Endometrial carcinoma: MR staging and causes of error.

PURPOSE: This study was undertaken to prospectively determine the diagnostic capabilities of magnetic resonance (MR) imaging in detecting myometrial and cervical invasion and lymph node involvement in endometrial carcinoma and to identify the causes of errors in staging endometrial carcinoma. MATERIALS AND METHODS: Twenty consecutive patients with a histological diagnosis of endometrial carcinoma underwent preoperative MR imaging. MR findings were compared with surgical staging, considered as the standard of reference. RESULTS: In assessing myometrial invasion, MR imaging showed 70% accuracy, 80% sensitivity, 40% specificity, 80% positive predictive value (PPV), and 40% negative predictive value (NPV). In detecting cervical invasion, MR imaging had 95% accuracy, 100% sensitivity, 94.4% specificity, 66.7% PPV, and 100% NPV. In evaluating lymph node involvement, MR imaging showed 100% accuracy, sensitivity, specificity, PPV and NPV. Errors in evaluating myometrial invasion were caused by polypoid tumour, adenomyosis and leiomyomas, whereas those in evaluating cervical invasion were caused by dilatation and curettage. CONCLUSIONS: MR imaging is a reliable technique for preoperative evaluation of endometrial carcinoma. Its main limitation is differentiating between stage IA and IB carcinomas, which is not highly important for surgical planning. Cooperation between the gynaecologist and radiologist is mandatory to avoid staging errors.

Pelvic floor imaging: comparison between magnetic resonance imaging and conventional defecography in studying outlet obstruction syndrome.

PURPOSE: This study prospectively compared the diagnostic capabilities of magnetic resonance (MR) imaging with conventional defecography (CD) in outlet obstruction syndrome. MATERIALS AND METHODS: Nineteen consecutive patients with clinical symptoms of outlet obstruction underwent pelvic MR examination. The MR imaging protocol included static T2-weighted fast spin-echo (FSE) images in the sagittal, axial and coronal planes; dynamic midsagittal T2-weighted single-shot (SS)-FSE and fast imaging employing steady-state acquisition (FIESTA) cine images during contraction, rest, straining and defecation. MR images (including and then excluding the evacuation phase) were compared with CD, which is considered the reference standard. RESULTS: Comparison between CD and MR with evacuation phase (MRWEP) showed no significant differences in sphincter hypotonia, dyssynergia, rectocele or rectal prolapse and significant differences in descending perineum. Comparison between CD and MR without evacuation phase (MRWOEP) showed no significant differences in sphincter hypotonia, dyssynergia or enterocele but significant differences in rectocele, rectal prolapse and descending perineum. Comparison between MRWEP and MRWOEP showed no significant differences in sphincter hypotonia, dyssynergia, enterocele or descending perineum but significant differences in rectocele, rectal prolapse, peritoneocele, cervical cystoptosis and hysteroptosis. CONCLUSIONS: MR imaging provides morphological and functional study of pelvic floor structures and may offer an imaging tool complementary to CD in multicompartment evaluation of the pelvis. An evacuation phase is mandatory.

Isospin dependence of incomplete fusion reactions at 25 MeV/nucleon.

40Ca+;{40,48}Ca,46Ti reactions at 25 MeV/nucleon have been studied using the 4pi CHIMERA detector. An isospin effect on the competition between fusionlike and binarylike reaction mechanisms has been observed. The probability of producing a heavy residue is lower in the case of N approximately Z colliding systems as compared to the case of reactions induced on the neutron rich 48Ca target. Predictions based on constrained molecular dynamics II calculations show that the competition between fusionlike and binary reactions in the selected centrality bins can constrain the parametrization of the symmetry energy and its density dependence in the nuclear equation of state.

Fast ternary and quaternary breakup of the 197Au + 197Au system in collisions at 15 MeV/nucleon.

A new reaction mechanism of violent reseparation of a heavy nucleus-nucleus system, 197Au + 197Au, into three or four massive fragments in collisions at 15 MeV/nucleon has been observed. After reseparation, the fragments are almost exactly aligned, thus showing a very short time scale of the reseparation process, of about 70-80 fm/c.

Effects of interferon beta-1a and -1b over time: 6-year results of an observational head-to-head study.

OBJECTIVE: To evaluate and compare the long-term efficacy and safety of two different beta-interferon preparations (IFN-beta-1a vs IFN-beta-1b). MATERIALS AND METHODS: Two parallel outpatient groups with relapsing-remitting multiple sclerosis (RRMS), according to Poser criteria, were treated with either intramuscular IFN-beta-1a 30 microg (group A, n = 62) or subcutaneous IFN-beta-1b 250 microg (group B, n = 64). RESULTS: A statistically significant reduction was seen in the relapse rate (P < 0.0001) in both groups. No significant difference was found between the two groups (P = 0.43). After 6 years of therapy, the mean Expanded Disability Status Scale score was 3.22 +/- 1.47 (delta 1.03 +/- 1.35) in group A and 3.34 +/- 1.47 (delta 0.97 +/- 1.47) in group B (P = 0.47). CONCLUSIONS: Our study results suggest that the efficacy of IFN-beta-1a 30 microg once weekly and SC IFN-beta-1b 250 microg every other day is similar. Both IFN-beta-1a and IFN-beta-1b are effective in slowing disability progression.

Chronic anaemia and adhesion molecules in patients with liver cirrhosis. A preliminary report.

AIM: The aim of our study was to investigate circulating levels of intercellular adhesion molecule-1 (sICAM-1) and vascular cellular adhesion molecule-1 (sVCAM-1) in cirrhotic patients, with and without chronic anaemia, to establish whether there was a relationship between inflammatory activity and anaemia. METHODS: We investigated 14 anaemic (mean hemoglobin value 10.65+/-1.06 g/dL) and 14 non anaemic (mean hemoglobin value 13.8+/-0.89 g/dL) subjects affected by virus C-related liver cirrhosis comparable for sex, age and degree of liver dysfunction such as expressed by Child-Pugh classification. Circulating sICAM-1 and sVCAM-1 were measured by EIA commercial kit (R&D System Co, Abington, UK) and mean+/- standard deviation values in two groups were compared by t-test and Kruskall-Wallis test. RESULTS: Mean+/-standard deviation sICAM-1 was 35.06+/-4.06 ng/mL in anaemic and 23.39+/- 6.1 ng/mL in non anaemic cirrhotic patients. Mean+/-standard deviation sVCAM-1 was 47.66+/-8.18 ng/mL in anaemic 31.77+/-6.08 ng/mL in non anaemic patients, respectively. Statistical analysis showed a significant difference between the two groups both in sICAM-1 (p=0.01) and sVCAM-1 (p=0.03) values. CONCLUSIONS: Our study show that chronic anaemia, in liver cirrhosis, is associated to a greater increase of circulating adhesion molecules and suggests that inflammation may contribute to persistence of anaemic state, worsening the outcome of cirrhotic patients.

Vesico-ureteral reflux: diagnosis and staging with voiding color Doppler US: preliminary experience.

INTRODUCTION: The aim of this study is to assess the accuracy of a new US examination: 'voiding color Doppler US ' in the early diagnosis and staging of vesico-ureteral reflux (VUR). The contrast agent US was SH U 508A (Levovist, Schering, Berlin), which produces a chromatic accentuation of the signals picked up by the color Doppler US. Eighteen patients (10 females, eight males) were recruited for the study. In two patients a second examination was performed for follow-up after a VUR conservative therapy. All patients were taken under examination for the evaluation of possible VUR. In all patients the voiding color Doppler US was followed by voiding cystourethrography (VCUG) and the data obtained were compared. MATERIALS AND METHODS: A total of 18 patients aged between 3 months and 10 years, were recruited for the study. The results of the examination were the following: urinary tract infections, follow-up of VUR after conservative or surgical therapy, miscellaneous indications. Voiding color Doppler US was performed, followed by a VCUG. The voiding color Doppler US consists in the trans-catheter introduction of a contrast agent SHU 508 A (Levovist, Schering, Ag. Berlin) into the bladder and a subsequent test with the color Doppler US to show or exclude the presence of reflux into the ureters and/or into the pyelo-caliceal cavity of the kidneys. After the introduction of the contrast agent US the ultrasound scanning of the bladder, the ureters and the pyelo-caliceal cavity was performed to examine the reflux degree. The ultrasonographic investigations were perfomed with AU 590 asyncronus US (Esaote Biomedica, Genova) with a 3.5 MHz convex probe. RESULTS: After the trans-catheter introduction of the contrast agent US, vesico-ureteral reflux occured in 13 patients (77.2%). The reflux degree was also measured by means of ultrasound and was later confirmed by VCUG. The mean times of each examination were as follows: initial US, 10 min; catheterization, 8 min; voiding color Doppler US, 15 min; overall VCURG examination 10 min. The overall mean duration of the voiding color Doppler US examination was 33 min. The comparable mean time for VCUG, including the catheterization time, was 20 min. No reactions of intolerance to the ultrasound contrast agent occurred. DISCUSSION AND CONCLUSIONS: The voiding color Doppler US test has evidenced in all patients the presence of the contrast agent US in the bladder after the introduction. In 13 patients (77.2%) with presence of VUR, the voiding color Doppler US test has established the reflux degree confirmed by cystourethrography. The superimposability of the data obtained with voiding color Doppler US and VCUG would seem to confirm the importance of this new ultrasonographic technique in the diagnosis and staging of VUR.

[Retrograde echocystography: a new ultrasonographic technique for the diagnosis and staging of vesicoureteral reflux]. / L'ecocistografia retrograda: una nuova tecnica ecografica per la diagnosi e stadiazione del reflusso vescico-ureterale.

PURPOSE: We investigated the accuracy of a new US investigation technique, called retrograde cystography US, in the early diagnosis and staging of vesicoureteral reflux. MATERIAL AND METHODS: We examined 5 patients, aged 3 months to 10 years, suffering from hydronephrosis and/or pyelonephritis. Retrograde cystography US was followed by conventional retrograde cystography. Retrograde cystography US consists in the transcatheter introduction of a contrast agent (Levovist, Schering AG, Berlin, Germany) into the bladder and a subsequent color Doppler examination to show or exclude the presence of reflux. Superpubic scanning of bladder, ureters and pyelocaliceal cavity was performed after echocontrast agent introduction to assess the reflux grade. US was performed with an Esaote AU 590 asynchronous scanner (Esaote Biomedica, Genova, Italy) with a 3.5 MHz convex probe. RESULTS: After the transcatheter introduction of Levovist, vesicoureteral reflux was seen in 5/5 patients. Reflux grade was also measured with US and then confirmed at retrograde cystography. In a patient with pyelonephritis and no reflux at follow-up cystography, retrograde cystography US identified a unilateral reflux (grade 1). DISCUSSION AND CONCLUSIONS: Retrograde cystography US showed the echocontrast agent in the urinary tract and assessed the reflux grade in all 5 patients, which was then confirmed at cystography. In a patient with grade 1 unilateral reflux at cystography US, follow-up conventional cystography showed no reflux, which seems to confirm a higher sensitivity of the US technique. The total agreement of conventional and US findings seems to confirm the importance of the US method for the diagnosis and staging of vesicoureteral reflux.

[Hepatic focal lesions: role of color Doppler ultrasonography with contrast media]. / Lesioni focali epatiche: ruolo dell'eco color Doppler con mezzo di contrasto.

INTRODUCTION: The differential diagnosis of focal hepatic lesions is still studied by diagnostic imaging operators. A big step forward in the field of ultrasound (US) has come from the color Doppler mode permitting accurate studies of the vascularization of focal hepatic lesions. Echocontrast agents have further improved color Doppler sensitivity to slow flows and have permitted to visualize intralesional vascular signals which were missed at B-mode US. New data have thus been acquired which can be integrated with flowmetric findings to help make the correct differential diagnosis with a fair safety margin. We studied the pathognomonic US pattern for each type of lesion. MATERIAL AND METHODS: We examined 55 patients with single hepatic lesions which had already been typified: they were 10 hepatic angiomas, 3 focal nodular hyperplasias (FNH), 2 hepatic adenomas, 20 hepatocarcinomas and 20 hepatic metastases. Color Doppler investigations were performed on each patient before and after the intravenous (i.v.) administration of an echocontrast agent (Levovist, Schering AG, Berlin, Germany). For each lesion we studied the morphological characteristics, the resistance index (RI) of intralesional arterial vessels, the hepatic perfusion index and the maximum speed in intralesional vessels. RESULTS: Contrast-enhanced US showed no intralesional signals or afferent branches in 8 hepatic angiomas, which however exhibited some peripheral vascularization; weak intralesional vascular signals were demonstrated in 2 cavernous angiomas. Intralesional signals, as well as peripheral vascularization, were detected in the 3 FNH cases, which also exhibited a centripetal afferent branch; the hepatic perfusion index in these lesions never exceeded .25. The two hepatic adenomas had similar color flowmetry to FNH also after i.v. contrast agent administration, except for the contripetal afferent vessel which was not seen. In the 20 hepatocarcinomas, contrast-enhanced images showed numerous intralesional signals and afferent branches which, with the peripheral vascularization, resulted in a basket-like pattern. Flowmetry of intralesional arterial vessels showed an irregular systodiastolic range, with RI = .32 +/- .5 in 12 lesions and high in the remaining 8 lesions (RI = .82 +/- 10). The hepatic perfusion index was .65 +/- 10 in all patients. In 14 of the 20 hepatic metastases, B-mode US showed no intralesional signals except for 6 metastases from colorectal carcinoma, and contrast-enhanced findings were about the same. The hepatic perfusion index at flowmetry ranged .30 to .45 in all patients.