MRI findings of intraductal papillary mucinous neoplasms (IPMNs).

Cystic lesions of the pancreas are relatively frequent imaging findings due to the improvement of imaging technologies. They may be secondary to both benign and malignant disease processes and their prevalence increases with age. In most cases, these lesions are detected incidentally by computed tomography and magnetic resonance imaging (MRI) performed for other reasons. Intraductal papillary mucinous neoplasms (IPMNs) represent 25% of the cystic neoplasms, morphologically classified into "main pancreatic duct IPMN" (MPD-IPMN), "side branches IPMN" (SB-IPMN) and mixed forms. Magnetic Resonance Cholangiopancreatography (MRCP) is a multiparametricity not invasive radiological technique that doesn't use ionizing radiation or organ iodinized contrast agents; it allows an accurate characterization of the lesions (number and size of cystic lesions, internal features of a cyst, ducts dilation, communication with main pancreatic duct) that is important to guide the differential diagnosis and establish a correct follow-up. International guidelines consider IPMN of MPD and mixed forms to be an indication for surgery, while clinical and radiological follow-up is indicated in asymptomatic patients with SB-IPMN, especially when lesions are < 2,5-3 cm in diameter and there are no mural nodules or dilation of MPD.

Imaging of congenital pulmonary malformations.

Congenital pulmonary malformations represent a broad spectrum of anomalies that may result in varied clinical and pathologic pictures, ranging from recurrent pulmonary infections and acute respiratory distress syndrome, which require timely drug therapy, up to large space-occupying lesions needing surgical treatment. This classification includes three distinct anatomical and pathological entities, represented by Congenital Cystic Adenomatoid Malformation, Bronchopulmonary Sequestration and Congenital Lobar Emphysema. The final result in terms of embryological and fetal development of these alterations is a Congenital Lung Hypoplasia. Since even Bronchial Atresia, Pulmonary Bronchogenic Cysts and Congenital Diaphragmatic Hernias are due to Pulmonary Hypoplasia, these diseases will be discussed in this review (1, 2).

CT arthrography for evaluation of autologous chondrocyte and chondral-inductor scaffold implantation in the osteochondral lesions of the talus.

PURPOSE: to analyse the findings of CT arthrography of the ankle, one year after the transplant of autologous chondrocytes in solution (ACI technique) and the covering with the only scaffold implantation of the osteochondral lesions of the talus, in comparison with the clinical evaluation of the ankle. METHODS: This retrospective study includes 10 patients (6 male, 4 female, mean age 49.4, range 25-74 years) with an osteochondral lesion of the medial side of the talus, 4 pure chondrals, 6 osteochondrals, painful and limiting the articulation, who underwent ACI using autologous chondrocyte (5 cases) and a covering with the only scaffold implantation (5 cases), in patients who underwent multi-detector CT arthrography between April 2006 and December 2013, at least 12 months after the surgery. RESULTS: Grade 0 was presented in 5 cases (50%), grade 1 in 2 cases (20%), grade 3 in 2 cases (20%) and grade 4 in 1 case (10%). Among the 5 cases even to 0 according to ICRS classification, the patient presented no symptoms in 4 out of 5 cases (80%); in 1 case, the patient presented post-operation pain of moderate entity due to the onset of adhesive capsulitis (20%). The 2 grade 1 patients, according to the ICRS classification, did not report any post-operation pain (0%). The 2 grade 3 patients, according to the ICRS classification, reported a light pain in 1 case (50%). The grade 4 patient, according to the ICRS classification, reported moderate pain (100%). CONCLUSIONS: The CT arthrography, for the elevate spatial and contrast resolution, is a very accurate exam in detecting irregularities in the chondral-inductor scaffold implantation, and in correlating the clinical presentation.

CT-guided fine-needle aspiration of abdominal and retroperitoneal small lesions with the coaxial technique using MPR images.

PURPOSE: To demonstrate the advantages of CT-guided fine-needle aspiration (FNA) of abdominal and retroperitoneal small lesions with the coaxial technique using MPR images. MATERIALS AND METHODS: The study included retrospectively 50 patients who underwent CT-guided FNA of abdominal and/or retroperitoneal small lesion (<30 mm). Patients with suspected lymphomas or sarcomas were excluded. Cytology reports were the reference standard. RESULTS: The cytology was diagnostic in 48/50 biopsies (96%): out of 41 neoplastic lesions (85%), 37 were malignant (90.2%) and 4 were benign (9.8%); 7 out of 48 were non-neoplastic (14.6%). No procedural complications were observed (0%). CONCLUSION: By using MPR images there is an effective improvement in coaxial CT-guided FNA of abdominal and retroperitoneal small lesions.

Gynecomastia: a common indication for mammography in men of all age.

BACKGROUND AND AIM: Gynecomastia (GM) is the most frequent cause of male breast-related signs and symptoms and represents also the most common indication for mammography (MX) in men. In this article, our 7-year long experience with MX in men suffering from GM is reviewed, and the mammographic features of GM are presented. METHODS: MXs performed in male patients at our institution from January 2009 to January 2016 were retrospectively reviewed and patients with mammographic features of GM were selected. Informed consent was waived by the local institutional review board given the retrospective nature of the study. Mammograms were performed in both cranio-caudal (CC) and medio-lateral-oblique (MLO) views according to diagnostic needs. Clinical and pathologic data were obtained by review of patient charts. RESULTS: 37 males (aged between 13-79 years, mean 59 years) referred for MX at our institution because of palpable lump (31/37; 83.8%), breast enlargement (33/37; 89.2%), tenderness or pain (25/37; 67.6%). Of the 37 patients evaluated, 32 (86.5%) had true GM while 5 (13.5%) had pseudoGM. CONCLUSIONS: The evaluation of GM can be complex but a stepwise approach that starts with careful history taking and physical examination may obviate the need for extensive work-up. In this context, MX has been shown to be an accurate diagnostic tool for detecting GM and should be the first imaging examination to be performed in all clinically suspicious lesions referred for imaging.

Texture analysis in a rare case of tibial intraosseous lipoma.

Intraosseous lipoma is a very rare lesion, accounting for only 0.1% of all primary osseous tumors (1), first described in 1980 (2). This lesion is considered the rarest of benign bone tumors (3); probably it is not the actual incidence because these lesions are frequently asymptomatic and the introduction of cross-sectional imaging, especially MRI, seems to have increased the detection (4). The majority of intraosseus lipomas are in the lower limbs (70%) and the os calcis being the most frequently involved (32%). Most cases reported in literature have an age of 40 years (5). Tumor texture could be measured from medical images that provide a non-invasive method of capturing intratumoral heterogeneity and could potentially enable a prior assessment of a patient. Some Authors recently proposed Texture analysis to characterize musculoskeletal lesions (6). For the first time we measured the tumoral texture from Magnetic Resonance images in tibial intraosseous lipoma in a 29-years-old female.