La Radiologia medica
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To assess the role of Ultrasound (US), US Color Doppler (CD) and Power Doppler (PD) in the diagnosis and in the follow-up of renal graft pathology by evaluating morphological and functional features of the vasculature and comparing these to other clinical parameters. ⋯ CD is a non-invasive diagnostic method which provides flow-metric quantitative parameters for the hemodynamic assessment of the renal transplant. These values present a certain sensitivity but are not specific of renal graft dysfunction, as there is no reliable differentiation between acute rejection and other parenchymal pathologies. During the follow-up, RI and PI have no predictive value. RI variations from renal artery to cortical vessels (hylum-cortical ratio) show a good correlation with the clinical evolution of the transplant. The evaluation of RI and PI can generally be limited to renal and interlobar arteries as arcuate sampling is necessary only when the hylum-cortical ratio shows reduction or inversion. Integration of clinical and instrumental diagnoses can reduce the number of biopsies.
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La Radiologia medica · Mar 2001
[Role of computerized tomography in the diagnosis of peritoneo-intestinal lesions resulting from closed trauma. Experience at 2 emergency departments].
Small and large bowel mesenteric injuries from blunt abdominal trauma are rare and often difficult to diagnose. Computed Tomography used in cases of blunt abdominal trauma has been found sensitive in detection of bowel and mesenteric injuries and discrimination of operable from nonoperable candidates. ⋯ Bowel and mesenteric injuries from blunt trauma are infrequent and difficult to diagnose clinically, as the physical and laboratory findings may be subtle and are often overshadowed by other injuries in patients with multisystem trauma. CT represents a proven modality in the evaluation of bowel and mesenteric injuries: careful inspection and technique are required to detect often subtle findings. In our series of 24 patients with surgically confirmed bowel and mesenteric injuries, the presence of mesenteric hematoma and of peritoneal or retroperitoneal fluid were the more frequent CT signs observed. Radiologists may play a crucial role in the timely diagnosis of these injuries, allowing prompt and appropriate management of these patients.
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La Radiologia medica · Mar 2001
[Personal experience with computerized tomography of shock and death in emergency situations].
The wide availability of CT machines in hospitals specialising in emergency care has made it possible to observe CT features of severe shock and death of the patient during the CT examination. Unique radiological signs can be evaluated that testify to the state of shock or indicate arrest of the contrast medium in the cardiovascular system and parenchymatous organs, with different hemodynamic features from those found in living persons. This paper aims to report our personal experience with the role of CT in documenting states of shock or death. Our series, which is relatively large considering the infrequency of cases, seems to be of interest as it is one of the few to describe these rare CT findings, which have ethical implications for all healthcare providers and the field of diagnostic imaging. ⋯ Such CT findings will probably become increasingly frequent in the future, because the need to avoid exploratory laparotomies or thoracotomies and unnecessary neurosurgical procedures will entail a greater demand for highly selective diagnostic examinations to be carried out on critical patients. This tendency is matched by the technological advances in diagnostic imaging, and particularly the availability of fast CT and spiral CT machines that give, in only a few seconds, an accurate diagnostic and clinical picture, on which immediate therapeutic decisions can be made.
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La Radiologia medica · Mar 2001
[Study of the liver and the portal venous system with digital rotational angiography].
Digital subtraction angiography is of common clinical use for the evaluation of vascular disease. The rotation of the X-ray tube around the patient's body during contrast medium injection was first proposed in the early seventies in the neuroradiologic field; only recently it has been applied to the evaluation of vascular structures and abdominal parenchymatous organs. We investigated the potential clinical value of digital rotational subtraction angiography in the evaluation of the hepatic arteries and of the portal venous system. ⋯ Digital rotational subtraction angiography is a useful tool for the evaluation of the liver as well as for transarterial chemoembolization or other interventional procedures. Images are obtained during a single contrast injection, with a better 3-D rendering of the hepatic artery and the portal venous system: no other method provides as complete a visualization of liver vascular anatomy after a single injection of contrast medium in one examination series. (ABSTRACT TRUNCATED)
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La Radiologia medica · Mar 2001
[Physical-dosimetric characterization of a multi-leaf collimator system for clinical implementation in conformational radiotherapy].
In the present paper we discuss the main dosimetric characteristics of the multileaf collimator (MLC) installed on the Elekta SLi Precise accelerators. To evaluate the effectiveness of the MLC in conformal radiotherapy, beam transmission through leaves and/or diaphragms, leakage between the leaves, central axis depth dose, surface dose, effective penumbra, scalopping effect and field size factors were measured. ⋯ The dosimetric characteristics and the case of use of the Elekta multileaf collimator make its application to conformal radiotherapy convenient and reliable, able to improve the accuracy and the effectiveness of radiation therapy and to develop new kinds of treatments. However, because of the complexity of the MLC, its implementation in radiotherapic practice requires careful dosimetric characterization to evaluate those parameters (transmission, penumbra and output factors) that play a fundamental role in the accuracy of the treatment.