Tubercular epididymitis and orchitis: US patterns.

For several decades tuberculosis has been adequately under control in this country, but there has been recent concern that this disease might be coming back to the forefront, due to the influx of immigrants from developing countries where tuberculosis is still rampant. In the years to come we are expecting an increase in cases of genitourinary lesions of tubercular origin, a disease which had practically disappeared in the Western world. The aim of this pictorial essay is to provide an outline of the typical US images of tubercular epididymitis and orchitis.

[Breast scintigraphy with technetium 99m sestamibi, as support to radiologic methods in the study of breast lesions]. / Scintigrafia mammaria con 99mTc-SESTAMIBI, come supporto alle metodiche radiologiche nello studio delle lesioni mammarie.

Our study was aimed at investigating the efficacy of scintigraphy with 99mTc-Sestamibi (MIBI) as a support to mammography and US in the diagnosis and staging of breast cancer. Twenty-seven women with breast lesions were examined: the masses, detected at mammography and US, ranged in diameter 0.7 to 2.5 cm; mass features suggested a benign lesion in 5 patients, a malignant lesion in 9 patients and a questionable diagnosis in 13 patients. 99mTc-MIBI scintigraphic images were analyzed blind by two observers and the pattern was considered positive when tracer uptake was demonstrated at the lesion. In neoplastic lesions, tracer uptake was looked for also in the axilla. All the patients were submitted to surgery and, in case of malignancy, lymphadenectomy was also performed. MIBI scintigraphy was negative in 14/16 benign lesions and positive in 9/11 malignant lesions. Tracer uptake in the axilla was observed in 3 of 5 patients with nodal involvement. Scintigraphy had 82% sensitivity, 87% specificity and 85% accuracy in the diagnosis of breast cancers.

An integrated approach to senology education: combination of a hypermedia program with a multimedia archive.

The aim of this work was to demonstrate the computerized system on senology, which combines a hypermedia application to a multimedia didactical archive, integrated with a radiological information system. These applications have been developed on Macintosh computers using the softwares Supercard and 4th Dimension. The hypermedia application deals with basic principles of anatomy as well as the radiologic semeiology and pathology through different imaging techniques in order to illustrate basic principles. Thus, students can modify their learning pathways and the timing as they wish. Limitations are related to time consumption in preparing the programs and technical difficulties in expanding them. Multimedia archive allows to classify a large number of difficult and uncommon clinical cases, creating an easily updatable teaching file in digital format which considerably improves access to stored image data, also reducing loss of films and film degradation. From initial experiences we conclude that these systems are valid devices in information and up to date for physicians dedicated to the study of breast pathology.

[Integrated imaging of the breast. Use of a hypermedia program and multimedia archives for teaching purposes]. / Imaging integrato della mammella. Utilizzazione a scopo didattico di un programma ipermediale e di un archivio multimediale.

This paper deals with the results obtained with a computerized senology system developed at the Institute of Radiology of "La Sapienza" University in Rome. The system combines a hypermedia program with a multimedia didactic archive integrated with the radiologic information system. These programs have been developed on Macintosh computers: the hypermedia one on a Macintosh IIfx with 160-Mb hard disk and 8-Mb RAM and a Supercard software, the multimedia archive on Macintosh IIvx, IIvi and Quadra 650 units, connected with an Ethernet network to a server Quadra 950 (RAM: 20 Megabytes; optical disk: 1 Giga) and using the 4th Dimension as software. The basics of breast anatomy, radiologic semiology and breast diseases are illustrated with the hypermedia program: such a system has many advantages to teach the basics requiring just a process of learning by heart. The multimedia archive allows to classify a large number of difficult and uncommon clinical cases, according to the ACR code. Thus, it is useful also to teachers to study particular subjects, including anatomical variants and uncommon conditions. In conclusion, we believe these systems to be valuable tools in the formation and update of the physicians devoted to the study of breast diseases.

[Metachronous tumors of the breast. Mammographic findings]. / Tumori metacroni della mammella. Rilievi mammografici.

In breast carcinoma patients the risk to develop a second lesion in the contralateral breast is two to six times higher than in control subjects. The second lesion is called metachronous and classified among bilateral breast cancers. This kind of lesion affects the patients who were mastectomized for breast carcinoma; it may be a primary lesion, when the histologic type is different from that of the first breast cancer or secondary, when the histologic type is the same as that of the first tumor and the second lesion is therefore a metastasis. This study was made to assess the incidence of metachronous lesions and the average time between the first and the second tumor and to investigate the value of mammographic followup. We selected 375 patients who had undergone mastectomy for different histologic types of breast carcinoma and examined the contralateral breast with mammography 6 months after surgery and then every 12 months, January 1990 through January 1992. Mammography showed metachronous lesions in 23 cases: 15 infiltrating ductal carcinomas, 6 infiltrating lobular carcinomas and 2 in situ carcinomas, the latter with histologic confirmation in the patients operated on for benign breast lesions. The incidence of metachronous tumors was 6%, including both the primary and the metastatic lesions; the average time between the first and the second tumors was 20 months. Mammography allowed metachronous lesions to be diagnosed in a very early stage, much earlier than in other studies not including mammography. Prognosis is definitely improved by the early diagnosis of primary breast cancer, when no metastatic spread is present, and also in case of primary metachronous lesions, which are very uncommon.

[Magnetic resonance: the usefulness of gradient-echo refocusing sequences in the diagnosis of aneurysms of the abdominal aorta]. / Risonanza magnetica: utilità delle sequenze gradient echo refocusing nella diagnostica degli aneurismi dell'aorta addominale.

Sixteen patients bearing aneurysms of the abdominal aorta were studied by means of a 0.5 T MR unit. Spin-echo T1-weighted sequences and gradient-echo refocusing sequences were performed. All patients were previously submitted to US; in 8 cases angio CT was performed, and in 6 patients angiography of the abdominal aorta. A comparative analysis with the US findings showed a high correlation coefficient for the maximum diameters (R = 0.93) while site and size evaluations were not accurate. A very high correlation coefficient for the maximum diameters (0.97) was found at the comparative analysis with CT findings, while in two cases an erroneous suprarenal location was described. Angiographic examination provided valuable information about renal and iliac involvement, but the maximum diameters could not be accurately assessed. Spin-echo MRI allowed good evaluation of the maximum size, of location and extent of the aneurysm, as well as of iliac involvement; this technique, however, was useless in the characterization of the thrombus. Gradient-echo refocusing sequences have proven very useful for the identification of endoluminal contours and for the correct evaluation of the thrombus. Spin-echo sequences, on the contrary, accurately assessed only 7 cases, whereas the diagnosis was uncertain in the remaining 4 patients.

Intraarterial portography with gadopentetate dimeglumine: improved liver-to-lesion contrast in MR imaging.

Magnetic resonance imaging during arterial portography (MRAP) was performed by the authors in a selected group of 12 patients with hepatic lesions. A low dose of gadopentetate dimeglumine (4 mL of a 0.5-mol/L solution, corresponding to a dose of 0.05-0.07 mmol/kg) was injected into the superior mesenteric artery during acquisition of breath-holding gradient-echo or rapid acquisition spin-echo images. Images were always acquired during the first passage of gadopentetate dimeglumine through the liver parenchyma. An increase in liver-to-lesion contrast was obtained with MRAP imaging (contrast-to-noise ratio = 8 +/- 1.8 vs 19 +/- 2.7). Signal intensity enhancement of the liver was high (signal-to-noise ratio = 9.48 +/- 2.42), while the lesion presented no significant enhancement (signal-to-noise ratio = 0.55 +/- 0.22). Lobar portal vein thrombosis was detected in one patient owing to lack of enhancement of the left lobe of the liver. No side effects related to administration of iodinated and paramagnetic contrast agents were observed. This new technique provides specific enhancement of liver parenchyma with improved liver-to-lesion contrast.