Xeroradiography of soft tissue tumors.

The main features of 300 consecutive cases of soft tissue tumors at xeroradiography were submitted to retrospective evaluation. The parameters assessed were: visibility, density, shape, size, outline and relationships of the lesions. The distribution of each parameter between benign and malignant tumors was evaluated by means of statistical analysis. The xerographic signs of malignancy of soft tissue tumors are reviewed and the typical features of some particular tumors are outlined.

Angioscintigraphic assessment of arterial and portal liver blood flow: comparison with splanchnic angiography.

In order to validate an angioscintigraphic method for the evaluation of the components of hepatic blood flow, the results of angioscintigraphy were compared with splanchnic angiography in 25 cirrhotics. Two indices of hepatic portal perfusion and a splenohepatic arterial index were calculated. These were correlated with portal diameter and hepatic artery diameter, respectively. No correlation was found between grades of portal perfusion according Nordlinger's criteria and these indices. The method is very simple and could be applied to evaluate the changes of liver hemodynamics induced by drugs or shunt surgery.

Conventional radiographic follow-up in the irradiated lung.

AIMS: To highlight the different changes induced in lung tissues by various forms of radiotherapy (RT) according to tumor site and type. METHODS: A retrospective analysis of the roentgenographic evaluation of and long-term follow-up data on 2375 patients who received RT for various intrathoracic and extrathoracic tumors at the National Cancer Institute of Milan. RESULTS: The iconographic patterns of post-RT changes, grouped by site and type of tumor and RT procedure and described in detail, afford deeper insight into a little-known area of lung pathology. CONCLUSIONS: These descriptions of common and uncommon patterns of the irradiated lung as they appear on conventional chest roentgenograms enable the radiologist and radiotherapist to assess exactly the response of tumor and lung tissues and to plan the most appropriate clinical follow-up.

[Treatment of prostate adenoma with finasteride. Contribution of cases]. / Trattamento dell'adenoma prostatico con finasteride. Contributo casistico.

During recent years more and more researchers and clinicians have become interested in HPB in order to identify a medical therapy instead of surgery. The aim of our study was to find the value of finasteride in HPB therapy. We wanted to know if finasteride was able to improve the symptomatology and blood tests of patients afflicted with HPB. Every patient was agreed with the course of action of the 1991 Paris Urology Congress. All patients were treated with finasteride 5 mg/die for one year and inspected by prostatic echography and blood tests. The results of our study are every interesting and are discussed in the article.

[Pharmaco-radiodiagnosis of the digestive tract]. / La farmaco-radiodiagnostica dell'apparato digerente.

A brief account of the subject from the chronological standpoint is followed by a classification of the drugs most often used in radiological examination of the digestive tract into two groups according to their effects on individual viscera, namely excitomotor and hypotonising drugs. The indications and contraindications for each drug are explained, and the most common methods for the pharmacoradiological investigation of each organ are indicated. It is felt that this form of examination leads to an earlier radiological diagnosis and one more consonant with the real anatomical and pathological situation.

Cholangiographically-enhanced CT of the pancreas and biliary tree.

Cholangiographically-enhanced CT scans were performed on nine patients with biliary obstruction or suspected pancreatic masses. The opacification of the biliary tree was obtained by slow infusion of 25 ml of cholangiographic contrast medium diluted in 75 ml of saline and administered 45 mins before the CT examination. Two separate CT sequences were obtained, one with cholangiographic contrast alone, the other with associated parenchymal enhancement. The tolerability of the overall procedure was very good. The measurement of the HU values of the biliary ducts showed a marked increase in bile density. These structures could easily be appreciated within the liver and in the porta hepatis; the pancreatic head and its relationships with the main bile duct were evident. The densitometric measurement of the liver parenchyma before and after contrast enhancement did not show any variation with respect to the standard HU values. Cholangiographically-enhanced CT proved to be useful for the diagnosis of biliary obstruction; it may also be a promising diagnostic tool for the evaluation of pancreatic masses.

Three-year follow-up of 62 cirrhotic patients with hepatocellular carcinoma treated with chemoembolization.

BACKGROUND: The aim of this study is to present our experience in 62 patients suffering from hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolization (TACE) in two years. METHODS: TACE was performed with injection of doxorubicin mixed with lipiodol before embolization with spongostan. This procedure was repeated for 3 cycles almost. Follow-up was performed by US and CT and by assessment of clinical status and biochemical tests. TACE results were assessed comparing size, local spread and TACE technique with patients' survival. The lesion was single in 51 while multiple in 11. In 6 patients the lesion was greater than 5 cm while in 56 less than 5 cm. RESULTS: Overall survival rates were 95.7% at 6 months, 78.3% at 1 year, 46% at 2 years, 40% at 3 years. The best responses were obtained with single lesions smaller than 5 cm and treated with at least 3 cycles of TACE. CONCLUSIONS: We can conclude that TACE is an efficacious therapeutic choice in the HCC patients who cannot undergo surgery.

[Spiral computerized tomography in the diagnosis of acute occlusion of the abdominal aorta. A case report]. / La Tomografia Computerizzata spirale nella diagnosi dell'occlusione acuta dell'aorta addominale. Descrizione di un caso.

Aim of this report is to present a case of acute occlusion of the abdominal aorta recognized by spiral-CT. After a brief description of the etiology and pathology of abdominal aorta acute occlusion, stress is laid on diagnostic role of spiral-CT, based on personal and literature data. The advantage of spiral respect to non-spiral CT is the quicker examination time which is very important, mostly in emergencies. On the contrary, the diagnosis of acute abdominal aorta occlusion is not modified by volumetric CT respect to non-spiral and it is based on the absence of aorta contrast enhancement above the occlusion level.

[Efficiency of tetracaine in digital angiography of the blood vessels of the neck]. / Efficacia della tetracaina nell'angiografia digitale dei vasi del collo.

Deglutition artifacts often degrade diagnostic quality in digital subtraction angiography (DSA) of neck vessels. In order to reduce this drawback, the authors gave a local anesthetic (Tetracaine) to the patients undergoing DSA of aortic arch and carotid arteries. Hundred-twenty-three subjects divided into two groups were examined: Tetracaine was administered to one group (64 patients) and not to the other (59 cases). In the first group deglutition artifacts were not noted in 59/64 cases. Among those patients not treated with Tetracaine/deglutition artifacts were absent in 45/59 cases. This local anesthetic did not produce important toxic reactions. Therefore the authors believe that administration of local anesthetics can reduce deglutition artifacts in DSA of neck vessels.

[Xeroradiographic diagnosis of bone tumours (author's transl)]. / La xeroradiografia nella diagnosi dei tumori ossei.

The value and drawbacks of xeroradiography were evaluated on 130 patients with benign and malignant bone tumors, 93 of which (72%) were submitted to histological control. Xeroradiography was compared to standard film radiography in 115 cases (88%). In 57 cases (50%), xeroradiography appeared to be more effective than film radiography; it was less effective in 17 cases (15%) and the two techniques were substantially equivalent in the remaining 41 (35%). The best results of xeroradiography were found in malignant tumors, in particular in the presence of an extraosseous spread of the lesion, and it was highly effective in Ewing's sarcoma. According to the sites examined, xeroradiography was more effective in the skeleton of the extremities, while the examination of the trunk and the head were frequently unsatisfactory due to the low sensitivity of this technique. Xeroradiography is held to be an useful second-line examination, to be performed in neoplastic lesions of the limb bones, for the search of small trabecular irregularities, of periosteal reactions or of extraosseous spread of the tumor.

[Unusual application of computerized tomography: the study of musical instruments]. / Un'insolita applicazione della Tomografia Computerizzata: lo studio degli strumenti musicali.

INTRODUCTION: We report on the use of CT in the study of bowed stringed instruments to assess structural defects and/or damage before proceeding to any repair. MATERIAL AND METHODS: Two antique masterpieces from the Castello Sforzesco Museum of Antique Musical Instruments were analyzed with CT. They were an exquisite wood and ivory guitar from Naples (Italy) and a very rare Giuseppe Guarneri "del Gesù" violin from Cremona (Italy), both crafted in the early years of the 18th century. We evaluated the wood thickness, the neck and its heel. In the wood structure we studied the course and thickness of hypo- and hyperdense lines. RESULTS: The examination showed three types of signs: normal wood structure: hypodense, thin, parallel lines; wormholes: hypodense lines with irregular course and variable thickness; previous repair signs: thin or thick more or less parallel hyperdense lines. CONCLUSIONS: The study confirmed that CT is a valuable tool to investigate normal structure, defects and damage, providing accurate information for the evaluation and repair of antique stringed instruments.

Acute posttraumatic rupture of the thoracic aorta: the role of angiography in a 7-year review.

Between 1983 and 1989, 15 patients with acute rupture of the thoracic aorta by blunt trauma were seen. Superior mediastinal widening and obscuration of the aortic arch were the most important findings on chest radiograph. Computed tomography examinations in 7 patients showed mediastinal hematomas but did not reveal aortic lesions. Definitive diagnosis of traumatic aortic rupture was established by aortography in all 15 patients. Intraarterial digital subtraction angiography proved to be as accurate as conventional film aortography and saved time.

[Study of the liver and the portal venous system with digital rotational angiography]. / Studio del fegato e del sistema venoso portale con angiografia digitale con rotazione.

PURPOSE: Digital subtraction angiography is of common clinical use for the evaluation of vascular disease. The rotation of the X-ray tube around the patient's body during contrast medium injection was first proposed in the early seventies in the neuroradiologic field; only recently it has been applied to the evaluation of vascular structures and abdominal parenchymatous organs. We investigated the potential clinical value of digital rotational subtraction angiography in the evaluation of the hepatic arteries and of the portal venous system. MATERIALS AND METHODS: Digital rotational subtraction angiography was performed in 46 patients (34 males and 12 females), mean age 59.3 years (range: 43-72). All the patients underwent digital rotational subtraction angiography after ultrasonographic, CT and/or MRI imaging for evaluation of hepatocellular carcinoma (31 patients) prior to trans-arterial chemoembolization, hepatic metastases from gastrointestinal cancer (9 patients) and pre-surgical study in portal hypertension (6 patients). Digital rotational subtraction angiography was performed using the following technical parameters: a maximum frame rate of 10 views per second, a 1024 x 1024 matrix, a rotation time of 5 seconds, a rotational arch of 90 degrees with a speed of 30 degrees/second. Digital rotational subtraction angiography of the liver was carried out after positioning of a Cobra angiographic catheter in the proper hepatic artery or in the left or right hepatic artery, and subsequent injection of 20-30 ml on contrast medium at a flow rate of 4-7 ml/sec. Conversely, in the portal study the catheter was placed in the splenic or superior mesenteric artery and contrast was administered at 10 ml/sec for an amount of 40-60 ml. Conventional, non-rotational angiography was always obtained with the same catheter and less contrast medium (15-25 at 4-7 ml/sec in the hepatic study, 25-40 ml at 5-7 ml/sec in the portal study). We have evaluated the diagnostic quality (rated as equal, superior or inferior) and the presence of image noise of digital rotational subtraction angiography when compared to digital non-rotational subtraction angiography. We also evaluated the tolerability and the mean time to perform the examination. RESULTS: Compared to non-rotational digital subtraction angiography, the diagnostic quality of digital rotational subtraction angiography was superior in 26 cases, equal in 20 and never inferior: these results are particularly evident in cine-mode. Diagnostic efficacy was similar in the arterial phase and generally better in the venous phase. Image noise was always perceptible, mostly in lateral and oblique views and is related to the patient's size. Noise especially hindered evaluation of the portal venous phase. Digital rotational subtraction angiography was well tolerated by all patients, although its most significative drawback was the prolonged apnea time required (about 8 seconds per single rotation) which can sometimes be difficult for elderly patients. Examination duration is about 5 to 10 minutes. Contrast medium doses required never exceeded 20-60 ml. DISCUSSION: Current evaluation of an hepatic lesion requires injections and multiple views to fully delineate arterial anatomy. This requires the radiologist to create a mental 3-D rendering based upon a 2-D view, obtained on the basis of the radiologist's experience. Rotational angiography, when reviewed in cine-loop, allows a better 3-D rendering than conventional angiography, increasing the advantages of the multiple views obtained from a single angiographic run and allowing an exact imaging of the course and direction of the hepatic arterial branching, making selective catheterization during trans-arterial chemoembolization or other interventional procedures easier. Magnification further improves the evaluation of a mass and of the arterial tree. In hepatic surgery, the most important problem is the precise knowledge of the segment involved and the position of the lesion inside the segment, since a mass in the middle of the segment requires a segmentectomy while a mass near the borders is treated by a larger resection. Digital rotational subtraction angiography improves the visibility of vascular anatomy, allows a better knowledge of hepatic artery branches and improves the angiographic investigation of the liver, permitting a correct spatial assessment. CONCLUSION: Digital rotational subtraction angiography is a useful tool for the evaluation of the liver as well as for transarterial chemoembolization or other interventional procedures. Images are obtained during a single contrast injection, with a better 3-D rendering of the hepatic artery and the portal venous system: no other method provides as complete a visualization of liver vascular anatomy after a single injection of contrast medium in one examination series. (ABSTRACT TRUNCATED)

[Intra-arterial digital angiography of the liver and portal system]. / L'angiografia digitale intra-arteriosa del fegato e del sistema portale.

Twenty-seven patients were evaluated by intra-arterial digital subtraction angiography: 20 for portal hypertension--6 also after a porto-systemic shunt--, 4 for evaluation of a hepatic mass and 3 for pancreatic or biliary tumours. Intra-arterial DSA has always shown vascular abnormalities. The advantage of intra-arterial DSA are reduction of the required amount of contrast medium and, consequent, reduction of the frequency of contrast medium reactions. Its disadvantages are limited field size of image intensifier and reduced spatial resolution as compared with conventional angiography. However diagnosis had never been affected by this limitation.

[Abnormalities of the hepatic artery++ in relation to portal hypertension surgery. Study with angiography and echography]. / Le anomalie dell'arteria epatica in relazione alla chirurgia dell'ipertensione portale. Studio con angiografia e ecografia.

This study was aimed at investigating the occurrence of hepatic artery variants, at comparing the diagnostic value of duplex Doppler US with that of angiography, and at correlating the results with the technical problems in portal hypertension surgery. All patients were studied with angiography, conventional and duplex Doppler US. In 162 patients with portal hypertension, 38 hepatic artery variants (23.4%) were observed and classified according to Michaels. The commonest variant recognized by angiography was right hepatic artery arising from superior mesenteric artery (type III according to Michaels). US demonstrated hepatic artery variants in 9/162 patients (5.5%). At surgery, variants were found in 3/162 subjects (1.8%) and caused surgical problems in 2 of them (1.2%) - i.e., right hepatic artery arising from superior mesenteric artery. Arteriography is still the best examination to depict hepatic artery variants, while duplex Doppler US demonstrates only a few types. Moreover, the number of variants detected by imaging techniques (23.4%) differs greatly from that observed at surgery (1.8%). Finally, hepatic artery variants are not correlated with surgical problems, nor can the latter be foreseen by imaging methods. US is useful but not essential to detect hepatic artery variants which are subsequently confirmed by angiography.

[Arterial CT in the diagnosis of hepatocellular carcinoma: initial experience with 12 patients]. / L'arterio-TC nella diagnosi del carcinoma epatocellulare: iniziale esperienza in 12 pazienti.

Intra-arterial CT of the liver is a valuable method to evaluate hepatocellular carcinoma (HCC). It consists of an infusion of contrast medium into the hepatic artery during CT scanning. Twelve patients with suspected resectable HCCs were evaluated with CT arteriography before surgery. The results of CT arteriography were compared with those of US, of CT with intravenous contrast medium and of angiography; on the rule, all exams had been performed some days earlier. The diagnosis of HCC was confirmed by US-guided fine-needle biopsy. CT arteriography demonstrated liver lesions in 11 patients. The lesions were hyperdense in 3/11 patients (27.3%) and hypodense and surrounded by a hyperdense ring in 8/11 patients (72.7%). In 4 of 11 patients (36.4%) CT arteriography identified additional tumor nodules and thus surgery was excluded. In the latter cases, on the basis of CT arteriographic findings, US, CT with i.v. contrast medium and angiography were repeated but failed to demonstrate the additional nodules, either because they were too small or because of cirrhotic changes in liver parenchyma. Therefore, CT arteriography is recommended in the evaluation of selected patients, especially when detailed information on liver parenchyma is needed--e.g., before surgery. In these patients CT arteriography can be performed together with preoperative angiography.