High-resolution sonography of breast carcinoma.

The use of broad band transducers determined a great increase in spatial, contrast and vascular resolution of ultrasound probes dedicated to breast studies. Providing better definition of normal as well as pathologic features, high resolution sonography improves the specificity of the diagnosis for the majority of malignant nodules and allows a better definition of both local and regional staging. The most impressive results have been achieved in the evaluation of multifocal and multicentric carcinomas, in determining the size of the tumor, its degree of invasion of the surrounding tissues and of the ducts. Color and power Doppler offer further characterization that may be particularly useful in evaluating tumor vascularity during therapies that are planned before surgery. These new staging possibilities must push the radiologists to adequate their instruments and their methods to provide up-to-date and more accurate informations to the surgeon.

[Digital radiography in urography]. / La radiografia digitale in urografia.

The clinical utility was evaluated of a computed radiographic system in urography. The system (FCR 101, Philips Medical Systems, Inc., Shelton, CT) is based on a photo-stimulatable phosphor screen (imaging plate) for X-ray image detection and storage. The X-ray information recorded on the imaging plate is converted into digital from and processed by means of a computer. After processing is completed, the digitized image is reversed back to analogic signals, which modulate the intensity of a laser beam scanning the image on a single-emulsion film (Fuji CR 633). Two hundred IVP's were obtained in four groups, of 50 patients each, with normal azotemic values by rapid infusion of a low osmolality contrast medium (iopamidol 150 mgI/ml). While conventional radiographs were performed on the first group of patients with the injection of 0.6 gI/kg body weight of contrast medium, digital examinations were carried out, in the remaining three groups, with the injection of 0.6, 0.3 and 0.12 gI/kg, respectively. The digital images were processed with the "Abdomen-routine" program. A specific algorithm was implemented in order to reduce the excessive contrast resolution of the bladder, which is due to the characteristics of the nonionic contrast medium and enhanced by the reading program. The image details were evaluated by two observers and then statistically analyzed with nonparametric tests. Statistical analysis did not show any difference in the quality of digital and screen-film images. Image processing improved some inadequate images, by reducing the contrast resolution of the bladder, and allowed a better detection of some details. Low doses (0.3 gI/kg) of a low osmolality (150 mgI/kg) contrast medium were enough to obtain good images. Another biological advantage was obtained by a consistent radiation dose reduction (about 40%).

[The quality of urography with iopamidol and various diuretic agents]. / Qualità dell'urografia con ipoamidolo e diversi agenti diuretici.

The results obtained in four successive trials based on the analysis of urography performed on patients with normal kidney function are reported. The scores obtained with a non-ionic contrast (iopamidol) were compared with those produced after injecting the same contrast medium with the addition of various diuretics (furosemide, various quantities of 5% glucose solution, 20% mannitol). The results obtained by injecting the diuretic together with the iopamidol were usually unsatisfactory. Injection of diuretic 15 ms after the iopamidol gave better results in the lower urinary tract, particularly the bladder. The best results were obtained by injecting 250 ml, 20% mannitol, after 15 ms. However this technique is not applicable to patients requiring a voiding cystourethrogram due to the inadequate opacification of the urethra it provides.

[Quality control in urography with iopamidol and iohexol. A parallel comparison]. / Controllo di qualità in urografia con iopamidolo e ioexolo. Confronto parallelo.

Iohexol has a slightly higher osmolarity in comparison with iopamidol; therefore it might induce a more pronounced diuretic effect and then a better distension of the excretory pathway. A trial was carried out in two groups of 50 patients with normal renal function who underwent urography, namely with 50 ml (15 gI) of iopamidol and of iohexol. No significant differences in the evaluated parameters (nephrography, calyces, pelvis, ureters and bladder) have been found. Both contrast media allowed to perform good quality urographies.

[Findings in myelographic block. Correlations with computerized tomography image]. / Reperto di blocco mielografico. Correlazioni con le immagini TC.

Fifteen cases with complete myelographic stop were examined by CT. CT showed stenosis of the spinal canal in 11/12 cases with extradural lesion (92%). The stenosis was or was not associated to disk pathology; one case was due to a large herniated disk. Three cases were due to a neurinoma and were not visualized at CT without intrathecal contrast medium. This situation represents a limitation of CT and therefore an indication for myelography.

[Quality control in urography using non-ionic contrast media (iopamidol) and induced hydration]. / Controllo di qualità in urografia con mezzo di contrasto non ionico (iopamidolo) ed idratazione indotta.

A trial was carried out with the aim to overcome the limits of the non ionic contrast medium (cm) in the urographic evaluation of ureters and bladder (poor distention and high density). 200 urographies have been performed in patients with normal renal function (group 1: sodium iodamide; group 2: iopamidol; group 3: iopamidol with glucose solution; group 4: iopamidol and injection of glucose solution after 15'). The scores ascribed to the four groups have been compared: in the comparison between ionic and non ionic cm a slight advantage of iodamide is evident, particularly in the evaluation of calyces and ureters. By adding glucose solution to iopamidol after 15', an improvement in the quality of the urogram has been obtained, but not statistically significant.

Impact of technology and technique on the performance of the intravenous D.S.A. of the carotid arteries.

Intravenous Digital Subtraction Angiography (i.v. D.S.A.) was performed at the carotid bifurcation level in 259 patients with clinical or physical findings of a Cerebrovascular Insufficiency (C.V.I.). The angiographic examinations have been performed during two different periods, basically differing for the technology of the digital equipment and for the technique used. The personal experience showed how these two factors are important in determining the quality of the image and therefore the accuracy of the i.v. studies. Images of good quality of the common and internal carotid arteries have been obtained in 73% and 54% of the cases of the first period and in 93% and 82% of the cases of the second period. The role of the i.v. D.S.A. in the management of the C.V.I. depends not only upon the quality of the images, but also upon the surgical policy and from the availability of ultrasounds.

Routine evaluation of arteriopathies of the lower extremities by digital subtraction angiography.

Intravenous digital subtraction angiography (DSA) was performed in 119 patients with lower extremity ischemia using a 14" amplifier. Four injections of contrast medium were usually necessary for a complete evaluation of this vascular region. Images of good quality were obtained in most cases; movement artifacts and a faint opacification accounted for any poor results, which occurred mainly under the knee. The technique of pixel shifting turned out to be very useful to remove movement artifacts. The "measuring field" allowed us to minimize the problem of the inhomo geneous saturation of the amplifier. In 8% of the cases an intra-arterial DSA has been performed after an unsatisfactory intravenous examination. Conventional angiography appears to be no longer necessary.

[Computed tomography of the femur head. Normal aspects and appearance in aseptic necrosis]. / Tomografia computerizzata delle teste femorali. Aspetti normali ed in corso di necrosi asettica.

The diagnostic value of Computed Tomography (CT) in the diagnosis of the aseptic necrosis of the femoral head is discussed. The CT findings in the different evolutive stages are reported and the respective diagnostic value of Conventional Radiology and CT are discussed. The CT findings of femoral head necrosis in the early phases are emphasized. The capability of CT to demonstrate structural changes in femoral heads with regular morphology allows to consider this technique when there exists a clinical doubt of osteonecrosis of the femoral head and in risk patients.

[Cardiac complications of intravenous digital angiography. Comparison of ionic and nonionic contrast media]. / Complicanze cardiache in angiografia digitale venosa. Confronto fra mezzo di contrasto ionico e non ionico.

The review of 1405 digital intravenous subtraction angiographies carried out in the period may 1982-february 1985 showed in about 2% of the cases cardiac symptoms, which arose during or after the examination. In the great majority of the cases the symptomatology was characterized by angina pectoris. In order to better understand these data and analysing the results of the literature, a trial has been performed in 100 patients who underwent DSA. They have been divided into two groups in which two different contrast media, ionic (sodium meglumine diatrizoate) and non ionic (iopamidol) have been randomly injected. A detailed cardiologic anamnesis has been collected and EKG has been performed before and after each injection with pre-established gaps. The results showed that the incidence of cardiac symptoms and EKG variations is lesser with the non ionic contrast medium: therefore this agent is to be preferred at least in patients at risk from cardiologic point of view.