Osteoporosis is a silent disease without any evidence of disease until a fracture occurs. Approximately 200 million people in the world are affected by osteoporosis and 8.9 million fractures occur each year worldwide. Fractures of the hip are a major public health burden, by means of both social cost and health condition of the elderly because these fractures are one of the main causes of morbidity, impairment, decreased quality of life and mortality in women and men. The aim of this review is to analyze the most important factors related to the enormous impact of osteoporotic fractures on population. Among the most common risk factors, low body mass index; history of fragility fracture, environmental risk, early menopause, smoking, lack of vitamin D, endocrine disorders (for example insulin-dependent diabetes mellitus), use of glucocorticoids, excessive alcohol intake, immobility and others represented the main clinical risk factors associated with augmented risk of fragility fracture. The increasing trend of osteoporosis is accompanied by an underutilization of the available preventive strategies and only a small number of patients at high fracture risk are recognized and successively referred for therapy. This report provides analytic evidences to assess the best practices in osteoporosis management and indications for the adoption of a correct healthcare strategy to significantly reduce the osteoporosis burden. Early diagnosis is the key to resize the impact of osteoporosis on healthcare system. In this context, attention must be focused on the identification of high fracture risk among osteoporotic patients. It is necessary to increase national awareness campaigns across countries in order to reduce the osteoporotic fractures incidence.

No abstract

Accurate knowledge of the liver structure, including liver surface and lesion localization, is usually required in treatments such as liver tumor ablations and/or radiotherapy. This paper presents a new method and corresponding algorithm for fast segmentation of the liver and its internal lesions from CT scans. No interaction between the user and analysis system is required for initialization since the algorithm is fully automatic. A statistical model-based approach was created to distinguish hepatic tissue from other abdominal organs. It was combined to an active contour technique using gradient vector flow in order to obtain a smoother and more natural liver surface segmentation. Thereafter, automatic classification was performed to isolate hepatic lesions from liver parenchyma. Twenty-one datasets, presenting different anatomical and pathological situations, have been processed and analyzed. Special focus has been driven to the resulting processing time together with quality assessment. Our method allowed robust and efficient liver and lesion segmentations very close to the ground truth, in a relatively short processing time (average of 11.4 s for a 512 x 512-pixel slice). A volume overlap of 94.2% and an accuracy of 3.7 mm were achieved for liver surface segmentation. Sensitivity and specificity for tumor lesion detection were 82.6% and 87.5%, respectively.

Silica nanoparticles at a diameter of about 330 nm are very promising contrast agents for ultrasound imaging and specific tumor targeting at conventional diagnostic frequencies, being in particular automatically detectable with high sensitivity already at low doses. Future studies will be carried out to assess the acoustic behavior of nanoparticles with different geometries/sizes and to improve sensitivity of the automatic detection algorithm.

A simple and efficient method for synthesizing a range of hybrid nanocomposites based on a core of silica nanospheres (160, 330, and 660 nm in diameter) covered by an outer shell of superparamagnetic nanoparticles, either iron oxide or heterodimeric FePt‐iron oxide nanocrystals, is presented. The magnetic and ultrasound characterization of the resulting nanocomposites shows that they have great potential as contrast agents for dual‐mode imaging purposes, combining magnetic resonance imaging (MRI) and ultrasonography (US).

The accurate knowledge of the liver structure including blood vessels topography, liver surface and lesion localizations is usually required in treatments like liver ablations and radiotherapy. In this paper, we propose an approach for automatic segmentation of liver complex geometries. It consists of applying a graph-cut method initialized by an adaptive threshold. The algorithm has been tested on 10 datasets (CT and MR). A parametric comparison with the results obtained by previous algorithms based on active contour is also carried out and discussed. Main limitations of active contour approaches result to be overcome and segmentation is improved. Feasibility to routinely use graph-cut approach for automatic liver segmentation is also demonstrated.

BackgroundThe objective of this work is to evaluate a new concept of intraoperative three-dimensional (3D) visualization system to support hepatectomy. The Resection Map aims to provide accurate cartography for surgeons, who can therefore anticipate risks, increase their confidence and achieve safer liver resection.MethodsIn an experimental prospective cohort study, ten consecutive patients admitted for hepatectomy to three European hospitals were selected. Liver structures (portal veins, hepatic veins, tumours and parenchyma) were segmented from a recent computed tomography (CT) study of each patient. The surgeon planned the resection preoperatively and read the Resection Map as reference guidance during the procedure. Objective (amount of bleeding, tumour resection margin and operating time) and subjective parameters were retrieved after each case.ResultsThree different surgeons operated on seven patients with the navigation aid of the Resection Map. Veins displayed in the Resection Map were identified during the surgical procedure in 70.1% of cases, depending mainly on size. Surgeons were able to track resection progress and experienced improved orientation and increased confidence during the procedure.ConclusionsThe Resection Map is a pragmatic solution to enhance the orientation and confidence of the surgeon. Further studies are needed to demonstrate improvement in patient safety.

SummaryCurrently, the accepted "gold standard" method for bone mineral density (BMD) measurement and osteoporosis diagnosis is dual-energy X-ray absorptiometry (DXA). However, actual DXA effectiveness is limited by several factors, including intrinsic accuracy uncertainties and possible errors in patient positioning and/or post-acquisition data analysis. DXA employment is also restricted by the typical issues related to ionizing radiation employment (high costs, need of dedicated structures and certified operators, unsuitability for population screenings). The only commercially-available alternative to DXA is represented by "quantitative ultrasound" (QUS) approaches, which are radiation-free, cheaper and portable, but they cannot be applied on the reference anatomical sites (lumbar spine and proximal femur). Therefore, their documented clinical usefulness is restricted to calcaneal applications on elderly patients (aged over 65 y), in combination with clinical risk factors and only for the identification of healthy subjects at low fracture risk. Literature-reported studies performed some QUS measurements on proximal femur, but their clinical translation is mostly hindered by intrinsic factors (e.g., device bulkiness). An innovative ultrasound methodology has been recently introduced, which performs a combined analysis of B-mode images and corresponding "raw" radiofrequency signals acquired during an echographic scan of the target reference anatomical site, providing two novel parameters: Osteoporosis Score and Fragility Score, indicative of BMD level and bone strength, respectively. This article will provide a brief review of the available systems for osteoporosis diagnosis in clinical routine contexts, followed by a synthesis of the most promising research results on the latest ultrasound developments for early osteoporosis diagnosis and fracture prevention.