Intracranial Masses with Perilesional Edema: Differential Diagnosis with Perfusion CT.

Perilesional edema (PE) is commonly observed in association with an intracranial mass. PE is thought to be determined by vasogenic effects in the cerebral parenchyma surrounding the mass due to the loss or absence of the blood-brain barrier (BBB) inside the lesion. Alterations in capillary permeability induce extrusion of fluids into the extravascular space around the mass. On Computed Tomography (CT) PE corresponds to an area of low density for the increased water content, outside the margins of the lesion. It is difficult to differentiate PE from areas of parenchymal compressive ischemia and sometimes the two events could be associated. A solitary mass with PE is more commonly discovered on a non-enhanced computed tomography (NECT) study performed for the onset of stable or rapidly progressive neurological symptoms. In such cases, a supplementary CT scan with contrast (CECT) is generally indicated to complete the baseline imaging before MRI. Contrast enhancement is generally present in a mass with PE and it is not specific for differential diagnosis. Perfusion computed tomography (PCT) requires a few minutes in addition to the time needed for CECT. PCT may give information on regional microvascular density, permeability and blood flow, thus it may play a role when tumoral neo-angiogenesis or non-neoplastic altered haemodynamics are suspected. We therefore investigated the utility of PCT in the differential diagnosis of the intracranial solitary masses with PE.

Metastatic tumor of the spermatic cord from a primary silent colorectal adenocarcinoma.

Tumors of the spermatic cord are indeed rare and 91% are of mesenchymal origin. Nearly all epithelial tumors are metastases with the primary tumor located in the gastrointestinal tract, prostate, kidney. In 9.5% of cases, initial symptoms are localized to the metastatic site prior to the discovery of the primary tumor. When a diagnosis of epithelial malignant tumor of the spermatic cord is made an investigation for the primary site must be performed. We report a case of metastatic tumor of the right spermatic cord occurring as first clinical manifestation of a silent adenocarcinoma of the sigmoid colon.

Magnetic resonance in the study of cranial nerves.

The course of cranial nerves was studied by means of magnetic resonance (MR), which allowed a multiplane visualization of the investigated structures. The obtained results showed that MR was an excellent method for visualization of the optic, trigeminal, facial and acoustica nerves. The oculomotor and the abducent nerves were detectable only in some regions where the contrast with the surrounding structures was greater. The glossopharingeus, vegus and accessory nerves were identifiable only in the first tract of emergency from the encephalic trunk and they could no be distinguished separately. The trochlear nerve was seldom visible whereas the olfactory nerve failed to be revealed. Further technological progress will allow for additional advances as regards the acquisition of knowledge concerning these important nerves.

[Simultaneous enucleo-resection of synchronous bilateral renal carcinoma, incidentally discovered during prostate disease screening]. / Enucleoresezione contemporanea di carcinoma renale bilaterale sincrono, scoperto incidentalmente nel corso di uno screening per le malattie della prostata.

Bilateral synchronous renal cell carcinoma is rare, incidental discovery is exceptional. We report a case of asymptomatic bilateral simultaneous renal tumor discovered during screening for prostatic disease. Two year previously the patient underwent sonography and IVP for right ureteral stone, spontaneously ejected, with no evidence of renal masses. Ultrasound, CT and selective digital angiography demonstrated two renal tumors < 3 cm in size. Bilateral simultaneous enucleoresection was the therapeutic choice, that we consider to be elective in such a case.

New joint imaging tools in osteoarthritis. I--Validation and preliminary experience with GGGS treatment.

In the pathology of joints, the main aim is an early diagnosis. In osteoarthritis (OA), where laboratory support is particularly poor, traditional radiology is informative only when the pathologic process is so advanced that prevention is difficult, either by changing life habits or by treating with chondroprotective drugs. Therefore an ideal diagnostic imaging tool should be sensitive, specific, reproducible and not invasive. In our opinion, Nuclear Magnetic Resonance (NMR) has all these characteristics and in particular can show meaningful pictures of cartilage and subchondral bone. We therefore compared NMR and traditional radiology to the gross pathology shown by arthroscopy at an early stage of OA, before and after treatment with glycosamino-glucuron-glycan-sulphate (GGGS) or placebo. Our results suggest that NMR is quite meaningful and can detect early OA joint modifications. With this technique the placebo-treated OA patients showed a natural increase in their pathologic picture, while the GGGS-treated patients seemed to experience a retardation in the progression of the disease.

[Magnetic resonance imaging of aortic and mitral valve insufficiency. Comparison with Doppler echocardiography and angiocardiography]. / Studio con risonanza magnetica dell'insufficienza valvolare aortica e mitralica. Confronto con ecocardiografia Doppler ed angiocardiografia.

Fourty-five subjects--10 normal volunteers and 35 patients with valvular insufficiency were examined with MRI and [20 of them with mitral (MI) and 15 with aortic (AI) insufficiency] were evaluated with MR imaging and with Doppler echocardiography (echo-Doppler); 22 of these patients were also studied with angiocardiography. The extent of regurgitation jet was classified as follows: minimal (1+), mild (2+), moderate (3+), and severe (4+), according to the max distance of regurgitant jet signal from valvular leaflets. In our series, MR imaging with FFE sequences always showed the regurgitant jet. High agreement was found between MR and echo-Doppler results (80% for MI, and 86% for AI). In 22 patients who underwent angiocardiography, we observed 73% agreement. Cine-MR imaging proved to be an accurate and sensitive technique to recognize and to evaluate severity of regurgitant valvular flow in patients with AI and MI. This technique may be useful in those patients in whom Doppler echocardiography is inadequate or impossible to perform.

[Nuclear magnetic resonance in congenital cardiopathies in adults]. / La risonanza magnetica nucleare nelle cardiopatie congenite dell'adulto.

Magnetic resonance imaging is a newly developed diagnostic technique recently used for the study of the cardiovascular system. One of the most promising fields of application for magnetic resonance is the study of congenital heart diseases. Since it offers high contrast and resolution tomographic images of the heart, this technique appears particularly suitable for the anatomic assessment of cardiovascular malformations. In order to evaluate the potential of magnetic resonance imaging in the evaluation of congenital heart diseases, we reviewed 21 cases of cardiac malformations (age: 9-81, mean: 48 +/- 23). Two dimensional echo-cardiography was performed on all of them. Out of the 21 patients, 13 were imaged to confirm previous diagnoses based on echocardiographic (8) or angiographic (5) data. Four more patients underwent a cardiac angiography after the magnetic resonance study. The remaining eight patients were imaged due to a poor echocardiographic examination (4) and for other reasons (4). Eight patients had an atrial septal defect, 1 had a patent foramen ovale, 2 had a ventricular septal defect, 1 had a corrected transposition of the great vessels, 2 had an aortic coarctation, 2 had a developmental venous abnormality, 5 had different congenital diseases of the aorta or of the pulmonary valve or artery. Image quality was optimal in 18 out of the 21 patients studied (85.7%). In the remaining 3 subjects image quality enabled a diagnosis. In all patients magnetic resonance imaging correctly depicted the cardiac malformation and in some cases furnished data on the severity of the disease. In 9 cases (4 atrial septal defects, 2 developmental venous abnormalities, 2 aortic aneurysms, 1 right pulmonary artery atresia) magnetic resonance imaging provided the diagnosis. These data indicate that magnetic resonance imaging may represent an important non-invasive diagnostic tool capable of offering valuable information on adult patients with suspected congenital heart disease. It is also possible to foresee that this technique will play an outstanding role as a non invasive alternative imaging technique whenever echocardiography cannot be performed is not satisfactory. Furthermore, magnetic resonance imaging should be considered a major diagnostic technique to be used for the anatomic study of the heart prior to resorting to angiography.

[Demonstration of an acute myocardial infarction by nuclear magnetic resonance: comparison with 2-dimensional echocardiography in localization of the necrotic area]. / Dimostrazione dell'infarto miocardico acuto mediante risonanza magnetica nucleare: confronto con la ecocardiografia bidimensionale nella localizzazione dell'area necrotica.

In order to evaluate the ability of magnetic resonance imaging (MRI) to detect acute myocardial infarction (AMI) in man, we studied 15 normal volunteers and 22 patients with a recent AMI (13.5 +/- 7.7 days, range 4-28). To establish the ability of MRI in localizing the site of infarction we also performed a comparison between the segments of the left ventricle showing evidence of AMI by MRI and those presenting wall motion abnormalities by 2-dimensional echocardiography. By using strict criteria and 2 imaging planes MRI proved to be a reliable technique for the detection of AMI. MRI correctly identified AMI in 20 out of 22 subjects (90.9%). The site of AMI appeared as an area of increased signal intensity on spin echo images, particularly evident on late echoes: 15 patients had MRI findings compatible with transmural AMI and 5 patients with non-transmural AMI. The site of AMI as detected by MRI closely correlated with that indicated by 2-dimensional echocardiography, thus showing that MRI is a reliable tool for AMI localization. We also observed that the number of left ventricular segments judged as infarcted by MRI was significantly higher than that showing wall motion abnormalities. As MRI correctly identified the presence of 2 subendocardial lesions, not detected by echocardiography, it is suggested that MRI may be superior to echocardiography in detecting non-transmural lesions and the lateral extension of a transmural infarct. Our data show that MRI is a reliable tool for the detection and location of recent AMI in man. In particular MRI can locate AMI with a precision similar to that offered by 2-dimensional echocardiography.

[Gadolinium DTPA in a MR study of expansive lesions of the cranial base]. / Il Gadolinio DTPA nello studio RM delle lesioni espansive della base cranica.

Twenty-five patients were investigated by MR imaging in order to evaluate the diagnostic value of Gadolinium (Gd)-DTPA in skull-base tumors. The patients were studied with standard acquisition techniques (T1, mixed and T2-weighted images) without contrast medium. The images obtained were then compared with the T1-weighted images obtained after intravenous injection of Gd-DTPA. The contrastographic results in the different types of acquisition were evaluated. Thanks to the extraordinary increase in contrast resolution it provides, Gd-DTPA allowed the precise evaluation of the lesion and of its perfect spatial definition in all cases. Our experience demonstrated that Gd-DTPA considerably increases the sensitivity of the technique in this anatomical region. On the contrary, as regards the nature of the lesion, the signal did not significantly vary after the iv injection of Gd-DTPA in the various kinds of lesion. In addition to the important diagnostic advantages of Gd-DTPA, its excellent tolerability and the absence of side-effects must be stressed.

Magnetic resonance and echocardiography in the investigation of cardiac tumour in an infant.

An intracardiac tumour in an asymptomatic female infant was diagnosed by means of echocardiography and magnetic resonance. The natural history of this pathology in patients showing no symptoms of cardiac involvement is still unknown. The development of these modern diagnostic techniques, however, has made it easier to carry out longitudinal follow-up studies aimed at obtaining useful information about the prognosis and growth potentialities of these tumours.

[Methods for studying the heart with magnetic resonance]. / Metodologia di studio del cuore con risonanza magnetica.

Magnetic resonance imaging is a new completely non-invasive diagnostic technique now available even for heart studies. Due to the long time of this examination the main goal for the application to the cardiovascular diagnosis is to obtain the major number of information in a reasonable time for the patient. On the basis of our initial experience with this technique we propose a method suitable for the morphological, functional and tissular characterization in cardiovascular diagnosis.

[Cardiac imaging with nuclear magnetic resonance. Preliminary experience]. / L'"imaging" cardiaco con la risonanza magnetica nucleare. Esperienze preliminari.

Magnetic Resonance Imaging (MRI) is a new completely noninvasive diagnostic tool available for studying the cardiovascular system. In order to assess its utility in cardiovascular protonic imaging, we studied normal individuals and patients with different heart diseases by means of a 0.5 Tesla superconductive magnet triggered by the ECG. Images were obtained in 38 subjects. By electronically angulating the gradients and by acquiring the images at different phases of the cardiac cycle we obtained several different diagnostic possibilities which can allow both anatomic and functional studies of the heart. On the 21 patients, MRI showed the main features of each disease. Our initial experience with MRI confirms the need for oblique images of the heart in order to obtain planes useful in cardiovascular diagnosis. Among many diagnostic possibilities we tested the ability of MRI in the detection of acute and old myocardial infarction. Although MRI requires extensive application in order to delineate its role in cardiovascular diagnosis it is to be considered an important diagnostic tool and a very interesting investigative method.

Arteriovenous fistula associated with renal cell carcinoma: demonstration by magnetic resonance imaging.

Two cases of arteriovenous fistula associated with renal cell carcinoma were studied using multiple techniques, including magnetic resonance imaging (MR). These techniques clearly delineated the vascular abnormalities without the use of a contrast agent; they also demonstrated the extent of the tumors. Data derived from MR were confirmed upon surgical exploration and were useful in planning the approach to the kidney.