Incidental finding of bronchial diverticula in a non-smoker population: evaluation on thin-section CT

Bronchial diverticula have been described as a common radiological finding in smoker patients with COPD, but the specificity of this sign should be further investigated. Thus, the aim of our study was to evaluate the prevalence of diverticula in a cohort of non-smoker subjects. Between February and July 2012, 2438 patients were admitted to our Radiology Unit to undergo a chest CT. Among them, we enrolled 121 non-smoking patients (78/121-64.5% females, 43/121-35.5% males), of different age (57.0±20.7 years-range: 12-88), without any respiratory symptoms, submitted to chest CT for several reasons (oncologic evaluation: 59/121-48.8%; follow up of lung nodules: 27/121-22.3%; screening in connectivitis: 12/121-9.9%; others: 23/121-19.0%). We considered thin-section CT scan on axial, coronal and sagittal plans to evaluate prevalence, numbers and level of bronchial diverticula. Diverticula were found in 41/121-33.9% patients, with a slight major prevalence in males (p=0.048), but no significant difference on age. In 31/41-75.6% the number was <3, whereof 17/31-54.8% with just one diverticulum assessed. Regarding the level, in 30/41-73.2% they were subcarinal, but they were also detected in mainstem (2/41-4.9%) and lobar bronchi (with the right upper lobe bronchus most frequently involved- 12/41-29.3%). Bronchial diverticula can be observed in non-smokers, as well as in smoker patients with COPD. However, their prevalence seems to be lower than in smokers and they tend to be isolated and subcarinal. The age of patients does not influence their finding. More studies should be proposed to better define a cut-off between smokers and healthy subjects

Efficacy of radioembolization according to tumor morphology and portal vein thrombosis in intermediate–advanced hepatocellular carcinoma

Purpose: We analyzed overall survival (OS) following radioembolization according to macroscopic growth pattern (nodular vs infiltrative) and vascular invasion in intermediate-advanced hepatocellular carcinoma (HCC). Methods: Between September 2005 and November 2013, 104 patients (50.0% portal vein thrombosis [PVT], 29.8% infiltrative morphology) were treated. Results: Median OS differed significantly between patients with segmental and lobar or main PVT (p = 0.031), but was 17 months in both those with patent vessels and segmental PVT. Median OS did not differ for infiltrative and nodular HCC. Median OS was prolonged in patients with a treatment response at 3 months (p = 0.023). Prior TACE was also a significant predictor of improved OS. Conclusion: A further indication for radioembolization might be infiltrative HCC, since OS was similar to nodular types

Three cases of bone metastases in patients with gastrointestinal stromal tumors

Gastrointestinal stromal tumors (GISTs) are rare, but represent the most common mesenchymal neoplasms of the gastrointestinal tract. Tumor resection is the treatment of choice for localized disease. Tyrosine kinase inhibitors (imatinib, sunitinib) are the standard therapy for metastatic or unresectable GISTs. GISTs usually metastasize to the liver and peritoneum. Bone metastases are uncommon. We describe three cases of bone metastases in patients with advanced GISTs: two women (82 and 54 years of age), and one man (62 years of age). Bones metastases involved the spine, pelvis and ribs in one patient, multiple vertebral bodies and pelvis in one, and the spine and iliac wings in the third case. The lesions presented a lytic pattern in all cases. Two patients presented with multiple bone metastases at the time of initial diagnosis and one patient after seven years during the follow-up period. This report describes the diagnosis and treatment of the lesions and may help clinicians to manage bones metastases in GIST patients

Focal lesions in the cirrhotic liver: Their pivotal role in gadoxetic acid-enhanced MRI and recognition by the Western guidelines

Hepatocellular carcinoma (HCC) is a major health concern, and early HCC diagnosis is a primary radiological concern. The goal of imaging liver cirrhosis is the early identification of high-grade dysplastic nodules/early HCC since their treatment is associated with a higher chance of radical cure and lower recurrence rates. The newly introduced MRI contrast agent gadoxetic acid (gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid, Gd-EOB-DTPA) has enabled the concurrent assessment of tumor vascularity and hepatocyte-specific contrast enhancement during the hepatobiliary phase (HBP), which can help to detect and characterize smaller HCCs and their precursors. HBP-EOB-MRI identifies hypovascular HCC nodules that are difficult to detect using ultrasonography or computed tomography, which do not show the diagnostic HCC hallmarks of arterial washin and portal/delayed washout. During the HBP, typical HCC and early HCC appear hypointense on EOB-MRI, whereas lowgrade dysplastic or regenerative nodules appear as iso- or hyperintense lesions. The diagnostic accuracy of EOB-MRI for the diagnosis of early HCC is approximately 95-100%. One third of hypovascular hypointense nodules in HBP become hypervascular 'progressed' HCC, with a 1- and 3-year cumulative incidence of 25 and 41%, respectively. Therefore, these hypovascular nodules should be strictly followed up or definitely treated as typical HCC. Due to this capability of identifying the precursors and biological behavior of HCC, EOB-MRI has rapidly become a key imaging tool for the diagnosis of HCC and its precursors, despite the scarce MRI availability throughout Europe. With increasing experience, EOB-MRI may eventually be established as the diagnostic imaging modality of choice in this setting. Full recognition by the Western EASL-AASLD guidelines is expected

PERCUTANEOUS TREATMENT OF BILIARY AND VASCULAR COMPLICATIONS

Advances in surgical techniques and immunosuppression have made liver transplantation (LT) a first-line treatment for many patients with end-stage liver disease. The early imaging detection and the technological improvements in miniinvasive treatment of postoperative complications have contributed significantly to improved graft and patient survival, with interventional radiology playing a pivotal role in the multidisciplinary team following LT recipients

Intraoperative microvascular assessment with contrast-enhanced ultrasound (CEUS) during uterine artery embolisation (UAE) : a case report and literature review

The clinical success of uterine artery embolization is determined by its endpoint. An aggressive UAE could lead to endometritis and increases the risk of unintended embolization of other organs. Conversely, an incomplete procedure may result in a poor clinical outcome due to regrowth of the fibroids. We present a case with innovative use of intraoperative contrast-enhanced ultrasonography (CEUS) for the assessment of vascularity of the targeted fibroid to determine the endpoint of embolization perioperatively. We aim to report a case of the use of intraoperative CEUS during UAE to highlight the potential pitfall of its use and provide a review of its application in the literature. Our case affirms the reported usefulness and the practical feasibility to assess the vascularity of fibroids during UAE and highlights that caution should be made by operators in cases of multiple fibroids

Thoracic manifestations of Eisenmenger's Syndrome in Adult Patients: A MDCT Review

The aim of this review was to illustrate the thoracic MDCT angiography findings and complications of adult patients with PAH-CHD and in particular of those with ES

New regions of interest in body composition analysis by dual energy X-ray absorptiometry: "liver adiposity".

Purpose: Hepatic steatosis is an increasing worldwide metabolic disease and the earliest biomarker for the liver fibrosis development. Thus, its detection and quantification during non-invasive examinations should be always considered as clinically relevant. Our aim was to test new designed regions of interest (ROIs) on whole body images acquired by dual energy x-ray absorptiometry (DXA) in comparison with DXA conventional ROIs and ultrasonography (US) in order to evaluate predictive values on liver steatosis detection and grading. Methods and Materials: Ninety-nine subjects directed to body composition assessment by DXA were prospectively enrolled. All patients were submitted to whole body DXA scan (Lunar iDXA, software enCORE 12.0) and underwent US evaluation on the same day to assess hepatic steatosis (mild-moderate-severe). On every DXA image three new liver-suited ROIs were manually created by a skilled radiologist. Fat mass (FM) and FM percentage (FMp) were investigated on whole body and regionally (android and new ROIs). FM and FMp results were correlated with US Results: Out of 99 patients, 70 (70.7%) resulted affected by liver steatosis on US evaluation (32/70&#8722;45.7% mild, 32/70&#8722;45.7% moderate and 6/70&#8722;8.6% severe). FM and FMp of all ROIs were significantly correlated with presence and grading of steatosis (p &lt; 0.001); however, they were able to predict and to distinguish steatosis absence from moderate and severe grade, but not mild. FMp of one among the new liver-suited ROIs showed the best predictive value for liver steatosis. Conclusion: New ROIs should be included in whole body DXA examinations to provide additional information and higher predictive value on liver steatosis