[Radiology area as a federal reality. I].
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Forecasting↗
Biomedical subjects
R Passariello
Publications and source records attributed to R Passariello.
[Identification of pancreatic insulinomas. The role of magnetic resonance].
Insulinomas are the most common endocrine tumors of the pancreas. Although their clinical and biochemical diagnosis is extremely accurate, these lesions must be correctly located preoperatively to plan the best possible treatment. Many different noninvasive diagnostic techniques have been proposed, with only partially satisfying results. For many years such non-invasive modalities as arteriography have been considered the most reliable and accurate diagnostic tools. Recently, however, MRI has been proposed for best pancreas imaging, especially for tumor detection, and its results have been excellent especially thanks to its optimal contrast resolution. Fat-suppressed and turbo-spin-echo (TSE) sequences now yield even better results. In our study we examined 21 patients, whose symptoms were typical of insulinoma, using two different 0.5T magnets, one of which with 15 mT/m gradients. We used T1-weighted spin-echo (SE) sequences with and without respiratory compensation, SE ad TSE T2-weighted and fat-suppressed T1-weighted SE sequences. In 16 patients the lesions were correctly diagnosed and located, as confirmed at surgery. In the other 5 patients, MRI failed to locate the insulinomas. Three of these 5 patients were submitted to surgery, during which palpation and intraoperative US findings were also negative for a solid mass. The remaining 2 patients underwent clinical follow-up. Our study demonstrated that MRI, especially with fat-suppressed and T2-weighted TSE sequences, is a very accurate modality to detect pancreatic insulinomas and can therefore be proposed as the only preoperative technique.
Adolescent↗
[Carcinoma of the pancreas. Typical and atypical aspects using midfield-strength magnetic resonance].
Until few years ago, MR assessment of pancreatic carcinoma was thought to be feasible only with high-strength equipment, but today also low- and midfield units allow pancreatic lesion detection, thanks to parameter optimization. The authors retrospectively analyzed the MR findings of 57 patients examined with a midfield MR unit; all the patients had clinically suspected pancreatic carcinoma, which was confirmed in 54 cases. The lesions were more easily detected using T1-weighted sequences, thanks to their high intrinsic contrast, while T2-weighted sequences often confirmed the glandular changes already depicted by T1-weighted sequences. MRI correctly depicted vascular and lymph node involvement and detected liver metastases with no i.v. contrast agent injection. The only limitations of this technique are the unfeasibility of MR exams of diagnostic value in uncooperative patients (5% of cases) and the very similar MR features of parenchymal scars, due to previous acute pancreatitis, to those of pancreatic carcinoma. In conclusion, CT remains the gold standard in the study of pancreatic cancers, but midfield strength MRI, if correctly performed, can be proposed as a complementary tool to CT, especially in questionable cases and in the patients with known reactions to iodinated contrast agents.
Aged↗
Sonographic and NMR imaging study of sausage digit.
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Adult↗
[Metachronous tumors of the breast. Mammographic findings].
In breast carcinoma patients the risk to develop a second lesion in the contralateral breast is two to six times higher than in control subjects. The second lesion is called metachronous and classified among bilateral breast cancers. This kind of lesion affects the patients who were mastectomized for breast carcinoma; it may be a primary lesion, when the histologic type is different from that of the first breast cancer or secondary, when the histologic type is the same as that of the first tumor and the second lesion is therefore a metastasis. This study was made to assess the incidence of metachronous lesions and the average time between the first and the second tumor and to investigate the value of mammographic followup. We selected 375 patients who had undergone mastectomy for different histologic types of breast carcinoma and examined the contralateral breast with mammography 6 months after surgery and then every 12 months, January 1990 through January 1992. Mammography showed metachronous lesions in 23 cases: 15 infiltrating ductal carcinomas, 6 infiltrating lobular carcinomas and 2 in situ carcinomas, the latter with histologic confirmation in the patients operated on for benign breast lesions. The incidence of metachronous tumors was 6%, including both the primary and the metastatic lesions; the average time between the first and the second tumors was 20 months. Mammography allowed metachronous lesions to be diagnosed in a very early stage, much earlier than in other studies not including mammography. Prognosis is definitely improved by the early diagnosis of primary breast cancer, when no metastatic spread is present, and also in case of primary metachronous lesions, which are very uncommon.
Adult↗
[Cystic neurinoma of the axilla. A case report].
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Axilla↗
Italian radiology. Advanced technology, progress, and promise.
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Health Expenditures↗
Role of magnetic resonance imaging (MRI) in detecting liver changes after gallstone extracorporeal shock wave lithotripsy (ESWL).
Recently published literature on biliary extracorporeal shock wave lithotripsy (ESWL) has shown that high-energy ESWL utilizing high kV is more effective than the low-energy ESWL and low kV used previously. Prior studies have not reported injury to the gallbladder or adjacent liver following ESWL. Our study evaluated 29 patients that were treated with high kV ESWL. Magnetic resonance imaging (MRI) was used to study the gallbladder and adjacent liver for possible injury resulting from the high-energy treatment. The patients, selected using the Dornier MPL-9000 United States protocol, underwent ESWL using 18-24 kV (average 21 kV). MRI was done both pre and post-ESWL in all 29 patients. Ten patients had a second treatment to reduce fragment size and, subsequently, had an additional MRI examination. Spin echo MRI images were obtained at the level of the gallbladder fossa using a 0.5-Tesla ESATOM RM 5000 (ESAOTE Biomedica, Genva, Italy.) superconductive unit. Both T1- and T2-weighted images were obtained. In 26 patients the hepatic parenchyma was normal post-ESWL. Two patients had a hyperintense region on T1-weighted images post-ESWL that was felt to be related to pericholecystic fat. A third patient had an abnormality detected on T2-weighted images that was thought to be due to hepatic edema or microhemorrhage. No significant changes were shown by laboratory or concurrent ultrasound examinations. Repeat MRI examinations in these three patients were normal. High-energy ESWL appears as safe as low-energy ESWL in the treatment of patients with symptomatic gallstones.
Adult↗
[Hypermedia software for teaching anatomy of the upper abdomen with computerized tomography and magnetic resonance].
The authors have developed a hypermedia program for creating a tutorial of CT and MR anatomy of the upper abdomen. The program was created on a Mcintosh computer, with the Supercard software: it is made up of a series of windows, each of them containing images, texts, schematic representations and sound. Moreover, each window contains buttons which are activated with the mouse and allow different kinds of function, all created by the authors to be displayed. In particular, navigation buttons allow the users to move in the program either sequentially or non-linearly, according to their needs. The possibility of obtaining information and schematic representations is given by specific buttons. There are also multiple buttons hidden in the images which, when activated, allow the name of the selected organ to be displayed. In conclusion, this program can be especially helpful since it allows different data sets to be integrated to provide the user with complete information. Moreover, the program allows learning to be controlled, that is the user to be informed on timing and methods for more effective studying.
Abdomen↗
[Imaging of atherosclerosis: magnetic resonance].
Atherosclerosis is the disease with the most important social impact in terms of cost and human life. Its study in the prevention and cure of its consequences needs integration using many imaging modalities, and magnetic resonance presents advantages due to its particular characteristics. The Authors make an overview of its indications and potential applications in the assessment of atherosclerotic disease. In vitro studies have demonstrated that it is possible to evaluate the normal and abnormal components of vessel walls by means of magnetic resonance imaging (MRI) as well as fatty deposition and intraplaque hemorrhage. On the other hand, in the in vivo studies, despite the impossibility to make a too fine structural analysis of the vessel wall, MRI allows to easily discriminate between blood flow and parietal wall. This is of great importance in the study concerning arterial aneurysms, that represent a consequence of atherosclerotic disease. Information as the presence, the site, the extension, the collateral vessel involvement and, finally, the presence or absence of dissection are all obtainable by using MRI. In the early 1990's magnetic resonance angiography (MRA) was developed and is now used in clinical practice. By means of this new application of MRI there is the possibility of increasing the non invasive screening of atherosclerosis especially in some body districts. The evaluation of the plaque obtainable by the combined use of MRA and ultrasound studies allows to decrease the employment of traditional and digital angiography. If, as studies predict, we will able to obtain coronary angiograms in the near future, there will be a further increase in the non invasive evaluation and in the prevention of atherosclerotic disease.
Aortic Aneurysm↗
[Evaluation of aortic distensibility using cine-MR before and after antihypertensive treatment with calcium antagonists and ACE-inhibitors].
Several studies have been performed in the last years to evaluate arterial distensibility, particularly of the aorta, in hypertension and to estimate the changes of this distensibility after anti-hypertensive treatment. The aim of this study was to assess the aortic distensibility in a group of 10 patients with essential hypertension in comparison with a control group, with regard to the vascular effects of a long-term anti-hypertensive treatment with calcium-antagonists and ACE-inhibitors. All patients were studied using cine-MR imaging, a technique with several peculiarities (multiplanar scanning, intrinsic contrast, etc) that allows simple and quick assessment of the aortic vascular parameters in the ascending and descending tracts. The results of our study show the absence of a significant improvement of aortic vascular areas, and therefore of vessel distensibility, even in the presence of a complete blood pressure normalization in all patients after a 3-month treatment. These data do not confirm previous reports in this setting, based on the ultrasonographic techniques (2D and Doppler echocardiography). Two major reasons may explain our results: first, the rigorous criteria of patient enrollment that we have stated in order to avoid any influence of age and/or other pathologies; second, the ability of MR imaging to allow accurate estimation of aortic vascular parameters and to achieve an excellent intraobserver and interobserver reproducibility in comparison with other techniques. We conclude that MR imaging is the method of choice for the assessment of cardiovascular function and morphology.
Angiotensin-Converting Enzyme Inhibitors↗
[Angiography with magnetic resonance of the ++carotid arteries. Evaluation of clinical results obtained with low magnetic field equipment].
Magnetic Resonance Angiography (MRA) is the latest diagnostic technique for the noninvasive evaluation of cardiovascular conditions. This technique has proved to be especially useful in the study of carotid arteries. All the clinical studies reported to date have been obtained at high or medium field strength; our purpose is to assess the clinical value of MRA in the evaluation of carotid arteries at low field strength. All the exams were performed with an 0.2 T permanent magnet, using the 2D time of flight (TOF) technique, the only one which is currently available on our equipment. Forty-two patients with clinical diagnosis of cerebrovascular insufficiency were examined. In all cases MRA findings were confirmed with digital subtraction angiography (DSA), which was considered the gold standard. The double-blind evaluation of the results showed high agreement of the two techniques in 70 of 84 carotid arteries. A mild tendency to overestimation was observed in 4 normal cases considered as mild stenoses on MRA, in 2 cases with mild stenosis considered as discrete stenoses on MRA and in 1 case of severe stenosis considered as an occlusion on MRA. Underestimation was seen in 1 case of mild stenosis considered as normal on MRA, in 2 cases of discrete stenosis which appeared as mild stenoses on MRA and in 2 cases of occlusion considered as severe stenoses. Our study showed high agreement between MRA and DSA results, which means that high quality exams can be obtained even at low field strength. Further progress can be expected when 3D TOF and phase-contrast techniques will be introduced.
Adult↗
[Magnetic resonance imaging in patients with sickle cell anemia].
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Anemia, Sickle Cell↗
[Animal experimentation in radiology. Objectives, organizational and ethical problems].
The contribution of biomedical sciences to the scientific breakthroughs in the last years has benefitted also by experiments on animals. As for diagnostic imaging, the use of new contrast media for angiography, CT and MRI makes it necessary, according to the law, to perform preliminary animal studies to test efficacy, pharmacokinetics and pharmacodynamics of the contrast agents. Experimental animal studies of clinically well-established contrast agents are also justified by the need to implement new imaging modalities. The close relationship between medical research and animal experimentation has awakened public opinion, as well as the researchers themselves, to the ethical and legal problems related to animal testing. This paper reports on the regulations which are currently in use in this field.
Animals↗
[Transrectal echography in the assessment of anastomosis and local recurrence after prior resection].
The value of rectal endosonography was investigated in the follow-up of the patients submitted to anterior resection for rectal cancer. Rectal endosonography was performed on 42 patients who had been operated on two months to five years before; all patients were monitored according to a carefully planned follow-up schedule including clinical and instrumental examinations and laboratory tests. Sixteen patients had altered clinical and laboratory data; 26 were completely asymptomatic. In the latter group, no signs of local recurrences were found, while in 4 cases the rectal wall appeared homogeneously thickened and hypoechoic: this pattern was due to postoperative or post-irradiation hyperemic-edematous phenomena. In 14 of 16 symptomatic patients, a mass was detected--in 9 of them inhomogeneous and hypoechoic and developing mainly in the perirectal perianastomotic tissue and in 5 limited to the rectal wall, in the anastomotic area. In the last 2 cases, no lesions were found. Both the manual and the stapler anastomoses were always demonstrated, which exhibited different US patterns. US findings were compared with histologic results or were clinically checked in the subsequent follow-up. To conclude, rectal endosonography proved to be useful in the postoperative follow-up of this kind of patients even though it did not allow the differential diagnosis between fibrosis and local recurrence.
Anastomosis, Surgical↗
[Magnetic resonance in the assessment of critical points of impingement of the shoulder].
Impingement syndrome is caused by a conflictual status between rotator cuff, subacromial bursa and anatomic and functional acro-mioclavicular arch. The clinical signs of this syndrome include pain and functional disability in abduction and extrarotation of the shoulder. This study was aimed at verifying Magnetic Resonance Imaging (MRI) capabilities in showing the critical points of impingement and their incidence. Fifty-four cases of impingement syndrome were studied. The best visualization of functional acromioclavicular arch was obtained using a new study technique. All patients had critical points of impingement. In 65% of cases, acromioclavicular arthritis induced impingement on the supraspinatus tendon and in 35% of cases on the muscle. In 46% of the patients, impingement between coracoacromial ligament, partially thickened in 25% of the cases and totally thickened in 75%, and supraspinatus tendon was observed. In 7% of the whole of shoulders, the acromion had an uncinatus shape. MRI, thanks to its multiplanar imaging, allowed the complete evaluation of the articular structures with complex anatomy. The assessment of different types of impingement points can be considered a valuable approach to the therapeutic stage.
Adult↗
Magnetic resonance angiography: current clinical applications.
Magnetic Resonance Angiography (MRA) is the newest non-invasive procedure for the evaluation of the vascular system. The basis to obtain images of vessels from Magnetic Resonance (MR) data rely upon the specific signal alteration determined by flowing blood. By using special techniques only these signals are evidenced, with cancelling of the surrounding stationary tissues. Clinical applications are reviewed in this paper. They include: Evaluation of intracranial vessels with important adjunct information to those obtained by conventional MR images; Definition of cerebrovascular disease including the carotid artery with good correlation with Digital Subtraction Angiography (DSA); Evidence of abdominal vessels, with clear imaging of abdominal aortic aneurysms; Definition of renal arteries; although problems exist, the technique may become useful in the future for the screening of renovascular hypertension; Visualization of peripheral vessels; initial results indicate a potential application in the evaluation of peripheral run-off distal to occlusions.
Carotid Artery Diseases↗
Identification of coronary artery by-pass grafts: reliability of MRI in clinical practice.
In order to test MRI ability to detect the number and the sites of coronary artery by-pass grafts (CABGs), 22 patients with CABGs were studied. The detection of a neo-vessel in even one of the examination slices was considered as positive for the study, disregarding the difference between its origin and course. With such a criterion, MRI total percentage of vascular bridges identification resulted in 76.1% (51/67) with very low values for CABGs implanted on diagonal, obtuse marginal and posterior descending vessels (11/24 = 45.8%). These results lead to the conclusion that, although MRI has some advantages in the identification of CABGs implanted on the main coronary vessels in the early post-operative period, its extensive use cannot be proposed at the present state of the art.
Adult↗