Magnetic Resonance Assessment of Peritoneal Carcinomatosis: Is There a True Benefit From Diffusion-Weighted Imaging?

Purpose: To assess the added value of diffusion weighted imaging (DWI) with intermediate (500 s/mm) and high (1000 s/mm) b values when combined to conventional contrast-enhanced magnetic resonance imaging (MRI) in identifying peritoneal neoplastic involvement.

Methods: Twenty-four patients with peritoneal carcinomatosis from gastrointestinal or gynecological tumors were retrospectively evaluated. All patients underwent peritonectomy with hyperthermic intraoperative chemotherapy and 1.

Ultra-low dose CT colonography with automatic tube current modulation and sinogram-affirmed iterative reconstruction: Effects on radiation exposure and image quality.

Objective: To assess the radiation dose and image quality of ultra-low dose (ULD)-CT colonography (CTC) obtained with the combined use of automatic tube current (mAs) modulation with a quality reference mAs of 25 and sinogram-affirmed iterative reconstruction (SAFIRE), compared to low-dose (LD) CTC acquired with a quality reference mAs of 55 and reconstructed with filtered back projection (FBP).

Methods: Eighty-two patients underwent ULD-CTC acquisition in prone position and LD-CTC acquisition in supine position. Both ULD-CTC and LD-CTC protocols were compared in terms of radiation dose [weighted volume computed tomography dose index (CTDI ) and effective dose], image noise, image quality, and polyp detection.

Performance of diffusion-weighted magnetic resonance imaging at 3.0T for early assessment of tumor response in locally advanced rectal cancer treated with preoperative chemoradiation therapy.

Purpose: The purpose of the article is to determine whether changes in apparent diffusion coefficient (ADC) values of locally advanced rectal cancer (LARC) obtained 2 weeks after the beginning of chemoradiation therapy (CRT) allow to predict treatment response and whether correlate with tumor histopathologic response.

Methods: Forty-three patients receiving CRT for LARC and 3.0T magnetic resonance imaging with diffusion-weighted sequences before treatment, 2 weeks during, and 8 weeks post the completion of CRT were included.

Molecular, Cellular and Pharmaceutical Aspects of Bone Grafting Materials and Membranes During Maxillary Sinus-lift Procedures. Part 1: A General Overview.

Sinus augmentation procedure has been demonstrated to be a highly predictable treatment in posterior maxilla atrophy. All the surgical interventions in the maxillary region require deep knowledge of anatomy and possible anatomical variations. In this article, pre-operative and post- operative assessments of sinus cavity as well as novel approaches to deepen our knowledge of the behavior of bone substitute materials are described.

Molecular, Cellular and Pharmaceutical Aspects of Bone Grafting Materials and Membranes During Maxillary Sinus-lift Procedures. Part 2: Detailed Characteristics of the Materials.

Various grafts or combination of bone substitute materials have been used in sinus lift procedures. Currently, ongoing developments in several disciplines, from molecular biology and chemistry to computer science and engineering, have contributed to the understanding of biological processes leading to bone healing after the use of bone substitute materials (BSBs) and therefore of the behavior of BSBs. The understanding of the properties of each graft enables individual treatment concepts and therefore allows shift from a simple replacement material to the modern concept of an individually created composite biomaterial.

The role of diffusion-weighted imaging in the detection of hepatic metastases from colorectal cancer: A comparison with unenhanced and Gd-EOB-DTPA enhanced MRI.

Objectives: To compare the role of DWI vs. gadoxetic-acid-disodium enhanced MRI in the detection of colorectal hepatic metastases.

Methods: Fifty-four patients with 115 hepatic metastases were included in this retrospective study, approved by the Ethical Board.

CT findings in acute peritonitis: a pattern-based approach.

Many inflammatory and infectious entities may acutely affect the peritoneum causing a thickening of its layers. Unfortunately, several acute peritoneal diseases can have overlapping features, both clinically and at imaging. Therefore, the awareness of the clinical context, although useful, may be sometimes insufficient to identify the underlying cause.

Developing a decision-making model based on an interdisciplinary oncological care group for the management of colorectal cancer.

Aim: To report our experience on implementation and preliminary results of a decision-making model based on the recommendations of an Interdisciplinary Oncological Care Group developed for the management of colorectal cancer.

Patients And Methods: The multidisciplinary team identified a reference guideline using appraisal of guidelines for research and evaluation (AGREE) tool based on a sequential assessment of the guideline quality. Thereafter, internal guidelines with diagnostic and therapeutic management for early, locally advanced and metastatic colonic and rectal cancer were drafted; organizational aspects, responsibility matrices, protocol actions for each area of specialty involved and indicators for performing audits were also defined.

A tumour score with multidetector spiral CT for venous infiltration in pancreatic cancer: influence on borderline resectable.

Purpose: A tumour score for venous invasion in patients with pancreatic adenocarcinoma was evaluated by means of computed tomography (CT), in order to improve the assessment of medical treatment and clinical outcome with special attention to borderline resectable disease.

Materials And Methods: Fifty-six consecutive patients who underwent curative surgical resection for pancreatic cancer were analysed. On the basis of CT criteria, tumour involvement of the portal vein (PV) and superior mesenteric vein (SMV) was graded according to an adapted 4-point scale: score 1, definite absence of invasion; score 2, probable absence of invasion; score 3, probable presence of invasion; score 4, definite presence of invasion.

Focal liver lesion classification and characterization in noncirrhotic liver: a prospective comparison of diffusion-weighted magnetic resonance-related parameters.

Purpose: The objective of this study was to prospectively verify if diffusion-weighted magnetic resonance (DwMR)-related parameters such as perfusion fraction (f) and slow diffusion coefficient (D), according to Le Bihan theory, are more effective than apparent diffusion coefficient (ADC) for classification and characterization of the more frequent focal liver lesions (FLLs) in noncirrhotic liver.

Methods: Sixty-seven patients underwent standard liver magnetic resonance imaging (MRI) and free-breath multi-b DwMR study. Two regions of interest were defined by 2 observers, including 1 FLL for each patient (21 hemangiomas, 21 focal nodular hyperplasias, 25 metastases) and part of surrounding parenchyma, respectively.

Obscure and occult gastrointestinal bleeding: comparison of different imaging modalities.

Patients with persistent, recurrent, or intermittent bleeding from the gastrointestinal (GI) tract for which no definite cause has been identified by initial esophagogastroduodenoscopy, colonoscopy, or conventional radiologic evaluation are considered to have an obscure GI bleeding (OGIB). The diagnosis and management of patients with OGIB is challenging, often requiring extensive and expensive workups. The main objective is the identification of the etiology and site of bleeding, which should be as rapidly accomplished as possible, in order to establish the most appropriate therapy.

The role of hepatocyte-specific staining in liver pathology.

The advantages of MRI in the investigation of liver disease are well documented. Recent developments, including fast scanning technique and new MRI contrast agents, enable improved detection and characterization of focal liver lesions. Therefore, a definitive diagnosis can be made avoiding invasive procedures, such as liver biopsy.

A prospective evaluation of iron deficiency anemia in the GI endoscopy setting: role of standard endoscopy, videocapsule endoscopy, and CT-enteroclysis.

Background: Iron deficiency anemia (IDA) is a frequently encountered condition in clinical practice. After conventional endoscopy, the cause of anemia remains unknown in up to 40% of patients.

Objective: To evaluate prospectively the diagnostic efficacy of a systematic endoscopic approach to IDA and to compare the diagnostic yield of videocapsule endoscopy (VCE) and CT-enteroclysis in endoscopy-negative patients.

Enhancement of liver parenchyma after injection of hepatocyte-specific MRI contrast media: a comparison of gadoxetic acid and gadobenate dimeglumine.

Purpose: To compare enhancement of liver parenchyma in MR imaging after injection of hepatocyte-specific contrast media.

Materials And Methods: Patients (n = 295) with known/suspected focal liver lesions randomly received 0.025 mmol gadoxetic acid/kg body weight or 0.

Effect of clinical history in focal liver lesion detection and classification on 4-detector row computed tomography and gadoxetic acid enhanced MR imaging in oncologic patients.

Purpose: To determine the influence of clinical data on reader diagnostic accuracy in focal liver lesion (FLL) detection and classification.

Materials And Methods: Eighty-seven oncologic patients with FLLs underwent contrast-enhanced multidetector-row computed tomography (MDCT) and gadoxetic acid-enhanced magnetic resonance imaging (MRI). Two independent readers reviewed images for FLL detection and classification as benign or malignant without knowledge and after provision of clinical information.

Resovist enhanced MR imaging of the liver: does quantitative assessment help in focal lesion classification and characterization?

Purpose: To improve characterization of focal liver lesions by a prospective quantitative analysis of percentage signal intensity change, in dynamic and late phases after slow (0.5 mL/s) Resovist administration.

Materials And Methods: Seventy-three patients were submitted on clinical indication to MR examination with Resovist.

Four-detector row computed tomographic angiography in the evaluation of infrarenal aorta and peripheral arterial occlusive disease: influence of contrast medium concentration.

Purpose: To prospectively compare the diagnostic accuracy and quality of vascular enhancement of 2 contrast agents with different iodine concentrations in 4-detector row computed tomographic angiography of abdominal aorta and lower-extremity arteries.

Materials And Methods: Forty consecutive patients with peripheral arterial occlusive disease referred for conventional angiography (digital subtraction angiography [DSA]) of the lower extremity were prospectively enrolled in the study and underwent multidetector row computed tomographic angiography (CTA) receiving either 90 mL of iomeprol 400 (Iomeron 400, group A; Bracco Imaging S.p.

Multidetector-row computed tomography angiography in abdominal aortic aneurysm treated with endovascular repair: evaluation of optimal timing of delayed phase imaging for the detection of low-flow endoleaks.

Purpose: To evaluate the optimal timing of delayed phase imaging for detecting low-flow endoleaks.

Materials And Methods: Fifty-eight patients with unruptured abdominal aortic aneurysm treated with endovascular repair underwent 1- and 6-month follow-up multidetector row computed tomography (CT) performed during unenhanced, arterial, and delayed phase. At 6-month follow-up, delayed phase imaging, focused on stent graft, was performed with a delay of 60 (early delayed enhanced phase) and 300 seconds (late delayed enhanced phase) after intravenous injection of 120 mL of iodinated nonionic contrast medium (iomeprol 300 mgI/mL, Iomeron), at a flow rate of 3 mL/s via an antecubital vein, with a detector-row configuration of 4 x 1-mm, a 1.

MDCT angiography in abdominal aortic aneurysm treated with endovascular repair: diagnostic impact of slice thickness on detection of endoleaks.

Objective: The objective of our study was to evaluate the diagnostic impact of slice thickness on the detection of endoleaks at MDCT.

Subjects And Methods: Fifty patients with abdominal aortic aneurysm treated with endovascular repair who had undergone follow-up MDCT were enrolled in this study. Contrast-enhanced images were obtained with a 4-MDCT scanner (1-mm collimation).

Endovascular treatment of thoracic aortic diseases: Follow-up and complications with multi-detector computed tomography angiography.

Endovascular procedures with placement of stent-graft has become an accepted alternative to traditional open surgery for treatment of descending thoracic aortic aneurysms, ulcers, post-traumatic rupture, or complications of type-B dissection, due to significant reduction in perioperative mortality, rate of complications and length of hospitalization. Moreover, increasing operator experience and continuous advances in stent-graft technology are making treatment of a wider range of cases possible with redefinition of guidelines for endovascular stent-graft. The feasibility of endovascular stent-graft is mainly dependent on anatomic factors which represent the important predictors of the success of this procedure as well as on strictly follow-up in order to obtain early detection and treatment of eventual complications.

Four-section multidetector computed tomographic imaging of bowel obstruction: usefulness of axial and coronal plane combined reading.

Objective: To compare the diagnostic performance of axial and coronal views in multidetector-row computed tomography (MDCT) of patients with small-bowel obstruction (SBO) or large-bowel obstruction (LBO).

Materials And Methods: Among 157 patients with clinical and radiographic findings of BO, 73 patients, who underwent MDCT and were found to have surgically proven SBO (49/73) or LBO (24/73), were retrospectively evaluated. Portal-enhanced MDCT was performed using 4 x 2.

Obscure gastrointestinal bleeding and small bowel pathology: comparison between wireless capsule endoscopy and multidetector-row CT enteroclysis.

Obscure gastrointestinal bleeding is defined as bleeding of unknown origin, that persists or recurs after negative conventional barium contrast studies and upper and lower tract endoscopy. The causes of such a bleeding frequently arise in the small bowel, and they are represented by mucosal vascular abnormalities, neoplasms and other conditions such as Crohn's disease, Meckel's diverticulum, and vasculitis. Conventional barium contrast studies and push enteroscopy allow only a limited small bowel examination; moreover, intraoperative endoscopy may be inconclusive, since the small bowel is difficult to evaluate given its length and tortuous course.

Idiopathic segmental infarction of the greater omentum diagnosed by unenhanced multidetector-row CT and treated successfully by laparoscopy.

Idiopathic segmental infarction of the greater omentum is a rare disorder presenting with nonspecific clinical symptoms that may mimic a variety of acute abdominal conditions. We describe the diagnosis and treatment of two patients who had idiopathic infarction of the greater omentum and presented with localized abdominal pain, mimicking acute cholecystitis and acute diverticulitis, respectively. Patients underwent unenhanced multidetector-row computed tomography (CT) examination, which demonstrated the characteristic features of omental infarction, consisting of a heterogeneous density fatty mass, containing hyperattenuating streaks, located in the greater omentum, between the anterior abdominal wall and the colon; a moderate amount of free peritoneal fluid was also present.