Cone-beam computed tomography compared to X-ray in diagnosis of extremities bone fractures: A study of 198 cases.

CBCT is an imaging technique consisting of X-ray computed tomography, in which the x-rays are divergent, forming a cone. During 2015, a new model of CBCT, New Tom 5G XL (Verona), was used in the Radiology Department of The University of Verona, in collaboration with the Orthopaedics Department. Our study was carried out from October 2015 to October 2016 (198 patients). We compared CBCT with standard x-ray in the diagnosis of foot and anke fractures (and Lisfranc lesions), tibial plateau fractures, wrist and scaphoid fractures, elbow fractures. All patients were analyzed, of which 143 were positive or had documented bone lesions, while 55 were with no fractures seen. Of the 55 negative patients, 19 were considered positive at Standard RX, thus in 34.5% of cases the X-ray Standard examination overestimated the disease (false positive cases). Similarly, of the 143 positive patients, 21 were negative at RX, resulting in 14.6% of false negatives. We can say that if compared to standard X-ray, CBCT has higher sensitivity and specificity in the proper identification and typing of these kind of lesions, with low exposition dose if compared to MDCT. The most common rx-unrecognized fractures were in small bones of carpus and tarsus.

Severe necrotic and septic pancreatitis. Indications to endoscopic, surgical, and nutritional therapy.

Severe acute pancreatitis (SAP) management has changed over the last fifteen years, and from too aggressive behaviour, we moved to a cautious one. In every case, we can appreciate defect of extremist conceptual position. We reviewed our strategy on disease treatment, and we analyzed treatment of single cases. We collected 4 SAP cases from January 2009 to January 2010. All patients were septic, and we adopted the same approach for all of them, avoiding surgery without peritoneal infection. In all patients we placed jejumostomy and, after cleaning of septic site, we started immediate enteral nutrition (EN). Antibiotic therapy against Gram+, Gram- and antifugal drug had been started. No one died and all patients were back to an active life even if social costs are considerably high especially due to very long hospital stay.

Role of CT and MRI in the preoperative evaluation of auditory brainstem implantation in patients with congenital inner ear pathology.

PURPOSE: The purpose of this study was to evaluate the reliability of computed tomography (CT) and magnetic resonance imaging (MRI) in characterising cochlear nerve anomalies in auditory brainstem implant candidates with congenital hearing loss. MATERIALS AND METHODS: Seventeen patients affected by congenital sensorineural hearing loss were examined by CT and MRI. Inner ear malformations eligible for auditory brainstem implants were classified according to the Casselman classification. All patients subsequently received auditory brainstem implants. RESULTS: Suspected congenital anomalies were confirmed by CT and MRI in all 17 patients. There were 5/17 bilateral cochlear nerve aplasias and 12/17 cochleovestibular anomalies. Of these, 5/12 patients had a common cochleovestibular cavity, 2/12 had bilateral cochlear aplasia and cochlear nerve agenesis, 1/12 had type I incomplete partition, 2/12 had type II incomplete partition and 2/12 had cochlear hypoplasia. CONCLUSIONS: Preoperative CT and MRI assessment of patients with sensorineural hearing loss is reliable. MRI provided additional information, identifying the possible absence of cochlear nerve and excluding other central nervous system (CNS) diseases.

Intraductal papillary mucinous tumors of the pancreas: spectrum of CT and MR findings with pathologic correlation.

The reports of intraductal papillary mucinous tumors (IPMT) of the pancreas are increasingly more frequent in the literature. The diagnosis by means of cross-sectional imaging of these tumors is not easy, especially in the early stages, when they can mimic an inflammatory disease of the pancreas. Prompt identification of the disease is nevertheless extremely important, especially in the case of tumors originating from the collateral branches, since its recognition can modify the management of the patient, in some cases obviating recourse to surgery.

[Serous cystadenoma of the pancreas: imaging findings]. / Cistoadenoma sieroso del pancreas: i rilievi del'imaging.

PURPOSE: To present the imaging findings of serous cystadenoma (SCA) and discuss the main problems of differential diagnosis with other cystic pancreatic lesions. MATERIALS AND METHODS: 55 cases of SCA were reviewed; all the lesions proved to be benign at pathology. 35 tumors were evaluated with Ultrasonography (US), 49 with Computed Tomography (CT), and 15 with Magnetic Resonance Imaging (MRI). RESULTS: Among the patients who underwent either demolitive (47) or derivative (3) interventions, two different morpho-structural patterns were identified: microcystic (37), and oligocystic (13). The diagnosis of SCA, possible in the presence of microcystic pattern, was achieved in 63% of cases by US (22/35), in 63% of cases by CT (31/49), and in 73% of cases by MRI (11/15). In 12 patients evaluated with all the imaging modalities, the combined information allowed a correct diagnosis in 10 cases (83%). The 13 oligocystic tumors were almost always undistinguishable from other cystic masses of the pancreas. CONCLUSIONS: The diagnosis of SCA can be considered certain if a microcystic pattern is detected. A correct diagnosis is not achievable in the presence of oligocystic architecture. MRI is the best imaging modality in characterizing this tumor.