Computed tomography (CT) is a very useful tool in the assessment of pancreatic disease. Searching for subtle signs, as in chronic pancreatitis or staging of adenocarcinoma, high spatial and contrast resolution is needed. The high resolution computed tomography (HRCT) technique for pancreatic scans, and its evolution from dynamic CT to multislice spiral CT, is described. 2D and 3D dimensional reconstructions are depicted and their role in diagnosis is focused. Together with spatial resolution, contrast enhancement protocols are discussed, aimed to achieve optimal contrast between the lesion and normal parenchyma.
ABSTRACT Maternal infectious diseases are frequent complications of pregnancy and can cause negative outcomes. Perinatal infections can cause serious damage to fetal central nervous system (CNS), but incidence of symptomatic congenital infections at birth is low. Complete and multidisciplinary (obstetric, infectologist, microbiologist, neonatologist/pediatrician, psychologist) evaluation of the pregnant women is crucial to define fetal prognosis. The ultrasound (US) surveillance has an irreplaceable role in identifying serious fetal damage and complications. Complete evaluation of the fetus in selected cases needs to be integrated with invasive prenatal diagnosis, particularly amniocentesis, which has optimal predictive values in excluding vertical transmission, and fetal magnetic resonance imaging (MRI), which can add important anatomical detail when fetal CNS damage is suspected. Congenital infections, furthermore, need to be considered in differential diagnosis of some common abnormal CNS findings at prenatal US. With the present review, we intend to provide an overview of the major perinatal infections and the role of US diagnosis in their assessment to recognize fetal CNS damage. We highlight the most recognizable syndromes due to congenital infections by linking etiopathogenesis with pathology and imaging. In particular, we focus on US diagnostic and prognostic values in relation to other invasive and noninvasive prenatal diagnosis options and summarize up-to-date recommendations on US evaluation of most common findings. Cytomegalovirus (CMV) is the most common cause of congenital infection, while Toxoplasmosis is the most preventable cause of infectious CNS damage; rubella, varicella virus, and herpes viruses, even if rarely, may be responsible for extremely serious fetal damage, while Zika virus is an emerging concern on global scale. How to cite this article Masini L, Apicella M, De Luca C, Valentini P, Manfredi R, Lanzone A, De Santis M. Fetal Central Nervous System and Infectious Diseases. Donald School J Ultrasound Obstet Gynecol 2017;11(4):314-327.
Cystic fibrosis transmembrane conductance regulator (CFTR), cationic trypsinogen gene (PRSS1), and serine protease inhibitor kazal type 1 (SPINK1) gene mutations have been associated with chronic pancreatitis (CP). The aim of this study was to compare clinical and radiological findings in sporadic CP with (CPgm) and without (CPwt) gene mutations.Data from patients observed between 2001 and 2006 were collected. All patients were tested for 25 CFTR gene mutations, for R122H and N29I on the PRSS1 gene, and for N34S mutation on the SPINK1 gene.We found 34 (17.2%) of 198 patients with CPgm, 23 (11.6%) of them on the CFTR gene, 11 (5.6%) on the SPINK1, and none on the PRSS1 gene. The age at clinical onset was younger in CPgm (36.2 +/- 17.2 years) than in CPwt (44 +/- 12.6 years; P = 0.005). There were more heavy drinkers among CPwt (33%) than among CPgm (9%; P = 0.003), and the same applied to smokers (69% vs 33%, respectively; P < 0.0001). In CPgm group, the onset of pancreatic calcifications was observed more frequently in drinkers and/or smokers. Exocrine and endocrine insufficiency occurred less frequently and later in CPgm than in CPwt patients.Clinical and radiological outcome differ in CPgm compared with CPwt. Alcohol, even in small quantities, and cigarette smoking influence the onset of pancreatic calcifications.
