11 research outputs found
A Better Characterization of Spinal Cord Damage in Multiple Sclerosis: A Diffusional Kurtosis Imaging Study
BACKGROUND AND PURPOSE: The spinal cord is a site of predilection for MS lesions. While diffusion tensor imaging is useful for the study of anisotropic systems such as WM tracts, it is of more limited utility in tissues with more isotropic microstructures (on the length scales studied with diffusion MR imaging) such as gray matter. In contrast, diffusional kurtosis imaging, which measures both Gaussian and non-Gaussian properties of water diffusion, provides more biomarkers of both anisotropic and isotropic structural changes. The aim of this study was to investigate the cervical spinal cord of patients with MS and to characterize lesional and normal-appearing gray matter and WM damage by using diffusional kurtosis imaging. MATERIALS AND METHODS: Nineteen patients (13 women, mean age = 41.1 ± 10.7 years) and 16 controls (7 women, mean age = 35.6 ± 11.2-years) underwent MR imaging of the cervical spinal cord on a 3T scanner (T2 TSE, T1 magnetization-prepared rapid acquisition of gradient echo, diffusional kurtosis imaging, T2 fast low-angle shot). Fractional anisotropy, mean diffusivity, and mean kurtosis were measured on the whole cord and in normal-appearing gray matter and WM. RESULTS: Spinal cord T2-hyperintense lesions were identified in 18 patients. Whole spinal cord fractional anisotropy and mean kurtosis ( P = .0009, P = .003), WM fractional anisotropy ( P = .01), and gray matter mean kurtosis ( P = .006) were significantly decreased, and whole spinal cord mean diffusivity ( P = .009) was increased in patients compared with controls. Mean spinal cord area was significantly lower in patients ( P = .04). CONCLUSIONS: Diffusional kurtosis imaging of the spinal cord can provide a more comprehensive characterization of lesions and normal-appearing WM and gray matter damage in patients with MS. Diffusional kurtosis imaging can provide additional and complementary information to DTI on spinal cord pathology
Augmented 17α-hydroxyprogesterone response to ACTH stimulation as evidence of decreased 21-hydroxylase activity in patients with incidentally discovered adrenal tumours ('incidentalomas')
Malpractice claims in interventional radiology: frequency, characteristics and protective measures Il contenzioso in radiologia interventistica: frequenza, caratteristiche ed azioni di tutela
interventistica \ue8 sensibilmente aumentato negli ultimi anni;
di pari passo si \ue8 notato un incremento del contenzioso
medico-legale ad esse associato. Questo studio mira a
sottolineare i problemi all\u2019origine delle denunce per
malapratica in radiologia interventistica, ed a valutare
l\u2019importanza del consenso informato.
Materiali e metodi. Sono state esaminate tutte le denunce
assicurative causate da presunti errori in radiologia
interventistica in un periodo di 14 anni, enuncleandole dal
data-base assicurativo dei radiologi iscritti alla Societ\ue0
Italiana di Radiologia Medica (SIRM) dal 01/01/1993 al
31/12/2006.
Risultati. Nel periodo in esame sono state sporte 98
denunce contro radiologi che avevano effettuato procedure
interventistiche. In 21 casi (21,4%) l\u2019evento aveva causato
la morte del paziente. In oltre l\u201980% dei casi l\u2019evento
lesivo era occorso in una struttura pubblica. Il rischio di
ricevere una denuncia per presunta malapratica per un
radiologo che pratichi tecniche interventistiche \ue8 pari al 47
per mille, il che corrisponde ad una denuncia per ogni 21
anni di attivit\ue0.
Discussione. La radiologia interventistica, attivit\ue0
sovrapponibile per profilo di rischio biologico alle
procedure chirurgiche, espone gli operatori ad un elevato
rischio di contenzioso medico-legale sia per problemi
intrinseci alle tecniche usate, sia per la necessit\ue0 di operare su soggetti con gravi patologie, e in condizioni
cliniche compromesse.
Conclusioni. La prevenzione del contenzioso dipende in
gran parte da una riduzione della percentuale di errore
medico abbinata ad una corretta ed organica informazione
del paziente. L\u2019adozione di buone pratiche radiologiche,
la scrupolosa revisione delle procedure e dell\u2019efficienza
tecnica degli strumenti usati, la verifica delle procedure
organizzative e gestionali sono i fattori che riducono la
probabilit\ue0 dell\u2019errore. Il miglioramento delle tecniche di
comunicazione, nel rispetto dell\u2019autonomia del paziente,
passa anche attraverso l\u2019adozione di procedure chiare e
rigorose per l\u2019ottenimento del consenso all\u2019atto medico.Purpose. The use of interventional radiology procedures
has considerably increased in recent years, as has the
number of related medicolegal litigations. This study aimed
to highlight the problems underlying malpractice claims in
interventional radiology and to assess the importance of the
informed consent process.
Materials and methods. The authors examined
all insurance claims relating to presumed errors in
interventional radiology filed by radiologists over a
period of 14 years after isolating them from the insurance
database of all radiologists registered with the Italian
Society of Medical Radiology (SIRM) between 1
January1993 and 31 December 2006.
Results. In the period considered, 98 malpractice claims
were filed against radiologists who had performed
interventional radiology procedures. In 21 cases (21.4%),
the event had caused the patient\u2019s death. In >80% of
cases, the event occurred in a public facility. The risk of a
malpractice claim for a radiologist practising interventional
procedures is 47 per 1,000, which corresponds to one
malpractice claim for each 231 years of activity.
Discussion. Interventional radiology, a discipline with a
biological risk profile similar to that of surgery, exposes
practitioners to a high risk of medicolegal litigation both
because of problems intrinsic to the techniques used and
because of the need to operate on severely ill patients with
compromised clinical status.Conclusions. Litigation prevention largely depends on
both reducing the rate of medical error and providing the
patient with correct and coherent information. Adopting
good radiological practices, scrupulous review of
procedures and efficiency of the instruments used and audit
of organisational and management processes are all factors
that can help reduce the likelihood of error. Improving
communication techniques while safeguarding the patient\u2019s
right to autonomy also implies adopting clear and rigorous
processes for obtaining the patient\u2019s informed consent to
the medical procedure