7T mMR in the assessment of acute arterial mesenteric ischemia in a rat model.

To validate a rat model of acute arterial mesenteric ischemia correlating MRI patterns with macro and microscopic changes in the small bowel. Thirty Sprague-Dawley rats were assigned to two experimental groups (Group I and Group II) of fifteen rats each. Group I underwent surgical procedure of superior mesenteric artery (SMA) ligation, followed by macroscopic observation. In Group II, a loop was tied loosely around the SMA without occluding the vessel. Three days after surgery, the loop was tied by external tips to completely occlude the artery. 7T microMR (7Tesla microMR) was performed before and 8 hours after SMA occlusion. At predetermined time-points the histopathological examinations were performed in both of groups. Macroscopic monitoring revealed thinning of mesenteric vessels, hypotonic reflex ileus and chromatic change of some loops. 7T microMR sequences evidenced loop dilation with gas-fluid mixed stasis, intraperitoneal free fluid and bowel wall hyperintensity. There were no significant differences in the histological analysis between the two groups. The gap of three days from surgery, adopted in the Group 2, allowed to avoid signs of peritoneal and mesenteric irritation which could bias imaging patterns. MR succeeded to identify the signs of arterial mesenteric ischemia.

Entero-colpo-defecography vs supine entero-MRI: which one is the best tool in the differentiation of enterocele, elytrocele and edrocele?

Pelvic floor disorders represent a significant cause of morbidity associated with a severe reduction of quality of life. It represents a very common clinical problem that afflicts women three to seven time more often than men. The purpose of this study was to assess the diagnostic tools available to define the imaging strategy in patients with pelvic floor dynamic dysfunctions and to investigate their abilities in the diagnosis of enterocele, elytrocele and edrocele. From January 2008 to May 2011, 614 patients with symptoms related to pelvic floor dynamic dysfunctions were enrolled in our retrospective study. After anamnesis and clinical examination, entero-colpo-defecography (ECD) and supine entero-magnetic resonance (SE-MR) exams were performed in all patients. This study showed that the diagnostic efficacy of ECD is higher than that of SE-MR in the detection of enterocele and edrocele. Furthermore, elytrocele can be visualized only with ECD considering the position of patient during SE-MR examination. In addition, in patients planned for surgery, SE-MR is more useful to clarify the intra-pelvic interaction of multiple organ prolapse and to better define the pelvic anatomy and functioning.

HRCT in systemic sclerosis: correlation between respiratory functional indexes and extension of lung failure.

The purpose of the study was to identify the correlation between functional lung parameters to the extent of lung involvement evaluated by High Resolution Computed Tomography (HRCT) in systemic sclerosis (SSc), using a modified score scale. Forty-two patients with established clinical diagnosis of systemic sclerosis were retrospectively selected from the hospital information system and were prospectively included in the study protocol undergoing chest radiography, HRCT and functional lung testing. Lung involvement was assessed by HRCT, lesions were assessed in the individual segments and an additional severity score was introduced by assigning 3 points for bilateral lesions. The total new HRCT score was statistically related to severity of functional lung parameters. Thirty-six out of 42 patients showed an interstitial lung involvement by HRCT: Ground Glass (GG) n=36/42 of which n=27/36 were bilateral; IPM n=30/42, of which 24/30 were bilateral; SL n=33/42 of which 18/33 were bilateral; HC n=6/42 of which 6/6 were bilateral; SC n=6/42 of which 3/6 were bilateral.18/42 had a total score between 0-10, 6/42 between 11-20, 12/42 between 21-30, 6/42 greater than 31. Fifteen out of 42 had restrictive deficit. The results of functional respiratory testing were: FVC less than 80 percent in 12/42 patients (28.5 percent), TLC less than 80 percent in 15/42 patients (35.7 percent), DLCO less than 80 percent in 38/42 patients (90.4 percent) and DLCO/VA less than 80 percent in 21/42 patients (50 percent). The total score was statically related with FVC and TLC and with DLCO and DLCO/VA showing a significant negative correlation found between the total HRCT score of extent of lung damage and lung-function parameter (TLC: r= -0.65, P=0.00000264; FVC: r= -0.50; P=0.000575; DLCO: r= -0.74, P=2.02E-8; DLCO/VA: r= -0.68, P=0.0000005). All Pairwise Multiple Comparison Procedures showed a significant difference between the two rank sums that enclosed the comparison for DLCO/VA vs SCORE and DLCO vs SCORE. In conclusion, our modified score scale gives interesting additional data to evaluate the extension of interstitial lung involvement in SSc. It is inversely proportional to spirometry and DLCO and DLCO/VA. The bilateralism of the lesions is directly proportional to the lung damage.

Anatomical features of cephalothoracopagus variations: CT and MRI.

Conjoined twins have fascinated human mankind for a long time. Until recently, their description was limited to the dissection of non-viable cases, the description of external features and of bones by x-ray imaging. The introduction of ultrasonographic techniques gave the first in uterus images of conjoined twins, though the spatial resolution did not allow detailed descriptions. Subsequently, CT and MRI techniques allowed more precise definition of organs without any dissection, thus the need of formal interpretation of similar new images. As a matter of fact, few monstrosities have been studied by CT and MRI techniques. To this day very few cases still lack any CT/MRI documentation. Here we present a very rare type of cephalothoracopagus twins (joined at the head and the thorax). They have been accurately examined by CT and MRI imaging to study visceral structures. Pathophysiology and genetic aspects are also reviewed. These data offer precious details for accurate comprehension of imaging studies, and for theoretical studies concerning the information of several anatomical structures.