CT-MR integrated diagnostic imaging of the oral cavity: neoplastic disease.

The oral cavity is a complex anatomical region consisting of different anatomical sites and subsites. Cancer undoubtedly represents the most frequent and relevant disease of this region. Clinical examination is often the first approach to oral cavity tumours. Cross-sectional computed tomography (CT) and magnetic resonance imaging (MRI) play a key role in staging locoregional disease by demonstrating submucosal spread and involvement of deep layers; evaluation of specific pathways of spread to peculiar anatomical subsites is also fundamental information that can be obtained with these techniques. The purpose of this paper is to illustrate CT and MRI findings of anatomical subsites involved by tumours of the oral cavity.

Anterior urethral valves in the fossa navicularis in a newborn: report of a case and review of the literature.

Anterior urethral valves in the fossa navicularis is an exceptionally uncommon causes of lower urinary tract obstruction in newborn. The authors report a case of anterior urethral valves in thefossa navicularis in an 5 days-old boy, that observation of the voided stream revealed a filiform micturition and marked ballooing of the penile urethra. The meatus was located normally and of normal calibre. Voiding cystourethrography showed obstruction at the fossa navicularis, and a hyghly trabeculated bladder. Ultrasonography showed a severe bilateral hydroureteronephrosis. After a temporary soprapubic cystostomy, the urethroscopy revealed a valve on the floor of the fossa navicularis, excised with tenotomy scissor. Postoperatively ,urethral obstruction was relieved immediately by a good urinary stream. At 6 months follow-up the patient voided with a good stream and ultrasonography revealed complete disappearance of hydroureteronephrosis.

Head and neck radiology: role of multidetector computed tomography in the evaluation of the tympanic canaliculus.

PURPOSE: This study was undertaken to evaluate the potential of multidetector computed tomography (MDCT) for multiplanar visualisation of the tympanic canaliculus both in healthy individuals and in patients affected by chronic inflammatory disease of the middle ear. MATERIALS AND METHODS: A preliminary study was performed on three dried skulls by placing a metal landmark inside the tympanic canal lumen with a view to optimising depiction by multiplanar CT. Subsequently, 50 patients were enrolled in a prospective study. Three of the 100 petrous pyramids studied were excluded owing to the presence of jugulotympanic glomus tumour with severe bone changes. RESULTS: The entire course of the tympanic canaliculus was identified in 80/97 petrous pyramids (82.4%), 57 of which were normal (75.4% detection rate) and 40 pathological (90% detection rate). To assess the tympanic canaliculus in the pathological petrous pyramids and evaluate its possible role in the disease process, some qualitative criteria were introduced: canal enlargement, loss of margin sharpness, focal erosion of canal margins and presence of pathological tissue. CONCLUSIONS: MDCT represents the only technique allowing evaluation of the tympanic canal in vivo and with multiplanar images in a large number of cases (82.4%).

Neonatal intrathoracic gastric volvulus in Marfan's syndrome.

Intrathoracic gastric volvulus is extremely rare in the newborn period. The authors describe the case of a newborn with unusual combination of intrathoracic gastric volvulus and Marfan's Syndrome and discuss its management.

An uncommon case of associate intrinsic and extrinsic stenosis of the duodenum in newborn.

The incidence of congenital combinations of extrinsic and intrinsic compression of duodenum is uncommon. The authors report a rare case of a neonate with a duodenal stenosis due to the contemporary presence of an annular pancreas and wind sock web. The diagnostic strategies and management will be discussed.

Role of coronal oblique reconstruction as a complement to CT study of the temporal bone: normal anatomy.

PURPOSE: The purpose of this study was to demonstrate the usefulness of coronal oblique multiplanar reconstruction computed tomography (MPR CT) reformation parallel to the basal turn of the cochlea in the evaluation of the retrotympanum and hypotympanum to complete the standard CT examination of the temporal bone obtained with axial and coronal images. MATERIALS AND METHODS: We studied 30 patients aged 18-79 years for a total of 60 normal petrous pyramids. All examinations were performed on a multislice CT (MSCT) scanner (Sensation 16, Siemens, Erlangen, Germany) with axial volumetric acquisition and completed with reformations of coronal and coronal-oblique images. MSCT scan parameters for axial acquisition were set as follows: 0.75-mm scan collimation, FOV 300 mm, 170 mAs. Axial images were reconstructed at 0.7-mm thickness and with a reconstruction increment of 0.5 mm using a high-resolution bone algorithm. RESULTS: Coronal oblique MPR CT reformations provided additional information with respect to standard CT images in all cases. In particular, they enabled measurement of the craniocaudal and laterolateral diameters of the sinus tympani. In all cases, there was optimal visualisation of the ponticulus and subiculum. Analysis of the pyramidal eminence was improved thanks to its visualisation in profile. Moreover, we obtained an optimal representation of the hypotympanum, which was always exhaustively explored with only one reconstruction. Finally, in all cases, it was possible to identify the facial nerve canal and main vascular structures and to measure the distance between these and the sinus tympani, pyramidal eminence and hypotympanum. The coronal oblique CT reformation was of no advantage in the evaluation of the fossa of the oval window and the niche of the round window. CONCLUSIONS: Coronal oblique MPR CT reformation should not be considered an alternative to the standard CT examination, but it can represent a valid integration to provide additional information on particularly crucial districts characterised by frequent involvement of inflammatory and/or expansile disease and because of their difficult endoscopic approach. Moreover, it can represent a meaningful aid to optimise surgical planning thanks to its different perspectives of observation.

[Acute urine retention: early clinical sign of a rhabdomyosarcoma of the bladder or prostate in children: report of three cases]. / Ritenzione acuta d'urina: primo segno di rabdomiosarcoma vescico-prostatico in età pediatrica: presentazione di tre casi.

Acute urine retention can be the first clinical sign of a rabdomyosarcoma (RMS) of bladder and prostate. This is particularly evident in the age group comprised between 2 and 4 years. The Authors report their experience on three cases of 2 years old males admitted for acute urine retention. One case was diagnosed to have an prostate RMS, the other two a RMS of the bladder. The prostate RMS refused the operation dying 2 years after operation. Of the two cases of RMS of the bladder, one was treated successfully by polychemotherapy treatment, the second, after polychemotherapy underwent a partial cystectomy. The Authors conclude affirming the importance of a ultrasonography of the lower urinary tract in all patients with acute retention of urine, since this could be the first sign of a RMS of prostate or bladder.

[Endovascular repair of abdominal aortic aneurysm: helical CT findings]. / Follow up post-procedura delle endoprotesi aorticho. Rilievi ocn TC spirale.

Endovascular repair of infrarenal abdominal aortic aneurysms is currently widely diffuse. Imaging plays a major role in the preprocedural patient evaluation, implantation of stent-graft, and patient follow-up. The aim of this paper is to describe the more frequent findings that can be seen in CT examinations after endovascular repair of infrarenal abdominal aortic aneurysm. We discuss CT findings related to the aneurysm (size, exclusion with complete perigraft thrombosis, back-filling of aneurysm sac via branch vessels) and to the device (dislocation, rotation, kinking, device expansion, patency/thrombosis, device disruption). We also show some examples of incorrect assembly of the modular components of the stent-graft.

[Doppler power with contrast media in the characterization of renal masses]. / Power Doppler con mezzo di contrasto nella caratterizzazione delle masse renali.

PURPOSE: To report the results of a prospective study investigating the potentials of contrast-enhanced power Doppler in the diagnosis of expansive renal lesions. MATERIAL AND METHODS: From 1997 to October 30, 1999, we studied 59 expansive renal lesions (28 malignant, 31 benign) in 48 patients (mean age 55 years, range 10-79) with power Doppler US before and after the administration of an echo-enhancing agent (Levovist, Schering AG, Berlin, Germany). We identified 5 patterns of vascular architecture of the lesions, both before and after contrast agent administration, following the classification by Jinzaki e Coll. RESULTS AND DISCUSSION: Power Doppler US showed vascular structures in 34 patients. The administration of Levovist revealed vessels in 12/25 lesions which had none at baseline studies and in 6 cases vascularity was particularly evident. Color signals were enhanced in all the 34 vascularized lesions, which allowed better definition of vascular patterns. The characterization of vascular patterns with baseline power Doppler US helped improve diagnostic accuracy compared to gray-scale US (58% versus 32%) for hyperechoic lesions, complex cysts and pseudomasses. Independent of contrast agent administration, the integration of gray-scale and power Doppler modes increased diagnostic accuracy even further (76% correct diagnoses). CONCLUSIONS: In our series, the US contrast agent did not increase the diagnostic accuracy of power Doppler in the differential diagnosis of hyperechoic renal lesions; conversely, Levovist can be advantageous for the characterization of suspected pseudomasses and complex cysts.

Giant fibrovascular polyp of the esophagus: CT and MR findings.

We present a case of giant fibrovascular polyp of the esophagus with predominant fat contents. Both computed tomography (CT) and magnetic resonance imaging (MRI) findings of this rare tumor are reported. The employment of CT and MRI in the presurgical evaluation of fibrovascular esophageal polyp is suggested.

[Urinary hydrometrocolpos by persistent urogenital sinus; prenatal diagnosis and neonatal management]. / Idrometrocolpo urinoso da persistenza del seno urogenitale: diagnosi prenatale e management neonatale.

Urogenital Sinus (UGS) malformation can be ascribed to an arrest of normal embryonic vaginal development. Neonates with UGS frequently have ambiguous genitalia, rarely the vulva may be normal. The aim of this work is to define the role of prenatal sonography in the diagnosis of UGS associated with hydrocolpos and/or hydrometrocolpos. The Authors report their experience on 3 cases of UGS without ambiguous genitalia with hydrometrocolpos, in which prenatal sonography had shown a cystic dilatation in the pelvis. After birth the 3 neonates presented with female genitalia and a single orifice between the labia. The pelvis sonography showed in all the cases an hydrometrocolpos with a large vagina and a compressed and anteriorly located bladder. Voiding cystourethrogram, genitography and genitoscopy confirmed the presence of an UGS with urinary retention inside the vagina and stenosis of the distal portion of the vagina itself. An early drainage of the capacious vagina was performed in the three patients. There are very few reports in the literature of UGS with hydrometrocolpos diagnosed in utero. The cystic dilatation of the vagina is always misdiagnosed with a distended bladder. In utero, infact, the bladder can not be identified being displaced anteriorly by the vagina. The presence of a fluid-debris level inside the cystic anechoic mass must be considered a crucial finding. Multiple echoes are due to vaginal secretions. Prenatal ultrasound has then a definitive role in detecting an obstructed genital tract. This allows to rapidly drain the vagina relieving urinary tract obstruction.

[The computed tomographic semeiotics of rhino-sinusal inflammatory pathology]. / Semeiotica della patologia flogistica rino-sinusale con Tomografia Computerizzata.

Recent advances in "functional" endoscopic surgical techniques require the radiologist to understand the anatomy and pathophysiology of the nose and paranasal sinuses as well as their normal and abnormal CT patterns. Endoscopy and CT are complementary procedures, but in the evaluation of the extent of chronic inflammation and in the demonstration of possible associated local and regional complications, the latter method has become the imaging technique of choice, providing a detailed map for the functional sinus surgeon and replacing plain radiography. The authors reviewed a personal series of 322 coronal thin-slice CT examinations of the paranasal sinuses relative to 169 patients with chronic or acute sinusitis and polyposis. The main CT findings of sinusitis (mucosal thickening, fluid retention, mucous cysts, bone alterations, mucoceles and polyposis) and their complications are reported. Finally, ostiomeatal conditions are considered, particularly the obstruction of ducts and ostia which provide aeration and mucous clearance from the paranasal sinuses.

[Computerized tomography in the evaluation of anatomic variations of the ostiomeatal complex]. / La tomografia computerizzata nella valutazione delle varianti anatomiche del complesso ostiomeatale.

This work was aimed at showing the main anatomical variations in the ostiomeatal complex which are usually depicted by CT. A hundred and thirty CT exams including 59 normal cases (45.4%) and 71 cases of chronic sinus disease (54.6%) were reviewed. The following anatomical variations were considered: concha bullosa, middle turbinate, septum, uncinate process and bulla changes, Haller cells and agger nasi cells. Anatomical variations were demonstrated in 69 patients--31 normal subjects and 38 patients with chronic sinusitis. The incidence of every anatomical variation was investigated and the results were compared with literature data. Excluding agger nasi cells, which were seen in nearly all patients, the most common variations were concha bullosa and septal spur and deviations, while the least common variations were those in the middle turbinate and uncinate process.

[Bronchogenic carcinoma with extramucosal development. Diagnostic problems]. / Il carcinoma broncogeno a sviluppo extramucoso. Problematiche diagnostiche.

Bronchogenic carcinoma is characterized by three different patterns of spread: endobronchial, the commonest, submucosal, and peribronchial. While the diagnostic yield of bronchoscopy is very high for endobronchial masses, both submucosal and peribronchial tumors are more difficult to detect, and standard forceps biopsy can be negative. In such cases transbronchial needle aspiration biopsy allows higher diagnostic accuracy. CT findings of extramucosal neoplastic spread are not specific. Thickening of the bronchial walls is the commonest sign, but CT is inaccurate in predicting whether bronchial thickening will result in endobronchial/extramucosal neoplasm, fibrosis or bronchial wall edema. Despite this inaccuracy, CT is complementary to bronchoscopy since it allows to: 1) detect a pathology in the bronchial walls, which appear thickened; 2) delineate the extent of extraluminal spread; 3) help plan transbronchial needle aspiration biopsy.

Pelvic carcinomatous neuropathy: CT findings and implications for radiation treatment planning.

The CT findings in 24 patients with clinically evident carcinomatous neuropathy from pelvic soft tissue involvement are described. Computed tomography is mandatory to differentiate carcinomatous pelvic neuropathy from other causes of pelvic neuropathy as well as to plan radiation treatment.

[X-ray computed tomographic aspects of neoplastic pathology of the parapharyngeal space]. / Aspetti tomodensitometrici nella patologia neoplastica dello spazio parafaringeo.

The parapharyngeal space is a fat-filled region situated deep in the head between the basicranium and the oral floor. It can be divided in two parts: the prestyloid and the poststyloid space. The mandibular nerve is contained in the prestyloid space, while the carotid artery, jugular vein, IX, X, XI, XII cranial nerves, cervical sympathetic chain and junctional lymph nodes are situated in the poststyloid compartment. The normal CT anatomy and CT findings in 22 patients with proven lesions of the parapharyngeal space are described. Three different groups of neoplastic processes can be distinguished: primary tumours, secondary tumours and enlarged lymph nodes. The nature of the lesions developing in the parapharyngeal space can be diagnosed by CT in many cases.