Vittorio Maragliano (1878 -1944) in the history of European medicine: Grand master and pioneer of Italian radiology.

Vittorio Maragliano was born in Genoa in 1878. Fascinated since childhood by all things electric, he succeeded in installing the first radiological apparatus in 1896, only one year after the discovery of "Röntgen rays", and immediately began to make his first radioscopy observations. Having graduated from the University of Genoa in 1901 with a thesis on high-frequency currents, he continued assiduously to frequent the Department of Electrotherapy of the Medical Clinic, where he immediately became an assistant. A teacher of special medical pathology and physical therapy in 1910, Maragliano became tenured professor of electrotherapy and radiology in 1913, occupying one of the first three chairs in the history of Italian radiology, and later directed the Institute of Radiology of the Royal University of Genoa. In the same year, he co-founded, together with Aristide Busi, the Italian Society of Medical Radiology, one of Europe's first scientific societies of radiology.As a pioneer of radiology, Maragliano suffered serious injuries due to radiodermatitis from 1901 onwards, which required amputations and repeated skin transplants. His tireless scientific activity and his great success in the international scientific sphere, together with his copious publications, make Vittorio Maragliano one of the greatest pioneers of 19th-century radiology and a source of pride for the Genoese and Ligurian School of Medicine.

Qualitative and quantitative evaluation of solitary thyroid nodules with contrast-enhanced ultrasound: initial results.

To assess the feasibility of contrast-enhanced ultrasound (CEUS) of the thyroid gland and to evaluate the potential of this method for characterising solitary thyroid nodules.18 patients affected by solitary thyroid nodules (size range: 0.6 to 3.6 cm; mean: 1.8 cm) confirmed by surgery (nine papillary carcinomas, four follicular carcinomas, three hyperplasias, one follicular adenoma and one Plummer's adenoma) underwent pulse inversion US at low M.I. (0.06 to 0.08) after i.v. injection of a 2.4-mL bolus of SonoVue. Baseline echogenicity and the dynamic enhancement pattern of each nodule, in comparison with adjacent thyroid parenchyma, were assessed. Signal intensity values on grey-scale images were also calculated at baseline, 30 s, 60 s and 120 s after SonoVue administration. Following administration of SonoVue, malignant nodules showed absent (4 out of 13), faint dotted (4 out of 13) and diffuse (5 out of 13) contrast enhancement, in this last case inhomogeneous (4 out of 5 cases) or homogeneous (1 out of 5). Benign nodules showed diffuse contrast enhancement, both homogeneous (3 out of 5) and heterogeneous (2 out of 5). Quantitative data have confirmed subjective findings, but CEUS never modified precontrast analysis. CEUS of thyroid gland is a feasible technique, but overlapping findings seem to limit the potential of this technique in the characterization of thyroid nodules.

Ultrastructural biologic effects of sonography with pulse inversion and microbubble contrast in rabbit liver.

PURPOSE: This prospective study was conducted to evaluate the biologic effects of microbubble destruction with pulse-inversion harmonic imaging on rabbit liver parenchyma. METHODS: The livers of 6 albino rabbits were examined sonographically by a single investigator. Three rabbits underwent contrast-enhanced sonography, with scanning starting 5 seconds after injection by using pulse-inversion harmonic imaging with a mechanical index of 1.2. Four time-triggered images were recorded at a rate of 1 frame every 2 seconds. For comparison, 3 control rabbits had pulse-inversion harmonic imaging with a mechanical index of 1.2 only, without contrast medium. Immediately after sonography, the animals were killed and uninterrupted, thin serial sections of the liver from both groups were analyzed by energy-filtered transmission electron microscopy. RESULTS: The hepatic parenchyma of rabbits exposed to contrast agents had ultrastructural damage: mitochondria with fragmented crests; interrupted rough endoplasmic reticulum; enlarged intercellular spaces; highly vacuolized cytoplasmic areas; dilated sinusoids, sometimes with an irregular and interrupted endothelial wall; fragmented hepatocyte microvilli in dilated spaces of Disse; fragmented or missing microvilli in bile canaliculi; vacuolated and lysosome-deprived hepatic cytoplasm around the bile canaliculi; markedly injured or fragmented endothelium in larger vessels; and damaged basal membrane. Control-group results indicated that exposure to ultrasound alone did not cause ultrastructural damage to hepatic cells. CONCLUSIONS: Simultaneous exposure to contrast administration and pulse-inversion harmonic imaging with a high mechanical index causes ultrastructural damage in the rabbit liver.

Benign focal liver lesions: spectrum of findings on SonoVue-enhanced pulse-inversion ultrasonography.

The prevalence of benign focal liver lesions (BFLL) is high both in the general population and in patients with known malignancies. The gray-scale ultrasound (US) technique is usually the first-line imaging modality used in the radiological workup of such lesions, but unfortunately it lacks specificity. Furthermore, Doppler examination may often be unsatisfactory owing to motion artefacts, or when small or deeply located lesions are evaluated. Recently, microbubble-based contrast agents used in combination with gray-scale US techniques, which are very sensitive to nonlinear behavior of microbubbles, have led to a better depiction of both microvasculature and macrovasculature of focal hepatic masses, thus improving the reliability of using US in the assessment of liver tumors. This review illustrates the spectrum of enhancement patterns of BFLL on contrast-enhanced ultrasonography with SonoVue, a second-generation microbubble-based contrast agent.

[Bleeding renal angiomyolipomas. CT findings].

PURPOSE: To describe our experience in three cases of abdominal haemorrhage caused by bleeding renal angiomyolipomas, which were studied with Computed Tomography (CT). MATERIALS AND METHODS: A retrospective study carried out at our archives identified 3 patients (aged 58.6 on average) with renal angiomyolipomas clinically manifested with acute abdomen and haemorrhage. The patients underwent an emergency CT scan of the abdomen. One patient also under-went a subsequent renal angiography. All patients had surgery and histological characterizations of the renal lesions. RESULTS: The CT study on all three patients allowed detection of a lesion in the kidneys with inhomogeneous density due to haemorrhage. Areas with fat-density values (-60 -80 UH) were always observable within the lesions. The lesions, measuring 5-9 cm, were located in the right kidney in two patients and in the left kidney in one. CONCLUSIONS: In 40% of patients, renal angiomyolipoma may account for a picture of hypovolemic shock, so a correct diagnostic approach is important to guide the surgical approach. CT allows detection of the angiomyolipoma as the cause of the haemorrhage in most cases. The diagnosis is relatively simple when the lesion has typical features such as adipose content, whereas it may be difficult with non-typical aspects. Furthermore the fat content may also be detected in varying quantities in other renal lesions responsible for bleeding.

[Development of a low-cost DICOM-server for teaching and research purposes].

PURPOSE: This paper describes our experience in developing a DICOM (Digital Imaging and Communications in Medicine) server based on widely available personal computers enabling to use X-ray digital images for teaching and scientific purposes. MATERIALS AND METHODS: The system is based on a DICOM server running on a widely used personal computer. The selected DICOM images are collected directly from the radiological equipment or from a dedicated 3D image processing workstation through a LAN connection and converted into one of the standard formats (JPEG or GIF) to allow their direct importing into multimedia presentations for teaching or scientific purposes. RESULTS: This system allows fast and easy collection of radiological images in DICOM format directly from the diagnostic equipment or from the graphical workstation. These images may be used for scientific and teaching presentations without loss of image quality and colour characteristics in 3D images as there is no off-line acquisition process. CONCLUSIONS: The extensive possibilities of implement the system described on widely used PCs makes the system extremely versatile and facilitates the preparation of teaching material and scientific publications.

Breast lesion characterization with contrast-enhanced US. Work in progress.

PURPOSE: To characterise breast lesions on the basis of microcirculation features detected with contrast-enhanced US. MATERIALS AND METHODS: Thirty-six patients aged 42-63 years (mean age 55 years) with a single breast lesion previously detected at standard mammography were studied. All US examinations were performed using an ATL HDI 5000 ultrasound device with a 5-10 MHz linear-array transducer, before and after administration of ultrasound contrast medium Levovist (Schering(R), Berlin) was administered by bolus injection (2 ml/s) via a 20 G catheter probe. The mechanical index was set to high to obtain instant rupture of the microbubbles under insonation. Intensity/time curves of the transient scattering in the region of interest (ROI) after contrast administration were extrapolated. The areas under the ROI curves were also evaluated to quantitatively assess the scattering. RESULTS: The US baseline study and colour Doppler US identified 19 benign lesions (15 histologically proven) and 17 malignant lesions (16 histologically proven). The administration of contrast medium did not improve the specificity of the examination. Only by plotting the intensity/time curves of the regions of interest (ROI) and evaluating the areas under the ROI curves, was a significant correlation detected between US and histopathologic diagnosis. CONCLUSIONS: Although further evaluation on a larger series is needed, the analysis of breast lesions by contrast-enhanced perfusion US seems to be a promising technique. Perfusion US can usefully complement high-frequency US, especially when mammography is inconclusive.