Familial pulmonary fibrosis: Clinical and radiological characteristics and progression analysis in different high resolution-CT patterns.

BACKGROUND: Familial pulmonary fibrosis (FPF) is defined as an idiopathic diffuse parenchymal lung disease affecting two or more members of the same primary biological family. The aim of the present study was to contribute to the clinical, functional and radiological characterisation of FPF with particular regards to disease progression and survival. METHODS: Baseline clinical, functional and radiological data of a FPF population (n = 46 patients) were retrospectively collected and analysed according to the 2011 IPF guidelines HRCT classification. A PFT follow-up after 1-year and survival analysis was conducted among to different HRCT patterns. RESULTS: 22 female and 24 male patients (age at diagnosis 58.5 ± 9.7 years-old), belonging to 30 families, were included in this study. Radiological analysis demonstrated the presence of a UIP pattern at HRCT in 54.3% of patients, Poss-UIP in 21.8% and Incon-UIP in 23.9%. Incon-UIP patients were younger and more frequently female. Pulmonary function tests showed a restrictive ventilatory defect in patients with UIP and Incon-UIP patterns, while Poss-UIP patients had normal volumes with only a mild reduction of DLCO. BAL composition revealed increased lymphocytes percentage in Incon-UIP patients. Respiratory functional 1-year follow-up showed a significant worsening in UIP patients only. HRCT pattern progression was only demonstrated from Poss-UIP to UIP (18% of patients). Median survival was not statistically different among the 3 HRCT groups, although Poss-UIP patients presented a better outcome. CONCLUSIONS: FPF has been confirmed to be a complex condition with poor prognosis. The present study firstly analysed functional and radiological follow-up data of patients with FPF, showing that it may manifests with several HRCT patterns with different rates of progression, in which Possible UIP and UIP could be considered phases of the same disease and Inconsistent UIP patients may represent a different clinical and radiological condition.

Bowel and mesenteric injuries from blunt abdominal trauma: a review.

The bowel and the mesentery represent the third most frequently involved structures in blunt abdominal trauma after the liver and the spleen. Clinical assessment alone in patients with suspected intestinal and/or mesenteric injury from blunt abdominal trauma is associated with unacceptable diagnostic delays. Multi-detector computed tomography, thanks to its high spatial, time and contrast resolutions, allows a prompt identification and proper classification of such conditions. The radiologist, in fact, is asked not only to identify the signs of trauma but also to provide an indication of their clinical significance, suggesting the chance of conservative treatment in the cases of mild and moderate, non-complicated or self-limiting injuries and focusing on life-threatening conditions which may benefit from immediate surgical or interventional procedures. Specific and non-specific CT signs of bowel and mesenteric injuries from blunt abdominal trauma are reviewed in this paper.

Differences in perfusion CT parameter values with commercial software upgrades: a preliminary report about algorithm consistency and stability.

BACKGROUND: Computed tomographic perfusion (CTp) imaging is a promising technique that allows functional imaging, as an adjunct to a morphologic CT examination, that can be used as an aid to carefully evaluate the response to therapy in oncologic patients. Considering this statement, it could be desirable that the measurements obtained with the CT perfusion software, and their upgrades, are consistent and reproducible. PURPOSE: To determine how commercial software upgrades impact on algorithm consistency and stability among the three version upgrades of the same platform in a preliminary study. MATERIAL AND METHODS: Blood volume (BV), blood flow (BF), mean transit time (MTT), and permeability surface area product (PS) were calculated with repeated measurements (n = 1119) while truncating the time density curve at different time values in six CT perfusion studies using CT perfusion software version 4D (CT Perfusion 4D), then repeated with the previous version (CT Perfusion 3.0 and CT Perfusion 4.0), using a fixed ROI both for arterial input and target lesion. The software upgrades were compared in pairs by applying a Kolmogorov-Smirnov test to all the parameters measured. Stability and reliability of the three versions were verified through the variation of the truncated parameters. RESULTS: The three software versions provided different parent distributions for approximately 80% of the 72 parameters measured. A complete agreement was found only for one patient in version 3.0 vs. 4.0 and 3.0 vs. 4D. Perfusion 4.0 vs. 4D: a complete agreement was found only in two cases. Parameters obtained with Perfusion 4D always showed the lowest standard deviation in all temporal intervals and also for all individual parameters. CONCLUSION: The three versions of the same platform tested yield different perfusion measurements. Thus, our preliminary results show that Perfusion 4D version uses a stable deconvolution algorithm to provide more reliable measurements.