[Value of magnetic resonance in the diagnostic definition of neurotoxoplasmosis and in the assessment of the response to pharmacological treatment]. / Valore della Risonanza Magnetica nella definizione diagnostica della neurotoxoplasmosi e nella valutazione della risposta al trattamento farmacologico.

PURPOSE: We investigated the role of Magnetic Resonance Imaging (MRI) in the diagnosis of neurotoxoplasmosis and in the evaluation of drug treatment response. MATERIAL AND METHODS: Twenty-six AIDS patients (22 men and 4 women, mean age 26.7 years) with clinical suspicion of neurotoxoplasmosis were examined. A patient was considered to have neurotoxoplasmosis if there were signs of focal neurologic impairment and a positive/questionable response to the serum test for Toxoplasma gondii. MR images were acquired with T1-weighted spin-echo (SE) and inversion recovery (IR) sequences and with T2-weighted SE sequences. Gd-DTPA was administered in all cases. After the beginning of therapy with sulfadiazine and pyrimethamine all patients were submitted to clinical and neuroradiologic follow-up for 60 days. RESULTS: MR examinations on admission demonstrated at least one brain lesion in all patients and multifocal involvement in 70% of cases. Enhancing lesions were found in 90% of patients (83% ring enhancement, 4% focal enhancement, 3% mixed patterns). The most frequent lesion sites were the basal ganglia and thalami (70%). The brain lesions were subdivided into 4 groups by their morphology and signal patterns. DISCUSSION: The time course of clinical and neuroradiologic responses demonstrates a rapid improvement after the first week of therapy, which stabilized after the second week. Pearson correlation between clinical and neuroradiologic treatment responses showed a nearly linear correlation (r = .97; p < .001). The diagnosis was then confirmed in all patients based on the positive response to the serum test for Toxoplasma gondii (IgG > 12 UI/mL) and/or clinical and neuroradiologic improvement after therapy. DISCUSSION AND CONCLUSIONS: This study demonstrates the accuracy of MRI in the detection of toxoplasmosis brain lesions and in the evaluation of treatment response.

[Bucket-handle meniscal tears of the knee. Magnetic resonance findings]. / Rotture meniscali a manico di secchio del ginocchio. Aspetti con risonanza magnetica.

Magnetic Resonance Imaging (MRI) is a valuable technique to study knee meniscal tears. A series of 330 patients with knee traumas was retrospectively reviewed to systematize the semiologic features of a particular kind of meniscal tear, the "bucket-handle" one. MR investigations were performed with an 0.5-T superconductive magnet, surface coil and spin-echo T1-weighted and gradient-echo (FFE) T2*-weighted sequences on the coronal and the sagittal planes. Twenty-nine patients exhibited bucket-handle tears, 25 of the medial and 4 of the lateral meniscus. In all 29 patients joint effusion was observed; in 18 patients capsulo-ligamentous lesions were associated. MR findings were confirmed by arthroscopy and/or surgery. Semiologic features characterizing the bucket-handle tear on the coronal plane are: truncated triangular shape of the peripheral meniscus and low-intensity band between the posterior cruciate ligament and the tibial plateau, corresponding to the central fragment displaced in the intercondylar notch. In the lateral meniscus, the fragment is found beneath the anterior cruciate ligament. On the sagittal plane this band parallels the posterior or anterior cruciate ligaments, depending on the involved meniscus, with a typical "second cruciate posterior or anterior ligament" or "third cruciate ligament" pattern. The semiology of such findings of bucket-handle meniscal tears is useful in the differential diagnosis with other kinds of meniscal tears.

[The role of needle aspiration biopsy in the diagnosis of parotid masses]. / Il ruolo della citologia per agoaspirazione nella diagnostica delle neoformazioni della parotide.

The aim of this work is to assess the list of fine needle aspiration in the diagnosis of lesions of the parotid. Thirty-nine patients suffering from parotid pathology were subjected to cytology examination through fine needle aspiration. Thirty seven patients subjected to surgical operation have a histological comparison. We have proved the validity of the technique considering the sensibility, specificity and the accuracy. We didn't have FN we only had 1 FP that could be a suspect cytology. We had a 100% sensibility, a 75% specificity and 97.29% accuracy.

[Magnetic resonance in the study of tubercular coxitis]. / La risonanza magnetica nello studio della coxite tubercolare.

The hip joint is the most common skeletal site for tuberculous disease, aside from vertebrae. Eight patients underwent MR investigations. In four cases (group A) there was suspicion of hip tuberculosis on the basis of clinical and laboratory findings, whereas the other 4 patients (group B) were known to suffer from hip tuberculosis. In group A, MRI always demonstrated inflammatory joint effusions, capsular distension, and subchondral bone conditions. No changes in the synovial membrane were found at onset, while the correct evaluation of the articular cartilage was not possible, due to the presence of concomitant effusion. In group B, MRI yielded no additional diagnostic information with respect to plain film, whereas it was undoubtedly the best diagnostic technique to detect joint effusions and to exclude other concomitant pathologic conditions such as neuroalgodystrophy and osteonecrosis. In conclusion, MRI does not yield specific or peculiar semeiological elements for the diagnosis of hip tuberculosis. On the other hand, MRI, together with clinics and with laboratory findings, allows the early and aspecific diagnosis of hip pain to be confirmed and specified, for the technique is a sensitive indicator of the presence of early lesions.

Ocular pseudomyasthenia: report of a case with a pineal region tumor.

A case presenting with clinical features of ocular myasthenia and a false-positive edrophonium test is reported. Brain CT and MRI scan revealed a pineal region tumor histologically verified as germinoma. We recommend evaluating patients with clinical features of myasthenia gravis (MG) confined to the ocular muscles for intracranial mass lesions.

Transurethral ultrasonography, CT scan, nuclear magnetic resonance (NMR) imaging and pathological control in staging and follow up of invasive bladder carcinoma.

Diagnostic accuracy in clinical staging of bladder cancer, using traditional methods, is still imperfect. Clinical and pathological staging do not always correlate. The accuracy of the new imaging techniques in the staging and in the follow-up of this kind of neoplasia, has yet to be assessed. Our study involved 7 patients with invasive bladder cancer who had undergone transurethral ultrasonography, CT scan, NMR and transurethral resection of the tumour. We have compared the clinical staging accuracy of the three imaging methods with the pathological reports. We conclude that transurethral ultrasonography is superior to the other methods, as far as local staging is concerned. In regional staging, NMR has shown very promising results and, in our preliminary opinion, may be more accurate than CT scan.

[Role of digital intravenous angiography in the study of reversible cerebral ischemia]. / Le rôle de l'angiographie numérique par voie intra-veineuse dans l'étude de l'ischémie cérébrale régressive.

The brachiocephalic, carotid, vertebral and intra-cranial vessels of 497 patients presenting reversible ischemic attacks (R.I.A.) were evaluated with venous digital subtraction angiography (V.D.S.A.). Alterations of the vascular wall were observed in 289/497 (58.2%) patients, of whom 60% presented multiple locations (539 lesions): obstruction (12%), stenosis greater than 50% (29%), stenosis less than 50% (49.8%), kinking (9%), aneurysm (0.2%). An ulcerating arteriosclerotic plaque was observed in 24.6% of the stenoses less than 50% and in 48% of the stenoses greater than 50%. The incidence of vascular lesions was higher (p less than 0.01) in patients with multiple R.I.A. (66.6%) than in those with one isolated R.I.A. (55.6%). Among the patients (207/497) studied also with cerebral computed tomography (C.T.) no relationship could be defined between the extra-cranial vascular lesions demonstrated by V.D.S.A. and the cerebral alterations shown by C.T. Among the patients (64/497) studied also with high frequency ultrasonography (U.S.), the lesion shown by V.D.S.A. could be also demonstrated by U.S. in 84.8% of cases. The personal flow-chart in the study of R.I.A. is described emphasizing the primary role played by V.D.S.A. as well as the complementary role of the other techniques, both non invasive (U.S., C.T.) and invasive (conventional or digital subtraction angiography).

Venous digital subtraction angiography in the evaluation of renovascular hypertension.

The study of renovascular hypertension (R.V.H.) presently requires multiple non invasive examinations in order to select between patients with R.V.H. or other kind of hypertension, before resorting to angiography. The use of venous digital subtraction angiography (V.D.S.A.) may change this diagnostic flow-chart. For this purpose, 100 patients with clinical and laboratory data suspect of R.V.H. underwent V.D.S.A. Compared to angiography, V.D.S.A. showed a 100% sensitivity and 93% specificity. Since the sensitivity and specificity of the non invasive techniques vs. V.D.S.A. in the same series was always lower, V.D.S.A. may be proposed as the first examination in the study of R.V.H. The arterial route for D.S.A. is generally not required for diagnostic purposes.