SARS-CoV-2 infection does not induce HIV viral escape in the central nervous system: A case series.

We report two cases of HIV positive patients with SARS-CoV-2 infection and a recent diagnosis of opportunistic infections of central nervous system (CNS). We investigated the potential impact of coinfection with SARS-CoV-2 on HIV replication in CNS.

E-learning in radiology: an Italian multicentre experience.

OBJECTIVE: The aim of this study was to design, deliver and evaluate an e-learning teaching programme for post-graduate radiodiagnostics training that would involve various post-graduate schools throughout Italy. MATERIALS AND METHODS: All of the Directors of Italian post-graduate schools of radiodiagnostics were sent an e-mail on 27 September 2010 informing them of our willingness to set up an e-learning project for the academic year 2010-2011 in the form of single-subject teaching seminars. The proposed subjects were the semeiotics of the various organs and apparatuses in the context of "Urgent/Emergency Pathology". After having received registrations, a calendar of lessons was planned to be held between 10 November 2010 and 12 October 2011. The validity of the project was tested by means of a multiple-choice questionnaire covering the technical and didactic quality of the entire project, to be completed by the students. RESULTS: Fifty-one percent of the universities in Italy participated in the project: Trieste, Udine, Verona, Milan-Bicocca, Novara, Varese, Genoa, Sassari, Rome Campus, the Catholic University of Rome, Chieti, Foggia, Catania, Modena, Florence, Palermo, Bologna, Pavia, Parma and Ferrara. The lessons were attended by a total of 10,261 post-graduate medical students, for an average of 513.1 students per lesson. Seventy percent of the students judged the didactic content "excellent", 25% "good", and 5% "satisfactory"; none said it was unsatisfactory. In terms of visual quality (particularly the details of the radiological images proposed in the form of slides and/or video clips), 73% judged it "excellent", 20% "good", 6% "satisfactory", and 1% "poor". The audio quality was judged "excellent" by 71%, "good" by 22%, "satisfactory" by 6% and "poor" by 1%. In relation to judgement of audio and video quality, it has to be underlined that this was greatly affected by the hardware/software configuration and the band speed and technology of the Internet connection. CONCLUSIONS: Technological evolution is overcoming all barriers, and technology is also having a positive impact on the approach to teaching. Our multicentre teaching experience merits the following considerations: the quality of the teaching product was certified by the students' judgements of its didactic content and the quality of reception; the economic cost of the teaching had a minimal impact on the post-graduate schools (€ 18 per lesson). In terms of breaking down national barriers, it is to be hoped that the coordination and integration of diagnostic imaging e-learning projects, with the participation of post-graduate schools in different European countries, can be developed not only in a spirit of "cultural sharing" and the exchange of teaching experiences.

Imaging of segmental testicular infarction: our experience and literature review.

PURPOSE: The purpose of this study was to evaluate the usefulness of the main methods of diagnostic imaging in patients with segmental testicular infarction (STI) for obtaining accurate clinical and therapeutic approaches. MATERIALS AND METHODS: Between January 2004 and January 2011, 798 patients were examined with colour Doppler ultrasound (CDUS) for disease of the scrotum. Fourteen patients with CDUS findings suspicious for STI were subjected to magnetic resonance imaging (MRI). In five patients, contrast-enhanced ultrasonography (CEUS) was performed. RESULTS: CDUS showed hypoechoic avascular areas suspicious for STI in 14 patients (1.75%). MRI confirmed the presence of predominantly hypointense lesions in T1- and T2-weighted sequences, with perilesional vasculature and no intrinsic contrast enhancement in 13 patients. In follow-up examinations, these abnormalities gradually decreased. This finding was confirmed in the five patients examined with CEUS. Only in one case did MRI reveal discrete intralesional contrast enhancement after injection of contrast medium, and the lesions appeared stable during the CDUS and MRI follow-up; this patient underwent orchiectomy, with a diagnosis of B-cell lymphoma. CONCLUSIONS: In our experience CDUS, CEUS and MRI proved indispensable for accurate clinical and therapeutic approaches in suspected STI.

Imaging of the scrotum: role of MRI.

PURPOSE: The aim of this study was to evaluate the usefulness of imaging for correct clinical and therapeutic management of patients with scrotal disease. MATERIALS AND METHODS: Between 2000 and 2007, 801 patients with suspected scrotal disease underwent colour Doppler ultrasonography (CDUS) at our centre. In 46 patients, the CDUS study was followed by magnetic resonance imaging (MRI). RESULTS: CDUS revealed an inflammatory process in 277 patients (34.58%), testicular trauma in 112 (13.9%), funicular torsion or torsion of the vestigial remnant in 44 (5.4%), findings suggestive of testicular neoplasm in 35 (4.3%) and no abnormality in 41.5%. MRI, used to further investigate the CDUS findings in 46 cases, showed three cases of intraparenchymal haematoma, one of intrascrotal cavernous body rupture, one of testicular abscess with intrascrotal fistula, two of testicular infarction and 15 of neoplasm. MRI allowed the exclusion of focal abnormalities in ten patients with testicular microlithiasis, in three with chronic orchitis and in four with atrophic involution. MRI confirmed the finding of inguinal hernia in three cases. CONCLUSIONS: On the basis of our experience, CDUS is irreplaceable as an initial approach to patients affected by scrotal disease, whereas MRI is an ideal second-line investigation. MRI offers useful, and in some cases decisive, information, as it is capable of revealing unexpected findings and elucidating complex aspects. MRI helps improve patient management, with an overall reduction in costs.

Role of color-Doppler sonography in the follow-up of renal artery stenting.

PURPOSE: The aim of this study was to evaluate the utility of color-Doppler ultrasound (CDUS) in detecting haemodynamically significant in-stent restenosis in patients who underwent endoluminal renal artery revascularisation by stent deployment. MATERIALS AND METHOD: Between January 2000 and December 2006, 42 patients (nine women and 33 men, age range 45-87 years) treated by endovascular renal artery stenting were studied with CDUS. Renal artery haemodynamics were evaluated to identify haemodynamically significant restenosis. Patients with CDUS signs of restenosis underwent angiography for a possible further revascularisation procedure. RESULT: Of 42 patients examined by CDUS, 13 (31%) showed signs of haemodynamically significant in-stent renal artery restenosis. Of these 13, three did not undergo endoluminal renal artery revascularisation because renal ischaemia deterioration and irreversible renal circulation impairment. In the remaining ten patients (23.8%), who had no signs of severe nephropathy, angiography confirmed the CDUS findings of in-stent restenosis in all cases. Restenoses were successfully treated by a repeat endovascular revascularisation procedure. CONCLUSION: Our results confirm the fundamental role of CDUS in the follow-up of patients after renal artery stenting. It enables early restenosis detection and evaluation of renovascular disease associated with renal artery stenosis. CDUS provides essential information for the subsequent clinical management of these patients.

Association between testicular microlithiasis and primary malignancy of the testis: our experience and review of the literature.

PURPOSE: The aims of this study were to evaluate the association of testicular microlithiasis with testicular neoplasm, to assess the accuracy of ultrasonography (US) in comparison with histology in detecting microlithiasis, and to identify the prevalent cytohistological features that accompany testicular cancer. MATERIALS AND METHODS: Between 2004 and 2005, 14 patients were referred to us for US examination, 13 of whom underwent surgery for testicular cancer. Their age ranged from 19 to 43 years, except for one patient aged 60. US findings and histological examination were compared to assess the accuracy of US in detecting microlithiasis associated with testicular cancer. RESULTS: In two patients (15.3%), microlithiasis had been detected in a previous US examination, and two patients (15.3%) had altered sperm function. At US examination, testicular cancer was associated with microlithiasis in seven out of 13 patients (53.8%) (the distribution pattern of microlithiasis was intranodular in two, perinodular in two and both intra-and perinodular in three), and colour-Doppler US showed perinodular and intranodular vascularity. Histological evaluation identified nine seminomas, two mixed germ-cell tumours, one embryonal carcinoma, one yolk-sac tumour and one benign Sertoli-cell tumour. In nine (69.2%) patients, microlithiasis was confirmed at histologic evaluation, and its distribution was intranodular in two, perinodular in five and both intra-and perinodular in two. Tubular hyalinisation was demonstrated in 12 out of 13 patients (92.3%). CONCLUSIONS: Testicular microlithiasis and poor sperm function represent risk factors for testicular cancer: in our study, 30.6% of the patients who developed cancer presented these features. At US examination, testicular microlithiasis is often associated with testicular cancer (53.8%). A high accuracy has been demonstrated for US in detecting microlithiasis (53.8%) compared with histological evaluation (69.2%). At histology, tubular hyalinisation (92.3% of cases) is, with testicular microlithiasis, the most frequent finding in the parenchyma adjacent to testicular cancer.

New techniques and technology to repair cerebrospinal fluid rhinorrhea.

Cerebrospinal fluid rhinorrhea occurs as a result of abnormal communication between the subarachnoid space and the pneumatized portion of the skull base, the paranasal sinuses and the middle ear. Conservative measures may be sufficient in the management of cerebrospinal fluid rhinorrhea, but, in some cases, surgical treatment may be required. Transnasal endoscopic techniques are constantly being used in preference to the intra- and extracranial approaches. Recently, image guidance systems have been adopted in neurosurgery, skull base and paranasal sinus surgery. The present report refers to 4 cases of nasal cerebrospinal fluid rhinorrhea leak successfully treated with a transnasal endoscopic approach using various techniques and materials to close the bone defect, in 2 of which, the navigation system (Stealth Station Treon ENT Image Guidance System with Landmark X, Software, Medtronic, XOMED, Jacksonville, FL, USA) was also used. In all cases, correct localization and repair of the leak was achieved and no major complications occurred. Following a review of the literature, the Authors conclude that, at present, transnasal endoscopic repair of cerebrospinal fluid rhinorrhea is the surgical treatment of choice when the techniques and materials are correctly used. Furthermore, preliminary findings indicate that it is possible to make routine use of the navigation systems and that this technology may be usefully employed, above all, in the management of cerebrospinal fluid leaks.

New bioimpedance model accurately predicts lower limb muscle volume: validation by magnetic resonance imaging.

Conventional bioimpedance analysis (BIA) methods now simplify the representation of lower limb geometry and electrical properties for body composition estimation. In the present study, a three-dimensional model of the lower limb was assembled by segmentation of magnetic resonance cross-sectional images (MRI) for adipose tissue, skeletal muscle, and bone. An electrical network was then associated with this model. BIA and MRI measurements were made in six lean subjects (3 men and 3 women, age 32.2 +/- 6.9 yr). Assuming 0.85 S/m for the longitudinal conductivity of the muscle, the model predicted in the examined subjects an impedance profile that conformed well to the BIA impedance profile; predicted and measured resistances were similar (261.3 +/- 7.7 vs. 249 +/- 9 Omega; P = not significant). The resistance profile provided, through a simpler model, muscle area estimates along the lower limb and total leg muscle volume (mean 4,534 cm(3) for men and 4,071 cm(3) for women) with a mean of the absolute value of relative error with respect to MRI of 6.2 +/- 3.9. The new approach suggests that BIA can reasonably estimate the distribution and volume of muscles in the lower extremities of lean subjects.

Contrast-enhanced gray-scale and color Doppler voiding urosonography versus voiding cystourethrography in the diagnosis and grading of vesicoureteral reflux.

PURPOSE: The purpose of this study was to compare contrast-enhanced gray-scale voiding urosonography (CE-VUS) and contrast-enhanced color Doppler voiding urosonography (CE-CDVUS) with voiding cystourethrography (VCUG) to verify whether the use of color Doppler imaging improves the diagnosis and grading of vesicoureteral reflux (VUR). METHODS: In 74 patients, CE-VUS and CE-CDVUS were compared with VCUG, which was used as the gold standard. SHU 508 A (Levovist) was used as the echo-enhancing contrast agent. VUR was diagnosed if hyperechoic dots or color signals were visualized in the ureter on sonograms. VUR grading was based on morphologic and dynamic findings on CE-VUS and morphologic and color findings on CE-CDVUS. VCUG was performed conventionally, and grading by VCUG was in accordance with the international system of radiographic VUR grading. Patients who voided during 1 examination only (either CE-VUS and CE-CDVUS or VCUG) were excluded from the study. Agreement between the results of CE-VUS and VCUG and between those of CE-CDVUS and VCUG in diagnosing VUR was calculated by kappa statistics. CE-VUS and CE-CDVUS were compared for diagnostic accuracy by the McNemar test. RESULTS: The agreement between CE-VUS and VCUG in predicting VUR was 90% (kappa score, 0.77; p < 0.001). The agreement between CE-CDVUS and VCUG was 96% (kappa score, 0.91; p < 0.001). CE-CDVUS showed a significantly higher diagnostic accuracy than did CE-VUS (96% versus 90% of cases correctly classified; McNemar chi2 = 4; p < 0.05). This was mainly related to the lower number of false-negative results for grade I and grade II VUR when CE-CDVUS was used. CONCLUSIONS: The use of color Doppler imaging significantly improves the accuracy of contrast voiding urosonography in the detection and grading of VUR.

[Diagnostic imaging and patient database managing systems: The integration of digital information in the experience of an intensive care center]. / Diagnostico per immagini e cartelle cliniche elettroniche: integrazione di informazioni digitali nell'esperienza di un centro di rianimazione poliovalente.

AIM: To present our experience with integrating digital information on Intensive Care Unit patients (clinical data, laboratory findings, imaging, etc) to create electronic patient records. MATERIAL AND METHODS: Using the hospital Intranet, a connection was established between the Local area Network (LAN) of the Intensive Care Unit (ICU) and the Digital Imaging and Communications in Medicine (DICOM(R)) network of the Radiology Department allowing to receive, process and archive digital images locally at the ICU. Using the software RADclient-RADimage, the information received was managed by an electronic patient record system (DIGISTAT by UMS-Unterberger Medical Software, Florence). All the above software runs on Microsoft WindowsNT 4.0 platforms. RESULTS: Images of various kinds and formats (CT, MRI, etc.) pertaining to the ICU patients were semi-automatically handled and filed on a local server acting as a central databank. The images were then included in the electronic patient record and made available to the end user who could view them using either web technologies (hypertexts were automatically generated that could be viewed through the widely available World Wide Web browsers) or specific viewing utilities supplied with DIGISTAT . DISCUSSION AND CONCLUSIONS: For the intensivist, the handling and filing of data on hospitalised or discharged patients for treatment or research purposes involves having to process large amounts of information. Furthermore, in the event of patients being re-admitted to the unit, it is crucial to have ready access to all the information regarding previous hospital stays, including diagnostic images, to avoid the need for time-consuming searches through the hospital s paper-based archives. The possibility to access clinical information and diagnostic images using a single computer programme proved to be useful both for evaluating the patient s conditions immediately after the imaging procedure and for monitoring the patient s progress over time by comparing the different diagnostic images and imaging procedures. This pilot experience could be seen to provide the basic know-how for applying the method in the future Emergency Department of the A. Gemelli Hospital in Rome.

Automated scheduling of radiologic procedures.

The dramatic advances in radiology have increased the number and type of machines and of daily performed exams. Consequently, workload and management organization problems have also markedly increased. Automated, computerized scheduling of radiologic exams is certainly a step forward in a modern rational management of a Diagnostic Imaging service: the relationship with the patient is improved with the optimization of care delivered and of the radiologist's work, who with the new technology is able to rapidly consult the previous exams as well as the list of exams to be performed. The advances in health care information technology imply communications at a distance. From each ward of the hospital, requests for radiologic exams can be automatically scheduled or kept on a dynamic waiting list for automated input in future work shifts. Via the same system, reports (and also radiologic images) can by rapidly transmitted to the wards. At the "Università Cattolica del S. Cuore" from several years, an integrated information system has been implemented for management of patient data, exams and care delivered. Radiology represents one of major departmental systems of the network for the number of machines installed and the amount of information supplied. The system will be soon able to store images from all digital and nondigital machines, and visualize on dedicated workstations the images of ongoing exams or stored previous ones.

Management of radiologic archive in a diagnostic imaging department.

One of the major and demanding problems in the management of a modern department of Radiology is undoubtedly the organization of a radiologic archive. Its management has been increasingly difficult in last years both for the increase in procedures and the number of radiologic exams. At the Radiology department of UCSC, since some years, this problem has been tackled. Major objectives have been identified in focusing on responsibilities, global management and planning of radiologic film retrieval and archiving integrated with health care activities (scheduling of admissions and exam appointments, reporting, discharge). Based on these assumptions, the archive has been divided into 3 sections, each dynamically integrated with the others. The 3 archives should be integrated with RIS and supported by information technology. RIS is considered the starting point of the process. In fact the system ensures communication to the archiving workstation and to the radiology room of patient admission and consequent execution of the exam which involves image production. This user-friendly procedure enables consistent information between RIS and archiving system and correct association of images to the patient medical report, for subsequent consultation.

Information management of a department of diagnostic imaging.

It is well-known that while RIS allows the management of all input and output data of a Radiology service, PACS plays a major role in the management of all radiologic images. However, the two systems should be closely integrated: scheduling of a radiologic exam requires direct automated integration with the system of image management for retrieval of previous exams and storage of the exam just completed. A modern information system of integration of data and radiologic images should be based on an automated work flow management in al its components, being at the same time flexible and compatible with the ward organization to support and computerize each stage of the working process. Similarly, standard protocols (DICOM 3.0, HL7) defined for interfacing with the Diagnostic Imaging (D.I.) department and the other components of modules of a modern HIS, should be used. They ensure the system to be expandable and accessible to ensure share and integration of information with HIS, emergency service or wards. Correct RIS/PACS integration allows a marked improvement in the efficiency of a modern D.I. department with a positive impact on the daily activity, prompt availability of previous data and images with sophisticated handling of diagnostic images to enhance the reporting quality. The increased diffusion of internet and intranet technology predicts future developments still to be discovered.

Nuclear medicine in primary bone tumors.

INTRODUCTION: Conventional radiography is the method of choice to diagnose a primary bone tumor but in many cases it is necessary to integrate it with nuclear medicine scintigraphy using several radionuclides, including 67Ga, 201Tl, 99mTc-MIBI and especially 99mTc-diphosphonates. Recently a new technique has been recently introduced, that is positron emission tomography with 2(18F) fluoro-2 deoxy-D-glucose as radiopharmaceutical. OBJECTIVE: The specific purpose of this work is to show that nuclear medicine bone scanning is a very important method in the detection and diagnostic management of primary bone tumors. DIAGNOSIS, STAGING AND FOLLOW-UP: Three-phase bone scintigraphy, integrated with SPECT, is clinically useful to confirm the radiologic diagnosis of bone tumor. These techniques conveniently related to each other and to radiographic findings, can evaluate the tumor's local aggressiveness, often differentiating benign from malignant lesions, to monitor treatment efficacy, to permit total body scanning for the detection of recurrences. Nuclear medicine diagnostic techniques are not in competition with radiographic tools as CT and MRI which are highly sensitive in detecting even small lesions thanks to their excellent anatomical resolution. In questionable cases, we can integrate radiologic imaging with dynamic studies, in particular with FDG-PET, increasing the specificity of diagnosis and permitting more accurate follow-up. CONCLUSIONS: Patient management optimization needs the integration between dynamic nuclear medicine findings and the anatomical patterns provided by conventional radiology to increase imaging sensitivity and specificity. Equipe work is determinant to customize the diagnostic work-up to the individual patient's needs to reduce the cost of patient management avoiding useless examinations.

[Clinico-radiologic problems in the study of the male breast in gynecomastia]. / Problematiche clinico-radiologiche nello studio della mammella maschile nella ginecomastia.

INTRODUCTION: Gynecomasty is usually classified as normal of abnormal, except for 25% of cases which are classified as idiopathic because their causes and pathogenesis remain unknown. Gynecomasty is diagnosed mainly on clinical grounds, while integrated imaging, sometimes combined with cytology, is used to distinguish benign from malignant forms. Bilateral gynecomasty is easy to diagnose, especially when patients report assuming particular drugs or present other risk factors, but unilateral or asymmetrical gynecomasty is a diagnostic problem. Primary male breast cancer usually presents as a unilateral hard mass, often infiltrating the dermis and with early lymph node metastases; it is associated with gynecomasty in 20% of cases. MATERIAL AND METHODS: We examined 76 men (age range, 15-75 years) referred for breast enlargement; the patients with radiologic findings of breast adiposis were not included in our series. All patients were submitted to standard projection mammography with a high resolution dedicated film and to real time US with high frequency probes (7.5-12 MHz). RESULTS: Breast enlargement was unilateral in 48% of cases and bilateral in 52%. The radiologic patterns, compared with histologic or clinical-therapeutic follow-up, permitted the correct diagnosis in 72 of 76 patients (94%). The extant four patients had chronic inflammation (3 cases) and a malignant tumor with questionable imaging features. Overall imaging findings were: 55 cases (72%) of actual gynecomasty--unilateral in 17 and bilateral in 38 cases--9 unilateral malignant tumors (12%), eleven cases of inflammation (14%) and 1 case (2%) of unilateral metastasis from plasmocytoma. Sixteen (29%) actual gynecomasty patients (21% of the whole series) had a nodular form (unilateral in 6 and bilateral in 10 cases), 23 (42% and 30% of the whole series) had a dendritic form (unilateral in 7 and bilateral in 16 cases) and 16 (29%, 21% of the whole series) had a glandular form. CONCLUSIONS: Diagnosing gynecomasty is relatively easy in the patients with bilateral forms with a positive history of associated exogenous or endogenous factors, while focal unilateral or asymmetrical forms are difficult to distinguish into benign and malignant. The radiologic pattern may be questionable especially in chronic inflammation and in some malignant forms and must therefore be integrated with cytologic or surgical findings.

[Role of diagnostic imaging of the breast in patients treated with postsurgical radiotherapy or presurgical radiotherapy or chemotherapy]. / Ruolo della diagnostica per immagini della mammella nelle pazienti sottoposte a radioterapia postchirurgica o a radio o chemioterapia prechirurgica.

INTRODUCTION: In the last 25 years, random trials on the advantages of combined surgery and irradiation/chemotherapy of breast cancer demonstrated similar survival rates to those of massive surgery. However, both irradiation and chemotherapy have advanced and now yield good local control of the disease, so that even large breast cancers can be made operable. Breast cancer follow-up is carried out with imaging and clinical examinations to detect early locoregional recurrences, contralateral lesions and distant recurrences: to this purpose, we carried out a comparative study of all imaging modalities. MATERIAL AND METHODS: We retrospectively reviewed the data of 42 breast cancer (T2-T3 N0-N+) patients of the Senology Center of the Catholic University (Rome, Italy) treated with irradiation and/or chemotherapy for tumor debulking to permit conservative surgery. We investigated the sensitivity and the indications of mammography, B-mode and color Doppler US and MRI in measuring the exact tumor size and detecting locoregional metastatic nodes. RESULTS: After 3 years' treatment, our recurrence rate (19%) is a little higher than those in the major international trials (4.2-9% and 5 tears). The recurrence was on the surgical scar in 75% of cases (6/8), while multifocal tumors were found in 25% of cases. US was the most accurate method in measuring tumor size in 90% of cases (18/20), while mammography frequently overstaged the lesion and yielded exact measurements in 65% of cases (13/20). MRI was as accurate as US, but this technique is too expensive and little available in Italy. US accurately diagnosed lymph node recurrences (70% sensitivity), but MR rate was even higher (80%), while mammography and color Doppler US had only 5-10%. As for treatment outcome, an irregular and blurred nodule or multifocal lesions at mammography indicate poor/no response, while a much smaller radial scar than at previous similar follow-ups indicates treatment success. CONCLUSIONS: When correctly integrated, mammographic, US and MR patterns permit exact tumor size measurement and show possible locoregional lymph node involvement in the patients submitted to conservative surgery and irradiation/chemotherapy. In contrast, color Doppler findings remain poorly specific in this disease, with about 55% sensitivity. Therefore, radiologic studies, with clinical and laboratory data, have a major prognostic value in assessing the biological response to combined treatment.

Diagnostic imaging in cervical incompetence.

Cervical incompetence is defined as an abnormal dilatation of the cervical canal at the body-neck junction with no pain or blood loss and in the absence of uterine contractile activity. Cervical incompetence is the frequent cause of abortion in the second trimester and premature delivery, with adverse fetal prognosis. Usually, three causative factors are considered: traumatic, constitutional, dysfunctional. While in multiparous women the medical and remote obstetric history poses the diagnostic suspicion, in primigravidae, in the absence of previous risk factors (traumas, malformations, etc) early diagnosis may allow prompt treatment with a better prognosis. Hysterosalpingographic (tunnel-shaped cervix or appearing as an inverted sac, diameter of internal uterine orifice) but especially sonographic findings (cervical length, dilated endocervical canal, tunnel-shaped internal uterine orifice, herniation of the amniotic sac into the endocervical canal) represent the most significant radiologic signs. The radiologist should be able to recognize the typical imaging of this condition to select the patients who should undergo serial controls in time since the start of the second trimester of pregnancy, or to indicate a suitable treatment based on sonographic signs suggestive for incompetence identified before the clinical exam. This is the present correct approach while waiting for future clinical and technological developments of three-dimensional sonography and MRI which will be able to detect those changes in cervical connective structures responsible for incompetence and still not identified by any imaging procedure.

Quantitative cerebral blood flow and metabolism determination in the first 48 hours after severe head injury with a new dynamic SPECT device.

OBJECTIVE: To determine cerebral blood flow (CBF) and metabolism in the acute phase after severe head injury by a new dynamic SPECT device using 133Xenon and to evaluate a possible role of CBF and metabolism in the determination of prognosis. DESIGN: Prospective study. SETTING: General intensive care unit in a universitary teaching hospital. SUBJECTS: 23 severely head injured patients having CT scan and CBF determination, intracranial pressure (ICP) and jugular bulb oxygen saturation monitoring in the first 48 hours. MEASUREMENTS AND MAIN RESULTS: CBF varied from 18.0 to 60.0 ml/100 g/min. No correlation was found between early CBF and severity of trauma evaluated with the Glasgow Coma Score (GCS) (F = 2.151, p = 0.142) and between CBF and prognosis at 6 months evaluated with Glasgow outcome score (GOS) (F = 0.491, p = 0.622: rs = 0.251, p = 0.246). CMRO2 was depressed in relation to the severity of injury, specifically ranging from 0.9 +/- 0.5 ml/100 g/min in patients with GCS 3 to 1.7 +/- 0.8 ml/100 g/min in patients with GCS 6-7. In no patient with CMRO2 less than 0.8 ml/100 g/min was a good outcome observed. A significant correlation was found between GCS and GOS (rs = 0.699, p = 0.0002), between CMRO2 and GOS (F = 4.303, p = 0.031; rs = 0.525, p = 0.013) and between AJDO2 and GOS (F = 3.602, p = 0.046; rs = 0.491, p = 0.017). Fronto-occipital ratio (F/O) of CBF distribution was significantly lower than normal values (chi 2 = 18.658, p = 0.001) but did not correlate either with prognosis (chi 2 = 1.626, p = 0.443) or with severity (chi 2 = 1.913, p = 0.384). CONCLUSIONS: CBF in the first 48 hours after trauma varies within a large range of values and is not correlated with severity and prognosis. Clinical evaluation with GCS and CMRO2 are much more reliable indicators of severity of head trauma and have a significant role in the determination of prognosis. F/O ration is significantly altered from normal values confirming "post-traumatic hypofrontalism" but does not correlate with severity and prognosis.

Standardization of digital radiologic images.

The need for uniform digital formats of radiologic images obtained from the human body by the various methods (CT, MRI, DF, DSA, NM) is felt by both the manufacturers and the radiologists since a long time. The ACR-NEMA standard was initially established to overcome this problem, however it was not fully satisfactory. Its up-dated version, DICOM 3 seems a more successful approach to the solution of the problem. The rationale on which DICOM 3 is based, the main guidelines with some reference to the various parts of the new standard, are analyzed. Its advantages as well as disadvantages are considered in view of a future complete integration of data and images of a radiology department within a hospital information system. In the appendix, a list of DICOM components and addresses where to find the original documentation are supplied.