Evaluation of second cancer induction risk by CT follow-up in oncological long-surviving patients.

The goal of establishing prompt localization of the malignant spread or recurrence of a tumor has found a powerful solution in the definition of follow-up protocols, which include the indication for CT scans on an annual or semiannual basis. In the case of long-surviving patients, however, this approach will lead to a considerable integrated dose level over a period of several years after recovery from the illness. Pathologies treated primarily by surgery and/or chemotherapy have been considered, not taking into account cancers treated with adjuvant or radical radiotherapy. Given that the most likely protocols for these cancers often call for total body scans, an estimation of the consequent effective and organ doses can be performed with acceptable accuracy. The data acquired from five centers have been collected and the related effective and organ doses calculated by means of IMPACT software. Use of the effective dose concept, however, has lately become the subject of criticism, and the recently proposed Effective Risk Model has therefore also been applied. The evaluated absolute additional risk of second tumor induction ranges between 0.1% and 10%, depending primarily on age and pathology. These results depict this additional risk as an issue of significant importance for clinical practice. A revision of follow-up and scan parameter protocols, as well as the introduction of new algorithms for dose reduction, could significantly improve the risk-benefit ratio for all the pathologies studied.

[Angiographic diagnosis in intestinal angiodysplasia. Series of 13 cases]. / Diagnosi angiografica dell'angiodisplasia intestinale. Osservazione di 13 casi.

The authors report 13 cases of intestinal bleeding; while serials endoscopic and radiological examinations had been negative, arteriography allowed intestinal angiodysplasia to be diagnosed, and detected 18 lesions (12 of the right colon, 6 of the small bowel), confirming the fundamental role of arteriography in the diagnosis the localization and extension of these lesions. The importance of accuracy is emphasized both in the performance and in the evaluation of angiographic findings, in order to avoid missing multiple localizations (colon and small bowel). The authors illustrate and evaluate the different angiographic findings. Among these, the collection of contrast medium into parietal vascular lacunae and the early and dense opacification of the draining veins appear to be the most specific and frequent findings of angiodysplasia. In their series of patients the authors have also observed how the dilatation of the feeding artery, up to the antimesenteric side (a sign which is hardly ever reported in literature), was often present in the cecal localizations but could never be observed in the small bowel. Finally the surgical results and follow-up are considered.

[Arrhythmogenic dysplasia of the right ventricle. Evaluation of 7 cases using computerized tomography]. / Displasia aritmogena del ventricolo destro. Valutazione di 7 casi mediante tomografia computerizzata.

Right ventricular arrhythmogenic dysplasia is a rare cardiomyopathy which involves the right ventricle either totally or partially. Up to now diagnoses have been based on Ecg, hemodynamics, angiography and echocardiography. This paper deals with the first 7 patients examined also by means of Computed Tomography. The CT picture is well defined and rather accurate. The most important elements are: total (6/7) or partial (1/7) enlargement of the right ventricle; thinning of right ventricular myocardium (6/7); marked increase in subepicardial fat limited to the right ventricular wall (7/7); right ventricle hypokinesia (7/7). A good correlation exists between CT, echographic and traditional methodologies findings. Because of its densitometric evaluation, CT is much more precise in the demonstration of fatty degeneration. Moreover, it can be very useful in differentiating intracardiac thrombi from hypertrophic papillary muscles and trabeculae.

[Thrombosis of the false lumen in acute aortic dissection. CT diagnosis]. / Trombosi del falso lume nelle dissezioni aortiche acute. Diagnosi TC.

Three cases are reported of acute aortic dissection with complete thrombosis of the false channel, which is a very uncommon event in De Bakey's I and II type aortic dissections. The 3 patients entered hospital because of severe thoracic pain without any ECG sign of myocardial infarction. Emergency CT showed evidence of pericardial effusion suggesting hemopericardium, enlargement of the ascending aorta and a peripheral semilunar filling defect which caused a slight deformation of the true channel. On precontrast scans, only one case showed inward displacement of peripheral intimal calcifications and high-density aortic wall. No typical signs of aortic dissection were reported, except in the first patient--where a double contrast filled lumen, separated by an intimal flap was seen. CT findings are individually discussed. It is emphasized that in all patients more than one CT sign was present at a time. The correct evaluation of these signs together with the clinical data could lead to the right diagnosis of aortic dissection in spite of the lack of a filled false channel.

[Heart transplants. The value of computerized tomography]. / I trapianti cardiaci. Valore della tomografia computerizzata.

In 9 of 12 patients who underwent cardiac transplantation computed tomography was performed. In 5 of them CT was obtained also before the surgical treatment. In all patients angio-CT technique was performed, while the ECG-gated technique was employed only before surgery. CT shows changes in morphology of both atria but over all of the right one, and rotation of the heart on the longitudinal axis. The conditions of the pericardium are particularly well demonstrated: in 5 cases pericardial effusion was observed, 3 times localized and 2 times diffuse. Only in 1 patient a small thrombus in the right atrium was demonstrated. CT allows the possibility to obtain simultaneously information on mediastinum, lungs and pleura. Pleural effusion, pulmonary infections and mediastinal complications are easily demonstrated.