Sanzioni antitrust e giudice amministrativo, prima e dopo Menarini

La giurisprudenza CEDU ha riaperto il dibattito sulle garanzie del procedimento antitrust e sulla pienezza del sindacato giurisdizionale, affidato al giudice amministrativo. La disciplina legislativa, la prassi europea e la giurisprudenza hanno ampliato la discrezionalità della Commissione e delle Autorità nazionali: la sanzione può recedere dinanzi all’esigenza pragmatica di garantire il funzionamento del mercato concorrenziale attraverso l’accettazione degli impegni dell’impresa. Ciò segna una distanza dal regime sanzionatorio penale. Ora, però, la Corte EDU individua nelle sanzioni antitrust chiari elementi di afflittività, e richiede il controllo giurisdizionale pieno da parte del giudice nazionale. Innovazioni sono necessarie nel procedimento che si svolge innanzi all’Autorità, soprattutto in tema di contraddittorio, per rispondere alla spinta evolutiva, di segno garantistico, della Corte di Strasburgo. The jurisprudence of the Court of Strasbourg has reopened the debate on the guarantees that must be respected in the antitrust proceedings and on the adequacy of the judicial review, entrusted to the administrative judge. Legislative legislation, European practice and jurisprudence have widened the discretion of the Commission and National Competition Authorities, so that the sanctions may not be applied when the undertakings’ commitments are deemed effective to guarantee the functioning of the competitive market. Antitrust sanctions appear to be very distant from the penal sanction regime. Now, however, the European Court of Human Rights considers antitrust sanctions as essentially punitive and demands the judicial review be full. Innovations are also necessary in the proceedings that take place before the National Competition Authority, consistent with the level of guarantee requested by the Court of Strasbourg

Role of computed tomography and magnetic resonance imaging in local complications of acute pancreatitis

Acute pancreatitis (AP) represents a pancreas inflammation of sudden onset that can present different degrees of severity. AP is a frequent cause of acute abdomen and its complications are still a cause of death. Biliary calculosis and alcohol abuse are the most frequent cause of AP. Computed tomography (CT) and magnetic resonance imaging (MRI) are not necessary for the diagnosis of AP but they are fundamental tools for the identification of the cause, degree severity and AP complications. AP severity assessment is in fact one of the most important issue in disease management. Contrast-enhanced CT is preferred in the emergency setting and is considered the gold standard in patients with AP. MRI is comparable to CT for the diagnosis of AP but requires much more time so it is not usually chosen in the emergency scenario. Complications of AP can be distinguished in localized and generalized. Among the localized complications, we can identify: acute peripancreatic fluid collections (APFC), pseudocysts, acute necrotic collections (ANC), walled off pancreatic necrosis (WOPN), venous thrombosis, pseudoaneurysms and haemorrhage. Multiple organ failure syndrome (MOFS) and sepsis are possible generalized complications of AP. In this review, we focus on CT and MRI findings in local complications of AP and when and how to perform CT and MRI. We paid also attention to recent developments in diagnostic classification of AP complications

Transcranial Magnetic Resonance Imaging-Guided Focused Ultrasound Treatment at 1.5 T: A Retrospective Study on Treatment- and Patient-Related Parameters Obtained From 52 Procedures

Objective: To present a retrospective analysis of patient- and sonication-related parameters of a group of patients treated with a transcranial magnetic resonance imaging (MRI)-guided focused ultrasound (tcMRgFUS) system integrated with a 1.5-T MRI unit. Methods: The data obtained from 59 patients, who underwent the tcMRgFUS procedure from January 2015 to April 2019, were retrospectively reviewed for this study. The following data, among others, were mainly collected: skull density ratio (SDR), skull area (SA), number of available transducer elements (Tx), and estimated focal power at target (FP). For each of the four different treatment stages, we calculated the number of sonication processes (S-n), user-defined sonication power (S-p), effective measured power (S-mp), sonication duration (S-d), user-defined energy (E), effective measured energy (E-m), maximum temperature (T-max), and MR thermometry plane orientation. Furthermore, the time delay between each sonication (S-t) and the total treatment time (T-t) were recorded. Results: Fifty-two patients (40 males and 12 females; age 64.51 +/- SD 11.90 years; range 26-86 years), who underwent unilateral Vim thalamotomy (left = 50, 96.15%; right = 2, 3.85%) for medication-refractory essential tremor (n = 39; 78%) or Parkinson tremor (n = 13; 22%) were considered. A total of 1,068 (95.10%) sonication processes were included in our final analysis (average S-n per treatment: 20.65 +/- 6.18; range 13-41). The energy released onto the planned target was found to decrease with the SDR for all temperature ranges. A positive correlation was observed between the slope of T-max vs. E-m plot and the SDR (R-2 = 0.765; p < 0.001). In addition, the T-max was positively correlated with SDR (R-2 = 0.398; p < 0.005). On the contrary, no significant correlation was found between SDR and SA or Tx. An analysis of the MR thermometry scanning plane indicated that, at our site, the axial and the coronal planes were used (on average) 10.4 (SD +/- 3.8) and 7.7 (SD +/- 3.0) times, respectively, whereas the sagittal plane was used only 2.5 (SD +/- 3.0) times per treatment. Conclusion: Our results confirm the factors that significantly influence the course of a tcMRgFUS procedure even when a 1.5-T MRI scanner is used for procedure guidance. The experience we gained in this study indicates that the SDR remains one of the most significant technical parameters to be considered in a tcMRgFUS procedure. The possibility of prospectively setting the sonication energy according to the presented curves of energy delivery as a function of SDR for each treatment stage could provide a further understanding and a greater awareness of this emerging technology

Magnetic Resonance Imaging-Guided Focused Ultrasound Surgery for the Treatment of Symptomatic Uterine Fibroids

Uterine broids, the most common benign tumor in women of childbearing age, may cause symptoms including pelvic pain, menorrhagia, dysmenorrhea, pressure, urinary symptoms, and infertility. Various approaches are available to treat symptomatic uterine broids. Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) represents a recently introduced noninvasive safe and e ective technique that can be performed without general anesthesia, in an outpatient setting. We review the principles of MRgFUS, describing patient selection criteria for the treatments performed at our center and we present a series of ve selected patients with symptomatic uterine broids treated with this not yet widely known technique, showing its e cacy in symptom improvement and broid volume reduction

New advances in radiomics of gastrointestinal stromal tumors

Gastrointestinal stromal tumors (GISTs) are uncommon neoplasms of the gastrointestinal tract with peculiar clinical, genetic, and imaging characteristics. Preoperative knowledge of risk stratification and mutational status is crucial to guide the appropriate patients’ treatment. Predicting the clinical behavior and biological aggressiveness of GISTs based on conventional computed tomography (CT) and magnetic resonance imaging (MRI) evaluation is challenging, unless the lesions have already metastasized at the time of diagnosis. Radiomics is emerging as a promising tool for the quantification of lesion heterogeneity on radiological images, extracting additional data that cannot be assessed by visual analysis. Radiomics applications have been explored for the differential diagnosis of GISTs from other gastrointestinal neoplasms, risk stratification and prediction of prognosis after surgical resection, and evaluation of mutational status in GISTs. The published researches on GISTs radiomics have obtained excellent performance of derived radiomics models on CT and MRI. However, lack of standardization and differences in study methodology challenge the application of radiomics in clinical practice. The purpose of this review is to describe the new advances of radiomics applied to CT and MRI for the evaluation of gastrointestinal stromal tumors, discuss the potential clinical applications that may impact patients’ management, report limitations of current radiomics studies, and future directions

Resectable and borderline resectable pancreatic ductal adenocarcinoma: Role of the radiologist and oncologist in the era of precision medicine

The incidence and mortality of pancreatic ductal adenocarcinoma are growing over time. The management of patients with pancreatic ductal adenocarcinoma involves a multidisciplinary team, ideally involving experts from surgery, diagnostic imaging, interventional endoscopy, medical oncology, radiation oncology, pathology, geriatric medicine, and palliative care. An adequate staging of pancreatic ductal adenocarcinoma and re-assessment of the tumor after neoadjuvant therapy allows the multidisciplinary team to choose the most appropriate treatment for the patient. This review article discusses advancement in the molecular basis of pancreatic ductal adenocarcinoma, diagnostic tools available for staging and tumor response assessment, and management of resectable or borderline resectable pancreatic cancer

Classification and imaging of ankle impingement syndromes.

Learning Objectives: To review the classification of ankle impingement syndromes. To describe and illustrate the spectrum of appearance of ankle impingement syndromes using conventional radiography (CR), multidetector computed tomography (MDCT), ultrasonography (US), magnetic resonance imaging (MRI), and MR arthrography (MRA). Background: Ankle impingement syndromes are a spectrum of diseases common in both athletic and general population and depend on many causes that can be distinguished by the type of tissue which determines the conflict (bone, fibrous, synovial). In general, classification of ankle impingement syndromes takes into account the anatomical site relative to the tibio-tarsal joint, and thus they may be classified as anterior, antero-medial, antero-lateral, posterior and postero-medial. Imaging findings: CR alone already suffices to demonstrate a bone impingement in most cases, while there is necessity to use MDCT where the site of impingement is in an anatomical site not clearly demonstrable by CR because of the presence of superimposed structures. US has the ability to recognize the presence of an anterior impingement and it may assess tendon disorders (stenosing tenosynovitis) which may be an associate sign of an impingement syndrome. MRI is the method of choice to assess synovial or fibrous impingement syndromes thanks to its excellent contrast resolution. MRA is used when there is capsular thickening that could not be detected by simple MRI. Conclusion: Diagnostic imaging has a very important role in the recognition of the cause of impingement and of the anatomical site where such a conflict takes place, thus allowing a correct therapeutic management

Detection of liver metastases in cancer patients with geographic fatty infiltration of the liver: the added value of contrast-enhanced sonography

The aim of this study is to assess the role of contrast-enhanced ultrasonography (CEUS) in the detection of liver metastases in cancer patients with geographic liver fatty deposition on greyscale ultrasonography (US)

Computerised tomography and magnetic resonance imaging of laryngeal squamous cell carcinoma: A practical approach

Squamous cell carcinoma is the most common head and neck cancer. This review describes the state-of-the-art computerised tomography and magnetic resonance imaging protocols of the neck and the normal larynx anatomy, and provides a practical approach for the diagnosis and staging of laryngeal squamous cell carcinoma