Biomedical subjects

M Bazzocchi

Publications and source records attributed to M Bazzocchi.

At least 19 recordsLinked to original sources

PubMed2006

Sonographic criteria for differentiation of benign and malignant solid breast lesions: size is of value.

PURPOSE: The purpose of this study was to evaluate whether lesion size may influence the value of sonographic findings in the differential diagnosis between benign or malignant breast lesions. MATERIALS AND METHODS: Sonographic features of 256 histologically confirmed (148 benign, 108 malignant) breast lesions were retrospectively and independently reviewed by three radiologists unaware of mammographic findings and pathology results. Each lesion was assessed for several sonographic features and assigned a level of suspicion. Logistic modelling defined the predictive value of each sonographic feature per se and in relation to lesion size. The k statistic (k) evaluated interobserver agreement in lesion classification. The accuracy of breast sonography in characterising solid lesions was also evaluated. RESULTS: Analysis of the sonographic features predictive of malignant disease, taken as a whole, showed that only irregular margins and marked hypoechogenicity maintain their predictive value independent of lesion size. When lesion size is considered, the other features remain significant only for lesions larger than 7 mm. Interobserver agreement for sonographic suspicion, when calculated not taking into account lesion size, was good or excellent whereas it was reduced for lesions smaller than 7 mm. Accuracy of breast sonography improved when evaluating lesions larger than 7 mm. CONCLUSIONS: Lesion size influences the value of sonographic findings in distinguishing benign from malignant lesions. The usually adopted criteria in sonography have a significantly lower accuracy in characterisation of small lesions.

Adolescent↗

PubMed2006

Ultrasonographic analysis in vitro of parietal thickness of lower limb varicose veins.

PURPOSE: The aim of this study was to evaluate the ability of ultrasound (US) to measure the parietal thickness of varicose veins. MATERIALS AND METHODS: In a blind in vitro analysis, 28 great saphenous veins, obtained after stripping surgery from 28 patients with chronic venous insufficiency, were examined with a digital US scanner ATL-HDI5000, linear 5-1 to 2-MHz broadband probe, compound imaging technique and analogic-digital zooming. We obtained one to three progressive measurements for each vein wall (total 67 parietal thicknesses). The samples, fixed in formalin, were sent to the pathology laboratory: sections were obtained at the same level of the sonographic planes, and images were obtained by digital camera mounted on an optical microscope. Measurements obtained at histology were considered as the gold standard. K-statistic was applied to compare sonographic and histologic measurements. RESULTS: Considering only the hypoechoic wall portion, 29/29 (100%) diagnoses of hypotrophy (K=0.91), 19/22 (86%) diagnoses of normotrophy (K=0,47) and 12/16 (75%) diagnoses of hypertrophy (K=0.7) were obtained by sonography. CONCLUSIONS: In our preliminary experience, the in vitro study of varicose veins allows precise, at least morphological, detection of hypotrophic walls. If these preliminary data are confirmed in vivo, sonography could be used to discriminate patients eligible for conservative treatment instead of surgery.

Adult↗

PubMed2006

Gastrointestinal stromal tumour: spiral computed tomography features and pathologic correlation.

PURPOSE: Our purpose was to define the diagnostic accuracy of helical computed tomography (CT) in the identification, characterisation and evaluation of extension of gastrointestinal stromal tumours (GIST) through correlation with some pathological findings. MATERIALS AND METHODS: Between August 2000 and September 2004, we conducted a retrospective study of the abdominal CT of 15 patients with histological diagnosis of GIST - that is, the immunopositivity for c-kit (CD117) - on a surgical specimen of the primary disease. We used a helical CT single-slice (Toshiba, Asteion; rotation time 0.75 s) in ten cases and helical CT multislice (Toshiba, Aquilion; 4 slices/rotation; rotation time 0.5 s) in five cases. In all cases, we used an organ-iodate nonionic contrast agent intravenously at a concentration of 350-400 mgI/ml. All cases studied the entire abdomen. Site, morphology and tumour size (smaller than 5 cm, 5-10 cm and larger than 10 cm) were considered parameters for tumour identification. Size, partial or total extraluminal tumour growth, homogeneous or inhomogeneous lesion enhancement and the eventual presence of calcifications were assumed to be criteria for characterisation of a GIST. Hepatic, peritoneal and/or lymph node metastases were considered parameters of intermediate or high malignancy. We correlated the results with some pathological features derived from the analysis of surgical tissue: site, morphology and tumour size, tissue components and risk of malignancy of GIST (on the basis of the 2002 Fletcher classification). RESULTS: We demonstrated one substantial concordance between radiological and pathological valuation of site, morphology, tumour size and absence of intralesional calcifications of GIST. Nine of ten GIST smaller than 5 cm, the two 5-10 cm and the three larger than 10 cm presented extraluminal growth. Enhancement was inhomogeneous in five of ten lesions smaller than 5 cm and in all cases larger than 5 cm. At pathological analysis, in all cases of inhomogeneous enhancement, solid, hemorrhagic, necrotic and cystic areas were found. Of seven tumours of intermediate malignancy, six were smaller than 5 cm and only one larger than 10 cm; the two 5-10 cm were of high malignancy and all tumours superior of 10 cm were at intermediate or high malignancy. Of the two cases with metastases, one was of intermediate and one of high malignancy. In the other cases of intermediate or high malignancy, metastases were absent. CONCLUSIONS: The immunopositivity for c-kit is requisite for definitive diagnosis of GIST, but imaging, and particularly helical CT, has a primary role. In this study, CT is was reliable for tumour identification. All tumours larger than 5 cm presented extraluminal growth, inhomogeneous enhancement, absence of calcifications and lymph node metastases. Furthermore, the tumour larger than 5 cm showed extraluminal growth and inhomogeneous enhancement. Tumour size established with CT was not sufficient to determine the degree of malignancy. Metastases at the time of diagnosis were indicative of intermediate or high malignancy, but the absence of metastases did not allow classification of GIST in the group of low and very low risk of malignancy.

Adult↗

PubMed2006

Supraspinatus tendon US morphology in basketball players: correlation with main pathologic models of secondary impingement syndrome in young overhead athletes. Preliminary report.

PURPOSE: The purpose of this study was to investigate supraspinatus tendon sonographic morphology in a population of young overhead athletes in correlation with main pathologic models of secondary shoulder impingement syndrome. SUBJECTS AND METHODS: Between April and May 2004, 20 subjects (ten professional basketball players and ten non-athlete controls of the same age, weight and height ranges) underwent bilateral, standardised, sonographic sholulder examination to evaluate supraspinatus echotexture, supraspinatus and subacromial bursa thickness, subacromial space width (cutoff of 7 mm) and dynamic anterior impingement beneath the acromial margin. RESULTS: All subjects were right handed. No symptomatic controls were found. Four players showed signs and symptoms of right atraumatic shoulder instability (two cases) or supraspinatus impingement with anterior pain (one right and one left shoulder). Subacromial space width was reduced in five right-dominant players' shoulders (three symptomatic and two asymptomatic) versus zero controls (p<0.05) and in eight players' shoulders versus zero controls on total shoulders (p<0.05). No other significant differences were observed between the two groups in sonographic parameters considered. CONCLUSIONS: Despite the study limitations, ultrasonography (US) is able to detect subacromial space narrowing in young overhead athletes as early shoulder impingement sign, according to the continuum impingement-instability pathologic model.

Adolescent↗

PubMed2006

Multidetector CT with double arterial phase and high-iodine-concentration contrast agent in the detection of hepatocellular carcinoma.

PURPOSE: The purpose of this study was to determine whether the double arterial phase with multidetector computed tomography MDCT and high-iodine-concentration contrast material (CM) improves identification of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Fifty patients with 111 HCC foci (61 confirmed histologically, 46 confirmed by percutaneous interventional procedures, four confirmed by CT follow-up of at least 6 months) underwent MDCT with a double arterial phase and a portal venous phase after administration of contrast material with a high iodine concentration (400 mgI/ml, 2 ml/kg, 5 ml/s). Two radiologists independently evaluated the images in three distinct reading sessions (early arterial phase (EAP), late arterial phase (LAP) and double arterial phase) to determine presence, number and degree of suspicion of HCC. The sensitivity and the positive predictive value (PPV) were calculated for every reading session. The following statistical evaluations were used: k statistic and McNemar's test. RESULTS: Mean sensitivity and PPV in the detection of HCC were, respectively, 83.8% and 93.5% for EAP, 90.5% and 94.8% for LAP, and 94.1% and 95.1% for the double arterial phase. Sensitivity of the double arterial phase was statistically higher when compared with EAP alone but showed no statistically significant difference when compared with LAP. The k values ndicated moderate-to-excellent interobserver agreement in all reading sessions. CONCLUSIONS: Sensitivity and PPV increase progressively when passing from EAP to LAP to double-arterial-phase images obtained with contrast material with a high iodine concentration. However, the difference in sensitivity between LAP and the double arterial phase was not statistically significant.

Adult↗

PubMed2005

Postmenopausal hormone therapy and mammographic breast density.

OBJECTIVE: The aim of this study was to evaluate the effects of different types of hormone replacement therapy (HRT) on mammographic density. MATERIALS AND METHODS: In a prospective 1-year study, 103 postmenopausal women were randomized to receive tibolone 2.5 mg/die, continuous conjugated equine estrogens 0.625 mg/die plus medroxyprogesterone acetate (MPA) 5mg/die or placebo. Mammograms were performed at baseline and after 12 months of treatment. Mammographic density was quantified according to the Wolfe classification. RESULTS: After 12 months of HRT 16 of the 35 patients (45.1%) receiving continuous combined hormonal therapy showed an increase of breast density change in the Wolfe classification. After treatment with tibolone, an up grading in breast density, according to Wolfe's classification, was found in 2 of the 43 patients (2.3%). No changes were recorded in the 25 patients of the control group. The difference between the group treated with continuous combined hormonal therapy and the control group was highly significant (p<0.001). The difference in breast density between patients in treatment with tibolone and the control group was not statistically significant (p=0.34). DISCUSSION: Continuous combination HRT may be more commonly associated with an increase of mammography density than tibolone treatment.

Breast↗

PubMed2002

Ductal carcinoma in situ: is there a role for MRI?

The purpose of our study is to report personal experience about 28 cases of Ductal Carcinoma In Situ (DCIS) studied with Magnetic Resonance Imaging (MRI). From September 1995 to December 2001, 28 women affected by DCIS lesions underwent contrast enhanced MRI. All patients were submitted previously to mammographic examination. The results of histopathological examination included: 19 DCIS and 9 DCIS with associated microinvasive component or microfoci of invasive ductal carcinoma (IDC). MRI was performed with a 1 T system. A three dimensional fast low-angle shot (FLASH) pulse sequence was used, with a repetition time (TR) of 14 ms, an echo time (TE) of 7 ms and a flip angle of 25 degrees. We evaluated the morphologic features of the enhancement, the enhancement rate and the signal time intensity curve. On MRI 26 out of 28 (92.85%) DCIS lesions showed contrast uptake. 17 out of 19 pure DCIS lesions demonstrated contrast enhancement: 5 showed a low, 7 indeterminate and 5 a strong enhancement. Morphologically, the enhancing lesion was focal in 9, segmental in 5 and linear branching in 3. Wash out was found in 5 cases, plateau curve in 9 and Type I curve in 3. There were 5 cases of multifocality. All DCIS with associated microinvasion demonstrated contrast enhancement: 2 out of 9 cases showed a low enhancement, 4 out of 9 showed an indeterminate enhancement and 3 out of 9 showed a strong enhancement. Morphologically the enhancing lesion was focal in 3 out of 9, segmental in 5 and linear branching in 1. The wash out was demonstrated in 4 cases out of 9, plateau curve in 4 and Type I curve in 1. There were 3 cases of multifocality. In conclusion, MR imaging sensitivity for DCIS detection is lower than that achieved for invasive breast cancer; however, contrast enhanced MR imaging can depict mammographically occult foci of DCIS. The MR imaging technique is of complementary value in better description of tumor size and in additional malignant lesions detection.

Aged↗

PubMed2002

The Italian multi-centre project on evaluation of MRI and other imaging modalities in early detection of breast cancer in subjects at high genetic risk.

This report presents the preliminary results of the first phase (21 months) of a multi-centre, non-randomised, prospective study, aimed at evaluating the effectiveness of contrast-enhanced magnetic resonance imaging (MRI), X-ray mammography (XM) and ultrasound (US) in early diagnosis of breast cancer (BC) in subjects at high genetic risk. This Italian national trial (coordinated by the Istituto Superiore di Sanità, Rome) so far recruited 105 women (mean age 46.0 years; median age 51.0; age range 25-77 years), who were either proven BRCA1 or BRCA2 mutation carriers or had a 1 in 2 probability of being carriers (40/105 with a previous personal history of BC). Eight cases of breast carcinomas were detected in the trial (mean age 55.3 years, median age 52.5; age range 35-70 years; five with previous personal history of BC). All trial-detected BC cases (8/8) were identified by MRI, while XM and US correctly classified only one. MRI had one false positive case, XM and US none. Seven "MRI-only" detected cancers (4 invasive, 3 in situ) occurred in both pre- (n = 2) and post-menopausal (n = 5) women. With respect to the current XM screening programmes addressed to women in the age range 50-69 years, the global incidence of BC in the trial (7.6%) was over ten-fold higher. The cost per "MRI-only" detected cancer in this particular category of subjects at high genetic risk was substantially lower than that of an XM-detected cancer in the general women population. These preliminary results confirmed that MRI is a very useful tool to screen subjects at high genetic risk for breast carcinoma, not only in pre-, but also in post-menopausal age, with a low probability of false positive cases.

Adult↗

PubMed2001

[Application of a computer-aided detection (CAD) system to digitalized mammograms for identifying microcalcifications].

PURPOSE: It is estimated that during mammographic screening programs radiologists fail to detect approximately 25% of breast cancers visible on retrospective review; this percentage rises to 50% if minimal signs are considered. Independent double reading is now strongly recommended as it allows to reduce the rate of false negative examinations by 5-15%. Recent technological progress has allowed to develop a number of computer-aided detection (CAD) systems. The aim of CAD is to help radiologists interpret lesions by serving as a second reader. In this study the authors developed and applied a CAD system to measure its ability to microcalcifications detect and compare its performance with that of a human observer. MATERIAL AND METHODS: The study was performed as part of the CALMA (computer-aided library for mammography) project of the Pisa section of the National Institute of Nuclear Physics. The aim of this project is to set up a large database of digital mammograms and to develop a CAD system. Our study series consisted of 802 mammograms - corresponding to 213 patients - digitalized between March and June 2000. We performed traditional mammography and then digitalized the mammograms using a CCD linear scanner (pixel size of 85 x 85 microm2, 12 bits). The images were evaluated by two radiologists with similar experience and then by the CAD system. This CAD system searches for microcalcifications by using ad hoc algorithms and an artificial neural network (Sanger type). RESULTS: The number of clusters in our database was 141 corresponding to 140 images; 692 images were non pathological. The CAD system identified a variable number of clusters depending on the threshold values. The threshold value is a number over which the probability of finding a lesion is highest. With thresholds of 0.13 and 0.14 the CAD system identified 140/141 clusters (99.3%); with a threshold of 0.15 it identified 139/141 clusters (98.6%); with a threshold of 0.16, 137/141 (97.2%); with a threshold of 0.18, 133/141 (94.3%); with thresholds of 0.18 and 0.20, 130/141 (92.2%). With threshold values of 0.13, 0.14, 0.15, 0.16 and 0.17 the system's sensitivity was greater than 82%, whereas with values of 0.18 and 0.20 it was greater than 80%. The number of false positive region of interest (ROI) / image was greater with low threshold values: in particular, thresholds of 0.13 and 0.14 yielded 16 false positives /image, thresholds of 0.15 and 0.16 yielded 9 and 7 false positives/image, and both 0.18 and 0.20 only 5/image. DISCUSSION: ROC curve shows how the use of high threshold values determined a very high specificity despite very low sensitivity rates. Conversely, low threshold values allowed to have a high sensitivity and a very low specificity. The best performance of our CAD system was obtained with threshold values at 0.15 and 0.16. In fact these thresholds resulted in a high sensitivity (greater than 82%) with an acceptable number of false positives/image, 9 and 7/image, respectively. It is not yet known how radiologists can deal with large numbers of false positives in screening programmes but in our opinion the most important feature of a good CAD system is a high sensitivity. CONCLUSIONS: In the near future the use of CAD systems will be widespread and easier to apply to everyday practice above all in centers where digital mammography is performed. Mammograms could be directly shown to radiologists after the CAD system has selected the ROI and analysed the images. Thanks to its high sensitivity and despite its low specificity CAD represents a concrete aid for radiologists.

Breast Diseases↗

PubMed2001

[Papillary lesions of the breast: diagnostic imaging and contribution of percutaneous needle biopsy with 14G needle].

PURPOSE: To evaluate the presence of suggestive mammographic, US, color-Doppler, RM findings of 33 PLB and to show the accuracy of the large-core biopsy in evaluating these lesions. MATERIAL AND METHODS: A retrospective review of imaging-guided large-core biopsy of 860 consecutive lesions revealed that PLB were diagnosed in 31/33 cases and 3 were suspicious papillary lesions. Surgical correlation was available for all these lesions. Mammography and US were performed in all patients, Color-Doppler in 13/33 and MR in 10/33. RESULTS: Histological findings by percutaneous biopsy demonstrated 26 (79%) benign, 3 (9%) atypical, and 4 (12%) malignant lesions. Histological findings after surgery confirmed the diagnosis for benign and malignant lesions, while of the 3 atypical lesions, 1 was benign and 2 were malignant. One encysted papillary carcinoma in situ at core-biopsy was classified as invasive papillary carcinoma after surgery. PLB were usually found (52%) in subareolar location and the mean size was 17 mm (range 5-60 mm). The most frequent mammographic appearance of benign PLB was of a well-defined (71%), oval (53%) mass. The microcalcifications had variable features; they were isolated in 3/27 (15%) cases and associated with masses in 4/27 (20%). The mammographic finding of papillary carcinoma was of a well-defined (50%) or ill-defined, oval (50%) or lobulated (50%) mass, but never of a spiculated mass. US finding of the benign PLB most commonly showed a well-defined (84%), oval (84%), complex solid/cystic (52%) mass with frequently (60%) posterior enhancement. US finding of papillary carcinoma was of a well-defined (50%) or ill-defined (50%), oval (50%) or lobulated (50%) mass, most commonly solid-inhomogenous-hypoechoic. Color-Doppler showed high blood flow in 8/10 benign PLB and in 2/3 malignant PLB. Contrast-enhanced MR imaging demonstrated usually well-circumscribed, round masses (71%). The intensity/time curve showed marked focal enhancement (peak signal intensity over 70% at the first minute) in both benign and malignant lesions. DISCUSSION: Often the patients with PBL were symptomatic (for presence of nipple discharge or palpable mass). 31/33 papillary lesions identified at the subsequent imaging-guided large-core biopsy and in the 3/33 remaining lesions percutaneous core-biopsy required a subsequent surgical biopsy for the atypical papillary lesions. US proved to have the highest sensitivity, showing the suggestive feature of a frond-like mass within a dilated duct, and color-Doppler demonstrated high blood flow (which should be considered in differential diagnosis of galactocele). Mammographic finding of papillary lesions was often consistent with benign lesions (fibroadenoma, cyst). MR confirmed the high vascularization of these lesions, showing marked enhancement of the solid component. CONCLUSIONS: US, with Color-Doppler, proved to be the most useful examination for the identification and demonstration of the solid component of these lesions, which, observed further diagnostic investigation. As no definite mammographic, sonographic or RM pattern could be identified to differentiate between benign and malignant PLB, core-biopsy was required. Percutaneous biopsy has shown to be reliable in the diagnosis of benign and malignant PLB (without any false negative): infact, any atypical lesions require surgical examination. The framing of benign and malignant PLB with imaging and core-biopsy was useful because the frequent association of benign PLB with concurrent or subsequent breast carcinoma suggests surgical excision and radiological follow-up.

Adult↗

PubMed2000

[Ultrasonographic study of Peyronie's disease].

Induratio penis plastica (IPP) is a degenerative disease, which consists in a thickening of the albuginea tunica of cavernous corpora, especially on the dorsal aspect. In 25% of the cases a calcified deposit is present. This disease can determine a bending of the penis, usually upward, pain during erection and impotentia coeundi. It is associated with Dupuytren's disease in 25% of the cases. IPP is of unknown etiological origin. The more reliable etiological theories are the degenerative one (micro trauma and inflammation) and the autoimmune one. The assessment of IPP is based on story, physical examination, autophotography (which are necessary) and on imaging techniques such as ultrasound, color Doppler, CT, MRI and X-ray in mammography. Color Doppler has demonstrated to be the best technique because of its cost/benefit and cost/effectiveness ratio. RMI with gadolinium can determine plaques activity but it has a lower cost/benefit ratio. Color Doppler can determine the presence of an IPP plaque and its status, which is size, location, and degree of calcification. Some authors sustain that inflammation can be suggested by the presence of micro vascularization around the plaque. US can be very useful to detect plaque in a size not easily accessible by physical examination (on the dorsal aspect of the penis) and to demonstrate plaques in different evolution moment. Ultrasonography is the better technique to show directly albuginea tunica. Authors illustrate the methodology, which use intra-cavernous injection of prostaglandin E1 (PGE1) to induce erection and its semeiotic findings.

Humans↗

PubMed2000

[Diagnostic imaging of lobular carcinoma of the breast: mammographic, ultrasonographic and MR findings].

PURPOSE: To evaluate the most frequent mammographic, US and MR findings of invasive lobular carcinoma and the role of MRI in defining multifocality and/or multicentricity of this tumor histotype. MATERIAL AND METHODS: We studied 45 lobular carcinomas (39 patients) were selected from 421 breast cancers. Core biopsy with a 14 G needle was performed in 39 cases, under US guidance in 36/39 and under mammographic guidance in 3/39 cases. Surgical biopsy was performed in 2 cases and the diagnosis could be made only after mastectomy in 5 cases. All patients were examined with mammography and US and (10-13 MHz) and 8 also with MRI. RESULTS: 28/46 palpable lesions (60.9%). Core biopsy correctly diagnosed 38/39 lesions (97.4%). The most frequent mammographic findings was that of a nodular opacity without microcalcifications (34.8%), followed by a mass with spiculated borders (30.4%). Microcalcifications were seen in one case only (2.2%). Mammography detected no abnormalities in 15.2% of cases, but US showed a lesion in 2 of these cases. The most frequent US pattern was that of a hypoechoic lesion (43.5%), followed by posterior US beam attenuation. No US signs of abnormality were seen 15.2%. MRI correctly detected 13 lesions. Contrast enhancement was greater than 70% at one minute in 10 cases and greater than 40% in one case; two lesions exhibited atypical slow contrast enhancement, peaking at 5 minutes. MRI detected 5 lesions missed at both mammography and US and showed multifocal (3 and 2) lesions where the other techniques had detected one lesion only. DISCUSSION: At mammography and US invasive lobular carcinoma exhibits no different features than ductal carcinoma but is difficult to identify especially in its early stages. US is a useful tool especially to characterize mammography-detected lesions but in our experience it also demonstrated 2 lesions missed at mammography. MRI is a precious examination to define the multifocal, multicentric or bilateral character of invasive lobular carcinoma. CONCLUSIONS: Invasive lobular carcinoma of the breast is often very difficult to diagnose. Thus, we suggest the use of integrated diagnostic imaging with mammography, US and, in some cases, MRI for earlier diagnosis and to identify further tumor localizations.

Adult↗

PubMed1999

Diagnostic accuracy of perforated compression grid approach for mammographically guided core needle biopsy of breast lesions.

The aim of this study was to evaluate the diagnostic accuracy of large core breast biopsy with the use of the perforated compression grid (PCG) in a series of 106 consecutive mammographically detected breast lesions. The PCG consists in a fenestrated paddle that replaces the usual mammographic compressor. Each hole in the grid is marked by letters and numbers in order to obtain the coordinates of the area to biopsy. By analysing the two orthogonal projections, the depth of the lesion in the breast is calculated. With the breast positioned in the PCG, a skin incision is made. After calculations about the depth of needle insertion, the tip of the needle is inserted proximally to the target area. In such a way, taking into consideration the total running of the needle (23 mm), a correct sampling is assured, and multiple needle passes are performed. Sensitivity was of 90.62 and 90.90%, specificity was of 100 and 95.45% and positive predictive value was of 100 and 90.90% by excluding and including suspicious diagnoses, respectively, for each computation. In conclusion, the study indicated that image-guided core biopsy performed by the approach of PCG is a cost-effective, simple and accurate technique for the diagnosis of breast lesions, and it could be proposed as a low-cost alternative where the stereotactic equipment is not available.

Adult↗

PubMed1999

Functional MR with use of FLASH sequences in the evaluation of the phono-articulatory tract.

The aims of this study are to determine visualization of normal phonation structures with the use of MR fast sequences and anatomical reference indices which can be used in evaluating upper resonator pathologies. A total of 12 normal subjects were studied, a 1 T system, a volumetric receiving head and neck coil and FLASH sequences for one sagittal and two coronal scans. Each subject was instructed to take a deep breath and then to produce the vowel sounds for the entire duration of the scan. The movement of the following anatomical structures were considered: lips, tongue, soft palate, pharynx and epiglottis. For each subject sagittal scans were used to measure the minimal palate tongue distance (p-t), the minimal anterio-posterior diameter of the mesopharynx (mp), and the epiglottis excursion angle (ep) with respect to the plane determined by the false vocal cords. Our results were compared with a diagrammed representation of tongue movements (vocal trapezium). This study underlines the validity of MR imaging techniques in the study of the phono-articulatory tract, because MR provided good detail of the phono-articulatory structures enabling an overall functional evaluation. MR would appear useful in evaluating defects in the velum and palate, in staging of oropharyngeal neoplasms and in surgical reconstructions of the tongue.

Adult↗

PubMed1999

[Atypical ductal hyperplasia of the breast. Its diagnostic imaging and the role of percutaneous needle biopsy with a 14-gauge needle].

PURPOSE: To investigate the yield of core biopsy in the histologic characterization of atypical ductal hyperplasia (ADH) and to assess the radiological patterns, if any, of this condition. MATERIAL AND METHODS: January 1993 to October 1997 we studied 553 lesions, 8 of them with a diagnosis of ADH made on microhistologic samples obtained with 14G needles. Biopsy was performed under US guidance in 81.7% of cases and under mammographic guidance in 18.3%. The breast lesions were studied with mammography, US and MRI, the latter in one case. ADH was diagnosed by strict application of Page's and lesion extent criteria. RESULTS: Seven of 8 lesions with a core biopsy diagnosis of ADH were submitted to surgical biopsy. The diagnosis was changed in as many as 6 of 8 cases, into typical ductal hyperplasia (1 case) and carcinoma (1 papilliferous, 3 ductal infiltrating and 1 in situ lesions). ADH was confirmed in one case only. DISCUSSION: In agreement with other authors, we found no specific radiological patterns of ADH. Moreover, the core biopsy diagnosis of ADH requires a surgical biopsy, because ADH is often associated with carcinoma. CONCLUSIONS: Surgical biopsy is needed to diagnose ADH and therefore it is useless to perform more invasive procedures than 14G core biopsy.

Biopsy, Needle↗

PubMed1999

[Frequency of musculoskeletal symptoms in diagnostic medical sonographers. Results of a pilot survey].

INTRODUCTION: We report the results of a pilot survey in diagnostic medical sonographers. Aim of the study was to evaluate the frequency of musculoskeletal disorders in sonologists and the relationship of these symptoms to ergonomic factors. MATERIALS AND METHODS: 340 sonographers (258 male, 82 female doctors; mean age 41.5 +/- 7.2 years) were given a questionnaire to fill out. The questionnaire asked questions about the sonologist's age, gender, technique of ultrasound procedure, physical activity, and work-related musculoskeletal complaints. Two symptom lists regarded carpal tunnel syndrome (CTS) symptoms (8 items) and other work-related musculoskeletal symptoms (13 items). The categorized response variables "have now" or "in the past" were provided. The symptoms experienced were categorized into three levels as no symptoms, few symptoms (1-4 symptoms), and many symptoms (> 5 symptoms). RESULTS: One third of the respondents reported having at least one or more work-related symptoms in the upper extremities. The most frequent symptoms were tingling (17.6%), numbness or finger pain (13.5%). Carpal tunnel syndrome had been diagnosed in 5 cases (1.5%). More than 60% of all respondents have experienced one or more musculoskeletal symptoms in the cervical or lumbar spine. The commonest symptom was neck and low back pain (67%). The pain was generally intermittent and occurred at the end of the workday. Motion impairment in the neck and/or back was present in 23.5% of cases. Twenty-five percent of respondents had received treatments for their symptoms and 10% reported having stopped work because of their symptoms. Data analysis showed that muscular efforts such as gripping the transducer, applying sustained pressure, and scanning with a correlated flexed or hyperextended wrist were significantly correlated with increasing severity of symptoms in the hand, wrist, and forearm area. On the other hand, low back pain appeared to be negatively correlated with correct position of the body. CONCLUSIONS: Several physical risk factors (e.g., repetitive work and force exertion, twisting of the body and poorly-adjustable chairs) have been identified for work-related upper extremity and spine disorders. Ergonomic redesign of the workstation configuration as well as allowing sufficient recovery time to body and arm muscles appear to be the main goals to achieve prevention of musculoskeletal disorders in sonographers.

Adult↗

PubMed1998

Image-guided core breast biopsy: a suitable method for preoperative biological characterization of small (pT1) breast carcinomas.

Multiple prognostic indicators, namely histological grade and immunostaining for estrogen (ER) and progesterone receptors (PgR), MIB 1, bc1-2, and p53, were retrospectively determined on preoperative core biopsies from 75 patients with pT 1 breast carcinoma. The association of the preoperatively evaluated factors with those on the corresponding resected tumors (i.e. nodal status, histological grade, presence or absence of vascular invasion and necrosis) was assessed. In univariate analysis, histological grade on resected tumors was significantly associated with histological grade on core biopsy, p53 expression, MIB1 immunostaining. An inverse association was found between postoperative histologic grade and ER, PgR, and bc1-2. Necrosis was significantly associated with grade, p53, MIB1, and inversely with ER, PgR, and bc1-2. Nodal involvement and vascular invasion were significantly associated with MIB1. In multivariate analysis, histological grade and ER were the only independent core biopsy variables associated with postoperative histological grade and necrosis, respectively. This study showed that image-guided core biopsy is a suitable method that can be used to reveal some characteristics of the tumor biology in a preoperative stage.

Aged↗

PubMed1998

Transcranial Doppler: state of the art.

INTRODUCTION: Transcranial color Doppler sonography permits the accurate assessment of intracranial arteries. The latest Doppler units, using the color and power techniques, can show even very small flow volumes (1 x 1 mm). Low frequency (2-2.5 MHz) and very focused transducers are used in transcranial color Doppler. The skull is a very strong barrier for ultrasounds, which requires the use of some acoustic windows like some thin portions of the skull bone or some natural skull foramina. The use of echocontrast agents in color Doppler seems to increase the applications of transcranial studies. OBJECTIVE: (1) To report on transcranial color Doppler technique and findings. (2) To assess the role of contrast agents in the visualization of intracranial vessels. (3) To define the main indications of this technique. MATERIAL AND METHODS: The temporal, the orbital and the suboccipital are the main acoustic windows used for transcranial color Doppler studies. We use phased-array transducers (2-2.5 MHz) and, preferrably, the echocontrast agent. We examined 15 patients with severe internal carotid artery stenoses after the infusion of Levovist (Schering AG, Berlin, Germany) suspension (8 ml at 300 mg Galactose/ml, infused at 0.5 ml/s). RESULTS: Levovist infusion permitted to depict the main intracranial vessels in all cases. The middle and the anterior cerebral arteries are shown through the temporal window. The former is the main cerebral artery, it is the easiest to identify and presents the highest peak systolic velocity. The orbital window can be used to visualize the ophthalmic artery and the internal carotid artery siphon, while the vertebral and the basilar arteries are demonstrated through the suboccipital window. DISCUSSION: We report the most important findings and discuss the main indications of transcranial color Doppler studies. In addition to flow presence and direction, the main indices of arterial flow can be measured thanks to contrast agent administration, namely the peak systolic velocity, the end diastolic velocity, the resistance index and the pulsatility index. A morphological assessment of the Willis circle can also be carried out with color and power Doppler. Functional studies can be performed to assess the residual autoregulatory function of the cerebral circle in the patients with internal carotid artery stenosis or occlusion. The development of intracranial collateral circles can also be studied in these patients. Moreover, the M1 segment of the middle cerebral artery and the internal carotid artery siphon can be demonstrated directly. Transcranial color Doppler is also a useful tool to detect vasospasm after subarachnoid hemorrhage and to monitor blood flow velocity in the middle cerebral artery during carotid endarterectomy. The assessment of blood supply to arteriovenous malformations and to intracranial neoplasms is another application. CONCLUSION: With reference to internal carotid stenoses, the main applications of transcranial color Doppler are the study of intracranial vessels, of intracranial arterial stenosis, of arteriovenous malformations and of Willis circle aneurysms, as well as the monitoring of blood flow velocity during carotid endarterectomy. Echocontrast agents play an important role in the visualization of intracranial vessels.

Arterial Occlusive Diseases↗