[The 3rd national workshop on defecography: the functional radiology of (neo) rectal ampullae (ileal reservoir, colo-anal anastomosis, continent perineal colostomy)]. / III workshop nazionale sulla defecografia: la fisioradiologia delle (neo)ampolle rettali (reservoir ileale, colo-ano-anastomosi, colostomia perineale continente).

A survey was made in 13 Italian centers with a questionnaire concerning the (a) indications, (b) postoperative complications, (c) functional results and (d) diagnostic imaging modalities related to the making of an ileal or colonic (neo) rectum. Ulcerative colitis (100%), familial polyposis (61.5%) and Crohn's disease (15.3%) were the most common indications for an ileal pouch; rectal cancer (7.96%), chronic inflammatory diseases (15.3%), diverticulosis, rectal prolapse, redundant colon and imperforate anus (7.6% each) were the most common indications for a colonic pouch. Postoperative complications included pelvic abscess (14%), sinus tract/dehiscence (10%) and bowel obstruction (9%). When compared with the S and W variants, the J-shaped ileoanal pouch proved superior because urgency and fecal retention rates were lower (18.4% vs. 44.4% and 23% vs. 28.6%, p < 0.01 and p < 0.05, respectively), despite slightly more frequent staining episodes (15.8% vs. 11.1%; p < 0.05). As for colonic ampullae, fecal retention and provoked evacuation were more frequent in the J pouch and after gracileplasty; urgency and incontinence in the straight colo-anal anastomosis (33.3% vs. 22.2% and 41.6% vs. 33.3%, respectively). The functional outcome was assessed by anal endosonography (available in 4/13 centers), defecography and anorectal manometry. Abnormal findings included: (a) reduced capacity, barium leakage, anal gaping, sphincter damage (urgency and incontinence); (b) barium retention, pouch dilatation, split evacuation, knobs and strictures (fecal retention).

[The National Workshop on Defecography: anorectal deformities with a functional origin (prolapse, intussusception, rectocele)]. / II Workshop Nazionale sulla defecografia: le deformità ano-rettali con origine funzionale (prolasso, intussuscezione, rettocele).

The nonoperative treatment--i.e., rubber band ligation and sclerotherapy--of mucous rectal prolapse, rectocele and intussusception is much less expensive than conventional surgery (Lit. 325,000 vs. 6,500,000, p < 0.0001 on the average). Symptom relief, however, has been reported in 0 to 57% of cases only, according to current literature. A possible cause is represented by improper management from misdiagnosis, relying on clinical findings only, overestimating mucous prolapse in 36.37% of cases and underestimating intussusception in 14.22% of cases (with respect to defecography). Defecography is a cost-effective method (average cost: Lit. 37,000) potentially reducing failure rate after the surgical repair of rectal prolapse.

[National working team report on defecography]. / "Working team report" nazionale sulla defecografia.

A questionnaire concerning defecography was submitted to 5 national experts in order to: 1) quantify the demand and 2) develop a consensus report. The demand is currently 2-8 exams week and the most frequent indication (70%) is obstructed defection, with/without constipation. The highest discriminatory capabilities was exhibited by the following variables: a) the anorectal angle (ARA) on straining and b) the distance from the pubococcygeal line (PCL) on squeezing (101.2 degrees +/- 15 vs. 120.6 degrees +/- 13, p < 0.05 and 27.4 mm +/- 15 vs. 2.4 mm +/- 7, p = 0.005, respectively) in chronically constipated patients (mean age: 60 years) when compared to the control group; and c) PCL on squeezing and at rest (35.5 mm +/- 20 vs. 2.4 mm +/- 7, p = 0.005 and 38.9 mm +/- 18 vs 18.4 mm +/- 17, p < 0.05, respectively) in patients with severe incontinence with respect to healthy subjects. While sensitivity and positive predictive values of the test were highest (97 and 98% respectively) for rectocele, specificity ranked first (92%) in anal gaping.

[Quantitative evaluation of blood in vivo with computed tomography]. / Valutazione quantitativa del sangue in vivo mediante Tomografia Computerizzata.

A positive correlation between the attenuation values of blood in vitro and hemoglobin concentration has been described by other authors. Our study is aimed at: 1) investigating the influence of artifacts on the measurement of blood density in vivo, 2) verifying the possible correlation between blood values and Hounsfield's units (HU) in vivo, 3) assessing whether such a correlation may be useful in calculating hemoglobin concentration, 4) investigating whether a significant difference in blood density exists between normal and anemic subjects, and 5) investigating the eventual borderline density values which separate the two populations. Fifty adult patients underwent CT of the upper abdomen for several clinical reasons. Twenty-six males, mean age 63 +/- 15 SD, and 24 females, mean age 63 +/- 14 SD, were included in our series. The two groups were then subdivided into two additional groups including anemic and normal subjects -14 g/dl and 12 g/dl being taken as the borderline values for males and females, respectively. Blood density was measured after defining two regions of interest (ROI) on the aorta and inferior vena cava. The results show that: 1) there are few image artifacts, which are sometimes detected only because of different numbers in aorta and vena cava; for quantitative blood measurement, 4 HU was considered as an acceptable difference; 2) the correlation between HU and hemoglobin concentration which was found in vitro was also seen in vivo (r = 0.76, p < 0.001). Furthermore, high positive correlation was observed between attenuation values and red cell count (r = 0.68) or hematocrit (r = 0.75). 3) However, this correlation cannot be used to calculate the patients's blood count since HU dispersion relative to the regression line is too high. The straight line of regressed computation, reporting the density values on the abscissa axis, shows a b = 0.33 slope and the intersection point is a = -1.43, SE b = 0.04, SE a = 1.76 and SE estimate = 1.56. When the mean density value was 43 HU in our sample, the expected hemoglobin value was 12.76 g/dl (+/- 1.58 SD). 4) Nonetheless, a significant difference in blood attenuation values was seen between normal subjects and anemic patients (p < 0.001). 5) This difference identifies a borderline density value, below which the patient is sure to be anemic (99% confidence), but nothing else can be said on the patient's normality: the value is 33 HU for females and 36 HU for males. These values allowed 20% of anemic subjects to be correctly identified, versus 5% of the same group detected with diagnosis images.

Role of oral cholecystography, real-time ultrasound, and CT in evaluation of gallstones and gallbladder function.

The capacity of oral cholecystography (OCG), real-time ultrasound (RUS), and computed tomography (CT) to detect gallstones and to analyze their size, number, and composition was tested preoperatively in 37 patients undergoing elective cholecystectomy. Gallbladder response to a standard meal was also evaluated by OCG and RUS. Gallstones were analyzed chemically for calcium, cholesterol, and bilirubin content. The results show that RUS is the most valuable test for detecting gallstones and is similar to OCG in measuring their size and number, whereas CT underestimates the stone size. Gallbladder function in terms of contractibility can be evaluated by RUS and OCG, but RUS provides useful information even if the gallbladder is not opacified at OCG. CT is more accurate than OCG in detecting the presence of calcium, and CT attenuation numbers are positively correlated with calcium content of the stone (r = 0.87, p less than 0.01).

[Hepatic steatosis: combined echography-computerized tomography imaging]. / Steatosi epatica: imaging integrato ecografia-tomografia computerizzata.

The authors report their experience with the combined use of US and CT in the study of diffuse and subtotal fatty infiltration of the liver. An apparent disagreement was initially found between the two examinations in the study of fatty infiltration. Fifty-five patients were studied with US and CT of the upper abdomen, as suggested by clinics. US showed normal liver echogenicity in 30 patients and diffuse increased echogenicity (bright liver) in 25 cases. In 5 patients with bright liver, US demonstrated a solitary hypoechoic area, appearing as a "skip area", in the quadrate lobe. In 2 patients with bright liver, the hypoechoic area was seen in the right lobe and exhibited no typical US features of "skip area". Bright liver was quantified by measuring CT density of both liver and spleen. The relative attenuation values of spleen and liver were compared on plain and enhanced CT scans. In 5 cases with a hypoechoic area in the right lobe, CT findings were suggestive of hemangioma. A good correlation was found between bright liver and CT attenuation values, which decrease with increasing fat content of the liver. Moreover, CT attenuation values confirmed US findings in the study of typical "skip areas", by demonstrating normal density--which suggests that CT can characterize normal tissue in atypical "skip areas".

[Opaque enema and radiography of defecation in the pre- and postoperative morpho-functional evaluation of rectal neoplasms]. / Clisma opaco e defecografia nella valutazione morfo-funzionale pre- e post-operatoria delle neoplasie del retto.

From November 1989 to April 1990, 16 patients with rectal cancer were examined preoperatively by means of double contrast barium enema and defecography. Double contrast barium enema was used to identify the cancer: based on the distance of cancer from anal rima, the patients were divided into 3 groups: 1) less than 6 cm; 2) 6-11 cm; 3) more than 11 cm. In all patients defecography was performed at the end of barium enema to evaluate rectal wall mobility. Thus, the morphological information yielded by barium enema could be integrated with the dynamic data from defecography. The evaluation was thus possible of both longitudinal and, indirectly, transverse tumor spread. All the patients underwent surgery and radiological findings were compared with surgical ones. In those patients in whom defecography had shown rigidity of the rectal walls, extraparietal tumor spread was observed during surgical resection. Seven patients underwent anterior resection, and were subsequently examined by the same combination of barium enema and defecography. The combined use of the two methods was useful to evaluate the anastomosis and to show possible dynamic changes after surgery.

[Magnetic resonance angiography of the pulmonary artery. Preliminary considerations]. / Angiografia a risonanza magnetica dell'arteria polmonare. Considerazioni preliminari.

The possibility was evaluated of imaging the pulmonary artery with MR angiography. Twenty healthy volunteers were studied using 3D FT gradient-echo sequences on the coronal plane, with post-processing by the maximum intensity projection method. TE and TR remaining short, flip angles were selected to increase pulmonary artery signal in contrast with hypointense adjacent tissues and vessels. Flip angle selection allowed the optimal differentiation between pulmonary artery and aorta with 15 degree-25 degree angles (range: 110.7 to 122 for the 15 degree flip angle and 158.7 to 182.1 for the 20 degree flip angle). The sequence was obtained on the coronal plane and the following parameters were employed: TR 0.03 s, TE 10 ms, flip angle 15 degree-20 degree, slice of the total volume 100 mm with 64 partitions, 256 x 256 matrix, 1 zoom factor, 1 acquisition. The patient was positioned with the right hemithorax raised by 30 degrees to visualize the common pulmonary artery and lying on his back, face upward, to visualize the right and left pulmonary arteries. Post-processing employed axial plane rotations from -45 degrees to +45 degrees, with 5 degrees step, and from 0 degrees to 180 degrees, with 15 degrees step. Angio-MR images of the pulmonary artery allowed the visualization of its main components, up to its right and left lobar branches. The main limitation of this technique consisted in its poor spatial resolution.