Musculoskeletal hydatid disease: report of a rare case with primary and exclusive localization in right hemi-pelvis and femur.

Hydatid Disease (HD), also called Echinococcosis or Hydatidosis, is a parasitic infection caused by the larval stage of the tapeworm Echinococcus: E. granulosus or E. multilocularis. HD occur most frequently in liver or lungs, rarely in brain, skeletal muscles, bones, kidneys, spleen. Bone infestation of Echinococcosis hydatid cysts occurs respectively by haematogenous seeding and progressive invasion into bone by lesions in the adjacent soft tissues. Patients with musculoskeletal HD clinically show the disease in adulthood because the lesions develop very slowly. In some cases, HD is an uncommon cause of soft tissue mass, pain and neurovascular symptoms due to compression or to secondary infection. Diagnostic imaging plays an important role in the diagnosis of HD and in the differential diagnosis with soft tissue tumors. We present a rare case of male patient of 42 year-old with diagnosis of HD with primary and exclusive localization in right hemi-pelvis and femur.

Ultrasound and MRI for the long-term evaluation of surgical repair of the rotator cuffs.

About 1 year after surgery to repair the rotator cuff, a total of 20 patients (80% monotendinous injuries, 20% bitendinous injuries) were submitted to ultrasound and MRI to evaluate repair, quality of residual tissue, and to reveal any discrepancies between the two instrumental tests. The results showed that there was normal tendinous integrity in 16 cases (group A), while there were partial injuries, without evidence of complete lesion, in 4 cases (group B); tendinous thinning was evident in 10 patients (50%), while there were areas of intratendinous degeneration in 40% of the cases. The authors observed agreement between the data obtained by the two methods in 75% of cases, and emphasize the effectiveness of the two methods in postoperative evaluation of the cuff; they also confirm the tendinous dishomogeneousness observed in the patients in group B, not associated with poor clinical results, considering the absence of significant differences in the functional results between the two groups.

Magnetic resonance imaging in the study of ischemic heart disease.

In ischemic heart disease, as compared to other procedures, Magnetic Resonance Imaging (MRI) offers the advantage of providing in a single diagnostic session an ample and reliable multiparametric analysis. The technological advances of recent years have been increasing exponentially and marked qualitative refinements are thus predictable in the near future for morphological, functional, perfusional and metabolic studies.

Hypothalamic-pituitary vascularization in pituitary stalk transection syndrome: is the pituitary stalk really transected? The role of gadolinium-DTPA with spin-echo T1 imaging and turbo-FLASH technique.

We examined 14 patients, aged 10-25 years, with idiopathic hypopituitarism. All presented an ectopic posterior pituitary at the median eminence with a hypoplastic anterior pituitary on magnetic resonance imaging (MRI). Eight patients had isolated growth hormone deficit (IGHD) and six had multiple hormone deficits (MPHD). Unenhanced MRI showed the pituitary stalk, which was extremely thin, in only three patients, while T1-weighted images obtained after intravenous injection of gadopentetate dimeglumine (Gd-DTPA) showed a thin pituitary stalk in seven patients (six with IGHD and one with MPHD), demonstrating a preserved vascular component of the stalk. MRI with Gd-DTPA was more sensitive than unenhanced MRI in detecting the pituitary stalk in patients with hypopituitarism with an ectopic posterior pituitary: the stalk was demonstrated in 50 % of the cases (seven patients), versus 21.4 % (three patients) by unenhanced MRI. The dynamic study of the hypothalamo-hypophyseal axis performed with turbo-FLASH sequences after bolus injection of Gd-DTPA showed the residual anterior pituitary to have arterial enhancement times, which suggests that an arterial system compensates for the absent or diminished blood supply from the portal system, independent of stalk detection.

[Dynamic vascular imaging with magnetic resonance imaging of the thoracic and abdominal region. Technique optimization]. / L'imaging vascolare dinamico con risonanza magnetica dei distretti toracico e addominale. Ottimizzazione della tecnica.

Several Magnetic Resonance (MR) imaging techniques for the study of the main thoracic and abdominal vessels are analyzed. Such techniques based on the static representation of vessels, as MR angiography (MRA), are considered, together with dynamic techniques--i.e., cine MR--and those based on ultra-fast sequences with bolus contrast medium administration; the latter are considered also according to their use in the study of the early parenchymogram. Namely, the investigated techniques are: 3D/2D inflow imaging with and without presaturation, 3D inflow imaging with paramagnetic contrast medium administration, 2D/3D phase/dephase subtraction imaging, cine MR with heart gating, the sequential dynamic single-slice technique with bolus contrast medium, and the apnea multi-slice imaging. The main parameters are indicated for each technique and type of sequence. From our experience, rather precise indications emerge as to the use of the various techniques according to the investigated region and to the suspected disease. The best techniques for demonstrating sacciform aneurysms proved to be the 3D inflow ones, as well as the cine MR and the turbo-flash sequences with contrast medium; as for dissecting aneurysms, cine MR proved best. In portal flow conditions and in major veins thromboses, 2D inflow and phase/dephase subtraction sequences are suggested. In the study of renal stenoses, limitations and advantages of 2D versus 3D sequences are compared. Moreover, indications, limitations and specificity are analyzed of the early parenchymogram based on ultra-fast sequences with paramagnetic contrast medium. In the authors' experience, the different MR vascular imaging techniques must be considered only an integration to more specific investigations, but it is likely that, as it happened with MRA of the head and neck, the increase in resolution and the reduction in artifacts will--soon--turn this kind of imaging into the examination of choice in vascular studies.

[Dynamic sequential study of hepatic nodular lesions with ultra-fast sequences and fast bolus of gadolinium-DTPA]. / Studio sequenziale dinamico delle lesioni nodulari epatiche mediante sequenze ultra-fast e impiego di gadolinio-DTPA in bolo rapido.

Eighty-five patients with single/multiple nodular hepatic lesions (10 focal nodular hyperplasias, 37 liver hemangiomas, 24 metastases and 16 hepatocellular carcinomas; 2 patients had associated lesions) were examined with dynamic single-slice sequences and fast i.v. bolus injection of Gd-DTPA. The dynamic single-slice technique was used to evaluate the peculiar features of the dynamic enhancement. The snapshot sequence proved best to provide the high temporal resolution of the dynamic parenchymal enhancement (scanning time < 1 second, one frame every third second). The following variables were investigated: nodular lesion intensity in the first basal snapshot image, enhancement appearance and its contemporaneity with arterial, venous or portal flows, enhancement gradient relative to surrounding liver parenchyma, morphologic features of the enhancement and its centrifugal/centripetal patterns. The enhancement curve of focal nodular hyperplasia increased very quickly during the first 20-25 seconds. This enhancement was quite similar to the arterial one and always occurred before portal and systemic venous times. Hemangiomas exhibited a typically slow growth-curve in the first 120 seconds, with a positive final gradient value relative to liver parenchyma. The appearance of peripheral contrast enhancement was a typical sign after 30 seconds. Metastases exhibited similar dynamic enhancement to hemangiomas, but peripheral enhancement was never observed and, after 120 seconds, gradient was null or negative relative to the adjacent liver parenchyma. Moreover, enhancement always followed portal times. Hepatocellular carcinomas showed an early growth curve, preceding portal times, but less marked than in hyperplasia. The study of our series provided the preliminary semiology of early dynamic enhancement patterns, which is quite specific to recognize and differentiate nodular hepatic lesions.