Osteoporosis detection by 3T diffusion tensor imaging and MRI spectroscopy in women older than 60 years.

Aim of this study was to evaluate the cancellous bone quality of postmenopausal women (age >60 years) by diffusion tensor imaging (DTI) using mean diffusivity (MD) and fractional anisotropy (FA) in combination with proton magnetic resonance spectroscopy (1H-MRS). 20 postmenopausal women older than 60 years were introduced to dual-energy X-ray absorptiometry (DXA) examination in femoral neck and to an MRI spectroscopy and DTI evaluation at 3T. We observed that fat fraction (FF) can discriminate healthy and osteoporotic patients. Water mean diffusivity (MD) and FA can discriminate the healthy group from osteopenic and osteoporotic group. MD/FF vs FA/FF graph extracted from the femoral neck identifies all healthy individuals, according to DXA results. DTI and spectroscopy protocol performed in the femoral neck could be highly sensitive and specific in identifying healthy subjects.

Three-dimensional densitometric analysis of maxillary sutural changes induced by rapid maxillary expansion.

OBJECTIVE: This prospective study evaluated the density of the midpalatal and transverse sutures as assessed by low-dose CT before rapid maxillary expansion (T0), at the end of active expansion (T1) and after a retention period of 6 months (T2). METHODS: The study sample comprised 17 pre-pubertal subjects (mean age 11.2 years) with constricted maxillary arches. Total amount of expansion was 7 mm in all subjects. Multislice low-dose CT scans were taken at T0, T1 and T2. On the axial CT scanned images six regions of interest (ROIs) were placed along the midpalatal and transverse sutures and two in maxillary and palatal bony areas. Density was measured in Hounsfield units. Mann-Whitney U test and Friedman analysis of variance with post hoc tests were used (p < 0.05). RESULTS: The three ROIs in the midpalatal suture showed a significant decrease in density from T0 to T1, a significant increase from T1 to T2 and a lack of statistically significant differences from T0 to T2. Both ROIs located in the transverse suture showed a significant decrease in density from T0 to T1, followed by a non-significant increase in density from T1 to T2. CONCLUSIONS: At the end of the active phase of expansion a significant reduction in density along the midpalatal and transverse sutures was observed in all subjects. The sutural density of the midpalatal suture at T2 indicated reorganization of the midpalatal suture while the density along the transverse suture increased without reaching the pre-treatment values, possibly due to different morphology between midpalatal and transverse sutures.

Diagnosis and treatment of paranasal sinus fungus ball of odontogenic origin: case report.

In recent years the incidence of fungal sinusitis has increased considerably, due both to increased survival of patients at risk and to improved diagnostic equipment. The pathogen responsible in most cases is the Aspergillus in its forms Fumigatus, Flavus and Niger. The diagnosis is often delayed because the symptoms, characterized by headache, cough, and facial algia, are generally similar to that of chronic bacterial rhinosinusitis. It can be divided into invasive and non-invasive forms based on the clinical evolution and extent of the lesion. We report a case of non-invasive fungal rhinosinusitis in a patient with recurrent sinusitis and pain in the left maxillary region, resistant to antibiotic therapy.

Rapid maxillary expansion: effects on palatal area investigated by computed tomography in growing subjects.

AIM: The aim of this prospective study was to evaluate the effects of rapid maxillary expansion (RME) on the palatal area as assessed by low-dose CT before treatment (T0), at the end of active expansion (T1) and after a retention period of 6 months (T2). MATERIALS AND METHODS: The study sample comprised 17 prepubertal subjects (mean age 11.2 years) with constricted maxillary arches. Total amount of expansion was 7 mm in all subjects. Multi-slice low-dose CT scans were taken at T0, T1, and T2. On axial CT scanned images a circle line corresponding to the palatal area was drawn and the area inside the circle registered at all three observation times. The area was measured in mm². Statistical comparisons were carried out with Friedman test with post-hoc tests (P<0.05). RESULTS: The palatal area showed a significant increase from T0 to T1 and from T0 to T2 as a consequence of the opening of the midpalatal suture after RME. CONCLUSION: Opening the midpalatal suture by using orthopedic forces allowed to extend the area of the maxilla. After a 6-months retention period the palatal area demonstrated a stable increase due to a bone deposition along the midpalatal suture in both the anterior and posterior parts of the maxilla.

Cone Beam CT use in the pre-prosthetic evaluation of endodontically treated of the rear maxilla.

With our study we wanted to compare the diagnostic accuracy of conventional radiography (orthopanoramic and intraoral radiography) and Cone Beam CT (CBCT) for the diagnosis of periapical lesions on the posterior elements of the upper maxilla endodontically treated.The images were analyzed by a radiologist and an endodontist whose interpretation of radiological examinations is unique. Were examined 34 molars (23 first molars and 13 second molars) with a total of 102 roots. The CBCT detected a significantly higher number of lesions (43%, p <0.001) compared to conventional radiography. Our results demonstrate that the CBCT can be inserted into the diagnostic routine for the evaluation of all pre-prosthetic posterior elements of the upper jaw endodontically treated in addition to the diagnostic techniques 2D, especially when in the treatment plan is provided the realization of an abutment. The CBCT, which has reduction of cost and absorption of radiation with respect to the conventional CT, is also very useful even when there is a need to perform a surgical treatment-endodontic (apicectomy) of a lesion diagnosed with 2D techniques.

Dynamic MR defecography with an open-configuration, low-field, tilting MR system in patients with pelvic floor disorders.

PURPOSE: This study was undertaken to explore the capabilities of an open-configuration, low-field, tilting, magnetic resonance (MR) system for investigating pelvic floor disorders and to compare the results obtained with the patient in the semiorthostatic and supine positions. MATERIALS AND METHODS: Eighteen female patients with a diagnosis of pelvic floor disorder (physical examination and conventional defecography) underwent dynamic MR defecography (MRD) with a 0.25-T tilting MR system (G-scan, Esaote). Images were obtained after administration of contrast agent into the rectum, bladder and vagina in both the orthostatic and supine positions. Three-dimensional T2-weighted hybrid contrast-enhanced (HYCE) sequences and dynamic T1-weighted gradient echo (GE) sequences were acquired at rest, during maximal contraction of the anal sphincter, straining and defecation. RESULTS: Good image quality was obtained in 15/18 patients; three presented severe artefacts due to motion, and three had incontinence, which hampered the functional studies. Better anatomical detail was obtained with MRD compared with conventional defecography. Three prolapses were observed in the semiorthostatic position only, and seven were found to be more severe in the orthostatic than in the supine position. CONCLUSIONS: Dynamic MRD with an open-configuration, low-field, tilting MR system is a feasible and promising tool for studying the pelvic floor. Larger series are necessary to assess its real diagnostic value.

Comparison of different dose reduction system in computed tomography for orthodontic applications.

TO CORRELATE DIFFERENT CT SYSTEM: MSCT (multislice computed tomography) with different acquisition parameters (100KV, 80KV), different reconstruction algorithm (ASIR) and CBCT (cone beam computed tomography) examination in terms of absorbed X-ray dose and diagnostic accuracy.80 KV protocols compared with 100 KV protocols resulted in reduced total radiation dose without relevant loss of diagnostic image information and quality. CBCT protocols compared with 80 KV MSCT protocols resulted in reduced total radiation dose but loss of diagnostic image information and quality although no so relevant.In addition the new system applies to equipment ASIR applicable on MSCT allows 50% of the dose without compromising image quality.

Is 3T-MR spectroscopy a predictable selection tool in prophylactic vertebroplasty?

This study was designed to confirm relationships between decrease of bone mineral density and increase of marrow fat and to delineate, through MR spectroscopy, vertebral body at high risk for compression fracture onset to justify prophylactic vertebroplasty. We enrolled 127 women: 48 osteoporotic, 36 osteopenic, and 43 normal subjects, who underwent DXA and MR examination of spine. Then, we selected 48 patients with at least two acute osteoporotic vertebral fractures with interposed normal "sandwich" vertebrae; all patients underwent MR examination of spine. Significant statistical differences were found among "Fat Fraction" (FF) values in normal, osteopenic, and osteoporotic subjects: 59.8 ± 5.1%; 64.8 ± 4.4%; and 67.1 ± 3.3%. A mild, significant, negative correlation was observed between T-score and vertebral fat content (r = - 0.585; P = 0.0000). In the second part of the study, 9 new vertebral fractures were observed in 48 patients (19%): 6 were "sandwich" vertebrae (12.5%), and 3 were located in distant vertebral body. The mean FF in sandwich fractured vertebrae was 72.75 ± 1.95 compared with the FF of the nonfractured sandwich, and distant control vertebrae were 61.83 ± 3.42 and 61.42 ± 3.64. We found a significant statistical difference between fractured and nonfractured vertebrae (P < 0.001). The results of this study suggest that MR spectroscopy could be a reliable index to predict the risk of new compression vertebral fracture and could be used for vertebroplasty planning contributing to clarify the possibility to add prophylactic PVP to standard treatment.

Jaw expansive lesions: population incidence and CT dentalscan role.

AIM: The aim of the study is to evaluate the incidence of different expansive lesions and the advantages of the clinical employment of Dentalscan to study bones lesions and to establish a common diagnostic path. MATERIALS AND METHODS: Since January 2005 to November 2009, 3200 patients, not selected for sex or age, have undergone a CT "Dentalscan" in the department of Diagnostic Imaging, Tor Vergata University Hospital (PTV), a suspect bone pathology was found in 704 of them through the XR-orthopantomograpy (OPT). CT images were obtained with General Electric CT Light Speed multislice. Images were saved in the Advantage Workstation (GE) supported by the "Dentascan" dedicated software and by the 3D software (3D SSD). The protocol was : Slice thickness 1,25 mm, gap 0, matrix 512 × 512, 140 KV and 70 mA. All the lesions were also studied with the dedicated three-dimensional reconstructor 3D SSD. Biopsy for diagnosis was performed on all the lesions, except one (false positive with digital OPT). THE TECHNIQUE SENSITIVITY WAS ASSESSED FOR TWO IMPORTANT CLASSES: benign and malignant lesions. RESULTS: Through CT Dentascan a detailed evaluation of the jaws lesions and their extension was obtained. 656 patients (93.1 %) out of 704 examined for a suspicious lesion on the orthopantomography had a benign lesion: (127 follicular cysts (18.2 %), 181 radicular cysts (25.1%), 93 non odontogenic cysts (13.2%), 29 fibroma (4.2%), 198 odontomes (28.2%), 24 ameloblastoma (3.6%), 4 brown tumors (0.7%), 47 (6.9%) had malignant lesions: (12 carcinoma (1.7%), 29 metastasis (4.3%), 6 sarcoma (0.8%), 1 Dentascan CT resulted to be negative (1 false positive of digital OPT). The sensitivity of the technique for both groups was 99% for benign lesions and 98% for malign lesions. CONCLUSIONS: CT Dentascan characteristics suggest to consider these techniques as the gold standard for the evaluation of jaw expansive lesions and the support of surgical planning.

Role of interventional radiology in pudendal neuralgia: a description of techniques and review of the literature.

PURPOSE: The authors sought to evaluate indications, technical feasibility and clinical efficacy of computed tomography (CT)-guided pudendal nerve infiltration in patients with chronic anoperineal pain by reviewing the role of the CT technique in their personal experience and in the recent interventional literature. MATERIALS AND METHODS: Twenty-eight women, mean age 50 years, and with a diagnosis of pudendal neuralgia on the basis of clinical and electromyographic criteria were enrolled in the study. CT-guided pudendal nerve injections were performed during three consecutive sessions held 2 weeks apart. In each session, patients received two percutaneous injections: one in the ischial spine, and the other in the pudendal (Alcock's) canal. RESULTS: One patient dropped out of the study after the first session. At clinical assessment, 24h h after treatment, 21/27 patients reported significant pain relief. At follow-up at 3, 6, 9 and 12 months, 24/27 patients reported a>or=20% improvement in the Quality of Life (QOL) index. CONCLUSIONS: In pudendal nerve entrapment, CT-guided perineural injection in the anatomical sites of nerve impingement is a safe and reproducible treatment with a clinical efficacy of 92% at 12 months.

Low-dose CT protocol for orthodontic diagnosis.

AIM: This was to correlate the dosimetric evaluation with high diagnostic accuracy by suggesting a protocol that significantly reduces the dose administered by a Dentascan exam without affecting diagnostic accuracy. MATERIALS AND METHODS: 17 patients were selected consecutively (7 males and 10 females) of a mean age of 11.2 (8-14 years) who sought orthodontic treatment. They needed CT control before and after treatment with RME to evaluate impacted canines. The study was performed using a multidetector 16-rows CT with two protocols that provided 2 different KV acquisition parameters: 80 KV or 120 KV. Radiation dose was evaluated in two ways: CTDI and DLP. Image quality was rated and the results were compared to identify significant differences in terms of image quality, radiation exposure and presence of artefacts. RESULTS: The 80 KV scanning has a significantly lower effective radiation dose compared to the 120 KV scanning (p <0.05). The images of all patients were used for comparing the protocols in terms of image quality. The mean scores for the 80 KV scanning images were 4.18 +/-0.81 and 4.41 +/-0.80 for dose obtained by 120 KV scanning. The median image quality was 4 (good) for both protocols. The 80 KV protocol allowed, as well as the 120 KV, a careful analysis by the orthodontist and the dental surgeon that together, based on this images, can choose the best line of treatment between several available options. CONCLUSION: 80 KV protocols compared with 120 KV protocols resulted in reduced total radiation dose without relevant loss of diagnostic image information and quality. The images were good enough to obtain information about the exact position of impacted teeth and to plan the best line of surgical treatment and mechanotherapy strategy.

[Clinical correlations between lumbar superficial veins and Batson's epidural plexus congestion in chronic low back pain: analysis of two case reports]. / Correlazioni cliniche tra reticolo venoso superficiale lombare e congestione venosa profonda del plesso epidurale di Batson nel paziente con lombalgia cronica: analisi di 2 case reports.

Batson's epidural venous plexus plays a crucial role for the generation of vascular back pain, in particular in those conditions characterized by venous congestion, such as heart failure or pregnancy. Except some rudimentary cuspids, the vertebral venous system is considered to be a valveless anastomotic system; as a result the blood is supposed to flow in either direction depending on changes of cardiovascular conditions during the day. Within the narrow boundaries of the neural canal, the epidural veins can therefore get congested, inducing low back pain. The aim of this case report was to highlight a correlation between lumbar superficial veins in patients with chronic low back pain and epidural deep venous plexus congestion. The patients selected underwent a morphologic examination of venous epidural plexus (included its connections with lumbar superficial blood vessels) through a 3D dynamic contrast-enhanced Magnetic Resonance Angiography. The Authors found two different radiological behaviours: total and partial congestion of the vertebral deep venous system. Clinical consequences were discussed and therapeutic strategies were suggested.

Bennett movement of mandible: a comparison between traditional methods and a 64-slices CT scanner.

OBJECTIVE: compare the values of the Bennett angle measured by an average value articulator with the ones measured by a 64 slices Computed Tomography (CT). METHODS: we have studied a patient aged 72. Maxillary and mandibular impressions were obtained from the patient and placed on the average value articulator using wax-ups and a facial arch in order to perform the Bennett angle measurations by such device. CT measurements were carried out using templates in order to block the Patient in the correct mandibular position. RESULTS: our study has demonstrated that the measurements of the Bennett angle obtained with the average value articulator are consistent with the ones obtained with the 64 slices CT. CONCLUSIONS: CT scanning is a useful method, alternative to conventional procedures, as the average value articulator for Bennett angle measurements, and it could become an important diagnostic tool in the gnathological and rehabilitative area.

Role of diagnostic imaging to malignant sinus tumors in presurgical staging.

The aim of this study is to describe the current role of imaging in pre-surgical planning, reporting 25 cases of paranasal sinus tumors examined in our Institute. Between June 2006 and May 2008, we identified 25 patients with malignant tumors of the paranasal sinuses. All of the patients were evaluated with CT and/or MR exams. US were used to assess regional lymph node involvement. When necessary CT-PET scanning using FDG, was done. Diagnostic imaging is essential during the initial work-up of a patient suspected of having a paranasal sinus tumor. The role of imaging is to define the tumor extension, nodal involvement, metastases and recurrences in the postoperative patient. CT and MR imaging are the primary modalities employed; each have advantages and disadvantages but tend to be complementary. The involvement of fine bone structures is best evaluated with CT. In assessing the extent of the tumor, MR provides excellent soft tissue detail, allowing for delineation of neoplasm from surrounding inflammatory tissue and secretions. For evaluation of lymph node enlargement color-Doppler US, CT and MR provide morphologic data, while CT-PET provides metabolic data. CT-PET can be used to stage nodal and metastatic disease and for assessing the efficacy of therapy or recurrent disease.

Post-retention effects of rapid maxillary expansion on nasal cavity and on periodontal structures.

AIM: The aim of this study was to apply low-dose CT scans to evaluate the treatment and post-retention effects of RME on nasal cavity and periodontal effects. MATERIALS AND METHODS: CT scans of 17 subjects (7 males 10 females, mean age 11.2 years) were taken before RME (T0), at the end of the expansion phase (T1), and after a retention period of 6 months (T2). Measurements were performed on axial scans and on 3 different coronal scans. Statistical analysis was performed with ANOVA for repeated measures with post-hoc tests. RESULTS: Transverse dimensions of nasal cavity showed statistically significant T0-T1 increments at all the 3 coronal scans. All T0-T1 increments at the nasal levels showed a decrease in magnitude from the anterior to the posterior measurements. In the evaluation of T0-T1 changes, periodontal measurements were significant on the buccal aspect of banded teeth with a reduction in alveolar bone thickness. In the evaluation of T0-T2 changes, the lingual bone plate thickness resulted significantly increased. CONCLUSIONS: RME therapy induces a significant increase in the transverse dimension of the nasal cavity without permanent injuries to the periodontal bony support discernible at CT imaging. After six months the expansion of the nasal cavity results stable.

Multiparameter characterisation of vertebral osteoporosis with 3-T MR.

PURPOSE: This study was undertaken to evaluate the diagnostic capabilities of 3-Tesla (T) magnetic resonance (MR) in vertebral osteoporosis. MATERIALS AND METHODS: Thirty subjects (ten healthy controls, ten with osteoporosis but no fracture, ten with osteoporotic vertebral fractures) underwent MR of the lumbar spine. Turbo spin echo (TSE) T1-, T2- and T2- spectral selection attenuated inversion recovery (SPAIR) weighted imaging and spectroscopy for the selective evaluation of water and fat content were performed. The apparent diffusion coefficient (ADC) was calculated, and diffusion tensor imaging (DTI) was performed to create a map of the spatial arrangement of the tissue structures. RESULTS: Morphological imaging detected recent vertebral fractures. In osteoporotic patients, spectroscopic imaging demonstrated an increase in the saturated fats and a decrease in the ADC, whereas the data provided by DTI demonstrated a bone structure with medium-degree anisotropy. DISCUSSION: Osteoporosis is characterised by trabecular thinning, with an increase in the intertrabecular spaces, which are filled with fats. The anisotropic study and the subsequent assessment of colour and vector maps can provide a noninvasive tool for assessing the risk of fracture due to osteoporosis.

Multidetector CT and dentascan software: dosimetric evaluation and technique improvement.

PURPOSE: The development of new operative techniques in oral and maxillofacial surgery within the last few years has led to an increasing demand for Dentascan examination, also in paediatric patients. It is necessary to modify acquisition parameters to reduce the absorbed dose. The aim of this study was to define a Dentascan protocol in which a reduced X-ray dose could be used. MATERIALS AND METHODS: Dosimeters were applied to the eyes, mouth, parotid glands, thyroid and back of the neck of an anthropomorphic Plexiglas phantom that underwent multidetector computed tomography (MDCT) Dentascan examinations. Both 120kV and 80 kV were used to study the mandibular and maxillary arches. RESULTS: Examinations obtained with the 80 kV protocol showed a ten-fold reduction in the absorbed dose, without affecting image quality. CONCLUSIONS: We suggest a Dentascan protocol that reduces the X-ray dose administered to the patient while ensuring the same high diagnostic accuracy.

CT-guided injection of botulinic toxin for percutaneous therapy of piriformis muscle syndrome with preliminary MRI results about denervative process.

Piriformis muscle syndrome (PMS) is a cause of sciatica, leg or buttock pain and disability. The pain is usually increased by muscular contraction, palpation or prolonged sitting. The aim of our paper was to evaluate the feasibility of CT-guided percutaneous botulinic toxin (BTX) injection for the purpose of PMS treatment. Thirty patients suffering from PMS, suspected with clinical and electrophysiological criteria, after imaging examinations excluding other causes of sciatic pain, resulted positive at the lidocaine test and were treated by intramuscular injection of BTX type A under CT guidance. The follow-up (12 months) was performed with clinical examination in all cases and with MR 3 months after the procedure in 9 patients to evaluate the denervative process entity of the treated muscle. In 26 cases relief of symptoms was obtained after 5-7 days. In 4 patients an insufficient relief of pain justified a second percutaneous treatment which was clinically successful. No complications or side effects were recorded after BTX injection. The MR examination showed a signal intensity change of the treated muscle in 7 patients due to the denervative process of PM, whereas in the remaining 2 cases only an atrophy of the treated muscle was detected. Larger series are necessary to confirm these MRI preliminary results. The CT-guided BTX injection in the PMS is an emergent and feasible technique that obtains an excellent local therapeutic effect without risk of imprecise inoculation.