Search

The authors illustrate the technique for small-bowel imaging using enteroclysis with multidetector-row computed tomography (MDCT), underscoring the important role played by CT in the assessment of the small bowel thanks to the advent of first the spiral and later the multidetector technique. The paper makes a detailed comparison of the various methods that have been used in CT study of the small bowel and proposes a standardised technique to achieve correct distension of bowel loops and adequate evaluation of bowel wall vascularity, making reference to the well-consolidated experiences of the various Italian research groups. The paper accurately describes the different procedures required for CT assessment of the small bowel, from nasojejunal intubation to the selection of the most appropriate acquisition phases for assessment of bowel wall vascularity.

Introduction: Lobular and ductal carcinomas in situ of the breast (LCIS and DCIS) origin from the ductal-lobular unit of mammary gland, but they are characterized for different morphologic patterns and evolution. In 1980 they represent 1.4% of diagnosis in breast biopsy, less of 5% of carcinomas of the breast. Actually in 7.5% of breast biopsy an in situ carcinoma is recognized (approximating 40% of breast cancers). Our purpose is to evaluate the different available strategies in the clinic management of DCIS and LCIS and, in case of surgical treatment, which reconstructive approach obtains satisfactory breast conformation., Materials and Methods: The study enclose 125 patients: 40 of them presented LCIS (32%) and 85 DCIS (68%). In 40 patients (32%) underposed to mastectomy was performed a reconstruction in cooperation with aesthetic surgeons. 35 of 40 women with LCIS are included in a follow-up programme, 5 of them had a bilateral mastectomy and reconstruction., Results: No recurrences were observed in patients affected by LCIS. Six patients underposed to wide excision for DCIS developed local recurrence, treated by mastectomy. No recurrences were observed in patients treated initially with mastectomy. Some complications correlated to reconstruction were detected., Conclusions: One of most controversial sights in breast pathology is the understanding of biological meaning of CLIS: in facts CDIS can be considered a pre-invasive cancer, CLIS is reasonably considerable only a risk indicator for developing breast cancer but it isn't a pre-neoplastic lesion. Very important is the reconstruction of the breast to improve the quality life of patients.

Purpose: Gastrointestinal (GI) leiomyosarcoma is an uncommon malignant cancer arising in the smooth muscle of the alimentary tract. It is known for its widely variable patterns and aspecific symptoms and signs preventing correct clinical assessment in the majority of cases. We will illustrate the key role of diagnostic imaging in the detection and staging of this lesion, describing the most suggestive imaging findings for the correct diagnosis., Material and Methods: January, 1990, to June, 1998, we examined 12 patients with GI leiomyosarcoma; they were 10 men and 2 women whose age ranged 42 to 85 years (mean: 63.7 years). Four lesions were found in the stomach, 3 in the jejunum and ileum, and 2 in the rectum. Due to the difficult clinical assessment of this type of lesion and to the development of emergency conditions, we could plan no diagnostic protocol in advance; thus, the most suitable diagnostic imaging approach was decided on the spot for studying the supposedly involved GI portions. Double contrast studies, US, CT and endoscopy were performed and each patient underwent at least two examinations., Results: Barium contrast studies were performed in 9 patients: the lesion was detected in 7 cases and tumor site and extent were defined in 5, while the double contrast study of the colon allowed to exclude large bowel involvement in 2 ileal tumors. In all 9 cases US and US-guided endoscopy permitted better assessment of extra-luminal spread and involvement of adjacent organs. CT, which is essential to staging, provided useful information suggesting the lesion nature: a round, inhomogeneous mass in continuity with the intestinal wall, with irregular margins, peripheral enhancement after i.v. injection of contrast material and a central necrotic area. Histology confirmed CT diagnosis in 7/9 cases while an aspecific diagnosis of large retroperitoneal and abdominal lesion was made in 2 cases. CT did not allow to define the origin of 2 large exophytic lesions in the stomach and jejunum and missed peritoneal metastases in 3 cases., Conclusions: Although the aspecific and quite variable clinical patterns make it extremely difficult to plan a correct diagnostic protocol, in our experience all diagnostic imaging techniques played a fundamental role in identifying and staging alimentary tract leiomyosarcoma. Particularly, CT showed high sensitivity and specificity in characterizing and staging this lesion but exhibited rather poor sensitivity in recognizing peritoneal spread.

Eleven patients with benign postoperative colonic strictures were treated with balloon dilatation November, 1990, through November, 1995. The anastomosis was sigmoidrectal in 7 patients and colocolic in 4 patients. All patients were submitted to contrast enema and colonscopy to assess the site, shape, grade and length of the stenosis. Biopsy was performed in 7 patients whose strictures had developed 2 months or more postoperatively. The dilatation was performed with 20-mm balloon catheters in the strictures developed 30 days postoperatively, to avoid any complications, and with 30-mm balloon catheters in the other cases. Balloon dilatation was performed under fluoroscopic guidance, with no-drug treatment. The procedure was well tolerated by all patients. One or two dilatation sessions were performed in ten and one patients, respectively. No complications were observed. The results were satisfactory in all cases, with symptom resolution. Follow-up included clinical, endoscopic and radiologic assessment. At follow-up, the technical result was good in all patients and the symptoms were completely relieved. In our experience, radiologically-guided balloon catheter dilatation proved to be an easy, safe and effective tool to treat benign postoperative colonic strictures.

Lobular carcinoma in situ is an uncommon noninvasive breast neoplasm; it accounts for about 0.8-3.8% of breast cancers and presents 3 peculiar characteristics: multicentricity (60-90%), bilaterality (35-59%), and the risk of invasive cancer (17-37%). The latter feature led some authors to consider this lesion as a marker of the development of an invasive cancer rather than a real malignant neoplasm. The main problem after histologic diagnosis is the choice of treatment: follow-up or surgery? Some authors reported, in the patients with lobular carcinoma in situ, the same incidence of ipsilateral invasive carcinoma as that in the normal population, which suggests a "wait and see" policy. This study, carried out on 27 patients (mean age: 49 years) with histologic diagnosis of lobular carcinoma in situ yielded the following aspecific mammographic findings: clustered microcalcifications; stellate masses and irregular nodular lesions with or without calcifications; architectural distortion with calcifications. In 10 surgical patients, 2 ductal carcinomas were demonstrated near the lobular carcinoma in situ. In the 17 patients submitted to follow-up, lobular carcinoma in situ recurrences were found in 4 patients at biopsy; a comedocarcinoma associated with a metastatic axillary node was found in one patient. Thus, we conclude that, in the patients with lobular carcinoma in situ, a "wait and see" policy of close observation should be adopted.

The authors reviewed the complications occurred in 393 patients who underwent needle localization breast biopsy from September, 1987, through September 1994. The lesions were located using 20-22 G needles with a teminal hook wire. The maneuver was carried out under US guidance in 7 patients, using stereotaxic equipment in 88 patients and without stereotaxic equipment in 298 patients. Clinical and guide-wire related complications were reported. The former complications were: severe vagal crises (in 3 patients), mild vagal crisis (10 patients) and bleeding (1 patient). Guidewire complications were: wire breakage (in 8 patients) and wire dislodgment (3 patients). Vagal crisis occurred above all in anxious patients. Guide-wire breakage or dislodgement may prevent lesion removal and, subsequently, lead to a diagnostic error. Our experiences suggests that information and continuous radiologist attendance positively influence patient's psychology reducing clinical complications. Moreover, operator's experience and care in choosing the appropriate devices greatly reduce the incidence of maneuver-related complications.

The authors report on the diagnostic role of radiological imaging in the study of the patients who underwent gastric surgery. This kind of intervention is often followed by postoperative complications, so that accurate clinical-instrumental investigations are required. Routine controls both in the immediate postoperative period and during follow-up are useful especially when a neoplastic lesion was the underlying condition leading to surgery. Radiological imaging plays a fundamental role especially in evaluating such postoperative conditions as afferent and efferent loop syndromes. Radiology is thought to be essential to demonstrate the syndrome and to identify the mechanical/functional nature of the factors causing the disease, all of which are essential to an appropriate and safe therapy. Both the duration of follow-up (early and late controls) and the choice of contrast (water-soluble contrast medium or double contrast enema) are very important factors depending on the time of surgery and the clinical indication.

The authors report on the use of interventional radiology modalities in the treatment of some gastrointestinal diseases (intussusception, stenosis, hemorrhage, etc). The results are compared with literature data relative to both interventional radiology and conventional therapeutic procedures. In our series, hydrostatic reduction of ileocolic intussusception was successful in 60% of cases. Transluminal dilatation with a balloon catheter was attempted in 108 patients with alimentary tract stenosis and was successful in 93. Hemorrhage and ischemia can be treated by means of transcatheter therapy (vasopressin, embolization) and percutaneous angioplasty. Percutaneous gastrostomy appears to be an effective alternative to surgical gastrostomy. Tapeworm infections can be cured by intraduodenal injection of "Gastrografin" (Schering). The success achieved in the different applications is such as to suggest a wider use of interventional radiology procedures, for they offer a more favorable cost/benefit ratio and often yield better results than conventional techniques.

The use of mammography as a screening examination has considerably increased our ability to detect non-palpable breast lesions less than 1 cm phi. A conclusive diagnosis frequently requires surgical biopsy. However, breast lesions can be localized prior to surgical biopsy by placing a wire in the lesion, with/without the use of stereotaxic equipment. Our method for lesion localization consisted in acquiring two orthogonal radiographs (cranio-caudal and latero-lateral) centered on the nipple. We used 20-21 G needles, 6-10 cm long, with curved-end wire. Mammographic findings possibly suggesting cancer were: microcalcifications, nodules, spiculated opacities, and architectural distortions. From January 1987 to January 1990, 223 patients were submitted to needle localization of breast lesions under mammographic guidance and without stereotaxic equipment. Sixty-seven cases (30%) were positive for malignancy, with a 2.3:1 benign/malignant ratio. Patients' age ranged 30-70 years, but most of them were 50-60 years old. No significant complications were observed: in one case only the hook wire broke, within breast parenchyma, which was at any rate resected together with the surgical specimen.

Thirteen patients with urethral stenoses of different etiopathology underwent TUP with an angioplasty balloon catheter. At follow-up, more than 10 months later, 8 out of 10 patients had normal urinary function. Excluding cases of urethral compression due to prostatic hyperplasia, 90% of the stenoses were successfully dilated. The gradualness of the dilatation, the application of a Foley catheter to maintain the dilatation obtained and the prevention of urinary infections are important factors for the success of this method.

The authors analyze their experience on 9 cases of esophageal stenosis dilated by "Grüntzig" type balloon catheter under fluoroscopic examination (transluminal esophagus plastica: TE). This procedure also allows dilatation of severe narrowing, offering distinct advantages represented by: low risk, easy performance, good tolerance, reduction or disappearance of disphagia. Esophageal perforation is possible, though it never appeared in author's experience.

The authors describe the importance of embolization of the splenic artery by means of Gianturco coils in splenomegalic portal hypertension. They propose their first experience of six cases and the good results on the basis of clinical parameters, of bleeding of esophageal varices, of hematological values. They also show the influence of this method on hemodynamic, metabolic, and respiratory parameters, altered in cirrhotic patients.