Peripheral arterial occlusive disease: role of MR angiography.

PURPOSE: Magnetic resonance angiography (MRA) has recently become instrumental in the diagnosis of arterial disease in various body districts and is gaining an increasingly important role in the study of peripheral vascularisation. The aim of our study was to evaluate the reliability of MRA using digital subtraction angiography (DSA) as the reference standard. MATERIALS AND METHODS: Between November 2003 and August 2004, 30 patients with known peripheral arterial disease were studied by MRA and DSA. MRA was performed with a Philips Intera 1.5 T, with acquisitions from the coeliac trunk to the feet. For acquisitions of the feet and ankles we used unenhanced time-of-flight (TOF) sequences with a head coil. The angiographic sequence was acquired in three volumes of 40-45 cm after administration of paramagnetic contrast material. RESULTS: In the patients with peripheral arterial disease, the technique provided a precise evaluation of the stenosis (mild, moderate, severe) or obstruction of the peripheral district as well as the detection of other diseases, such as stenosis of the renal arteries or aneurysms. CONCLUSIONS: Total-body three-dimensional (3D) MRA allows a fast, safe, and accurate assessment of the arterial system in patients with arteriosclerosis and can be considered an alternative to DSA in the management of patients with steno-obstructive disease of the peripheral arteries.

[Percutaneous positioning of port catheter in the hepatic artery for chemotherapy of metastases using the Arai technique]. / Posizionamento percutaneo di catetere di Port nell'arteria epatica per la chemioterapia delle metastasi secondo la tecnica di Arai.

INTRODUCTION: Liver metastases from colorectal, gastric and breast cancers are a very frequent event; these metastases are treated with cycles of intraarterial chemotherapy with a permanent catheter positioned in the hepatic artery or with surgical or interventional radiology techniques. We tested Arai's technique and its feasibility and evaluated the efficacy of this chemotherapy schedule. MATERIAL AND METHODS: Four patients with liver metastases from colorectal carcinoma were treated with combined systemic and locoregional chemotherapy with a permanent catheter placed in the hepatic artery according to Arai's technique. Arai's technique consists in studying the hepatic vascularization and then redistributing hepatic flow in case of multiple hepatic arteries; the vessels in which the infusion of chemotherapies could cause toxicity are then occluded and finally a catheter is positioned in the hepatic artery with subclavian artery catheterization and the connection with a subcutaneous reservoir for injection--the port-a-cath system. We planned CT examinations to study liver morphology and radiographs of the abdomen and chest to depict the catheter position and patency, respectively. RESULTS: The catheter was positioned correctly without any complications in all patients, as planned. We administered 37 cycles of combined systemic and locoregional chemotherapy in all. Two patients died of disease progression after 6 months but the other 2 are still alive and CT showed partial disease remission. We observed no catheter dislocation or occlusion at chest radiography and transport angiography, respectively. CONCLUSIONS: Infusion chemotherapy in the hepatic artery from permanent catheters is widely accepted in our country and we believe that Arai's technique could be an alternative to the more classic and established surgery. The small number of our patients and the short follow-up do not permit definitive conclusions to be drawn on the clinical efficacy of this combined systemic and intra-arterial treatment.

[Intra-arterial chemotherapy in locally advanced or recurrent breast neoplasms]. / La chemioterapia intraarteriosa nella neoplasia mammaria localmente avanzata o recidiva.

Intraarterial chemotherapy is studied as an alternative procedure for the neoadjuvant treatment of locally advanced and recurrent breast cancer. Our study was aimed at investigating the feasibility, the toxicity and the local response rate of an intraarterial chemotherapy regimen including 5-fluorouracil, epirubicin and mitomycin. These drugs were administered angiographically into the subclavian and internal mammary arteries ipsilateral to the lesion. We treated 20 women with a median age of 58 years (range: 42-74 years); 12 patients had locally advanced breast cancer with a median tumor size of 12 cm (range: 6-20 cm) and 8 patients exhibited cutaneous, thoracic or axillary recurrences, with a median lesion size of 6 cm (range: 3-12 cm). In all, we administered 54 cycles of chemotherapy drugs (mean: 2.7 cycles a patient). Most patients were submitted to selective catheterization of the internal mammary artery (44/54 cycles); all the drugs were injected into the subclavian artery only when catheterization of this vessel was unfeasible. No angiography-related toxicity was observed. No systemic, particularly hematological, toxicity was observed. Four patients exhibited skin erythema in the feeding region of the internal mammary artery, 2 hemialopecia, 1 cutaneous steatonecrosis and 1 transient hemiplegia. We obtained 1 complete remission and 11 partial responses, with 60% overall response rate (12/20 patients). All the patients with locally advanced breast cancer had an objective response and the mean interval between the start of therapy and radical mastectomy was only 49 days. In conclusion, intraarterial chemotherapy for locally advanced or recurrent breast cancer is a feasible and well-tolerated tool which needs further studies, particularly to assess its efficacy.

[Primary non-Hodgkin's lymphoma of the bone. Description of 2 cases]. / Linfomi non Hodgkin primitivi dell'osso. Descrizione di due casi.

Primary bone non Hodgkin's lymphomas (PBL) are approximately 5% of extranodal lymphomas and 5% of all primary bone tumors. A standard treatment has not been codified yet. The most received only radiotherapy but recently it was introduced combined modality treatment with radiotherapy plus chemotherapy or chemotherapy alone. The authors describe two cases of high grade PBL that received combined treatment with chemotherapy (VACOP-B regimen and monochemotherapy with mitoxantrone respectively) and radiotherapy. The patients achieved complete remission and up to day are alive and disease free at 33 and 15 months from the diagnosis respectively.