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Learning objectives Background Findings and procedure details Conclusion Personal information References, Learning objectives: -To review the CT and MRI appearance of the cirrhotic liver. -To describe thepathologic conditions that can mimic...

Once considered an obscure tumor entity with poor prognosis, gastrointestinal stromal tumors (GISTs) are nowadays recognized as the most common mesenchymal tumors of the alimentary tract. GISTs differ from other mesenchymal neoplasms at pathology since 90% of them exhibit strong immunohistochemical staining for KIT, a tyrosinase kinase growth factor receptor. In the early 2000s, the ability of imatinib mesylate, a tyrosine kinase inhibitor, to inhibit KIT established a new paradigm for cancer treatment. A reduction in lesion size may not be observed or may appear many months after therapy; thus, tumor response criteria alternative to the Response Evaluation Criteria in Solid Tumors were developed. This review highlights the role of imaging in the detection, characterization, preoperative staging, postoperative assessment, therapy-response evaluation and treatment-related toxicities. All this information is crucial in optimizing patient management. Contrast-enhanced computed tomography is the most commonly used modality for staging the disease and assessing treatment response, whereas positron-emission tomography adds valuable functional information. Magnetic resonance imaging (MRI) may also be useful, especially in ano-rectal GISTs. Diffusion-weighted MRI may provide promising indicators of tumor response to targeted molecular therapy. Radiologists and oncologists should be aware of all these issues related to GISTs, since multidisciplinary teams gathering different expertise are usually needed to properly treat patients with GISTs.

Purpose. Our aim was to assess the incidence and ultrasound features of thyroid nodules in an adult population screened by means of high-resolution ultrasonography (HRUS) and to evaluate the contribution of real-time spatial compound sonography (CS) in terms of image quality. Materials and methods. A total of 704 consecutive patients (400 women, 304 men) without thyroid disease underwent HRUS and CS examination of the thyroid gland. Number, size, location, echotexture and colour Doppler pattern of detected nodules were assessed. Two radiologists also assessed image quality of the two techniques. Results. Seven hundred and eleven thyroid nodules (size range 0.18-4.1 cm; mean: 1.1 cm) were detected in 233 subjects (33.1%). Of these, 416 (58.5%) were found in 143 women whereas 295 (41.5%) were detected in 90 men. In both genders, the number of detected nodules increased with age, with the highest prevalence in the seventh decade (p

Aims and objectives Methods and materials Results Conclusion Personal information References, Aims and objectives: In the last years, the number of MRI scans has more than tripled[1]and this resulted in an unavoidable rise of incidentally detected findings[2-6]. According to a study by Orme et al.[7], a minimum of one incidental finding was present in 39.8% of...

This book offers an image-based, comprehensive quick reference guide that will assist in the interpretation of contrast-enhanced ultrasound (CEUS) examinations of the liver in daily practice. It describes and depicts typical and atypical behavior of both common and less frequently observed focal liver lesions. For each type of lesion, the findings on pre- and post-contrast images are presented and key characteristics are highlighted. Individual chapters also focus on the assessment of response to locoregional and systemic treatment and the impact of European guidelines on CEUS. The Atlas of Contrast-Enhanced Sonography of Focal Liver Lesions will serve as an invaluable hands-on tool for practitioners who need to diagnose liver lesions using CEUS in the major clinical settings: oncology patients, cirrhotic patients, and patients with incidental focal liver lesions. .

Purpose Methods and Materials Results Conclusion References Personal Information, Purpose: Gastro-Intestinal Stromal Tumors (GIST)are the most common tumors of non-epithelial gastrointestinal tract.Since the introduction of molecular targeted drug, there has been increasing concern about the use of the traditional tumor response...

Purpose Methods and Materials Results Conclusion References Personal Information, Purpose: The aim of our study was to assess the prognostic value at a long-term follow-up of CTCA in patients at intermediate pre-test probability of...

Purpose Methods and Materials Results Conclusion References Personal Information, Purpose: To assess the role of sonoelastography in the characterization of focal breast lesions undetermined at B-mode ultrasound...

Purpose Methods and Materials Results Conclusion References Personal Information, Purpose: Despite the remarkable improvements in spatial and contrast resolution brought about by technological progress, greyscale ultrasonography (US) remains burdened by limited specificity in the characterisation of focal liver lesions (FLL)...

The aim of the study was to assess the prognostic value of multidetector-row CT coronary angiography (MDCT-CA) in patients with suspected coronary artery disease (CAD) in a routine clinical context.A total of 125 patients (82 men, age 57.4±10.3 years) with suspected CAD underwent MDCT-CA. All patients were assessed for cardiovascular risk factors, symptoms and coronary calcium score. A 2-year follow-up study for the occurrence of major adverse cardiac events was performed.According to the Morise pretest score, 76 patients (60.8%) were at intermediate risk. Patients with suspected CAD presented the following prognostic outcome (p0.0001): in 41 patients with normal coronary arteries at MDCT-CA, the event rate was 0%; five of 49 patients with nonobstructive CAD had major cardiac events; two of 35 patients with obstructive CAD suffered cardiac death and 19 underwent revascularisation. At multivariate analysis, the presence of obstructive CAD is the only significant independent prognostic variable (hazard ratio, 10.1393; 95% confidence interval 3.2189-31.9379; p0.0001).Routine clinical MDCT-CA provides an excellent prognostic value at 2-year follow-up in patients with normal coronary arteries. The cardiac event rate increases with CAD severity.

Purpose Methods and Materials Results Conclusion References Personal Information, Purpose: Evaluate the diagnostic accuracy of MRI, comparing STIR images versus T1w post-contrast fat-sat images in patients affected by perianal Crohn’s Disease...

Purpose Methods and Materials Results Conclusion References Personal Information, Purpose: To evaluate the reliability and diagnostic potential of MDCT-Enterography (MDCT-E), an emerging technique of small bowel examination that combines the advantages of MDCT examination of the abdomen and the enteral volume challenge of enterography, in...

Purpose: to evaluate the role of contrast-enhanced ultrasound (CEUS) in the characterization of focal liver lesions (FLLs) for surgical patients selection. Materials and Methods: 135 consecutive patients (71 women, 64 men) with 165 FLLs (mean size: 3.1 cm) - 89 benign (10 simple cysts, 26 hemangiomas, 29 focal nodular hyperplasia (FNH), 2 hepatocellular adenomas, 11 focal fatty sparing, 3 focal fatty areas, 5 regenerative nodules, 2 hydatid cysts, 1 abscess) and 76 malignant - 47 metastases, 26 hepatocellular carcinomas and 3 peripheral cholangiocarcinomas - underwent CEUS after the administration of SonoVue®. Two readers reviewed in consensus baseline US and CEUS scans obtained 25-30 s (arterial phase), 55-80 s (portal-venous phase), and 235-260 s (late phase) after the beginning of SonoVue® injection respectively. The readers classified each lesion as malignant or benign by means of definite diagnostic criteria. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated. Results: CEUS correctly ha characterized 156/165 (94,5%) FLLs, 85 benign and 71 malignant. 5/165 (3%) FLLs, 3 hemangiomas e 2 HCCs, remained undetermined after CEUS and 4/165 (2,4%) FLLs, 3 HCCs and 1 abscess were misdiagnosed. CEUS showed sensitivity, specificity, and diagnostic accuracy values of 93,4%, 95,5% e 94,7% respectively. positive predictive value and negative predictive values were 94,7% e 94,4%.

Purpose: To evaluate the diagnostic accuracy of MRI, comparing STIR images versus T1w post-contrast fat-sat images in patients affected by perianal Crohn’s disease (CD). Material and methods: From January 2007 to July 2008, 73 patients with perianal CD underwent pelvic MRI using an external phased array coil. All studies were performed with a 1.5T MRI scanner. STIR and T1w post-contrast fat-sat images were independently analysed by two expert radiologists. Perianal fistulas were classified according to the Parks surgical classification. All patients underwent examination under anesthesia (EUA) that was considered gold standard. Results: By analysing STIR, images documented 31 simple fistulas, 58 complex fistulas, 12 perianal abscess, 4 rectovaginal fistulas and 1 enteroenterica fistula. By analysing T1w, post-contrast fat-sat images documented 33 simple fistulas, 59 complex fistulas, 12 perianal abscess, 4 rectovaginal fistulas and 1 enteroenteric fistula. Pelvic MRI clearly depicted perianal manifestations of CD in all patients with full concordance with EUA in 70 patients (96%). Conclusion: MRI can be considered an accurate technique to identify and classify perianal manifestations of CD. STIR images were almost as useful as T1w post-contrast fat-sat images to show perianal CD findings and could be used to follow-up these patients without administration of contrast-medium.

Learning objectives: To provide a detailed step-by-step description of the technique of MR enteroclysis (MRE). To illustrate the spectrum of MRE findings in patients with Crohn’s disease (CD) and their correlation with findings at conventional enteroclysis (CE). To discuss the advantages and limitations of MRE in patients with CD. Background: CE is the gold standard for small bowel pathologies. However, submucosal and mesenteric involvements, which are common in CD, cannot be assessed by CE. Therefore, the evaluation of the mucosa alone by CE may under-represent the extent and activity of the disease. Also, CE is associated with the risk of several complications, mainly exacerbation in severe disease. MRE is a promising new modality that is useful in CD since it allows the assessment of mural and mesenteric changes. Imaging findings OR Procedure details: Between January 2007 and December 2008, 48 patients with CD were submitted to MRE performed with a 1.5 T MR scan unit. All patients had undergone a previous CE. We report step-by-step the methodology MRE procedure, its technical aspects, strengths and weaknesses of each sequence, and future directions of the technique. MRC findings and their correlation with CE are illustrated and shown according to the type of CD using Crohn’s disease activity index (CDAI) and pathology as referenced standard. Conclusion: MRE allows the evaluation of both CD activity and extramural complications. MRE findings show a good correlation with CE. MRE can be a feasible alternative method to CE for assessing CD and its complications.