Non-small cell lung cancer evaluated with quantitative contrast-enhanced CT and PET-CT: net enhancement and standardized uptake values are related to tumour size and histology.

BACKGROUND: Personalized cancer therapy remains a challenge. In this context, we attempted to identify correlations between tumour angiogenesis, tumour metabolism and tumour cell type. To this aim, we used single=phase multidetector computed tomography (MDCT) and hybrid positron emission tomography-computed tomography (PET/CT) to determine whether net enhancement and standardized uptake value (SUVmax) were correlated with tumour size and cytology in patients affected by non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: Our study included 38 patients (30 men, 8 women, mean age 70) with a NSCLC measuring between 3 cm and 7 cm, using a 16-slice multidetector CT (Brilliance Philips) and with PET-CT (Biograph 16 Siemens Medical Solutions). The following lesion parameters were evaluated: maximum diameter, medium density before contrast injection (CTpre), medium density after contrast injection (CTpost average), density in the most enhanced part of the lesion after contrast (CTpost max), net enhancement, SUVmax, age, and cytology. Correlation coefficient and p-value were computed for each pair of variables. In addition, correlations were computed for each pair of variables, and for all combinations of tumour types. We focused on subsets of data with more than 10 observations, and with correlation r>0.500 and p<0.05. RESULTS: A weak correlation (r=0.32; p=0.048) was found between SUVmax and tumour size; the correlation was stronger for masses larger than 31 mm (r=0.4515; p=0.0268). No other correlations were found among the variables examined. CONCLUSIONS: Our data may have prognostic significance, and could lead to more appropriate surgical treatment and better treatment outcome.

Abdominal hernias: Radiological features.

Abdominal wall hernias are common diseases of the abdomen with a global incidence approximately 4%-5%. They are distinguished in external, diaphragmatic and internal hernias on the basis of their localisation. Groin hernias are the most common with a prevalence of 75%, followed by femoral (15%) and umbilical (8%). There is a higher prevalence in males (M:F, 8:1). Diagnosis is usually made on physical examination. However, clinical diagnosis may be difficult, especially in patients with obesity, pain or abdominal wall scarring. In these cases, abdominal imaging may be the first clue to the correct diagnosis and to confirm suspected complications. Different imaging modalities are used: conventional radiographs or barium studies, ultrasonography and Computed Tomography. Imaging modalities can aid in the differential diagnosis of palpable abdominal wall masses and can help to define hernial contents such as fatty tissue, bowel, other organs or fluid. This work focuses on the main radiological findings of abdominal herniations.

Preliminary study on the correlation between grading and histology of solitary pulmonary nodules and contrast enhancement and [18F]fluorodeoxyglucose standardised uptake value after evaluation by dynamic multiphase CT and PET/CT.

AIM: To evaluate whether the histology and grading of solitary pulmonary nodules (SPNs) correlated with the results of dynamic multiphase multidetector CT (MDCT) and the [(18)F]fluorodeoxyglucose standardised uptake value (SUV) in 30 patients. METHODS: Chest x-rays of 270 patients with incidentally detected SPNs were retrospectively evaluated. Thirty patients with histologically proven SPNs were enrolled. On MDCT and positron emission tomography (PET)/CT images, two experts measured the density of nodules in all perfusion phases and the SUV. Net enhancement (NE) was calculated by subtracting peak pre-contrast density from peak post-contrast density. The Pearson test was used to correlate nodule NE, SUV, grading, histology and diameter. RESULTS: Of the 30 malignant SPNs, six were classified as G1 (median NE, 31.5 Hounsfield units (HU); median SUV, 4.8 units), 15 were classified as G2 (median NE, 49 HU; median SUV, 6 units), and nine were classified as G3 (median NE, 32 HU; median SUV, 4.5 units). A highly negative correlation was found in G3 SPNs between NE and the corresponding diameters (r=-0.834; p=0.00524). NE increased with the increase in diameter (r=0.982; p=0.284). SUV increased as the SPN diameter increased (r=0.789; p=0.421). NE and SUV were higher in G2 than G1 SPNs, and lower in G2 than G3 SPNs (r=0.97; p=0.137). CONCLUSIONS: The significant correlation in dedifferentiated (G3) SPNs between NE and diameter (r=-0.834; p=0.00524) supports the theory that stroma and neoangiogenesis are fundamental in SPN growth. The highly negative correlation between NE and diameter demonstrates a net decrease in perfusion despite an increase in dimension. The multidisciplinary approach used herein may result in a more precise prognosis and consequently a better therapeutic outcome, particularly in patients with undifferentiated lung cancer.

Gastric traumatic injuries: CT findings.

OBJECTIVE: Gastric blunt traumatic injuries are uncommon and their radiological appearance has been infrequently reported in medical literature. These injuries are difficult to diagnose preoperatively, though they require immediate recognition to minimize their otherwise high mortality and morbidity. The aim of our study is to describe the radiological appearance of blunt gastric traumatic injuries. MATERIALS AND METHODS: Retrospective evaluation of a 25 patients series observed between January 1997 and May 2005. RESULTS: We observed rupture of the stomach in 20% of cases, in 44% of cases a partial lesion of the stomach, in one case a necrotic post-traumatic volvulus, five patients (20%) had benign portal pneumatosis, in three patients the stomach was secondarily involved because of a diaphragmatic hernia. The fundus resulted to be the most frequently damaged part of the stomach (80%). CONCLUSIONS: Blunt traumatic injuries need a careful and systematic approach given their economical and social relevance. For these reasons uncommon lesions require attention and may be important to search for specific findings of gastric lesions.

[Heart failure in a subject treated with anthracyclines in childhood: myocardial dysfunction is not always the only reason of it]. / Scompenso cardiaco biventricolare in soggetto trattato nell'infanzia con antracicline: non sempre la disfunzione miocardica ne è la causa.

Anthracyclines, found to be efficacious in the treatment of a broad spectrum of pediatric malignancies, are cardiotoxic and may lead to heart failure even a long time after successful treatment of cancer. It is thought that subtle abnormalities can progress to the more permanent myocardial disease, resulting in cardiomyopathy which may progress to congestive heart failure. There are some precipitating factors leading to the sudden onset of cardiac symptoms such as increase in afterload or preload. We describe a young patient with congestive heart failure treated with doxorubicin (cumulative mean dose 420 mg/m2) in infancy because of pelvic sarcoma in whom the appearance of symptoms was related to pulmonary embolism. Four years before hospital admission, the patient presented echocardiographic abnormalities such as left ventricular fractional shortening and thickness reduction and he was treated with ACE-inhibitors. The myocardial ischemia, which is present in pulmonary embolism, probably worsened the left ventricular systolic function and caused congestive heart failure.

[Biventricular heart failure in patient treated with anthracycline in childhood: myocardial dysfunction is not always the cause]. / Scompenso cardiaco biventricolare in soggetto trattato nell'infanzia con antracicline: non sempre la disfunzione miocardica ne è la causa.

Anthracyclines, found to be efficacious in the treatment of a broad spectrum of pediatric malignancies, are cardiotoxic and may lead to heart failure even a long time after successful treatment of cancer. It is thought that subtle abnormalities can progress to the more permanent myocardial disease, resulting in cardiomyopathy which may progress to congestive heart failure. There are some precipitating factors leading to the sudden onset of cardiac symptoms such as increase in afterload or preload. We describe a young patient with congestive heart failure treated with doxorubicin (cumulative mean dose 420 mg/m2) in infancy because of pelvic sarcoma in whom the appearance of symptoms was related to pulmonary embolism. Four years before hospital admission, the patient presented echocardiographic abnormalities such as left ventricular fractional shortening and thickness reduction and he was treated with ACE-inhibitors. The myocardial ischemia, which is present in pulmonary embolism, probably worsened the left ventricular systolic function and caused congestive heart failure.

Relação do nível médio e variabilidade da pressão arterial com a geometria do ventrículo esquerdo na hipertensão arterial sistêmica / Relation Between Average Level and Variability of Blood Pressure With the Geometry of the Left Ventricle in Systemic Hypertension

PURPOSE--To study the relation between the average level and variability of blood pressure (VBP) obtained by ambulatory monitoring (AMBP) and the geometric pattern (GP) of the left ventricle (LV) obtained by echocardiography (ECHO) in patients with hypertension (Hy) METHODS--AMBP and ECHO were performed in 37 patients with Hy, divided into three groups: group A--11 women using antihypertensive therapy (AH); group B--15 men using AH and group C--7 male and 4 female without AH. The GP of LV was obtained by ECHO based on mass index (MI) and relative thickness of the wall (RTW). Mean systolic (MSBP) and diastolic (MDBP) were analyzed during daytime (DT) and nighttime (NT) periods. VBP was defined by mean standard deviation (SD) of mean pressures considered. RESULTS--In G-A, there was a significant association between the MI and both VBP and MSBP (r = 0.65 and p < 0.005, r = 0.61, and p < 0.005, respectively), and MSBP and VBP during the DP (r = 0.64 and p < 0.005, r = 0.75, and p < 0.005). In G-B, there was a relation between the LVRTW (r = 0.55 and p < 0.005), and MSBP during the DP (r = 0.65 and p < 0.005). In G-C, there was a significant association (p < 0.005) between the MI and the MDBP in the DP and with the MSBP in the NP (r valueS ranged from 0.51 to 0.66). There was also a significant relation (p < 0.005) between the LVRTW and the SD of all variables in both DP and NP (r ranged from 0.47 to 0.78 and mean diastolic in the wakeful period (r = 0.42 to 0.78) and MDBP in the DP (r = 0.42 and p < 0.05). CONCLUSION--Both the increase in VBP and the mean BP are involved in the changes of LVGP in Hy.

Monitorizaçäo ambulatorial da pressäo arterial: critérios diagnósticos / Ambulatory blood pressure monitoring. Diagnostic criteria

Objetivo: Estudar critérios diagnósticos para monitorizaçäo ambulatorial da pressäo arterial (MAPA) em grupo de indivíduos normais, selecionados segundo critério detalhado, e levando-se em conta seus próprios limites. Métodos: Foram estudados 40 indivíduos: 30 homens e 10 mulheres. A idade média foi 28 mais ou menos 6 anos. Os critérios de inclusäo foram: pressäo arterial(PA) em repouso menor do que 140/90 MMHg (sistólico/diastólica); ecocardiograma normal; resposta cardiovascular fisiológica durante teste de esforço (TE) máximo em esteira rolante. Foi utilizado para MAPA o Pressurômetro IV da Del Mar Avionics, modelo 1990. Resultados: Para o critério diagnóstico de carga pressórica durante o dia, 38 por cento das medidas sistólicas e l6 por cento das medidas diastólicas ficaram elevadas. Durante a noite 13 por cento das medidas sistólicas e, 13por cento das medidas diastólicas ficaram elevadas. Em relaçäo à cifra diastólica de 90 mmHg, 11 por cento das medidas foram superiores. Comparadas ao nível ideal diastólico, isto é, estatura em centímetros dividida por 2 (estatura-cm/2), 17por cento foram superiores, e em relaçäo à PA máxima no TE, 24 por cento das tomadas ficaram acima. Conclusäo: Na avaliaçäo da normotensäo de um determinado indivíduo seria relevante considerar näo somente o padräo obtido em grupos normais, bem como os desvios observados em relaçäo a seus próprios limites (PA ideal para o indivíduo e PA máxima em esforço)