[16-MDCT angiography coronary artery in the emergency department for patients with acute coronary syndrome (NSTEMI-UA)]. / La 16-MDCT delle arterie coronarie eseguita in urgenza nei pazienti affetti da sindrome coronarica acuta (NSTEMI-UA).

AIM: The diagnosis of acute coronary syndrome (ACS), non-ST-elevation myocardial infarction and unstable angina in the emergency department (ED) remains a challenge. The aim of our study was to investigate quality and the diagnostic accuracy of 16-MDCT coronary angiography, detecting coronary artery lesions in patients with suspected ACS presented in ED. MATERIALS AND METHODS: We studied with 16-MDCT (Sensation 16, Siemens, Forchleim, Germania) and coronary angiography 37 patients with the following inclusion criteria: chest pain compatible with myocardial ischemia, normal or no-diagnostic ECG changes and initial concentrations of serum troponin-I < or =1 ng/ml. The 16-MDCT was performed with ECG-gated technique after the intravenous administration of 90-100 ml of iodinated contrast material followed by a saline bolus. The scan parameters were: 120 kV, 650-720 mAs, 16 x 0.75mm collimation, 0.42s rotation time, 3 mm (pitch 0.25) feed/rot, B30f kernel. We evaluated for each patient: image quality and different artefacts, plaques identification and characterization. RESULTS: The evaluation of the image quality was based on a total of 453 segments, of which 415 segments (92.2%) were considered to have diagnostic image quality. MDCT correctly detected 15 patients with at least 1 stenosis >50% and correctly ruled out significant coronary artery disease in 19 patients with 1 FP and 2 FN: sensitivity 88%, specificity 95%, PPV 94%, NPV 90%. The plaques were hard in 6 cases, mixt in 16 cases and soft in 14 cases, respectively. CONCLUSIONS: Our results point-out that 16-MDCT in ED has the real ability to detect and rule out significant coronary stenoses in patients with ACS.

[The radiation dose problem in computed tomography. Actual data and strategies for a corrected use of ionizing radiation in computed tomography]. / Il problema della dose di radiazioni in tomografia compute- rizzata. dati attuali e strategie per un corretto utilizzo delle radiazioni ionizzanti in tomografia computerizzata.

New technologies in these years has taken to a spread and to a growth of the CT application with an increase of patients and population exposure. In clinical practice some technical devices can be used to reduce the exposure dose of multidetector CT that allows radiologist to answer the clinical question with less damage to the patient. The radiologist remains however the guarantor of the ionizing radiation exposition and he has to consider also the opportunity to use other methodics (MR, US) to answer some questions. The radiologist has the role to evaluate the clinical indication to the exam demanded from other doctor and has the responsibility for exam management and for progressive radiologic course, controls and follow-up.

[Child abuse: imaging of multiorgan damages]. / Il bambino maltrattato: imaging dei danni multiorgano.

An abused child can present with every lesion known to medicine, but some of these lesions can be specific of child abuse. The most frequent skeletal lesions are that of the long bones, of the head and the chest. Head damages are responsible for 80% of the dead in abused child. These kind of lesions are very important because they can produce important neurological deficits. Most frequent are extraxial bleeding and intraparenchimal lesions. Abdominal damages are the second cause of dead in the abused child. They can be asymptomatic and so they can be misdiagnosed. They are not so frequent but if they are present, they are letal. Conventional radiology, CT and MRI are very important in the management of child abuse because they allow to reveal multiorgan damages which, in some instances, can be specific of a child abuse.

[Vertebral fractures: radiological diagnosis, differential diagnosis and prognostic implications]. / Fratture vertebrali: diagnosi radiologica, diagnosi differenziale e implicazioni prognostiche.

Vertebral fractures are a relevant problem for the heavy clinical implications and carrying disability. Vertebral fractures can be traumatic or pathologic, the latter can be benign or malignant, both mostly frequent in the elderly. An initial approach to this issue can use plain radiographs, but the correct extension and evaluation must involve CT and MR imaging. In particular MR is a useful tool for the prognostic evaluation of spine marrow injuries and the differential diagnosis of osteoporotic and metastatic fractures.

[Imaging of acute brain inflammatory disease]. / Imaging della patologia infiammatoria acuta dell'encefalo.

The central nervous system inflammatory disease can be due to any kind of infective agent (bacterial viral, fungal and parasitic), but entails also multiple sclerosis, a primary demyelinating disease in which the causal agent is unknown. MR imaging is, in most often, the procedure of choice, due to her multiplanar and multiparametric imaging, and to her better contrast resolution. The post-contrast imaging with double dose of gadolinium and late sequences enable visualisation of smallest pathologic foci or slightest blood-brain barrier alterations, with a sensibility very higher than post-contrast CT scan. In addition, RM provide to many functional informations, by means of diffusion, perfusion and spectroscopy studies, Bold technique for cortical activation studies and Fiber Tracking technique, in order to demonstrate pathologic modification earlier than they are evident on morphologic imaging. Functional imaging is also employed to monitor response to treatment and damage reversibility.

A rare cause of acute gastrointestinal hemorrhage: ileal lipoma Case report.

Primary small bowel tumors account for 1-6% of all Gastrointestinal (G.I.) tract malignancies. Among these pedunculated lipomas are unusual. We report a case of a 66-year-old male with a history of G.I. hemorrhage and acute anemia, negative upper and lower endoscopies and a pedunculated lipoma in distal ileum, revealed by CT enterography. The patient was successfully treated by open surgery. Patients with G.I. hemorrhage and negative upper and lower endoscopies need an accurate evaluation of small bowel. Multislice CT enterography or Magnetic Resonance enteroclysis/ enterography represent the fastest and more accurate tools to obtain an exhaustive evaluation of small bowel. In case of small bowel tumors this diagnostic procedures can show site and stage and can even suggest histological type of such neoplasms, with a significant impact in the surgical planning, avoiding time consuming surgical exploration. In this patient multislice TC enterography allowed a correct diagnosis of benign lipoma due to its radiological density and absence of infiltration of the intestinal wall and surrounding tissues. KEY WORDS: CT enterography, Gastrointestinal hemorrhage, Lipoma, Small bowel.

[Imaging of median sternotomy complications]. / Imaging delle complicanze dopo sternotomia mediana.

Median sternotomy is the surgical technique of chosen for cardiac surgery. Although the complications after median sternotomy are not so frequent, these are associated to elevated mortality. The complications can interest the presternal compartment, the sternal compartment or the retrosternal compartment. Even if the clinical diagnosis of infection is not difficult for the clinician, it is nearly impossible to establish the depth of the infection. Multislice CT, thanks to the possibility to obtain thin layers and three-dimensional multiplanar reconstructions and Volume Rendering, turns out extremely useful for being able to demonstrate the extension and the depth of the infection. Of fundamental importance it is the elaboration of the images, executed on workstation, with which multiplanar reformatted and Volume Rendering images are obtained. The CT turns out useful moreover like guide for the execution of interventional procedures such as aspiration of material for bacteriological characterization or eventual positioning of a catheter for abscess drainage. The Magnetic Resonance, thanks to its high resolution of contrast and to its multiplanarity, finds one of its elective applications in the study of the flogistic and neoplastic processes of the soft tissues. A great limit of the MR is the possible generation of artifacts due to sternal suture.

Plasma endothelin-1 levels, pulmonary hypertension, and lung fibrosis in patients with systemic sclerosis.

PURPOSE: To investigate the behavior of circulating endothelin (ET)-1 concentrations in patients affected by systemic sclerosis, and to elucidate the possible relationships existing in this disease among plasma peptide levels, pulmonary hypertension, and lung fibrosis. PATIENTS AND METHODS: Circulating ET-1 levels were determined by reverse-phase, high-pressure liquid chromatography followed by sensitive radioimmunoassay in 20 patients affected by systemic sclerosis (18 women and 2 men, mean age 48.1 +/- 13.7 years) with or without pulmonary hypertension as evaluated by Doppler echocardiography, or lung fibrosis as measured by a score method based on lung examination by high-resolution computed tomography (HRCT). A group of 18 normal volunteers served as controls (15 women and 3 men, mean age 45.0 +/- 10.1 years). RESULTS: Plasma ET-1 levels were significantly higher (P < 0.001) in patients with systemic sclerosis (1.72 +/- 0.28 pg/mL) than in control subjects (0.63 +/- 0.06 pg/mL). Pulmonary artery systolic hypertension was detected in 10 patients (50%) with systemic sclerosis (56.2 +/- 18.0 mm Hg, range 37 to 97) versus none of the control subjects (30.2 +/- 2.2 mm Hg, P < 0.0001). Lung fibrosis was present in 12 patients (60%), with an HRCT overall score of 9.0 +/- 4.6. There were no significant differences in plasma ET-1 levels between patients with pulmonary hypertension (1.58 +/- 0.20 pg/mL) or without it (1.76 +/- 0.39 pg/mL, P = 0.188, not significant [NS]); or between patients with lung fibrosis (1.65 +/- 0.14 pg/mL) or without fibrosis (1.78 +/- 0.37 pg/mL, P = 0.290, NS). In particular, 6 patients had neither pulmonary hypertension nor lung fibrosis. In these patients, plasma ET-1 levels were similar compared with the others (1.85 +/- 0.49 versus 1.66 +/- 0.13, respectively; P = 0.180, NS). No correlations were observed between ET-1 levels and either pulmonary pressure levels or HRCT overall scores. CONCLUSIONS: The use of a sensitive assay, highly selective for ET-1, showed higher levels of circulating peptide in patients affected by systemic sclerosis than in control subjects. Neither pulmonary hypertension nor lung fibrosis was accompanied by a further rise in plasma ET-1 concentrations.

Intracerebral schwannoma: CT and MR findings.

A case of intracerebral schwannoma in a 19-year-old man is reported. CT and MR findings were nonspecific, suggesting a primary glioma. The histologic features were of schwannoma.

111In-pentetreotide detection of gastrinoma before and after surgery.

Eighteen patients with Zollinger-Ellison syndrome were studied with 111In-pentetreotide SPECT in order to localize gastrinoma, the tumour responsible for this pathology. NMR imaging was also carried out. Eight patients were operated. 111In-pentetreotide was reinjected 4 hours before operation and the radioactivity of the excised tumours counted. The nature of the withdrawn tissues was assessed by immunohistochemistry (chromogranina A). The scintigraphy was repeated 3-6 months after surgery. 111In pentetreotide SPECT was more sensitive than NMR. It was also absolutely specific because all the radioactive tumours excised showed positive chromogranin A staining. The radioactivity/gram counted in gastrinomas exceeded 10 fold the hepatic and biliary radioactivity and 20-100 folds the radioactivity of blood and omentum. In all the operated patients but three, the scintigraphy performed after surgery did not detect tumours. However complete eradication did not occur, because though 3-6 months after surgery the gastrinemia was significantly lower with respect to pre-surgery results it did not return to normal values in all patients but two.

Computed tomography for preoperative assessment of T3 and T4 bronchogenic carcinoma.

Between January 1986 and January 1991, 175 patients with suspected T3 or T4 bronchogenic carcinoma underwent computed tomographic (CT) examination of the chest before thoracotomy. We considered two groups of patients: group 1 includes 98 patients with a paramediastinal mass on standard chest X-ray; invasion of hilar and mediastinal structures was preoperatively investigated with CT and then assessed at thoracotomy. The sensitivity, specificity and accuracy were 72%, 75% and 73%, respectively; positive and negative predictive values were 71% and 76%. In group 2 77 patients had a peripheral tumor suspected of invading the parietal pleura and the soft tissues of the chest wall (patients with evident rib or vertebral invasion were not included). Sensitivity, specificity and accuracy of CT were 52%, 86% and 71%, respectively; positive and negative predictive values were 74% and 70%. We conclude that CT with injection of contrast material is indispensable when direct lung cancer infiltration must be ruled out; its accuracy is however not sufficient to be relied upon in all patients.

Pericardial cysts of the mediastinum.

Pericardial cysts are an uncommon benign disease. Their treatment, in the past, was based on excision by thoracotomy or, in selected cases, on percutaneous aspiration. The progress of video-assisted thoracoscopy gave new possibilities, but most surgeons still consider the thoracotomic approach as the treatment of choice. The aim of this study is to report our experience and to discuss the role of different therapeutic procedures in the management of pericardial cysts. Between 1970 and 1996, 24 patients with pericardial cysts were treated at the first Department of Surgery of the University of Rome <>. Of 24 cysts, six were located in the right cardiophrenic angle, three in the left cardiophrenic angle, two in the subcarenal areas, one in the paracardiac area and one on the posterior mediastinum. Ten patients were asymptomatic. Diagnosis was performed preoperatively only in patients with cysts typically located in the cardiophrenic angle. Twenty-three patients were surgically treated by a standard posterolateral thoracotomy or limited thoracotomy with sparing of muscles. One patient underwent CT-guided transparietal fine-needle aspiration. There were no cases of operative mortality. Morbidity was 12.5% and consisted of retained secretions, moderate hypoxemia and partial atelectasis. All patients were submitted to a long-term follow-up and no cyst recurrences were found. We conclude that excision via thoracotomy is an optimal treatment for pericardial cysts. Limited thoracotomy with sparing muscles offers a good cosmetic result and a rapid functional respiratory recovery. Percutaneous cyst aspiration may be, in selected patients, an attractive alternative to surgery.

Pre-operative staging of endometrial carcinoma: magnetic resonance imaging versus ultrasounds and hysteroscopy.

Ultrasound, hysteroscopy and magnetic resonance imaging has been considerated to assess the loco-regional or extrapelvic extension of the endometrial carcinoma. Sonography has demonstrated a certain inaccuracy in predicting myometrial invasion or the involvement of the canal. Hysteroscopy allows us to characterize neoplasia and to assess its extension in the cervical canal. MR imaging is more helpful in the diagnosis of channel invasion. The assessment of ovarian metastasis requires ultrasonography or coronal planes RM imaging. As regards the involvement of the pelvic and extrapelvic lymph nodes MR is more accurate than ultrasound scan.

Comparison between computed tomography and magnetic resonance data and pathologic findings in substernal goiters.

Computed Tomography (CT) and Magnetic Resonance (MR) permit the acquirement of important diagnostic elements for the anatomo-topographic staging of substernal goiters, and for their characterization. The authors compared data obtained by CT and MR with intraoperative anatomo-topographic findings and definitive histology in 28 patients with substernal goiters. CT was performed in all these patients while MR only in 9. The results obtained showed an accuracy of 85.7% for CT and 100% for MR regarding the anatomo-topographic correspondence with intraoperative findings, without a significant statistical difference between these two diagnostic procedures. MR is more accurate than CT in showing the vascular dislocations. CT and MR have an accuracy of 82.1% and 77.7% respectively comparing their findings with histologic results obtained in operative specimens, without a significant statistical difference. In conclusion MR has to be considered the more accurate diagnostic procedure and therefore recommended in the study of patients with substernal goiters, while CT can be performed only in selected patients.

[Radiologic staging after surgical, chemical, and radiation treatment of non-seminomatous tumors of the testis]. / La stadiazione radiologica dopo trattamento chirurgico, chemio e radioterapico dei tumori non seminomatosi del testicolo.

The aim of this work was to evaluate the clinic usefulness of Computed Tomography (CT) and Magnetic Resonance (RM) in the staging after surgery, radiotherapy and chemotherapy of the nonseminomatous germ cells tumours of the testis. The Authors discussed the CT and MR dimensional criteria for the diagnosis of retroperitoneal metastases of the nonseminomatous germ cells tumours and delineated their CT and MR morphologic appearances in detail. The density of the residual mass on CT was classified as solid, cystic and half-cystic. The retroperitoneal hematoma and lymphocele formed as a complication respectively of orchiectomy and retroperitoneal lymphadenectomy can be misinterpreted to represent metastatic disease on post operative staging CT scans. Early recognition of this complication are crucial if unnecessary treatment is to be avoided. Finally the Authors evaluated, in patients affected from nonseminomatous germ cells tumours of the testis, the possibility to characterize with CT and MR imaging the retroperitoneal mass. The density and character of the residual mass on CT scan did not reliably predict the histology. On the basis of tumor consistency and signal intensity in T1 and T2 weighted images, MR cannot yet warrant any conclusion about the ultimate effect of chemotherapy.

[Clinical use of endorectal coil MR in the study of prostatic pathology with special reference to hyperplasia and carcinoma]. / Impiego clinico della RM con bobina endorettale nello studio della patologia prostatica con particolare riferimento all'iperplasia e al carcinoma.

In this report we evaluated the usefulness of endorectal surface coil MR imaging in the study of prostatic anatomy, age-related changes, benign prostatic hyperplasia and carcinoma. At present, endorectal coil MR imaging seems to be one of the most important diagnostic steps in the study of prostatic diseases, because it is the technique that allow to gain very high resolution images.

[Imaging of neuroendocrine tumors]. / Imaging dei tumori neuroendocrini.

Neuroendocrine tumors (NET) of the pancreas are distinguished in functional (85%) and non functional (15%) in relation to the production and release of the hormone produced. Functional tumors show early, because the neoplasm release the hormone produced when they are still small. Non functional tumors show late when the tumor grows. The localization and the evaluation of the extensive of these tumors has come fundamentally important both in correct presurgical detection and also in the diagnosis of metastases which excluded surgery. Also, as the survival of 20% of the patients with metastases is only five years, the use of non-invasive imaging techniques is very important for the evaluation of results of the various therapies (chemotherapy, interferon, somatostatin). Recent studies have shown that in patients with Zollinger-Ellison syndrome, SRS is the most sensitive non invasive method in localizing primitive tumors and metastases. The accuracy of this technique has not yet been provided in the study of tumors like insulinomas which do not have a high percentage of somatostatine receptors on their cell membranes. The sensitivity obtained in recent studies on a large number of patient and the low cost, lower than all the other imaging technique in use today, surely make SRS the first choice in the study of NET. Where SRS is negative and surgery is possible, Spiral CT or better still MRI is the best tool to check the results of chemotherapy in patients with hepatic metastases (already detected by SRS), because it is easier to compare the changes in size and morphology of metastases.

[Imaging techniques in the assessment of thoracic and abdominal manifestations of AIDS]. / Tecniche ad immagini nella valutazione delle manifestazioni toraciche ed addominali da AIDS.

In this report we take into consideration pulmonary and abdominal manifestation of AIDS. We assess the role of imaging in diagnosis and checking the spread of these diseases, particularly the role of US and TC.

[Non-seminomatous tumors of the testis: problems of radiological staging before and after treatment]. / Tumori non seminomatosi del testicolo: problemi di stadiazione radiologica pre e post-trattamento terapeutico.

The aim of this work was to evaluate the usefulness of Computed Tomography and Magnetic Risonance in the staging of the nonseminomatous germ cells tumours of the testis. The authors discussed the role of CT and MR imaging to value the detection of retroperitoneal metastases of the nonseminomatous germ cells tumours of the testis pre and post treatment.

[Images of hepatic parasitic cysts: echotomography, computed tomography and magnetic resonance compared]. / Immagini delle cisti parassitarie epatiche: ecotomografia, tomografia computerizzata e risonanaza magnetica a confronto.

Hepatic hydatic cysts are a very common finding in the endemic areas like Australia, the Middle East, New Zealand, South Africa and in some countries bordering the Mediterranean. Immigration has increased the finding of this pathology in some European and North American areas. Our purpose is to show possibilities and limits using US, TC and RM to demonstrate the presence of parasitic hepatic localizations and their evolution after therapy.