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The purpose of our study was to assess the potential role of chest CT in the early detection of COVID-19 pneumonia and to explore its role in patient management in an adult Italian population admitted to the Emergency Department.Three hundred and fourteen patients presented with clinically suspected COVID-19, from March 3 to 23, 2020, were evaluated with PaO2/FIO2 ratio from arterial blood gas, RT-PCR assay from nasopharyngeal swab sample and chest CT. Patients were classified as COVID-19 negative and COVID-19 positive according to RT-PCR results, considered as a reference. Images were independently evaluated by two radiologists blinded to the RT-PCR results and classified as "CT positive" or "CT negative" for COVID-19, according to CT findings.According to RT-PCR results, 152 patients were COVID-19 negative (48%) and 162 were COVID-19 positive (52%). We found substantial agreement between RT-PCR results and CT findings (p 0.000001), as well as an almost perfect agreement between the two readers. Mixed GGO and consolidation pattern with peripheral and bilateral distribution, multifocal or diffuse abnormalities localized in both upper lung and lower lung, in association with interlobular septal thickening, bronchial wall thickening and air bronchogram, showed higher frequency in COVID-positive patients. We also found a significant correlation between CT findings and patient's oxygenation status expressed by PaO2/FIO2 ratio.Chest CT has a useful role in the early detection and in patient management of COVID-19 pneumonia in a pandemic. It helps in identifying suspected patients, cutting off the route of transmission and avoiding further spread of infection.

The concept of ideal tumor surgery is to remove the neoplastic tissue without damaging adjacent normal structures. High-intensity focused ultrasound (HIFU) was developed in the 1940s as a viable thermal tissue ablation approach. In clinical practice, HIFU has been applied to treat a variety of solid benign and malig- nant lesions, including pancreas, liver, prostate, and breast carcinomas, soft tissue sarcomas, and uterine fibroids. More recently, magnetic resonance guidance has been applied for treatment monitoring during focused ultrasound procedures (magnetic resonance-guided focused ultra- sound, MRgFUS). Intraoperative magnetic resonance imaging provides the best possible tumor extension and dynamic control of energy deposition using real-time magnetic resonance imaging thermometry. We introduce the fundamental principles and clinical indications of the MRgFUS technique; we also report different treatment options and personal outcomes.

Atherosclerosis is the leading cause of peripheral occlusive arterial disease in patients aged over 40 years ( Dormandy and Rutherford, 2000). This pathology often affects adult patients with diabetes, metabolic syndrome or severe chronic renal disease, but also young people with vasculitis or paraneoplastic syndromes.

Objectives: The objectives of this study were to evaluate the efficacy in painmanagement of magnetic resonance (MR)Yguided focused ultrasound for theprimary treatment of painful bone metastases and to assess its potential for localcontrol of bone metastases.Materials and Methods: This was a prospective, single-arm research studywith approval from the institutional review board. Eighteen consecutive patients(female, 8; male, 10; mean [SD] age, 62.7 [11.5] years) with painful bone me-tastases were enrolled. The patients were examined clinically for pain severityand pain interference in accordance with the Brief Pain Inventory-Quality ofLife criteria before and at each follow-up visit. Computed tomography andMR imaging were performed before and at 1 and 3 months after the mag-netic resonanceYguided focused ultrasound treatment. The nonperfused volume(NPV) was calculated to correlate the extension of the ablated pathological tis-sue in the responder and nonresponder patients.Results: No treatment-related adverse events were recorded during the study.The evaluation of pain palliation revealed a statistically significant differencebetween baseline and follow-up values for pain severity and pain interference(P = 0.001, both evaluations). In the evaluation of local tumor control, we ob-served increased bone density with restoration of cortical borders in 5 of the18 patients (27.7%). In accordance with the MD Anderson criteria, completeand partial responses were obtained in 2 of the 18 patients (11.1%) and 4 of the18 patients (22.2%), respectively. Nonperfused volume values ranged between20% and 93%. Mean NPV values remained substantially stable after the treat-ment (P = 0.08). There was no difference in the NPV values between the re-sponder and nonresponder patients (46.7% [24.2%] [25%Y90%] versus 45%[24.9%] [20%Y93%]; P = 0.7).Conclusions: Magnetic resonanceYguided focused ultrasound can be safelyand effectively used as the primary treatment of pain palliation in patientswith bone metastases and has a potential role in local tumor control.Key Words: MRgFUS, high-intensity focused ultrasound, bone metastases,pain palliation, MR-guided interventional radiology, cancer, oncology(Invest Radiol 2013;48: 00Y00)

Purpose: To evaluate the diagnostic performance and effect on therapeutic management of 64-section computed tomographic (CT) angiography in the assessment of steno-occlusive disease in patients with peripheral arterial disease (PAD), with conventional digital subtraction angiography (DSA) as the reference standard. Materials and Methods: The study protocol was approved by the institutional review board, and written informed consent was obtained from all patients. A total of 212 patients with symptomatic PAD underwent CT angiography and subsequent DSA. For stenosis analysis ( ≥70% stenosis), the arterial bed was divided into 35 segments and evaluated by three readers. Interobserver agreement was determined with generalized k statistics. Accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were calculated. In addition, according to the TransAtlantic Inter-Society Consensus (TASC) Document on Management of Peripheral Arterial Disease guidelines, treatment recommendations based on CT angiographic and DSA fi ndings were compared. McNemar test was used to prove signifi cant differences between CT angiographic and DSA fi ndings. Results: A total of 7420 arterial segments were evaluated, with excellent agreement between readers ( κ ≥ 0.928). On a segmental basis, both sensitivity and specifi city for stenosis of 70% or more were at least 96% (3072 of 3113 segments and 4141 of 4279 segments, respectively), with an accuracy of 98% (7213 of 7392 segments), a PPV of 96% (3072 of 3187 segments), an NPV of 99% (3141 of 3187 segments), a PLR of 36.7, and an NLR of 0.013. There was no significant difference between CT angiographic and DSA findings ( P = .62-.87 ). In accordance with TASC II guidelines, 49 patients were referred for conservative treatment, 87 underwent endovascular procedures, 38 underwent surgery, and 17 received hybrid treatment. Therapy recommendations based on CT angiographic fi ndings alone were identical to those based on DSA fi ndings in all but one patient. Conclusion: The diagnostic performance of 64-section CT angiography is excellent in patients with clinical symptoms of PAD. The results can be used to effectively guide therapeutic decision making in these patients. © RSNA, 2011.

Materials and methods After giving their informed consent 5 patients with histologically proven unresectable pancreatic adenocarcinoma and 1 patient with unresectable right lobe HCC (4 males, 2 females; age range 58-72) underwent MRgFUS treatment on a dedicated 3T unit featuring the ExAblate 2100 system (InSightec). The system is composed by a 200-element transducer located within the MR table. The MR guidance allows a detailed depiction and visualization of the lesion; moreover, the use of the proton resonance frequency (PRF) shift method allows a real time monitoring of the temperature inside the target lesion and the adjacent anatomical structures, in order to ensure adequate tissue ablation and safe ablation margins. The treatment was performed in general anesthesia with breath control. After the procedure, gadolinium-enhanced gradient echo T1-weighted sequences were performed in order to evaluate the ablated area and the absence of possible local complications. Clinical and imaging follow-up was performed with both MR and CT at 3 and 6 months after treatment respectively for the patient with HCC and those with pancreatic cancer. Results Treatment was successfully performed in all patients without any adverse events during or after the procedure. MR images acquired immediately after treatment demonstrated necrosis of ablated area within the lesion in all cases; in particular the HCC was completely non-enhancing. At short term clinical follow-up, all the patients with pancreatic cancer referred reduction of pain symptoms due to infiltration of the celiac plexus. However follow-up imaging demonstrated recurrence of pathologic tissue within the ablated area, even if there was no local progression of the disease. Two patients with pancreatic cancer underwent radiotherapy after treatment, while the remaining one underwent another MRgFUS ablation.

Palliative treatment of bone metastases: analysis of biological effects of MR guided Focused Ultrasound (MRgFUS) versus External Beam Radiation Therapy (EBRT). A randomized comparative trial using Functional Diffusion Maps as molecular activity indicator Michele Anzidei, Alessandro Napoli, Giulia Brachetti, Maurizio Del Monte, Daniel De Olivera, Fabrizio Andrani, Carola Palla, Luca Bertaccini, Daniela Musio, Vincenzo Tombolini, Carlo Catalano