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Objective: In this study, we investigate whether a Convolutional Neural Network (CNN) can generate informative parametric maps from the pre-processed CT perfusion data in patients with acute ischemic stroke in a clinical setting., Methods: The CNN training was performed on a subset of 100 pre-processed perfusion CT dataset, while 15 samples were kept for testing. All the data used for the training/testing of the network and for generating ground truth (GT) maps, using a state-of-the-art deconvolution algorithm, were previously pre-processed using a pipeline for motion correction and filtering. Threefold cross validation had been used to estimate the performance of the model on unseen data, reporting Mean Squared Error (MSE). Maps accuracy had been checked through manual segmentation of infarct core and total hypo-perfused regions on both CNN-derived and GT maps. Concordance among segmented lesions was assessed using the Dice Similarity Coefficient (DSC). Correlation and agreement among different perfusion analysis methods were evaluated using mean absolute volume differences, Pearson correlation coefficients, Bland-Altman analysis, and coefficient of repeatability across lesion volumes., Results: The MSE was very low for two out of three maps, and low in the remaining map, showing good generalizability. Mean Dice scores from two different raters and the GT maps ranged from 0.80 to 0.87. Inter-rater concordance was high, and a strong correlation was found between lesion volumes of CNN maps and GT maps (0.99, 0.98, respectively)., Conclusion: The agreement between our CNN-based perfusion maps and the state-of-the-art deconvolution-algorithm perfusion analysis maps, highlights the potential of machine learning methods applied to perfusion analysis. CNN approaches can reduce the volume of data required by deconvolution algorithms to estimate the ischemic core, and thus might allow the development of novel perfusion protocols with lower radiation dose deployed to the patient., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Gava, D’Agata, Tartaglione, Renzulli, Grangetto, Bertolino, Santonocito, Bennink, Vaudano, Boghi and Bergui.)

Endovascular treatment (ET) showed to be safe in acute stroke, but its superiority over intravenous thrombolysis is debated. As ET is rapidly evolving, it is not clear which role it may deserve in the future of stoke treatments. Based on an observational design, a treatment registry allows to study a broad range of patients, turning into a powerful tool for patients' selection. We report the methodology and a descriptive analysis of patients from a national registry of ET for stroke. The Italian Registry of Endovascular Treatment in Acute Stroke is a multicenter, observational registry running in Italy from 2010. All patients treated with ET in the participating centers were consecutively recorded. Safety measures were symptomatic intracranial hemorrhage, procedural adverse events and death rate. Efficacy measures were arterial recanalization and 3-month good functional outcome. From 2008 to 2012, 960 patients were treated in 25 centers. Median age was 67 years, male gender 57 %. Median baseline NIHSS was 17. The most frequent occlusion site was Middle cerebral artery (46.9 %). Intra-arterial thrombolytics were used in 165 (17.9 %) patients, in 531 (57.5 %) thrombectomy was employed, and 228 (24.7 %) patients received both treatments. Baseline features of this cohort are in line with data from large clinical series and recent trials. This registry allows to collect data from a real practice scenario and to highlight time trends in treatment modalities. It can address unsolved safety and efficacy issues on ET of stroke, providing a useful tool for the planning of new trials.

Aim: Aim of the present study was to evaluate advantages and disadvantages of the sacrospinous ligament fixation (SSF) technique using the Capio™ suture capturing device (Boston Scientific, Natick, MA, USA) in a group of menopausal women affected by vaginal vault prolapse., Methods: This was an observational, retrospective, cross-sectional study. Menopausal women with vaginal vault prolapse (grade >2) who had never before been treated to correct the vaginal prolapse received the SSF technique using the Capio™ suture capturing device., Results: Forty-seven patients underwent unilateral (38.2%) or bilateral (61.8%) fixation, through the paravescical (65.9%) or pararectal (34.1%) route. Median follow-up was 18.5 months (range 3-34); follow-up visits were performed 30 days after the intervention, at 3, 6 and 12 months in the first postoperative year and every 6 months from then on. Other concomitant procedures such as cystopexy, rectopexy, correction of enterocele or vaginal paravaginal repair were performed as necessary. The procedure was successful in 89.3% of patients, with a resulting mean vaginal length of 7.1±2.4 cm, regardless of the approach used. Only 5 patients suffered from prolapse recurrence. Main long-term complications were de novo and recurrent cystocele, observed mainly in patients who presented risk factors and with no significant differences related to the surgical procedure., Conclusion: The use of the Capio™ suture capturing device can simplify the SSF procedure compared with the traditional technique. The use of small devices requires less surgical dissection, reducing surgery time. Future studies are required to solve open issues.

In this work we report our initial experience on the utilisation of the spiral tomodensitometry in the study of the vascular complications due to the catheterization of the internal jugular vein. We present the results of a systematic search of vascular lesions after removal of an indwelling catheter in a group of 18 patients and describe a few cases of acute complications where the use of TDMS has been very useful in the diagnostic workout. The results confirm the risks associated with the catheterization of the internal jugular vein, showing a frequency of lesions of various degree in about 50% of the cases. Moreover, we discuss some aspects of the thrombotic complications in the patients carrying a central venous catheter and the advantages of the diagnostic application of the spiral tomodensitometry.

The authors present and demonstrate the more typical CT patterns of cerebrovascular diseases in old age, on the basis of literature and of personal experience of more than 1000 CT examinations of old patients in 1991-1992. They stress the basic role of CT in differential diagnosis between hemorrhagic and ischemic lesions. Finally, they propose a protocol for the better use of CT in the early diagnosis and the outcome of cerebrovascular diseases.

Chronic constipation and defecation disorders are a very common disease, but the diagnosis is often unsatisfactory and therefore therapy is mostly inadequate. The purpose of this paper is to demonstrate the contribution of radiological procedures and mainly of the defecography, in improving and determining the diagnosis itself. Many normal and pathological cases are reviewed, described and demonstrated by radiological patterns. Finally, a correct protocol of different procedures, radiological and not, for morphological and functional study of large bowel and pelvis floor is stressed.