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.

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.

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.

Inapparent pulmonary vascular disease in an ex-heroin user.

A severe pulmonary vascular derangement, usually reported in drug addicts, was diagnosed in a 28-year-old asymptomatic ex-heroin user by means of fortuitously performed pulmonary perfusion imaging. Neither physical findings nor pulmonary function tests, aroused suspicion of the diagnosis. A search for asymptomatic pulmonary vascular disease probably should be undertaken in drug addicts.

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.

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.

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.

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.

Diagnostic Imaging Information Systems: DREAM. Reporting management.

From the clinical standpoint, the report represents the synthesis of the diagnostic process and it is the central activity of radiology. However, reporting cannot be separated from the entire organizational cycle inside the Diagnostic Imaging Department as well as within the structure as a whole. The effectiveness of the contribution an information system can give to the radiologist is related to the information and functional integration of the various applications operating in the hospital and over the territory. Based on these considerations, the main types of support the information tool can offer, are reported together with the primary objectives which were basic to the development of the reporting module within the DREAM system and the major solutions adopted to facilitate the attainment of these objectives.

Telecommunications and multimedia systems in education: what developments for radiology?

What are the new perspectives for the radiologist with the development of new technologies of telecommunications? At present, when digitization of most biomedical images has become a reality, problems of remote transmission are simplified. However, telematic literacy is necessary to the radiologist. It is already possible through multimedia supports, as CD-ROM and Internet "navigation". Which are the modalities to access "the network of networks"? Through Internet, hypertexs can be consulted, databases can be accessed, programs and printings can be retrieved, electronic mail can be exchanged. The CD-ROM is a further source of knowledge, especially effective in education due to multimedia and hypertext technology. In this context in the education of the radiologist, the hypertext version of a radiology text, finds its place. It is conceived to offer to each user an individualized approach to learning.

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.

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.