The long-term consequences of COVID-19 in those who recover from acute infection requiring hospitalization have not been defined yet. In this study, we aim to describe the long-term symptoms and respiratory outcomes over 12 months in patients hospitalized for severe COVID-19. In this prospective cohort study, patients admitted to hospital for severe COVID-19 were prospectively followed up at 6 and 12 months after discharge from the Hospital of Fermo, Italy. Patients were interviewed for persisting symptoms and underwent physical examination, routine blood test, pulmonary function tests, chest high-resolution CT (HRCT), and 6 min walking test. A total of 64 patients were evaluated and participated in this study. The mean age of participants was 68 years, 41 (64%) were males, and the median body mass index (BMI) was 26 kg/m2. After 6 months, 36% of patients reported persistent dyspnea, 37.5% persistent fatigue, 30.6% hair loss, 14% arthralgia and 11% memory and attention deficits. The rate of these symptoms reduced at the 12 month follow-up. At least 50% of the patients reported anxiety and depression symptoms. At 6 months 57.4% of patients showed reduced DLCO and 21.3% reduced FVC% and improvement at 12 months was noted for FVC but not for DLCO and TLC. Persistent radiographic abnormalities, most commonly ground-glass opacities and interstitial changes, were observed at both timepoints in many patients. Long-term symptoms and pulmonary deficits are common in patients admitted for severe COVID-19. Further studies are needed to assess the clinical significance of long-term consequences of severe COVID-19.

Poster: ECR 2019 / C-1477 / Tips and tricks of MR arthrography of the hip by: G. Valeri 1, G. Gismondi2, S. Mangino 2, A. Giovagnoni3; 1Fermo /IT, 2Fermo/IT, 3Ancona/IT

AimsCardiovascular magnetic resonance (CMR) has dramatically changed the clinical practice in thalassemia major (TM), lowering cardiac complications. We prospectively reassessed the predictive value of CMR parameters for heart failure (HF) and arrhythmias in TM.Methods and resultsWe considered 481 white TM patients (29.48 ± 8.93 years, 263 females) enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) network. Myocardial and liver iron overload were measured by T2* multiecho technique. Atrial dimensions and biventricular function were quantified by cine images. Late gadolinium enhancement images were acquired to detect myocardial fibrosis. Mean follow-up was 57.91 ± 18.23 months. After the first CMR scan 69.6% of the patients changed chelation regimen. We recorded 18 episodes of HF. In the multivariate analysis the independent predictive factors were myocardial fibrosis (HR = 10.94, 95% CI = 3.28-36.43, P < 0.0001), homogeneous MIO (compared with no MIO) (HR = 5.56, 95% CI = 1.37-22.51, P  = 0.016), ventricular dysfunction (HR = 4.33, 95% CI = 1.39-13.43, P  = 0.011). Arrhythmias occurred in 16 patients. Among the CMR parameters only the atrial dilation was identified as univariate prognosticator (HR = 4.26 95% CI=1.54-11.75, P  = 0.005).ConclusionsCMR guided the change of chelation therapy in nearly 70% of patients, leading to a lower risk of iron-mediated HF and of arrhythmias than previously reported. Homogeneous MIO remained a risk factor for HF but also myocardial fibrosis and ventricular dysfunction identified patients at high risk. Arrhythmias were independent of MIO but increased with atrial dilatation. CMR by a multi-parametric approach dramatically improves cardiac outcomes and provides prognostic information beyond cardiac iron estimation.

Objectives-To evaluate the diagnostic performance of contrast-enhanced sonography for characterization of the lymph node status (metastatic or not) in patients with breast carcinomas by comparison with sentinel lymph node biopsy.Methods-From January to August 2015, 50 female patients with a histologic diagnosis of invasive breast carcinoma were prospectively examined by ipsilateral axillary contrast-enhanced sonography. The test was performed by a single radiologist using an ultrasound system with a broadband 8-12-MHz, 38-mm high-resolution linear transducer. For the target lymph node, we chose a node with a sonographic pattern that was suspicious for malignancy: ie, a longitudinal-to-transverse diameter ratio of less than 2, absence of a central hyperechogenic hilum, or both. In cases with a lack of sonographic signs of malignancy, we evaluated the node with the maximal transverse diameter. Nodes were considered malignant in cases with total absence of contrast enhancement and in those with enhancement alterations. Within 1 week, all patients underwent sentinel lymph node biopsy, followed by a histologic test.Results-The histologic test showed benignity in 22 of 50 sentinel lymph nodes, whereas 28 were metastatic. Among the 22 patients with negative biopsy results, contrast-enhanced sonography showed 18 concordances and 4 false-positives results; among the 28 with positive biopsy results, contrast-enhanced sonography obtained 100% correct characterizations of the axillary status. The sensitivity, specificity, and accuracy were 100%, 82%, and 92%, respectively.Conclusions-Contrast-enhanced sonography appears to be a method with high accuracy for characterization of axillary lymph nodes, very close to the reference-standard sentinel lymph node biopsy. This technique seems to have overall high sensitivity.

Mammography is the gold standard for detection of early breast cancer and it is still the only diagnostic tool which shows reduction of the mortality from that. Despite that, there is a high chance of false negatives that can lead to diagnostic errors resulting in delays of treatment and worsening of prognosis. The aim of this study is to analyze the rate of false negative in mammography and assess the source of diagnostic errors. Two radiologists have retrospectively evaluated 500 mammograms performed between January 2008 and December 2011 in Breast Imaging Clinic. 250 patients (Group A) had been operated for breast cancer and 250 patients (Group B) were healthy woman submitted to mammography according to the guideline for early detection of breast cancer. In Group A, 138 patients (55.2 %) were true missed cancer, 61 had minimal sign (24.4 %) and 53 were false negative (FN) (20.4 %). The source of errors amongst the FN were in 42 % of cases due to perception, in 15 % to interpretation, in 10 % to subtle/unusual lesion characteristics, in 9 % error for satisfaction of search, in 7 % to inherent limitations of mammography, in 4 % to poor technique and 13 % for inadequate clinical management. The diagnostic errors in breast clinic services are not negligible. The largest number of FN results from perception errors, misinterpretation and inadequate clinical management. These can be related to factors such as inattention, fatigue or lack of experience. To reduce it, it is necessary to have a dedicated multidisciplinary staff and adequate equipment and workloads.

BACKGROUND:Cardiovascular magnetic resonance (CMR) plays a key role in the management of thalassemia major patients, but few data are available in pediatric population. This study aims at a retrospective multiparametric CMR assessment of myocardial iron overload, function, and fibrosis in a cohort of pediatric thalassemia major patients.METHODS AND RESULTS:We studied 107 pediatric thalassemia major patients (61 boys, median age 14.4 years). Myocardial and liver iron overload were measured by T2* multiecho technique. Atrial dimensions and biventricular function were quantified by cine images. Late gadolinium enhancement images were acquired to detect myocardial fibrosis. All scans were performed without sedation. The 21.4% of the patients showed a significant myocardial iron overload correlated with lower compliance to chelation therapy (P<0.013). Serum ferritin ≥2000 ng/mL and liver iron concentration ≥14 mg/g/dw were detected as the best threshold for predicting cardiac iron overload (P=0.001 and P<0.0001, respectively). A homogeneous pattern of myocardial iron overload was associated with a negative cardiac remodeling and significant higher liver iron concentration (P<0.0001). Myocardial fibrosis by late gadolinium enhancement was detected in 15.8% of the patients (youngest children 13 years old). It was correlated with significant lower heart T2* values (P=0.022) and negative cardiac remodeling indexes. A pathological magnetic resonance imaging liver iron concentration was found in the 77.6% of the patients.CONCLUSIONS:Cardiac damage detectable by a multiparametric CMR approach can occur early in thalassemia major patients. So, the first T2* CMR assessment should be performed as early as feasible without sedation to tailor the chelation treatment. Conversely, late gadolinium enhancement CMR should be postponed in the teenager age.

To the Editor: We evaluated pancreatic iron by magnetic resonance imaging (MRI) in a large cohort of well-treated thalassemia major (TM) patients and we assessed its relationship with myocardial iron overload (MIO) using a segmental approach and with cardiac function. We studied 147 TM patients (70 males, 31.73 ± 8.12 years) enrolled in the MIOT (MIO in Thalassemia) Network 1. The disturbances of glucose metabolism were assessed within three months from the MRI by means of oral glucose tolerance test (OGTT). MRI was performed using a 1.5 T scanner. Iron overload (IO) was measured using a T2* gradient-echo multiecho sequence and the images were analyzed using a previously validated software (HIPPO-MIOT®). T2* values over pancreatic head, body and tail were assessed and global value was the mean 2. The lowest threshold of normal T2* value was 26 ms 2. Liver T2* values were calculated in a circular region of interest and were converted into liver iron concentration (LIC) values. The T2* value in all the 16 cardiac segments was calculated and global value was the mean 3. A T2* > 20 ms was taken as "conservative" normal value. Biventricular function parameters were quantified by cine images. The mean global pancreatic T2* value was 12.12 ± 8.27 ms (range: 1.4–33.7 ms). One-hundred thirty-seven patients (93.2%) had pancreatic iron. The pancreatic head had a significant higher T2* value than the body (12.28 ± 8.88 ms vs. 11.34 ± 7.79 ms; P = 0.050). The posterior-inferior part of the pancreatic head and the uncinate process derive from the ventral pancreatic anlage while the other pancreatic regions originate from the dorsal anlage. These two parenchymal portions differ in many histological and functional aspects and may load iron at a slight different extent. Clinical consequence of this different regional IO are of interest. Global pancreatic T2* value was comparable between the sexes and it was not associated to age. None of the teen patients without pancreatic IO had diabetes or impaired glucose tolerance (IGT). A normal global pancreas T2* value showed a negative predictive value of 100% for disturbances of glucose metabolism. However, global pancreatic T2* values were comparable between patients without and with impaired glucose metabolism (12.54 ± 8.69 ms vs. 10.48 ± 6.18; P = 0.503). It has been shown that pancreatic atrophy (volume) was a better predictor of diabetic status than pancreatic hemosiderosis (T2*) and that endocrine failure was not statistically related to pancreatic T2* results 4. Moreover, T2* measurements represent a punctual observation, providing information about the present. Conversely, pancreatic iron deposition is an early event and many patients may have initially normal glucose metabolism. Along the time the iron-mediated oxidative stress triggers apoptosis, volume loss, and fatty replacement, leading to pancreatic dysfunction 5, 6. Furthermore, to interpreter our findings, we must consider that although it is known hat iron accumulates selectively within beta-cells and that the progression of IGT toward overt diabetes mellitus depends on the severity and duration of severe IO, the pathogenetic mechanisms leading from siderosis to the development of diabetes are still poorly understood. There was a significant negative correlation between serum ferritin levels and global pancreatic T2* values (R = −0.341, P < 0.0001). No patient with a serum ferritin level ≥2500 ng/ml had a normal global pancreas T2* value. A significant inverse correlation was found between MRI LIC and pancreatic T2* values (R = −0.329, P < 0.0001). This datum differs from some previous studies 5. Improved efficiency of T2* relaxometry compared with semiquantitative techniques over a wide range of IO and a larger population in our study may account for this discrepancy. Global pancreas T2* values showed a significant positive correlation with global heart T2* values (R = 0.330, P < 0.0001; Fig. 1A) and the number of segments with normal T2* (R = 0.346, P < 0.0001). Of the 137 patients with pancreatic IO, 45 (32.8%) had a pathological global heart T2* value. No patients without pancreatic IO had MIO. A normal global pancreas T2* value showed a negative predictive value of 100% for cardiac iron. The positive correlation between myocardial and pancreatic IO is more likely due to the same L-type calcium iron channels in the two organs, taking up circulating NTBI. A: Scatter plot of global pancreas T2* values versus global heart T2*values. The horizontal and vertical dotted lines represent the cut-off for T2* values. B: Global pancreas T2* values in the 4 groups of patients with different patterns of MIO. Four groups of patients were identified by the cardiac segmental approach: 42 patients (28.6%) showed no MIO (all segments with T2* > 20 ms), 60 patients (40.8%) showed an heterogeneous iron distribution (some segments with T2* > 20 ms and others with T2* < 20 ms) with global heart T2* ≥ 20 ms; 16 patients (10.9%) showed an heterogeneous MIO with global heart T2* < 20 ms, and 29 patients (19.7%) showed an homogeneous MIO (all segments with T2* < 20 ms). The global pancreas T2* was significantly higher in patients with no MIO than in patients with heterogeneous MIO and global heart T2* < 20 ms and in patients with homogeneous MIO (Fig. 1B). We showed for the first time ever that the association between cardiac and pancreatic haemosiderosis was true also considering a myocardial segmental analysis and the patterns of iron distribution. There was a significant correlation between global pancreatic T2* values and LV EF (R = 0.171, P = 0.039). Out of the 31 patients with LV dysfunction, none showed a normal pancreatic T2* value (Fig. 1A). Global pancreas T2* values were significantly higher in patients with normal LV function than in patients with LV dysfunction (13.21 ± 8.75 ms vs. 8.05 ± 4.16 ms; P = 0.013). Conversely, pancreatic iron load was not significantly correlated with RV EF and this finding probably reflects the different RV sensitivity to the iron. In conclusion, pancreatic IO was positively correlated to myocardial iron distribution and LV function. Pancreas T2* was a powerful predictor for heart iron burden and function. We strongly recommend to incorporate in clinical practice T2* pancreatic measurements as prospective markers of cardiac iron risk. If a patient with no cardiac iron demonstrates pancreatic iron, it would be prudent to modify iron chelation therapy to prospectively prevent cardiac iron accumulation rather than wait for cardiac iron and dysfunction to appear. Moreover, performing abdominal MRI could significantly reduce need of sedation in young patients, costs, and magnet time, particularly in countries where it is difficult to perform cardiac MRI. The authors would like to thank the following colleagues from the Italian thalassemia centers involved in the MIOT network:, M. G. Bisconte (Presidio Ospedaliero Annunziata, Cosenza), V. Caruso (Ospedale Garibaldi, Catania), M. Benni (Policlinico S. Orsola, Bologna), A. Spasiano (A.O.R.N. Cardarelli, Napoli), S. Campisi (A. O. Umberto I, Siracusa), T. Casini (Ospedale Meyer, Firenze), G. Secchi (Azienda USL n 1, Sassari), A. Quarta (Ospedale A. Perrino, Brindisi), R. Rosso (Azienda Policlinico, Catania), B. Piraino (Policlinico G. Martino, Messina), L. Cuccia (ARNAS Ospedale Civico, Palermo), S. Pulini (Ospedale Civile Spirito Santo, Pescara), A. Ciancio (Ospedale Madonna delle Grazie, Matera), C. Gerardi (Ospedali Civili riuniti, Agrigento), D. Maddaloni (Ospedale Engles Profili, Ancona), M. E. Lai (Ospedale microcitemico, Cagliari), A. Filosa (A.O.R.N. Cardarelli, Napoli), M. P. Smacchia (Policlinico Umberto 1, Roma), S. Armari (Azienda Ospedaliera di Legnago, Verona), R. Mattei (U.L.S.S. 19, Rovigo), G. Giuffrida (Ospedale Ferrarotto, Catania), MR. Gamberini (Arcispedale S. Anna, Ferrara), G. Palazzi (Policlinico, Modena), C. Fidone (Az. Osp. Civile, Ragusa). They thank Claudia Santarlasci for her skillful secretarial work. They finally thank all patients for their cooperation. Antonella Meloni,1,2 Gennaro Restaino,3 Massimiliano Missere,3 Daniele De Marchi,1 Vincenzo Positano,1,2 Gianluca Valeri,4 Domenico Giuseppe D'Ascola,5Angelo Peluso,6 Maria Caterina Putti,7 Maddalena Lendini,8 Maria Giovanna Neri,1 Massimo Midiri,9 Giuseppina Sallustio,3 and Alessia Pepe,1* 1CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy; 2U.O.C.Bioingegneria e Ingegneria Clinica, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy; 3Dipartimento Di Radiologia, Centro Di Ricerca E Formazione Ad Alta Tecnologia Nelle Scienze Biomediche "Giovanni Paolo II", Campobasso, Italy; 4Dipartimento Di Radiologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti "Umberto I-Lancisi-Salesi," Ancona, Italy; 5U.O. Microcitemie, A.O. "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy; 6Microcitemia, Azienda Unità Sanitaria Locale TA/1, Presidio Ospedaliero Centrale,Taranto, Italy;7Clinica Di Emato-Oncologia Pediatrica, Dipartimento Di Pediatria,Università Di Padova/Azienda Ospedaliera, Padova, Italy;8Centro Trasfusionale, Ospedale Giovanni Paolo II, Olbia, Italy;9Istituto Di Radiologia, Policlinico "Paolo Giaccone", Palermo, Italy

The aim of the study was to determine the potential role of occupational exposures to chromium (Cr) in the onset of extragonadal germinal embryonal carcinoma. The first two cases of workers in a company with Cr exposure are reported. The published scientific literature regarding the topic in peer-reviewed journals including MEDLINE and CancerLit databases was extensively reviewed. Two young patients who were coworkers in the same company, exposed to Cr, developed extragonadal germinal embryonal carcinomas. One of them also developed angiosarcoma of the mediastinum. To the best of our knowledge these are the first two cases of germinal embryonal carcinoma in patients with occupational exposure to Cr.

PURPOSE:To implement a hardware and software system able to perform the major functions of an Open-Source PACS, and to analyze it in a simulated real-world environment.MATERIALS AND METHODS:A small home network was implemented, and the Open-Source operating system Ubuntu 11.10 was installed in a laptop containing the Dcm4chee suite with the software devices needed.RESULTS:The Open-Source PACS implemented is compatible with Linux OS, Microsoft OS, and Mac OS X; furthermore, it was used with operating systems that guarantee the operation in portable devices (smartphone, tablet) Android and iOS.CONCLUSIONS:An OSS PACS is useful for making tutorials and workshops on post-processing techniques for educational and training purposes.

Abstract Background. The aim of this study was to assess the changes in cardiac and hepatic iron overload and in morpho-functional cardiac parameters by Magnetic Resonance Imaging (MRI) in transfusion-dependent thalassemia patients who got pregnant and interrupted their chelation treatment. Methods. Among the956 women with hemoglobinopathies in reproductive age enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) project, we selected 17 women with thalassemia (14 with thalassemia major and 3 with transfusion-dependent thalassemia intermedia) who had a pregnancy with successful delivery and who performed a MRI scan before and after the pregnancy. Myocardial and liver iron overload were measured by T2* multiecho technique. Atrial dimensions and biventricular function were quantified by cine images. Results. The pre-pregnancy MRI was performed 15.02±5.31 months before the delivery while the post-partum MRI was performed 5.73±4.45 months later. For 16 new-mothers the post-partum MRI was performed after the restart of the chelation therapy, specifically 3.95 ± 4.10 months later. One new-mother performed the post-partum MRI about 3 months before restarting the chelation therapy. The table shows the MRI parameters at the two MRIs. The pre-pregnancy and the post-partum global heart T2* values and number of pathological segments were comparable. Two patients with a normal global heart T2* value (>20 ms) before pregnancy showed a pathological post-partum value. After pregnancy there was a significant increase of MRI liver iron concentration (LIC) values. At the pre-partum MRI six (35.3%) patients had a MRI LIC < 3 mg/g/dw while at the post-partum MRI all patients had a pathological MRI LIC. Among the biventricular volumetric and functional parameters, there was a significant increase of right ventricular (RV) end-systolic volume index and a significant reduction of RV ejection fraction. Conclusion. In some transfusion-dependent patients, cessation of chelation therapy allows rapid iron overload. Pregnant women with thalassemia should be monitored carefully for iron loading and cardiac status before they embark upon a pregnancy and afterwards and consideration should be given to offering desferrioxamine chelation therapy immediately after delivery. In women showing severe iron overload before pregnancy desferrioxamine should be started after the middle of the second trimester. The negative impact on the RV parameters could reflect the effect of the high cardiac output state independent of the physiological changes during pregnancy. Table 1. Changes in MRI parameters following the pregnancy. Before pregnancy Post pregnancy Mean difference P-value Global Heart (ms) 33.27 ± 6.72 34.09 ± 9.46 0.82 ± 8.07 0.523 N seg. With T2* < 20 ms 1.71 ± 2.93 2.35 ± 4.72 0.65 ± 5.44 0.953 LIC (mg/g dw) 4.08 ± 3.55 16.89 ± 8.89 12.82 ± 8.19 <0.0001 LV EDVI (ml/m2) 76.53 ± 8.46 78.53 ± 10.42 2.00 ± 11.95 0.500 LV ESVI (ml/m2) 27.06 ± 3.96 29.24 ± 5.67 2.18 ± 5.37 0.114 LV SVI (ml/m2) 49.41 ± 7.19 47.41 ± 7.28 -2.00 ± 9.69 0.408 LV mass index (g/m2) 51.53 ± 8.43 54.76 ± 9.54 3.24 ± 6.66 0.062 LV EF (%) 64.00 ± 4.64 62.53 ± 4.68 -1.47 ± 5.86 0.317 RV EDVI (ml/m2) 73.24 ± 9.47 75.76 ± 10.94 2.53 ± 11.94 0.395 RV ESVI (ml/m2) 24.24 ± 6.06 27.82 ± 6.44 3.59 ± 6.43 0.035 RV SVI (ml/m2) 47.47 ± 8.35 47.41 ± 7.28 - 0.06 ± 10.69 0.982 RV EF (%) 66.82 ± 5.43 63.06 ± 5.51 3.77 ± 5.84 0.017 Disclosures Pepe: ApoPharma Inc: Speakers Bureau; Novartis: Speakers Bureau; Chiesi: Speakers Bureau.

This study was done to evaluate the appropriateness of dose indices in computed tomography (CT) by comparing the body computed tomography dose index (CTDI) and the size-specific dose estimates (SSDE) to determine which of these two parameters is more appropriate to estimate the radiation dose to both adult and paediatric patients.

Background Recently two novels indicators of left ventricular (LV) performance assessed by Cardiovascular Magnetic Resonance (CMR) have been introduced: the LV global function index (LVGFI) and the LV mass/volume ratio (LVMVR). The LVGFI combines LV stroke volume, end-systolic and end diastolic volumes, as well as LV mass, integrating structural as well as mechanical behaviour. Elevated LVMVR is indicative of concentric remodelling. A LVGFI 1 were shown to be associated with the occurrence of cardiovascular events in no-thalassemic populations. This retrospective cohort study aimed to systematically evaluate in a large historical cohort of thalassemia major (TM) in the CMR era whether the LVGFI and the LVMVR were associated with a higher risk of heart failure.

AIMS [Formula: see text] multislice multiecho cardiac magnetic resonance (CMR) allows quantification of the segmental distribution of myocardial iron overload (MIO). We evaluated whether a preferential pattern MIO was preserved between two CMR scans in regularly chelated thalassaemia major (TM) patients. METHODS AND RESULTS We evaluated prospectively 259 TM patients enrolled in the MIO in Thalassaemia (MIOT) network with a CMR follow-up (FU) study at 18 ± 3 months and significant MIO at baseline. The [Formula: see text] in the 16 segments and the global value were calculated. Four main circumferential regions (anterior, septal, inferior and lateral) were defined. We identified two groups: severe (n = 80, global [Formula: see text] <10 ms) and mild-moderate MIO (n = 179, global [Formula: see text] = 10-26 ms). Based on the CMR reports, 56.4% of patients changed the chelation regimen. For each group, there was a significant improvement in the global heart as well as in regional [Formula: see text] values (P < 0.0001). At the baseline, the mean [Formula: see text] value over the anterior region was significantly lower than the values over the other regions, and the mean [Formula: see text] over the inferior region was significantly lower than the values over the septal and the lateral regions. The same pattern was present at the FU, with a little difference for patients with mild-moderate MIO. CONCLUSION A preferential pattern of iron store in anterior and inferior regions was present at both CMRs, with an increment of [Formula: see text] values at FU due to a baseline CMR-guided chelation therapy. The anterior region seems the region in which the iron accumulates first and is removed later.

PURPOSE:The purpose of this paper is to evaluate the use of open source software (OSS) to process DICOM images.MATERIALS AND METHODS:We selected 23 programs for Windows and 20 programs for Mac from 150 possible OSS programs including DICOM viewers and various tools (converters, DICOM header editors, etc.). The programs selected all meet the basic requirements such as free availability, stand-alone application, presence of graphical user interface, ease of installation and advanced features beyond simple display monitor. Capabilities of data import, data export, metadata, 2D viewer, 3D viewer, support platform and usability of each selected program were evaluated on a scale ranging from 1 to 10 points.RESULTS:Twelve programs received a score higher than or equal to eight. Among them, five obtained a score of 9: 3D Slicer, MedINRIA, MITK 3M3, VolView, VR Render; while OsiriX received 10.CONCLUSIONS:OsiriX appears to be the only program able to perform all the operations taken into consideration, similar to a workstation equipped with proprietary software, allowing the analysis and interpretation of images in a simple and intuitive way. OsiriX is a DICOM PACS workstation for medical imaging and software for image processing for medical research, functional imaging, 3D imaging, confocal microscopy and molecular imaging. This application is also a good tool for teaching activities because it facilitates the attainment of learning objectives among students and other specialists.

Background Cardiovascular Magnetic Resonance (CMR) by late gadolinium enhancement (LGE) allows to detect myocardial fibrosis. Myocardial fibrosis was shown to be a relative common finding in large cohort of Italian thalassemia major (TM) patients mainly related to HCV infection, but specific studies involving only pediatric patients are not available. Our aim was to investigate the prevalence and clinical-instrumental correlates of myocardial fibrosis in pediatric TM patients.

Background. Few studies have evaluated the efficacy of iron chelation therapy in thalassemia intermedia (TI) patients. Our study aimed to prospectively assess by quantitative Magnetic Resonance imaging (MRI) the efficacy of the three available chelators in monotherapy in transfusion dependent (TD) TI patients.