Updates on Quantitative MRI of Diffuse Liver Disease. A Narrative Review

Diffuse liver diseases are highly prevalent conditions around the world, including pathological liver changes that occur when hepatocytes are damaged and liver function declines, often leading to a chronic condition. In the last years, Magnetic Resonance Imaging (MRI) is reaching an important role in the study of diffuse liver diseases moving from qualitative to quantitative assessment of liver parenchyma. In fact, this can allow noninvasive accurate and standardized assessment of diffuse liver diseases and can represent a concrete alternative to biopsy which represents the current reference standard. MRI approach already tested for other pathologies include diffusion-weighted imaging (DWI) and radiomics, able to quantify different aspects of diffuse liver disease. New emerging MRI quantitative methods include MR elastography (MRE) for the quantification of the hepatic stiffness in cirrhotic patients, dedicated gradient multiecho sequences for the assessment of hepatic fat storage, and iron overload. Thus, the aim of this review is to give an overview of the technical principles and clinical application of new quantitative MRI techniques for the evaluation of diffuse liver disease

Chest CT Features of COVID-19 in Rome, Italy

Background The standard for diagnosis of SARS-CoV-2 virus is reverse transcription polymerase chain reaction (RT-PCR) test, but chest CT may play a complimentary role in the early detection of COVID-19 pneumonia. Purpose To investigate CT features of patients with COVID-19 in Rome, Italy, and to compare the accuracy of CT with RT-PCR. Methods In this prospective study from March 4, 2020, until March 19, 2020, consecutive patients with suspected COVID-19 infection and respiratory symptoms were enrolled. Exclusion criteria were: chest CT with contrast medium performed for vascular indications, patients who refused chest CT or hospitalization, and severe CT motion artifact. All patients underwent RT-PCR and chest CT. Diagnostic performance of CT was calculated using RT-PCR as reference. Chest CT features were calculated in a subgroup of RT-PCR-positive and CT-positive patients. CT features of hospitalized patients and patient in home isolation were compared by using Pearson chi squared test. Results Our study population comprised 158 consecutive study participants (83 male and 75 female, mean age 57 y ±17). Fever was observed in 97/158 (61%), cough in 88/158 (56%), dyspnea in 52/158 (33%), lymphocytopenia in 95/158 (60%), increased C-reactive protein level in 139/158 (88%), and elevated lactate dehydrogenase in 128/158 (81%) study participants. Sensitivity, specificity, and accuracy of CT were 97% (60/62)[95% IC, 88-99%], 56% (54/96)[95% IC,45-66%] and 72% (114/158)[95% IC 64-78%], respectively. In the subgroup of RT-PCR-positive and CT-positive patients, ground-glass opacities (GGO) were present in 58/58 (100%), multilobe and posterior involvement were both present in 54/58 (93%), bilateral pneumonia in 53/58 (91%), and subsegmental vessel enlargement (> 3 mm) in 52/58 (89%) of study participants. Conclusion The typical pattern of COVID-19 pneumonia in Rome, Italy, was peripherally ground-glass opacities with multilobe and posterior involvement, bilateral distribution, and subsegmental vessel enlargement (> 3 mm). Chest CT sensitivity was high (97%) but with lower specificity (56%)

POSTER. The Euphrate City Gate (1998 Ist International Congress of Ancient Near East, Rome).

ABSTRACT. The excavation area is situated on the North-East slope of the earthenwork. The first stage of field work involved the eastern part of the excavation area and then proceeded in an East-West direction. In the second stage of the excavation the central western and southern sectors were excavated. The excavation ended on 23/10/1997 with the discovery of an area of 23 squares for a total of almost 575 sq. m.. During the first stage of the excavation, facing the northern part, a classical three-piered gate was found with the central axis oriented NE-SW. The North side rests directly on the main part of the rampart, to which is connected by stratified layers of compacted red soil containing heavy deposit of limestone, arranged in horizontal strips almost intentionally, like a hinge between the two, uniting them (door and rampart) architecturally. The structure is constructed entirely of stone, but each part has distinctive technical and constructive features. The eastern end of the area consists of a long wall oriented in an East-West direction which establishes the boundaries of a hypothetical outer forecourt, which is situated in front of the entrance to the gate. In the central eastern area of the North front, the discovery of a probable substructure has been found of a more or less square, angular, defensive tower (M.7030), measuring 4 x 4 m., which is raised by using rows of medium and large stones arranged in three horizontal rows. These stones in the eastern façade form a stepped wall which could possibly have been, originally, used as access stairs to the fortification. The upper part of the substructure features a surface drawing, consisting of well arranged small stones, possibly the base for the collapsed mudbrick wall which was removed during the excavation. The wall defining in the North the passage of the gate M.7010 features a structural body built of medium large stones arranged in superimposed rows, sloping towards the surface of the inner passage. The low revetment of the façade is composed of large, attractive, well-hewn squared stones arranged in a way to draw the three-piered plan, that is a classical architectural and structural element of Middle Bronze city gates. The eastern part of the façade was badly damaged and shows the superimposition of constructions work done at a later date (taken down and removed). These last structures also covered the southern façade of the so-called M. 7030 tower. The West part of the exterior perimeter of the gate, presumed to be the third pier delimiting the room L. 7015, has been completely removed, but its existence is well documented by a mark, where the low revetment of the gate and the stone-paved road L. 7015, were in contact. The inner gate access consisted of an impressive stone-paved road (L. 7015), under which was located a well built drain (L. 7007), that allowed the lower city’s sewage to be transported outside of the rampart. The road is seriously damaged in its eastern half, because of continued usage for remover up until recent times. Plundering of these stones are also a reason for the disappearance of the entire southern section of the gate. In the western area of the excavation a small, rectangular room with an entrance on the south side and an axial niche obtained from the northern part of the wall, was identified. The foundations of the North and West sides abutted the rampart. Only after the removal of an Iron Age small installation that had a similar orientation, which concealed the original southern structure of the Middle Bronze room, while reusing the North and West walls, was it possible to reach the building. The southern area of the excavation is also seriously damaged, nevertheless it was possible to find traces of a large wall oriented NW-SE (M. 7031), delimited on the West by a row of regular, square, hewn stones. This structure was reached after the removal of collapsed boulder sized stones, which were positioned in a North-South line. The body of the wall was constructed, like M. 7010, of a bed of large stones positioned horizontally to form a stepped western side. The upper part was a surface made up of stones of varying dimensions, probably the base for the mudbrick structure. A well made floor of small pebbles and mortar (4 cm. thick) abuts the West side of M. 7031, so that it is difficult to value the stratigraphic relation between the two architectural elements (the floor L. 7021 and the wall M. 7031). The short wall M. 7049 is the South-West border between the zone behind the gate and the lower city; the beaten floor found outside the wall is similar to the one that originally was connected to the paved road. On the North side of M. 7031 a limestone orthostat has been found, perfectly cut, that probably was part of the low outer revetment of the gate’s South-West limit. A small door socket, immediately on the East, if in situ, should indicate, along with the orthostat, the South limit of the gate’s inner road

A master role for neutrophils in Kawasaki syndrome

Kawasaki syndrome (KS) is well-known as a systemic vasculitisthat predominantly affects small and medium-sized vessels in chil-dren younger than 5 years, with a specific risk of coronary arteryinvolvement: its diagnosis is based on clinical criteria and echocar-diographic assessment according to the guidelines of the JapaneseKS Research Committe

Imaging of Hepatocellular Carcinoma

Imaging techniques play a crucial role in the diagnosis, staging, surveillance and assessment of the treatment response of hepatocellular carcinoma (HCC). An increasingly pivotal role is currently played by computed tomography and magnetic resonance imaging, which can simultaneously provide a conclusive diagnosis without the need for histological confirmation and tumor staging, while ultrasound and contrast-enhanced ultrasound are limited to surveillance of HCC patients. The aim of this chapter is to give an overview of the most used liver imaging techniques and the main imaging characteristics of HCC

Critical Overview of the Risk Scoring Systems to Predict Non-Responsiveness to Intravenous Immunoglobulin in Kawasaki Syndrome

Kawasaki syndrome (KS) is the most relevant cause of heart disease in children living in developed countries. Intravenous immunoglobulin (IVIG) has a preventive function in the formation of coronary artery abnormalities and a poor strictly-curative action in established coronary damage. More than two decades ago, the Harada score was set to assess which children with KS should be subject to administration of IVIG, evaluating retrospectively a large cohort of patients with regard to age, sex and laboratory data. Nowadays, high dose IVIG is administered to all children with a confirmed diagnosis of KS, but a tool for predicting non-responsiveness to the initial infusion of IVIG has not been found. The prediction of IVIG resistance is a crucial issue, as recognising these high-risk patients should consent the administration of an intensified initial treatment in combination with IVIG in order to prevent coronary injuries. Few reports have focused on factors, referring to both clinical parameters and laboratory data at the onset of KS, in order to predict which patients might be IVIG non-responsive. We have analysed three different risk scores which were formulated to predict IVIG resistance in Japanese children with typical KS, but their application in non-Japanese patients or in those with incomplete and atypical patterns of the disease has been studied in a fragmentary way. Overall, our analysis showed that early and definite ascertainment of likely IVIG non-responders who require additional therapies reducing the development of coronary artery involvement in children with KS is still a challenge

Influence of adaptive statistical iterative reconstructions on CT radiomic features in oncologic patients

Iterative reconstructions (IR) might alter radiomic features extraction. We aim to evaluate the influence of Adaptive Statistical Iterative Reconstruction-V (ASIR-V) on CT radiomic features. Patients who underwent unenhanced abdominal CT (Revolution Evo, GE Healthcare, USA) were retrospectively enrolled. Raw data of filtered-back projection (FBP) were reconstructed with 10 levels of ASIR-V (10-100%). CT texture analysis (CTTA) of liver, kidney, spleen and paravertebral muscle for all datasets was performed. Six radiomic features (mean intensity, standard deviation (SD), entropy, mean of positive pixel (MPP), skewness, kurtosis) were extracted and compared between FBP and all ASIR-V levels, with and without altering the spatial scale filter (SSF). CTTA of all organs revealed significant differences between FBP and all ASIR-V reconstructions for mean intensity, SD, entropy and MPP (all p < 0.0001), while no significant differences were observed for skewness and kurtosis between FBP and all ASIR-V reconstructions (all p > 0.05). A per-filter analysis was also performed comparing FBP with all ASIR-V reconstructions for all six SSF separately (SSF0-SSF6). Results showed significant differences between FBP and all ASIR-V reconstruction levels for mean intensity, SD, and MPP (all filters p < 0.0315). Skewness and kurtosis showed no differences for all comparisons performed (all p > 0.05). The application of incremental ASIR-V levels affects CTTA across various filters. Skewness and kurtosis are not affected by IR and may be reliable quantitative parameters for radiomic analysis

Imaging of abdominal complications of COVID-19 infection

Coronavirus disease 2019 (COVID-19) is a respiratory syndrome caused by severe acute respiratory syndrome corona- virus 2 (SARS-CoV-2) first described in Wuhan, Hubei Province, China in the last months of 2019 and then declared as a pandemic. Typical symptoms are represented by fever, cough, dyspnea and fatigue, but SARS-CoV-2 infection can also cause gastrointestinal symptoms (vomiting, diarrhoea, abdominal pain, loss of appetite) or be totally asymptomatic. As reported in literature, many patients with COVID-19 pneumonia had a secondary abdominal involvement (bowel, pancreas, gallbladder, spleen, liver, kidneys), confirmed by laboratory tests and also by radiological features. Usually the diagnosis of COVID-19 is suspected and then confirmed by real-time reverse-transcription-polymerase chain reaction (RT-PCR), after the examination of the lung bases of patients, admitted to the emergency department with abdom- inal symptoms and signs, who underwent abdominal-CT. The aim of this review is to describe the typical and atypical abdominal imaging findings in patients with SARS-CoV-2 infection reported since now in literature