Publications by authors named "Sergio Salerno"

48 Publications

Preventable fatal injury during rally race: a multidisciplinary approach.

Int J Legal Med 2021 May 25;135(3):893-901. Epub 2020 Nov 25.

Radiology Section, DIBIMED, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy.

Introduction: The motor vehicle crash (MVC) constitutes an important challenge for forensic pathology in order to identify the manner and cause of death. Our study focuses on a fatal accident during a rally race corresponding to MVC sub-category.

Materials And Method: Postmortem computed tomography (PMCT) was performed before the conventional autopsy. Autoptic and PMCT data were compared. Data collection allowed analyzing biomechanical dynamics of the incident and post-traumatic injuries through qualitative-statistics and solicitation quantitative indices.

Results: Photo and circumstantial evidence analysis showed a wrong installation of double shoulder belt system of head and neck support (HANS) collar. PMTC clearly highlighted multiple and bilateral fractures involving roof and base of skull; a displaced fracture of the right acetabulum was also encountered. Autopsy confirmed PMCT data and revealed a brainstem laceration. AIS (Abbreviated Injury Scale) achieved a maximum score in consideration of fatal injuries.

Discussion: The injuries analysis resulting from photographic surveys examination, conventional autopsy, and PMCT has led us to confirm a fatal front collision with a tree trunk. Head trauma represents a major injury in the present case. In this case, head injuries, related to whiplash trauma, are a consequence of a double shoulder belt system (HANS collar component) wrong installation.

Conclusion: MVC and especially high-speed motor racing represent an important death cause. There was, for this reason, a marked development of cars and occupants' safety systems, such as HANS collar. PMCT improves the diagnostic performance of conventional autopsy and increases forensic medical knowledge related to traumatic injuries.
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http://dx.doi.org/10.1007/s00414-020-02470-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036227PMC
May 2021

Italian inter-society expert panel position on radiological exposure in Neonatal Intensive Care Units.

Ital J Pediatr 2020 Oct 27;46(1):159. Epub 2020 Oct 27.

Società Italiana di Radiologia Medica e Interventistica (SIRM), Milan, Italy.

Background: In the recent years, clinical progress and better medical assistance for pregnant women, together with the introduction of new complex technologies, has improved the survival of preterm infants. However, this result requires frequent radiological investigations mostly represented by thoracic and abdominal radiographs in incubators. This document was elaborated by an expert panel Italian inter-society working group (Radiologists, Paediatricians, Medical Physicists) with the aim to assist healthcare practitioners in taking choices involving radiation exposures of new-born infants and to provide practical recommendations about justification and optimization in Neonatal Intensive Care Units. The adherence to these practice recommendations could ensure a high quality and patient safety. More complex and less common radiological practice, such as CT scan or fluoroscopy have been excluded.

Methods: The consensus was reached starting from current good practice evidence shared by four scientific societies panel: AIFM (Italian Association of Physics in Medicine), SIN (Italian Neonatology Society), SIP (Italian Paediatric Society), SIRM (Italian Medical Radiology Society) in order to guarantee good standard practices for every professional involved in Neonatal Intensive Care Units (NICU). The report is divided into clinical and physical-dosimetric sections: clinical Indications, good practice in radiological exposures, devices, exposure parameters and modalities, patient positioning and immobilization, Reference Diagnostic Levels, operators and patient's radiation protection. Another important topic was the evaluation of the different incubators in order to understand if the consequences of the technological evolution have had an impact on the increase of the dose to the small patients, and how to choose the best device in terms of radiation protection. At the end the working group faced the problem of setting up the correct communication between clinicians and parents following the most recent indications of the international paediatric societies.

Results: Taking into account the experience and expertise of 10 Italian Centres, the guideline sets out the criteria to ensure a high standard of neonatal care in NICU about procedures, facilities, recommended equipment, quality assurance, radiation protection measures for children and staff members and communication on radiation risk.

Conclusions: This document will allow a standardization of the approach to the exposures in NICU, although oriented to a flexible methodology.
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http://dx.doi.org/10.1186/s13052-020-00905-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592562PMC
October 2020

Radiation protection in non-ionizing and ionizing body composition assessment procedures.

Quant Imaging Med Surg 2020 Aug;10(8):1723-1738

Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy.

Body composition assessment (BCA) represents a valid instrument to evaluate nutritional status through the quantification of lean and fat tissue, in healthy subjects and sick patients. According to the clinical indication, body composition (BC) can be assessed by different modalities. To better analyze radiation risks for patients involved, BCA procedures can be divided into two main groups: the first based on the use of ionizing radiation (IR), involving dual energy X-ray absorptiometry (DXA) and computed tomography (CT), and others based on non-ionizing radiation (NIR) [magnetic resonance imaging (MRI)]. Ultrasound (US) techniques using mechanical waves represent a separate group. The purpose of our study was to analyze publications about IR and NIR effects in order to make physicians aware about the risks for patients undergoing medical procedures to assess BCA providing to guide them towards choosing the most suitable method. To this end we reported the biological effects of IR and NIR and their associated risks, with a special regard to the excess risk of death from radio-induced cancer. Furthermore, we reported and compared doses obtained from different IR techniques, giving practical indications on the optimization process. We also summarized current recommendations and limits for techniques employing NIR and US. The authors conclude that IR imaging procedures carry relatively small individual risks that are usually justified by the medical need of patients, especially when the optimization principle is applied. As regards NIR imaging procedures, a few studies have been conducted on interactions between electromagnetic fields involved in MR exam and biological tissue. To date, no clear link exists between MRI or associated magnetic and pulsed radio frequency (RF) fields and subsequent health risks, whereas acute effects such as tissue burns and phosphenes are well-known; as regards the DNA damage and the capability of NIR to break chemical bonds, they are not yet robustly demonstrated. MRI is thus considered to be very safe for BCA as well US procedures.
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http://dx.doi.org/10.21037/qims-19-1035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378088PMC
August 2020

Editorial from guest editors current Euratom legislation (DE 59/2013): new patient management in radiation protection.

Radiol Med 2019 08 29;124(8):711-713. Epub 2019 Aug 29.

Department of Diagnostic Radiology, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy.

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http://dx.doi.org/10.1007/s11547-019-01070-4DOI Listing
August 2019

Up-to-date imaging review of paediatric soft tissue vascular masses, focusing on sonography.

Radiol Med 2019 Oct 11;124(10):935-945. Epub 2019 Jun 11.

Department of Biopathology and Medical Biotechnologies (DI.BI.MED), Policlinico University of Palermo, Palermo, Italy.

The purpose of this article is to provide an up-to-date overview on imaging of paediatric vascular soft tissue masses, including both neoplastic and non-neoplastic lesions. We describe the-often challenging-imaging diagnosis-mainly performed by ultrasound (and secondarily by MRI) and differential diagnosis of vascular soft tissue lesions in children. We underline how important it is to determine whether a vascular anomaly has a regional vascular origin, or if there are other entities, ranging from benign to malignant lesions, which have flow-signal or blood degradation products. Even though clinical examination and patient's history are the first and indispensable steps in the initial diagnosis, the role of imaging is crucial, not only to determine whether a mass represents a true tumour/pseudo-tumour, but also to achieve a more correct diagnosis and determine the extension of the tumour/pseudo-tumour and its relation with the nearby anatomic structures.
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http://dx.doi.org/10.1007/s11547-019-01050-8DOI Listing
October 2019

Practical recommendations for the application of DE 59/2013.

Radiol Med 2019 Aug 5;124(8):721-727. Epub 2019 Apr 5.

Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Policlinico Università di Palermo, Via del Vespro 127, 90127, Palermo, Italy.

The changes introduced with Council Directive 2013/59/Euratom will require European Member States adapt their regulations, procedures and equipment to the new high standards of radiation safety. These new requirements will have an impact, in particular, on the radiology community (including medical physics experts) and on industry. Relevant changes include new definitions, a new dose limit for the eye lens, non-medical imaging exposures, procedures in asymptomatic individuals, the use and regular review of diagnostic reference levels (including interventional procedures), dosimetric information in imaging systems and its transfer to the examination report, new requirements on responsibilities, the registry and analysis of accidental or unintended exposure and population dose evaluation (based on age and gender distribution). Furthermore, the Directive emphasises the need for justification of medical exposure (including asymptomatic individuals), introduces requirements concerning patient information and strengthens those for recording and reporting doses from radiological procedures, the use of diagnostic reference levels, the availability of dose-indicating devices and the improved role and support of the medical physics experts in imaging.
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http://dx.doi.org/10.1007/s11547-019-01031-xDOI Listing
August 2019

Protecting sensitive patient groups from imaging using ionizing radiation: effects during pregnancy, in fetal life and childhood.

Radiol Med 2019 Aug 4;124(8):736-744. Epub 2019 Apr 4.

Department of Clinical Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.

The frequency of imaging examinations requiring radiation exposure in children (especially CT) is rapidly increasing. This paper reviews the current evidence in radiation protection in pediatric imaging, focusing on the recent knowledge of the biological risk related to low doses exposure. Even if there are no strictly defined limits for patient radiation exposure, it is recommended to try to keep doses as low as reasonably achievable (the ALARA principle). To achieve ALARA, several techniques to reduce the radiation dose in radiation-sensitive patients groups are reviewed. The most recent recommendations that provide guidance regarding imaging of pregnant women are also summarized, and the risk depending on dose and phase of pregnancy is reported. Finally, the risk-benefit analysis of each examination, and careful communication of this risk to the patient, is emphasized.
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http://dx.doi.org/10.1007/s11547-019-01034-8DOI Listing
August 2019

Overdiagnosis and overimaging: an ethical issue for radiological protection.

Radiol Med 2019 Aug 21;124(8):714-720. Epub 2019 Mar 21.

Department of Diagnostic Radiology, Hopital Européen Georges Pompidou Paris APHP, Université Paris-Descartes, Paris, France.

Aims And Objectives: This study aimed to analyse the key factors that influence the overimaging using X-ray such as self-referral, defensive medicine and duplicate imaging studies and to emphasize the ethical problem that derives from it.

Materials And Methods: In this study, we focused on the more frequent sources of overdiagnosis such as the total-body CT, proposed in the form of screening in both public and private sector, the choice of the most sensitive test for each pathology such as pulmonary embolism, ultrasound investigations mostly of the thyroid and of the prostate and MR examinations, especially of the musculoskeletal system.

Results: The direct follow of overdiagnosis and overimaging is the increase in the risk of contrast media infusion, radiant damage, and costs in the worldwide healthcare system. The theme of the costs of overdiagnosis is strongly related to inappropriate or poorly appropriate imaging examination.

Conclusions: We underline the ethical imperatives of trust and right conduct, because the major ethical problems in radiology emerge in the justification of medical exposures of patients in the practice. A close cooperation and collaboration across all the physicians responsible for patient care in requiring imaging examination is also important, balancing possible ionizing radiation disadvantages and patient benefits in terms of care.
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http://dx.doi.org/10.1007/s11547-019-01029-5DOI Listing
August 2019

Patient centring and scan length: how inaccurate practice impacts on radiation dose in CT colonography (CTC).

Radiol Med 2019 Aug 8;124(8):762-767. Epub 2019 Mar 8.

Department of Surgical and Medical Sciences and Translational Medicine, Sapienza-University of Rome, Sant'Andrea University Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.

Objective: The aim of this study was to acknowledge errors in patients positioning in CT colonography (CTC) and their effect in radiation exposure.

Materials And Methods: CTC studies of a total of 199 patients coming from two different referral hospitals were retrospectively reviewed. Two parameters have been considered for the analysis: patient position in relation to gantry isocentre and scan length related to the area of interest. CTDI vol and DLP were extracted for each patient. In order to evaluate the estimated effective total dose and the dose to various organs, we used the CT-EXPO software version 2.2. This software provides estimates of effective dose and doses to the other various organs.

Results: Average value of the patients' position is found to be below the isocentre for 48 ± 25 mm and 29 ± 27 mm in the prone and supine position. It was observed that the increase in CTDI and DLP values for patients in Group 1, due to the inaccurate positioning, was estimated at about 30% and 20% for prone and supine position, respectively, while in Group 2, a decrease in CTDI and DLP values was estimated at about 16% and 18% for prone and supine position, respectively, due to an average position above isocentre. A dose increase ranging from 4 up to 13% was calculated with increasing the over-scanned region below anal orifice.

Conclusion: Radiographers and radiologists need to be aware of dose variation and noise effects on vertical positioning and over-scanning. More accurate training need to be achieved even so when examination protocol varies from general practice.
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http://dx.doi.org/10.1007/s11547-019-01021-zDOI Listing
August 2019

Virtopsy and Living Individuals Evaluation Using Computed Tomography in Forensic Diagnostic Imaging.

Semin Ultrasound CT MR 2019 Feb 27;40(1):67-78. Epub 2018 Oct 27.

Department of Biopathology and Medical Biotechnologies (Di.Bi.Med), University of Palermo, Palermo, Italy.

The applications of forensic radiology involve both Virtopsy both studies on living people - to demonstrate bone age, search for foreign bodies, such as voluntary injection of drug ovules or surgical sponges accidentally forgotten, to assess gunshot wounds, to evaluate injuries by road accidents, and cases of violence or abuse (both in adults and in children). Computed tomography is the most used imaging tool used in forensic pathology and its indications are mainly focused on cases of unnatural deaths or when a crime is suspected. It is preferred over the standard autopsy in selected cases, such as in putrefied, carbonized or badly damaged bodies; or as a preliminary evaluation in mass disasters.
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http://dx.doi.org/10.1053/j.sult.2018.10.013DOI Listing
February 2019

Role of Imaging in the Assessment of Age Estimation.

Semin Ultrasound CT MR 2019 Feb 28;40(1):51-55. Epub 2018 Oct 28.

Department of Biopathology and Medical Biotechnologies (Di.Bi.Med) University of Palermo, Palermo, Italy.

Age assessment by skeletal age estimation of unknown individuals is of paramount importance in forensic science, both for assessing imputability (if the author of a crime is old enough to be tried and judged), both in case of unaccompanied minors, or whether refugees and asylum seekers are adults or juveniles, which implies different legal issues and procedures. The aim of this article is to review the age estimation methods used in forensic practice.
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http://dx.doi.org/10.1053/j.sult.2018.10.010DOI Listing
February 2019

Swallowing impairment in neurologic disorders: the role of videofluorographic swallowing study.

Pol J Radiol 2018 13;83:e394-e400. Epub 2018 Aug 13.

Section of Radiological Sciences, DIBMIMEF, University Hospital Policlinico, University of Palermo, Palermo, Italy.

Patients with neurologic diseases almost inevitably develop various degrees of swallowing disorders during their life. Dysphagia is one of the main negative prognostic factors in this class of patients, leading to severe morbidity (i.e. aspiration pneumonia, dehydration, malnutrition, and life quality deterioration) and to a noticeable increase in public health spending. Videofluorographic swallowing study is considered the gold standard technique for swallowing impairment assessment. It is aimed at early identification of the risk of aspiration, definition of the kind and grade of dysphagia, and an indication to suspend oral nutrition and adopt other feeding strategies, and define when the patient is able to return to physiological nutrition. Every radiologist should be familiar with the main videofluorographic swallowing features in neurological patients, not only because early diagnosis of deglutition disorders widely improves their prognosis, but also because customising feeding strategies has a great impact on patients' quality of life.
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http://dx.doi.org/10.5114/pjr.2018.79203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334091PMC
August 2018

The burnout phenomenon among student radiographers: a single centre experience.

G Ital Med Lav Ergon 2017 12;39(4):256-262

Section of Radiological Sciences, DIBIMED, University of Palermo, Italy.

Objectives: Burnout syndrome is a condition that may occur not only for staff in human service sectors/jobs, involving intensive interactions with others, but also people that are engaged in activities psychologically similar to work, such as students. Radiographers in training suffer double stress, first linked to the status of being a university student and secondly as early career workers who have relations with the public of the health system. Aim of our study was to investigate the prevalence and levels of burnout syndrome among radiographers in training in an University Hospital.

Methods: In order to gain a better understanding of nature of the burnout syndrome a modified version of Maslach's questionnaire (investigating three areas: emotional exhaustion, depersonalization and reduced personal accomplishment), was administered to two groups selected from a cohort of radiographers University students (from the 1st and 3rd year of course).

Results: 62/62 questionnaires were completed, returned and analysed. The research outcomes highlighted a clear difference between group I and group II in relation to one of the three areas of the Maslach's model: "depersonalization" (p<0.001). Moreover, the third year students group presented a significantly higher risk to develop burnout. On the other hand, the third area examined, the reduced personal accomplishment domain, was surprisingly high even among first-year students.

Conclusions: The research outcomes seem to suggest that the presence of emotional burnout, or risk of burnout, among third year students is statistically significant, compared to the first year students, being a significant aspect to investigate further in this class of students. It is also assumed that the high degree of "past failures, feeling of self failure" observed among all student, is related to a feeling of poor efficacy and poor self worth that appear to grow from the beginning of the course. This topic needs further investigation in the light of the result of this study.
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December 2017

Radiation dose in non-dental cone beam CT applications: a systematic review.

Radiol Med 2018 Oct 5;123(10):765-777. Epub 2018 Jun 5.

Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.

Background: Radiation-induced health risks are broadly questioned in the literature. As cone beam computed tomography (CBCT) is increasingly used in non-dental examinations, its effective dose needs to be known. This study aimed to review the published evidence on effective dose of non-dental CBCT for diagnostic use by focusing on dosimetry system used to estimate dose.

Materials And Methods: A systematic review of the literature was performed on 12 November 2017. All the literature up to this date was included. The PubMed and web of science databases were searched. Studies were screened for inclusion based on defined inclusion and exclusion criteria according to the preferred reporting items for systematic reviews.

Results: Fifteen studies met the inclusion criteria and were included in our review. Thirteen and two of them examined one and two anatomical areas, respectively. The anatomical areas were: ear (6), paranasal sinuses (4), ankle (3), wrist (2), knee (1), and cervical spine (1). Effective dose was estimated by different methods: (i) RANDO phantom associated with thermoluminescent dosimeters (6), metal oxide semiconductor field-effect transistor dosimeters (3), and optically stimulated luminescent dosimeters (1). (ii) Scanner outputs, namely computed tomography dose index (1) and dose area product (2). (iii) Monte Carlo simulations (2).

Conclusion: CBCT of extremities, cervical spine, ears and paranasal sinuses was found to be a low-dose volumetric imaging technique. Effective doses varied significantly because of different exposure settings of CBCT-units and different dosimetry systems used to estimate dose.
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http://dx.doi.org/10.1007/s11547-018-0910-7DOI Listing
October 2018

Complete written/oral information about dose exposure in CT: is it really useful to guarantee the patients' awareness about radiation risks?

Radiol Med 2018 Oct 31;123(10):788-798. Epub 2018 May 31.

Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.

Aims And Objectives: According to the European directive 2013/59/Euratom, starting from February 2018, the information relating to patient exposure will be part of computed tomography (CT) reports, but the impact of this information on patients has not been deeply evaluated. Aim of our study was to evaluate patients' perception of radiation exposure related to routine CT and their understanding after communication of their dose exposure.

Materials And Methods: A survey, investigating patient's knowledge of radiation dose, was given to all adult patients (> 18 years) undergoing a CT examination both before and after CT scan. The first survey was the same for all patients. After CT scan, a second questionnaire was administered (after receiving the CT dose bill report and medical written and/or explanation about ionizing radiation risk). Results of the pre- and post-CT questionnaires responses were compared according to demographics characteristics and among the four post-CT groups.

Results: For some questions, statistically significant differences were found between the two centres. Seventy per cent of the patients answered that the presence of CT parameters in the report is considered useful. Even if not always statistically significant there was a slight increase in awareness of ionizing radiation risk comparing the pre- and post-CT surveys. The group that had both written and oral explanations had a better comprehension of CT dose bill (group III vs. I, p = 0.002).

Conclusion: The way of communication of ionizing radiation risks did not affect the results of the post-CT survey. Indeed, the interest in the topic did not rise in the post-CT survey in any of the group. Adequate information about ionizing radiation risks provided together with dose exposure information may be useful. However, there is not a standardized better way of communicating information on ionizing radiation risks due to CT.
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http://dx.doi.org/10.1007/s11547-018-0909-0DOI Listing
October 2018

Is MRI imaging in pediatric age totally safe? A critical reprisal.

Radiol Med 2018 Sep 3;123(9):695-702. Epub 2018 May 3.

Dipartimento Diagnostica per Immagini, Ospedale Pediatrico Bambino Gesù, Rome, Italy.

Current radiological literature is strongly focussed on radiation imaging risks. Indeed, given there is a small but actual augment in cancer risk from exposure to ionizing radiation in children, it is important to understand what the risk of alternative techniques could be. We retrospectively review literature data concerning possible MR imaging risks, focussing on the biological effects of MR, sedation and gadolinium compound risks when dealing with infant patients. The main concerns can be summarized in: (1) Biological effects of non-ionizing electromagnetic fields (EMF) employed-whose mechanisms of interaction with human tissues are polarization, induced current, and thermal heating, respectively. (2) Risks associated with noises produced during MRI examinations. (3) Hazards from ferromagnetic external and/or implanted devices-whose risk of being unintentionally brought inside MR room is higher in children than in adults. (4) Risks associated with sedation or general anaesthesia, essential problem in performing MR in very young patients, due to the exam long-lasting. (5) Risks related to gadolinium-based contrast agents, especially considering the newly reported brain deposition.
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http://dx.doi.org/10.1007/s11547-018-0896-1DOI Listing
September 2018

Comparison of US Strain Elastography and Entero-MRI to Typify the Mesenteric and Bowel Wall Changes during Crohn's Disease: A Pilot Study.

Biomed Res Int 2017 30;2017:4257987. Epub 2017 Oct 30.

Section of Radiology-Di.Bi.Med., University of Palermo, Palermo, Italy.

Purpose: To evaluate and compare the mesenteric and bowel wall changes during Crohn's disease (CD) on ultrasonography (US) Strain Elastography (SE) and Enterography Magnetic Resonance Imaging (E-MRI).

Methods: From July 2014 to September 2016, 35 patients with ileocolonoscopy diagnosis of CD were prospectively examined with E-MRI and in the same time with US and SE.

Results: A total of 41 affected bowel segments and 35 unaffected bowel segments in 35 patients were evaluated. US-SE color-scale coding showed a blue color pattern in the fibrotic mesentery and bowel wall in 15 patients and a green color pattern in the edematous ones in 20 patients. The signal of the bowel wall and mesenteric fat was iso/hypointense on T2-weighted sequence in the fibrotic pattern (23/35 and 12/35 patients) and hyperintense in the edematous pattern (12/35 and 23/35 patients). Mean ADC values were, respectively, 2,58 ± 0,33 × 10 for the fibrotic mesentery and 2,14 ± 0,28 × 10 for edematous one. There was a statistical correlation between US-SE color-scale and T2 signal intensity and between the US-SE color-scale and ADC maps.

Conclusions: US-SE, ADC, and signal intensity on T2-weighted sequences on MR prove to be useful tools for the evaluation of CD pattern.
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http://dx.doi.org/10.1155/2017/4257987DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5682913PMC
July 2018

Hyaline fibromatosis syndrome (juvenile hyaline fibromatosis): whole-body MR findings in two siblings with different subcutaneous nodules distribution.

Skeletal Radiol 2018 Mar 23;47(3):425-431. Epub 2017 Oct 23.

Dipartimento di Biopatologia e Biotecnologie Mediche, Policlinico, Università degli Studi di Palermo, Via del Vespro, 127 90127, Palermo, Italy.

Hyaline fibromatosis syndrome (juvenile hyaline fibromatosis) is a rare, progressive, autosomal recessive disorder whose main hallmark is the deposition of amorphous hyaline material in soft tissues, with an evolutionary course and health impairment. It may present involvement of subcutaneous or periskeletal soft tissue, or may develop as a visceral infiltration entity with poor prognosis. Very few radiological data about this inherited condition have been reported, due to the extreme rarity of disease. We herein present a case of two siblings, affected by different severity of the disease, with different clinical features. They were examined by whole-body MR (WBMR) in order to assess different lesions localization, to rule out any visceral involvement and any other associated anomalies and to define patients' management.
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http://dx.doi.org/10.1007/s00256-017-2799-yDOI Listing
March 2018

MR Imaging of Perianal Crohn Disease: The Role of Contrast-enhanced Sequences.

Radiology 2017 09;284(3):921-922

University Hospital "Paolo Giaccone," Section of Radiology, DIBIMED, University of Palermo, Italy.

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http://dx.doi.org/10.1148/radiol.2017170721DOI Listing
September 2017

The Videofluorographic Swallowing Study in Rheumatologic Diseases: A Comprehensive Review.

Gastroenterol Res Pract 2017 15;2017:7659273. Epub 2017 Jun 15.

Section of Radiology-Di.Bi.Med., University of Palermo, Palermo, Italy.

Autoimmune connective tissue diseases are a heterogeneous group of pathologies that affect about 10% of world population with chronic evolution in 20%-80%. Inflammation in autoimmune diseases may lead to serious damage to other organs including the gastrointestinal tract. Gastrointestinal tract involvement in these patients may also due to both a direct action of antibodies against organs and pharmacological therapies. Dysphagia is one of the most important symptom, and it is caused by failure of the swallowing function and may lead to aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction. The videofluorographic swallowing study is a key diagnostic tool in the detection of swallowing disorders, allowing to make an early diagnosis and to reduce the risk of gastrointestinal and pulmonary complications. This technique helps to identify both functional and structural anomalies of the anatomic chain involved in swallowing function. The aim of this review is to systematically analyze the basis of the pathological involvement of the swallowing function for each rheumatological disease and to show the main features of the videofluorographic study that may be encountered in these patients.
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http://dx.doi.org/10.1155/2017/7659273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494561PMC
June 2017

Intraoperative ultrasound-assisted approach for endoscopic treatment of vesicoureteral reflux in children.

J Pediatr Surg 2017 Oct 18;52(10):1661-1665. Epub 2017 Apr 18.

Pediatric Urological Unit, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", AOU Policlinico Paolo Giaccone, Via Giordano 3, 90127 Palermo, Italy.

Purpose: Despite minimal invasiveness and high success rate, guidelines still prescribe voiding Cystourethrogram (VCUG) after endoscopic treatment for vesicoureteral reflux (VUR) in children. The aim of this paper was to analyze whether intraoperative ultrasound (IO-US) could improve surgical accuracy and perioperative counseling, thus potentially decreasing the need for postoperative VCUG.

Methods: We selected children treated for moderate to high grade VUR, renal scarring or repeated infections under antibiotic prophylaxis from January to December 2015. Endoscopic injection was combined with IO-US to detect optimal needle placement and to guide mound formation. IO-US findings were compared to surgeon opinion and postoperative VCUG, performed 3months after surgery. All patients were followed-up for 1year.

Results: A significant relationship was found between IO-US mound height (p=0.003) or localization (p<0.0005) and VCUG. Success of endoscopic treatment vs persistence of reflux groups had a mean mound height of 10.62±1.36mm and 8.39±1.08mm respectively (p<0.0005). Height maintained a significant correlation with success in simple and multivariable regression analysis. ROC curve determined ≥9.8mm as predictor of reflux resolution (95% CI 0.825 to 0.998; p<0.0001).

Conclusions: IO-US facilitates pediatric urologists to find an optimal location, to reach a volcano mound morphology and height, thus increasing intraoperative accuracy. IO-US also helps evaluating high-risk recurrence and guiding prognostic counseling.

Type Of Study: Treatment study.

Level Of Evidence: II.
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http://dx.doi.org/10.1016/j.jpedsurg.2017.04.004DOI Listing
October 2017

Whole-body magnetic resonance imaging in the diagnosis and follow-up of multicentric infantile myofibromatosis: A case report.

Mol Clin Oncol 2017 Apr 17;6(4):579-582. Epub 2017 Feb 17.

Department of Radiology, University Hospital Paolo Giaccone, I-90127 Palermo, Italy.

Myofibromatosis is an uncommon disorder of infancy, characterized by proliferation of myofibroblasts in solitary or multiple nodules. The clinical characteristics depend on the involved sites: Myofibromatosis may develop as a musculoskeletal form, with non-painful swellings and eventual mass effect symptoms, or as a generalized form with visceral involvement and organ failure. Prognosis and therapy vary between the abovementioned patterns. When there is no visceral involvement, the tumors may regress spontaneously; however, the visceral form may represent a lifethreatening condition with poor outcome and it requires aggressive management. Imaging assessment of disease spread is mandatory to determine diagnosis, prognosis and therapy. Due to the young age of the patients, a radiation-free evaluation is recommended. We herein describe a case of musculoskeletal myofibromatosis diagnosed in a 3-month-old male infant, investigated by serial wholebody magnetic resonance imaging (MRI) examination. The histological analysis and MRI characteristics enabled a correct diagnosis and organ involvement assessment with no radiation exposure. Moreover, whole-body MRI sequences provided a detailed evaluation of the disease within a short time frame, reducing the time of sedation, which is required to perform MRI in very young patients. Therefore, whole-body MRI was found to be accurate and safe in the diagnosis and follow-up of multicentric infantile myofibromatosis.
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http://dx.doi.org/10.3892/mco.2017.1171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5374893PMC
April 2017

Umbilical venous catheters placement evaluation on frontal radiogram: application of a simplified flow-chart for radiology residents.

Radiol Med 2017 May 10;122(5):386-391. Epub 2017 Feb 10.

Section of Radiological Sciences, DIBIMED, University of Palermo, Via del Vespro 127, 90127, Palermo, Italy.

Background: Umbilical Venous Catheter (UVC) are commonly used in neonatal period; they can be not correctly positioned and could be associated with complications. The purpose of this article is to suggest a flow-chart to evaluate the placement of UVC, testing it in young radiologists-in-training.

Method: We developed a simple flow-chart to asses, steps by step, UVC placement considering its course and tip location (ideally placed in the atriocaval junction). We tested the flow-chart impact asking to 20 residents to evaluate the placement of 10 UVC before and after they familiarized with the flow-chart and the anatomical findings of a newborn. The agreement among the 20 students was evaluated too.

Results: The number of correct characterizations was different due to the administration of the flow-chart. One hundred and six correct UVC assessments at the beginning switched to 196 after the administration of the flow-chart (p = 0.0001). The observed agreement among the twenty radiology residents was statistically significant, both before (kappa = 0.41, p < 0.001) and after (kappa = 0.37, p < 0.001) the flow-chart administration.

Conclusion: The developed flow-chart demonstrated to be useful in increasing residents performance in UVC placement assessment.
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http://dx.doi.org/10.1007/s11547-017-0732-zDOI Listing
May 2017

Corrigendum to "Multiple Congenital Colonic Stenosis: A Rare Gastrointestinal Malformation".

Case Rep Pediatr 2016 25;2016:5353012. Epub 2016 Jul 25.

Pediatric Surgical Unit, Department of Mother and Child Care, AOU Policlinico Paolo Giaccone, Via Giordano 3, 90127 Palermo, Italy.

[This corrects the article DOI: 10.1155/2016/6329793.].
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http://dx.doi.org/10.1155/2016/5353012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976166PMC
August 2016

Relationship between anxiety level and radiological investigation. Comparison among different diagnostic imaging exams in a prospective single-center study.

Radiol Med 2016 Oct 22;121(10):763-8. Epub 2016 Jun 22.

Dipartimento di discipline chirurgiche Oncologiche e stomatologiche, DICHIRONS, University of Palermo, Policlinico Paolo Giaccone, Via Liborio Giuffrè 5, 90127, Palermo, Italy.

Objective: Every patient could feel anxious when he waits in a radiological department to undergo diagnostic exams. The aim of our study is to evaluate the impact of the radiological exams on patient anxiety.

Materials And Methods: We evaluated 343 patients (mean age 54.83 years) who underwent different types of diagnostic exams in the Department of Diagnostic Imaging at our Hospital from April 2013 to August 2014. We administered to patients the State and Trait Anxiety Inventory Test, which detected with high sensitivity both state anxiety and trait anxiety. A team of clinical psychologists and radiologists evaluated the scores obtained.

Results: 83 out of 343 patients were excluded because refused to file the questionnaire. 31 % of the patients were submitted to MR, 18 % to breast imaging, 10 % to X-ray, 22 % Computer Tomography and 19 % to ultrasound, as previously described. 41 % of patients were submitted to the examination because of an oncologic disease, while 59 % because of non-oncological disease. Therefore, it was found that high levels of anxiety were present in most (about 91 %) of the patients and the scores varied according to the imaging examination and to the examination's reason: anxiety level was higher in non-oncological patients (54 %) and in patients waiting to undergo to MRI exams (29 %).

Conclusion: Our data suggest that the diagnostic exams are stressful events for the patient, also in non-oncological patients. So, it is important to adequate the radiological staff to receive the patient, to inform him and perform exams with emotive involvement with a targeted education. Also, further studies are needed to evaluate the anxiety level and the quality of the images, because the anxiety can result in a somatic disorder with hyperactivity of the autonomic nervous system which may affect the patient's physical examination, causing problems in the evaluation of radiological images making to non-cooperative patient. MRI imaging is the examination that more of all led to an anxious state of patients but the main stressor is not related to the type of diagnostic examination, but to the uncertainty of the diagnosis, therapy and prognosis.
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http://dx.doi.org/10.1007/s11547-016-0664-zDOI Listing
October 2016

Multiple Congenital Colonic Stenosis: A Rare Gastrointestinal Malformation.

Case Rep Pediatr 2016 15;2016:6329793. Epub 2016 Mar 15.

Pediatric Surgical Unit, Department of Mother and Child Care, AOU Policlinico Paolo Giaccone, Via Giordano 3, 90127 Palermo, Italy.

Congenital colonic stenosis is a rare pediatric condition. Since 1968, only 16 cases have been reported in the literature. To the authors' knowledge, multiple congenital colonic stenosis has not been previously reported in the literature. We report the case of a 2-month-old male, presented at our Neonatal Intensive Care Unit with a suspicion of intestinal malrotation. Clinical examination revealed persistent abdominal distension. During the enema examination, the contrast medium appeared to fill the lumen of the colon up to three stenotic segments and could not proceed further. Intraoperatively we confirmed the presence of four types of colonic atresia, located in the ascending, transverse, and descending colon, respectively, plus appendix atresia. First surgical steps consisted in resection of proximal stenotic segment, appendix removal, proximal cecostomy, and distal colostomy on ascending colon in order to preserve colonic length. Histopathological examination confirmed the diagnosis of colonic stenosis. Final surgical step consisted in multiple colocolostomy and enteroplasty. A planned two-stage procedure, consisting of resection with colostomy for decompression as the first step and a later anastomosis, is recommended in order to allow bowel length preservation.
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http://dx.doi.org/10.1155/2016/6329793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811083PMC
April 2016

Small Bowel Perforations: What the Radiologist Needs to Know.

Semin Ultrasound CT MR 2016 Feb 5;37(1):23-30. Epub 2015 Nov 5.

Section of Radiological Sciences, DIBIMED, University of Palermo, Palermo, Italy.

The incidence of small bowel perforation is low but can develop from a variety of causes including Crohn disease, ischemic or bacterial enteritis, diverticulitis, bowel obstruction, volvulus, intussusception, trauma, and ingested foreign bodies. In contrast to gastroduodenal perforation, the amount of extraluminal air in small bowel perforation is small or absent in most cases. This article will illustrate the main aspects of small bowel perforation, focusing on anatomical reasons of radiological findings and in the evaluation of the site of perforation using plain film, ultrasound, and multidetector computed tomography equipments. In particular, the authors highlight the anatomic key notes and the different direct and indirect imaging signs of small bowel perforation.
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http://dx.doi.org/10.1053/j.sult.2015.11.001DOI Listing
February 2016
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