Microspheres vaginal discharge as a complication after Uterine Artery Embolization for intramural/submucosal fibroid.

Among Uterine Artery Embolization (UAE) complications, vaginal discharge is considered very frequent, especially for submucosal fibroids. Until now, it was reported as clear odorless viscous material. To our knowledge, we describe the first report of intrauterine microsphere migration after UAE. A 45-year-old-woman was admitted to our hospital complaining metromenorrhagia, menstrual cramping, pelvic pain and dyspareunia. After a preprocedural Magnetic Resonance Imaging (MRI) study, she underwent a superselective transradial UAE using 500-700 µm and 700-900 µm microspheres with a good morphological results. At 2-month follow-up, she complained viscous vaginal discharge with "strange pink stiff sphere of about 2 mm in diameter". A post-procedural-MRI showed fibroid migration towards the uterine cavity, a frequent occurrence especially for submucosal fibroids. The microspheres transvascular migration outside the vessel wall was already reported in a study performed in sheep. Our hypothesis is that the phenomenon of transvascular migration along with the fibroid migration towards the uterine cavity after UAE, may have led the migration of the microspheres directly into the vaginal cavity causing chronic vaginal discharge with pink stiff sphere. Vaginal discharge mixed with "sphere of particles" should be included among the UAE late complication especially for intramural and/or submucosal fibroids with distance to the endometrium less than 2.4 mm at pre-procedural MRI.

In situ diagnostic analysis of the XVIII century Madonna della Lettera panel painting (Messina, Italy).

The scientific investigation of the techniques employed by the artist, such as composition of the paints, color palette, and painting style represents a fundamental pre-requisite in order to develop proper conservation and restoration strategies. In this context, the combined use of non-destructive, non-invasive in situ image and chemical analyses was here successfully employed for the investigation of the XVIII century Madonna della Lettera panel painting from the ancient Basilian abbey of Santa Maria di Bordonaro in Messina (Italy). The used techniques were visible, infrared (IR) and false-color infrared (FCIR) photography, X-ray radiography, X-ray fluorescence (XRF) and Raman spectroscopy. The goal was to obtain accurate information on materials and techniques originally used and possible later interventions, with particular regard to the nature of the painting materials. From the results, details of the artwork useful for restoration and conservation procedures were revealed. The identification of most of the artist's palette was also achieved: Prussian blue for blue color, lead white for white, umber for the brown, cinnabar for the red, and carbon black for the black color. The composition of different preparatory substrates was also investigated. The obtained results, other than constituting a crucial step for future restoration works, can be at the same time useful for the dating of the painting, that does not report the date and the artist's signature.

Dual-energy CT for detection of endoleaks after endovascular abdominal aneurysm repair: usefulness of colored iodine overlay.

OBJECTIVE: The purpose of our study was to evaluate the value of dual-source dual-energy CT with colored iodine overlay for detection of endoleaks after endovascular abdominal aortic aneurysm repair. We also calculated the potential dose reduction by using a dual-energy CT single-phase protocol. SUBJECTS AND METHODS: From November 2007 to November 2009, 74 patients underwent CT angiography 2-7 days after endovascular repair during single-energy unenhanced and dual-energy venous phases. By using dual-energy software, the iodine overlay was superimposed on venous phase images with different percentages ranging between 0 (virtual unenhanced images) and 50-75% to show the iodine in an orange color. Two blinded readers evaluated the data for diagnosis of endoleaks during standard unenhanced and venous phase images (session 1, standard of reference) and virtual unenhanced and venous phase images with colored iodine overlay images (session 2). We compared the effective dose radiation of a single-energy biphasic protocol with that of a single-phase dual-energy protocol. The diagnostic accuracy of session 2 was calculated. RESULTS: The mean dual-energy effective dose was 7.27 mSv. By using a dual-energy single-phase protocol, we obtained a mean dose reduction of 28% with respect to a single-energy biphasic protocol. The diagnostic accuracy of session 2 was: 100% sensitivity, 100% specificity, 100% negative predictive value, and 100% positive predictive value. Statistically significant differences in the level of confidence for endoleak detection between the two sessions were found by reviewers for scores 3-5. CONCLUSION: Dual-energy CT with colored iodine overlay is a useful diagnostic tool in endoleak detection. The use of a dual-energy single-phase study protocol will lower radiation exposure to patients.

[Comparison between magnetic resonance angiography and duplex ultrasound for preoperative planning of lower limb revascularisation]. / Comparazione tra angio-RMN ed ecocolordoppler nella diagnostica preoperatoria delle rivascolarizzazioni degli arti inferiori.

The purpose of this study was to compare magnetic resonance angiography with duplex ultrasound for defining anatomical features relevant to performing lower limb revascularisation. From June 2003 to June 2004, 30 consecutive patients with chronic lower limb ischaemia underwent magnetic resonance angiography and duplex ultrasound investigations before undergoing lower limb revascularisation procedures. The mean age was 72 years (range: 45-93). Indications for the procedure included resting pain (6 cases), ischaemic ulcer (8 cases), and gangrene (16 cases). We compared magnetic resonance angiography and duplex ultrasonography findings and the differences in the aorto-iliac, femoro-popliteal and infrapoliteal segments were noted. Magnetic resonance angiography and duplex ultrasound findings agreed in 13/15 cases (86%) in the aorto-iliac segment, in 14/17 (82%) in the femoro-popliteal segment, and in 8/11 (74%) in the infrapopliteal segment. In all, duplex ultrasound agreed with intraoperative findings in 97% of cases while magnetic resonance angiography agreed in 81%. These data show that magnetic resonance angiography is less accurate than duplex ultrasound in the infrapopliteal segment. Adeguate training is necessary before duplex ultrasound can be used as the only preoperative imaging procedure.

Interventional radiology in the preoperative management of stromal tumors causing intestinal bleeding.

PURPOSE: Our experienee in the preoperative diagnostic and therapeutic management of small bowel gastrointestinal stromal tumors, cause of intestinal bleeding, by means of interventional radiological procedures is reported. MATERIALS AND METHODS: From October 1999 to October 2001 6 patients admitted for melena due to bleeding of a gastrointestinal stromal tumor were treated. In all cases the lower and/or upper gastrointestinal endoscopy were the first diagnostic approaches. In two cases a Te 99m pertechnetate-labeled autologous red blood cells (TRBC) scintigraphic examination was also performed. All the patients underwent an abdominal angiography that was followed in two cases by preoperative trans-catheter arterial embolization. All the patients had the surgical resection of the bleeding neoplasm. RESULTS: In all patients, the endoscopic examinations weren't able to localize the exact site of bleeding. The TRBC scintigraphic examination performed in 2 patients was negative in one case, instead gave an incorrect localization of the bleeding site in the other one. The localization of the bleeding tumors was provided by the selective abdominal angiography that also suggested the presumable nature of the neoplasm on the basis of angiographic characteristics. The embolization of the two tumors was technically successful and was followed by surgical resection. CONCLUSIONS: On the basis of our data, we emphasize and confirm the predominant role of interventional radiological procedures in the detection and in the preoperative management of bleeding gastrointestinal stromal tumors of the small bowel.

CT and MRI findings of mucin-containing tumors and pseudotumors of the thorax: pictorial review.

Bronchial mucus has tomodensitometric features and MR signal intensity similar to that of water. However, chronic entrapped mucus collections, due to water reabsorption and higher protein content, can have CT attenuation values higher than 20 and reaching even 130 HU. Higher protein concentration also causes a sensible reduction in T1 relaxation time. The demonstration of mucus within a mediastinal, bronchial or pulmonary lesion is an important diagnostic clue permitting remarkable shortening of the list of differential diagnoses. This article illustrates the CT and MR findings allowing correct characterization of the mucus-containing lesions of mediastinum, bronchi, and lung.