Staging and follow-up of nasopharyngeal carcinoma: magnetic resonance imaging versus computerized tomography.

PURPOSE: To compare computerized tomography (CT) and magnetic resonance (MR) in relation to their accuracy in the staging of nasopharyngeal carcinoma (NPC); to compare CT and MR in postirradiation follow-up of NPC. METHODS AND MATERIALS: Staging: From 1985 to 1993, 53 patients affected with NPC were studied with MR and CT. All cases were biopsy-proved epithelial carcinoma. Plain and contrast-enhanced CT scans were performed with third-generation scanners. Magnetic resonance were obtained with 0.5 and 1.5 Tesla units in sagittal, axial, and coronal planes. Computerized tomography was chosen as reference method and findings obtained with MR were compared to those obtained with CT. FOLLOW-UP: From 1985 to 1993, 53 patients irradiated with radical intent were followed up with both CT and MR; 71 examinations were performed in all. The baseline follow-up scan was performed, in general, no sooner than 2 months after the end of radiotherapy. All patients were submitted to unlimited clinical follow-up. RESULTS: Staging: Magnetic resonance showed retropharyngeal adenopathies in 6 of 14 cases in which oropharyngeal involvement had been reported after CT; in 3 other patients, adenopathies were recognized on MR, while primary extent to parapharyngeal space had been diagnosed on CT initially. Infiltration of long muscles of the neck was revealed with MR in 14 cases. On the other hand, CT showed bone invasion in 12 patients vs. 8 on MR. Upstaging to T4 occurred in four cases on the basis of CT; no upstaging occurred after MR. FOLLOW-UP: Findings on CT were uncertain in 10 out of 53 patients, disease recurrence was excluded by MR in nine cases, whereas progressive disease was confirmed in one patient. CONCLUSION: Staging: Our series shows that either CT and MR can provide essential information in the staging of NPC. Magnetic resonance, however, seems to provide the most detailed imaging of soft tissue invasion outside the nasopharynx and of retropharyngeal node involvement. Nonetheless, its limitations in evaluating bone details suggest that CT should be always performed when the status of base of skull is uncertain on MR. General reasons and our data indicate that CT can still be considered a valuable tool in routine NPC staging. Follow up: Magnetic resonance may be the modality of choice because it seems to solve, more often than CT, the problems of differentiation between postradiation changes and recurring tumor, apart from those cases showing subtle bone erosions on initial CT scan.

[The role of CT and MR in assessing the patient operated on for rectal carcinoma: the local recurrence of the disease]. / Ruolo della TC e della RM nella valutazione del paziente operato per carcinoma rettale: recidiva locale della malattia.

Computed tomography (CT) and magnetic resonance (MR) findings in a series of 27 patients treated surgically for rectal cancer (13 rectal amputations, 8 sphincter-saving resections and 6 with the Hartmann technique) and affected with local recurrence at the time of examination (1989-1993), were retrospectively reviewed. Every detected lesion was studied relative to morphologic features (shape, outline, surrounding tissue involvement, symmetric growth toward the mid-longitudinal plane), patterns of both CT contrast enhancement and MR signal intensity with different acquisition techniques. The most typical patterns of disease recurrence were: a roundish or nodular shape (the whole group of rectal amputations), irregular outline (25 of 27 cases), infiltrative growth (23 of 27), asymmetry (25 of 27), CT enhancement > 20 HU (24 of 27), medium-high MR signal intensity on T2-weighted images (26 of 27 cases). We report on 5 cases with no positive correlation between CT enhancement and MR signal on T2-weighted images, trying to correlate this disagreement with specific histopathologic patterns.

[Role of CT and RM in postoperative evaluation of the patient after rectal carcinoma surgery: postoperative anatomy and nonneoplastic sequelae]. / Ruolo della TC e della RM nella valutazione del paziente operato per carcinoma rettale: anatomia post-chirurgica e sequele non neoplastiche.

The CT and MRI findings in a series of 57 patients submitted to curative surgery for rectal cancer, 1989 to 1993, and locally free of disease at the time of examination, were retrospectively reviewed. Both postoperative anatomy and tissue repair features were studied relative to the different surgical approaches, i.e., rectum amputation, sphincter-saving resection, Hartmann technique. The retrospective analysis of CT and MR findings led to the identification of some signs rather typical of every predictable non-malignant postoperative event, with max accuracy when radiologic findings were correlated with clinical and laboratory findings, as well as with the results of baseline study performed about 3-6 months after surgery. Florid granulation tissue exhibited marked enhancement after i.v. contrast agent administration and high signal intensity on T2-weighted MR scans: such questionable findings as a pseudonodular pattern were often clarified on multiplanar MR images by the identification of normal anatomic structures within repairing scar tissue. The major features exhibited by fibrosis were low signal intensity on T2-weighted MR scans, laminar or spindle-like shape and some retraction of the surrounding tissues. Poor enhancement after i.v. contrast agent administration proved to be a less reliable diagnostic criterion. Abscesses were identified because of their water-like content and ring of peripheral enhancement, both easily demonstrated on CT scans. The differential diagnosis of necrotic colliquative recurrence required clinical correlation with a careful morphologic analysis of lesion outline. Non-colliquative inflammation exhibited no typical CT/MR features suggestive of diagnosis. Finally, radiation fibrosis was characterized by laminar pattern but its enhancement patterns and MR signal behavior were quite different from postoperative scar tissue: irregular enhancement spots and fairly high signal areas were often observed in these patients even months and years after radiation exposure.

[Impact of diagnostic imaging on: staging, results and follow-up of rhinopharyngeal carcinoma]. / Impatto della diagnostica per immagini su: stadiazione, risultati e follow-up nel carcinoma rinofaringeo.

Ninety-seven patients affected with nasopharyngeal carcinoma (NPC) were examined with both conventional and Computed Tomography (CT) to evaluate the involved sites with both methods. CT staging was more accurate, showing involvement in more locations than conventional tomography, so that staging was modified in 23 of 97 patients. Two hundred and seventeen patients treated from 1970 to 1985 were subdivided into group A (111 patients who underwent conventional tomography only) and group B (106 patients examined with CT, from 1978 on). A trend toward more advanced stages at presentation was observed in group B; nevertheless, local control at 5 years was higher in group B (59%) than in group A (42%). The role of Magnetic Resonance (MR) imaging in NPC staging was also evaluated in 30 patients: there was disagreement in 2 cases. Involvement of different structures was shown in 10 of 28 cases with the same CT and MR staging. MR imaging proved a valuable tool in the follow-up as well: in fact, it clarified 12 questionable opacities on CT in a group of 35 followed patients as inflammatory lesions in 10 patients and tumors in 2.

Association between testicular cancer and spina bifida occulta.

Data are reported suggesting a high incidence of spina bifida occulta among testicular cancer patients. The relevance of a diagnosis of spina bifida occulta as a risk factor for testicular cancer is discussed, also considering the background information available on a common genetic origin for some urogenital malignancies which are often associated with different types of malformations.

Computed tomography in nasopharyngeal carcinoma: Part I: T-stage conversion with CT-staging.

Two hundred seventeen consecutive patients were treated with radiotherapy alone, with curative intent, from 1970 to 1985 at the Radiotherapy Unit of the University and Hospital of Florence. The distribution according to T and N staging with polytomography was compared to patients (106 out of 217) who had CT scans done at presentation. T1 cases were less frequent (6.6% vs 27%) in the CT-staged series, whereas T3 showed a higher incidence (30.2% vs 12.6%). The advantages of CT over conventional tomography were quantitated in a subset of 97 patients who underwent both staging procedures. Site-by-site, CT displayed a higher percentage of involvement than polytomography: parapharyngeal spread 18% vs 2%, oropharynx 16% vs 8%, choanae and nasal cavities 28% vs 13%, ethmoid and maxillary sinus 29% vs 13%. Information provided by CT caused a T-stage conversion in 23 out of 97 cases (23%): 4 out of 11 T1, 16 out of 44 T2, 3 out of 16 T3.

Computed tomography in nasopharyngeal carcinoma: Part II: Impact on survival.

Two hundred and seventeen consecutive patients affected by nasopharyngeal carcinoma (NPC) were treated with radiotherapy alone, with curative intent, from 1970 to 1985 at the Radiotherapy Unit of the University and Hospital of Florence. A group (A) of 111 patients staged with conventional clinical and radiological method was compared to a second group (B) of 106 patients who underwent CT staging before treatment. Group B showed better 5-year NED survival and local control; only the differences in local control were significant (p less than 0.01). As to primary control statistically significant differences were observed in T2 and T4 cases. We feel that CT could have contributed to the improvement, probably through a more reliable display of the primary extent and a more adequately planned radiotherapeutic treatment. With CT staging we could not increase our skills in prognostically separating stages according to UICC criteria (1978); in Group B only T2 patients presented significant differences in primary control when compared to T3 and T4 patients. However, a multivariate analysis of prognostic factors showed that nodal involvement, primarily, and histology, secondarily, were the most important factors; T stage showed a minor influence on prognosis.

[Renal volume and human somatic type]. / Volume renale e tipologia somatica umana.

The abdominal C. T. of 128 patients (45 women and 83 men) aged more than 25, without any history of renal disease, have been analyzed by an evaluation computer. By the measure of the areas of kidney in each C. T. scan, the volume of the whole organ has been calculated. In men the volume resulted to be cm3 167 +/- 84,6 (M. +/- S.D.) for the right kidney and cm3 170 +/- 58 for the left one. In women it was cm3 142 +/- 54,9 for the right kidney and cm3 156 +/- 54,5 for the left one. The volumes of the organs collected into 3 classes according to their dimension, have been compared to the 3 somatic types of the subjects (Mega, Medium, Micro) obtained following the Brian & coll. method. Using a test for a monotonic trend for two ordered variables, no significant association has been demonstrated between the volume of the kidney and the human somatic type.

Plasma amylase activity as a biochemical indicator of radiation injury to salivary glands.

Irradiation of the salivary glands produces a rapid increase of salivary amylase in serum, released by the highly radiation sensitive serous cells of the glands. Serial assays of salivary amylase in serum were performed in patients treated by radiation to the upper neck region. The changes observed were compared with the amount of salivary gland mass irradiated and with the dose fractionation modality used. The irradiated volume included either the entire salivary gland mass or less than 50 per cent of the gland. Two fractionation modalities were used: a conventional fractionation of 2 Gy per day, 5 times a week, or a multiple daily fractionation of 2 Gy, 3 times a day in two series of 4 days with a 4-day interval. Both parameters (salivary gland mass irradiated and fractionation modality used) significantly influenced the shape of the amylase curve in the serum. Serum amylase may therefore be considered a reliable biologic indicator of early injury to the salivary glands.

Enzyme activities in ageing small intestine and modifications after irradiation.

Brush border enzyme activities in control rats of different ages were studied. Disaccharases, dipeptidases and alkaline phosphatase levels were similar in both age groups. When the rats were sacrificed at two different times of the day the activity was significantly lower in the morning than in the evening in both adult and young animals. No similar differences were observed in lysosomal activities. After irradiation the enzyme activities in both groups presented the same patterns although variations were more marked in adult animals. At 120 hrs the tendency to return to control levels appeared less evident in adult rats. Morphologic data confirmed these results.

The diagnostic efficacy of mammography and palpation in early detection of breast cancer.

The diagnostic efficacy of mammography and physical examination, separately and considered together, are evaluated in 912 cases of breast cancer detected at the Center for Social Diseases of the Florence District, where there is a mass-screening program (110 cases) and a diagnostic service for self-referred women (810 cases). The overall sensitivity of the 2 methods increases with age; the trends of diagnostic efficacies of mammography and palpation according to age are similar, except in the 40-44 year age group, in which physical examination has a lower percentage of false-negative cases. In the screening group, there is a greater proportion of nonpalpable cancers and mammography has a larger diagnostic efficacy except in the 40-44 year age group. These results agree with the better sensitivity of mammography in smaller lesion (TI) and with the larger proportion of noninterpretable mammographies in younger women, because of the density of mammalian glands.

Radiation effects on the parotid gland of mammals. Part 4: Biochemical and morphological changes after local irradiation.

A morphological and biochemical study was done on rat parotids to evaluate the modifications after 2400 rad in the parotid area only. As previously observed, whole-body irradiation with lower doses produced only slight effects on the gland. The enzymes peculiar to glandular function decreased significantly 3 days after irradiation, later they fluctuated on control values. Increase in alkaline phosphatase, LAP, and decrease in protein content was a constant result. Beta-glucuronidase only among lysosomal enzymes increased significantly at some intervals. Morphological alterations in the glandular sections of the sacrificed animals appeared modest and mostly consisted of progressive fibrosis.

Radiation effects on the parotid gland of mammals. Part 2: Modifications of plasma and parotid amylase activity.

The early modifications of the activity of plasma and parotid amylase have been evaluated in rats after whole-body irradiation in different experimental conditions. The modifications observed in the rat are less evident than in humans. The results have shown an initial decrease and a subsequent increase appearing significant 74 hours after irradiation. This could be due to a direct action of ionizing radiation on the parotid glands. However we cannot exclude that the increase of alpha-amylase could be determined by the intestinal radiation syndrome. In fact, this syndrome leads to a reduced food uptake, and consequently alpha-amylase could accumulate in parotids.

Radiation effects on the parotid gland of mammals. Part 3: Behaviour of enzyme activity after irradiation.

Modifications of some enzyme activities in parotid tissue homogenates have been studied in animals which were also examined for morphological changes and for plasma and parotid amylase activity. Results from irradiated animals show a certain increase in maltase activity. Alkaline phosphatase and LAP show no significant variations; a similar behaviour is shown by lysosomal enzymes and protein content. A different pattern was seen by comparing the curves of these enzymes with those of the same activity in the small intestine. This result appears to be due to the different radiosensitivity of these tissues.

Radiation effects on the parotid gland of mammals. Part 1: Modifications on the morphology and uptake and elimination after 14C-leucine administration.

U-14C-Leucine uptake and eliminaton in connection with morphological investigations after sublethal doses have been studied. The tracer uptake and elimination curves do not show significant differences between controls and irradiated animals, except for early appearance of initial peaks. An increased uptake of labeled amino acid was observed only 32 and 120 hours after irradiation, when sacrifices were done at the same hours of the day. The dose employed does not seem to affect in any significant way either the acinar and duct cells or other structures. Only a mild thickening of the connective tissue has been observed in the parotid of animals sacrificed at longer intervals.

Water (electrolyte) balance after abdominal therapeutic treatment.

Total body water, plasma volume and Na space have been studied in 34 patients receiving external radiotherapy on the pelvic region. Determinations were made on the same patients before, and half-way treatment; in a few cases, some determinations were also repeated after the end of treatment. The results failed to show any appreciable modification of the different parameters studied.