Diffusion-weighted whole-body MRI for evaluation of early response in multiple myeloma.

AIM: To evaluate the modifications of the apparent diffusion coefficient (ADC) in myelomatous lesions before and after induction treatment and the correlation with patient response to therapy according to International Myeloma Working Group (IMWG) criteria. MATERIALS AND METHODS: A homogeneous group of 18 patients with a diagnosis of symptomatic multiple myeloma who underwent whole-body MRI with diffusion-weighted imaging (DWI-MRI) before and after bortezomib-based induction chemotherapy were evaluated prospectively. Quantitative analysis of ADC maps of myelomatous lesions was performed with the following pattern types: focal pattern, diffuse pattern (moderate and severe), and "salt and pepper" pattern. Lesions were evaluated by quantitative image analysis including measurement of the mean ADC in three measurements. Imaging results were compared to laboratory results as the clinical reference standard. RESULTS: A statistically significant increase in ADC values were found in the lesions of patients that responded to treatment. Interestingly, focal lesions showed a strongly significant increase in ADC values in responders, whereas no significant variation in ADC value in non-focal lesions (diffuse pattern and "salt and peppers" pattern) between responders and non-responders group was demonstrated. CONCLUSIONS: DWI-MRI could provide additional quantitative information useful in monitoring early therapy response according to ADC changes of focal lesions.

[Sacroiliitis in seronegative arthritis. The anatomicopathological aspects and imaging methods compared]. / Sacroileite da artriti sieronegative. Considerazioni anatomo-patologiche e metodiche di imaging a confronto.

Sacroiliitis is usually the first and main feature of seronegative spondyloarthropathies. In its early stages it is difficult for diagnostic imaging techniques to demonstrate it and specificity is poor. At the same time, there may be few or even no symptoms at all. Therefore, the anatomical damage is quite often diagnosed at an advanced and irreversible stage. This study was aimed at assessing sacroiliac joint impairment during seronegative arthritis by means of diagnostic imaging techniques. The abnormal features of this condition are reported, pointing out the different findings of ankylosing spondylitis, psoriatic arthritis, Reiter's disease, reactive arthritis and sacroiliitis associated with chronic enteritis--e.g., Crohn's disease, ulcerative colitis, etc. Then, the capabilities and the features of each imaging method (conventional radiology, CT, bone scan, MRI) are reported. Modern techniques are dealt with in depth, especially relative to their capabilities in solving radiographic dilemmas. Technological progress is currently focused on MRI, whose use in early inflammatory sacroiliitis during seronegative spondyloarthropathies remains however in the experimental stage. Therefore, plain radiography is still the method of choice and its findings are used as a diagnostic criterion in unquestionable cases. To conclude, if the peculiar morphologic features of this condition are known and supported by clinical and radiographic findings, the condition can be diagnosed early, which means proper treatment and a lower incidence of highly invalidating sequelae.

Lipomas of the esophagus: a new case.

We present a new case of esophageal lipoma. The rarity of this tumor and its submucosal origin can create problems for the correct diagnosis. Symptoms, when present, are of mechanical origin (obstruction) with dysphagia. Treatment is endoscopic or surgical removal.

[Cost analysis of ultrasound-guided transrectal needle biopsy in prostatic carcinoma]. / Analisi dei costi dell'agobiopsia transrettale eco-guidata nel carcinoma prostatico.

INTRODUCTION: The literature mortality and morbidity rates from prostatic carcinoma prompt to the better use of some routine diagnostic tools such as transrectal ultrasound-guided biopsy. We evaluated the overall cost of transrectal ultrasound biopsy (TRUSB) of the prostate and investigated the economic impact of the procedures currently used to diagnose prostatic carcinoma. MATERIAL AND METHODS: The total cost of TRUSB was calculated with reference to 247 procedures performed in 1996. The following cost factors were evaluated: personnel, materials, maintenance-equipment depreciation, energy consumption and hospital overheads. A literature review was also carried out to check if our extrapolated costs corresponded to those of other authors worldwide and to consider them in the wider framework of the cost effectiveness of the strategies for the early diagnosis of prostatic cancer. RESULTS: The overall cost of TRUSB was Itl. 249,000, obtained by adding together the costs of: personnel (Itl. 160,000); materials (Itl. 59,000); equipment maintenance and depreciation (Itl. 12,400); energy consumption (Itl. 100); hospital overheads (Itl. 17,500). The literature review points out TRUSB as a clinically invasive tool for diagnosing prostatic carcinoma whose cost-effectiveness is debated. Cadaver studies report the presence of cancer cells in the prostate of 50% of 70-year-old men, while extrapolations calculate a morbidity from prostatic carcinoma in 9.5% of 50-year-old men. It is therefore obvious that randomized prostatic biopsies, methods apart, are very likely to be positive. This probability varies with the patient's age, the level of prostate specific antigen (PSA), the density of PSA/cm3 of prostate volume (PSAD), and the positivity of exploration and/or transrectal ultrasound findings. CONCLUSIONS: Despite the strict application of all these criteria and the critical assessment of the patient's general conditions, TRUSB is indicated for 16% of the male population over 50, with obvious implications. It has been recently suggested that the ratio between free PSA (antigen fraction of the total serum PSA) and total PSA could be clinically useful as an effective predict of TRUSB positivity or negativity. Free PSA evaluation might thus help reduce the number of TRUSB.