Dolo eventuale e colpa cosciente. Penal flavour del rischio assunto: un discrimen di natura legale o morale?

Lo scopo di questa indagine, lungi dall'aspirare a fornire risposte risolutive ad antichi interrogativi o ad esporre novelli dogmi penalistici, è quello di misurare sulla bilancia della legalità le più moderne teorie, attualmente maggiormente accreditate nella dottrina penalistica italiana, atte a discernere tra dolo eventuale e colpa con previsione. La convinzione di fondo è costituita dall'intuizione che il noto criterio che poggia sulla natura del rischio assunto dall'agente, Risikotheorie, (per cui si ritiene che esistano rischi intrinsecamente dolosi e, all'opposto, rischi intrinsecamente colposi) nasconda, in realtà, prese di posizione aprioristiche e pre-giuridiche di natura essenzialmente morale. Di fronte a tale deriva metagiuridica, forse, il criterio classico dell'accettazione del rischio si presenta a tutt'oggi più neutro e presta meno il fianco all'eventualità di declinazioni soggettivistiche legate alle differenti Weltanschauungen degli interpreti. Il dolus eventualis è un "fantasma", tuttavia - filtrata attraverso il setaccio delle Kulturnormen - tale categoria concettuale potrebbe trovare un'adeguata collocazione nel sistema penale già de lege lata. Brevi riflessioni s'impongono circa le prospettive de iure condendo: anziché lasciare relegata alla mera dosimetria della pena ex art. 133 I comma n° 3 cod. pen. la definizione sanzionatoria del dolus eventualis e, in definitiva, confinare l'espressione normativa della sua diversa e minore intensità alla sola opera di commisurazione; parallelamente ed in senso simmetricamente inverso a quanto è avvenuto, ab imis, per la colpa cosciente, potrebbe ponderarsi l'introduzione a livello normativo di una circostanza attenuante volta ad alleviare il castigo previsto per il delitto doloso e che renda l'inesprimibile leggerezza del dolo eventuale

The Influence of Gd-EOB-DTPA on T2 Signal Behavior: An Example from Clinical Routine

In the literature, it has repeatedly been stated that the introduction of hepatospecific contrast agents in Magnetic Resonance Imaging prolongs the acquisition time due to the hepatobiliary phase, normally acquired 15-20 min after injection. Many efforts have been made to shorten the time-consuming protocols, and it was demonstrated that T2-Weighted Images (T2WI) and Diffusion-Weighted Images (DWI) acquired after Gd-EOB-DTPA show a comparable diagnostic capability to pre-contrast T2WI and DWI in the detection and characterization of hepatic tumors. Therefore, T2WI and DWI are usually acquired after the acquisition of vascular phases, in the dead time until the acquisition of the hepatobiliary phase. Unfortunately, contrast agents, especially Gd-EOB-DTPA, reduce the hydrogen nuclei's relaxation time and modify signal intensity. We report a case in which, due to these limitations of the acquisition protocol, two hemangiomas showed an inhomogeneous, low signal on T2WI and DWI that was not visible in a follow-up scan a few days later. In conclusion, when liver lesions of unknown nature must be characterized, and there is a lack of previous radiological investigations, it could be useful to acquire pre-contrast T2WI and DWI to avoid diagnostic confusion, especially in non-tertiary centers

Imaging of Liver Tumors in Patients with Chronic Liver Disease

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Liver collision lesion: inflammatory hepatocellular adenoma within focal nodular hyperplasia

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MRI Appearance of Focal Lesions in Liver Iron Overload

Liver iron overload is defined as an accumulation of the chemical element Fe in the hepatic parenchyma that exceeds the normal storage. When iron accumulates, it can be toxic for the liver by producing inflammation and cell damage. This can potentially lead to cirrhosis and hepatocellular carcinoma, as well as to other liver lesions depending on the underlying condition associated to liver iron overload. The correct assessment of liver iron storage is pivotal to drive the best treatment and prevent complication. Nowadays, magnetic resonance imaging (MRI) is the best non-invasive modality to detect and quantify liver iron overload. However, due to its superparamagnetic properties, iron provides a natural source of contrast enhancement that can make challenging the differential diagnosis between different focal liver lesions (FLLs). To date, a fully comprehensive description of MRI features of liver lesions commonly found in iron-overloaded liver is lacking in the literature. Through an extensive review of the published literature, we aim to summarize the MRI signal intensity and enhancement pattern of the most common FLLs that can occur in liver iron overload

Pseudoaneurysm of the splenic artery mimicking a solid lesion

A 64-year-old man presented to the hospital because of hematemesis; on admission, he had weakness and pale skin, tachycardia and hypotension. Laboratory tests revealed severe anemia (hemoglobin 7.8 g/dL); liver, renal and pancreatic function tests were normal. An upper digestive endoscopy revealed a gastric ulcer of the cardia, treated with metallic clips and adrenalin injection. The patient was treated with fluids and was transfused with three units of red blood cells. In the previous two months, due to the presence of bloating and diarrhea, associated with abdominal distension, a colon-computed tomography (CT) revealed a large retroperitoneal hypodense mass, 53x37 mm in size, without contrast enhancement localized between the body and the tail of the pancreas and the stomach, near the splenic artery and without signs of infiltration. To better define the mass, endoscopic ultrasound and biopsy were performed; however histopathology of multiple biopsies was not diagnostic, because of the presence of necrotic tissue and inflammatory cells. Since hematemesis recurred, the patient underwent a second upper digestive endoscopic examination, but no source of bleeding was found. Then a new contrast enhanced CT was performed that showed a size reduction of the mass, the presence of blood in the stomach and a small pseudoaneurysm of the splenic artery. Because of these findings an angiograpghic study was carried out; angiography confirmed a splenic artery pseudoaneurysm that was successfully embolized with metal microcoils

Sarcopenia Predicts Major Complications after Resection for Primary Hepatocellular Carcinoma in Compensated Cirrhosis

The burden of post-operative complications of patients undergoing liver resection for hepatocellular carcinoma (HCC) is a cause of morbidity and mortality. Recently, sarcopenia has been reported to influence the outcome of patients with cirrhosis. We aimed to assess factors associated with sarcopenia and its prognostic role in liver surgery candidates. We included all patients with compensated advanced chronic liver disease (cACLD) undergoing liver resection for primary HCC consecutively referred to the University of Bologna from 2014 to 2019 with an available preoperative abdominal CT-scan performed within the previous three months. A total of 159 patients were included. The median age was 68 years, and 80.5% of the patients were male. Sarcopenia was present in 82 patients (51.6%). Age and body mass index (BMI) were associated with the presence of sarcopenia at multivariate analysis. Thirteen (8.2%) patients developed major complications and 14 (8.9%) presented PHLF grade B-C. The model for end-stage liver disease score was associated with the development of major complications, whereas cACLD presence, thrombocytopenia, portal hypertension (PH), Child-Pugh score and Albumin-Bilirubin score were found to be predictors of clinically significative PHLF. The rate of major complications was 11.8% in sarcopenic patients with cACLD compared with no complications (0%) in patients without sarcopenia and cACLD (p = 0.032). The rate of major complications was significantly higher in patients with (16.3%) vs. patients without (0%) sarcopenia (p = 0.012) in patients with PH. In conclusion, sarcopenia, which is associated with age and BMI, may improve the risk stratification of post-hepatectomy major complications in patients with cACLD and PH

Automatically extracted machine learning features from preoperative CT to early predict microvascular invasion in HCC: the role of the Zone of Transition (ZOT)

open12noMicrovascular invasion (MVI) is a consolidated predictor of hepatocellular carcinoma (HCC) recurrence after treatments. No reliable radiological imaging findings are available for preoperatively diagnosing MVI, despite some progresses of radiomic analysis. Furthermore, current MVI radiomic studies have not been designed for small HCC nodules, for which a plethora of treatments exists. This study aimed to identify radiomic MVI predictors in nodules ≤3.0 cm by analysing the zone of transition (ZOT), crossing tumour and peritumour, automatically detected to face the uncertainties of radiologist’s tumour segmentation. Methods: The study considered 117 patients imaged by contrast-enhanced computed tomography; 78 patients were finally enrolled in the radiomic analysis. Radiomic features were extracted from the tumour and the ZOT, detected using an adaptive procedure based on local image contrast variations. After data oversampling, a support vector machine classifier was developed and validated. Classifier performance was assessed using receiver operating characteristic (ROC) curve analysis and related metrics. Results: The original 89 HCC nodules (32 MVI+ and 57 MVI−) became 169 (62 MVI+ and 107 MVI−) after oversampling. Of the four features within the signature, three are ZOT heterogeneity measures regarding both arterial and venous phases. On the test set (19MVI+ and 33MVI−), the classifier predicts MVI+ with area under the curve of 0.86 (95%CI (0.70–0.93), p∼10^−5), sensitivity = 79% and specificity = 82%. The classifier showed negative and positive predictive values of 87% and 71%, respectively. Conclusions: The classifier showed the highest diagnostic performance in the literature, disclosing the role of ZOT heterogeneity in predicting the MVI+ status.noneMatteo Renzulli, Margherita Mottola, Francesca Coppola, Maria Adriana Cocozza, Silvia Malavasi, Arrigo Cattabriga, Giulio Vara, Matteo Ravaioli, Matteo Cescon, Francesco Vasuri, Rita Golfieri, Alessandro BevilacquaMatteo Renzulli, Margherita Mottola, Francesca Coppola, Maria Adriana Cocozza, Silvia Malavasi, Arrigo Cattabriga, Giulio Vara, Matteo Ravaioli, Matteo Cescon, Francesco Vasuri, Rita Golfieri, Alessandro Bevilacqu

An Imaging Overview of COVID-19 ARDS in ICU Patients and Its Complications: A Pictorial Review

A significant proportion of patients with COVID-19 pneumonia could develop acute respiratory distress syndrome (ARDS), thus requiring mechanical ventilation, and resulting in a high rate of intensive care unit (ICU) admission. Several complications can arise during an ICU stay, from both COVID-19 infection and the respiratory supporting system, including barotraumas (pneumothorax and pneumomediastinum), superimposed pneumonia, coagulation disorders (pulmonary embolism, venous thromboembolism, hemorrhages and acute ischemic stroke), abdominal involvement (acute mesenteric ischemia, pancreatitis and acute kidney injury) and sarcopenia. Imaging plays a pivotal role in the detection and monitoring of ICU complications and is expanding even to prognosis prediction. The present pictorial review describes the clinicopathological and radiological findings of COVID-19 ARDS in ICU patients and discusses the imaging features of complications related to invasive ventilation support, as well as those of COVID-19 itself in this particularly fragile population. Radiologists need to be familiar with COVID-19's possible extra-pulmonary complications and, through reliable and constant monitoring, guide therapeutic decisions. Moreover, as more research is pursued and the pathophysiology of COVID-19 is increasingly understood, the role of imaging must evolve accordingly, expanding from the diagnosis and subsequent management of patients to prognosis prediction