Biomedical subjects
Publications and source records attributed to L Cecconi.
A case of an uncommon sphenoidal metastasis from prostate carcinoma with cranial nerve involvement is described. Current concepts of metastatic spread of this tumor to the skull base, clinical signs and therapeutic approaches are reviewed in the light of the available literature.
INTRODUCTION: Kaposi's sarcoma is an uncommon multifocal angiogenic lesion but the most frequent tumor (15%) in HIV+ patients: it is found in homosexual HIV+ men in 95% of cases and appears as cutaneous-mucous lesions in most patients; the respiratory system is involved in 20% of cases. We investigated the yield of conventional radiography, CT and HRCT in the diagnostic imaging of pulmonary Kaposi's sarcoma. MATERIAL AND METHODS: We retrospectively reviewed the findings of 205 patients with cutaneous Kaposi's sarcoma. Chest radiography (two projections) had been performed in all of them, chest CT in 23, HRCT in 7, and tracheobronchial endoscopy in 20. RESULTS: The respiratory system was involved in 22% of the patients with cutaneous-mucous Kaposi's sarcoma. The pulmonary pattern was perivasculobronchial interstitial thickening with bilateral and symmetrical ilifugal involvement in 78% of cases, associated with multiple perivascular nodular opacities (< 1 cm) in 19 patients. Pleural effusion was seen in 52% of cases, while 3 patients had plaque thickening of visceral pleura; mediastinal adenopathy was found in 8.6% of cases. Endoscopy detected 14 tracheobronchial Kaposi's lesions. Kaposi's involvement of the respiratory system was confirmed histologically in 26 autopsy cases. CONCLUSIONS: In our experience, conventional radiology and clinical-history data permit to evaluate early pleuropulmonary involvement of Kaposi's sarcoma and to follow its evolution. CT and HRCT unquestionably detect the typical signs earlier than conventional radiology and yield further information on disease extent.
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Over the last decade the number of subjects with acquired immunodeficiencies has markedly increased; this phenomenon depends on both the large number of patients receiving organ transplants or antiblastic therapy and the spread of infections caused by the HIV virus. In 70-90% of these patients primary diseases include different pulmonary infections, relative to the type and degree of immune compromission. Pathogenic or, in most cases, opportunistic germs are responsible for severe pneumonia whose mortality rate can top 50%. Since prognosis depends on the promptness of treatment, the diagnosis of nature must be made quickly by integrating clinical and diagnostic findings with laboratory and instrumental results. Conventional chest radiology plays a major role as the first step in a diagnostic iter which can now include rather sensitive techniques--e.g., equalized chest films. CT and nuclear medicine often represent the necessary diagnostic complements but, in some cases, etiology can be diagnosed only with such invasive procedures as lung biopsy. The authors reviewed the current data on the diagnostic imaging findings of pulmonary infections caused by common germs, by Pneumocystis carinii mycobacteria, mycetes and viruses in immunocompromised patients, integrating their personal experience with literature data.
The tolerance to and the clinical value of a new positive oral contrast agent, Gd-DTPA-Dimeglumine, were evaluated. Ten healthy volunteers and 30 patients with abdominal and pelvic tumors were studied. Fourteen patients underwent MR scans only after cm administration, while 16 patients were examined both before and after. All images were obtained by means of a 1.5-T MR unit using SE and GE pulse sequences on the axial and coronal planes. Before the examination, a 1-mmol Gd-DTPA-Dimeglumine solution with mannitol and sodium citrate diluted in 1L of water was administered to all patients in 100-150-ml fractions. The product was well tolerated and its taste was good; adverse reactions were uncommon and mild. The solution was stable during gastrointestinal tract transit. Bowel signal was hyperintense on both GE and SE pulse sequences, which clearly demonstrated the bowel lumen distinguishing it from the surrounding fatty tissue and depicting even the smallest vascular structures. Moreover, from a clinical point of view, the hepatic, pancreatic and colic borders were better demonstrated in both normal and pathologic conditions.
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The major problem in MRI of the esophagus is the lack of a reliable oral contrast agent. To determine the value of Gd-DTPA as an oral contrast medium for the esophagus as a part of phase III clinical trial, 17 patients (10 esophageal neoplasms, 4 neoplasms of the pharyngo-laryngeal tract, 3 Zenker's diverticula) underwent MRI. The oral contrast medium is proposed in a new preparation: 5 cc of oral Gd-DTPA were emulsionated with 30 g of a low-density barium paste for esophageal CT (3% p/v). High signal intensity in the esophageal lumen was observed in all patients and in all sequences. In neoplastic lesions, the c.m. improved the definition of both the level of stenosis and the longitudinal extent of the lesion. In diverticula, the real and the false lumen could be demonstrated. In one patient the exam could not be completed. No adverse reactions were observed.
Twenty-five patients with histologically-proven cervical carcinoma (clinical stages I and II according to FIGO classification system) were studied by means of transrectal US (TRUS) and MR imaging (MRI) at 1.5 T, to evaluate the primary tumor and measure its size. Stage Ib cancers were divided into small 4 (less than 4 cm) and large (greater than 4 cm). The patients with large Ib and those with stage II lesions were administered preoperative radiation therapy. All the patients underwent TRUS, MRI, and clinical examination under sedation; they were subsequently operated. Stage Ia and small Ib patients underwent therapeutic surgery, while large Ib and stage II cases had surgical exploration for pathologic staging. The tumor was correctly identified and measured in 22 patients with MRI, and in 20 cases with TRUS. Tumoral involvement of parametria and uterine ligaments was demonstrated in 75% of cases by MRI and in 62.5% of patients by TRUS. Vaginal involvement was demonstrated by MRI in 77.8% of cases and by TRUS in 66.6% of patients. Tumor size could be evaluated more accurately than with clinical examination under sedation, while the results were poorer in the demonstration of tumor spread into uterus and parametria.
Thirty-three patients with ovarian carcinoma who had no evidence of metastases or ascites demonstrated on computed tomography (CT) with and without contrast agent were examined with CT after injection of approximately 3000 cc of a 2.4% solution of nonionic contrast media into the peritoneum. After intraperitoneal injection with CT (IPC CT), 22 were diagnosed as having intraperitoneal metastases. Of these, 19 were found to be true positives and 3 false negatives. Three other patients diagnosed as normal were found to have metastases. In all patients the peritoneum was well outlined and generally any metastases smaller than 1 cm were demonstrated. It was possible to identify compartmentalization of the peritoneum and to determine the location of the lesion to be in the peritoneum or the extraperitoneal space. This information is necessary in the planning of chemotherapy, particularly endoperitoneal chemotherapy. Tiny metastases to the omentum or adherent loops of small bowel could not be seen well.
Magnetic Resonance Angiography (MRA) is a new diagnostic technique which allows vascular structures to be studied atraumatically and without any contrast medium. Its basic principles are reported in the present paper, together with the results of a preliminary study of normal neck anatomy. Twenty healthy volunteers and 10 patients with no cerebral vascular diseases underwent this MRA study. Internal and common carotid arteries were always well visualized, while external carotid was demonstrated in 87% of cases. Among intracranial vessels, the middle cerebral artery was clearly depicted in 63% of cases, while the anterior cerebral artery was visible in 18% of the study population only.
Forty-one patients with histologically proven hepatic lesions (6 cysts, 6 hemangiomas, 8 hepatomas, 19 metastases and 2 negative cases) were studied with Magnetic Resonance (MR) imaging at 1.5 T, and with US and CT. This prospective study was aimed at evaluating: the comparative accuracy of MR, US and CT; the sensitivity and specificity of spin-echo (SE) vs FISP pulse sequences; the efficacy of T1 and T2 relaxation time values in differentiating hemangiomas from hepatomas and metastases. MR diagnostic accuracy was 94.7% vs 89.4% of CT and 84.2% of US. FISP sequences provided 60% sensitivity and 66% specificity. T2 relaxation time values were statistically significant (p less than 0.05) in differentiating hemangiomas (T2 range: 80.9-218.9 ms) from hepatomas (T2 range: 59.4-83.2 ms). The differences in mean T2 values between hemangiomas and metastases (T2 range 54.3-177.3 ms) were not statistically significant (p greater than 0.25).
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Twelve patients affected with meningiomas with a fluid component are reviewed. Six presented with intratumoral cysts and 6 with extratumoral fluid collections that in 3 cases were of clear CSF. The formation mechanism of the two types are quite different. Intratumoral cysts are caused by biological changes within the tumor, while the extratumoral ones appear to be secondary to local hydrodynamic changes and CSF reabsorption disturbances. The CT (computerized tomography) scan may be equivocal either for the diagnosis of the meningioma or, once the meningioma is suspected, for identifying the type of cyst involved. The angiography is useful for a correct preoperative diagnosis that, once suspected, can be frequently made.
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