European Radiology Supplements 

About: European Radiology Supplements is an academic journal. The journal publishes majorly in the area(s): Neuroradiology & Gadofosveset. It has an ISSN identifier of 1613-3749. Over the lifetime, 73 publications have been published receiving 1402 citations.

Osteomyelitis in infants and children.

Abstract: Infection of the pediatric skeletal system is a dramatic diagnostic and therapeutic challenge. The consequences of a missed diagnosis could lead to long-lasting functional sequelae. This disease has multiple aspects according to the clinical presentation and evolution, the causative microorganism, the site of infection, and, finally, the patient's age and immunological status. The choice of the most appropriate imaging modality according to the clinical presentation is very important to assess the diagnosis, the extent of the disease, and to obtain the causative germ when needed; thus, plain films, ultrasound, nuclear medicine, computed tomography, and MR imaging are discussed, each of them having pros and cons. This multimodality approach of the musculoskeletal infections is mandatory to guide surgery, to deliver an appropriate antibiotic therapy, and to reduce the rate of long-term functional sequelae.

Economic assessment of contrast-enhanced ultrasonography for evaluation of focal liver lesions: a multicentre Italian experience.

Abstract: The aim of this study was to evaluate the clinical and economic consequences of the introduction of contrast-enhanced ultrasonography (CEUS) into the diagnostic clinical algorithm for the characterization of incidental focal liver lesions (FLLs). This prospective study enrolled 485 subjects at three hospitals in Italy. Two diagnostic algorithms were utilized: (1) a classic patient work-up, which included baseline US followed by a CT or MR examination, and (2) a new patient management scheme in which, following the baseline US, a CEUS examination was performed. For each pathway, both direct and indirect health costs for the National Health System (NHS) at two of the three hospitals involved in the study were calculated. Clinical outcome was measured in terms of number of cases correctly diagnosed, using contrast-enhanced CT/contrast-enhanced MR as the reference standard. CEUS correctly differentiated (benign vs. malignant) 559 of 575 lesions (97.2%), with a sensitivity of 98.1% and a specificity of 95.7%. Histological characterization was correct in 502 of 575 lesions (87%) with a sensitivity of 90.5% and a specificity of 85.4%. In terms of cost, the conventional diagnostic algorithm incurred for the NHS a total cost of €134.576,60 vs. €55.674,30 with CEUS, for a saving of €78.902 (€162 per patient). For the hospitals, the total cost was €147.045 without CEUS vs €61.979 with CEUS, for a saving of €85.065,96 or €175,39 per patient. The routine use of CEUS for the characterization of FLLs provides significant cost savings, both for the NHS and for the hospital.

How to design injection protocols for multiple detector-row CT angiography (MDCTA).

Abstract: The basis of the development of optimal injection protocols for multiple detector-row CT-angiography is knowledge of the physiological and pharmacokinetic principles of arterial enhancement. This article reviews the key rules of early arterial contrast medium dynamics: (1) Arterial enhancement is directly proportional to the iodine administration rate (iodine flux), and can be controlled by the injection flow rate and the iodine concentration of the contrast medium; (2) Arterial enhancement continuously increases over time with longer injection durations, due to the cumulative effects of bolus broadening and recirculation; (3) The strength of an individual’s enhancement response to intravenously administered CM depends primarily on the patient’s cardiac output and correlates inversely with body weight.

Management of intussusception.

Abstract: Intussusception represents the most common abdominal emergency in infancy. The classical clinical triad, consisting of abdominal colics, red jelly stools and a palpable mass, is only present in approximately 50% of cases, 20% of patients are symptom free at clinical presentation. Primary imaging modality of choice is ultrasound scanning, which enables the diagnosis or exclusion of an intussusception at a sensitivity of 98–100%, specificity of 88% and a negative predictive value of 100%. In emergency cases, additional plain films are necessary to detect potential intestinal perforation, to identify intestinal obstruction or other diseases mimicking the clinical presentation. Once the diagnosis of an intussusception is established, non-surgical reduction (NSR) is used. A surgical approach is chosen in patients with signs of perforation, shock or peritonitis. Depending on the choice of guiding imaging technique, different contrast media are used for NSR. Barium suspension or air with fluoroscopic guidance, or saline only or mixed with water-soluble contrast under sonographic guidance, has to be used. Regardless of the used contrast medium, NSR is an effective technique, being successfully employed in more than 90% of cases.

Perfusion imaging with computed tomography: brain and beyond.

Abstract: The availability of rapid imaging with multidetector CT systems and commercial analysis software has made perfusion imaging with CT an everyday technique, not only for the brain but also for other body organs. Perfusion imaging is usually performed as an adjunct to a conventional CT examination and is therefore particularly appropriate when a conventional CT is part of routine clinical protocols. The derived values are reproducible and have been validated against a range of reference techniques. Within neuroradiology, perfusion CT has attracted interest in the assessment of acute stroke but can also be used to assess secondary injury in head trauma and as an adjunct to CT angiography to evaluate cerebral spasm in subarachnoid haemorrhage. Within oncology, perfusion CT provides an imaging correlate for tumour vascularity that can be used to discriminate benign and malignant lesions, as an indicator of tumour aggressiveness, to reveal occult tumour and improve the delineation of tumours during radiotherapy planning, and as a functional assessment of tumour response to therapy. By exploiting the ability of CT systems to quantify contrast enhancement, CT perfusion imaging uses contrast media to assess vascular physiology and so improve diagnosis, prognosis, treatment selection and therapy monitoring.