Magnetic resonance imaging of the prostate.
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Biomedical subjects
Publications and source records attributed to M Bezzi.
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The case of a 78-year-old male with a large, firm, not tender mass of the left anterolateral region of the chest is reported. Previously he had been treated with cyproterone acetate for a year, being affected by a locally unresectable prostate carcinoma. At CT-scan of the chest mass appeared solid, extending to the pleural cavity with compression of the lung and erosion of third to fifth rib. Operation consisted in complete removal of the mass with "en bloc" resection of involved ribs. Chest wall was reconstructed by means of a Marlex mesh sandwich. Histology revealed a carcinoma, probably originating from the breast. The role of antiandrogenic chemotherapy in the development of the tumor and the use of plastic mesh for chest wall defects are discussed.
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High-resolution magnetic resonance (MR) imaging of 24 fresh radical prostatectomy specimens was performed on an experimental 1.9-T system. Direct correlation between the findings in 7-micron-thick macrosections and their corresponding MR images was possible. Fourteen patients had macroscopic evidence of cancer. In all 14 cases, the carcinoma nodules appeared as areas of low signal intensity on images obtained with a repetition time of 2,500 msec and an echo time of 80 msec. Ten of 14 nodules had well-defined margins and consisted of densely packed glandular elements, which displaced the surrounding normal glandular material of higher signal intensity. Ten specimens displayed benign prostatic hyperplasia (BPH). The MR characteristics of this entity were quite variable but relatively predictable, depending on the distribution and size of the glandular elements, as well as the composition of the surrounding stroma. In BPH, the changes began in the central portion of the gland. The areas of highest signal intensity corresponded to dilated glandular elements (cystic ectasia), while the areas of lowest signal intensity corresponded to collagen (scar) and fibromuscular stroma. Nodules of mixed glandular BPH and fibromuscular BPH were found to have signal intensities similar to those of well-differentiated nodules of prostatic adenocarcinoma.
A retrospective study was performed to determine the radiographic features of prostatic carcinoma invading the rectum on double-contrast barium enemas. In 11 such patients, these examinations revealed localized narrowing and/or speculation of the rectum (four cases); a smooth, extrinsic mass impression on the rectosigmoid colon (two cases); an umbilicated submucosal mass in the rectosigmoid colon (one case); and rectosigmoid narrowing with spiculated, pleated mucosal folds in the narrowed segment of bowel (four cases). Thus, most patients (64%) had localized involvement of the rectosigmoid colon with sparing of the distal rectum. The anatomic-pathologic basis for the localized spread of prostatic carcinoma to the rectosigmoid colon is illustrated on MR scans. Thus, prostatic carcinoma invading the rectum may be manifested on double-contrast barium enema by a spectrum of radiographic findings, and most patients have localized rectosigmoid involvement with sparing of the distal rectum.
We have described the clinical presentation of the commonest syndromes associated with hormone production by functioning pancreatic tumors. The role of the radiologist in tumor localization, staging, and treatment is discussed and the various imaging methods employed are examined individually. The problems of reviewing the world literature on such rare lesions are discussed and a tentative diagnostic algorithm is suggested.
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Magnetic resonance (MR) imaging was used to stage prostatic carcinoma in 81 patients with a proved diagnosis. MR imaging findings were correlated with histologic findings regarding the local extent of disease (37 patieNts) and the presence of nodal metastases (51 patients). Tumor nodules were detected in the peripheral zone (PZ) in 34 of 37 patients and were of low signal intensity compared with the signal of the PZ. Hemorrhage in the PZ represented a problem in tumor detection and in tumor volume measurement. When multiple criteria for local tumor spread were combined, MR imaging had a sensitivity of 72%, a specificity of 84%, and an accuracy of 78% in the differentiation of stage A or B from Stage C or D disease. Assessment of seminal vesicle invasion was more accurate than assessment of direct extracapsular spread. In five patients, microscopic invasion of the capsule (stage C) was classified as stage B with MR imaging; from a clinical standpoint, this should not affect patient treatment and prognosis. The MR imaging sensitivity in the detection of lymph node metastases was 69%, with a specificity of 95% and an accuracy of 88%. In this study MR imaging proved reliable in the comprehensive evaluation and staging of prostatic carcinoma.
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Radiologic and endoscopic demonstration of ileosigmoid fistulas is difficult: some are discovered only at operation. In these cases the surgeon is faced with the decision of either to remove "en bloc " the involved bowel or to simply close the sigmoid defect. Twelve patients with Crohn's disease complicated by ileosigmoid fistulas were operated: 7 by ileal and/or colonic resection and simple closure of the sigmoid fistula, 4 by double resection and 1 by total colectomy. Stomas were performed in 2. The review of this experience demonstrated that conservative surgery is effective and safe in most cases. Local extended resection should be reserved to cases where secondary involvement of a rather long segment of the intestine is present or where the sigmoid and rectum are primarily involved by active severe Crohn's disease. In these cases, a protective stoma may be considered.
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The sonographic appearance of 141 hepatic and abdominal hydatid cysts was studied in 63 patients undergoing therapy with benzoimidazolic compounds. The cysts were evaluated for size, margins of the cyst wall, and echo pattern of cyst contents to establish the response to the drugs. Changes seen on ultrasound (US) scans were classified as decrease in size, detachment of the cyst membrane, and appearance of echogenic material (matrix) in the cyst cavity. These findings, particularly the diffusely hyperechoic pattern, are explained on the basis of the action of the drugs. Twenty-one patients underwent surgery at the end of treatment. The US patterns of treated hydatid cysts are similar to those seen, though more rarely, in cases of spontaneous parasite involution in long-standing hydatidosis.
Three patients with clinically suspected pseudoaneurysm as a complication of femoral puncture were referred for ultrasound (US) evaluation with both conventional duplex Doppler US and color Doppler imaging. Pseudoaneurysm (n = 2) and simple hematoma (n = 2) were depicted with both Doppler systems, and a separate pseudoaneurysm and a hematoma were found in one patient. These diagnoses were confirmed surgically. Distinctive Doppler spectral waveforms and color Doppler findings enabled confident diagnoses. Color Doppler imaging allowed faster detection of intraaneurysmal flow, and the track between the injured artery and the pseudoaneurysm was identified only with color Doppler imaging. Duplex Doppler US with color Doppler imaging allows for the rapid, unequivocal diagnosis of pseudoaneurysm, thus enabling prompt treatment without the need for invasive diagnostic modalities.
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