Pelvic floor dysfunctions involving some or all pelvic viscera are complex conditions that occur frequently and primarily affect adult women. Because abnormalities of the three pelvic compartments are frequently associated, a complete survey of the entire pelvis is necessary for optimal patient management, especially before surgical correction is attempted. With the increasing use of magnetic resonance (MR) imaging in assessing functional disorders of the pelvic floor, familiarity with normal imaging findings and features of pathologic conditions are important for radiologists. Dynamic MR imaging of the pelvic floor is an excellent tool for assessing functional disorders of the pelvic floor such as pelvic organ prolapse, outlet obstruction, and incontinence. Findings reported at dynamic MR imaging of the pelvic floor are valuable for selecting patients who are candidates for surgical treatment and for choosing the appropriate surgical approach. This pictorial essay reviews MR imaging findings of pelvic organ prolapse, fecal incontinence, and obstructed defecation. Supplemental material available at http://radiographics.rsnajnls.org/cgi/content/full/e35v1/DC1.

Our objective was to assess the diagnostic value of magnetic resonance enteroclysis (MRE) compared with conventional enteroclysis (CE) in patients with Crohn's disease. A secondary objective was to evaluate the diagnostic accuracy of each different MR sequence. Sixty-six consecutive patients with known Crohn's disease underwent MRE and CE. Fast imaging employing steady-state acquisition (FIESTA), single-shot fast spin-echo (ssFSE), and contrast-enhanced T1-weighted sequences were assessed by two radiologists who reached a consensus about the following findings: visualization of wall ulcers, pseudopolyps, fistulae, mural stenosis, and mesenteric abnormalities. Standard descriptive statistics and the McNemar test were used. The sensitivity, specificity and accuracy of MRE were 90-87% and 83% for the depiction of parietal ulcers, 84%-88% and 86% for pseudopolyps, 100-94% and 96% for mural stenosis, 93-100% and 94% for fistulae. The number of detected extraluminal findings was significantly higher with MRE (P < 0.01). The accuracy of FIESTA sequence was statistically higher in the depiction of wall ulcers and fistulae than that of three-dimensional fast spoiled gradient echo (3D-FSPGR) (P < 0.01) and ssFSE (P < 0.05) sequences. Contrast-enhanced 3D-FSPGR was superior for mural stenosis visualization compared to ssFSE (P < 0.05) and FIESTA (P < 0.05). MRE correlates accurately with CE in the detection of superficial and transmural abnormalities and has the advantage of assessing the mesenteric manifestations.

Multidetector computed tomography-generated virtual bronchoscopy (VB) is a recent technical development that allows visualisation of the lumen and wall of the trachea and proximal part of the bronchial tree. A dynamic image is produced that resembles what is seen with fibreoptic bronchoscopy (FB).Although the technique has not yet reached daily clinical practice and it can never replace FB, performing VB can be useful in well-defined clinical situations.In this paper, the value and limitations of virtual bronchoscopy will be reviewed, to illustrate the potential role of virtual bronchoscopy in the evaluation of trachea and bronchial tree pathology. Virtual bronchoscopy (VB) is a novel computed tomography (CT)-based imaging technique that allows a noninvasive intraluminal evaluation of the tracheobronchial tree. Several studies have shown that VB can accurately show the lumen and the diameter of the trachea, the left and right main stem bronchi, and the bronchial tree down to the fourth order of bronchial orifices and branches [1,2]. The morphology of the carinas can be evaluated accurately and the images look very similar to that seen with fibreoptic bronchoscopy (FB).Although VB is a promising imaging tool, this technique is not currently used in daily clinical practice and more randomised clinical trials are necessary to prove its clinical use. Nevertheless, it seems valuable to review its potential clinical indications. The purpose of this paper is to discuss and illustrate these indications based on VBs generated from the CT scans of a randomly selected group of patients. Materials and methodsCases were selected retrospectively and randomly from patients undergoing a multidetector row CT (MDCT) examination of the chest for various reasons. Selection was based on the presence of tracheal and bronchial abnormalities identified on the regular axial images and, when made, on additional coronal and sagittal reconstructions. MDCT was performed on a Phillips 16 slice CT (Philips, Best, the Netherlands). Technical parameters were: Kvp: 120; mAs: 150; collimation: 16*0.75; pitch: 0.9; rotation time: 0.42; slice thickness: 1 mm and an increment of 1 mm. MDCT was either performed with or without IV contrast administration depending on the clinical question. A proprietary virtual endoscopic software program (Endo3D; Philips) was used to reconstruct the CT data into VB images. This software program uses a volume rendering technique. A threshold value between -400 and -600 HU was chosen to evaluate the central bronchial tree. The more distal bronchial tree was evaluated using a threshold of -750 HU.Endo3D generates a perspective three-dimensional view from the inside of an anatomical structure, such as the inner wall of the colon, trachea or abdominal aorta. This insideview is generated step by step, creating a film at the end-point. The thickness of each step is 2 mm. The images are orientated with the posterior side at 12 o9clock, the left side at 3 o9clock, the anterior side at 6 o9clock and the right side at...

Purpose The purpose of our study was to assess the potential role of chest CT in the early detection of COVID-19 pneumonia and to explore its role in patient management in an adult Italian population admitted to the Emergency Department. Methods Three hundred and fourteen patients presented with clinically suspected COVID-19, from March 3 to 23, 2020, were evaluated with PaO2/FIO2 ratio from arterial blood gas, RT-PCR assay from nasopharyngeal swab sample and chest CT. Patients were classified as COVID-19 negative and COVID-19 positive according to RT-PCR results, considered as a reference. Images were independently evaluated by two radiologists blinded to the RT-PCR results and classified as “CT positive” or “CT negative” for COVID-19, according to CT findings. Results According to RT-PCR results, 152 patients were COVID-19 negative (48%) and 162 were COVID-19 positive (52%). We found substantial agreement between RT-PCR results and CT findings ( p < 0.000001), as well as an almost perfect agreement between the two readers. Mixed GGO and consolidation pattern with peripheral and bilateral distribution, multifocal or diffuse abnormalities localized in both upper lung and lower lung, in association with interlobular septal thickening, bronchial wall thickening and air bronchogram, showed higher frequency in COVID-positive patients. We also found a significant correlation between CT findings and patient’s oxygenation status expressed by PaO2/FIO2 ratio. Conclusion Chest CT has a useful role in the early detection and in patient management of COVID-19 pneumonia in a pandemic. It helps in identifying suspected patients, cutting off the route of transmission and avoiding further spread of infection.

Two distinct genomic disorders have been linked to Xq28‐gains, namely Xq28‐duplications including MECP2 and Int22h1/Int22h2‐mediated duplications involving RAB39B. Here, we describe six unrelated patients, five males and one female, with Xq28‐gains distal to MECP2 and proximal to the Int22h1/Int22h2 low copy repeats. Comparison with patients carrying overlapping duplications in the literature defined the MidXq28‐duplication syndrome featuring intellectual disability, language impairment, structural brain malformations, microcephaly, seizures and minor craniofacial features. The duplications overlapped for 108 kb including FLNA, RPL10 and GDI1 genes, highly expressed in brain and candidates for the neurologic phenotype.

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If more than two major signs associated with one minor sign or at least one sign of complication are present at US, CT is mandatory to recognise and thoroughly evaluate the type of complication and indicate appropriate treatment.

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