Confirmed Autochthonous Case of Human Alveolar Echinococcosis, Italy, 2023.

In September 2023, a patient in Italy who had never traveled abroad was referred for testing for suspected hepatic cystic echinococcosis. Lesions were incompatible with cystic echinococcosis; instead, autochthonous alveolar echinococcosis was confirmed. Alveolar echinococcosis can be fatal, and awareness must be raised of the infection's expanding distribution.

The role of an artificial intelligence software in clinical senology: a mammography multi-reader study.

PURPOSE: To evaluate the diagnostic role of a dedicated AI software in detecting anomalous breast findings on mammography and tomosynthesis images in the clinical setting, stand-alone and as aid of four readers. METHODS: A total of 210 patients with complete clinical and radiologic records were retrospectively analyzed. Pathology was used as the reference standard for patients undergoing surgery or biopsy, and a 1-year follow-up was used to confirm no change in the remaining patients. The image evaluation was performed by four readers with different levels of experience (a junior and three senior breast radiologists) using a 5-point Likert scale moving from 1 (definitively no cancer) to 5 (definitively cancer). The positivity of mammograms was assessed on the presence of any breast lesion (masses, architectural distortions, asymmetries, calcifications), including malignant and benign ones. A multi-reader multi-case analysis was performed. A p value < 0.05 was considered statistically significant. RESULTS: The stand-alone AI system achieved an accuracy of 71% (69% sensitivity and 73% specificity), which is overall lower than the value achieved by readers without AI. However, with the aid of AI, a significant increase of accuracy (p value = 0.004) and specificity (p value = 0.04) was achieved for the less experienced radiologist and a senior one. CONCLUSION: The use of AI software as a second reader for breast lesions assessment could play a crucial role in the clinical setting, by increasing sensitivity and specificity, especially for less experienced radiologists.

Dual-Energy CT Arthrography: Advanced Muscolo-Skelatal Applications in Clinical Practice.

This paper provides a comprehensive overview of the potential applications of dual-energy CT (DECT) in improving image quality and the diagnostic capabilities of CT arthrography (CTA) in clinical practice. The paper covers the use of virtual non-contrast (VNC) images, in which the injected contrast medium is subtracted from the articular cavity in order to better analyze 2D and 3D images of the bone. Moreover, virtual monoenergetic imaging (VMI) applications and their potential use for the reduction of metal artifacts and improving image contrast are reviewed. The role of virtual non-calcium (VNCa) in detecting bone marrow edema surrounding the imaged joint will be discussed. Furthermore, the role of iodine maps in enhancing the contrast between soft tissues, optimizing the visualization of contrast material, and distinguishing contrast material from calcifications is described. Finally, a case series including different joints is provided to underline the additional advantages of high-spatial-resolution dual-energy CT reconstructed images.

Osteomyelitis of the Lower Limb: Diagnostic Accuracy of Dual-Energy CT versus MRI.

BACKGROUND: MRI is the preferred imaging technique for the identification of osteomyelitis. The key element for diagnosis is the presence of bone marrow edema (BME). Dual-energy CT (DECT) is an alternative tool which is able to identify BME in the lower limb. PURPOSE: To compare the diagnostic performance of DECT and MRI for osteomyelitis, using clinical, microbiological, and imaging data as reference standards. MATERIALS AND METHODS: This prospective single-center study enrolled consecutive patients with suspected bone infections undergoing DECT and MRI imaging from December 2020 to June 2022. Four blinded radiologists with various experience levels (range of 3-21 years) evaluated the imaging findings. Osteomyelitis was diagnosed in the presence of BMEs, abscesses, sinus tracts, bone reabsorption, or gaseous elements. The sensitivity, specificity, and AUC values of each method were determined and compared using a multi-reader multi-case analysis. A p value < 0.05 was considered significant. RESULTS: In total, 44 study participants (mean age 62.5 years ± 16.5 [SD], 32 men) were evaluated. Osteomyelitis was diagnosed in 32 participants. For the MRI, the mean sensitivity and specificity were 89.1% and 87.5%, while for the DECT they were 89.0% and 72.9%, respectively. The DECT demonstrated a good diagnostic performance (AUC = 0.88), compared with the MRI (AUC = 0.92) (p = 0.12). When considering each imaging finding alone, the best accuracy was achieved by considering BME (AUC for DECT 0.85 versus AUC of MRI of 0.93, with p = 0.07), followed by the presence of bone erosions (AUC 0.77 for DECT and 0.53 for MRI, with p = 0.02). The inter-reader agreement of the DECT (k = 88) was similar to that of the MRI (k = 90). CONCLUSION: Dual-energy CT demonstrated a good diagnostic performance in detecting osteomyelitis.

Dual-Energy CT for Detecting Painful Knee Prosthesis Loosening.

Background Dual-energy CT (DECT) is an alternative to radiography and single-energy CT (SECT) for detecting prosthesis-related complications. Purpose To compare the diagnostic performance of DECT, SECT, and radiography for knee prosthesis loosening, with use of surgery or imaging follow-up reference standards. Materials and Methods In this prospective single-center study from December 2018 to June 2021, participants with unilateral painful knee prostheses underwent radiographic, SECT, and DECT imaging. Five blinded readers, four radiologists, and one orthopedic surgeon evaluated the images. Prosthesis loosening was diagnosed by a periprosthetic lucent zone greater than 2 mm. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of each method were determined and compared with use of a multireader multicase analysis. Results There were 92 study participants (mean age ± SD, 70 years ± 9.4; 67 women) evaluated. Tibial and femoral loosening were diagnosed in 47 and 24 participants, respectively. For the tibia, mean sensitivity and specificity for arthroplasty loosening were 88% and 91%, respectively, for DECT, 73% and 78% for SECT, and 68% and 81% for radiography. For the tibia, DECT demonstrated similar diagnostic performance (AUC, 0.90) to SECT (AUC: 0.90 vs AUC: 0.87, respectively; P = .13) but was superior to radiography (AUC: 0.90 vs AUC: 0.82; P = .002). Overall diagnostic performance of DECT (AUC, 0.87) for the femur was superior to both SECT and radiography (P < .001). Conclusion Dual-energy CT had generally better diagnostic performance in detecting loosening of tibial and femoral components after total knee arthroplasty compared with single-energy CT or radiography. Clinical trial registration no. 2942 © RSNA, 2022.

Epstein-Barr Virus (EBV) acute acalculous cholecystitis in an immunocompromised adult patient: a case report and a literature review of a neglected clinical presentation.

Primary Epstein-Barr virus (EBV) infection may present with self-limiting abdominal involvement, characterized by hepatitis with mild elevation of aminotransferases, splenomegaly, and rarely with acute acalculous cholecystitis (AAC). Usually, treatment of EBV related AAC is symptomatic, without the need for surgery. Here, we describe a severe case of AAC occurring as the first manifestation of infectious mononucleosis in a young adult woman, receiving treatment with interleukin 6 receptor (IL-6r) inhibitor for rheumatoid arthritis (RA); moreover, we have performed a review of the literature on EBV-related AAC.

Bone marrow edema around the hip in non-traumatic pain: dual-energy CT vs MRI.

OBJECTIVES: To evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) in identifying bone marrow edema (BME) around the hip joint in non-traumatic patients. METHODS: This prospective IRB-approved study was conducted between January 2019 and October 2019 and included 59 consecutive patients (18 males, 41 females; mean age 61.5 years, range 32-82) who were assessed by DECT and magnetic resonance imaging (MRI) within a 5-day period. Diagnostic accuracy values for diagnosing BME on a per-patient and on a per-partition-basis analysis were calculated for DECT images by two readers (R1 and R2, with 15 and 10 years of experience, respectively), using MRI as reference for diagnosis. Inter-observer agreements were calculated with k-statistics. A p value of < 0.05 was considered as statistically significant. RESULTS: MRI depicted BME in 44/59 patients (74.58%), with the involvement of 83/708 (11.72%) partitions. The sensitivity, specificity, and accuracy of R1 and R2 were 95.45% (42/44), 86.67% (13/15), and 93.22% (55/59) for R1, and 86.36% (38/44), 80.00% (12/15), and 84.75% (50/59) for R2. For both readers, the BME detection rate was higher in patients with severe edema (100%) in comparison to patients with mild edema (91.30% and 73.91%). In the partition-basis analysis, sensitivity, specificity, and accuracy ranges were 33.3 to 100%, 91.84 to 100%, and 88.14 to 100%, respectively. The inter-observer agreement for patients' analysis was substantial (k = 0.7065), whereas for partition analysis ranged from fair (k = 0.2976) to near-perfect (k = 1.000). CONCLUSION: DECT can accurately identify BME around the hip joint, in comparison to MRI. KEY POINTS: • DECT can accurately identify bone marrow edema around the hip joint in a cohort of non-traumatic patients. • The detection of bone marrow edema by means of DECT may help the radiologist to identify associated findings, including avascular necrosis of the femoral head and insufficiency or stress fractures. • In cases of patients suffering from groin pain with bone marrow edema identified by DECT, the concurrent reading of high-resolution conventional CT images may increase the confidence of diagnosis and/or reduce the reading time.

Effect of Endurance and Strength Training on the Slow Component of O 2 Kinetics in Elderly Humans.

We compared the effects of 8 weeks of high intensity, aerobic interval training (HIT) and isoinertial resistance training (IRT) on: (i) O 2 kinetics during heavy (HiEx) intensity exercise and; (ii) work economy during moderate (ModEx) intensity exercise in 12 healthy elderly men (69.3 ± 4.2 years). Breath-by-breath O 2 and muscle deoxygenation ([HHb] by means of NIRS) were measured in HiEx and ModEx at identical workloads before and after trainings. In HiEx, O 2 and HHb responses were modeled as tri-exponential and mono-exponential increasing functions, respectively. A two-way ANOVA for repeated measures analysis was made; Effect size (η2) was also evaluated. After HIT the amplitude and the time delay of the slow component of O2 uptake (O 2sc) during HiEx were smaller (-32%; P = 0.045) and longer (+19.5%; P = 0.001), respectively. At Post IRT: (i) during ModEx, gain was lower (-5%; P = 0.050); (ii) during HiEx, τ2 (+14.4%; P = 0.050), d3 (+8.6%; P = 0.050), and τ3 (+17.2%; P = 0.050) were longer than at Pre IRT. After HIT, the decrease of the O 2sc amplitude was likely induced by the beneficial effects of training on a more responsive O 2 delivery and consumption cascade leading to a better muscle metabolic stability. IRT training was able to increase exercise economy during ModEx and to reduce the amplitude and delay the onset of O 2sc during HiEx. These effects should be due to the reduction and the delayed recruitment of Type II muscle fibers. The better exercise economy and the delayed appearance of O 2sc induced by IRT suggests that strength training might be included in endurance training programs to improve exercise economy and resistance to fatigue in this population of old subjects.

Distribution of Solid Solitary Pulmonary Nodules within the Lungs on Computed Tomography: A Review of 208 Consecutive Lesions of Biopsy-Proven Nature.

BACKGROUND: The solitary pulmonary nodule (SPN) is a common radiologic abnormality on chest x-rays or computed tomography (CT) scans of the lungs. The differential diagnosis of SPNs is particularly wide as it includes a multitude of benign as well as malignant entities. Nodule location within the lungs has been proposed as a predictive feature in the literature. This study aims at illustrating the distribution within the lungs of a large current series of consecutive SPNs according to their histological subtype, which was definitely proved at core biopsy. MATERIAL/METHODS: Two hundred-eight SPNs referred to our center for characterization were reviewed in this single-centre retrospective study. Histological subtypes were defined following the IASLC/ATS/ERS and WHO (2004) histological classification. RESULTS: This study provides evidence with respect to the prevalence of adenocarcinomas and other non-neuroendocrine primary lung cancer types in the right upper lobe. It also provides new evidence with respect to the prevalence of carcinoid tumors in the middle and right lower lobe, with a tendency to occur in the central lung parenchyma. CONCLUSIONS: This work updates existing knowledge of solid SPNs location within the lungs by providing a current picture of SPN distribution according to their nature.

Effects of eight weeks of aerobic interval training and of isoinertial resistance training on risk factors of cardiometabolic diseases and exercise capacity in healthy elderly subjects.

We investigated the effect of 8 weeks of high intensity interval training (HIT) and isoinertial resistance training (IRT) on cardiovascular fitness, muscle mass-strength and risk factors of metabolic syndrome in 12 healthy older adults (68 yy ± 4). HIT consisted in 7 two-minute repetitions at 80%-90% of V˙O2max, 3 times/w. After 4 months of recovery, subjects were treated with IRT, which included 4 sets of 7 maximal, bilateral knee extensions/flexions 3 times/w on a leg-press flywheel ergometer. HIT elicited significant: i) modifications of selected anthropometrical features; ii) improvements of cardiovascular fitness and; iii) decrease of systolic pressure. HIT and IRT induced hypertrophy of the quadriceps muscle, which, however, was paralleled by significant increases in strength only after IRT. Neither HIT nor IRT induced relevant changes in blood lipid profile, with the exception of a decrease of LDL and CHO after IRT. Physiological parameters related with aerobic fitness and selected body composition values predicting cardiovascular risk remained stable during detraining and, after IRT, they were complemented by substantial increase of muscle strength, leading to further improvements of quality of life of the subjects.

Late-onset multiple sclerosis presenting with cognitive dysfunction and severe cortical/infratentorial atrophy.

OBJECTIVE: Although cognitive dysfunction is a relevant aspect of multiple sclerosis (MS) from the earliest disease phase, cognitive onset is unusual thus jeopardizing early and accurate diagnosis. Here we describe 12 patients presenting with cognitive dysfunction as primary manifestation of MS with either mild or no impairment in non-cognitive neurological domains. METHODS: Twelve patients with cognitive onset who were subsequently diagnosed with MS (CI-MS) were included in this retrospective study. Twelve cognitively normal MS patients (CN-MS), 12 healthy controls and four patients having progressive supranuclear palsy (PSP) served as the reference population. RESULTS: Ten CI-MS patients had progressive clinical course and all patients had late disease onset (median age = 49 years; range = 40-58 years). Among cognitive functions, frontal domains were the most involved. Compared to CN-MS and healthy controls, significant cortical and infratentorial atrophy characterized CI-MS patients. Selective atrophy of midbrain tegmentum with relative sparing of pons, known as "The Hummingbird sign," was observed in eight CI-MS and in three PSP patients. DISCUSSION: Our observation suggests that MS diagnosis should be taken into consideration in case of cognitive dysfunction, particularly when associated with slowly progressive disease course and severe cortical, cerebellar and brainstem atrophy even in the absence of other major neurological symptoms and signs.