Extraocular muscle sampled volume in Graves' orbitopathy using 3-T fast spin-echo MRI with iterative decomposition of water and fat sequences.

BACKGROUND: Current magnetic resonance imaging (MRI) techniques for measuring extraocular muscle (EOM) volume enlargement are not ideally suited for routine follow-up of Graves' ophthalmopathy (GO) because the difficulty of segmenting the muscles at the tendon insertion complicates and lengthens the study protocol. PURPOSE: To measure the EOM sampled volume (SV) and assess its correlation with proptosis. MATERIAL AND METHODS: A total of 37 patients with newly diagnosed GO underwent 3-T MRI scanning with iterative decomposition of water and fat (IDEAL) sequences with and without contrast enhancement. In each patient, the three largest contiguous coronal cross-sectional areas (CSA) on the EOM slices were segmented using a polygon selection tool and then summed to compute the EOM-SV. Proptosis was evaluated with the Hertel index (HI). The relationships between the HI value and EOM-SV and between HI and EOM-CSA were compared and assessed with Pearson's correlation coefficient and the univariate regression coefficient. Inter-observer and intra-observer variability were calculated. RESULTS: HI showed a stronger correlation with EOM-SV (P < 0.001; r = 0.712, r2 = 0.507) than with EOM-CSA (P < 0.001; r = 0.645 and r2 = 0.329). The intraclass correlation coefficient indicated that the inter-observer agreement was high (0.998). The standard deviation between repeated measurements was 1.9-5.3%. CONCLUSION: IDEAL sequences allow for the measurement EOM-SV both on non-contrast and contrast-enhanced scans. EOM-SV predicts proptosis more accurately than does EOM-CSA. The measurement of EOM-SV is practical and reproducible. EOM-SV changes of 3.5-8.3% can be assumed to reflect true volume changes.

MRI rare finding: Absence of the left liver lobe.

We report a rare case of left liver lobe absence in an 80-year-old male patient discovered during an MRI scan. The main imaging features of this condition are briefly reviewed, together with its pathogenesis and the most common associations and differential diagnoses.

Endorectal ultrasonography performance in staging rectal cancer before and after neoadjuvant chemoradiotherapy.

AIM: To evaluate accuracy of endorectal ultrasonography (ERUS) both in staging and restaging rectal cancer after neoadjuvant chemoradiotherapy treatment. METHODS: In a group of 80 patients with rectal cancer, we retrospectively selected 67 patients and divided in two groups: 41 patients affected by a stage I were investigated with a single preoperative endorectal sonography; 26 patients with locally advanced rectal cancer (stage II or more) were restaged after neoadjuvant treatment, which consisted of 5,040 cGy in 28 daily fractions associated with continuous infusion of 5-Fluorouracil. All patients underwent surgery and ERUS findings were subsequently compared with histological findings. RESULTS: Diagnostic accuracy of ERUS in the first group of patients was high: in fact T-staging was accurate in 85% of cases. Results in the second group were significantly less accurate, with a correct T-staging just for 47% of cases. Nodes involvement was correctly evaluated in 86% of cases for the first group and in 63% of cases for the second one. CONCLUSIONS: Endorectal sonography is a valid staging modality for early rectal malignancy. Advanced cancer is treated with neoadjuvant preoperative chemoradiotherapy which is associated with better outcome than postoperative treatment. We found endorectal sonography, based on the layer model of rectal wall, often fails restaging and we think we have to develop new criteria for a correct preoperative assessment after neoadjuvant chemoradiation. KEY WORDS: Endorectal ultrasonography, Neoadjuvant chemoradiotherapy, Rectal cancer, Staging.

Rectal villous tumours: MR features and correlation with TRUS in the preoperative evaluation.

AIM: The aim of this study was to assess the clinical relevance of MR and transrectal ultrasonography (TRUS) imaging of rectal villous tumours to elucidate the correlation between imaging results and specific histopathological tumour features, such as tumour size (T) and lymph node involvement (N), in order to establish the better technique for the pre-surgical patient evaluation. PATIENTS AND METHODS: 23 cases of villous tumours of the rectum were studied with phased-array MR and TRUS. All patients underwent either surgical or endoscopic treatment. Final diagnosis was based on histopathological results. In particular, the following features were characterized by the imaging techniques mentioned above: lesion site, distance between lesion and ano-rectal junction, size, morphology and contrast enhancement of lesions, fluid layer around the lesion, alterations of the deep layers of the rectal wall, sphincter infiltration, presence or absence of mesorectal, iliac and obturatory lymphnode involvement. RESULTS: Histology established muscular involvement in 7 cases (T2), perirectal fat infiltration in 1 case (T3); in the remaining 15 cases, staging was Tis-T1. In 17/23 cases (73.9%) the lesions were correctly staged with both imaging techniques, whereas in 5/23 cases (21.7%) the lesions were overstaged. No cases were understaged. TRUS concorded with histological exams in 17/23 cases (73.9%). 5/23 cases (21.7%) were overstaged and 1/23 (4%) was understaged. MR and TRUS were in accordance in 20/23 cases (86.9%). DISCUSSION: Considering the frequent degeneration of villous tumours, correct preoperative identification and precise evaluation of these lesions, such as the detection of rectal wall invasion, is essential in deciding optimal treatment strategy. MRI and TRUS allow the identification of specific features of villous tumours and of malignant degeneration, allowing for a correct local disease staging.

Circulating leptin and adiponectin levels in patients with primary hyperparathyroidism.

Primary hyperparathyroidism (PHPT) has been associated with high cardiovascular morbidity and mortality; its pathogenesis is not fully understood. Moreover, many metabolic abnormalities are frequently present in patients with PHPT. Several substances (such as leptin and adiponectin) are secreted from adipocytes, which may contribute to regulate energy homeostasis and the development of cardiovascular diseases. We examined the relationship between leptin and adiponectin levels and metabolic disorders in 67 newly diagnosed never-treated patients with PHPT and in 46 healthy subjects (HS). Twenty (29.8%) patients with PHPT presented a metabolic syndrome (as defined by Adult Treatment Panel III criteria). Serum leptin and adiponectin levels in HS were 6.28 +/- 3.3 ng/mL (range, 1.7-19.2 ng/mL) and 6.65 +/- 1.7 microg/mL (range, 3.72-10.86 microg/mL), respectively. In all patients with PHPT, the mean leptin levels (34.28 +/- 20.4 ng/mL) were significantly higher than those of HS (P < .01) and, in particular, in PHPT patients with metabolic syndrome (52.63 +/- 31.2 ng/mL) and positively correlated with body mass index, waist circumference, and cholesterol. The mean adiponectin level was significantly lower (4.34 +/- 3.5 mug/mL) only in PHPT patients with metabolic syndrome (P < .005) and negatively correlated with waist circumference and fasting glucose. We concluded that increased serum level of leptin and decreased serum level of adiponectin coexist in patients with PHPT and may represent a pathogenetic factor for cardiovascular disease in this condition.

Preoperative locoregional staging of rectal carcinoma: comparison of MR, TRUS and Multislice CT. Personal experience.

PURPOSE: The aim of this study was to measure the sensitivity and clinical indications of Magnetic Resonance (MR) as compared to Transrectal Ultrasonography (TRUS) and spiral Computed Tomography (CT) in the preoperative staging and evaluation of rectal carcinoma. MATERIALS AND METHODS: Twenty patients with histologically proven rectal carcinoma were examined with phased-array coil MRI. We used T1 and T2, spin-echo, turbo-spin-echo, flash2D sequences with and without fat suppression; FOV 180-280; 4-6 mm slice thickness; i.v. Gadolinium. The MR images were compared with TRUS, spiral CT and with the final histological diagnosis. RESULTS: MR showed a 92.3% sensitivity for rectal wall infiltration vs. 100% of TRUS and 75% of CT. The sensitivity for lymph node metastases was 76.4% vs. 72.2% for TRUS and 88% for CT. CONCLUSIONS: Locoregional staging of rectal cancer by MRI shows a high sensitivity and is also feasible in stenosing or proximal rectal lesions. TRUS, despite its limitations, is still the most sensitive method for the evaluation of wall infiltration. CT was less sensitive than the other two METHODS: The sensitivity of MR and CT for lymph node metastases is comparable, but the former is more specific.

A case of duodenal duplication in an adult.

We report a rare case of duodenal duplication, manifested in an adult with aspecific symptoms, whose diagnosis was possible with ultrasound at the beginning and then with gastrointestinal barium study, endoscopic ultrasonography and contrast enhanced CT scan; it was confirmed surgically.

Gray-scale and color Doppler findings in bilateral internal jugular vein thrombosis caused by anaplastic carcinoma of the thyroid.

Bilateral internal jugular vein thrombosis is a rare complication of thyroid cancer. The most common manifestation of this condition is superior vena cava syndrome. We report the sonographic findings in a case of bilateral internal jugular vein thrombosis with mild symptoms. There was evidence of direct infiltration of anaplastic thyroid carcinoma into the left internal jugular vein. Sonographic and CT examinations also demonstrated multiple dilated collateral veins.

Preoperative evaluation of primary hyperparathyroidism: role of diagnostic imaging.

This study analyses the diagnostic value of preoperative diagnostic imaging examinations in the identification and location of pathological parathyroid glands. We examined 77 patients with primary hyperparathyroidism using ultrasonography of the neck and Tc99m-MIBI scintigraphy for preoperative assessment purposes. All patients underwent surgical treatment. We compared the diagnostic imaging results with those furnished by histological examinations. TC99m-MIBI scintigraphy revealed the presence of a pathological parathyroid gland in 74/77 cases (96.1%) compared with 75/77 cases (97.4%) diagnosed by ultrasonography. The two examinations combined detected pathological glands in 100% of cases. The location of the pathological gland was correct in 57 cases (74.0%) at scintigraphy and in 56 cases (72.7%) at ultrasonography. In one case (1.3%) persistent hyperparathyroidism was demonstrated. There were no cases of relapse. In this study preoperative evaluation by ultrasonography and scintigraphy displayed great sensitivity in identifying and locating pathological parathyroid glands. Surgical neck exploration is still the gold standard in the correct location of pathological parathyroid glands measuring less than 5 mm.