[Emergency Radiology layout]. / Risorse tecnologiche in radiologia d'emergenza.

The purpose of Radiologic Unit in Emergency is to reach diagnostic and therapeutic effectiveness in the best way and in less time possible. The Portable Ultrasound Device is an instrument necessary in Emergency Room and in ambulance/helicopter to evaluate the evidence of endoperitoneal bleeding. The CT is the radiologic methodic more fast that permits a complete evaluation of all body segments in traumatized patient in the famous "golden hour" after the trauma, therefore it would be placed in Emergency Area. The multislice CT brought to a reduction of morbidity and mortality, thanks to a quick acquisition, to a thin collimation, to a more spatial resolution and to an optimal vessel opacization, determining a saving of hospital global costs, therefore a reduction of percentage of not necessaries operations and permitting a more rapid diagnosis, obtaining a considerable reduction of waiting in Trauma Emergency Room with more rapid and aimed therapies and a consequent costs reduction. To satisfy a so wide question of radiologic exams necessaries devices are informatic systems completely connected between Radiology department and other departments. Main advantages of MR in Emergency are the use of non ionising radiations, the possibility to effect diffusion and perfusion studies and to evaluate spinal cord damage. Reduction of time of patient preparation and times of acquisition and elaboration of imagines by modern and performant devices is basic to make more rapid therapeutic decisions.

[Imaging in diagnosis of acute pancreatitis and its complications]. / Imaging nella diagnosi delle pancreatiti acute e delle loro complicanze.

Pancreatitis is a flogistic disease, caused by activation and digestion of pancreas by its enzymes. Diagnosis is based on integrated evaluation of clinical and laboratoristic data and morphological imaging. To evaluate the severity of pancreatitis there is a clinical classification in interstitial--mild pancreatitis and severe--necrotic one. The evaluation of severity is basic, because it is strictly correlated to the prognosis of the patient. CT has revealed the best method for diagnosis, staging and for evaluate the complications and follow-up and in some cases it is useful for therapeutic change.The abdomen X-Ray in orthostatism is performed in every situation suspected for acute abdominal disease, also if aspecific; the ultrasound can be used as first instance method in patient with clinical suspect of acute pancreatitis; the MR has actually a secondary role for the diagnosis, with only except for dubious cases to exclude primitive tumor of pancreas and pancreatic shock, but it represents, instead, first instance method in patients with adverse reaction to contrast medium. The CPRE has, like angiography, a selective indication.

[The radiation dose problem in computed tomography. Actual data and strategies for a corrected use of ionizing radiation in computed tomography]. / Il problema della dose di radiazioni in tomografia compute- rizzata. dati attuali e strategie per un corretto utilizzo delle radiazioni ionizzanti in tomografia computerizzata.

New technologies in these years has taken to a spread and to a growth of the CT application with an increase of patients and population exposure. In clinical practice some technical devices can be used to reduce the exposure dose of multidetector CT that allows radiologist to answer the clinical question with less damage to the patient. The radiologist remains however the guarantor of the ionizing radiation exposition and he has to consider also the opportunity to use other methodics (MR, US) to answer some questions. The radiologist has the role to evaluate the clinical indication to the exam demanded from other doctor and has the responsibility for exam management and for progressive radiologic course, controls and follow-up.

[16-MDCT angiography coronary artery in the emergency department for patients with acute coronary syndrome (NSTEMI-UA)]. / La 16-MDCT delle arterie coronarie eseguita in urgenza nei pazienti affetti da sindrome coronarica acuta (NSTEMI-UA).

AIM: The diagnosis of acute coronary syndrome (ACS), non-ST-elevation myocardial infarction and unstable angina in the emergency department (ED) remains a challenge. The aim of our study was to investigate quality and the diagnostic accuracy of 16-MDCT coronary angiography, detecting coronary artery lesions in patients with suspected ACS presented in ED. MATERIALS AND METHODS: We studied with 16-MDCT (Sensation 16, Siemens, Forchleim, Germania) and coronary angiography 37 patients with the following inclusion criteria: chest pain compatible with myocardial ischemia, normal or no-diagnostic ECG changes and initial concentrations of serum troponin-I < or =1 ng/ml. The 16-MDCT was performed with ECG-gated technique after the intravenous administration of 90-100 ml of iodinated contrast material followed by a saline bolus. The scan parameters were: 120 kV, 650-720 mAs, 16 x 0.75mm collimation, 0.42s rotation time, 3 mm (pitch 0.25) feed/rot, B30f kernel. We evaluated for each patient: image quality and different artefacts, plaques identification and characterization. RESULTS: The evaluation of the image quality was based on a total of 453 segments, of which 415 segments (92.2%) were considered to have diagnostic image quality. MDCT correctly detected 15 patients with at least 1 stenosis >50% and correctly ruled out significant coronary artery disease in 19 patients with 1 FP and 2 FN: sensitivity 88%, specificity 95%, PPV 94%, NPV 90%. The plaques were hard in 6 cases, mixt in 16 cases and soft in 14 cases, respectively. CONCLUSIONS: Our results point-out that 16-MDCT in ED has the real ability to detect and rule out significant coronary stenoses in patients with ACS.

[CT and MR virtual colonscopy: indications, limits and comparison with conventional colonscopy]. / Colonscopia virtuale TC e RM: indicazioni, limiti e confronto con la colonscopia tradizionale.

Virtual endoscopy is a new method for studying the colon; it consists in acquisition of CT and MR images and to elaborate them with a workstation, to create endoluminal vision as like as traditional colonscopy, permitting the complete exploration of colonic lumen, also with stenotic tumors. The analysis of the differences between CT and MR colography shows like these two techniques present both advantages and disadvantages, such as the impossibility to perform MR in patients with pace-maker or in claustrophobic patients and the impossibility to perform CT with iodated agents in patients with renal failure or with a story of adverse reactions. The increased use of these techniques is due to the high sensitivity of last-generation CT and MR machine, to the increased spatial resolution, to specific softwares for digital cleaning of colon, to the introduction of high-end workstations and to the possibility of computed assisted diagnosis (CAD). So, it is desiderable that the increasing spread of multidetector CT devices and the future technical innovations, should have the effect to increase culture and experience in various diagnostic centers about CT-colography, making possible the spreading of virtual endoscopy as a screening tool.

[Radiological examination of the Lap-Band for the treatment of severe obesity]. / L'esame radiologico del Lap-Band nel trattamento della grave obesità.

The aim of this study is to determine the role of radiographic assessment in patient who underwent an adjustable laparoscopic (or laparotomic) banding for the treatment of morbid obesity, and to evaluate the different type of postoperative complications. Forty-three consecutive patients with morbid obesity were examined before and after surgical treatment with positioning of Lap-Band. In all patients radiological examination permitted to evaluate the bend position, the dimensions of the gastric pouch and of the stoma. In such cases it was possible to modify the stoma dimensions under fluoroscopy. 74.4% of patients obtained satisfactory weight loss without complications. In 16.2% of patients the treatment was unsatisfactory and the radiological examination demonstrated the presence and the type of complications. In 9.3% of patients the radiological exam was negative for complications but they didn't obtain satisfactory weight loss. Radiographic assessments are crucial in the management of weight loss and detection of postoperative complications in this surgical treatment.

Heterotaxia: radiological and surgical observations in a case of polysplenic syndrome.

We describe a case of asymptomatic polysplenic syndrome as suggested by ultrasonography, gastrointestinal series, computed tomography, magnetic resonance imaging scans and arteriography, and confirmed at surgery. Spleen malformation is frequently associated with heterotaxia and other malformations of the thoracic and abdominal organs, but no pathognomonic features can be detected in relation to this condition. In our patient, imaging studies revealed the presence of a polylobulated spleen in an atypical position below the liver, associated with malpositioning of the gastric fundus and gastro-oesophageal junction with interruption of the inferior vena cava, but no congenital heart disease. In conclusion, polysplenic syndrome is a rare clinical condition, occasionally found in asymptomatic adults. Radiological detection could be mistaken for mediastinal or abdominal pathological masses, and only a thorough study performed with several different radiological methods can determine the precise anatomy of the structures involved so as to be able to plan surgery where necessary.