Position paper on magnetic resonance imaging protocols in the musculoskeletal system (excluding the spine) by the Italian College of Musculoskeletal Radiology.

Magnetic resonance imaging (MRI) is a pivotal radiological examination in clinical practice, being widely applied for musculoskeletal examinations. In this setting, strict adherence to standardized protocol is crucial to increase diagnostic performance and minimize variability among different diagnostic centres and readers. The aim of this paper is to provide standardized technical recommendations for musculoskeletal MRI scans proposed by the Italian College of Musculoskeletal Radiology.

Percutaneous CT-guided vertebroplasty in the management of osteoporotic fractures and dorsolumbar metastases.

Percutaneous vertebroplasty (PVP) is a minimally invasive, image-guided procedure consisting of an injection of acrylic cement into a vertebral body to reinforce the compressed segment and achieve pain relief. The use of PVP is a minimally invasive option in the treatment of osteoporotic or metastatic vertebral collapses. Our personal experience, using a CT-guided technique, confirms the efficacy and safety of PVP with a lower risk for complications compared with conventional fluoroscopic approaches because of a precise placement of the instruments in the vertebral body and an early detection of small cement leakages.

Intra-arterial infusion of 5-fluorouracil, leucovorin, epirubicin and carboplatin (FLEC regimen) in unresectable pancreatic cancer: results of a ten-year experience.

Unlabelled: The final results of a new regimen given intra-arterially for unresectable pancreatic cancer (UPC) are presented.

Patients And Methods: From January 1994 to January 2006, 5-fluorouracil 1,000 mg/m2, leucovorin 100 mg/m2, epirubicin 60 mg/m2 and carboplatin 300 mg/m2 were administered every 3 weeks into the celiac axis (CA) angiografically (FLEC regimen) to 211 patients with UPC.

Results: Seven hundred and sixty-four cycles were administered.

Contribution of imaging to the evaluation of pyomyositis.

Purpose: To analyse the fundamental features of each imaging modality with the aim of defining their contribution to the diagnosis of pyomyositis.

Materials And Methods: We retrospectively reviewed 10 observations collected between 1997 and 2004, 5 of paravertebral muscles and 5 of the muscles of the limbs. Imaging was carried out with US (8/10 observations) and/or CT (9/10 observations), and/or MRI (6/10 observations).

MRI versus scintigraphy with 99mTc-HMPAO-labelled granulocytes in the diagnosis of bone infection.

Purpose: To assess the reliability of MRI and scintigraphy with 99mTc-HMPAO-labelled granulocytes in the diagnosis of bone infection.

Materials And Methods: Between November 2001 and November 2003, 25 patients (16 men and 9 women; age range 22-72 years; mean age 48 years) with suspected bone infection were evaluated. The lower limbs were more frequently involved (20/25 cases).

Alignment and articular orientation of lower limbs: manual vs computer-aided measurements on digital radiograms.

Purpose: To compare the manual measurements of lower limbs on digital images with those obtained with dedicated software.

Materials And Methods: Forty patients with a clinical suspicion of lower limb deformity were enrolled. Eighty digital radiographs were produced with a remote-controlled radiography system (Philips Omnidiagnost).

Phase II study of hepatic intraarterial epirubicin and cisplatin, with systemic 5-fluorouracil in patients with unresectable biliary tract tumors.

Background: Patients with unresectable biliary tract carcinomas have a very poor prognosis. To improve the efficacy and tolerance of the ECF regimen (epirubicin at a dose of 50 mg/m2, cisplatin at a dose of 60 mg/m2, and 5-fluorouracil [5-FU] at a dose of 200 mg/m2 per day by continuous infusion), the authors designed a novel approach that combined locoregional and systemic chemotherapy with the same agents at the same dosages.

Methods: Thirty consecutive patients with advanced or metastatic biliary tumors were treated with epirubicin at a dose of 50 mg/m2 and cisplatin at a dose of 60 mg/m2 administered as a bolus in the hepatic artery on Day 1, combined with systemic continuous infusion of 5-FU at a dose of 200 mg/m2 per day, from Day 1 to Day 14, every 3 weeks.

Imaging of bone micro-injuries.

Purpose: We evaluated the fundamental signs of each imaging modality to define the role of MRI in identifying and characterizing bone micro-injuries.

Materials And Methods: We retrospectively reviewed 50 MRI examinations performed after preliminary conventional radiography on 25 stress fractures and 25 insufficiency fractures between 1989 and 2002. The number of lesions identified was 55: 11 were evaluated with CT and 9 with radionuclide bone scan.