[Application of spiral computerized tomography in the study of traumatic lesions of the thoracic aorta]. / Applicazioni della Tomografia Computerizzata spirale nello studio delle lesioni traumatiche dell'aorta toracica.

PURPOSE: Acute thoracic aortic injuries account for up to 10-20% of fatalities in high-speed deceleration road accidents and have an estimated immediate fatality rate of 80-90%. Untreated survivors to acute trauma (10-20%) have a dismal prognosis: 30% of them die within 6 hours, 40-50% die within 24 hours, and 90% within 4 months. We investigated the diagnostic accuracy of Helical Computed Tomography (Helical CT) in acute traumatic injuries of the thoracic aorta, and the role of this technique in the diagnostic management of trauma patients with a strong suspicion of aortic rupture. MATERIAL AND METHODS: We compared retrospectively the chest Helical CT findings of 256 trauma patients examined June 1995 through August 1999. All patients underwent a plain chest radiograph in supine recumbency when admitted to the Emergency Room. Chest Helical CT examinations were performed according to trauma score, to associated traumatic lesions and to plain chest radiographic findings. All the examinations were performed with no intravenous contrast agent administration and the pitch 2 technique. After a previous baseline study, contrast-enhanced scans were acquired with pitch 1 in 87 patients. All examinations were assessed for the presence of mediastinal hematoma, periaortic hematoma, traumatic pseudodiverticulum, irregular aortic wall or contour and intimal flap as signs of aortic rupture. RESULTS: Helical CT showed thoracic aortic lesions in 9 of 256 patients examined. In all the 9 cases we found a mediastinal hematoma and all of them had positive plain chest radiographic findings of mediastinal enlargement. Moreover, in 6 cases aortic knob blurring was also evident on plain chest film and in 5 cases depressed left mainstem bronchus and trachea deviation rightwards were observed. All aortic lesions were identified on axial scans and located at the isthmus of level. Aortic rupture was always depicted as pseudodiverticulum of the proximal descending tract and intimal flap. We also found periaortic hematoma in 6 cases and intramural hematoma in 1 case. There were no false positive results in our series: 7 patients with Helical CT diagnosis of aortic rupture were submitted to conventional aortography that confirmed both type and extension of the lesions as detected by Helical CT, and all findings were confirmed by gross inspection at surgery. No false negative results have been recorded so far: untreated aortic ruptures are fatal within 4 months in 90% of patients, or they may evolve into chronic pseudoaneurysm in about 5% of survivors. CONCLUSIONS: In our experience Helical CT had much higher diagnostic sensitivity and specificity than plain chest radiography. In agreement with larger published series, in our small one the diagnostic accuracy of Helical CT was 100% in the evaluation of traumatic aortic ruptures. Moreover, Helical CT is faster and less invasive than conventional aortography, which makes this diagnostic modality increasingly used and markedly improves the management of the serious trauma patient. The more widespread use of this diagnostic tool has permitted to standardize the technique and now Helical CT can be used not only as a screening modality for patients that undergo digital aortography, but also as a reliable diagnostic method for surgical planning.

[Comparison of various parameters (pitch 1 and 2) in the study of the lung with spiral computerized tomography]. / Confronto tra diversi parametri (pitch 1 e 2) nello studio del polmone con tomografia computerizzata spirale.

INTRODUCTION: In Spiral CT, the pitch is the ratio of the distance the tabletop travels per 360 degrees rotation to nominal slice width, expressed in mm. Performing Spiral CT examinations with pitch 2 allows to reduce examination time, exposure and contrast dose, and X-ray tube overload. We investigated the yield of pitch 2 in lung parenchyma studies, particularly relative to diagnostic image quality. MATERIAL AND METHODS: Thirty patients were submitted to Spiral CT with pitch 1 [10 mm slice thickness, 10 mm/s table feed; 10 mm (a') and 5 mm (a") reconstruction index: protocol A] and with pitch 2 [10 mm slice thickness, 20 mm/s table feed; 10 mm (b') and 5 mm (b") reconstruction index: protocol B]. Five expert radiologists evaluated the images separately and blindly, grading noise, bronchial wall resolution and diagnostic yield on a 0-5 point scale. The results of protocol A versus protocol B images were analyzed statistically using the Mann-Whitney U-test. RESULTS: The mean scores for each parameter ranged 4.13 (.70 standard deviation) for protocol B with 5 mm reconstruction index (b") to 4.81 (.44 standard deviation) for protocol A with 10 mm reconstruction index (a'). These values (max: 5) indicate very positive results on both protocol A and B images. There were no statistically significant interprotocol differences, except for bronchial wall resolution, in favor of protocol A with 5 mm reconstruction index (a") (p = .025), and for diagnostic yield, in favor of protocol A with 10 mm reconstruction index (a') (p = .018). CONCLUSIONS: Spiral CT with pitch 2 is a reliable tool for lung parenchyma studies which permits to reduce examination time and contrast dose, as well as X-ray tube overload and exposure dose.

[Paranasal sinusitis: study with conventional and spiral computerized tomography]. / Flogosi dei seni paranasali: studio mediante Tomografia Computerizzata tradizionale e Tomografia Computerizzata spirale.

This study was aimed at comparing the diagnostic value of conventional computed tomography (CCT) with that of spiral computed tomography (SCT) in sinonasal structures and ostiomeatal complex in thirty patients with inflammatory disease. Ten patients were examined with CCT (3-mm slice thickness, 120 kV, 100 mA, 2-s gantry rotation) and 20 were examined with SCT (3-mm slice thickness, 120 kV, 200 mA, 1-s gantry rotation and computed image reconstruction every 3 mm); table gain was 3 mm (Pitch 1) in 10 patients and 5 mm (Pitch 1.6) in the other 10 patients. With the latter study protocol, diagnostic image quality was the same as with the other two protocols. Moreover, examination time was reduced, with increased patients' comfort; the exposure dose and X-ray tube overload were also reduced, with increased system yield.

Ultrasonography in pathological conditions of muscles, tendons and joints.

The authors discuss the use of ultrasonography in the investigation of pathological condtions of muscles, tendons and joints. The indications and related ultrasonographic findings are presented. The importance of this method is emphasized both as an aid to diagnosis and choice of treatment. Its use in evaluating the effectiveness of treatment is also discussed.

[Real-time high-resolution echotomography and oral cholecystography in the study of hyperplastic cholecystosis]. / Ecotomografia real-time ad alta definizione e colecistografia per via orale nello studio delle colecistosi iperplastiche.

A series of 305 patients underwent both cholecystosonography and oral cholecystography. Ultrasounds showed a higher diagnostic accuracy in the diffuse and localized cholesteroloses. Oral cholecystography is still reliable in the diagnosis of adenomyomatosis, especially of the fundus. As present diagnostic and therapeutical indications are nonhomogeneous, early sonographic visualization and follow-up of small cholesterol polyps are valuable for understanding the development of the disease and its clinical and prognostic significance.