OBJECTIVE: To compare 18-fluorine-labeled 2-deoxy-2-fluoro-D-glucose PET/computed tomography ((18)F-FDG-PET/CT) with contrast enhancement computed tomography (CECT) in the early follow-up of patients who had undergone treatment for primitive retroperitoneal sarcomas (RS). METHODS: This is a retrospective study on 24 patients who underwent (18)F-FDG-PET/CT and CECT within 2 years after therapy for RS. (18)F-FDG-PET/CT and CECT results were compared with results of histological examination and clinical-instrumental follow-up. We calculated the sensitivity and specificity of CECT and (18)F-FDG-PET/CT for retroperitoneal recurrences and compared them with results of the McNemar test. Negative predictive values (NPVs) and positive predictive values (PPVs) were calculated and the positive percentage agreement and negative percentage agreement were evaluated. RESULTS: The sensitivity and specificity of (18)F-FDG-PET/CT were 66.7 and 100% and those for CECT were 58.3 and 50%, respectively. For (18)F-FDG-PET/CT, PPV was 100% [95% confidence interval (CI): 67-100%] and NPV was 75% (95% CI: 58-75%); for CECT, PPV was 54% (95% CI: 33-73%) and NPV was 55% (95% CI: 30-78%). Positive percentage agreement and negative percentage agreement were, respectively, 38 and 72% for retroperitoneal lesions, 42.8 and 100% for liposarcomas, 40 and 50% for leiomyosarcomas, 14.2 and 94% for abdominal lymph nodes, and 16.6 and 100% for lung metastasis. Neither technique gave reliable results for liver metastasis. CONCLUSION: Our data show that (18)F-FDG-PET/CT has a higher overall specificity compared with CECT in identifying areas of recurrence, demonstrating its validity for early whole-body detection of lesions. In our hands (18)F-FDG-PET/CT seems to be a good tool in the early follow-up of patients experiencing recurrence of RS.

Purpose. This study was done to assess the possible clinical value of volume-rendered (VR) and curved volume-rendered (cVR) reconstructions obtained from isotropic data in the diagnosis of atypical appendicitis. Materials and methods. Forty-five patients with suspected acute appendicitis were examined with 16-slice multidetector computed tomography (MDCT) before and after contrast material injection. A diagnosis of atypical appendicitis was made in 33 cases. Two independent blinded radiologists with 2 and 9 years of CT experience assessed the axial scans and 2 months later the VR and cVR reconstructions. The following parameters were considered: presence, location, and wall thickness of the appendix; wall enhancement; distension; periappendiceal fat attenuation; presence of appendicolith; and free air and/or periappendiceal fluid collections. Sensitivity, specificity, and diagnostic accuracy values were calculated for each reader. The concordance between the two radiologists was analysed by using Cohen’s kappa statistic. Results. Mean sensitivity, specificity and accuracy for the less experienced radiologist were, respectively, 82%, 91% and 84% for the axial scans and 94%, 91% and 93% for the VR and cVR images, whereas the values for the more experienced reader were 94%, 100% and 95% for axial scans, and 97%, 100% and 98% for VR and cVR images. Conclusions. In patients with atypical appendicitis, VR and cVR reconstructions increase the accuracy of MDCT in relation to the reader’s experience and reduce the number of false negative results.

Pneumatosis intestinalis may be caused by bowel ischemia and may display different patterns of appearance. We report a case of pneumatosis intestinalis with an atypical target pattern, detected by multidetector computed tomography (CT) in a 66-year-old male presenting with acute abdominal syndrome. Abdominal CT scan showed a double gas collection within the wall of a jejunal segment, with a characteristic target air distribution. The patient was surgically treated and successfully discharged from our hospital with the diagnosis of acute bowel ischemia. The target air sign can be an initial CT finding of the typical pneumatosis intestinalis and it can be useful in the early diagnosis of bowel ischemia.

Hodgkin's lymphoma (HL) is now a highly curable disease, with an improving 5-year survival rate that has now reached 86%. At the time of presentation, HL is usually almost entirely confined to the lymph nodes. We performed a retrospective single-institution study of 384 cases with a median follow-up of 44 months, with the aim of identifying clinical and radiological characteristics and outcomes of patients with bone HL; 32 patients (8%) had primary bone involvement, always with concurrent nodal disease. These included 22 men (69%) and 10 women (31%) with the median age as 41 years. Advanced stages and nodular sclerosis histology prevailed among the subgroup. Radiographic features of bone HL are not specific but indicate a destructive malignant process with osteosclerosis and/or osteolysis. With current chemotherapeutic regimens, the long-term prognosis of patients with osseous HL appears good. The presence of bone lesions in HL should not be interpreted as implying a worse prognosis than without bone involvement.

To investigate whether background parenchymal enhancement (BPE) and breast cancer would correlate searching for any significant difference of BPE pattern distribution in case of benign or malignant lesions.

This study evaluated transition-point morphology for defining the nature of bowel obstructions.

PURPOSE: This study evaluated transition-point morphology for defining the nature of bowel obstructions. MATERIALS AND METHODS: Computed tomography (CT) examinations of 95 patients affected by severe bowel obstruction (23 neoplastic, 72 nonneoplastic) were retrospectively reviewed. RESULTS: The transition point was identified in 89 patients (94%); morphology in relation to the proximal loop was concave in 64 cases (68%), linear in five (5%) and convex in 20 (21%). Concave transition-point morphology was indicative of a nonneoplastic condition, with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy values of 89%, 100%, 100%, 74% and 92%, respectively. A linear shape had almost identical incidence among neoplastic (60%) and nonneoplastic (40%) conditions. A convex appearance correlated with neoplastic disease with sensitivity, specificity, PPV, NPV and diagnostic accuracy values of 87%, 100%, 100%, 96% and 97%, respectively. CONCLUSIONS: In the case of bowel obstruction, transitionpoint detection indicates the obstruction site, whereas its morphological evaluation can contribute to defining the nature of the obstruction. A concave morphology indicates a nonneoplastic condition with a high probability; a convex morphology correlates with neoplastic disease, whereas linearity is not significant.

The aim of this study was to evaluate the role of computed tomography (CT)-guided core needle biopsy (CNB) performed by modified coaxial technique as an alternative tool to surgical biopsy in patients with refractory or recurrent lymphomas. Between May 2005 and May 2012, 57 CT-guided CNB of deep lesions were performed in patients with a previous diagnosis of lymphoma and suspected for refractory or recurrent disease. A modified coaxial technique was used in all cases and multiple samples were obtained for histological and immunohistochemical studies. A diagnosis of lymphoma with specification of subtype according to the World Health Organization (WHO) classification was established in 30/57 cases (52.6 %). The previous diagnosis of lymphoma was confirmed in 27/57 patients (47.4 %), whereas histological progression in 3/57 (5.3 %) and other malignant neoplasms in 17/57 (29.8 %) were found. Lymphoma without subtype specification was diagnosed in 6/57 (10.5 %), and no conclusive diagnosis could be established in 4/57 cases (7 %). Overall diagnostic accuracy was 82.5 %. In patients with a final diagnosis of malignant lymphoma, accuracy was 75 %. No complications occurred. Percutaneous CT-guided CNB is a safe, effective and reliable tool in the management of patients with refractory or recurrent lymphomas without superficial lymphadenopathy and can be considered as alternative to surgical sampling.

Purpose: This study assessed the role of whole-body 18fluorodeoxyglucose positron-emission tomography/computed tomography (18FDG PET/CT) in the restaging and follow-up of patients with sarcoidosis previously studied by multidetector computed tomography (MDCT). Materials and methods: This retrospective study enroled 21 patients to evaluate the sensitivity, specificity and accuracy of 18FDG-PET/CT and MDCT. The results of the two techniques were compared with the Mc Nemar test. Cohen's K was used to compare concordance at the different lesion sites. Results: The sensitivity, specificity and accuracy of 18FDG-PET/CT were 80, 66.67, and 76.19 %, respectively. The sensitivity, specificity and accuracy of MDCT were 93.33, 33.33, and 76.19 %, respectively. In 16 patients who underwent whole-body MDCT, the sensitivity, specificity and accuracy values were 91.67, 81.25, and 50 % (MDCT) and 100, 50, and 87.5 % (18FDG-PET/CT). Conclusions: 18FDG-PET/CT is useful in evaluating the extent of sarcoidosis and recognising lesions at different sites, including lymph nodes, lungs, liver, spleen and bone. It also improves the interpretation of the morphological lesions seen on MDCT and depicts a larger number of lesions. Therefore, 18FDG-PET/CT could be used to complement other more traditional techniques for the restaging and follow-up in patients with sarcoidosis. © Italian Society of Medical Radiology 2013.

PURPOSE: This study assessed the diagnostic accuracy of pelvic magnetic resonance (MR) imaging completed by MR colonography for the preoperative evaluation of deep pelvic endometriosis in patients undergoing laparoscopic surgery. MATERIALS AND METHODS: A total of 143 patients (mean age 34.3 ± 5.1 years) with a clinical suspicion of deep pelvic endometriosis were assessed by pelvic MR and MR colonography. All patients underwent laparoscopic surgery 3-10 weeks after the MR examination. The presence, location, number and extent of endometriotic lesions were evaluated. Data obtained with MR were compared with surgical findings. MR sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and diagnostic accuracy values were calculated for each site by considering the laparoscopic and histological findings as the reference standard. RESULTS: Laparoscopy confirmed the presence of endometriosis in 119/143 patients (83%); in 76/119 (64%) deep pelvic endometriosis was diagnosed, whereas in the remaining 43/119 (36%), superficial peritoneal implants and endometriomas were found. In 32/119 (27%) patients, intestinal lesions were detected. MR had sensitivity, specificity, PPV, NPV and diagnostic accuracy values of 67-100%, 85-100%, 83-100%, 84-100% and 84-100%, respectively, in recognising lesions located in different pelvic sites. CONCLUSIONS: MR imaging combined with colonography is a highly accurate tool for characterising deep endometriotic lesions in patients scheduled for laparoscopic surgery. In particular, MR colonography has very high accuracy in detecting colorectal involvement.

OBJECTIVE: To investigate the contribution of contrast-enhanced MR-colonography (CE-MR-C) for the diagnosis of intestinal endometriosis. METHODS: One hundred and four women with suspected endometriosis were prospectively enrolled. All patients were subjected to MRI consisting of two phases: pelvic high-resolution MRI (HR-MRI) followed by CE-MR-C after colonic distension using a 1.5-liter water enema and injection of 0.15 ml/kg of 0.5 M gadolinium-DTPA with T1w high-resolution isotropic volume (THRIVE) and balanced turbo field echo (BTFE) images. HR-MRI and CE-MR-C were considered as two datasets, which were independently reviewed by two radiologists with 12 and 2 years' experience respectively. The presence of deep pelvic endometriotic lesions with particular attention to colorectal involvement was recorded. RESULTS: MRI findings correlated with laparoscopy in all cases. Thanks to CE-MR-C images, sensitivity, specificity, PPV, NPV and accuracy for diagnosis of colorectal endometriosis increased from 76%, 96%, 84%, 93% and 91%, to 95%, 97%, 91%, 99% and 97% for the most experienced radiologist and from 62%, 93%, 72%, 89% and 85%, to 86%, 94%, 82%, 96% and 92% for the less experienced radiologist; moreover, the interobserver agreement increased from 0.63 to 0.80 (Cohen's K test). CONCLUSION: CE-MR-C allows easier recognition of colorectal endometriosis and higher interobserver agreement.

To evaluate the role of multidetector computed tomography (MDCT) in recognizing the complications of extracorporeal shock wave lithotripsy (ESWL) and providing a prognostic grading system for the therapeutic approach.

Purpose. Hereditary haemorrhagic telangiectasia (HHT), or Rendu-Osler-Weber disease, is a rare autosomal dominant disorder characterised by mucocutaneous or visceral vascular abnormalities that may be widely distributed throughout the cardiovascular system. The purpose of this study was to compare multislice computed tomography angiography (MSCTA) and 4D dynamic contrast-enhanced magnetic resonance angiography (D-MRA) for evaluating vascular hepatic involvement in patients with HHT. Materials and methods. Fifty-two consecutive HHT patients underwent MSCTA and D-MRA examinations for systematic analysis of vascular visceral involvement. The images from the two techniques were reviewed independently by two expert radiologists to identify the following vascular abnormalities: telangiectases or large vascular masses; perfusion disorders [transient hepatic attenuation differences (THADs)]; hepatic arteriovenous malformations (HAVMs). Data, as well as diameters of the common hepatic artery and portal vein, were compared with Cohen's kappa statistic, Student's t test and receiver operating characteristic (ROC) curve analysis, as appropriate. Results. Both MSCTA and D-MRA detected one or more of the following hepatic vascular abnormalities in 36/52 cases (telangiectases in 29/52, THADs in 23/52 and HAVMs in 25/52[CE1]). A good concordance was found between the two techniques when determining the type of hepatic shunt (kappa=0.9). No statistically significant differences were found when comparing mean common hepatic artery and portal vein diameters (p=0.09 and 0.22, respectively) and their accuracy in predicting HAVMs. Conclusions. D-MRA has the same diagnostic accuracy as MSCTA and has the advantage of being less invasive due to the absence of ionising radiation.

Objectives To assess the contribute of intra-prosthetic MRI virtual navigation for evaluating breast implants and detecting implant ruptures. Methods Forty-five breast implants were evaluated by MR examination. Only patients with a clinical indication were assessed. A 1.5-T device equipped with a 4-channel breast coil was used by performing axial TSE-T2, axial silicone-only, axial silicone suppression and sagittal STIR images. The obtained dicom files were also analyzed by using virtual navigation software. Two blinded radiologists evaluated all MR and virtual images. Eight patients for a total of 13 implants underwent surgical replacement. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for both imaging strategies. Results Intra-capsular rupture was diagnosed in 13 out of 45 (29%) implants by using MRI. Basing on virtual navigation, 9 (20%) cases of intra-capsular rupture were diagnosed. Sensitivity, specificity, accuracy, PPV and NPV values of 100%, 86%, 89%, 62% and 100%, respectively, were found for MRI. Virtual navigation increased the previous values up to 100%, 97%, 98%, 89% and 100%. Conclusion Intra-prosthetic breast MR virtual navigation can represent an additional promising tool for the evaluation of breast implants being able to reduce false positives and to provide a more accurate detection of intra-capsular implant rupture signs.

Lipomas of the digestive tract are rare benign tumours which, in most cases, are totally asymptomatic. Because of their localization within the intestinal wall, endoscopy may be completely negative so contrast-enhanced computed tomography (CT) is very important for detecting and typing these lesions. The case of a 49-year-old man with abdominal pain is presented. Colonoscopy and biopsy of a polypoid lesion on the right colonic flexure concluded for tubulovillous adenoma. The subsequent CT showed a polylobate lesion of 5 cm in diameter with predominant fat density causing luminal sub-stenosis. Histological examination of the surgical specimen confirmed the presence of a voluminous submucosal lipoma. CT allows to diagnose lipomas of the large bowel thanks to the density measurement (between -40 and -120 Hunsfield Units) with an accurate detection of the site and nature of lumen stenosis.

To evaluate the effect of post-mastectomy radiation therapy (RT) on breast implants as detected by magnetic resonance imaging (MRI) searching for short-term complications.

Background: Diagnostic imaging provides useful anatomical and morphological information of cervico-mediastinal goiters. The aim of this study was to assess the usefulness of multidetector computed tomography (MDCT) with multiplanar reformatting and volume rendering reconstructions for the preoperative evaluation of retrosternal goiters in patients for whom magnetic resonance imaging is contraindicated. Methods: From March 2006 to January 2009, 34 patients (20 women and 14 men; mean age, 48 years; range, 42-74 years) with suspected cervico-mediastinal goiter were assessed by MDCT after intravenous injection of contrast material. The following parameters were evaluated: morphology, size, and enhancement of thyroid lobes; presence, location, and mediastinal extension of thyroid tissue; and relations with mediastinal vessels and organs. All patients underwent thyroidectomy. A reference group of 34 patients evaluated by single-detector computed tomography was created. The two groups of patients were compared searching for operative time (OT, in hours), hospital stay (HS, in days), and morbidity rate observed after thyroid surgery in all cases. Results: In 29/34 patients, thyroid was enlarged with left mediastinal extension in 12 cases, right extension in 10 cases, and posterior extension in 7 cases. In 3/34 patients, a normal cervical thyroid connected to the mediastinal goiter through a thin parenchymal stripe was observed. In 2/34 patients, thyroid lobes were enlarged, without mediastinal extension. By comparing the two groups of patients for OT and HS values, a significant reduction to 3.7 +/- 0.1 hours and 4.3 +/- 0.1 days, respectively, was found in the group of MDCT patients, and also a trend to the reduction for morbidity rate (21%) could be recognized. Conclusions: MDCT represents a noninvasive tool in the evaluation of retrosternal goiters. High-quality multiplanar reformatting and volume rendering reconstructions allow an optimal analysis of the plunged gland and could reduce OT, HS, and probably the morbidity rate.

Congenital pulmonary airway malformations (CPAMs) are a heterogeneous group of hamartomatous cystic and noncystic lung lesions that result from early airway maldevelopment. Usually they are distinguished according to Stocker's classification in type 0, 1, 2, 3 and 4. We present the case of a 2 weeks old baby who was admitted to hospital with RDS symptoms and left pleural effusion: X rays and CT were suggestive for a pulmonary cystic lesion with pleural complications. Because of the persistence of pleural empyema and the development of a pneumothorax the baby underwent surgery. The histological examination revealed a type 3 CPAM associated with pleural loculated empyema. According to this case, in newborns with RDS loculated pleural empyema may mimick pulmonary cystic lesions; a treatment-resistant pleural empyema or pyopneumothorax in a newborn can recognize a CPAM 3 as a probable underlying condition, even in the absence of lung suppurative changes; CPAM 3 involving only two lung segments can have an excellent prognosis after surgical excision.

This study aims to evaluate the diagnostic accuracy of 16-row multidetector CT (MDCT) and vessel probe reconstructions in the T staging of gastric carcinoma. Fifty-three patients (39 men, 14 women, mean age 57.5) with an endoscopic diagnosis of gastric adenocarcinoma underwent CT examination. A hypotonic drug was administered, and the gastric walls were distended by the ingestion of 400–600 ml of water. A biphasic technique with 40-s and 70-s delay was used after endovenous contrast material injection. All patients underwent surgery, and preoperative and histological stagings were compared. The diagnostic accuracy of T staging was 68% for axial images and 94% for VP reconstructions. In the T1, T2, T3 and T4 parameter evaluation, diagnostic accuracy values were 87%, 73.5%, 81% and 96%, respectively, for axial images and 96%, 96%, 98% and 100%, respectively for VP reconstructions. MDCT is an accurate technique for the preoperative staging of gastric cancer. The VP reconstructions obtained by isotropic data can evaluate the T parameter with a higher accuracy.

PURPOSE: The authors sought to evaluate the diagnostic accuracy of multidetector-row computed tomography (MDCT) performed with two different hypodense endoluminal contrast agents for the preoperative staging of colosigmoideal cancer. MATERIALS AND METHODS: Seventy consecutive patients with an endoscopically and histologically proven diagnosis of colosigmoideal cancer underwent MDCT examination. Thirty-five patients were evaluated with water MDCT colonography and the remaining 35 with air MDCT colonography. Patients were randomly assigned to the air or water groups for staging. Transverse images and multiplanar reconstructions (MPR) were retrospectively examined by two blinded expert radiologists in order to assess T and N parameters, and the results were compared with histological findings. RESULTS: The overall diagnostic accuracy of MDCT was 68.6% for water and 62.8% for air colonography. In the evaluation of the T parameter, the accuracy values were 88.6% for water and 80% for air colonography. In staging of the N parameter, the accuracy values were 77.1% and 74.3% for water and air MDCT colonography, respectively. CONCLUSIONS: MDCT examination can be proposed for the local staging of colosigmoideal cancer. Water is more accurate than air in evaluation of the T parameter, whereas the kind of endoluminal contrast material does not influence the definition of the N parameter.

Purpose. This study aimed to correlate multidetector-row computed tomography (MDCT) findings and postoperative prognosis in malignant large-bowel obstructions. Materials and methods. Twenty-seven patients affected by malignant colonic obstruction underwent MDCT examination and were analysed for obstruction site, colon-wall morphology, intestinal content alterations and transverse diameter of ascending colon. Results. Obstruction site was recognised in all cases (5/27 ascending colon; 1/27 transverse colon; 11/27 descending colon; 10/27 sigma-rectum). Intestinal content consisted of mainly air in 3/27 patients, mainly fluid in 11/27 and airfluid levels in 13/27. In 9/27 cases, pneumatosis intestinalis was found. Mean maximum diameter of the ascending colon was 8.2 cm. Overall mortality rate was 37%. An intestinal content mainly consisting of air (3/3 living patients) or fluid (7/11 living patients) were indicative of good prognosis. Air-fluid level detection indicated poor prognosis in 7/13 cases. Pneumatosis intestinalis (7/9 deceased patients) and ascending colon diameter values ≥10 cm (7/7 deceased patients) were indicative of poor prognosis. Conclusions. MDCT can identify the presence and site of malignant large-bowel obstructions and may provide useful prognostic information.

To evaluate the accuracy of water enema computed tomography (CT) for predicting the location of endometriosis in patients with contraindications to magnetic resonance imaging (MRI), focusing on rectosigmoid lesions and having laparoscopic and histological data as the reference standard.

Computed tomography (CT) does not represent the primary method for the evaluation of breast lesions; however, it can detect breast abnormalities, even when performed for other reasons related to thoracic structures. The aim of this study is to evaluate the potential benefits of 320-row multidetector CT (MDCT) in evaluating and differentiating incidentally detected breast lesions by using vessel probe and 3D analysis software with net enhancement value.

To assess the diagnostic accuracy of specimen ultrasound (US) for predicting resection margin status in women undergoing breast conserving therapy for US-detected cancer, having the histological findings as the reference standard.

The aim of the study was to assess the accuracy of multidetector CT (MDCT) with MPR reformation in the evaluation of large bowel obstruction. Thirty-one patients were evaluated retrospectively in a blinded fashion by two radiologists. All patients underwent MDCT with multiplanar reformation (MPR). The two radiologists interpreted independently the axial images and then the reconstructions. Each patient received a score from 1 (absent occlusion) to 5 (confirmed occlusion). The results were compared with surgical findings. Both axial and MPR images showed a very high accuracy in the diagnosis of bowel obstruction with a significant advantage of MPRs over native images and without any difference between the two radiologists. MDCT is an accurate technique in the evaluation of large bowel obstruction and use of MPRs facilitates the interpretation of imaging findings.

The modern approach to diagnostic imaging includes multimodal evaluation of patients. Physician knowledge of the clinical potential of each available imaging technique combined with efficient integration of functional and morphological data is mandatory in order to achieve a timely diagnosis and treatment, and to avoid unnecessary invasive examinations. Recent years have witnessed important advances in nuclear medicine techniques, including the development of a great variety of metabolic tracers that allow accurate detection, characterization and staging of diverse disease states other than neoplastic conditions. Nuclear medicine techniques play an important role in the diagnostic evaluation of different forms of inflammatory bowel disease (Crohn's disease, ulcerative rettocolitis, indeterminate colitis), and can provide optimal anatomo-functional information when used in association with multidetector CT and MRI, enabling tailored therapeutic interventions.

OBJECTIVE: To compare the capabilities of standard pelvic MRI with low-resolution pelvic MRI using fast breath-hold sequences to evaluate deep infiltrating endometriosis (DIE). METHODS: Sixty-eight consecutive women with suspected DIE were studied with pelvic MRI. A double-acquisition protocol was carried out in each case. High-resolution (HR)-MRI consisted of axial, sagittal, and coronal TSE T2W images, axial TSE T1W, and axial THRIVE. Low-resolution (LR)-MRI was acquired using fast single shot (SSH) T2 and T1 images. Two radiologists with 10 and 2 years of experience reviewed HR and LR images in two separate sessions. The presence of endometriotic lesions of the uterosacral ligament (USL), rectovaginal septum (RVS), pouch of Douglas (POD), and rectal wall was noted. The accuracies of LR-MRI and HR-MRI were compared with the laparoscopic and histopathological findings. RESULTS: Average acquisition times were 24 minutes for HR-MRI and 7 minutes for LR-MRI. The more experienced radiologist achieved higher accuracy with both HR-MRI and LR-MRI. The values of sensitivity, specificity, PPV, NPV, and accuracy did not significantly change between HR and LR images or interobserver agreement for all of the considered anatomic sites. CONCLUSIONS: LR-MRI performs as well as HR-MRI and is a valuable tool for the detection of deep endometriosis extension.

To evaluate breast lesion spatial displacement from prone MR to supine US positions and to determine whether the degree of displacement may be associated with breast density and lesion histotype.

To assess the role of STIR, T2-weighted TSE and DWIBS sequences for detecting and characterizing breast lesions and to compare unenhanced (UE)-MRI results with contrast-enhanced (CE)-MRI and histological findings, having the latter as the reference standard.

Lymphoscintigraphy and radio-guided research of the sentinel lymph node is the most important investigation in the staging of patients with cutaneous melanoma, because it allows the identification of the lymphatic drainage pathways, not always predictable, and locate the sentinel node in classic basins and in "unexpected" regions. The aim of this study was to evaluate the incidence of cases of unusual sentinel nodes detected by lymphoscintigraphy and their prognostic significance in patients with cutaneous melanoma.

Acute adrenal ischemia represents a rare cause of adrenal insufficiency which should be promptly diagnosed in order to preserve adrenal vitality and function. Our study aims to retrospectively evaluate the diagnostic accuracy of the CT capsular sign as an indicator of adrenal ischemia and its association with vascular involvement. Between January 2013 and January 2014, 69 consecutive patients (47 men, 22 women; mean age 46; range 22-67) with suspected adrenal insufficiency based on clinical and biochemical data underwent 320-row CT examination in our Emergency Department. Written informed consent was obtained for the CT examinations, and the institutional review board approval was obtained for our retrospective study. CT multi-planar images were retrospectively and independently analyzed by two radiologists searching for the patency of adrenal vessels, enlarged adrenals, the presence of the "capsular sign" represented by a peripheral subtle hyperdense line around a hypodense enlarged adrenal, and the presence of any periadrenal inflammatory changes. All CT findings were then compared with the surgical findings (n = 5), follow-up examinations (n = 20), or autopsy (n = 4). Sensitivity, specificity, diagnostic accuracy (DA), positive predictive value (PPV), and negative predictive value (NPV) were calculated for the "capsular sign" and were further evaluated by ROC analysis. Acute adrenal ischemia occurred in 29/69 patients (42 %), unilateral in 20, and bilateral in 9. Forty of sixty-nine patients (58 %) had no evidence of adrenal disease on CT. Thrombosis of the main adrenal vein was found in 20/29 (69 %) and non-venous ischemia in 9/29 (31 %). The capsular sign was found in 24/29 patients (83 %). Sensitivity, specificity, DA, PPV, and NPV values of 83, 100, 93, 100, and 89 %, respectively, were obtained. The capsular sign represents a CT indicator of acute adrenal ischemia, with a specificity of 100 % and leading to a prompt diagnosis in the early phase of the disease.

OBJECTIVE: This study aims to evaluate the diagnostic accuracy of a new CT sign in order to define or exclude a malignant aetiology of bowel obstruction. MATERIALS AND METHODS: CT scans of 137 patients affected by bowel obstruction were reviewed. Colonic obstruction occurred in 47 (34%) cases, small bowel obstruction in 90 (66%). Neoplastic aetiology was found in 42 cases (31%), while in the remaining 95 (69%) obstruction was caused by non-neoplastic conditions. Definitive diagnosis was surgically confirmed in all patients. CT images were evaluated searching for bowel obstruction's signs and for the presence of the "protruding lips" sign on the proximal surface of stenosis, which is represented by the evidence of a protrusion within the dilated loop. RESULTS: The sign was found in 31 (23%) cases, all of neoplastic origin. When malignant obstruction was diagnosed, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy values of the described sign were 74%, 100%, 100%, 90% and 92%, respectively. CONCLUSIONS: The "protruding lips" sign represents an alteration to be searched when bowel obstruction is diagnosed by CT examination. Its evidence correlates to a malignant condition with a 100% probability and when it is not found, the probability of a non-neoplastic condition is 90%.