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Biomedical subjects

G Gozzi

Publications and source records attributed to G Gozzi.

At least 19 recordsLinked to original sources

[The imaging diagnosis of hepatic focal nodular hyperplasia].

Focal nodular hyperplasia (FNH) is a rare benign hepatocellular tumor occurring in noncirrhotic patients, mostly females, 20-50 years of age. It is usually asymptomatic. The authors took the lead from 5 cases of FNH studied over last year to analyze the different patterns exhibited by the condition on the various imaging techniques currently available. At scintigraphy with 99mTc DISIDA or with TcSC, FNH can be hyper, normal, or hypocaptating. On US scans, the lesion is often homogeneous and isoechoic, but it can also be hyper/hypoechoic. With Doppler US, high-flow signals can be observed. On unenhanced CT scans the lesion is solid, well-demarcated, isodense or slightly hyperdense; sometimes it shows a central hypodense area corresponding to fibrovascular scar. On postcontrast scans it appears hyper/isodense. At dynamic CT the lesion density, which is high during the arterial phase, decreases quickly in the parenchymal and the venous phases and reaches equal/inferior values to surrounding liver parenchyma. On liver angio-CT it is sometimes possible to visualize the bile ducts in the central scar. At angiography, FNH is hypervascular and homogeneous. On MR scans, in T1-weighted SE sequences, the condition is isointense or slightly hypointense, whereas on T2-weighted pulse sequences it is slightly hyperintense; the central scar is hypointense on T1, and hyperintense on T2, weighted scans. As we have no pathognomonic patterns but only orientative ones, a reliable differential diagnosis with hepatocellular adenoma (HA) and fibrolamellar hepatocellular carcinoma (FL-HCC) must be based on biopsy or cytology or, even better, histology. The differential diagnosis is nevertheless necessary because, while FNH does not usually require a surgical approach but only a radiological follow-up, both HA (due to possible bleeding and degeneration) and FL-HCC require surgery.

Adult

[Echography and cytology in the study of spreading pathology of the salivary glands].

The contribution of the combined use of US and cytology is evaluated in the diagnosis of masses in the salivary glands and adjacent structures. US had 87.2% sensitivity in locating the mass; its accuracy in defining both physical structure and benign/malignant nature of the lesion was 91% and 74%, respectively. Thus US, after demonstrating a lesion, does not always allow the exact definition of its characteristic. In many of these cases, other imaging modalities do not help either. In our series of cases, cytology allowed an unquestionable diagnosis to be made in 87.2% of cases, and the combined use of US and cytology rose the figure to 97%. The only limitation is the evaluation of the deep extent of large masses: in such cases CT or, if available, MR imaging are recommended.

Cytodiagnosis

[Evaluation of the role of mammography and echography in breast diseases in a controlled caseload].

Data concerning patients who underwent mammography and breast ultrasonography and then breast surgery were collected and analyzed with a computer archive system. In previous papers the authors reported both design and implementation of the computer archive and analyzed the results concerning uncontrolled collected data; in the present paper data concerning controlled cases are evaluated, distinguishing between symptomatic and asymptomatic cases. Asymptomatic patients represented 92% of the whole evaluated population. However only one third of the patients who underwent surgery for breast cancer was included in this group. Breast cancer was discovered in 65% of the patients who underwent diagnostic procedures and then surgery because of a palpable nodule. This percentage was lower (52%) in asymptomatic patients. Mammographic accuracy was about 90% in symptomatic patients and 81% in asymptomatic patients. Breast ultrasonography was performed as a subsequent step and always detected the lesion when palpable. Its sensitivity was 86% in asymptomatic patients. In patients who underwent surgery the false positive rate for cancer was higher with ultrasonography (59%) than with mammography (45%). Focal dysplasis were responsible for the majority of false positive diagnoses with both procedures. However, the false positive rate is low referring to the whole investigated population and is reshuffled by guided bioptic procedures. Ultrasonography was a useful tool when mammography had limitations: in fact ultrasonography detected a focal lesion in all patients with a surgically proven cancer and a previous negative mammography. The sets of data available from the continuous updating of the computer archive immediately clarified the differences between symptomatic and asymptomatic patients and stressed the diagnostic capabilities of the different procedures.

Breast Diseases

[The definition and realization of a computerized archive for radiological data of scientific interest].

The general requirements are analyzed of a system designed to acquire and manage radiological data of scientific interest. These requirements consist in: easy implementation, to develop the system in the same environment where it is going to be used; easy use, to avoid excessive needs and resources for the system to be managed in practice; reduced implementation cost, in terms of resources required for its implementation; user-oriented approach, in the sense of meeting the radiologists' requirements, and flexibility, for the system to be an effective tool for the widest range of possible applications. Two actual applications of this general approach are then discussed, one relative to breast investigations data, and the other to digital procedures (US, CT, DSA, MR) data. For each application the software tools employed are analyzed, together with the archive structures and the used codes, the collecting data procedures and the programs. For the breast investigations archive the possibility of obtaining standard periodic reports is pointed out. These reports summarize the global department activity in this area during selected periods (six months-one year). They allow interesting clinical conclusions to be drawn. As for the digital procedures archive, the possibility is stressed of searching different combinations of scientific data out of tens of thousands of cases in just a few minutes.

Computer Systems

[Tha data management of a breast radiology section via a computerized archive].

In the Institute of Radiology of the University of Trieste, from January to December 1988, 7123 patients underwent breast diagnostic procedures following a screening program for breast cancer or in order to evaluate specific symptoms. The data relative to this series of cases were collected and processed using the system described in a colleague's paper. Several sets of data became available concerning the percentage distribution of the techniques employed, their main indications, the distribution of pathological features in relation to different indications, the diagnostic value of combining different techniques, and the suggestions based on the findings collected. Both mammography and US proved to be able to solve the great majority of diagnostic problems, sometimes also as a tool to guide bioptic procedures. Other techniques (galactography, pneumocystography, CT) were devoted to specific diagnostic problems. The results are interesting in view of their clinical, epidemiological and management implications.

Breast Neoplasms

[Role of ultrasonics in the diagnosis of subclinical carcinoma of the breast].

The authors report the results of a retrospective multicentric study concerning the sonographic diagnosis of subclinical breast cancer, 11,254 patients were examined by means of mammography, with last-generation mammographic equipment, and by means of real-time US with 7.5-10 MHz transducer. Fifty-seven subclinical breast cancers were identified and histologically confirmed. US detected 30/57 neoplastic lesions, versus mammography 47/57; in particular, US identified 10 cancers missed at mammography, while the latter detected 27 malignant lesions missed at US. Mammographic accuracy in the early detection of breast cancers was 82.4%, while US accuracy was 52.6%. Mammographic false negatives were due to opacity of the glandular parenchyma. US false negatives presented at mammography as microcalcifications (67%), lesions less than 1 cm phi (22%), and indirect signs (11%). The results of this study demonstrate the important role of US in women with radiographically-dense parenchymal patterns, but confirm the superiority of mammography in the detection of subclinical breast cancer.

Biopsy

[High-risk focal breast lesions in echography and mammography].

Proliferative breast diseases include a group of lesions which occupy an intermediate position between benign and malignant lesions and are extremely likely to develop into carcinomas. The authors studied 81 patients who had been surgically biopsied on the basis of mammographic and/or US findings. In 33/81 (40.7%) of them proliferative lesions were diagnosed at histology. Mammography was able to identify 18/33 lesions (54.5%) versus US 26/33 (81.8%). On the basis of these findings, a group of patients at risk for cancer could be identified. As a matter of fact, proliferative lesions, especially those presenting with atypical hyperplasia, are associated with a higher risk of developing into carcinomas than those presenting with typical features. For these patients, the authors suggest more frequent clinical and instrumental screening.

Adult

[Evaluation of mineral bone content using quantitative computerized tomography].

The authors have evaluated bone mineral content in the vertebral spongiosa by means of Computed Tomography. The method proposed by Genant and Cann has been applied to examine 164 healthy volunteers and 108 patients. Both healthy males and females showed a progressive bone mineral loss increasing with age; the bone mineral loss was most severe in females during the 4th and 5th decade of life. Pathology included patients with osteoporotic fractures (vertebral and femoral neck), patients with partial gastrectomy, renal failure, primary hyperparathyroidism, Cushing syndrome, corticosteroid therapy. Bone mineral values were significantly lower in most pathologic groups. Computed Tomography proves thus to be a valuable method to assess bone mineral content and to identify patients at risk for fractures.

Adolescent

[The role of computerized tomography in the diagnosis of postoperative intervertebral diskitis].

Six patients with diskitis following lumbar disk surgery were investigated by Computed Tomography (CT). Four patients underwent CT in a rather early phase of the disease (5-37 days after the onset of the symptoms): a posterior paravertebral fluid collection was always recognized, while the plain film was normal. Later on (2-4 months), the classical signs of diskitis were evident, with both CT and the plain film. The collection was always present at CT. A reintervention, performed on 3 patients, revealed the purulent content of the collections. It seems reasonable to suggest a relationship between the collection and the subsequent diskitis; the collection is probably an early sign of the disease. Its detection is of great value, because it could allow an immediate and adequate therapy. The authors stress the usefulness of performing CT in an early phase on this kind of symptomatic patients.

Adult

[Computerized tomography of the spine in the evaluation of multiple myeloma].

Computed Tomography (CT) of the spine was performed on 17 patients with myeloma in order to assess the role of the technique in recognizing and evaluating the extent of the lesions. Myelomatous lesions followed two patterns at CT: first of all, multiple focal lesions, whose density is either solid, liquid, or fatty; second, an extensive pattern involving the spongiosa of the vertebra, including the posterior arch. CT detected more lesions than conventional radiology; furthermore, the extent of the lesions was much better demonstrated by CT. CT should thus be performed: a) in case of pain and/or neurological findings in negative radiological examinations; b) to evaluate the extent of myelomatous lesions (mainly in the spine); c) in solitary myeloma CT may be performed on different bone segments with clinical symptomatology but normal X-ray findings.

Humans

[Mammographic diagnosis based on oblique projection. Personal experience].

It is widely known that an early detection of breast cancer, when still asymptomatic, can improve the prognosis. Screening is thus suggested, and mammography should be the methodology of choice. Therefore, we tried to evaluate the best mammographic approach to the screening of breast cancer. Since January 1st, 1986, we have changed our mammographic procedures: the results obtained have been compared with those previously acquired. Through the evaluation of the different parameters we observed that: 1) the best results in patients screened for the first time can be obtained by using the cranio-caudal and the oblique mammographic views; 2) in the follow-up the oblique view can be used alone--which must then be compared with the oblique view of the first exam. This new mammographic approach makes it possible for us to reduce the exposure-dose to the patient and to the population, as well as the time and the cost of the screening. Moreover, the number of examinations can be increased by 20%. These results are extremely interesting, since mammography is now as sensitive as ever.

Breast Neoplasms

[Evaluation of expansive myelo-vertebral pathology using different radiologic modalities, magnetic resonance excluded].

The authors review their personal experience in tumors of the spine and the spinal cord, based on 30 cases evaluated with plain x-ray film of the spine, plain Computed Tomography (CT), myelography and myelo-CT. The value of both plain film of the spine and CT in tumoral lesions involving the skeleton is assessed; however, as far as nervous structures are concerned myelography and myelo-CT are necessary. Both myelography and myelo-CT showed high sensitivity (96%), thus allowing the definition of intra- extra-thecal extension of the tumor, and its relationships with the spinal cord and surrounding structures. Myelo-CT turned out to be extremely useful in myelographic stop: the upper extension of the lesion could be defined in 85% of cases. However, the contribution of myelography and myelo-CT was relatively limited when positive findings were present at CT. The evaluation of the density of the lesions proved to be of limited value since no significant differences could be recognized in different tumors. Finally, a diagnostic protocol is proposed for patients with spinal neurologic symptoms, based upon the clinical level of the lesion.

Adult

Patient doses and risks from diagnostic radiology in North-east Italy.

A study has been conducted to asses the impact of radiological practice in 1983 in Friuli-Venezia Giulia, a region of North-east Italy with 1,250,000 inhabitants. The design involved three phases: a region-wide frequency survey; dosimetric measurements on patients in all public X-ray facilities; derivation of organ doses from those measurements. Frequencies by type, age and sex and values of the main technical parameters of radiological examinations are presented. Organ doses, effective dose equivalents and risk estimates are given for 14 selected examinations. The annual per-capita effective dose equivalent and the genetically significant dose are estimated at 0.848 mSv and 0.253 mSv, respectively. From these values, collective risks have been predicted by using the risk factors given in the International Commission on Radiological Protection Publication 26. The results indicate that 14 persons risk induced malignancies and 2.5 persons risk genetic detriment.

Female

[Instrumental diagnosis of non-glandular superficial inflammation].

The study of soft tissues has greatly improved since the introduction of ultrasonography (US) and computed tomography (CT). In order to define the role of instrumental investigations, 51 patients affected by non glandular superficial soft tissue masses underwent US and 9 were also examined with CT. US proved to be accurate to define the size, the structure of the mass (93%), the benign or malignant nature (91%). US was also useful for percutaneous biopsy. However, US cannot be considered the only investigation because it does not give enough data about bony and articular structures: a conventional X-ray film must be performed in order to define the relation of the mass with the adjacent bone and to clarify the possible presence of fatty tissue in a solid mass shown at US. CT has a role in case of large masses, surrounding a bone diaphysis, when the malignant nature is suspected and to define the relationship with vessels and muscles.

Abscess

[Causes of attenuation of the sound waves in neoplasms of the breast. Histologic and echographic correlation study].

The purpose of our study was to compare the ultrasound findings in malignant breast masses (which underwent biopsy) with their histological appearance. In our activity of breast sonography, we observed that the same histological type of breast cancer often shows a different ultrasonic image. The main difference concerns the sonic attenuation or increase through the neoplastic mass. The histological examination took into account the amount of stroma and cells and the architectural pattern of the lesion. Comparing these features with the ultrasonic image, it has been shown that sonic transmission is related more to the architectural pattern than to the fibrous content of the neoplastic tissue.

Breast