[Carcinoma of the pancreas. Typical and atypical aspects using midfield-strength magnetic resonance]. / Carcinoma del pancreas. Aspetti tipici e atipici con Risonanza Magnetica con media intensità di campo.

Until few years ago, MR assessment of pancreatic carcinoma was thought to be feasible only with high-strength equipment, but today also low- and midfield units allow pancreatic lesion detection, thanks to parameter optimization. The authors retrospectively analyzed the MR findings of 57 patients examined with a midfield MR unit; all the patients had clinically suspected pancreatic carcinoma, which was confirmed in 54 cases. The lesions were more easily detected using T1-weighted sequences, thanks to their high intrinsic contrast, while T2-weighted sequences often confirmed the glandular changes already depicted by T1-weighted sequences. MRI correctly depicted vascular and lymph node involvement and detected liver metastases with no i.v. contrast agent injection. The only limitations of this technique are the unfeasibility of MR exams of diagnostic value in uncooperative patients (5% of cases) and the very similar MR features of parenchymal scars, due to previous acute pancreatitis, to those of pancreatic carcinoma. In conclusion, CT remains the gold standard in the study of pancreatic cancers, but midfield strength MRI, if correctly performed, can be proposed as a complementary tool to CT, especially in questionable cases and in the patients with known reactions to iodinated contrast agents.

[Magnetic resonance in the study of inflammatory diseases of the pancreas]. / La Risonanza Magnetica nello studio delle malattie infiammatorie del pancreas.

The role of diagnostic imaging modalities in pancreatic inflammatory diseases is to assess gland damage and peripancreatic tissue involvement. The artifacts related to breathing and to peristaltic movements can be partially resolved with the optimization of acquisition parameters, which allows MRI to be suggested for the assessment of pancreatic inflammatory conditions. Sixty-nine patients with pancreatic inflammatory diseases (20 acute and 49 chronic pancreatitis cases) were examined. MRI was performed with a 0.5-T superconductive magnet and T1- and T2-weighted spin-echo (SE) sequences. In 4 of 20 acute pancreatitis patients image quality was poor. MRI in acute pancreatitis demonstrated glandular edema, intraparenchymal necrosis and the extent of peripancreatic fluid collections; in chronic pancreatitis MRI depicted glandular atrophy and Wirsung duct dilatation and detected the presence of pseudocysts. Even though its spatial resolution is lower than that of CT, MRI can provide useful pieces of information in inflammatory diseases of the pancreas, much more so after the introduction of Fast SE sequences and of fat-saturation techniques which are likely to make MR examinations of the pancreas more widely used.

[Characterization of hypertrophic cardiomyopathy with magnetic resonance]. / Caratterizzazione della cardiomiopatia ipertrofica con risonanza magnetica.

We selected 15 patients with hypertrophic cardiomyopathy (HCM) and 5 with secondary myocardial hypertrophy (SMH). All patients were examined by means of Magnetic Resonance Imaging (MRI) and echocardiography. The MR study was performed with gated T1- and T2-weighted spin echo sequences and cine MRI. We correlated echocardiographic and MRI measurements and found a correlation coefficient (R) of 0.72 for apex thickness, r = 0.84 for posterior wall thickness, 0.76 for the lateral wall and 0.89 for the area at papillary level. Cine MR acquisitions showed signal loss in the systolic phase at the outflow tract in 9 obstructive HCM patients, which was consistent with echocardiographic color Doppler findings. The signal intensity of myocardial tissue was analyzed with MRI. The values were correlated with those of the skeletal muscle. We performed the paired sample t-test on T1- and T2-weighted spin echo sequences between the signal at the septum and that of the free wall in the 15 HCM patients. The analysis showed significant differences on T2-weighted sequences (p < 0.02). Unpaired t-test was performed between the 15 HCM and the 5 SMH patients; the analysis showed significant differences on both T1- (p < 0.01) and T2-weighted sequences (p < 0.04).

[Magnetic resonance in gallbladder carcinoma. Its diagnostic reliability]. / La risonanza magnetica nel carcinoma della colecisti. Affidabilità diagnostica.

The use of magnetic resonance imaging (MRI) to study the liver is currently on the increase. Our study was aimed at evaluating MR diagnostic reliability in the detection and staging of gallbladder carcinomas. Thirty-one patients with gallbladder carcinoma were studied. MRI was performed with a 0.5 T superconductive magnet, using spin-echo (SE) T1- and T2-weighted sequences and gradient-echo (GE) refocusing sequences to evaluate portal system patency. Sixteen patients underwent surgery, while 24 were submitted to angio-CT. MR findings correlated well with angio-CT results. In 4 cases only MRI could not define tumor extent due to the presence of breathing artifacts. In 6 cases the tumor was identified at intracholecystic level, while in 21 cases it involved gallbladder fossa and infiltrated liver parenchyma. In 10 of these patients, the lesion involved also the hepatic hilum, while 7 patients exhibited liver metastases. Twenty patients presented lymphadenopathy at both the hilum and the portocaval space. In 8 patients GE refocusing sequences allowed the evaluation of neoplastic thrombosis of the portal vein. Of 16 patients who underwent surgery, MRI underestimated 2 cases--namely, the presence of micrometastases in one case and tumor spread greater than demonstrated by MRI in the other case. To conclude, in our experience MRI can be considered a valuable diagnostic technique to detect and stage gallbladder carcinomas.