Characterisation of carotid atherosclerotic plaque: comparison between magnetic resonance imaging and histology.

PURPOSE: The aim of this study was to identify and characterise by magnetic resonance imaging (MRI) carotid plaque constituents such as lipid-rich necrotic core, intraplaque haemorrhage and calcification in patients treated with carotid endarterectomy (CEA) using histological evaluation as the reference standard. MATERIALS AND METHODS: Nineteen patients (13 men and six women) scheduled for CEA between March and August 2004 were imaged on a 1.5-T scanner (Magnetom Symphony, Siemens, Erlangen, Germany). The protocol included four types of sequences [T1, T2, proton density (PD) and three-dimensional time of flight (3D-TOF)]. Images were reviewed for integrity of the fibrous cap, presence of lipid-rich necrotic core, intraplaque haemorrhage and calcification. Signal intensity was assessed relative to the adjacent sternocleidomastoid muscle. Four cross-sections for each lesion were compared with the corresponding histological specimens and independently reviewed by two radiologists and one pathologist. RESULTS: MRI detected lipid-rich necrotic core with a sensitivity and specificity of 91.6% and 95.0%, respectively, whereas it defined intraplaque haemorrhage alone with a sensitivity and specificity of 91.6% and 100%, respectively. Calcification was recognised with a sensitivity and specificity of 80% and 93.7%, respectively. CONCLUSIONS: MRI is able to identify signs of carotid plaque instability with a high sensitivity and specificity. Therefore, it may be useful in evaluating and guiding the treatment of haemodynamically nonsignificant stenoses with a potential embolic risk and, in the future, to assess coronary plaque.

[Echographic assessment of cutaneous neoplasms]. / Valutazione ecografica delle neoplasie cutanee.

A hundred and fifteen skin tumors were evaluated by means of US. Three variables were considered for each lesion--i.e., borders, echostructure and thickness--and the results compared with histology. High agreement was observed in melanomas: in these tumors, indeed, thickness is well known to be relevant for both surgical planning and prognosis. US scans with a 10 MHz transducer allowed the accurate assessment of borders and structure only in certain, mainly benign, kinds of skin tumors--e.g., angiomas, pilomatrixomas, sebaceous cysts and lipomas--, but also in lymphomas. On the contrary, most malignant neoplasms exhibit hypoechoic structure and borders from clear-cut to blurred. Finally, US proved to be highly reliable in demonstrating lesion thickness before surgery. High agreement was once again observed with histology relative to this variable: thickness (in mm) was the same in 30% of cases, overestimated by US (mean: 0.3 mm) in 44% of cases and underestimated by US (mean: 0.15 mm) in 26% of cases. Particularly, in 41 melanomas, histology-US agreement rate was 44% for the Breslow index, with r = 0.95 and 88% for the Clark index.

[Intra-renal ultrasound and color Doppler: pathology or nephrologic significance]. / Eco e color Doppler intra-renale: patologia di interesse nefrologico.

Us-Doppler examination of the native kidney gives more detailed information on nephrological vascular disease. Since there is a close connection between renal functional units (nephrons) and vascular and interstitial compartments, alterations in intrarenal flow will obviously occur in all types of medical nephropathy, irrespective of the origin of the anatomopathological damage. Altered intrarenal flow occur with increased vascular impedance, in turn related to an increased resistance index (RI). In nephropathy with dilatation, the RI can distinguish obstructive from non-obstructive dilatation (high and normal RI, respectively). Personal experience of 80 kidneys with nonobstructive medical nephropathy has shown a good correlation between increased RI and deterioration of renal function, demonstrating that, renal function being equal, RI is higher in Vascular than Tubulo-interstitial and Glomerular nephropathies. For medical nephropathy of transplanted kidneys, Us-Doppler evaluation can be combined with conventional Doppler for diagnosing acute rejection. In this series, an elevated RI (0.90) is highly predictive of acute rejection (92% specificity) but has low sensitivity (30%). At the threshold value of RI = 0.80, sensitivity is 66% and specificity is 78%. However, it is considered that far more reliable information is obtained if Doppler examination is combined with conventional U.S. morphology.

[Integration of diagnostic methods in renal vascular pathology]. / L'integrazione delle metodiche diagnostiche nella patologia vascolare renale.

Modern technology allows us to study the renal vascular diseases by means of many diagnostic procedures. In the past the main diagnostic technique was Urography, whereas Angiography were performed only in few selected cases. The new Imaging Techniques totally changed the diagnostic approach to this kind of diseases. Today in fact Echo-Color-Doppler and Nuclear Medicine are the early diagnostic techniques to be performed. Actually only few selected patients undergo Angiography, not the conventional one but the Digital; this new technique, in fact, in case of renovascular Hypertension is not only of diagnostic value but is often the definitive therapy.

Disseminated pulmonary ossification.

A case of idiopathic disseminated parenchymal pulmonary ossification is presented. Discussion is based on the radiological and pathological findings, taking into consideration the two different forms of presentation (nodular and branching type) of this rather rare condition. The related bibliography is reviewed and discussed with particular emphasis on the aetiology and pathogenesis.

Diffuse pulmonary changes caused by gold salt therapy. Report of a case.

A case of diffuse reversible pulmonary injury, developed during gold salt therapy, is presented. The discussion deals with the difficulty of excluding other diseases capable of mimicking this clinical and radiological picture. The pathogenesis and evolution of this interstitial pneumonitis-like entity is discussed and the related literature is reviewed.

Angiography in chronic pancreatitis and pancreatic cancer. A critical evaluation.

A critical "blind" evaluation of 129 randomly selected angiographic examinations was carried out including 37 control patients, 58 patients affected by proven chronic relapsing pancreatitis and 34 patients with cancer of the pancreas. In 48.5% of the control patients a completely normal angiographic picture was found. The false positives were found in 10.8% of chronic pancreatitis and in pancreatic carcinoma in 5.5% of the cases. Equivocal signs were found in 35.2%. The percentage of the false negative results in chronic pancreatitis was 34.4% (of which 8.6% were suggestive of pancreatic cancer). In pancreatic cancer positive results were seen in 70.6% of the cases. The percentage of the false negatives was 26.5% (suggestive of chronic pancreatitis); equivocal signs were found in 2.9% of these patients. Notwithstanding the not-negligible percentage of errors, angiography can be usefully employed in diagnosis of pancreatic disorders.

[Current role of lymphography in the study of systemic lymphatic diseases]. / Ruolo attuale della linfografia nello studio delle linfopatie sistemiche.

The usefulness and reliability of lymphography for staging purposes in Hodgkin's disease are discussed with reference to a personal series.