a good preservation of continence and sexual outcomes. Recurrence rate at 12 months was about 12.5%.
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Objective: To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus method. Methods: Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and finalized. Results: Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from <40 mL (80%) to >80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading to statements and recommendations. Conclusion: Echolaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.
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BACKGROUND: Patients with low back pain frequently demonstrate recumbent magnetic resonance imaging (MRI) alterations not always related to homogeneous clinical symptoms. The purpose of this study was to evaluate and quantify the statistical significance of variations of some anatomical parameters of the lumbosacral spine and reveal occult disc pathologies from recumbent to upright position in patients with acute and chronic low back pain. MATERIALS AND METHODS: Fifty-seven patients complaining of low back pain (27 women, 30 men) underwent dynamic lumbosacral MRI with a 0.25-T tilting system (G-scan Esaote). We settled five parameters for which variations have been evaluated: lumbosacral angle, lordosis angle, L3-L4 intersomatic disc height, L3-L4 interspinous processes distance, and widest anteroposterior dural sac diameter. Images were obtained in both recumbent and upright positions. RESULTS: Statistically significant differences [one-way analysis of variance (ANOVA), p = 0.0043] were found between each pair of values of parameters sampled in recumbent and upright positions. In 70 % of patients, on visual qualitative analysis only, an increment of disc protrusions and/or spondylolisthesis was found in the upright position; in three cases, in the upright position only, an interarticular pseudocyst was found. CONCLUSIONS: Dynamic MRI with an open-configuration, low-field tilting MRI system is a feasible and promising tool to study degenerative pathology of the spine. Moreover, in cases of low back pain with negative MRI in the recumbent position or in patients with pain in the upright position only, tilting MRI permits visualization of occult spine and disc pathologies in patients with acute or chronic low back pain.
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Dolor de la Región Lumbar/diagnóstico , Imagen por Resonancia Magnética/métodos , Enfermedad Aguda , Adulto , Anciano , Fenómenos Biomecánicos , Dolor Crónico/diagnóstico , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Prostate MRI is an essential tool in the diagnostic pathway of prostate cancer and its accurate reading helps decision to biopsy. The aim of this study was to assess the Urology residents' level of confidence in reading and interpreting prostate MRI, their interest in new learning opportunities and whether prostate MRI training should be part of the urology core curriculum during residency. METHODS: A 23-item survey has been created and distributed via Web to an international cohort of Urology residents over a 3-month period. Surveys obtained from Countries representing >10% total distribution of responses were analyzed. RESULTS: A total of 304 complete surveys were obtained from Urology residents, with a geographical prevalence from Europe (59.54%, 181/304) and South America (29.28%, 89/304). Only 17-20% of residents reported having received formal prostate MRI training during residency. Overall, <20% residents expressed to feel confident in reading and interpreting prostate MRI. As a result, >90% Urology trainees stated they would be willing to receive a formal training and would be interested in new learning opportunities in MRI reading and interpretation during residency, independently of their year of training. Despite UK Urology trainees showed to have a higher availability of MRI resources and MRI-based biopsies compared to the other countries, they still expressed concerns in regard to not feeling confident with MRI reading and interpretation and requested a formal training. CONCLUSIONS: This survey highlights the need for major learning opportunities and a formal training in prostate MRI reading and interpretation during urology residency.
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Urología , Masculino , Humanos , Urología/educación , Próstata , Brasil , Lectura , Italia/epidemiología , Imagen por Resonancia Magnética , Reino UnidoRESUMEN
Disorders of sexual differentiation are rare congenital conditions in which the chromosomal, anatomic or gonadal sex development is atypical. In some of these patients, chromosomal sex is inconsistent with phenotypic sex; in other cases, the phenotype is not classifiable as either male or female, resulting in a condition known as ambiguous genitalia. These are very complex cases in which diagnostic certainty is not always possible. A multidisciplinary team including geneticists, pediatricians, radiologists is certainly needed to approach these patients. We present the case of an 18-year-old boy with an XY karyotype, ambiguous genitalia, uterus and blind-ending vaginal pouch. The patient had not been previously diagnosed with a disorder of sex development. The patient underwent a panel of genetic analyses and diagnostic imaging investigations. Magnetic resonance imaging was decisive for the identification of the internal genital organs, especially the uterus. At the end of investigations, the patient was diagnosed with 46,XY disorder of sex development. Our purpose is to underline the role of imaging in the diagnosis and management of congenital disorders of sex differentiation.
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This study aimed to investigate the Diffusion-Tensor-Imaging (DTI) potential in the detection of microstructural changes in prostate cancer (PCa) in relation to the diffusion weight (b-value) and the associated diffusion length lD. Thirty-two patients (age range = 50-87 years) with biopsy-proven PCa underwent Diffusion-Weighted-Imaging (DWI) at 3T, using single non-zero b-value or groups of b-values up to b = 2500 s/mm2. The DTI maps (mean-diffusivity, MD; fractional-anisotropy, FA; axial and radial diffusivity, D// and Dâ´), visual quality, and the association between DTI-metrics and Gleason Score (GS) and DTI-metrics and age were discussed in relation to diffusion compartments probed by water molecules at different b-values. DTI-metrics differentiated benign from PCa tissue (p ≤ 0.0005), with the best discriminative power versus GS at b-values ≥ 1500 s/mm2, and for b-values range 0-2000 s/mm2, when the lD is comparable to the size of the epithelial compartment. The strongest linear correlations between MD, D//, Dâ´, and GS were found at b = 2000 s/mm2 and for the range 0-2000 s/mm2. A positive correlation between DTI parameters and age was found in benign tissue. In conclusion, the use of the b-value range 0-2000 s/mm2 and b-value = 2000 s/mm2 improves the contrast and discriminative power of DTI with respect to PCa. The sensitivity of DTI parameters to age-related microstructural changes is worth consideration.
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In recent years, the onco-nephrology field has acquired a relevant role in internal medicine due to the growing number of cases of renal dysfunction that have been observed in cancer patients. This clinical complication can be induced by the tumor itself (for example, due to obstructive phenomena affecting the excretory tract or by neoplastic dissemination) or by chemotherapy, as it is potentially nephrotoxic. Kidney damage can manifest as acute kidney injury or represent a worsening of pre-existing chronic kidney disease. In cancer patients, physicians should try to set preventive strategies to safeguard the renal function, avoiding the concomitant use of nephrotoxic drugs, personalizing the dose of chemotherapy according to the glomerular filtration rate (GFR) and using an appropriate hydration therapy in combination with nephroprotective compounds. To prevent renal dysfunction, a new possible tool useful in the field of onco-nephrology would be the development of a personalized algorithm for the patient based on body composition parameters, gender, nutritional status, GFR and genetic polymorphisms.
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In patients with follicular lymphoma (FL), therapeutic advances have led to improved survival, and within this framework, it is important to identify treatment strategies offering a better quality of life. Using (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT), in patients treated with R-CHOP-like or R-Bendamustine regimens, we assessed changes in the bone mineral density (BMD), musculoskeletal index (SMI), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) at disease onset and at the end of therapy. We evaluated whether the high-steroid regimen could lead to more significant radiological changes than those induced by the steroid-free regimen and whether a low BMD at disease onset is an unfavorable prognostic index. Seventy-nine patients between 60 and 80 years old with a new diagnosis of FL were included in the study. Evaluation of Delta values (pre- and post-therapy mean values) in the two immunochemotherapy regimens showed differences in radiomic parameters within the two patient cohorts. The R-CHOP-like regimen was associated with a significant reduction in BMD, an increase in SAT and VAT, and a reduction in skeletal muscle density (SMD) and SMI. Moreover, patients with high FLIPI showed a BMD below the cut-off value. This study represents the first study demonstrating a prognostic correlation between FLIPI and low BMD.