Rhabdomyoma of a rare type in a child: case report and literature review.

We describe a 9-year-old boy who presented with dyspnea and with a neck mass which was initially described as a thyroid nodule. At the end of the diagnostic-therapeutic research this mass was finally diagnosed as an adult rhabdomyoma originating from the mediastinum. This is an extremely rare tumor which is usually found in the adult population.

Ancient schwannoma of the motor branch of the median nerve: a clinical case.

The authors present a case of ancient schwannoma of the motor branch of the median nerve. An accurate peroperative diagnosis was not possible despite the use of MRI. Sectioning of the nerve was required as the tumor could not be enucleated.

Evaluation of the triangular fibrocartilage complex tears by arthroscopy, arthrography, and magnetic resonance imaging.

Arthroscopic findings in 11 patients with chronic ulnar painful wrist were compared both with arthrographic and magnetic resonance (MR) imaging results to evaluate the accuracy of the former procedure in the detection of triangular fibrocartilage complex (TFCC) lesions. MR imaging and arthrography investigations appeared to be sensitive modalities when compared with arthroscopic findings in TFCC lesions (specificity 100%; sensitivity 82 and 80%). MR imaging can be advantageously employed in the screening of patients suspected of having a TFCC tear, eliminating the necessity of an arthrographic examination. However, MR imaging could not define the exact site of the tear within the degenerate TFCC or detect lesions of the articular cartilage. Arthroscopy offers sure evidence of the site of TFCC lesion and more information about the intraarticular associated causes of chronic ulnar wrist pain such as chondromalacia and synovitis. An added benefit is that many of the pathologies seen can be treated using arthroscopic surgical techniques.

MR of benign peripheral nerve sheath tumors.

Seventeen benign peripheral nerve sheath tumors were studied using MR. In all cases T2 relaxation time, signal intensity on T1-weighted images (lesion/muscle ratio), detectability of nerve of origin, nerve-lesion relationship, and presence of a capsule were assessed. Sixteen tumors showed marked hyperintensity on T2-weighted images with T2 relaxation times values greater than 95 ms. One schwannoma was almost isointense with fat (T2 60 ms). All lesions were isointense with muscle on T1-weighted images. In schwannomas the nerve was usually situated at the periphery of the lesion and only in one case was it obliterated by the mass. In neurofibromas the nerve was either visible in a central position within the mass (two cases) or no longer visible (five cases). A capsule could be detected in 70% of the schwannomas and in 30% of the neurofibromas. In patients with soft tissue masses, MR may contribute to recognition of nerve sheath tumors by showing the nerve of origin and typical signal hyperintensity on T2-weighted images. It can also be helpful in distinguishing between schwannomas and neurofibromas by the location of the nerve of origin and the presence of a capsule.

[Magnetic resonance for the study of osteosarcoma]. / La risonanza magnetica nello studio dell'osteosarcoma.

The authors report their experience with MR imaging in the study of osteosarcoma. Two main elements were evaluated: signal characteristics and loco-regional staging. Seventy-one patients were studied: 65 of them had central long-bone osteosarcoma, and 6 had telangiectatic long-bone osteosarcoma. T1- and T2-weighted spin-echo sequences were employed and all cases were scanned on 3 planes (sagittal, coronal, and axial). In 28 patients MR imaging was performed both before and after preoperative chemotherapy. The obtained data were compared to surgical and pathological findings. With the exception of the typical signal patterns of quite-osteoblastic osteosarcoma (which presents with low signal on both T1- and T2-weighted sequences), no particular signal features were observed which could help distinguish the different types of osteosarcoma. MR imaging is the method of choice in loco-regional staging for, in our series, it allowed a rational and adequate surgical planning. For this purpose, at least a longitudinal T1- and an axial T2-weighted images are required.

MR evaluation of triangular fibrocartilage complex tears in the wrist: comparison with arthrography and arthroscopy.

To evaluate the accuracy of magnetic resonance (MR) in the detection of tears of the triangular fibrocartilage complex (TFCC), 10 consecutive patients with posttraumatic chronic wrist pain were examined with MR, arthrography, and arthroscopy and the results were compared. The MR images of 16 control subjects were also examined to define the MR appearance of the normal TFCC. When compared with arthroscopic findings, both MR and arthrography had two false-negative results (sensitivity, 80%) and no false-positive results. Regarding the sites of the TFCC tears, the findings on MR did not always correlate with the findings on arthrography. In no case was MR able to visualize the cartilaginous lesions visible by arthroscopy. These preliminary results illustrate the ability of MR to assess the integrity of the TFCC and suggest its use as the first imaging technique following plain radiography in the evaluation of patients with chronic posttraumatic pain on the ulnar side of the wrist.

Evaluation of ischaemic necrosis of carpal bones by magnetic resonance imaging.

Nine patients with chronic pain in the wrist were examined by M.R.I. to evaluate its accuracy in the detection of ischaemic necrosis of carpal bones. In seven patients, M.R.I. confirmed scintigraphic and radiographic signs of ischaemic necrosis. In two patients with radionuclide accumulations, M.R.I. did not confirm the diagnosis: in one, M.R.I. was totally normal and in the other it showed signs of a healing scaphoid fracture. From this limited experience, M.R.I. seems to be a sensitive imaging modality which is more specific than scintigraphy.

[Doppler flowmetry in the study of portal hypertension in patients with liver cirrhosis. Qualitative and quantitative analyses]. / La flussimetria Doppler nello studio dell'ipertensione portale dei pazienti con cirrosi epatica. Analisi qualitativa e quantitativa.

The recent development of the duplex-Doppler technique, which combined real-time US with pulsed Doppler flowmetry, has allowed the flowmetric hemodynamic study of large abdominal vessels. As yet, however, both accuracy and possible applications of this method in the study of portal hypertension have not been fully investigated. This study was aimed at assessing whether or not the combined use of Doppler flowmetry and bidimensional US is able to detect portal hypertension in patients with liver cirrhosis (LC), and could therefore represent a valid alternative to endoscopic, angiographic, and direct pressure measurement techniques. Twenty-six patients with LC and 25 control patients were studied with a strictly standardized method; portal hypertension was detected in the patients with LC by EGDS and laparoscopy. The results demonstrated pulsed duplex-Doppler US to be able to detect portal hypertension in 92.4% of LC patients, with 2 false negatives only (7.6%). The difference in the flowmetric data of normal and LC patients was highly significant (p less than 0.001 Student's t test). In conclusion, duplex-Doppler US can be considered as a valid technique to detect portal hypertension in LC patients, and can thus be used as an alternative to more invasive techniques of general use in clinics.

[1.5 T MR in the diagnosis of parotid masses: comparison with ultrasonography]. / La RM a 1.5 T nella diagnostica delle masse parotidee: confronto con l'ecografia.

Twenty-two patients who presented with laterocervical retromandibular enlargement were examined with both US and MR imaging to assess the intrinsic/extrinsic relationship of the mass to the parotid gland, the involvement of the facial nerve and adjacent structures, as well as the nature of the mass. Both US and MR imaging proved to be poorly specific in the characterization of the inflammatory lesions. Within the mass, both methods revealed high sensitivity (100%) in identifying the lesions, even very small ones. MR imaging allowed the lesion to be accurately located, the facial nerve to be identified, and its possible infiltration to be evaluated, with higher reliability than US, thanks to its higher contrast resolution and to its multiplanarity. Neither US nor MR imaging allowed the benign/malignant nature of the lesion to be assessed. On the basis of their experience, the authors suggest the use of T2-weighted MR sequences, with long TR and TE, to differentiate pleomorphic adenomas from other histotypes, after US assessment of the solid nature of parotid masses.

[Rotator cuff lesions: evaluation with RM and US]. / Lesioni della cuffia dei rotatori: valutazione con RM e US.

Physical and instrumental examination of the patients with an "aching shoulder" is often difficult and a positive out-come of surgical treatment may be impaired by the late diagnosis of long-standing rotator cuff lesions causing tendon adhesions and muscle atrophy. The authors report the results obtained in 25 selected patients with an aching shoulder examined with arthrography, real-time ultrasound (US) with a 5 MHz linear probe, and high-field (1.5 T) Magnetic Resonance (MR) imaging. Arthrography was able to demonstrate a cuff tear in 14/25 cases; US detected signs of tear in 14/25 (1 false negative); MR imaging showed a cuff lesion in 16/25 patients, and in one case allowed a partial cuff tear to be demonstrated, which had not been visualized with arthrography. MR imaging could also demonstrate other signs of periarticular pathologies (tendinitis, longhead of biceps inflammation, and bursitis) that may represent the early stages of the inflammatory-degenerative process underlying most of cuff lesions. The high diagnostic accuracy of US (95%) is stressed in the detection of cuff tears, in patients with an aching shoulder; as for questionable cases at US, MR imaging is indicated as a valid alternative to arthrography, which is more invasive and less accepted by the patients.

[1.5-T MR of the knee: the correlations with arthroscopy]. / La RM del ginocchio a 1,5 T: correlazioni con l'artroscopia.

The authors report their experience of knee articular pathologies studied with MR imaging. Forty patients (36 with and 4 without articular trauma) were examined with both MR imaging and arthroscopy. Arthroscopic findings were correlated with MR results in order to evaluate the accuracy of the latter in detecting meniscal tears. MR images were obtained with a 1.5 T unit and a transmit-receiver surface coil. Spin-echo sequences and, occasionally, fast-scan sequences were used both in the coronal and in the sagittal planes. High resolution MR imaging clearly depicted knee anatomy. As far as meniscal lesions were concerned, the authors employed a grading system to classify intrameniscal signals, as proposed by Lotysch. The preliminary results are encouraging and suggest the use of MR imaging as the first imaging modality for use in knee pathology before arthroscopy is performed.

[Nelson's syndrome. A case report (author's transl)]. / La sindrome di Nelson. Contributo casistico.

Two cases of Nelson syndrome with typical clinical and laboratory features are presented. Both had radiological evidence of pituitary tumor; in one case it was evident on the plain film while in the other one it was better appreciated by means of tomography. It is important in the post-surgery follow-up of patients who underwent bilateral adrenectomy for Cushing's disease a periodical evaluation of skin pigmentation, visual field width and sellar morphology for the early detection of a pituitary adenoma.

[Arterio-biliary crossing on the common bile duct (author's transl)]. / Croisement artério-biliaire sur la voie biliaire principale.

Three cases of crossing between the hepatic artery and the common bile duct, causing different grades of biliary obstruction, are reported. The diagnosis of this anatomical variation, usually asymptomatic, is possible by operative cholangiography, during cholecystectomy.