[Re-evaluation of bronchogenic carcinoma after radiochemotherapy. Role of CT and MR]. / Rivalutazione dopo radiochemioterapia nel carcinoma broncogeno. Ruolo della TC e della RM.

The above paper was intended to evaluate the usefulness of CT and MR in the study of radiation and chemotherapy induced pulmonary changes. CT proved very useful in the evaluation of the remission rates of the tumor and of radiation-induced pulmonary effects and, hence to minimize its confusion with malignancies and other abnormalities. On the other hand, MR proved very useful in the differentiation between post-therapy fibrosis and recurrent tumor at least 13 months after chemo-radiotherapy.

[Assessment of complications in patients with lung transplantation with high resolution computerized tomography]. / Valutazione delle complicanze nei pazienti con trapianto polmonare mediante Tomografia Computerizzata con alta risoluzione.

INTRODUCTION: High Resolution Computed Tomography (HRCT) has been used by many authors to study the early complications of lung transplantation. Bronchoscopy, transbronchial biopsy and the clinical parameters are the tools of choice to diagnose such complications; HRCT showed excellent sensitivity (100%) and good specificity (93%) especially in detecting bronchial stenoses. We report the preliminary results of HRCT in detecting early/late complications in lung transplant recipients. MATERIAL AND METHODS: Sixteen lung transplant recipients (5 single and 11 double transplants) were examined with HRCT at the Servizio Speciale Diagnostica V of "La Sapienza" University (Rome, Italy). The CT findings were compared with the results of bronchoscopy and respiratory function tests. The patients (8 men and 8 women; age range: 18-57 years, mean: 37.5) had cystic fibrosis (9), emphysema (3), alpha-1-antitrypsin deficiency (1), idiopathic pulmonary fibrosis (2), and bronchiectasis (1). RESULTS AND DISCUSSION: During the follow-up, one patient died of pulmonary edema. CT findings were normal in 3 patients and mild pleural effusion was seen in 2. The other HRCT findings were: bronchial stenosis in 5 cases (which was bilateral in 1) and bronchial dehiscence in 1 patient; four cases of infection (1 CMV, 1 aspecific bacterial pneumonia, 1 Chlamydia psittacea and 1 Aspergillosis) and one of brochiolitis obliterans. A patient was treated for acute and one for chronic rejection. A CMV infection involved only the native lung in a patient. CT is easy to perform and a repeatable and well-tolerated tool with high sensitivity (100%) and good specificity (93%) in the early diagnosis of complications, particularly bronchial stenoses, which complications are often missed at bronchoscopy or clinically silent. CT should be always performed before bronchoscopy because it can provide valuable information for bronchoscopy targeting. CONCLUSIONS: In agreement with other authors we consider HRCT a very useful tool in the early diagnosis of the complications following lung transplantation.

[Assessment with magnetic resonance imaging of response to radiotherapy for tongue and mouth floor tumors]. / Valutazione mediante Risonanza Magnetica della risposta al trattamento radiante dei tumori della lingua e del pavimento orale.

To investigate the role of Magnetic Resonance Imaging (MRI) in assessing the effects of radiation therapy and in differentiating postirradiation scar tissue from residual tumor, we examined 22 patients with primary squamous cell carcinoma of the tongue and floor of the mouth treated with definitive radiation therapy; all patients were examined before and after treatment. Pretreatment MRI showed mass effect and obliteration of the fascial planes, with hyperintense signal on T2 and T1 post-Gd-DTPA injection sequences in all patients. Follow-up exams were performed 4 months after radiation therapy completion to wait for postirradiation phlogistic changes to become less apparent. The role of posttreatment exams was determined on the basis of clinical and bioptic follow-up. Radiation therapy yielded complete remission in 16/22 patients and partial remission in 6/22. MR follow-up showed, in complete remission patients, persistently obliterated fascial planes in 12/16 patients (75%) and a residual mass, hypointense on T2-weighted sequences and without enhancement in 9/16 patients (56%). In all partial remission patients, MRI showed some residual tissue hyperintense on T2-weighted sequences, with persistent enhancement. Persistent alterations in primary tumor sites, such as residual tissue and fascial plane obliteration, are frequent findings after irradiation. Hyperintense signal and enhancement can persist for months after radiation therapy as signs of postirradiation changes. To conclude, MRI performed 4 months after radiation therapy appears as a reliable tool to refer a residual mass to scar tissue when MR signal is hypointense on T2-weighted and enhanced sequences and to residual tumor when MR signal is hyperintense on T2-weighted and post-Gd-DTPA sequences.

[Comparison of computerized tomography and magnetic resonance in staging of T and N parameters in head and neck neoplasms]. / Stadiazione dei parametri "T" e "N" dei tumori della testa e del collo con tomografia computerizzata e risonanza magnetica a confronto.

January 1990, through January 1994, eighty untreated patients with head and neck cancer were consecutively submitted to CT and MRI of the head and neck before surgery. CT and MR findings were then compared to operative histologic findings. Forty-eight of 52 T4 cases at CT were confirmed at surgery (89%), 7 of 13 T3 cases at CT were also confirmed (54%), as well as 8 of 15 T2 cases (53%). CT understaged 13 cases (6 T3 and 7 T2), which surgery staged as T4, CT overstaged 4 cases as T4, which were 2 pT2 and 2 pT3 at histology. All the 54 cases MRI staged as T4 were confirmed at surgery (100%), 3 of 12 MRI staged as T3 were pT4 at surgery (25%) and, finally, 4 of 14 cases MRI staged as T2 were pT4 at histology (28%). Only one case staged as pT4 at surgery and CT had been staged as T3 by MRI because the latter method had failed to depict hyoid involvement. On the other hand, in 6 cases MRI correctly modified CT staging. Overall CT accuracy was 79% and MR accuracy 91%. CT sensitivity was 70% versus 75% with MRI, specificity was 80% versus 78%, respectively, and overall accuracy 75% versus 76%. Only in two patients MRI correctly modified CT staging (N1 at surgery). Our results confirm various advantages of MRI over CT in the assessment of tumor mass ("T" parameter), mainly in T2 and T3 cases, because MRI yields higher soft tissue contrast resolution and has multiplanar capabilities. CT was superior to MRI only in the assessment of bone involvement. This study also confirmed similar CT and MR capabilities in detecting lymph node tumor spread. Finally, MRI did not allow earlier detection of micrometastases than CT.

Radiological assessment of necrosis in glioblastoma: variability and prognostic value.

In a previous study, we found that the extent of necrosis was the only radiological feature which correlated significantly with survival in patients with glioblastoma. The aim of this paper was to evaluate the variability and prognostic value of the extent of the necrotic area as seen on contrast-enhanced MRI and CT in a larger series. We studied 72 patients who underwent surgical removal of supratentorial glioblastomas and had CT and/or MRI with contrast medium before surgery; 38, all undergoing the same treatment (surgery plus radiotherapy), were followed clinically. Necrosis within the tumour varied greatly, ranging from none (only 1 case) to involvement of 76% of the tumour. Survival data in the subgroup suggested that only patients with a small area of necrosis (less than 35% of the tumour) had a significantly longer survival time. When necrosis involved more than 35% of the mass, patients had a shorter survival time, without any further correlation with the extent of necrosis.

[Computerized tomography in the evaluation of the larynx after surgical treatment and irradiation]. / Valutazione mediante tomografia computerizzata della laringe dopo trattamento chirurgico e irradiazione.

INTRODUCTION: The follow-up of the patients submitted to surgery for laryngeal carcinoma requires both clinical and CT examinations, particularly in the cases at high risk of recurrence. Our series consisted of 72 laryngeal carcinoma patients operated on and regularly followed-up with CT to distinguish relapse from normal or abnormal postoperative changes. MATERIALS AND METHODS: Seventy-two laryngeal carcinoma patients were submitted to surgery: total laryngectomy was performed in 33 cases, supraglottic laryngectomy in 16 cases, Labayle subtotal laryngectomy in 18 cases and Mayer Piquet subtotal laryngectomy in 5 cases. The patients were followed-up postoperatively with CT and 94 examinations were performed in all; pathology was performed in all the cases with radiologic suspicion of recurrence (19 patients) and further clinical examinations were performed to exclude recurrence in the 14 cases where imaging findings were questionable. RESULTS AND DISCUSSION: Local recurrences were confirmed in 16 of 19 patients with positive CT findings. Radiologically, the recurrence appeared as an irregular thickening of the pharyngo-laryngeal wall with inhomogeneous density after i.v. contrast agent infusion. The patients submitted to total or supraglottic laryngectomy recurred most often at the cranial site of resection (5/6 cases), those submitted to Labayle surgery at the mucosa adjacent to the cricoarytenoid unit (3/3 cases) and those submitted to Mayer Piquet surgery in the supraglottic region. Two more patients submitted to emergency tracheotomy recurred at this level. Lymph node recurrences were found in 6 total laryngectomy patients. Misinterpretations were most frequently due to postirradiation changes (5 of 14 cases) or to atypical postoperative images (4/14 cases). Three more patients presented a secondary lesion misinterpreted as a relapse. CONCLUSIONS: Our results confirm the role of CT in the follow-up of the patients operated on for laryngeal carcinoma when CT findings are closely correlated with clinical and endoscopic results, permitting to correctly assess the extent of relapse and possible nodal spread.

[Anatomic changes after radical surgery and reconstruction with pedunculated or revascularized flaps in advanced head and neck tumors: computerized tomography and magnetic resonance findings]. / Modificazioni anatomiche dopo chirurgia radicale e ricostruzione con lembi peduncolati o rivascolarizzati nei tumori cervico-facciali negli stadi avanzati: aspetti con Tomografia Computerizzata e Risonanza Magnetica.

January, 1992, to October, 1995, sixty-four patients with advanced head and neck cancer underwent head and neck reconstructive surgery using myocutaneous or revascularized flaps; in the same period, all patients were consecutively examined with CT and MRI. Myocutaneous flaps wer used in 26 patients: 12 flaps were tubular and 14 linear. Revascularized flaps were used in 38 patients: to repair a large defect in 26 patients (14 latissimus dorsi flaps and 12 temporal muscle flaps) and to repair an oral damage in 12 patients (5 revascularized radial and 7 jejunal flaps). CT and MR images of myocutaneous flaps showed the flaps as fatty areas, repairing large surgical defects, hypodense at CT and hyperintense at MRI, with no post-contrast enhancement. The postoperative scar around the flap exhibited soft-tissue density with slight post-contrast enhancement at CT and slightly hypodense on T2-weighted MR images. Post-contrast CT and MRI showed slight scar enhancement with no signal changes in the fatty component. The appearance of revascularized flaps at CT and MRI depends on the characteristics of the structure used to repair the surgical defect: jejunal and radial flaps appeared as mostly fatty thickened layers with both imaging methods. Temporal and latissimus dorsi flaps are made basically of muscular tissue, fatty tissue and occasionally skin (used to repair a mucosal defect): consequently, CT showed a structure with mostly parenchymal density in all cases and MRI depicted intermediate signal intensity. MRI was useful to detect 12 revascularized jejunal or radial flaps thanks to its higher contrast resolution and multiplanar capabilities showing even such thin structures as these flaps. Moreover, MRI permitted to study skull base reconstruction with revascularized (latissimus dorsi) flaps in 5 of our patients.

[Role of computerized tomography following transrectal air insufflation and hypotonization and transrectal ultrasonography in the staging of rectal tumors]. / Ruolo della Tomografia Computerizzata eseguita dopo insufflazione di aria per via transrettale e ipotonizzazione e dell'ecotomografia transrettale nella stadiazione locale del tumore del retto.

Computed Tomography (CT) with rectal air inflation was compared with transrectal ultrasound (TRUS) in the preoperative staging of lower rectal cancer in 126 patients. Precontrast and postcontrast CT scans were performed with 5 mm thick slices; the rectum was previously inflated with air and antiperistaltic agents were administered. Preoperative results were compared with histologic findings. The accuracy, sensitivity and specificity of CT in predicting perirectal spread were 76%, 62% and 83%, whereas the corresponding figures for TRUS were 84%, 69% and 92%. The accuracy, sensitivity and specificity of CT and TRUS for nodal involvement were 58%, 60%, 57% and 72%, 68% and 66%, respectively. These results show that TRUS predicts perirectal spread and detects nodal metastases better than CT. However CT, when performed appropriately, shows tumor spread into perirectal fat and locoregional lymph nodes with high accuracy. Lymphatic involvement is strictly correlated with tumor size: TRUS and CT correctly staged only 57% and 43%, respectively, of the cases with nodal metastases and max. diameter of 5 mm. TRUS sometimes overstaged perirectal tumor growth (13 patients in our series) due to perirectal inflammation (9 cases) or artifacts caused by the presence of air bubbles between the probe and the tumor surface (4 patients). TRUS is a very useful tool for detecting tumor distance from the anal opening; in our series, the distance was incorrectly calculated only in one case (3 cm with TRUS versus 4 cm at surgery).