[Diagnostic accuracy of computerized tomography. Preoperative staging of gastric cancer]. / Accuratezza diagnostica della tomografia computerizzata. Stadiazione preoperatoria del cancro gastrico.

"Imaging techniques" have assumed greater clinical value in the further assessment of an endoscopically or radiologically verified neoplastic lesion of the stomach through the ability to evaluate its extent of invasion, metastatic involvement of lymphnodes and/or distant organs. US, CT, and more recently NMR are non-invasive modalities that provide an accurate preoperative assessment of potential surgery decision making. Common current practice of preoperative CT in gastric cancer and relevant results documented in letterature, have inclined many clinicians in its use in staging this disease. The aim of the study is to evaluate and assign the efficacy of CT imaging in the preoperative staging of gastric cancer by comparing the results obtained with this imaging technique with the postoperative histopatologic findings of 25 patients with adenocarcinoma of the stomach. CT demonstrates the primitive lesion as a gastric wall differentiate T1 (parietal invasion extending to the lamina propria and submucosa) and T2 (invasion of the muscolaris propria and the submucosa). The performance values of CT in detecting tumor extension to the sierosa were as follows: sensitivity of 78%, specificity of 63%; and overall accuracy of 72%. The sensitivity and specificity of CT in demonstrating adjacent organ involvement were approximately 75% and 85% respectively, and overall accuracy of 84%. In the detection of metastatic involvement of lymphnodes CT demonstrated to be 70% sensitive, 62% specific with an efficacy of 68%. In terms of M-stage, CT imaging identified liver metastases in 3 patients (2 located in the VII segment and 1 in the IV) and 1 metastasis to the adrenal gland. All were confirmed by specimen histopathologic findings.

[Radiologic evaluation of parietal infiltration of bladder cancer (integrated imaging: US, TC, RM) and comparison with transurethral resection (TUR)]. / Valutazione radiologica dell'infiltrazione parietale nel carcinoma della vescica (imaging integrato: US, TC, RM) e valutazione in confronto con la resezione transuretrale (TUR).

In this work we checked the reliability of Ultrasounds (US), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) in the staging of parietal infiltration of bladder carcinoma. We studied 49 patients with documented bladder carcinoma. All patients underwent CT examination, 43 patients to MR examination and 40 patients to US examination. Between the patients who underwent US examination, 35 out of them had a sovra-pubic Ecography, 27 patients a trans-rectal Ecography and in 30 patients a trans-uretral Ecography was performed. After radiologic examination, all patients underwent a deep fractionated trans-uretral resection of the neoplastic mass (TUR) for the tumor staging. The results of the computed images and US examinations were then compared with the TUR staging. Among the group of patients studied with US, the agreement between imaging and TUR staging was respectively of 51% for the sovra-pubic study, 44.5% for the trans-rectal study and 56.7% for the trans-uretral study. The agreement was of 55% with the CT studies and 45.7% with the MRI. The sovra-pubic US studies showed a good correlation in the evaluation of superficial lesions (Tis-T1 stadied on TUR), if compared to the CT and MRI studies; moreover US is certainly more suitable because of its lower price and discomfort for the patient. On the contrary patients with a documented stage > T1 need a CT and MRI study for the correct staging. MRI has shown to be more sensitive in selected cases with localization of tumor on the top of the bladder roof, on its floor or in the follow-up after TUR. CT scan showed a better reliability in the staging of superficial lesions (Tis-T1 stages). On the contrary MRI has shown to be more sensitive in distinguishing superficial lesions (T1-T2 stages) from deeper lesions with muscles infiltration (T3a stage) on the basis of the loss of the parietal hypointense line on the T2 weighted images. Tumors with a grade T3b or more are well studied in both CT scan and MRI, which allow to get more useful information than US about the lynphoglandular involvement.

[Role of CT in the evaluation of patients with painful symptoms located in the lower right abdominal quadrant]. / Ruolo della TC nella valutazione dei pazienti con sintomatologia dolorosa in corrispondenza del quadrante addominale inferiore di destra.

Eleven patients presenting signs and symptoms related to flogistic disease of the right inferior abdominal region were studied with Computed Tomography. Four out of the eleven patients also underwent Magnetic Resonance examination. In 9 patients final diagnosis was correctly reached after surgery and in 1 case diagnosis was made on the basis of endoscopic findings and delayed echographic controls. Among the eleven patient a correct diagnosis was possible on the basis of CT findings in seven of the examined patients; 4 of them were correctly diagnosed as appendicitis; 1 case was diagnosed as Crohn disease; 1 case was a mucocele and 1 case was diagnosed as tubo-ovaric abscess. In 1 case no one diagnostic hypothesis was possible on the basis of CT and MR findings; on surgery the diagnosis was of appendicitis. In 2 cases of surgery proven tubo-ovaric abscesses a diagnosis of appendicitis was done on the basis of CT examination. In one case CT and MR findings were considered to be related to an ovaric tumor; on surgery the correct diagnosis was of post-surgical fibrosis. In 4 cases MR findings confirmed the diagnostic hypothesis reached with CT examination but only in two of them the final diagnosis was correct. In this paper we describe all the CT and MR findings found in each patient.

[Role of magnetic resonance in identification of biliary pathology. Comparison with other imaging techniques]. / Ruolo della risonanza magnetica nell'accertamento della patologia del sistema biliare. Confronto con altre techniche ad immagini.

We discuss in this paper the possibilities and limits of MR imaging in the evaluation of the biliary tree and its pathological aspects. We conclude that morphological aspects are the most important markers for differential diagnosis. Actually, signal intensity is not thought to be a decisive finding for differential diagnosis.

[Role of imaging technics in the identification, characterization and staging of lung neoplasms]. / Ruolo delle tecniche ad immagini nella identificazione, caratterizzazione e stadiazione delle neoplasie polmonari.

The findings in different imaging techniques in the diagnosis of bronchogenic carcinoma are discussed in this report. Conventional radiology is useful for diagnosis, but is insufficient for characterising and assessing the extension of neoplastic masses of the lung. CT and MR imaging are not essential for the diagnosis and characterization of these lesions, but they certainly allow a more accurate evaluation of staging than normal X-ray examination.

[Role of magnetic resonance in the evaluation of space-occupying mediastinal pathology]. / Ruolo della risonanza magnetica nella valutazione della patologia espansiva mediastinica.

All MR findings in the study of mediastinal masses are discussed in this report, with the aim of evaluating the reliability of MR imaging in this pathology. The results obtained in the assessment of the extension of these masses are very useful and MR imaging appears to be the most informative of all techniques. Masses originating from the thymus, cystic lesions, substernal goitre, and esophageal tumors were considered. MRI results were compared to those obtained by CT scan which is considered of proven reliability for the evaluation of mediastinal masses.

[Focal lesions of the spleen: contribution of magnetic resonance imaging]. / Lesioni focali della milza. Contributo delle immagini di risonanza magnetica.

MR findings in the study of focal splenic pathology are discussed in this paper. MR examination of the spleen shows some technical limits in the diagnosis of masses affecting this organ. On the contrary, the introduction of new paramagnetic contrast agents, with organospecific affinity, will no doubt improve the diagnostic power of MR imaging, in order to gain more information about these diseases.

[Characterization of hepatic neoplasms: contribution of magnetic resonance]. / Caratterizzazione delle neoplasie epatiche. Contributo della risonanza magnetica.

The reliability of MR imaging in the diagnosis and characterization of space occupying lesions affecting the liver are discussed in this study. We discuss the role of MR imaging in the diagnosis of these tumours and its advantages compared with other available techniques such as ultrasonography and CT. We also discuss the results of MR in the characterization of focal neoplastic masses.

[The role of magnetic resonance in the evaluation of diffuse liver diseases]. / Ruolo della risonanza magnetica nella valutazione delle epatopatie di tipo diffuso.

We discuss in this report the results and limits of MR imaging in the evaluation of non focal hepatic pathology. At present, MR imaging seems to be one of the most important diagnostic steps, in the study of widespread hepatic diseases.

[Magnetic resonance in the diagnosis, characterization, and assessment of renal carcinoma extension]. / La RM nella diagnosi, nella caratterizzazione e nel bilancio di estensione del carcinoma renale.

Many authors discussed the reliability of MR imaging in the diagnosis of small tumoral masses (less than 1.5 cm) affecting the kidney, and stressed its low diagnostic power. On the other hand, MR imaging is a useful technique in the study of renal masses, for its capability in the differentiation of adipose tissue (angiomyolipomas), fluid content (cystic lesions), parenchymatous tissues (neoplastic lesions). The distinction between malignant and benign masses is often impossible on the basis of MR except in the cases of invasion of the adjacent structures. MR imaging is, at present, the most accurate method in the staging of neoplastic masses of the kidney.

[Role of magnetic resonance in the identification, characterization and staging of prostatic cancer. Comparison with transrectal echotomography and computerized tomography]. / Ruolo della risonanza magnetica nella identificazione, caratterizzazione e stadiazione del carcinoma prostatico. Confronto con la ecotomografia trans-rettale e la tomografia computerizzata.

The results of MR imaging in diagnosing, and characterizing of prostatic malignant tumour, as well as its feasibility in assessing the extension are discussed in this paper. We also compared MR findings with the results obtained from trans-rectal ultrasonography and computed tomography. In particular, we emphasize the important role of MR examination with trans-rectal coil which is, at present, the most sensitive technique for the identification and characterization of prostatic tumours as well as for assessing their extension.

[Correlations between magnetic resonance, ultrasonography, and computerized tomography in invasive gynecologic pathology]. / Correlazioni tra risonanza magnetica, ultrasuoni e tomografia computerizzata nella patologia espansiva della sfera ginecologica.

In this report we evaluated the indications, the results and limits of MR examination in the diagnosis of neoplastic diseases affecting the ovary and in the staging of endometrial or cervical cancerous processes. MR findings are compared with the results of other techniques like Ultrasonography or Computed Tomography. The best advantages of MR imaging are the lack of radiation and the possibility of multiplanar studies of the pathologies. For these reasons we consider MR imaging a more accurate method for the study of neoplastic disease affecting the gynecologic sphere.

[The role of magnetic resonance in the evaluation of pathological processes involving the penis]. / Ruolo della risonanza magnetica nella valutazione dei processi patologici coinvolgenti il pene.

The above paper was aimed at defining the usefulness of MRI in the study of pathologies involving the penis. Disorders considered include Peyronie's disease, fibrosis of the penis, priapism, trauma, congenital anomalies, and tumors. In Peyronie's disease and in fibrosis of the penis, MRI permits to demonstrate the abnormal thickening of tunica albuginea and erectile tissue; after administration of gadolinium, it becomes possible in some cases to demonstrate plaques of the albuginea that are not palpable. In priapism, MRI is useful both for identifying the cause and for assessing the time elapsed since blood extravasation. In traumatic and congenital pathologies, MRI is essential for the acquisition of all information on anatomy that may be useful for selecting the most suitable surgical therapy. In neoplastic pathology, MRI has proved useful for accurately assessing the extension of lesions involving the basis of the penis.

[A comparison between intraurethral echography, computed tomography and magnetic resonance in the staging of bladder tumors]. / Confronto tra ecografia intrauretrale, tomografia computerizzata e risonanza magnetica nella stadiazione dei tumori della vescica.

The purpose of our study was to assess the utility of CT and MRI in the staging of bladder carcinoma. The overall accuracy of MR is in the range of 66 to 85%. T2 weighted and post-Gadolinium T1 weighted images allow one to differentiate T1-T2 from T3a type of neoplasms. Perivesical fat invasion is well shown with T1w images while pelvic wall invasion is better seen on T2w--images. The overall accuracy of CT ranges from 64 to 92%. CT cannot distinguish stage T1 from stage T3a tumors CT is accurate for demonstrating perivesical fat invasion. In the assessment of lymph node metastases CT and MRI have low sensitivity but high accuracy. Trans-urethral sonography is more accurate than CT and MRI in the staging of parietal invasion and it permits the differentiation between T1, T2 and T3a stages even though the distinction between T2 and T3a type of tumors is not always possible. Trans-urethral sonography is not useful in assessing extravesical extension and lymph node metastases. In summary, trans-urethral sonography is the method of choice for evaluating parietal invasion. CT and MR are very accurate for evaluating perivesical fat invasion and are also quite accurate for evaluating lymph nodes. MRI is superior to CT in distinguishing tumors limited to superficial muscle from those that invade deep muscle. MRI can also be helpful in distinguishing the tumor from fibrosis and edema.

[A comparison between computed tomography and magnetic resonance in the verification of prolactinomas]. / Confronto tra tomografia computerizzata e risonanza magnetica nell'accertamento dei prolattinomi.

First, computer tomography and subsequently magnetic resonance have profoundly changed the diagnostic protocol for the study pituitary pathology. Conventional X-ray and examination with the use of contrast media are being employed less and less. Tomographic techniques (CT and RM) permit direct identification of anomalies as well as precise evaluation of their relationship with surrounding structures.