Femoroacetabular Impingement (F.A.I.): biomechanical and dynamic considerations.

Femoroacetabular impingement (F.A.I.) is a pathologic process caused by abnormality of the shape of the acetabulum, of the femoral head, or both. F.A.I. often referred to as idiopathic, may be secondary to slipped capital epiphysis, congenital hypoplasia of the femur, Legg-Calv\ue9 Perthes desease, post-traumatic mal-union and protrusio acetabuli. From 2009 to 2012 we studied 21 patients (14 males), with average age of 52 years old (33 y - 75 y) affected by idiopathic F.A.I. Every patient underwent to pelvic and hip joint X-rays and CT scan with 3D reconstructions, in order to evaluate morphology of the pelvis and the hip joint and the torsion of the lower limbs (femoroacetabular ante-retroversion). Our results show an average femoral ante-version angle of 12,4\ub0 (15\ub0- 20\ub0 physiological range) in patients affected by CAM impingement and an average acetabular ante-version angle of 13,5\ub0 (15\ub0 - 20\ub0 physiological range) for those with PINCER impingement.These values, in patients affected by F.A.I., are probably related to the morphologic and biomechanical features that may lead to the onset of the idiopathic femoroacetabular impingement. In literature, other studies partially support our findings, suggesting a more critical approach to the patient with idiopathic F.A.I. extending the evaluations to near articulations. Impingement femoro-acetabolare (F.A.I.) indica quadri anatomopatologici caratterizzati da anomalie morfologiche dell\u2019epifisi prossimale femorale e/o della cavit\ue0 acetabolare.Dal punto di vista eziopatogenetico si possono individuare F.A.I. secondari ad esiti di patologie dell\u2019infanzia (displasia congenita dell\u2019anca, Legg- Calv\ue9 Perthes, epifisiolisi), di mancate consolidazioni post-traumatiche, protrusio acetabuli e FAI idiopatici.Abbiamo studiato, presso la nostra clinica, dal 2009 al 2012, 21 pazienti (14 maschi) con et\ue0 media di 52 anni (33- 75 aa) affetti da FAI idiopatico con anamnesi silente per patologie o cause note.Tutti i pazienti sono stati sottoposti a radiologia convenzionale e TC con ricostruzioni 3D per valutazione degli angoli di antiversione femorale e acetabolare. I nostri risultati hanno evidenziato un valore medio di antiversione femorale di 12,4\ub0 (range di normalit\ue0 15-20\ub0) nei pazienti affetti da CAMimpingement e 13,5\ub0 (15-20\ub0) di antiversione acetabolare in quelli affetti da PINCER impingement. Queste misurazioni, in rapporto ai quadri strumentali di F.A.I. hanno evidenziato una probabile correlazione tra il vizioso orientamento reciproco di cotile e testa femorale e la genesi del F.A.I. stesso, considerato idiopatico. Il confronto dei nostri risultati con quelli riportati in letteratura parrebbe avallare solo in parte le nostre ipotesi biomeccaniche, suggerendo un\u2019analisi pi\uf9 critica e approfondita ed allargata ad altre articolazioni quando ci si approccia ad un paziente affetto da F.A.I. idiopatico

Role of MDCT coronary angiography in the clinical setting: economic implications

PURPOSE:This study evaluated the incremental value and cost-effectiveness ratio of introducing coronary angiography (CA) with multidetector computed tomography (MDCT-CA) in the diagnostic management of patients with suspected coronary artery disease (CAD) compared with the traditional diagnostic workup.MATERIAL AND METHODS:Five hundred and fifty consecutive patients who underwent MDCT-CA between January 2009 and June 2011 were considered. Patients with atypical chest pain and suspected obstructive CAD were directed to one of two diagnostic pathways: the traditional protocol (examination, stress test, CA) and the current protocol (examination, stress test, MDCT-CA, and CA, if necessary). The costs of each protocol and for the individual method were calculated. Based on the results, the cost-effectiveness ratio of the two diagnostic pathways was compared. A third, modified, diagnostic pathway has been proposed with its relative cost-effectiveness ratio (examination, MDCT-CA, stress test, and CA, if necessary).RESULTS:Stress test vs. MDCT-CA had an accuracy of 66%, a sensitivity and specificity of 21% and 87%, respectively, and a positive (PPV) and negative (NPV) predictive value of 40% and 70%, respectively. Comparison between conventional CA (CCA) and MDCT-CA showed a sensitivity and specificity of 92% and 89%, respectively, a PPV and NPV of 89%, and an accuracy of 92%. The traditional protocol has higher costs than the second protocol: 1,645 euro against 322 euro (mean), but it shows a better cost-effectiveness ratio. The new proposed protocol has lower costs, mean 261 euro, with a better costeffectiveness ratio than the traditional protocol.CONCLUSIONS:The diagnostic protocol for patients with suspected CAD has been modified by the introduction of MDCT-CA. Our study confirms the greater diagnostic performance of MDCT-CA compared with stress test and its similar accuracy to CCA. The use of MDCT-CA to select patients for CCA has a favourable cost-effectiveness profile

Fibromuscular Dysplasia: Noninvasive Evaluation of Unusual Case of Renal and Mesenteric Involvement.

Fibromuscular dysplasia is the most common cause of renovascular hypertension in young patients. It primarily involves the renal and carotid arteries, and it is less common in the coronary, iliac, and visceral arteries. Digital subtraction angiography is still the best investigation to determine the location, extent, and complications of renal artery involvement. However, currently, other imaging modalities such as ultrasonography, computed tomography, and magnetic resonance imaging can reveal these findings noninvasively. We present the case of a 43-year-old woman who presented with high blood pressure and headache. Imaging revealed fibromuscular dysplasia of the renal arteries and the superior mesentery artery

Contrast Enhanced Ultrasonography vs. Spiral CT in the detection of the vascularization of solid pancreatic lesions.

poste

Role of coronary angiography MDCT in the clinical setting: changes of diagnostic workup and economic implications

Purpose: To assess the incremental value of MDCT- coronary angiography (MDCT-CA) in the diagnostic workup and cost management of patients with suspected coronary artery disease (CAD). Methods and Materials: 550 consecutive patients underwent MDCT-CA between 04/2008 and 07/2010. For each patient pre-test probability of CAD using Morise score was related to exercise test, MDCT-CA and CA. We calculated thereafter the incremental diagnostic value of stress test to MDCT-CA for each category of cardiovascular risk. The traditional diagnostic workup (without MDCT-CA) to the modified workup (with MDCT-CA) in terms of pre-test CAD probability\effectiveness and cost\effectiveness were compared. Results: The diagnostic performance of stress test had a sensitivity and specificity of 46.2% and 73.4% with PPV and NPV of 48 % and 72 %. MDCT-CA demonstrated a sensitivity of 100 %, a specificity of 94.7%, PPV of 96.7% and NPV of 100 %. According to Morise Score, in low pre-test probability, stress test accuracy resulted 30 %, in moderate pre-test 38 %, in high pre-test 45 % considering MDCT-CA as reference. The MDCT-CA modified diagnostic protocol offers an average increased diagnostic performance of 60 % compared with the traditional protocol, and an average cost saving of \u20ac 1323 per patient. Conclusions: MDCT-CA is the reference method for the non-invasive exclusion of critical coronary stenosis. Up to a low-medium CAD risk, the MDCT-CA diagnostic workup is the most cost-effective protocol, being superior to the traditional exercise ECG-based protocol

Diagnosis of cystic pancreatic lesions with intravenous contrast-enhanced abdominal ultrasound in comparison with Magnetic Resonance Imaging and pathology

no abstract availabl

Contrast enhanced US quantification analysis for objective characterization of pancreatic ductal adenocarcinoma (Scientific Session - the Pancreas 1- adenocarcinoma)

relazion

Ultrasound quantification of tissue strain properties: A way to overcome subjectivity?

No availabl