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Biomedical subjects

E Casciani

Publications and source records attributed to E Casciani.

At least 19 recordsLinked to original sources
PubMed2000

Local staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging: comparison with histologic findings.

PURPOSE: The aim of the present study was to compare the accuracy of endorectal coil magnetic resonance imaging with transrectal ultrasound in staging rectal carcinoma. METHODS: Twenty-six consecutive patients with rectal carcinoma, histologically proven by endoscopic biopsy, were staged with both endorectal coil magnetic resonance imaging and transrectal ultrasound and then underwent radical surgery. The preoperative staging was compared with histologic findings of the operative specimen according to TNM classification. RESULTS: Endorectal coil magnetic resonance imaging showed better results but was not statistically significantly different from transrectal ultrasound in evaluating T (accuracy, 84.6 vs. 76.9 percent): four overstaged and no understaged cases for the former and five overstaged cases and one understaged case for the latter. Both procedures showed similar results in evaluating N: 81 percent sensitivity and 66 percent specificity for endorectal coil magnetic resonance imaging and 72 percent sensitivity and 80 percent specificity for transrectal ultrasound. CONCLUSIONS: An accurate locoregional staging of rectal cancer is essential for the planning of optimal therapy for rectal cancer. Endorectal coil magnetic resonance imaging and transrectal ultrasound showed similar results; the former is more expensive, whereas the latter is operator dependent. At present the use of endorectal coil magnetic resonance imaging seems to be justified only in selected low rectal cancers where transrectal ultrasound yielded doubtful results. However, a more extensive study is necessary to compare the advantages of these diagnostic techniques.

Aged↗
PubMed1999

[Virtual cystoscopy of bladder neoplasms. Preliminary experience].

PURPOSE: We investigated the comparative sensitivity of virtual and conventional cystoscopy in patients with urinary bladder cancer. MATERIAL AND METHODS: Twelve patients (8 men and 4 women; mean age: 61 years, range: 49-73) with findings of bladder cancer at conventional cystoscopy were submitted to volumetric spiral CT of the urinary bladder. Before the examination, the urinary bladder was distended with 180-200 mL of air. CT findings were then sent to an independent workstation to generate interactive intraluminal views of the bladder. The findings of virtual cystoscopy were compared with those of conventional cystoscopy in 11 patients and with the findings of transurethral resection after urethrotomy in one patient. All lesions had pathologic confirmation. RESULTS: Eighteen (90%) of 20 masses detected on conventional cystoscopy were visualized with virtual cystoscopy. The latter allowed readers to identify 13 of 13 masses (100%) > 1 cm and only 5 of 7 (71%) < 1 cm; three 4-mm masses were missed. Although only a subjective evaluation of lesion size was possible on conventional cystoscopy, there seemed to be good agreement on mass size and site with both techniques. DISCUSSION: Cystoscopy plays a key role in the diagnosis of urinary bladder carcinoma. However cystoscopy is invasive, has a limited field of view and lacks an objective scale; moreover, it is not indicated in patients with severe urethral strictures or active vesical bleeding. In our study, virtual cystoscopy depicted all the masses > 1 cm, and a lesion in a diverticulum with a small opening. Virtual cystoscopy was also very useful in a patient with urethral stricture (who could no be submitted to conventional cystoscopy) where it showed the lesion before transurethral resection after urethrotomy. The virtual technique could also be complementary to conventional cystoscopy in evaluation of bladder base and anterior bladder neck, as well as for postchemotherapy follow-up. Unfortunately virtual cystoscopy does not allow biopsy of suspicious lesions.

Aged↗
PubMed1998

[Locoregional staging of prostatic carcinoma: accuracy of magnetic resonance with endorectal coil in 75 patients treated with radical prostatectomy].

INTRODUCTION: We investigated the accuracy of MRI of the prostate with an endorectal surface coil in determing penetration of the prostatic capsule and invasion of seminal vescicles in prostate carcinoma. MATERIAL AND METHODS: Endorectal coil MRI (1 Tesla) was performed in 300 patients with biopsy-proved cancer. The PSA levels were always calculated and all the patients were examined with transrectal ultrasound. The imaging protocol included Turbo Spin Echo T2-weigthed (3900/150 TR/TE) axial and coronal images and T1-weigthed (650/15 TR/TE) axial images, 4 mm thick interleaved sections with .4 mm intersection gap, FOV 180 mm, 256 x 256 matrix (reconstruction 512). Seventy-five patients underwent radical prostatectomy and MR images were compared with pathologic findings of capsular penetration and invasion of seminal vescicles. The MR signs specific for capsular penetration were: deformation (irregularity) of capsular profile, capsular retraction with irregular margins, capsular interruption, obliteration of periprostatic adipose tissue, asymmetry of neurovascular bundles. RESULTS: MRI correctly depicted 37 of 45 pathologic stage T2 lesions and correctly depicted macroscopic capsular penetration (T3) in 18 of 23 cases. Microscopic capsular penetration was overestimated in all 7 cases. Sensitivity, specificity, accuracy, for microscopic and macroscopic capsular penetration were 60, 82, 73% respectively. Sensitivity, specificity, accuracy for macroscopic capsular penetration were 78, 82, 80% respectively. Sensitivity, specificity, accuracy for depiction of seminal vesicle involvment were 80, 100, 93%, respectively. The most reliable signs of capsular penetration were capsular interruption and invasion of periprostatic adipose tissue, while asymmetry of the neurovascular bundle was not seen. CONCLUSIONS: MRI provides accurate preoperative local staging. The two main limitations of MRI were the high rate of microscopic capsular penetration and the difficulty in detecting capsular penetration of tumor when the lesions are in the prostate apex. Prostate enlargement also made diagnosis more difficult.

Aged↗
PubMed1998

[Triphasic spiral computerized tomography of the liver: vascular models of non-cystic focal lesions].

PURPOSE: The purpose of this study was to investigate if Triphasic Spiral CT (arterial, portal and equilibrium phases) can improve the characterization of noncystic focal lesions. MATERIAL AND METHODS: Sixty-six patients with suspected focal liver disease underwent Triphasic Spiral CT. After the injection of 120-140 ml contrast material at 3 ml/s the liver was imaged in the arterial (scanning delay: 20-27 s), portal (scanning delay: 45-80 s) and equilibrium (scanning delay: 5-8 min) phases. The enhancement of each lesion was evaluated in each phase and the lesions were grouped by enhancement pattern (11 patterns in all). The reference standards in our 66 patients were surgery (12), biopsy (43), MRI (9), follow-up (9), somatostatin receptor scintigraphy (6). RESULTS: One hundred and twenty-six liver lesions were detected in 66 patients, four of 11 enhancement patterns (hypo/hyper/hyper, hyper/iso/iso, hyper/hyper/iso, hyper/hyper/hyper) were always referrable to benign disease (hemangioma, focal nodular hyperplasia-FNH-adenoma). Four of 11 enhancement patterns (iso/hypo/hypo, iso/iso/hypo, hyper/hypo/hypo, hyper/hyper/hypo) were always referrable to malignant disease (hepatocellular carcinoma-HCC-metastases). The other two patterns (hypo/hypo/hypo, hypo/hypo/hyper) were seen in both benign and malignant diseases. CONCLUSIONS: Triphasic Spiral CT improves the characterization of HCC, FNH, adenoma and hemangioma. The arterial and the equilibrium phases add no information to the yield of the portal venous phase in metastases, except for those from pancreas neuroendocrine tumors in the arterial phase. In our experience, patients with unclassified lesions at US or conventional CT, suspected HCC and metastases from pancreas neuroendocrine tumors should be submitted to Triphasic CT of the liver. This technique however does not appear to be indicated in the study of liver metastases from hypovascular tumors, while it improves the detection of FNH and adenoma.

Female↗
PubMed1997

[Radiologic staging after surgical, chemical, and radiation treatment of non-seminomatous tumors of the testis].

The aim of this work was to evaluate the clinic usefulness of Computed Tomography (CT) and Magnetic Resonance (RM) in the staging after surgery, radiotherapy and chemotherapy of the nonseminomatous germ cells tumours of the testis. The Authors discussed the CT and MR dimensional criteria for the diagnosis of retroperitoneal metastases of the nonseminomatous germ cells tumours and delineated their CT and MR morphologic appearances in detail. The density of the residual mass on CT was classified as solid, cystic and half-cystic. The retroperitoneal hematoma and lymphocele formed as a complication respectively of orchiectomy and retroperitoneal lymphadenectomy can be misinterpreted to represent metastatic disease on post operative staging CT scans. Early recognition of this complication are crucial if unnecessary treatment is to be avoided. Finally the Authors evaluated, in patients affected from nonseminomatous germ cells tumours of the testis, the possibility to characterize with CT and MR imaging the retroperitoneal mass. The density and character of the residual mass on CT scan did not reliably predict the histology. On the basis of tumor consistency and signal intensity in T1 and T2 weighted images, MR cannot yet warrant any conclusion about the ultimate effect of chemotherapy.

Germinoma↗
PubMed1997

[The selective use of intraoperative cholangiography in video laparoscopic cholecystectomy].

Intraoperative cholangiography, a diagnostic method through images introduced in to clinical use in 1932, has recently become a different technical support from that attributed by traditional surgery and it has got a different diagnostic meaning with the introduction of video surgery. The authors used it in 54 of 194 patients submitted to a CVL, always making use of the trans-cystic access, with a percentage of success of 82.6%. It was not possible in 8 patients due to the complete section of the cystic duct during the work (3 cases) and the impossibility of introducing the catheter (5 cases). There is still no common agreement about the opportunity to use IC daily: the authors think selective use is better preceded by a careful clinical laboratory instrumental preoperative study to find patients with the common duct stone. Besides, they are of the opinion that a rigorous surgical technique is fundamental to reduce the lesions of the VBP that there are not in their experience.

Acute Disease↗
PubMed1997

[Cancer of the gallbladder].

Carcinoma of the gallbladder is the most frequent neoplasia of the biliary tract with an incidence of 2.5-4.4 cases for every 100,000 inhabitants; it more often affects females and elderly patients (60-70 years). It is an extremely malignant tumour with an often fatal prognosis owing to both its site and the generally late diagnosis; the majority of patients in fact undergo surgery at an advanced stage of the disease when surgery is only palliative. At the Surgical Division of S. Massimo Hospital in Penne (PE) a total of 897 operations on the gallbladder and biliary tract were performed between 1988 and 1994, revealing 21 cases of carcinoma of the cholecyst (2.3%). Sixteen patients were female (male-female ratio 1:3.2) with a mean age of 67.8 years (range 58-83 years). These patients were divided into 5 stages according to the UICC-1992 classification: 80.9% of cases were stage 3-4. Diagnosis was performed intraoperatively in 2 patients, whereas in 3 cases cancer had been diagnosed by the anatomo-pathologist. A total of 3 simple cholecystectomies were performed, 4 were associated with hepatic resection and lymphadenectomy of the hilus and hepatoduodenal ligament; surgery was enlarged in 2 cases due to the involvement of adjacent organs. After exploratory laparotomy, palliative surgery was performed in the remaining 12 patients in the form of biliary and derivation. Four system were implanted for intra-arterial chemotherapy. The most frequently found histological type was adenocarcinoma (76.2%). The mean survival rate of patients who died was 7.6 months. Six of the operated patients are still alive, of whom only one with a follow-up of 4 years. In conclusion, the authors agree with those who consider carcinoma of the gallbladder generally fatal in view of the rarity of early diagnosis and the difficulties of performing radical therapy.

Adenocarcinoma↗
PubMed1997

[Non-seminomatous tumors of the testis: problems of radiological staging before and after treatment].

The aim of this work was to evaluate the usefulness of Computed Tomography and Magnetic Risonance in the staging of the nonseminomatous germ cells tumours of the testis. The authors discussed the role of CT and MR imaging to value the detection of retroperitoneal metastases of the nonseminomatous germ cells tumours of the testis pre and post treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

[The role of MRI in the valuation of disorders involving the bone marrow].

MR is the most accurate imaging technique in bone marrow evaluation since it allows to recognize and distinguish its red and yellow components. MR shows high sensitivity but low specificity. At present, its role in bone marrow diseases evaluation is that of depicting the extent of the disease process and monitoring the effects of treatment.

Bone Marrow↗
PubMed1997

[Sensitivity of spiral volumetric TC in the diagnosis of hepatic metastases: advantages of the dual phase technic].

In this report the diagnostic possibilities of volumetric Spiral CT in hepatic metastases detection are discussed. Spiral CT presents numerous advantages when compared to the conventional one; these increase its sensitivity in hepatic metastases diagnosis of approximately 10% (Conventional CT sensitivity 80-85%; Spiral CT sensitivity 90-95%). "Dual phase" technique allows hypervascular metastases diagnosis, often isodense during portal venous phase, hence not detectable with conventional CT. Nonetheless, helical CT for hepatic metastases detection is not yet common, due to high exams costs and more often due to the limited availability of equipment.

Humans↗
PubMed1995

[A rare case of Meckel's diverticulum perforation].

Meckel's diverticulum is a pathology not rarely found everyday clinical medicine especially when it present with one of its complications. The specific diagnosis is a bit difficult to put because of the low sensibility and specificity of symptoms of diagnostic and instrumental techniques used. The reported case shows a rare type of complication constituted by the phlogosis of Meckel's diverticulum, itself due to an extraneous thing ingested by the patient. The authors discuss the entity of the manifestations of this pathology and highlight every aspects.

Acute Disease↗
PubMed1994

[Role of imaging technics in the identification, characterization and staging of lung neoplasms].

The findings in different imaging techniques in the diagnosis of bronchogenic carcinoma are discussed in this report. Conventional radiology is useful for diagnosis, but is insufficient for characterising and assessing the extension of neoplastic masses of the lung. CT and MR imaging are not essential for the diagnosis and characterization of these lesions, but they certainly allow a more accurate evaluation of staging than normal X-ray examination.

Biopsy↗
PubMed1994

[Characterization of hepatic neoplasms: contribution of magnetic resonance].

The reliability of MR imaging in the diagnosis and characterization of space occupying lesions affecting the liver are discussed in this study. We discuss the role of MR imaging in the diagnosis of these tumours and its advantages compared with other available techniques such as ultrasonography and CT. We also discuss the results of MR in the characterization of focal neoplastic masses.

Adenoma, Liver Cell↗
PubMed1994

[Internal hernias. Description of 2 cases].

The authors describe two cases of recent observed internal-hernia, regarding in the first case the right para-duodenal dimple, and in the second a mesenteric breach. They report the clinic presentation and the diagnostic and therapeutic approach compared with the data deriving from the international literature. A complete clinical classification of the internal-hernia is illustrated showing the different clinical signs. The respective symptomatology that in the initial phases of this pathology is not too evident, shows that the internal hernia should always be held in due consideration at the moment of diagnosis because the consequent mortality due to complications such as intestinal-gangrene is rather high.

Aged↗
PubMed1994

[Computerized tomography and magnetic resonance in the evaluation of patients with Crohn disease. Their role in the identification, assessment of extent and management of the disease].

In this study we evaluated the role of barium examinations and above all computed tomography and magnetic resonance imaging in the study of Crohn's disease. CT is most often requested for patients with suspected or known intraabdominal or pelvic abscesses. MR plays a very important role in the localization of perirectal and perianal abscesses.

Abdominal Abscess↗