Visualization of peri-prostatic neurovascular fibers before and after radical prostatectomy by means of diffusion tensor imaging (DTI) with clinical correlations: preliminary report.

To evaluate if diffusion tensor imaging (DTI) is able to detect morphological changes of peri-prostatic neurovascular fibers (PNF) before and after robot-assisted radical prostatectomy (RARP) and if these changes are related to urinary incontinence (UI) and erectile dysfunction (ED). From October 2014 and August 2017, 26 patients with biopsy-proven prostate cancer underwent prostatic multiparametric magnetic resonance imaging (mp-MRI) including DTI sequencing before, and 6 months after, RARP. Images were analyzed by placing six regions of interest (ROI), respectively, at base, mid gland, and apex, one for each side, to obtain tractographic reconstruction of the PNF. Patients were asked to complete International Consultation Incontinence Questionnaire-Short Form (ICIQ-SF) and International Index of Erectile Function (IIEF-5) questionnaires before RARP and 6 months post-operatively. Fractional anisotropy (FA), number (N), and length (L) of PNF before and after RARP were compared by means of Student's t test; Spearman's test was used to evaluate correlation between DTI parameters and questionnaires' scores. We observed a significant difference in N values before and after RARP (p < 0.001) and a negative correlation between IIEF-5 score and post-operative FA values at both the right (rho = - 0.42; p = 0.0456) and left (rho = - 0.66; p = 0.0006) base of the prostate. DTI with tractography of PNF is able to detect quantitative changes in N, L, and FA values in PNF after RARP. In particular, we observed an inverse correlation between FA of PNF and ED at 6 months after RARP. Further investigations are needed to confirm this trend.

Residual pancreatic function after pancreaticoduodenectomy is better preserved with pancreaticojejunostomy than pancreaticogastrostomy: A long-term analysis.

BACKGROUND: Pancreatico-enteric anastomosis after pancreaticoduodenectomy can be performed using either a pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG). Differences in surgical outcomes are still a matter of debate, and less is known about long-term functional outcomes. METHODS: Twelve years after the conclusion of a comparative study evaluating the surgical outcomes of PJ and PG (Bassi et al., Ann Surg 2005), available patients underwent morphological and functional pancreatic assessment: pancreatic volume and duct diameter measured by MRI, impaired secretion after secretin, fecal fat, fecal elastase-1 (FE-1), serum vitamin D and endocrine function. Quality of life and symptom scores were evaluated with the EORTC QLQ-C30 questionnaire. RESULTS: Only 34 patients were available for assessment. No differences were found in terms of BMI variation, endocrine function, quality of life or symptoms. Exocrine function was more severely impaired after PG than after PJ (fecal fats 26.6 ±â€¯4.1 vs 18.2 ±â€¯3.6 g/day; FE-1 121.4 ±â€¯6.7 vs 170.2 ±â€¯25.5 µg/g, vitamin D 18.1 ±â€¯1.8 vs. 23.2 ±â€¯3.1 ng/mL). MRI assessment identified a lower pancreatic volume (26 ±â€¯3.1 vs. 36 ±â€¯4.1 cm3) and a more dilated pancreatic duct (4.6 ±â€¯0.92 vs. 2.4 ±â€¯0.18 mm) in patients with PG compared to those with PJ. CONCLUSION: Compared to PJ, PG is associated with a more severely impaired exocrine function long-term, but they result similar endocrine function and quality of life. In patients with a long life expectancy, this should be taken into account.

Unenhanced magnetic resonance imaging immediately after radiofrequency ablation of liver malignancy: preliminary results.

PURPOSE: To assess the accuracy of unenhanced magnetic resonance imaging (MRI) immediately after the percutaneous ultrasound-guided radiofrequency ablation (RFA) of liver malignancy in predicting treatment efficacy at CT follow-up. MATERIALS AND METHODS: Percutaneous ablation was prospectively performed in 23 liver malignancies (20 hepatocarcinomas and 3 metastases). After the procedure in the same day all patients were studied with unenhanced MRI. The best sequence to detect the coagulative necrosis was visually established. Pre-RFA CT and post-RFA MRI were registered with non-rigid transformation algorithm. Manual segmentation of lesions and ablated areas in pre-RFA CT, post-RFA MRI, and follow-up CT were obtained. Sensitivity, specificity, positive predictive value (PPV), negative predicitve value (NPV), and accuracy of MRI in predicting the correct centering and the complete treatment of the lesion were calculated in respect to the 1-month follow-up CT. RESULTS: Fat-saturated T1-weighted (fs T1-w) was the sequence in which the best conspicuity of the ablated area was depicted. Coagulative necrosis was hyperintense in fs T1-w sequence in 17/23 (74%). In respect to follow-up CT, MRI predicted the correct centering of the lesions in 19/20 lesions with sensitivity, specificity, PPV, NPV, and accuracy of 100%, 75%, 95%, 100%, and 100%, respectively. MRI predicted the complete treatment of the lesions in 17/17 lesions with sensitivity, specificity, PPV, NPV, and accuracy of 100%. CONCLUSION: MRI with the single fs T1-w sequence was highly accurate in predicting the treatment efficacy of percutaneous ablation of liver malignancies in comparison to follow-up CT control. Unnecessary CT in case of incomplete treatment can be therefore easily avoided.

Renal stones composition in vivo determination: comparison between 100/Sn140 kV dual-energy CT and 120 kV single-energy CT.

The objective of this study is to compare in vivo, the accuracy of single-energy CT (SECT) and dual-energy CT (DECT) in renal stone characterization. Retrospective study approved by the IRB. 30 patients with symptomatic urolithiasis who underwent CT on a second-generation dual-source scanner with a protocol that included low-dose 120 kV scan followed by 100/Sn140 kV dual-energy scan have been included. Stone composition was classified as uric acid, cystine or calcium oxalates, and phosphates according to attenuation values at 120 kV and to 100/Sn140 kV attenuation ratios and compared with the infrared spectroscopy analysis. 50 stones were detected in 30 patients. SECT correctly assessed stone composition in 52 % of the cases, DECT in 90 %. Sensitivity, specificity, positive predictive value, and negative predictive value in differentiating uric acid vs. non-uric acid stones were 0.94, 0.72, 0.64, and 0.96 for SECT and 1.00, 0.94, 1.00, and 0.96 for DECT, respectively. DECT significantly performs better than SECT in characterising renal stones in vivo, and may represent a useful tool for treatment planning.

Percutaneous Radiofrequency Ablation of Unresectable Locally Advanced Pancreatic Cancer: Preliminary Results.

AIM: The objective of this study was to evaluate the efficacy of percutaneous radiofrequency ablation of locally advanced pancreatic cancer located in the pancreatic body. MATERIALS AND METHODS: Patients with biopsy-proven locally advanced pancreatic adenocarcinoma were considered for percutaneous radiofrequency ablation. Postprocedural computed tomography studies and Ca19.9 tumor marker evaluation were performed at 24 hours and 1 month. At computed tomography, treatment effect was evaluated by excluding the presence of complications. The technical success of the procedure is defined at computed tomography as the achievement of tumoral ablated area. RESULTS: Twenty-three patients have been included in the study. Five of the 23 patients were excluded. At computed tomography, the mean size of the intralesional postablation necrotic area was 32 mm (range: 15-65 mm). Technical success of the procedure has been obtained in 16 (93%) of the 18 cases. None of the patients developed postprocedural complications. Mean Ca19.9 serum levels 1 day before, 1 day after, and 1 month after the procedure were 285.8 U/mL (range: 16.6-942.0 U/mL), 635.2 U/mL (range: 17.9-3368.0 U/mL), and 336.0 U/mL (range: 7.0-1400.0 U/mL), respectively. Follow-up duration was less than 6 months for 11 patients and more than 6 months for 7 patients. At the time of the draft of this article, the mean survival of the patients included in the study was 185 days (range: 62-398 days). CONCLUSION: Percutaneous radiofrequency ablation of locally advanced adenocarcinoma has a high technical success rate and is effective in cytoreduction both at imaging and laboratory controls.

Distribution of liver metastases based on the site of primary pancreatic carcinoma.

OBJECTIVES: To investigate whether the different location of pancreatic adenocarcinoma affects the lobar distribution of metastases to the liver. METHODS: From all patients who underwent multidetector computed tomography (MDCT) examinations for staging of pancreatic adenocarcinoma in the last 4 years we selected 80 patients (42 men, 38 women; mean age, 60.56 years) with liver metastases and a pancreatic adenocarcinoma of the head (group A, 40 patients; diameter, 32.41 ± 2.28 mm) or body-tail (group B, 40 patients; diameter, 52.21 ± 2.8 mm). We analysed tumour site, diameter, vascular invasion and number of metastases in each lobe of the liver. The total number of metastases was compared between the two groups with an unpaired t-test, while Fisher's test was used to compare the number of metastases within the two lobes. RESULTS: As expected, the number of liver metastases was higher in group B than in group A. The ratio of metastases in the right-to-left hemi-liver was 7.4:1 for group A compared with 3.3:1 for group B (p < 0.0001). CONCLUSIONS: Although the number of liver metastases is higher in the right lobe than in the left lobe in both groups, there is a significant difference in the ratio of metastases between the right and the left hemi-liver. This supports the existence of a streamline phenomenon and a selective lobar distribution of metastases within the liver. KEY POINTS: • Pancreatic adenocarcinoma presents with liver metastases in 40% of cases • The presence of liver metastases disqualifies the patient from curative surgery • The distribution of metastases within the liver depends on the site of pancreatic adenocarcinoma • The distribution of liver metastases is due to the streamline phenomenon.

Effects of eight weeks of aerobic interval training and of isoinertial resistance training on risk factors of cardiometabolic diseases and exercise capacity in healthy elderly subjects.

We investigated the effect of 8 weeks of high intensity interval training (HIT) and isoinertial resistance training (IRT) on cardiovascular fitness, muscle mass-strength and risk factors of metabolic syndrome in 12 healthy older adults (68 yy ± 4). HIT consisted in 7 two-minute repetitions at 80%-90% of V˙O2max, 3 times/w. After 4 months of recovery, subjects were treated with IRT, which included 4 sets of 7 maximal, bilateral knee extensions/flexions 3 times/w on a leg-press flywheel ergometer. HIT elicited significant: i) modifications of selected anthropometrical features; ii) improvements of cardiovascular fitness and; iii) decrease of systolic pressure. HIT and IRT induced hypertrophy of the quadriceps muscle, which, however, was paralleled by significant increases in strength only after IRT. Neither HIT nor IRT induced relevant changes in blood lipid profile, with the exception of a decrease of LDL and CHO after IRT. Physiological parameters related with aerobic fitness and selected body composition values predicting cardiovascular risk remained stable during detraining and, after IRT, they were complemented by substantial increase of muscle strength, leading to further improvements of quality of life of the subjects.

Contrast-Enhanced Ultrasound of Focal Liver Lesions.

OBJECTIVE: The purpose of this article is to discuss the use of contrast-enhanced ultra-sound (CEUS) in focal liver lesions. CONCLUSION: Focal liver lesions are usually detected incidentally during abdominal ultrasound. The injection of microbubble ultrasound contrast agents improves the characterization of focal liver lesions that are indeterminate on conventional ultrasound. The use of CEUS is recommended in official guidelines and suggested as a second diagnostic step after ultrasound detection of indeterminate focal liver lesions to immediately establish the diagnosis, especially for benign liver lesions, such as hemangiomas, avoiding further and more expensive examinations.

Time-to-peak values can estimate hepatic functional reserve in patients undergoing surgical resection: a comparison between perfusion CT and indocyanine green retention test.

OBJECTIVE: To evaluate the potential usefulness of perfusion computed tomography (CT) for the estimation of hepatic functional reserve in patients scheduled for surgical resection and to compare the results with those of the indocyanine green retention test results. METHODS: Thirty-one patients with hepatobiliary malignancies were included. Perfusion CT and indocyanine green retention test were performed on the same day, and their results were compared using Pearson correlation test. RESULTS: A strong correlation was found between perfusion CT time-to-peak values and indocyanine green retention rate at 15 minutes and indocyanine green plasma disappearance rate values (R, 0.789 and -0.790; R, 0.832 and -0.823, respectively; P < 0.0001). CONCLUSIONS: Perfusion CT may be useful for the preoperative noninvasive estimation of hepatic functional reserve for patients undergoing liver resection.

Contrast-enhanced ultrasound of pancreatic tumours.

Indication/purpose: To review contrast-enhanced ultrasound features of the most common pancreatic tumours. Methods: Contrast-enhanced ultrasound (CEUS) can provide distinctive features of pancreatic tumours that are reported in the present paper, providing radiologic-pathological correlations and clarifying the main differential diagnosis. Conclusion: Contrast-enhanced ultrasound plays a well-established role in the evaluation of pancreatic tumours. When possible, CEUS should be always performed after the initial US diagnosis, in order to improve the accuracy of the first line examination.

Non-hyperfunctioning neuroendocrine tumours of the pancreas: MR imaging appearance and correlation with their biological behaviour.

OBJECTIVE: To describe MR imaging features of non-hyperfunctioning neuroendocrine pancreatic tumours by comparing them to histopathology and to determine the accuracy of MR imaging in predicting biological behaviour. MATERIALS AND METHODS: After institutional review board approval, we retrospectively reviewed 45 patients with pathologically proven NF-NET of the pancreas and ≥1 preoperative MR/MRCP examinations. Of the NF-NETS, 29/45 (64.4 %) were G1 and 16/45 (35.5 %) were G2. Image analysis included the lesion maximum diameter, vascular encasement, extrapancreatic spread, signal intensity on T1- and T2-weighted, contrast enhancement features, and presence of metastases. Tumour vessel density was calculated on the histological specimen using a grid. RESULTS: The median maximum diameter of NF-NETs was 20 mm (range 5-200 mm). Eighty per cent of the NF-NETs were hypointense on T1-weighted images, 82.2 % were hyperintense on T2-weighted images, and 75.6 % were hypervascular. Overall MRI accuracy showed a mean AUC of 0.86 compared to pathology. Lesions with a maximum diameter of 30 mm irregular margins, absence of a cleavage plane with the main pancreatic duct, vascular encasement, extrapancreatic spread and abdominal metastases were significantly associated with malignant NF-NETs. No correlation was found between the tumour vessel density and contrast-enhanced MR imaging pattern. CONCLUSIONS: Hyperintensity on T2-weighted images and iso-/hypervascularity occurred in 27/45 (60.0 %) of NF-NETs. MRI identifies malignant NF-NETs with a sensitivity of 93.3 % and a specificity of 76.9 % (AUC = 0.85). KEY POINTS: • Non-hyperfunctioning neuroendocrine pancreatic tumours (NF-NET) pose a difficult diagnostic challenge. • On T2-weighted MRI, 82.2 % of neuroendocrine tumours appeared hyperintense. • MR imaging showed 0.94 sensitivity and 0.77 specificity in predicting biological behaviour. • The hyper-/isointensity during dynamic MRI did not correlate with vessel density at pathology.

Multifocal branch-duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas: magnetic resonance (MR) imaging pattern and evolution over time.

PURPOSE: The aim of our study was to follow the evolution over time of multifocal intraductal papillary mucinous neoplasms (IPMN) of the pancreatic duct side branches by means of magnetic resonance imaging (MRI). MATERIALS AND METHODS: A total of 155 patients with multifocal IPMN of the side branches were examined with MRI and MR cholangiopancreatography (MRI/MRCP). Inclusion criteria were patients with ≥2 dilated side branches involving any site of the parenchyma; presence of communication with the main pancreatic duct and previous investigations by MRI/MRCP within at least six months. Median follow-up was 25.8 months (range, 12-217). Patients with a follow-up period shorter than 12 months (n=33) and those with a diagnosis of multifocal IPMN of the side branches without any follow-up (n=14) were excluded from the study. The final study population thus comprised 108 patients. A double, quantitative and qualitative, analysis was carried out. The quantitative image analysis included: number of dilated side branches in the head-uncinate process and body-tail; maximum diameter of lesions in the head-uncinate process; maximum diameter in the body-tail; maximum diameter of the main pancreatic duct in the head and body-tail. The qualitative image analysis included: presence of malformations or anatomical variants of the pancreatic ductal system; site of the lesions (head-uncinate process, body-tail, ubiquitous, bridge morphology); presence of gravity-dependent intraluminal filling defects; presence of enhancing mural nodules. RESULTS: At diagnosis, the mean number of cystic lesions of the side branches was 7.09. The mean diameter of the cystic lesions was 13.7 mm. The mean diameter of the main pancreatic duct was 3.6 mm. At follow-up, the mean number of cystic lesions was 7.76. The mean diameter of the cystic lesions was 13.9 mm. The mean diameter of the main pancreatic duct was 3.7 mm. Intraluminal filling defects in the side branches were seen in 18/108 patients (16.6%); enhancing mural nodules were seen in 3/108 patients (2.7%). CONCLUSIONS: Multifocal IPMN of the branch ducts shows a very slow growth and evolution over time. In our study, only 3/108 patients showed mural nodules which, however, did not require any surgical procedure, indicating that careful nonoperative management may be safe and effective in asymptomatic patients.

Preoperative assessment of nonfunctioning pancreatic endocrine tumours: role of MDCT and MRI.

PURPOSE: This study was done to compare the diagnostic accuracy of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the preoperative assessment of nonfunctioning pancreatic endocrine tumours (NFPET). MATERIALS AND METHODS: Fifty-one patients (25 men, 26 women; mean age, 52 years), preoperatively investigated by both MDCT and MRI and subsequently operated on with a histological diagnosis of NFPET, were included in this study. MDCT and MRI accuracy in evaluating location, size, margins, baseline density/signal intensity, structure, pattern of enhancement, peak enhancement phase, involvement of main pancreatic duct, involvement of adjacent organs, infiltration of peritumoural vessels, involvement of locoregional lymph nodes, and liver metastases was compared using Pearson correlation, Mann-Whitney and chi-square tests. A value of p<0.05 was considered statistically significant. RESULTS: MDCT and MRI had similar accuracy in assessing size, margins, baseline density/signal intensity, structure, pattern of enhancement, peak enhancement phase, involvement of main pancreatic duct, involvement of adjacent organs, involvement of locoregional lymph nodes, and liver metastases (p>0.05). MDCT was superior to MRI in evaluating the infiltration of peritumoural vessels (p=0.025). CONCLUSIONS: MDCT performed better than MRI in assessing vascular involvement and should be considered the best imaging tool for preoperative evaluation of NFPET.

Brain modifications after acute alcohol consumption analyzed by resting state fMRI.

Resting-state functional magnetic resonance imaging (fMRI) is a recent breakthrough in neuroimaging research able to describe "in vivo" the spontaneous baseline neuronal activity characterized by blood oxygen level dependent (BOLD) signal fluctuations at slow frequency (0.01-0.1Hz) that, in the absence of any task, forms spatially distributed functional connectivity networks, called resting state networks (RSNs). The aim of this study was to investigate, in the young and healthy population, the changing of the RSNs after acute ingestion of an alcohol dose able to determine a blood concentration (0.5g/L) that barely exceeds the legal limits for driving in the majority of European Countries. Fifteen healthy volunteers underwent two fMRI sessions using a 1.5T MR scanner before and after alcohol oral consumption. The main sequence acquired was EPI 2D BOLD, one per each session. To prevent the excessive alcohol consumption the subjects underwent the estimation of blood rate by breath test and after the stabilization of blood alcohol level (BAL) at 0.5g/L the subjects underwent the second fMRI session. Functional data elaboration was carried out using the probabilistic independent component analysis (PICA). Spatial maps so obtained were further organized, with MELODIC multisession temporal concatenation FSL option, in a cluster representing the group of pre-alcohol sessions and the group of post-alcohol sessions, followed by the dual regression approach in order to evaluate the increase or decrease in terms of connectivity in the RSNs between the two sessions at group level. The results we obtained reveal that acute consumption of alcohol reduces in a significant way the BOLD signal fluctuations in the resting brain selectively in the sub-callosal cortex (SCC), in left temporal fusiform cortex (TFC) and left inferior temporal gyrus (ITG), which are cognitive regions known to be part of the reward brain network and the ventral visual system.

Normal anatomy and variants of the venous cardiac system in MDCT coronary angiography.

Three separate venous systems drain the blood returning from the heart walls. These veins are characterised by remarkable variability in terms of frequency, size and course. The knowledge of cardiac venous anatomy is of primary importance during interventional cardiac procedures that require catheterisation of cardiac veins. Some anatomical variants may hinder or contraindicate access to target veins. Coronary angiography (CA) with multidetector computed tomography (MDCT-CA) and multiplanar reformations (MPR), maximum intensity projection (MIP) and 3D reconstructions provides noninvasive visualisation of normal cardiac veins and anatomical variants. The purpose of this pictorial review is to describe by MDCT-CA the anatomy and main variants of the cardiac venous system.

Role of MDCT coronary angiography in the clinical setting: economic implications.

PURPOSE: This study evaluated the incremental value and cost-effectiveness ratio of introducing coronary angiography (CA) with multidetector computed tomography (MDCT-CA) in the diagnostic management of patients with suspected coronary artery disease (CAD) compared with the traditional diagnostic workup. MATERIAL AND METHODS: Five hundred and fifty consecutive patients who underwent MDCT-CA between January 2009 and June 2011 were considered. Patients with atypical chest pain and suspected obstructive CAD were directed to one of two diagnostic pathways: the traditional protocol (examination, stress test, CA) and the current protocol (examination, stress test, MDCT-CA, and CA, if necessary). The costs of each protocol and for the individual method were calculated. Based on the results, the cost-effectiveness ratio of the two diagnostic pathways was compared. A third, modified, diagnostic pathway has been proposed with its relative cost-effectiveness ratio (examination, MDCT-CA, stress test, and CA, if necessary). RESULTS: Stress test vs. MDCT-CA had an accuracy of 66%, a sensitivity and specificity of 21% and 87%, respectively, and a positive (PPV) and negative (NPV) predictive value of 40% and 70%, respectively. Comparison between conventional CA (CCA) and MDCT-CA showed a sensitivity and specificity of 92% and 89%, respectively, a PPV and NPV of 89%, and an accuracy of 92%. The traditional protocol has higher costs than the second protocol: 1,645 euro against 322 euro (mean), but it shows a better cost-effectiveness ratio. The new proposed protocol has lower costs, mean 261 euro, with a better costeffectiveness ratio than the traditional protocol. CONCLUSIONS: The diagnostic protocol for patients with suspected CAD has been modified by the introduction of MDCT-CA. Our study confirms the greater diagnostic performance of MDCT-CA compared with stress test and its similar accuracy to CCA. The use of MDCT-CA to select patients for CCA has a favourable cost-effectiveness profile.

Learning curve in multidetector CT coronary angiography (MDCT-CA).

PURPOSE: Coronary angiography using multidetector computed tomography (MDCT-CA) is a recent technique for the nonivasive study of coronary arteries. This study assessed the diagnostic accuracy of coronary artery stenosis evaluation obtained by three readers at different levels of training or at different points of the learning curve proposed by the international guidelines. MATERIALS AND METHODS: Three radiologists in training with different levels of experience in MDCT-CA scored 50 cases at various time points of the learning curve: baseline, 4 weeks, 8 weeks and 6 months. The trainee radiologists evaluated the degree of stenosis on each coronary segment, and overall accuracy was calculated on a per-segment, pervessel and per-patient basis. RESULTS: All readers improved analysis accuracy per segment (range, 73-90%); sensitivity reached 45% per segment, 84% per vessel and 93% per patient; specificity was 99% per segment and vessel and 98% per patient. Positive and negative predictive values increased to 94% and 92%, respectively. CONCLUSIONS: Although all readers improved in diagnostic performance with growing experience with MDCT-CA, a longer training period may be necessary to achieve adequate levels of expertise in MDCT-CA to be able to perform as independent readers.

Virtual analysis of pancreatic cystic lesion fluid content by ultrasound acoustic radiation force impulse quantification.

OBJECTIVES: The purpose of this study was to prospectively evaluate the application of acoustic radiation force impulse (ARFI) imaging implemented with Virtual Touch tissue quantification (Siemens AG, Erlangen, Germany) in the study of pancreatic cystic lesions by using different analysis methods compared with the final diagnosis (pathologic or by magnetic resonance imaging and endoscopic sonographic findings). METHODS: Thirty-eight patients with pancreatic cystic focal lesions (diameter >3 cm and located at a depth of 5.5 cm) were included in the study and underwent conventional sonography. For every patient, 5 measurements in the Virtual Touch tissue quantification region of interest were obtained. To distinguish mucinous (potentially malignant) from serous (mainly benign) cystic lesions, the result XXXX/0 was considered to mean simple liquids (comparable to water), and the accuracy of Virtual Touch tissue quantification in differentiating pancreatic cystic lesions was calculated. To consider a lesion as containing complex fluids (potentially mucinous), two different reading methods were applied: (1) at least 2 numerical values when obtaining 5 measurements; and (2) the prevalence of numerical values irrespective of the number of measurements. The sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for the differential diagnosis between mucinous and nonmucinous cystic lesions. RESULTS: By the first reading method, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in the group of cystic lesions were 68.8%, 77.3%, 68.8%, 77.3%, and 73.7%, respectively; by the second method, the values were 37.5%, 100%, 100%, 68.8%, and 73.3%. CONCLUSIONS: Acoustic radiation force impulse imaging with Virtual Touch tissue quantification can have a role in the noninvasive characterization of pancreatic cystic lesions during conventional sonographic examinations.

Uncommon double fistula between sinus node arteries and right atrium in a patient with atypical chest pain.

The main coronary artery variants and anomalies are completely asymptomatic and are discovered incidentally or as they rise symptoms. Multidetector computed tomography coronary angiography represents an excellent technique for noninvasive assessment of the coronary tree mainly because of the multiplanar imaging modalities of computed tomography. Thin collimation permits to depict thin vessels such as the sinus node artery, as reported in this case. In this brief report, we describe a case of a rare anomaly of termination the coronaries, a double fistula between the sinus node artery, and the right atrium in a patient with atypical chest pain.

Prospective evaluation of subjects with chronic asymptomatic pancreatic hyperenzymemia.

OBJECTIVES: Chronic asymptomatic pancreatic hyperenzymemia (CAPH) has been described since 1996 as a benign disease. Recent studies described pathological findings at magnetic resonance cholangiopancreatography with secretin stimulation (s-MRCP) in more than half of the CAPH subjects. The aim of this study was to investigate the frequency and clinical relevance of s-MRCP findings in patients with CAPH. METHODS: Subjects prospectively enrolled from January 2005 to December 2010 underwent s-MRCP and biochemical tests routinely performed. RESULTS: Data relative to 160 subjects (94 males, 66 females, age 49.6±13.6 years) were analyzed. In all, 51 (32%) subjects had hyperamylasemia, 9 (6%) hyperlipasemia, and 100 (62%) an increase in both enzyme levels. The time between the first increased dosage of serum pancreatic enzymes and our observation was 3.3±3.9 years (range: 1-15). Familial pancreatic hyperenzymemia was observed in 26 out of 133 subjects (19.5%). Anatomic abnormalities of the pancreatic duct system at s-MRCP were found in 24 out of 160 subjects (15%). Pathological MRCP findings were present in 44 subjects (27.5%) before and in 80 subjects (50%) after secretin administration (P<0.0001). Five subjects (3.1%) underwent surgery, 3 for pancreatic endocrine tumor, 1 for pancreatic adenocarcinoma, and 1 for intraductal papillary-mucinous neoplasia (IPMN) involving the main pancreatic duct, and 18 patients (11.3%) needed a follow-up (17 for IPMN and 1 for endocrine tumor). CONCLUSIONS: Alterations of the pancreatic duct system at s-MRCP in subjects with CAPH can be observed in 50% of the subjects and are clinically relevant in 14.4% of cases.