Biomedical subjects
Publications and source records attributed to M Bazzocchi.
Following a discussion of individual symptomatological findings, urographical patterns obtained in the various disease conditions capable of causing chronic renal failure are examined. A number of cases are presented by way of example.
PURPOSE: To assess the potential value of magnetic resonance imaging (MRI) combined with 67Ga single-photon emission computed tomography (SPECT) versus computed tomography (CT) in the staging and in the monitoring of mediastinal malignant lymphoma. MATERIALS AND METHODS: Twenty-three patients, referred to our institute for the evaluation of lymphoma, underwent CT, 67Ga scan, and MRI between April 1993 and February 1996 at sequential intervals. The tests studied (MRI, 67Ga, and CT) were performed according to the following schedule: 1) before start of therapy; 2) after four courses of chemotherapy; and 3) 2, 6, 12, and 18 months after the end of treatment. RESULTS: All patients studied at the time of diagnosis had abnormal gallium accumulation in the mediastinum as well as pathologic CT and pathologic signal intensity at MRI. Six months after the end of treatment full consistency was found between the results of MRI and SPECT, whereas during treatment and 2 months after the end of therapy MRI and 67Ga scan were not in agreement in nine patients. In the 23 patients in follow-up, in CT there were nine false-positive and three false-negative findings; in SPECT three false negatives; in MRI one false positive and one false negative. CONCLUSION: MRI can give morphologic information similar to CT, even superior due to multiplanarity and with major precision in the distinction between fibrosis and active disease. MRI is thus an alternative to CT. The association with SPECT allows a great diagnostic accuracy in the positive and negative predictive value.
A new way of scanning the kidney by ultrasonography is the posterior oblique longitudinal scan. This provides new information about renal anatomy, especially the renal aspect of the parenchyma and the hilus in its vertical axis. It supplies useful diagnostic information particularly in pseudotumours, hydronephrosis, and lipomatosis.
BACKGROUND: Preoperative staging of pelvic endometriosis helps the gynecologist plan therapy and offers a prognosis to patients. We compared a staging system of pelvic endometriosis based on magnetic resonance imaging (MRI) findings with the American Fertility Society (AFS) laparoscopic classification. METHODS: Forty-four consecutive females with clinically suspected endometriosis underwent MRI examination to demonstrate the presence of endometriomas and pelvic implants. Laparoscopy was performed within 2 weeks. An MRI score was developed to classify endometriosis into four classes comparable to those of AFS laparoscopic staging. Concordance between MRI and laparoscopic classification was evaluated with kappa statistics. RESULTS: Laparoscopy confirmed 60 of 61 endometriomas detected by MRI. Implants were discovered in 20 of 44 patients with MRI and in 23 of 44 with laparoscopy. MRI detected 50 endometrial implants of 65 detected by laparoscopy (76.9%). With regard to endometriosis staging, we obtained a concordance between MRI and AFS classification in 42 of 44 patients (kappa = 0.913). CONCLUSION: Although MRI has limitations such as suboptimal depiction of small implants and adhesions, this technique is very useful to guide laparoscopy. Moreover, the optimal concordance (95%) between our proposed MRI staging and the AFS laparoscopic classification demonstrated a new advantage of MRI in preoperative staging of endometriosis.
The magnetic resonance (MR) images in six patients with seven adrenal myelolipomas are presented. Four lesions involved the right gland, and three the left; they ranged from 3 to 12.5 cm in diameter. Magnetic resonance was able to image all lesions. Using T1-weighted sequences, three structural patterns were observed; (a) homogeneous masses with intensity equal to adjacent fat (three cases); (b) heterogeneous masses with fat intensity areas and areas similar to renal cortex (two cases); and (c) nodules quite different from fat, hypointense to the liver (two cases). On T2-weighted images, myelolipomas were slightly hypointense to fat and either hypo- or isointense to the liver. A comparison with the results of CT studies was possible in all cases, and good correlation with determination of the presence and quantity of fat density tissues within the lesions was observed. However, MR imaging did not seem to help in diagnosing adrenal myelolipoma in patients with equivocal CT findings, and needle biopsy is still needed in difficult cases.
The US findings in the kidneys of diabetic patients were studied. Diabetic subjects without clinical or laboratory signs of nephropathy were investigated by means of US in order to detect early anatomical lesions predictive of renal injury. The kidneys of cadaver diabetics were also studied to correlate US and histologic patterns. US alterations were observed in half of the cases: they were diffuse in 9% of cases and focal in 39%--hyperechoic spots and hyperechoic juxta-medulla. Focal spots are more common in juvenile-onset diabetics and they are correlated with the age of diabetes. At histology the above US patterns were correlated with the vascular wall alterations typical of diabetic nephropathy. Diffuse alterations are not specific. The authors conclude by suggesting US as a prognostic test for diabetic nephropathy.
The authors assessed the efficacy of PTBD in a group of 72 patients with obstructive jaundice due to lithiasis or malignant obstruction, that underwent preoperatively PTBD procedure. They analysed the early and late complications and its effectiveness in decreasing the bilirubin levels. The results, in agreement with the most recent reports, suggest the uselessness of the preoperative PTBD in the treatment of the patients with a jaundice due to a biliary lithiasis. Concerning the patients with a neoplastic jaundice, this procedure seems to be more effective in the patients with a biliary obstruction due to pancreatic head or distal choledochus carcinoma: in the patients with a far advanced cancer, the PTBD procedure could be the first step to the insertion of biliary endoprosthesis; on the other hand, in the patients that may undergo a curative treatment, PTBD could be useful preoperatively both to reach an adequate water-electrolyte [correction of hydroelectrolithic] balance and nutritional status both to complete the diagnostic procedure.
The contribution of US, CT, and MR imaging was investigated in 25 cirrhotic patients with hepatocellular carcinoma. The following parameters were considered: lesion detection, site and size of the lesion, daughter nodules, location and/or infiltration of intrahepatic vessels, patency of portal vein and collateral vessels, signs of chronic liver disease, steatosis, ascitis, and lymphadenopathy. Our results confirm the value of US, which also allowed lesion biopsy in all cases. CT was as accurate as US in detecting the lesion and even superior in demonstrating daughter nodules. MR imaging, with conventional SE and IR sequences, was inferior since it missed 3 lesions due to motion artifacts; moreover, a smaller number of daughter nodules was seen than with CT. The authors conclude that, at present, MR imaging cannot replace US and CT; the latter, if combined with arteriography, using either hydrosoluble or liposoluble contrast agents, gives the best results in the detection of small hepatocellular carcinomas, and especially of daughter nodules which are important factors for planning appropriate therapy.
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Percutaneous biopsy of lytic lesions of the bone, in the past pertaining to orthopedic surgeons, has now become a part of interventional radiology. Fluoroscopic guidance has simplified its execution. US does not, under normal conditions, allow an accurate examination of the skeleton; on the other hand, when the bone tissue is replaced by soft tissue, US can easily demonstrate the presence of a tumefaction, caused by a lytic lesion, and determine its characteristics. Eleven patients with lytic lesions (recognized on plain film) underwent US. The lesions were demonstrated. In such cases, biopsy is essential to define their benign or malignant nature, in the latter case if primitive or metastatic, and their histology as well. US is a simple guide to the biopsy of noncorticalized lytic lesions, and it offers consistent advantages over fluoroscopic guidance--i.e. it is easier to perform, it requires no X-ray exposure, it provides with three-dimensional images, the guide is performed in real time, and a choice of the most appropriate (non-necrotic) areas is possible.
To determine the role of sonography (US) in patients with renal colic, 40 patients were examined by means of US, plain abdominal film (PF), and intravenous pyelography (ivp). US sensitivity was 92.3% in diagnosing hydronephrosis and 75% in detecting calculi. Small calculi were correctly identified, irrespective of their chemical composition. It must be stressed how US, as compared to ivp, proved unsatisfactory in such cases as difficult visualization of the middle portion of the ureter, unsuccessful identification of acute obstructions without hydronephrosis (although the patient's hydratation may be useful in this respect), poor functional information (although there was a correlation between renal hyper-echogenicity and obstructive nephrogram). US is safe and easy to perform, and is suggested for the initial evaluation of patients with renal colic, together with PF, and as an alternative to ivp. Moreover, US is the ideal technique in the follow-up of these patients. Therefore, ivp should be performed in case of differing clinical and sonographic findings, when the calculus is not ejected within the expected time, and when surgery or lithotripsy are foreseen.
The results obtained in four successive trials based on the analysis of urography performed on patients with normal kidney function are reported. The scores obtained with a non-ionic contrast (iopamidol) were compared with those produced after injecting the same contrast medium with the addition of various diuretics (furosemide, various quantities of 5% glucose solution, 20% mannitol). The results obtained by injecting the diuretic together with the iopamidol were usually unsatisfactory. Injection of diuretic 15 ms after the iopamidol gave better results in the lower urinary tract, particularly the bladder. The best results were obtained by injecting 250 ml, 20% mannitol, after 15 ms. However this technique is not applicable to patients requiring a voiding cystourethrogram due to the inadequate opacification of the urethra it provides.
A series of 325 patients with renal mass lesions were examined by means nephrotomography during the years 1973-76; 85 of them (26%) underwent angiographic investigations. The basic findings observed with nephrotomography are described followed by the criteria which have suggested the necessity of the arteriographic examination. The analysis of the correlations between the two methods, shows the criteria which may limit the use of renal arteriography.
The echotomographic patterns in 22 patients with hepatic neoplasms are reported and discussed. Ultrasonography has a high sensitivity in detecting the solid echopattern of the tumour and its origin from liver parenchyma; gray-scale B-scan and a meticulous technique are very helpful for this purpose. Echotomography plays an important part in the diagnostic evaluation of this pathology, to better select the patients for more invasive techniques, after the screening procedures, as scintigraphy.
We retrospectively reviewed the findings relative to 95 patients with known prostate specific antigen (PSA) values who had undergone digital rectal examination, transrectal US and US-guided biopsy for suspected prostate carcinoma. Histology (48 adenocarcinomas, 26 BPHs, 12 inflammations and 9 negatives) was compared with results from rectal examination, prostate US, PSA values and "density" (PSA/prostatic volume, as measured with US). PSA values < 4 ng/ml exhibited 90% negative predictive value and PSA > 10 ng/ml 70.8% positive predictive value. In the intermediate range (4-9.9 ng/ml) the positive predictive value of PSA was 44.4% and its negative predictive value was 55.5%. PSA density did not affect predictive values in the two groups with PSA < 4 and > 10 ng/ml, while in the intermediate 4-9.9 ng/ml group, positive predictive value raised to 62.5% and negative predictive value to 81.8%, thus increasing the specificity of PSA values and US findings. Our results suggest that PSA should be the examination of choice in the patients with prostatic disease. Follow-up with PSA dosage after one year may be suggested when PSA < 4 ng/ml. PSA density can be helpful in patients with PSA values ranging 4-9.9 ng/ml; biopsy should be performed when the index > 0.15, while follow-up at 6 months should be performed when the index < 0.15. PSA values > 10 ng/ml require further evaluation with rectal examinations, prostate US and US-guided biopsy. Random biopsies are suggested when PSA values are > 20 ng/ml.
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Polysplenia syndrome is a malformation with impaired visceral lateralization; it consists in the incomplete development of the spleen which is replaced by two or more splenules (1-3 cm phi). This malformation is often associated with other anomalies and is more frequently seen in situs inversus and situs ambiguus. On the basis of their findings in 3 cases, the authors describe the main US and radiographic patterns of polysplenia syndrome, that is: polysplenia syndrome associated with situs solitus (several splenules where the spleen should be, without other anomalies); polysplenia syndrome associated with situs ambiguus (splenules in the right hypochondrium with such anomalies as "umbrella-like" liver and the absence of the hepatic segment of the inferior vena cava and enlargement of both azygos and hemiazygos veins); polysplenia syndrome associated with situs viscerum inversus (right-sided splenules, with transposition of abdominal and thoracic organs). The splenules exhibit the same echogenicity as the liver; when situs viscerum ambiguus is present. US patterns of splenuli are equivocal and may mimic liver metastases. On the contrary, CT allows better demonstration of both the anomaly and the associated malformations.