Diagnostic approach to focal liver lesions at cross-sectional imaging: a primer for beginners.

Liver imaging encompasses a broad spectrum of diseases in different clinical backgrounds. The available literature is vast and reported data often lacks standardization. Because of all these issues, the differential diagnosis and the characterization of liver lesions can be challenging for the beginner. The aim of this narrative review is to provide the basics for an algorithm approach to liver lesions on cross-sectional imaging. First, some tips for the optimization of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) protocols will be provided. Liver Imaging Reporting and Data System (LI-RADS, version 2018) working group is proposing the adoption of their standardized lexicon beyond the original target population of LI-RADS (i.e., liver cirrhosis). Thus, the main imaging findings will be defined following the LI-RADS lexicon. Since the contrast study is the most important for lesion characterization, this narrative review separates the lesions into avascular, hypovascular, and hypervascular, with a focus on chronic liver disease (CLD) and hepatocellular carcinoma (HCC).

MRgFUS thalamotomy for the treatment of tremor: evaluation of learning curve and operator's experience impact on the procedural and clinical outcome.

BACKGROUND: MRgFUS Vim ablation is increasingly used for the treatment of tremor in ET e PD patients but there is little published research on the importance of operator experience in this procedure. This study aims to evaluate the learning curve and the influence of the operator experience on the procedural and clinical outcomes. METHODS: We retrospectively evaluated 90 patients (38 ET, 52 PD) submitted to MRgFUS unilateral thalamotomy in the period between February 2018 and July 2020. Clinical endpoints, procedural times, and technical parameters were recorded in all procedures. Based on the time of treatment, patients were divided into three groups of 30 units each, comparing all variables between each time period group. RESULTS: In Group A, the average patient preparation time was 120.6 min, the treatment time was 105.2 min, the number of was sonications 14.1, and the mean target shifts 3.1. In Group B, the mean preparation time was 105.5 min, the treatment time was 89.5 min, the number of sonications was 13.2, and the target shifts 3.0. Group C showed inferior values of preparation time (101.9 min), treatment time (71.7 min), numbers of sonications (10.6), and shifts (1.7). Thalamotomy-related complications occurred in 9 patients of Group A, 2 of Group B, and 5 of Group C. Tremor relapse occurred in 7 patients of Group A, 3 of Group B, and 2 of Group C. The days of hospitalization were comparable in the three groups. CONCLUSIONS: The operators experience is associated with the improvement of clinical and procedural outcome in MRgFUS thalatomy for the treatment of ET and PD tremor.

Technological advances in body CT: a primer for beginners.

Many technological advances have entered the clinical routine of Computed Tomography (CT) imaging. The new CT scanners have specific solutions in gantry design to bear the mechanical solicitations. The X-ray tubes have been improved for faster acquisitions at low radiation exposure, while the innovations in CT detectors provide a better image quality. The optimization of image quality and contrast, and the reduction of radiation dose, cannot be achieved without the implementation of adequate reconstruction software, such as Iterative Reconstructions (IR) and Artificial Intelligence (AI). In recent years, dual-energy (DECT) technology has expanded the indications of CT. In this narrative review, a panoramic overview of the technological novelties in CT imaging will be provided for optimal utilization of CT technology.

Degenerative and inflammatory musculoskeletal disorders: updates and hot topics in diagnostic and interventional imaging.

OBJECTIVE: The purpose of this review is to present the latest innovations and current topics in musculoskeletal diagnosis and interventional imaging, with a focus on degenerative and inflammatory diseases. MATERIALS AND METHODS: In this study, the search was conducted through the online databases PubMed and Google Scholar, including articles published in English in the past 15 years, in order to find existing studies, clinical cases, and reviews on the latest innovations and current topics in degenerative and inflammatory musculoskeletal pathologies. RESULTS: Imaging plays a pivotal role in the diagnosis and treatment of MSK degenerative and inflammatory disease. In the last few years continuous innovations and technological advances have allowed new clinical applications in the management of MSK disorder. Advanced magnetic resonance techniques, the introduction of fusion imaging techniques and new approaches to infiltrative medicine are revolutionizing the clinical and therapeutic approach to degenerative and inflammatory pathologies. Artificial intelligence also increasingly seeks to be applied in all fields of medicine and radiology with increasingly promising results. CONCLUSIONS: Imaging modalities undergo continuous innovations and revolutions due to technological advances, with direct repercussions on clinical applications and new therapeutic potential through interventional radiology techniques. In recent years, there have been particular innovations in the context of musculoskeletal imaging of degenerative and inflammatory diseases, both for diagnosis and intervention.

Diagnostic protocols in oncology: workup and treatment planning. Part 1: the optimitation of CT protocol.

The increase in oncology knowledge and the possibility of creating personalized medicine by selecting a more suitable therapy related to tumor subtypes, as well as the patient's management with cancer within a multidisciplinary team has improved the clinical outcomes. Early detection of cancer through screening-based imaging is probably the major contributor to a reduction in mortality for certain cancers. Nowadays, imaging can also characterize several lesions and predict their histopathological features and can predict tumor behaviour and prognosis. CT is the main diagnostic tool in oncologic imaging and is widely used for the tumors detection, staging, and follow-up. Moreover, since CT accounts for 49-66% of overall patient radiation exposure, the constant reduction, optimization, dose inter- and intraindividual consistency are major goals in radiological field. In the recent years, numerous dose reduction techniques have been established and created voltage modulation keeping a satisfactory image quality. The introduction of CT dual-layer detector technology enabled the acquisition of spectral data without additional CT x-ray tube or additional acquisitions. In addition, since MRI does not expose the body to radiation, it has become a mainstay of non-invasive diagnostic radiology modality since the 1980s.

Diagnostic protocols in oncology: workup and treatment planning. Part 2: Abbreviated MR protocol.

Magnetic resonance imaging (MRI) is a non-invasive imaging technique (non-ionizing radiation) with superior soft tissue contrasts and potential morphological and functional applications. However, long examination and interpretation times, as well as higher costs, still represent barriers to MRI use in clinical routine. Abbreviated MRI protocols have emerged as an alternative to standard MRI protocols. Abbreviated MRI protocols eliminate redundant sequences that negatively affect cost, acquisition time, patient comfort. However, the diagnostic information is generally not compromised. Abbreviated MRI protocols have already been utilized for hepatocellular carcinoma, for prostate cancer detection, and for nonalcoholic fatty liver disease screening.

Prognostic value of brain tissues' volumes in patients with essential tremor treated with MRgFUS thalamotomy.

MRgFUS Vim thalamotomy is a novel, effective, minimally invasive therapeutic option for patients with essential tremor (ET). Among the selection criteria, some parameters related to the patient's anatomy, such as the skull density ratio (SDR), are well recognized. The role of brain tissue interposed between the target and the ultrasound transducers has never been explored. Therefore, the purpose of our study was to evaluate the correlation and the possible predictive value between brain tissue volumes (grey matter - GM, white matter - WM, and cerebrospinal fluid - CSF) and several treatment-related variables (periprocedural parameters, MRI imaging findings, and the clinical outcome). We analysed data from thirty ET patients previously submitted to MRgFUS thalamotomy. Pre-treatment images were automatically segmented in sopra-tentorial (ST) WM, GM, and CSF using SPM 12. The most significant findings were a positive correlation of the ST-GM with the Accumulated Thermal Dose (ATD) (p < 0,001) and a negative correlation of the ATD temperature with ST-CSF and ST-TIV (p < 0,001). Ultrasound propagation speed is lower in fluids than brain tissues. Also, WM has an attenuation rate of 1.5 higher than the GM. Therefore, the difference in the ATD may be explained by the different acoustic properties of normal brain tissues interposed between the transducers and the VIM.

Comparative evaluation of meniscal pathology: MRI vs arthroscopy.

The meniscal pathology of the knee is one of the clinical realities the orthopedic surgeon must daily confront with. The diagnosis is generally both clinical and instrumental; among the different diagnostic imaging techniques, Magnetic Resonance Imaging (MRI) appears to be the most accurate method regarding sensitivity and specificity for the study of meniscal fibrocartilages and articular cartilage. In an attempt to clarify the roles of MRI and diagnostic knee arthroscopy, we performed a retrospective comparative study of the two methods to assess their sensitivity and specificity in the diagnosis of meniscal pathology. We evaluated 105 consecutive patients with a clinical diagnosis of intra-articular knee pathology who were subjected to MRI examination and subsequently to surgical arthroscopy, recording on a graphic card the surgical and radiographic findings expressed by a blinded expert radiologist. Comparison of MRI and arthroscopy data showed, for the internal meniscus, values of 98.5% sensitivity, 94.7% specificity and 93.8% "K" index for MRI compared to arthroscopy, and of 90%, 98.6% and 90.5% for the external meniscus. These results allow us to state that the diagnostic capacity of MRI appears to be very high and therefore crucial in the planning of the correct surgical treatment of individual patients, thanks to its ability to highlight even small changes affecting intra-articular structures.

Factors associated with circulating concentrations of irisin in the general population cohort of the ABCD study.

OBJECTIVE: Animal studies have shown that irisin is a myokine secreted following physical exercise, and that it induces the remodeling of white adipose tissue toward brown adipose tissue. Therefore, a protective role of irisin against obesity, diabetes, and other metabolic and cardiovascular conditions has been hypothesized. However, data in humans are contradictory and few data are available concerning the general population. DESIGN: We aimed to evaluate the association between serum irisin concentrations and habitual physical activity, as well as other metabolic and cardiovascular factors in a general population in a Mediterranean area. METHODS: We considered 858 consecutive individuals included in the ABCD (Alimentazione, Benessere Cardiovascolare e Diabete) study (ISRCTN15840340), a longitudinal observational single-center study of a cohort representative of the general population of Palermo, Sicily. Irisin serum concentrations (Phoenix Europe, Germany), habitual physical activity (HPA) level, and other blood and clinical variables were measured. RESULTS: The irisin serum concentrations were not normally distributed in the cohort (Shapiro-Wilk test=0.94; P<0.001). A significant association between irisin concentrations and HPA was observed (P<0.001). Irisin concentrations were higher in women than in men (P<0.01), and significantly correlated with serum concentrations of HDL-cholesterol (P<0.05) and hs-C-reactive protein (hs-CRP; P<0.05). Binary logistic regression analysis demonstrated that high (⩾ median value) irisin serum concentrations were significantly associated with female gender (OR=1.63; 95% CI=1.16-2.28), high serum hs-CRP concentrations (OR=1.61; 95% CI=1.02-2.54) and the HPA level (OR=1.42; 95% CI=1.02-1.96). CONCLUSIONS: Our study confirms, in a cohort of a general population, that irisin concentrations gradually increase with the usual level of habitual physical activity.

Yttrium-90 radioembolization treatment for unresectable hepatocellular carcinoma: a single-centre prognostic factors analysis.

The aim of this study was to evaluate the efficacy and the safety of Y90 radioembolization (Y90-RE) in patients with unresectable hepatocellular carcinoma (HCC) analysing our results and correlating them with independent prognostic factors for overall survival (OS) and for complications. Forty-three patients with advanced inoperable HCC including those with multiple bilobar lesions or portal vein thrombosis (PVT) treated with Y90-RE were reviewed. Treatment efficacy and safety were evaluated. Survival was calculated by the Kaplan-Meier method. Univariate analyses were performed for identifying potential prognostic factors. Radiologic response was evaluated with the modified Response Evaluation Criteria in Solid Tumours (mRECIST) criteria. Clinical toxicities were prospectively recorded. Median overall progression-free survival and OS were 27.7 and 16.8 months, respectively. Longer median OS was revealed in those without PVT (p = 0.0241) and those whose pre-treatment haemoglobin values was higher (p = 0.0471). According with mRECIST criteria, we observed a disease control rate of 69.2 and 61.9% at 3- and 6-month follow-up, respectively. Complications developed in 28 patients (65.1%), among which grade 2-3 events were reported in 17 patients. We noted that activity administered dose presented a correlation with intra-procedural toxicity (p = 0.039259) while common hepatic artery use as release site was associated with a most frequent presentation of remote adverse events. Y90-RE is an alternative treatment with a promising outcome for poor-risk advanced inoperable HCC. PVT and pre-treatment haemoglobin values can be predictors of efficacy. Activity administered dose and arterial release site can be predictors of safety.

What can be seen after rotator cuff repair: a brief review of diagnostic imaging findings.

Diagnostic imaging plays an important role in the postoperative evaluation of the rotator cuff, as pain and disability may occur or persist after treatment. Postoperative imaging is therefore of paramount importance for clinicians before planning additional treatments. Multimodality imaging of the postoperative shoulder includes radiography, magnetic resonance (MR) imaging, MR arthrography, computed tomography (CT), CT arthrography, and ultrasound. Correct interpretation of imaging findings of the postoperative shoulder necessitates that the radiologist be familiar with the various treatment strategies, their possible complications and sources of failure, knowledge of normal and abnormal postoperative findings, and awareness of the advantages and weaknesses of the different imaging techniques. Imaging findings, however, should always be correlated with the clinical presentation because postoperative imaging abnormalities do not necessarily correlate with symptoms. This manuscript is a review of some of the most common treatment strategies for rotator cuff pathology, with a focus on expected postoperative imaging findings and postoperative complications.

Imaging of post-operative spine in intervertebral disc pathology.

This work is an imaging review of spine after surgery with special regard to imaging modality in intervertebral disc pathology. Advances in imaging technology can be evaluated. Depending on the clinical question is asked to the radiologist, it is possible to evaluate post-operative patients with conventional radiology (X-ray), computed tomography and magnetic resonance. Main indications for each technique are analysed. Imaging is important in the diagnosis of many forms of spine pathology and plays a fundamental role in evaluating post-surgical effects of treatments, according to the imaging method which is used, both on spine and on its surrounding tissues (intervertebral discs, spinal cord, muscles and vessels).

Imaging of postoperative shoulder instability.

Postoperative imaging in shoulder instability is still a challenge for radiologists due to various postsurgical anatomical findings that could be considered pathologic in treated shoulder. For this reason is very important a deep knowledge about surgical procedures, anatomical changes after surgery and the appropriate diagnostic imaging modalities to work up the symptomatic postoperative shoulder. Postoperative imaging options include use conventional radiography, magnetic resonance imaging (MRI), MRI arthrography, computed tomography (CT) and CT arthrography. The purpose of our review is to explain the different surgical procedures and to describe postoperative changes detected with radiological imaging.

Postoperative imaging in arthroscopic hip surgery.

Arthroscopic surgery of the hip, compared to that of the knee or the shoulder, has only recently been developed in any significant way. Current indications for arthroscopic surgery of the hip include: diagnosis and treatment of lesions symptomatic of the acetabular labrum, femoroacetabular impingement (FAI), chondral lesions, joint infections, lesions of the teres ligament, impingement of the psoas tendon, pathology of the peritrochanteric space, external snapping hip (coxa saltans), and traumatic and atraumatic instability. Principal indications for imaging of the hip with arthroscopic techniques are represented by persistent groin pain which may be caused by inadequate recognition or treatment of bone alteration of FAI, fractures in the site of resectioned bones, intra-articular adhesion, development of cartilaginous lesions, iatrogenic chondral lesions, recurrent lesions of the fibrocartilaginous acetabular labrum and heterotopic ossification. Postoperative checkup examinations can be undertaken with conventional radiography. The appearance or persistence of groin pain may be investigated using MRI, arthro-MRI and even CT scans.

Follow-up of surgical and minimally invasive treatment of Achilles tendon pathology: a brief diagnostic imaging review.

The follow-up of an operated tendon is primarily clinical, although clinical examination may not be sufficient in the presence of certain complications. The imaging techniques are of great value not only in the diagnosis of tendon pathologies, but also as an adjunct to clinical evaluation. This is particularly true in the follow-up of patients submitted to surgical tendon reconstruction, by monitoring morphological effects of different interventions and evaluating tendon healing processes. Interpretation of imaging findings requires knowledge of the imaging appearance of the operated tendon during the healing phase, to distinguish between normal postsurgical changes and real pathology, as well as knowledge of surgical technique, postoperative course (including type of prescribed therapy) and possible postoperative complications. The most important imaging modalities to examine the Achilles tendon are ultrasound and magnetic resonance imaging. This article gives a review of some of the most common treatment strategies for Achilles tendon pathology, expected postoperative imaging findings and postoperative complications.

Clinical experience with Angiojet: a comprehensive review.

The development of various sophisticated mechanical thrombectomy devices and the amassed experience of physicians in minimal invasive therapy produced a paradigm shift in vascular access management toward percutaneous declotting procedures, using pharmaceutical thrombolysis, mechanical thrombectomy, balloon thrombectomy, and a combination of the above techniques. In this setting, in the last years, AngioJet™ (Possis, Minneapolis, MN, USA) rheolytic thrombectomy (RT) showed an increasing use in emergency and election patients. The purpose of this review is to present the current status of percutaneous rheolytic thrombectomy in different fields of applications.

Association of dietary patterns with insulin resistance and clinically silent carotid atherosclerosis in apparently healthy people.

BACKGROUND/OBJECTIVES: Dietary habits are important determinants of individual cardiovascular and metabolic risk. This study investigated the association between dietary patterns and asymptomatic carotid atherosclerosis, defined as the presence of plaques and/or increased intima-media thickness, and metabolic biomarkers of insulin resistance, including the homeostasis model assessment of insulin resistance (HOMA-IR) and the trygliceride/high-density lipoprotein (HDL)-cholesterol (Tg/HDL) ratio in a cohort of adults without known diabetes or atherosclerotic cardiovascular disease. SUBJECTS/METHODS: Nine hundred and twenty-nine randomly selected participants were cross-sectionally investigated. Each participant answered a food frequency questionnaire, and underwent high-resolution ultrasonographic evaluation of both carotid arteries. Laboratory blood measurements were obtained in a subsample of 507 participants. RESULTS: A dietary pattern that could be defined as unhealthy (high consumption of soft drinks, fried foods, seed oils, cured meats, butter, red meat and sweets) was identified in 21% of the cohort, whereas 34% of the cohort exhibited a dietary pattern that resembled the Mediterranean diet (high intakes of fruit, milk and cheese, olive oil, vegetables, pasta and bread). Intermediate habits characterized the remaining 45%. After adjusting for age, body mass index (BMI), waist circumference, glycated hemoglobin (HbA1c) and hypertension on treatment, the Mediterranean dietary pattern was associated with significantly lower HOMA-IR (ß-coefficient=-0.51; P=0.003). After adjusting for gender, BMI and HbA1c, the unhealthy dietary pattern was associated with a significantly higher Tg/HDL-cholesterol ratio (ß-coefficient=0.43; P=0.006). No significant association was found between dietary patterns and carotid atherosclerosis. CONCLUSIONS: This study suggests that, independent of measures of adiposity, a Mediterranean dietary pattern is associated with lower insulin resistance.

Lesions of the biceps pulley as cause of anterosuperior impingement of the shoulder in the athlete: potentials and limits of MR arthrography compared with arthroscopy.

PURPOSE: This study aimed to evaluate the diagnostic possibilities of MR arthrography in the correct identification of complex tears of the biceps pulley and their possible correlation with anterosuperior impingement (ASI) development. MATERIALS AND METHODS: MR arthrography examinations of 23 athletes with clinical suspicion of ASI were reviewed. All examinations were obtained with a 1.5-T unit (Signa Horizon, GE Healthcare). The shoulders were studied with a dedicated surface coil with the patient's arm in the neutral position and in internal and external rotation. In five patients, images in abduction-external rotation (ABER) were obtained. Within 2 month after MR arthrography, the athletes underwent arthroscopic surgery. RESULTS: MR arthrography images showed a spectrum of tears that, according to the Habermeyer classification, were subdivided into four groups: type 1 in three patients; type 2 in five; type 3 in seven; type 4 in eight. At arthroscopic evaluation, one patient presented type 1 lesion, five type 2, five type 3 and ten type 4. During arthroscopic dynamic manoeuvres, ASI signs were observed in three patients with type 3 lesion and in ten with type 4 lesion. CONCLUSIONS: MR arthrography is the imaging modality of choice for evaluating lesions of the rotator interval structures, and only complex lesions of the biceps pulley are related to the development of ASI.