Cornerstones of CT urography: a shared document by the Italian board of urogenital radiology

CT urography is a single term used to refer to different scanning protocols that can be applied for a number of clinical indications. If, on the one hand, this highlights the role of the radiologist in deciding the most suitable technique to perform according to the patient's needs, on the other hand, a certain confusion may arise due to the different technical and clinical variables that have to be taken into account. This has been well demonstrated by a previous work based on an online questionnaire administered to a population of Italian radiologists that brought out similarities as well as differences across the national country. Defining precise guidelines for each clinical scenario, although desirable, is a difficult task to accomplish, if not even unfeasible. According to the prementioned survey, five relevant topics concerning CT urography have been identified: definition and clinical indications, opacification of the excretory system, techniques, post-processing reconstructions, and radiation dose and utility of dual-energy CT. The aim of this work is to deepen and share knowledge about these main points in order to assist the radiology in the daily practice. Moreover, a synopsis of recommendations agreed by the Italian board of genitourinary imaging is provided.

The best prostate biopsy sampling system-fusion and systematic biopsy: A single center experience

BACKGROUND

Prostate cancer is the second most commonly diagnosed cancer in men. The diagnostic accuracy in prostate cancer can be increased by employing a preliminary multiparametric MRI followed by a fusion-targeted biopsy.

METHODS

To compare the diagnostic accuracy of fusion-targeted biopsy with the standard systematic biopsy in prostate cancer patients, we enrolled 139 patients on which we performed 139 prostate biopsies consisting of three targeted samples followed by 12 regular systematic samples. Based on histology, we analyzed the diagnostic performance of the two methods.

RESULTS

Both methods were equally good at detecting clinically significant cancer (83.3%, 50/60), while systematic biopsy detected more clinically insignificant cancers. However, the best diagnostic performance is obtained by combining the two methods.

CONCLUSION

The two methods are best seen as synergistic, and the addition of fusion biopsy can be used to detect more clinically significant prostate cancers than systematic biopsy alone.

Automatic PI-RADS assignment by means of formal methods

INTRODUCTION AND OBJECTIVES

The Prostate Imaging Reporting and Data System (PI-RADS) version 2 emerged as standard in prostate magnetic resonance imaging examination. The Pi-RADS scores are assigned by radiologists and indicate the likelihood of a clinically significant cancer. The aim of this paper is to propose a methodology to automatically mark a magnetic resonance imaging with its related PI-RADS.

MATERIALS AND METHODS

We collected a dataset from two different institutions composed by DWI ADC MRI for 91 patients marked by expert radiologists with different PI-RADS score. A formal model is generated starting from a prostate magnetic resonance imaging, and a set of properties related to the different PI-RADS scores are formulated with the help of expert radiologists and pathologists.

RESULTS

Our methodology relies on the adoption of formal methods and radiomic features, and in the experimental analysis, we obtain a specificity and sensitivity equal to 1.

Q CONCLUSIONS

The proposed methodology is able to assign the PI-RADS score by analyzing prostate magnetic resonance imaging with a very high accuracy.

Computed Tomography Imaging in Lemmel Syndrome: A Report of Two Cases

Lemmel syndrome is a rare and misdiagnosed cause of acute abdominal pain due to a juxtapapillary duodenal diverticulum causing mechanical obstruction of the common bile duct. Frequently, patients suffering from Lemmel syndrome have a history of recurrent access to the emergency room for acute abdominal pain referable to a biliopancreatic obstruction, in the absence of lithiasis nuclei or solid lesions at radiological examinations. Ultrasonography (US) may be helpful in evaluation of upstream dilatation of extra-/intra-hepatic biliary duct, but computed tomography (CT) is the reference imaging modality for the diagnosis of periampullary duodenal diverticula compressing the intrapancreatic portion of the common bile duct. Recognition of this entity is crucial for targeted, timely therapy avoiding mismanagement and therapeutic delay. The aim of this paper is to report CT imaging findings and our experience in two patients affected by Lemmel syndrome.

Coaxial biopsy during percutaneous vertebroplasty in patients with presumed osteoporotic vertebral compression fractures: retrospective review of biopsy results

PURPOSE

This study retrospectively analysed the results of biopsies obtained during percutaneous vertebroplasty (PVP) in patients with presumed osteoporotic vertebral compression fractures, with a view to highlighting the importance of coaxial biopsy in determining the aetiology of vertebral fractures and planning subsequent treatment.

MATERIALS AND METHODS

Between November 2003 and March 2009, 98 patients (78 women; 20 men) with a clinical and imaging suspicion of osteoporotic vertebral compression fractures underwent coaxial biopsy in conjunction with PVP of the thoracic and lumbar vertebrae. Mean age at the time of the procedure was 72.6 years. A pathologist interpreted all the biopsy samples.

RESULTS

In 83 patients, the biopsy results were consistent with the presumed osteoporotic aetiology. In two patients, a malignancy was identified. Biopsy samples from 13 patients were considered insufficient or unsuitable by the pathologist for evaluation.

CONCLUSIONS

Despite the number of biopsy samples considered insufficient or unsuitable, coaxial biopsy during PVP is useful in verifying the presumed aetiology of vertebral compression fractures, which is often unclear on the basis of clinical and imaging examinations. It is therefore both convenient and advisable to perform a vertebral coaxial biopsy in all patients undergoing a PVP.

[Contribution of intraoperative radiotherapy in the control of local recurrences of rectal cancer]

Local recurrence (LR) is a major problem following curative resection of rectal cancer. Intraoperative radiation therapy (IORT) is considered an ideal boost technique for increasing the dose of radiation therapy within a restricted area without introducing a significant toxicity. The aim of this study is to present the results of a multimodality treatment containing external beam irradiation, chemotherapy, surgical resection, and IORT delivered by a movable linear accelerator (NOVAC7, Hitesys SpA, Italia), employed in a "traditional" operating room.

Pain management for the elderly

Pain management for the elderly is based on the same principles as for all other age groups. There is no evidence that the elderly patient and the young patient perceive pain differently. Pain management should aim at achieving a specific diagnosis and a specific treatment with the appropriate choice of analgesic used in the optimal regimen and should give attention to all other factors contributing to the patient's suffering. Geriatric medicine uses an essentially multidisciplinary approach to treatment of medical problems, and this doctrine should apply to treatment of pain.