The value of fat saturation sequences and contrast medium administration in MRI of degenerative disease of the posterior/perispinal elements of the lumbosacral spine.

Degenerative-inflammatory lumbar spinal pathology is one of the most common reasons why individuals seek medical care, and low back pain is the main symptom among those most commonly associated with this pathologic condition. Pain is commonly attributed to degenerative disc disease, particularly herniated discs, but many different spinal and perispinal structures may undergo degenerative-inflammatory phenomena and produce pain: discs, bone, facet joints, ligaments and muscles. In particular, in patients with non-radicular low back pain, this syndrome may arise from changes of the posterior elements/perispinal tissues of the lumbar spine (i.e., the "posterior vertebral compartment"). They include: facet joint pathology (e.g., osteoarthritis, joint effusion, synovitis and synovial cysts), spondylolysis, spinal/perispinal ligamentous degenerative-inflammatory changes and perispinal muscular changes. It is well known that magnetic resonance is the most sensitive imaging method for the evaluation of spinal degenerative pathology, even in the initial stages of the disease. T2-weighted sequences with fat saturation, and when indicated the use of contrast-enhanced T1-weighted images with fat saturation, permit the visualization of degenerative-inflammatory changes of the posterior elements of the lumbar spine that in most cases would have been overlooked with conventional non-fat suppressed imaging.

Fat saturation technique and gadolinium in MRI of lumbar spinal degenerative disease.

We evaluated the potential of MR sequences with Fat Saturation and gadolinium in patients with degenerative disease of the lumbar spine and low back pain, by studying both anterior and posterior elements of the lumbar spine. We examined 3323 patients (age range 15-78 years) presenting low back pain. We used T2-weighted sequences with Fat Saturation and in some selected cases (1063 patients, 32%) administered gadolinium using T1-weighted sequences with Fat Saturation. In particular we used gadolinium in the following cases: 1) presence of hyperintense areas on T2 weighted images with Fat Saturation in the osteo-articular and muscular-ligamentous structures of the lumbar spine; 2) Clinical-radiological discrepancy in patients without disc-root conflict and clinical suspicion of posterior vertebral compartment syndrome. We found degenerative-inflammatory changes in osteo-articular, ligamentous and muscular structures in 1063 patients: osteochondrosis, "aseptic discitis", facet joint effusion and synovitis, osteoarthritis, synovial cysts, spondylolysis, degenerative-inflammatory changes of the posterior ligaments (flava, interspinous and supraspinous ligaments) and posterior perispinal muscles. To improve diagnostic accuracy and allow correct therapeutic guidance, MR examination in patients with low back pain must evaluate both anterior and posterior elements of the lumbar spine. Our study indicates that T2 sequences with Fat Saturation and, in selected cases, gadolinium administration, better visualize or disclose degenerative-inflammatory changes in the lumbar spine, showing the active-inflammatory phase and extension of these processes which may not be depicted during a standard MR examination.

[Schwannomas of the digestive tract. Observations on a case localizing in the ileum]. / Schwannomi deli tubo digerente. Osservazioni su di un caso a localizzazione ileale.

The schwannomas are rare tumors taking origin from Schwann's cells; even rarer is their location at a peripheral level. Even if they show the macroscopic and microscopic characteristics of a benign tumor, it is possible that they engage malignant course, with possibility of recurrency and of distant metastasis. In the alimentary tract the schwannomas reveal with repeated episodes of digestive hemorrhage which could engage, according to the location, the characters of enterorrhagia or melena. Arteriography has the higher diagnostic sensibility, in course of bleeding. The CT could demonstrate a submucosal neoplasia. The diagnosis of schwannomas is based on the immunohistochemical search of the protein S100, that allows to differentiate them from the tumors of muscular origin, having such tumors common histological and cytological aspects. The schwannomas are today set in the widest chapter of the so-called "stromal tumors of the gastrointestinal tract" (GISTs) with an indefinite malignancy which need surgical excision and an attentive follow-up. The authors report a case of schwannoma located at the first jejunal loop, having had repeated episodes of digestive hemorrhage. The diagnosis was based on the selective arteriography of the upper mesenteric artery and the immunohistochemical search of the protein S100. The surgical treatment consisted of the resection of the jejunal loop, after having sought for eventual multiple locations of the neoplasia.

Esophageal motility disorders in the rheumatic diseases: a review of 150 patients.

OBJECTIVE: Rheumatic diseases are a group of systemic disorders that may be concurrent with Raynaud's phenomenon and involvement of the internal organs, in particular the esophagus. Esophageal motor abnormalities have been widely described in systemic sclerosis, but have not frequently been reported in other diseases. In the present study we have examined the prevalence and pattern of esophageal motility disorders in different rheumatic diseases. METHODS: Esophageal manometry was performed on 150 patients, 21 males and 129 females, suffering from different rheumatic diseases (SSc, RA, SLE, MCTD, undifferentiated CTD, or DM/PM) and on 30 healthy controls. RESULTS: Functional involvement of the esophagus was demonstrated in all the rheumatic diseases considered, although at varying percentages. The frequencies of the functional abnormalities differed when each disease was considered separately. In SSc patients abnormalities were found more frequently in the lower esophageal sphincter (81.8%) and in the esophageal body (84.8%); data for the DM/PM and MCTD patients broadly overlapped. On the contrary, in SLE the lower sphincter appeared to be less (or even not at all) impaired, while the most specific disorder was an isolated abnormal peristalsis. RP did not always correlate with manometric changes in all of the groups studied. CONCLUSIONS: Three conclusions derive from our study: i) motor disorders affecting the esophagus were not only found in SSc, but also in all forms of non-lupus CTD; ii) the simultaneous involvement of the esophageal body and the lower esophageal sphincter is discriminant between non-lupus CTD and SLE; and iii) RP may be regarded as a condition pathogenetically unrelated to manometrically detected esophageal motor abnormalities.

[Radiologic evaluation and prognosis of lymphoid nodular hyperplasia of the mesenteric intestine]. / Valutazione radiologica e prognosi nell'iperplasia nodulare linfoide dell'intestino mesenteriale.

Nodular lymphoid hyperplasia (NLH) is a reaction of the intestinal lymphatic tissue to specific inflammatory stimuli. Radiologically, it presents with multiple nodular filling defects of various sizes (2-4 mm) and with segmental, focal or diffuse distribution. The condition may be benign but, under particular circumstances (chronic stimuli), it may evolve to neoplastic forms. Seven hundred and sixty-eight patients underwent small bowel X-rays from January 1990 to April 1992. Twenty-two patients with NLH with or without associated mucosal or wall lesions were selected. The radiologic and histologic features of the lesions, together with the clinical data, were helpful to make the diagnosis. In 8 patients the hyperplastic nodules were benign, while 10 patients were affected with Crohn's disease and 4 with Herman's syndrome or common variable immunodeficiency. This work was aimed at defining NLH from a diagnostic point of view relative to both morphology and extent of lesions and at stressing the role of radiology of the small bowel in the follow-up of the cases at risk of evolving to cancer.

[Peritoneal carcinosis]. / Carcinosi peritoneale.

Abdominal CT yields several pieces of information for the diagnosis of secondary neoplastic involvement of the peritoneum (peritoneal carcinosis). Peritoneal carcinosis may be the first clinical sign of an occult primary tumor. CT scans of 120 patients with peritoneal carcinosis confirmed by pre/peri-operative biopsy or at autopsy, were retrospectively reviewed. The CT patterns of peritoneal carcinosis were detected in 20 of 44 patients with an occult malignancy. In 16 of 76 cases with a known malignancy there was no evidence of secondary peritoneal involvement. The incidence of CT findings and their correlation with the primary tumor are critically discussed. The authors have assessed the utility of CT in detecting peritoneal carcinosis, even though in their experience CT findings of secondary neoplastic peritoneal involvement could not be correlated with primary tumor.

[Pancreatic necrosis. Correlations of traditional radiology of the colon and CT]. / La necrosi pancreatica. Correlazioni fra radiologia tradizionale del colon e TC.

Pancreatic necrosis is a possible complication of acute pancreatitis. It is characterized by diffuse inflammation associated with exudation or leakage of pancreatic juice with its proteolytic enzymes into the peripancreatic tissues. Colonic complications of acute pancreatitis are uncommon events. The main purpose of our study was to correlate radiological findings of pancreatic necrosis as observed during barium enema to CT patterns. A retrospective study was therefore carried out on 40 patients affected with acute pancreatitis with local and systemic complications. The analysis of the results allowed different patterns to be observed, with the two techniques, in the acute and in the chronic phases. In the acute phase, barium enema of the colon showed inflammatory extrinsic processes involving the wall, with a typical localization related to the spread of pancreatic enzymes along mesenteric pathways, as described by Meyers. CT allowed a thorough evaluation of both the pathologic process and its spatial balance. In the chronic phase, barium enema showed fibrotic strictures and fistulas. CT demonstrated pseudocystic masses and irregular focal areas of decreased attenuation or irregular pancreatic margins. This correlation shows how an extrinsic inflammatory involvement of the colon with a characteristic topography may help make a diagnosis and plan therapy.

[Computerized tomography for the study of lesions of the digestive system wall]. / La TC nello studio delle lesioni della parete dell'apparato digerente.

The authors investigated the role of CT in the study of intrinsic mural pathologic conditions originating from submucosal/muscular layers and of extrinsic conditions due to extraintestinal disease with secondary spread to the alimentary tract. According to the various diagnostic problems, either hypodense contrast agents (air, corn-oil emulsion, and water) or hyperdense contrast agents (iodine solutions, and barium suspensions) can be used to fill intestinal guts. Normal intestinal wall thickness does not exceed 5 mm. In case of intrinsic mural conditions, CT allows tumor extent to be evaluated, and, on the basis of densitometric values, makes the diagnosis of lipoma possible. As for intrinsic conditions (varices), CT yields specific findings. This is not the case with intestinal infarction, intramural hematoma, and phlogistic conditions, where CT generally shows aspecific parietal thickness. As for extrinsic mural conditions, CT demonstrates alimentary tract involvement due to phlogistic/neoplastic extraintestinal conditions, for it allows intestinal guts to be depicted, and the adjacent organs and structures. CT is a complementary method to conventional radiology and endoscopy which has given an excellent contribution to the study of mural pathologic conditions.

[Computed tomography in ascites]. / La TC nelle asciti.

Ascites can be found in a variety of diseases and may represent either a late complication or the clinical sign of a pathologic condition. The presence of even small fluid collections in peritoneal recess can be easily detected by CT. A number of reports confirm CT prediction of the benign/malignant nature of ascites. The CT scans of 100 patients affected with histologically confirmed ascites were reviewed to evaluate CT contribution to the assessment of the benign/malignant nature of ascites. On the basis of our results, it can be concluded that the only highly predictive CT finding of malignant ascites is the presence of a coexisting mass. Other findings do not allow the two types of collections to be discriminated.

[Significance of computerized tomography in the study of Crohn disease]. / Interesse della Tomografia computerizzata nello studio del morbo di Crohn.

Twenty-six patients affected with Crohn's disease were studied by means of CT. The method demonstrated transmural fistulas in 2 cases, and bowel wall thickening in all patients. In our series of cases, the advantages of CT over conventional radiology lay in the fact that the former allowed the evaluation of associated mesenteric pathologies (e.g. fibrofatty proliferation, and adenopathies) and demonstrated the presence of abscesses in 4 case. CT findings were in agreement with those from conventional contrast studies in the demonstration of entero-enteric fistulas, whereas they yielded additional information in the study of entero-muscular fistulas. Associated pathologies in other organs were found in 5 patients--i.e. fatty infiltration of the liver and cholelithiasis. CT is not useful in demonstrating early mucosal damage in Crohn's disease, but it should be regarded as a complementary method to conventional barium studies. As a matter of fact, CT is fundamental in the evaluation of associated mesenteric pathologies and of other complications which can affect therapeutic management.

Clinical and CT parameters in degenerative cerebellar atrophy in aged patients.

Fifteen cases of degenerative cerebellar atrophy are presented together with the criteria used to assess the diagnosis of cerebellar atrophy by computed tomography.

Clinical-angiographic correlations in 132 patients with megadolichovertebrobasilar anomaly.

We have found numerous case reports, but no systematic study of the megadolichovertebrobasilar anomaly ( MDVBA ). The purpose of this paper is to evaluate the relationships between arterial shifts of the vertebro-basilar system and neurological findings in the posterior fossa in our series of 132 cases. We found a high percentage (77.3%) of angiographic-clinical correlations having evaluated the arterial shifts, measured in mm, of the vertebro-basilar system in a frontal and a sagittal plane and concluded that the greater the degree of dislocation, the greater the number of positive cases. Nevertheless it is not possible to predetermine the presence of particular neurosymptomatology related to arterial dislocation degrees.