[Computerized tomography false positives in knee medial meniscus injuries. Retrospective study of 400 cases]. / Falsa immagine con Tomografia Computerizzata di lesione del menisco mediale del ginocchio. Studio retrospettivo in 400 casi.

PURPOSE: We retrospectively evaluated the diagnostic reliability of high resolution CT (HRCT) in the study of knee joint conditions. MATERIAL AND METHODS: We reviewed the results of 400 HRCT examinations of the knee performed in 1993 and compared them with arthroscopic findings. The patients were affected with knee pain and the physical findings were insufficient for diagnosis but a sufficient indication for further instrumental tests. CT slices were 1 mm, with .5 mm feed; the images were reconstructed on the coronal and sagittal planes (2 mm thickness and 2 mm gap) with a CT Sytec 3000 unit (GE Systems, Milwaukee, WI, USA). RESULTS: The patients positive for meniscal fracture were submitted to arthroscopy and operated on if positive arthroscopically. We had 164 surgical cases even though the meniscus was damaged in 236 cases. CT was negative in 16 of 164 surgical cases. The meniscal injury was demonstrated with both CT and arthroscopy in 236 cases; there were 8 false positives and 32 questionable cases. In the latter, arthroscopy showed 24 cases of meniscal degeneration and 8 horizontal fractures. Diagnostic accuracy was 96%. CT showed the 8 false positives as radial injuries of the free margin, but in fact they were false images caused by a normal fold which increases in knee valgus. DISCUSSION AND CONCLUSIONS: HRCT is more reliable than conventional CT (diagnostic accuracy: 96% vs 85-90%) and MRI (90% reliable). The use of thin slices also permitted to show that a meniscal tissue interruption on the radial margin is not referrable to fracture, as indicated also in the recent literature, but to a normal fold.

[The usefulness of angiographic studies in the vascular complications of liver transplantation. The authors' own experience]. / Utilità delle indagini angiografiche nelle complicanze vascolari del trapianto del fegato. Esperienza personale.

The authors report their experience with angiographic techniques in the diagnosis of vascular complications after liver transplantation. From 1986 to 1990, 78 patients were transplanted in our Hospital; of them, 8 underwent angiographic investigations for vascular complications. Angiography is very important when vascular complications are suspected, in the patients with a rise in cytolytic enzymes and in bilirubine levels, with hyperpyrexia, and with bioptic confirmation of no rejection. Duplex US is useful in the evaluation of portal canalization; if there are any doubts, angiography is performed also in the preoperative phase.

[Lipiodol UltraFluid in the imaging diagnosis of hepatocarcinoma with cirrhosis]. / Il Lipiodol UltraFluid nella diagnostica per immagini dell'epatocarcinoma su cirrosi.

Fifty patients with HCC associated with hepatic cirrhosis underwent intra-arterial injection of Lipiodol UltraFluid (LUF) during diagnostic DSA of liver parenchyma, 42 of them for a complete chemotherapeutic treatment, 8 for an isolated diagnostic control. LUF is known to be specifically captured by HCC neoplastic tissue, with long-term persistence in the lesion if injected in the arterial hepatic tree; this is not the case with other focal hepatic masses. Therefore LUF opacification can be used to demonstrate small daughter tumors not shown by CT or US in cases with evidence of HCC, or to diagnosis HCC in clinically positive patients with no evidence of tumor at non-invasive screening. In our series of patients, accumulation of LUF in the HCC was observed in 100% of the cases, with no false negatives. Two false positives (4%) were observed, due to CT being performed too early (it should be performed not sooner than 10 days after the injection). Overall DSA accuracy was 78%, with 22% false negatives. In 14% of the cases DSA was positive for HCC in patients with aspecific noninvasive screening. CT, performed 10 days after LUF injection, demonstrated HCC daughter tumors not depicted by US, conventional CT, and angiography, in 34% of the cases, and in 9% of the patients only CT/LUF was able to show HCC in clinically positive cases with no evidence of tumor on other imaging techniques. Specificity, sensitivity and over-all accuracy were thus 100% in our series; LUF was well tolerated by the patients, and no technical complications were observed. In our opinion, the diagnostic DSA and CT/LUF is justified only for the typification of suspected focal nodules unsuitable for biopsy: in other instances, especially in case of HCC with positive biopsy/clinical findings and focal nodular mass, the technique should be directly employed as a therapeutic approach, with the injection of lipiodolized agents to treat both primary and daughter nodules after surgery in operable patients, and to begin chemoembolization treatment in patients with intrahepatic polyfocal diffusion. DSA and LUF are therefore of primary importance in the diagnosis and therapeutic flow-chart of HCC associated with hepatic cirrhosis.

[Transcatheter embolization of expansive masses of the sacrum]. / Embolizzazione transcatetere delle masse espansive del sacro.

The authors report their 4-year (1984-1988) experience with TCE in the treatment of primary sacral benign/malignant and vascular bone tumors, after similar preliminary studies on aneurysmal bone cysts. Eleven patients were treated, for a total of 21 procedures: in 85% of the eight cases of palliative embolization, multiple instrumental approaches were needed for late revascularization, up to four consecutive embolizations in the same patients. Severe complications were observed in 19% of the procedures, due to arterial catheterization and/or instrumental maneuvers, but in none of them was surgery required. Technical results--i.e. devascularization of the mass--were optimal/suboptimal in all cases at the end of multiple procedures in the same patient: in 7/8 patients treated for palliation, however, the treatment was repeated, the late venous DSA angiographic control showing recanalization of the great vessels surrounding the lesion and/or revascularization through collateral channels. The analysis of morphological and clinical results (with reference to pain relief, dimension of the mass, and calcification at CT follow up) showed a complete pain relief in 100% of the patients treated preoperatively for palliation. The dimension of the mass was reduced in 12.5% of the cases treated for palliation, and recalcification was demonstrated on CT in 12.5% of cases. In 25.5% the mass had increased in size and in 62.5% its dimensions were unchanged. Effective pain relief was always obtained in the cases treated preoperatively. Thus, in our experience TCE of expansive lesions of the sacral bone can be considered as an effective therapeutical choice, with special reference to pain relief, for use in all inoperable cases, and as a preoperative treatment to minimize blood loss at surgery. Still, embolization materials are not completely satisfying: many of them are expensive, difficult to use and cannot be trusted to permanently occlude the vessels, which forces to intervene more than once to obtain optimal clinicomorphological results. As for malignant lesions, chemo-embolization with cytostatic substances should be used to improve the efficacy of the method. However, even through such negative judgements can be expressed on TCE, both technical and clinical results have been, in our experience, quite satisfactory, which calls for optimization of the methodology.