KEYWORDSLiver; Metastases; Ultrasound; Computed tomography; Magnetic resonance; Intraoperative ultrasound.Abstract Purpose: To evaluate the clinical impact of intraoperative ultrasound (IOUS) in the detection of liver metastases during the years, as compared with those of other imaging modalities. Materials and methods: All IOUS scans performed for detection of liver metastases from 2000 to 2006 were retrospectively reviewed and compared with the results of preoperative imaging modalities: Ultrasound (US), Computed Tomography (CT), and/or Magnetic Resonance (MR). The number of cases in which IOUS and preoperative imaging studies produced discordant results, in terms of presence/absence of focal liver lesions, was calculated per year. Statistical analysis was performed using the McNemar test. A p value < 0.05 was considered statistically significant. Results: Eighty-three IOUS scans performed in 2000e2003 were reviewed, and discordance with preoperative imaging findings was found in 19/83 (23%) cases. Of the 42 IOUS scans done during the 2004e2006 period, 10/42 (24%) showed discordance with preoperative studies. All metastases diagnosed with imaging studies were pathologically confirmed. The number of discordant cases in the two periods were not significantly different (p Z 0.2). Conclusion: IOUS is still useful in the detection of liver metastases. Its decreased use is probably due to the improved accuracy of preoperative imaging modalities.Sommario Scopo: Valutare l'impatto clinico negli anni dell'ecografia intraoperatoria (IOUS) nella identificazione delle metastasi epatiche rispetto alle altre metodiche di imaging. Materiali e metodi: risultati delle ecografie intraoperatorie effettuate per l'identificazione delle metastasi epatiche in un periodo compreso tra gli anni 2000 e 2006 sono stati retrospettivamente revisionati e comparati con le metodiche di imaging preoperatorio: Ecografia (US), Tomografia Computerizzata (TC) e/o Risonanza Magnetica (RM). Tutti i casi sono stati patologicamente provati. Sono stati calcolati per anno i casi discordanti in termini di presenza/assenza di lesione focale epatica. Il confronto statistico è stato effettuato con il test di McNemar. Un valore del p < 0,05 è stato considerato statisticamente significativo. Risultati: Nel triennio 2000e2003, i dati di 83 pazienti sono stati revisionati e i casi discordanti sono stati 19/83 (23%). Nel triennio 2004e2006, i dati di 42 pazienti sono stati revisionati e i casi discordanti sono stati 10/42 (24%). Non vi è stata differenza statisticamente significativa (p Z 0,2) circa il numero di casi discordanti nei due periodi. L'esame patologico ha confermato la presenza di metastasi in tutti i casi. Conclusioni: L'ecografia intraoperatoria (IOUS) risulta una metodica di imaging tuttora utile nella identificazione delle metastasi epatiche. La riduzione del suo impiego negli anni è probabilmente dovuta alla maggiore accuratezza diagnostica dell'imaging preoperatorio. ª

IntroductionMagnetic Resonance Imaging (MRI) is the best approach to investigate the hypothalamic-pituitary region in children with central precocious puberty (CPP). Routine scanning is controversial in girls aged 6-8 year, due to the overwhelming prevalence of idiopathic forms and unrelated incidentalomas. Cerebral lipomas are rare and accidental findings, not usually expected in CPP. We report a girl with CPP and an unusually shaped posterior pituitary gland on SE-T1w sequences.Case DescriptionA 7.3-year-old female was referred for breast development started at age 7. Her past medical history and physical examination were unremarkable, apart from the Tanner stage 2 breast. X-ray of the left-hand revealed a bone age 2-years ahead of her chronological age, projecting her adult height prognosis below the mid parental height. LHRH test and pelvic ultrasound were suggestive for CPP. Routine brain MRI sequences, SE T1w and TSE T2w, showed the posterior pituitary bright spot increased in size and stretched upward. The finding was considered as an anatomical variant, in an otherwise normal brain imaging. Patient was started on treatment with GnRH analogue. At a thorough revaluation, imaging overlap with adipose tissue was suspected and a new MRI scan with 3D-fat-suppression T1w-VIBE sequences demonstrated a lipoma of the tuber cinereum, bordering a perfectly normal neurohypophysis. 3D-T2w-SPACE sequences, acquired at first MRI scan, would have provided a more correct interpretation if rightly considered.ConclusionThis is the first evidence, to our knowledge, of a cerebral lipoma mimicking pituitary gland abnormalities. Our experience highlights the importance of considering suprasellar lipomas in the MRI investigation of children with CPP, despite their rarity, should the T1w sequences show an unexpected pituitary shape. 3D-T2w SPACE sequences could be integrated into standard ones, especially when performing MRI routinely, to avoid potential misinterpretations.

Variants and congenital anomalies of the coronary arteries are usually asymptomatic, but may present with severe chest pain or cardiac arrest. The introduction of multidetector CT coronary angiography (MDCT-CA) allows the detection of significant coronary artery stenosis. Improved performance with isotropic spatial resolution and higher temporal resolution provides a valid alternative to conventional coronary angiography (CCA) in many patients. MDCT-CA is now considered the ideal tool for three-dimensional visualization of the complex and tortuous anatomy of the coronary arteries. With multiplanar and volume-rendered reconstructions, MDCT-CA may even outperform CCA in determining the relative position of vessels, thus providing a better view of the coronary vascular anatomy. The purpose of this review is to describe the normal anatomy of the coronary arteries and their main variants based on MDCT-CA with appropriate reconstructions.

No abstract

MDCT-CA provides parameters of cardiac function comparable to those found in echocardiography. MDCT-CA although used primarily for coronary noninvasive imaging can provide additional information on ventricular function useful to the diagnostic workup of cardiac patients.