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Caruso M, Rinaldo C, Iacobellis F, Dell'Aversano Orabona G, Grimaldi D, Di Serafino M, Schillirò ML, Verde F, Sabatino V, Camillo C, Ponticiello G, Romano L. Abdominal compartment syndrome: what radiologist needs to know. LA RADIOLOGIA MEDICA 2023; 128:1447-1459. [PMID: 37747669 DOI: 10.1007/s11547-023-01724-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
The intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) are life-threatening conditions with a significant rate of mortality; therefore, early detection is paramount in their optimal management. IAH is diagnosed when the intra-abdominal pressure (IAP) is more than 12 mmHg. It can occur when the intra-abdominal volume increases (ileus, ascites, trauma, pancreatitis, etc.) and/or the abdominal wall compliance decreases. IAH can cause decreased venous flow, low cardiac output, renal impairment, and decreased respiratory compliance. Consequently, these complications can lead to multiple organ failure and induce the abdominal compartment syndrome (ACS) when IAP rises above 20 mmHg. The diagnosis is usually made with intravesical pressure measurement. However, this measurement was not always possible to obtain; therefore, alternative diagnostic techniques should be considered. In this setting, computed tomography (CT) may play a crucial role, allowing the detection and characterization of pathological conditions that may lead to IAH. This review is focused on the pathogenesis, clinical features, and radiological findings of ACS, because their presence allows radiologists to raise the suspicion of IAH/ACS in critically ill patients, guiding the most appropriate treatment.
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Affiliation(s)
- Martina Caruso
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy.
| | - Chiara Rinaldo
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | | | - Dario Grimaldi
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Maria Laura Schillirò
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Francesco Verde
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Vittorio Sabatino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Costanza Camillo
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Gianluca Ponticiello
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131, Naples, Italy
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2
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Congedo A, Mallardi D, Danti G, De Muzio F, Granata V, Miele V. An Updated Review on Imaging and Staging of Anal Cancer-Not Just Rectal Cancer. Tomography 2023; 9:1694-1710. [PMID: 37736988 PMCID: PMC10514831 DOI: 10.3390/tomography9050135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/19/2023] [Accepted: 08/24/2023] [Indexed: 09/23/2023] Open
Abstract
Anal cancer is a rare disease, but its incidence has been increasing steadily. Primary staging and assessment after chemoradiation therapy are commonly performed using MRI, which is considered to be the preferred imaging modality. CT and PET/CT are useful in evaluating lymph node metastases and distant metastatic disease. Anal squamous-cell carcinoma (ASCC) and rectal adenocarcinoma are typically indistinguishable on MRI, and a biopsy prior to imaging is necessary to accurately stage the tumor and determine the treatment approach. This review discusses the histology, MR technique, diagnosis, staging, and treatment of anal cancer, with a particular focus on the differences in TNM staging between anal and rectal carcinomas. PURPOSE This review discusses the histology, MR technique, diagnosis, staging, and treatment of anal cancer, with a particular focus on the differences in TNM staging between anal squamous-cell carcinoma (ASCC) and rectal adenocarcinoma. METHODS AND MATERIALS To conduct this updated review, a comprehensive literature search was performed using prominent medical databases, including PubMed and Embase. The search was limited to articles published within the last 10 years (2013-2023) to ensure their relevance to the current state of knowledge. INCLUSION CRITERIA (1) articles that provided substantial information on the diagnostic techniques used for ASCC, mainly focusing on imaging, were included; (2) studies reporting on emerging technologies; (3) English-language articles. EXCLUSION CRITERIA articles that did not meet the inclusion criteria, case reports, or articles with insufficient data. The primary outcome of this review is to assess the accuracy and efficacy of different diagnostic modalities, including CT, MRI, and PET, in diagnosing ASCC. The secondary outcomes are as follows: (1) to identify any advancements or innovations in diagnostic techniques for ASCC over the past decade; (2) to highlight the challenges and limitations of the diagnostic process. RESULTS ASCC is a rare disease; however, its incidence has been steadily increasing. Primary staging and assessment after chemoradiation therapy are commonly performed using MRI, which is considered to be the preferred imaging modality. CT and PET/CT are useful in evaluating lymph node metastases and distant metastatic disease. CONCLUSION ASCC and rectal adenocarcinoma are the most common histological subtypes and are typically indistinguishable on MRI; therefore, a biopsy prior to imaging is necessary to stage the tumor accurately and determine the treatment approach.
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Affiliation(s)
- Alessio Congedo
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (A.C.); (D.M.); (V.M.)
| | - Davide Mallardi
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (A.C.); (D.M.); (V.M.)
| | - Ginevra Danti
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (A.C.); (D.M.); (V.M.)
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy;
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy;
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (A.C.); (D.M.); (V.M.)
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3
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Reginelli A, Giacobbe G, Del Canto MT, Alessandrella M, Balestrucci G, Urraro F, Russo GM, Gallo L, Danti G, Frittoli B, Stoppino L, Schettini D, Iafrate F, Cappabianca S, Laghi A, Grassi R, Brunese L, Barile A, Miele V. Peritoneal Carcinosis: What the Radiologist Needs to Know. Diagnostics (Basel) 2023; 13:diagnostics13111974. [PMID: 37296826 DOI: 10.3390/diagnostics13111974] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/17/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Peritoneal carcinosis is a condition characterized by the spread of cancer cells to the peritoneum, which is the thin membrane that lines the abdominal cavity. It is a serious condition that can result from many different types of cancer, including ovarian, colon, stomach, pancreatic, and appendix cancer. The diagnosis and quantification of lesions in peritoneal carcinosis are critical in the management of patients with the condition, and imaging plays a central role in this process. Radiologists play a vital role in the multidisciplinary management of patients with peritoneal carcinosis. They need to have a thorough understanding of the pathophysiology of the condition, the underlying neoplasms, and the typical imaging findings. In addition, they need to be aware of the differential diagnoses and the advantages and disadvantages of the various imaging methods available. Imaging plays a central role in the diagnosis and quantification of lesions, and radiologists play a critical role in this process. Ultrasound, computed tomography, magnetic resonance, and PET/CT scans are used to diagnose peritoneal carcinosis. Each imaging procedure has advantages and disadvantages, and particular imaging techniques are recommended based on patient conditions. Our aim is to provide knowledge to radiologists regarding appropriate techniques, imaging findings, differential diagnoses, and treatment options. With the advent of AI in oncology, the future of precision medicine appears promising, and the interconnection between structured reporting and AI is likely to improve diagnostic accuracy and treatment outcomes for patients with peritoneal carcinosis.
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Affiliation(s)
- Alfonso Reginelli
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Giuliana Giacobbe
- General and Emergency Radiology Department, "Antonio Cardarelli" Hospital, 80131 Naples, Italy
| | - Maria Teresa Del Canto
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Marina Alessandrella
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Giovanni Balestrucci
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Gaetano Maria Russo
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Luigi Gallo
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Barbara Frittoli
- Department of Radiology, Spedali Civili Hospital, 25123 Brescia, Italy
| | - Luca Stoppino
- Department of Radiology, University Hospital of Foggia, 71122 Foggia, Italy
| | - Daria Schettini
- Department of Radiology, Villa Scassi Hospital, Corso Scassi 1, 16121 Genova, Italy
| | - Franco Iafrate
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza-University of Rome, Radiology Unit-Sant'Andrea University Hospital, 00189 Rome, Italy
| | - Roberto Grassi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Antonio Barile
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, 67100 L'Aquila, Italy
| | - Vittorio Miele
- Department of Translational Research, Diagnostic and Interventional Radiology, University of Pisa, 56126 Pisa, Italy
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4
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Brunese MC, Fantozzi MR, Fusco R, De Muzio F, Gabelloni M, Danti G, Borgheresi A, Palumbo P, Bruno F, Gandolfo N, Giovagnoni A, Miele V, Barile A, Granata V. Update on the Applications of Radiomics in Diagnosis, Staging, and Recurrence of Intrahepatic Cholangiocarcinoma. Diagnostics (Basel) 2023; 13:diagnostics13081488. [PMID: 37189589 DOI: 10.3390/diagnostics13081488] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND This paper offers an assessment of radiomics tools in the evaluation of intrahepatic cholangiocarcinoma. METHODS The PubMed database was searched for papers published in the English language no earlier than October 2022. RESULTS We found 236 studies, and 37 satisfied our research criteria. Several studies addressed multidisciplinary topics, especially diagnosis, prognosis, response to therapy, and prediction of staging (TNM) or pathomorphological patterns. In this review, we have covered diagnostic tools developed through machine learning, deep learning, and neural network for the recurrence and prediction of biological characteristics. The majority of the studies were retrospective. CONCLUSIONS It is possible to conclude that many performing models have been developed to make differential diagnosis easier for radiologists to predict recurrence and genomic patterns. However, all the studies were retrospective, lacking further external validation in prospective and multicentric cohorts. Furthermore, the radiomics models and the expression of results should be standardized and automatized to be applicable in clinical practice.
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Affiliation(s)
- Maria Chiara Brunese
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100 Campobasso, Italy
| | | | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, 86100 Campobasso, Italy
| | - Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Ginevra Danti
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
- Department of Emergency Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Alessandra Borgheresi
- Department of Radiology, University Hospital "Azienda Ospedaliera Universitaria delle Marche", 60121 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Pierpaolo Palumbo
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L'Aquila, Italy
| | - Federico Bruno
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L'Aquila, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, 16149 Genoa, Italy
| | - Andrea Giovagnoni
- Department of Radiology, University Hospital "Azienda Ospedaliera Universitaria delle Marche", 60121 Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Università Politecnica delle Marche, 60121 Ancona, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
- Department of Emergency Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
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Brillantino A, Iacobellis F, Brusciano L, Abu-Omar A, Muto G, Amadu AM, Foroni F, Antropoli M, Antropoli C, Castriconi M, Renzi A, Pirolo L, Giuliani A, Scarano E, Docimo L, Scaglione M, Romano L. Accuracy of computed tomography in staging acute appendicitis and its impact on surgical outcome and strategy: a multi-center retrospective case-control study. LA RADIOLOGIA MEDICA 2023; 128:415-425. [PMID: 36940006 DOI: 10.1007/s11547-023-01619-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/07/2023] [Indexed: 03/21/2023]
Abstract
INTRODUCTION The aims of this study were to evaluate the concordance between AAST-CT appendicitis grading criteria, first published in 2014, and surgical findings and to assess the impact of CT staging on the choice of surgical approach. METHODS This was a multi-center retrospective case-control study including 232 consecutive patients undergoing surgery for acute appendicitis and who had undergone preoperative CT evaluation between 1 January 2017 and 1 January 2022. Appendicitis severity was classified in 5 grades. For each degree of severity, the surgical outcome between patients undergoing open and surgical approach was compared. RESULTS An almost perfect agreement (k = 0.96) was found between CT and surgery in staging acute appendicitis. The vast majority of patients with grade 1 and 2 appendicitis underwent laparoscopic surgical approach and showed low morbidity rate. In patients with grade 3 and 4 appendicitis, laparoscopic approach was adopted in 70% of cases and was associated, if compared to open, with a higher prevalence of postoperative abdominal collections (p = 0.05; fisher's exact test) and a significantly lower prevalence of surgical site infections (p = 0.0007; fisher's exact test). All the patients with grade 5 appendicitis were treated by laparotomy. CONCLUSIONS AAST-CT appendicitis grading system seems to show a relevant prognostic value and a potential impact on the choice of surgical strategy, directing toward a laparoscopic approach in patients with grade 1 and 2, an initial laparoscopic approach, replaceable by the open one, for grade 3 and 4 and an open approach in patients with grade 5.
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Affiliation(s)
- Antonio Brillantino
- Department of Surgery, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Luigi Brusciano
- Division of General, Mininvasive and Obesity Surgery, University of Study of Campania Luigi Vanvitelli Naples, Via Luigi Pansini N° 5, 80131, Naples, Italy
| | - Ahmad Abu-Omar
- Department of Radiology, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Gianluca Muto
- Diagnostic Imaging Department, Hospitaux Universitaires de Genève, Geneva, Switzerland
| | - Antonio Matteo Amadu
- Diagnostic Imaging 1 Unit, University Hospital of Sassari, 07100, Sassari, Italy
| | - Fabrizio Foroni
- Surgery Department, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Massimo Antropoli
- Surgery Department, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Carmine Antropoli
- Surgery Department, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Maurizio Castriconi
- Surgery Department, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Adolfo Renzi
- Surgery Department, "Buonconsiglio Fatebenefratelli" Hospital, Naples, Italy
| | - Luigi Pirolo
- Radiology Department, "Buonconsiglio Fatebenefratelli" Hospital, Naples, Italy
| | | | - Enrico Scarano
- Radiology Department, "San Carlo" Hospital, Potenza, Italy
| | - Ludovico Docimo
- Division of General, Mininvasive and Obesity Surgery, University of Study of Campania Luigi Vanvitelli Naples, Via Luigi Pansini N° 5, 80131, Naples, Italy
| | - Mariano Scaglione
- Department of Radiology, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.,Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 112, 07199, Sassari, Italy
| | - Luigia Romano
- Radiology Department, A. Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
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Catalano O, Fusco R, De Muzio F, Simonetti I, Palumbo P, Bruno F, Borgheresi A, Agostini A, Gabelloni M, Varelli C, Barile A, Giovagnoni A, Gandolfo N, Miele V, Granata V. Recent Advances in Ultrasound Breast Imaging: From Industry to Clinical Practice. Diagnostics (Basel) 2023; 13:diagnostics13050980. [PMID: 36900124 PMCID: PMC10000574 DOI: 10.3390/diagnostics13050980] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Breast ultrasound (US) has undergone dramatic technological improvement through recent decades, moving from a low spatial resolution, grayscale-limited technique to a highly performing, multiparametric modality. In this review, we first focus on the spectrum of technical tools that have become commercially available, including new microvasculature imaging modalities, high-frequency transducers, extended field-of-view scanning, elastography, contrast-enhanced US, MicroPure, 3D US, automated US, S-Detect, nomograms, images fusion, and virtual navigation. In the subsequent section, we discuss the broadened current application of US in breast clinical scenarios, distinguishing among primary US, complementary US, and second-look US. Finally, we mention the still ongoing limitations and the challenging aspects of breast US.
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Affiliation(s)
- Orlando Catalano
- Department of Radiology, Istituto Diagnostico Varelli, 80126 Naples, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
- Correspondence:
| | - Federica De Muzio
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Igino Simonetti
- Division of Radiology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli”, 80131 Naples, Italy
| | - Pierpaolo Palumbo
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Federico Bruno
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
| | - Michela Gabelloni
- Department of Translational Research, Diagnostic and Interventional Radiology, University of Pisa, 56126 Pisa, Italy
| | - Carlo Varelli
- Department of Radiology, Istituto Diagnostico Varelli, 80126 Naples, Italy
| | - Antonio Barile
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, Corso Scassi 1, 16149 Genoa, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Vincenza Granata
- Division of Radiology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli”, 80131 Naples, Italy
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The Role of Magnetic Resonance Enterography in Crohn’s Disease: A Review of Recent Literature. Diagnostics (Basel) 2022; 12:diagnostics12051236. [PMID: 35626391 PMCID: PMC9140029 DOI: 10.3390/diagnostics12051236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
Inflammatory bowel disease (IBD) is the term used to identify a form of chronic inflammation of the gastrointestinal tract that primarily contemplates two major entities: ulcerative colitis (UC) and Crohn’s disease (CD). The classic signs are abdominal pain and diarrhoea that correlate with the localization of gastro-enteric disease, although in this pathology extraintestinal symptoms may coexist. The diagnosis of CD relies on a synergistic combination of clinical, laboratory (stool and biochemical), cross-sectional imaging evaluation, as well as endoscopic and histologic assessments. The purpose of this paper is to prove the role of imaging in the diagnosis and follow-up of patients with CD with particular focus on recent innovations of magnetic resonance enterography (MRE) as a pivotal diagnostic tool, analysing the MRE study protocol and imaging features during the various phases of disease activity and its complications.
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8
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Simulation-based clinical learning for final year medical students about Focused Assessment Sonography for Trauma. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1112865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Systemic Emergencies in COVID-19 Patient: A Pictorial Review. Tomography 2022; 8:1041-1051. [PMID: 35448718 PMCID: PMC9031887 DOI: 10.3390/tomography8020084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022] Open
Abstract
Since the first report of the outbreak in Wuhan, China in December 2019, as of 1 September 2021, the World Health Organization has confirmed more than 239 million cases of the novel coronavirus (SARS-CoV-2) infectious disease named coronavirus disease 2019 (COVID-19), with more than 4.5 million deaths. Although SARS-CoV-2 mainly involves the respiratory tract, it is considered to be a systemic disease. Imaging plays a pivotal role in the diagnosis of all manifestations of COVID-19 disease, as well as its related complications. The figure of the radiologist is fundamental in the management and treatment of the patient. The authors try to provide a systematic approach based on an imaging review of major multi-organ manifestations of this infection.
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10
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Common and Uncommon Errors in Emergency Ultrasound. Diagnostics (Basel) 2022; 12:diagnostics12030631. [PMID: 35328184 PMCID: PMC8947314 DOI: 10.3390/diagnostics12030631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 12/19/2022] Open
Abstract
Errors in emergency ultrasound (US) have been representing an increasing problem in recent years thanks to several unique features related to both the inherent characteristics of the discipline and to the latest developments, which every medical operator should be aware of. Because of the subjective nature of the interpretation of emergency US findings, it is more prone to errors than other diagnostic imaging modalities. The misinterpretation of US images should therefore be considered as a serious risk in diagnosis. The etiology of error is multi-factorial: it depends on environmental factors, patients and the technical skills of the operator; it is influenced by intrinsic US artifacts, poor clinical correlation, US-setting errors and anatomical variants; and it is conditioned by the lack of a methodologically correct clinical approach and excessive diagnostic confidence too. In this review, we evaluate the common and uncommon sources of diagnostic errors in emergency US during clinical practice, showing how to recognize and avoid them.
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Iyengar KP, Jun Ngo VQ, Jain VK, Ahuja N, Hakim Z, Sangani C. What does the orthopaedic surgeon want in the radiology report? J Clin Orthop Trauma 2021; 21:101530. [PMID: 34386345 PMCID: PMC8333142 DOI: 10.1016/j.jcot.2021.101530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/21/2021] [Indexed: 02/07/2023] Open
Abstract
Complementary imaging is crucial in the diagnosis and management of the spectrum of Musculoskeletal (MSK) pathologies. Like in all medical specialities, its role in trauma and orthopaedic conditions has evolved. A radiology report following an imaging study should provide an accurate, timely interpretation of images and be presented in a format that allows formal analysis or clarification of a patient's diagnostic dilemma. It is essential that it is descriptive enough to allow clinico-pathological correlation to a patient's condition. A high-quality report follows clinical governance processes, provides clinical feedback, and when appropriate, incorporates advice regarding differential diagnosis or further investigation/management that can be undertaken, permitting the attending clinician to formulate a suitable treatment plan for their patient. In this narrative we explore common radiological investigations and reporting information in trauma and orthopaedic conditions, which would be useful to the attending surgeon.
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Affiliation(s)
- Karthikeyan P. Iyengar
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Vivien Qi Jun Ngo
- Foundation Year 2 Doctor in Orthopaedics, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Neeraj Ahuja
- Consultant Orthopaedic and Shoulder Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Zuned Hakim
- Consultant Trauma and Upper Limb Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Chetan Sangani
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
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12
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Di Serafino M, Viscardi D, Iacobellis F, Giugliano L, Barbuto L, Oliva G, Ronza R, Borzelli A, Raucci A, Pezzullo F, De Cristofaro MG, Romano L. Computed tomography imaging of septic shock. Beyond the cause: the "CT hypoperfusion complex". A pictorial essay. Insights Imaging 2021; 12:70. [PMID: 34089401 PMCID: PMC8178660 DOI: 10.1186/s13244-021-01006-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/05/2021] [Indexed: 12/17/2022] Open
Abstract
Septic shock is a medical emergency that represents one of the most important underlying causes for presentation to the Emergency Department. Sepsis is defined as organ dysfunction, life-threatening event caused by a deregulated inflammatory host response to infection, with a mortality risk ranging from 10 to 40%. Early sepsis identification is the cornerstone of management and diagnostic imaging can play a pivotal role in this clinical context. The choice of imaging modality depends on several factors, associated with the clinical condition and the presence or absence of localising signs and symptoms. The diagnostic accuracy of contrast-enhanced total-body CT has been well established during septic shock, allowing for a rapid, panoramic, and detailed study of multiple body areas, simultaneously. The aim of this article is to illustrate the controversial CT hypoperfusion complex in patients with septic shock, characterised by the following imaging features: decreased enhancement of the viscera; increased mucosal enhancement; luminal dilation of the small bowel; mural thickening and fluid-filled loops of the small bowel; the halo sign and flattening of the inferior vena cava; reduced aortic diameter; peripancreatic oedema; abnormal parenchymal perfusion; and other controversial findings that are variably associated with each other and reversible during the early stages. Increasing physicians' awareness of the significance of these findings could prompt alternative approaches to the early assessment and management of septic shock. In this perspective, CT imaging represents a useful tool for a complete, rapid and detailed diagnosis of clinically suspected septic shock, which can be used to improve patient outcomes.
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Affiliation(s)
- Marco Di Serafino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy.
| | - Daniela Viscardi
- Department of Anesthesia and Resuscitation, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy
| | - Luigi Giugliano
- Department of Advanced Biomedical Sciences, "Federico II" University Hospital, Naples, Italy
| | - Luigi Barbuto
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy
| | - Gaspare Oliva
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy
| | - Roberto Ronza
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy
| | - Antonio Borzelli
- Department of Vascular and Interventional Radiology, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Antonio Raucci
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy
| | - Filomena Pezzullo
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy
| | | | - Luigia Romano
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Antonio Cardarelli st 9, 80131, Naples, Italy
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13
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Iacobellis F, Narese D, Berritto D, Brillantino A, Di Serafino M, Guerrini S, Grassi R, Scaglione M, Mazzei MA, Romano L. Large Bowel Ischemia/Infarction: How to Recognize It and Make Differential Diagnosis? A Review. Diagnostics (Basel) 2021; 11:diagnostics11060998. [PMID: 34070924 PMCID: PMC8230100 DOI: 10.3390/diagnostics11060998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/19/2022] Open
Abstract
Ischemic colitis represents the most frequent form of intestinal ischemia occurring when there is an acute impairment or chronic reduction in the colonic blood supply, resulting in mucosal ulceration, inflammation, hemorrhage and ischemic necrosis of variable severity. The clinical presentation is variable and nonspecific, so it is often misdiagnosed. The most common etiology is hypoperfusion, almost always associated with generalized atherosclerotic disease. The severity ranges from localized and transient ischemia to transmural necrosis of the bowel wall, becoming a surgical emergency, with significant associated morbidity and mortality. The diagnosis is based on clinical, laboratory suspicion and radiological, endoscopic and histopathological findings. Among the radiological tests, enhanced-CT is the diagnostic investigation of choice. It allows us to make the diagnosis in an appropriate clinical setting, and to define the entity of the ischemia. MR may be adopted in the follow-up in patients with iodine allergy or renal dysfunctions, or younger patients who should avoid radiological exposure. In the majority of cases, supportive therapy is the only required treatment. In this article we review the pathophysiology and the imaging findings of ischemic colitis.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Antonio Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (L.R.)
- Correspondence:
| | - Donatella Narese
- Department of Radiology, University of Campania “L. Vanvitelli”, Miraglia 2 Sq., 80138 Naples, Italy; (D.N.); (R.G.)
| | - Daniela Berritto
- Department of Radiology, Hospital “Villa Fiorita”, Appia St., km 199,00, 81043 Capua, Italy;
| | - Antonio Brillantino
- Department of Emergency Surgery, “Antonio Cardarelli” Hospital, Antonio Cardarelli St. 9, 80131 Naples, Italy;
| | - Marco Di Serafino
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Antonio Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (L.R.)
| | - Susanna Guerrini
- Unit of Diagnostic Imaging, Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, Bracci St. 10, 53100 Siena, Italy;
| | - Roberta Grassi
- Department of Radiology, University of Campania “L. Vanvitelli”, Miraglia 2 Sq., 80138 Naples, Italy; (D.N.); (R.G.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Mariano Scaglione
- Department of Radiology, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK;
- Teesside University School of Health and Life Sciences, Middlesbrough TS1 3BX, UK
- Department of Radiology, Pineta Grande Hospital, Domitiana St. km 30/00, 81030 Castel Volturno, Italy
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Bracci St. 10, 53100 Siena, Italy;
| | - Luigia Romano
- Department of General and Emergency Radiology, “Antonio Cardarelli” Hospital, Antonio Cardarelli St. 9, 80131 Naples, Italy; (M.D.S.); (L.R.)
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de Almeida Monteiro RA, Duarte-Neto AN, Ferraz da Silva LF, de Oliveira EP, do Nascimento ECT, Mauad T, Saldiva PHDN, Dolhnikoff M. Ultrasound assessment of pulmonary fibroproliferative changes in severe COVID-19: a quantitative correlation study with histopathological findings. Intensive Care Med 2021; 47:199-207. [PMID: 33392642 PMCID: PMC7779089 DOI: 10.1007/s00134-020-06328-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/28/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE This study was designed to evaluate the usefulness of lung ultrasound (LUS) imaging to characterize the progression and severity of lung damage in cases of COVID-19. METHODS We employed a set of combined ultrasound parameters and histopathological images obtained simultaneously in 28 patients (15 women, 0.6-83 years) with fatal COVID-19 submitted to minimally invasive autopsies, with different times of disease evolution from initial symptoms to death (3-37 days, median 18 days). For each patient, we analysed eight post-mortem LUS parameters and the proportion of three histological patterns (normal lung, exudative diffuse alveolar damage [DAD] and fibroproliferative DAD) in eight different lung regions. The relationship between histopathological and post-mortem ultrasonographic findings was assessed using various statistical approaches. RESULTS Statistically significant positive correlations were observed between fibroproliferative DAD and peripheral consolidation (coefficient 0.43, p = 0.02) and pulmonary consolidation (coefficient 0.51, p = 0.005). A model combining age, time of evolution, sex and ultrasound score predicted reasonably well (r = 0.66) the proportion of pulmonary parenchyma with fibroproliferative DAD. CONCLUSION The present study adds information to previous studies related to the use of LUS as a tool to assess the severity of acute pulmonary damage. We provide a histological background that supports the concept that LUS can be used to characterize the progression and severity of lung damage in severe COVID-19.
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Affiliation(s)
- Renata Aparecida de Almeida Monteiro
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
| | - Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
| | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
- Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo, Sao Paulo, Brazil
| | - Ellen Pierre de Oliveira
- Departamento de Cardiopneumologia, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Ellen Caroline Toledo do Nascimento
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
| | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
| | - Paulo Hilário do Nascimento Saldiva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
| | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil.
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