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Purpose: This study compared the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS) in evaluating the cause of extrahepatic bile duct dilatation., Materials and Methods: Forty-five patients (26 men, mean age 57 years) with extrahepatic biliary dilatation, as shown by transabdominal ultrasound, with or without elevated biliary and pancreatic serum indices, were prospectively studied with MRCP and EUS between September 2007 and October 2008. EUS and MRCP were performed within no more than 24 h of each other to reduce the possibility of changes due to stone migration. Image analysis was carried out in a double-blind fashion., Results: MRCP had 88.9% diagnostic accuracy, 91.9% sensitivity and 75% specificity, with 94.4% positive predictive value and 66.7% negative predictive value. EUS had 93.3% diagnostic accuracy, 97.3% sensitivity and 75% specificity; the positive and negative predictive values were 94.7% and 85.7%, respectively., Conclusions: MRCP and EUS do not show significant statistical differences in diagnostic accuracy. MRCP is an accurate, noninvasive modality in the study of extrahepatic biliary pathology. EUS is especially reliable in patients with extrahepatic biliary obstruction caused by endoluminal sludge.

Purpose: The authors compared biliary and pancreatic imaging obtained through 2D single-shot fast spin-echo (SSFSE), breath-hold 3D fast recovery fast spin-echo (FRFSE) and respiratory-triggered 3D FRFSE sequences., Materials and Methods: A total of 106 magnetic resonance cholangiopancreatography (MRCP) examinations performed between December 2007 and September 2008 were evaluated with a comparison of 2D SSFSE (thin section and thick slab), breath-hold 3D FRFSE and respiratory-triggered 3D FRFSE sequences. The biliary tract was divided into seven segments: right hepatic duct, left hepatic duct, common hepatic duct, cystic duct, common bile duct, cystic duct junction and biliary-pancreatic confluence. The main pancreatic duct was divided into three segments (head, body and tail). Visualisation of biliary variants was also compared. Two blinded radiologists evaluated segment visibility using a quantitative scale. The Student's t test for paired samples was used for statistical analysis., Results: Compared with 2D SSFSE, respiratory-triggered 3D FRFSE sequences showed better visibility of the right hepatic duct (p=0.0277), the cystic duct (p=0.0081), the cystic duct junction (p=0.0010), the biliary-pancreatic confluence (p=0.0334) and biliary variants (p=0.0198). In the comparison between breath-hold 3D FRFSE and 2D SSFSE, a significant statistical difference was found in visualisation of the cystic duct (p=0.027), the cystic duct junction (p=0.020), the biliary-pancreatic confluence (p=0.0338) and biliary variants (p=0.0311)., Conclusions: Three-dimensional FRFSE offers a significant benefit over conventional 2D imaging.

Purpose: Power Doppler ultrasound (US) with time-intensity curves was used to study renal graft function both in the absence of disease and with complications (acute tubular necrosis and chronic rejection) in an attempt to identify pathognomonic patterns. Time-intensity curves allow representation of the kidneys' wash-in and wash-out phases after intravenous administration of sonographic contrast material., Materials and Methods: Fifty-six asymptomatic renal transplant patients (36 men and 20 women), 19 of whom had altered creatinine clearance levels, were studied by power Doppler US with time-intensity curves followed by biopsy. Ten asymptomatic patients with normal creatinine clearance levels were used as controls., Results: Time-intensity curve analysis enabled identification of three groups of patients: group A, consisting of 27 patients showing peak enhancement between 50 and 65 s from intravenous administration of contrast material; group B, consisting of 16 patients with peak enhancement between 135 and 235 s; group C, consisting of three patients with peak enhancement between 100 and 130 s., Conclusions: Data showed significant variations according to renal graft function (no abnormality, acute tubular necrosis or chronic rejection). Although confirmation by a larger series is required, our findings appear to indicate pathognomonic patterns in patients with chronic rejection and acute tubular necrosis.

Purpose: The aim of this study was to compare the performance of double-contrast magnetic resonance imaging (DC-MRI) with the sequential use of superparamagnetic iron oxide (SPIO) and gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) contrast agents compared with unenhanced MRI and SPIO-enhanced MRI (SPIO-MRI) in the study of the cirrhotic liver. Special attention was paid to cases in which alterations of liver uptake and distribution of the SPIO contrast medium [SPIO-liver uptake and distribution alterations (SPIO-LUDA)] could lead to diagnostic errors at SPIO-MRI., Materials and Methods: We used DC-MRI to study 67 patients suffering from hepatic cirrhosis and on a waiting list for liver transplant. The study was performed with a 1.5-Tesla device and characterised by three phases: the first phase without contrast material (unenhanced MRI), the second after the administration of ferumoxides (SPIO-MRI), and the third, a double-contrast study following the injection of a bolus of paramagnetic contrast material (DC-MRI). The sensitivity of unenhanced MRI, SPIO-MRI and DC-MRI in identifying and characterising hepatic focal lesions was assessed, together with the diagnostic increment of one technique with respect to the others. The gold standard was histological confirmation in 38 cases and clinical-radiological follow-up in all cases. Liver function, kidney function, blood tests and urinalysis were performed in all patients 24-48 h before and after the MRI examination., Results: In 14/67 cases (20.8%), SPIO-LUDA were present, which posed a limitation to the SPIO-MRI examination. Focal lesions were absent in 44 patients, and the action of the ferumoxides was reduced by the presence of SPIO-LUDA in nine cases. There were five cases of confluent fibrosis, two of decompensated cirrhosis, one of vascular thrombosis, and one of scarring in a patient who had undergone hepatic resection for hepatocellular carcinoma (HCC). In all these cases, completion of the MR examination with the DC technique clarified the MR picture, confirming the absence of focal lesions. Twenty-three patients had a total of 68 lesions, which consisted of 37 dysplastic nodules (DN), 19 HCC nodules, two relapses of HCC following chemoembolisation, two HCC associated with portal thrombosis, one cancer-cirrhosis, two angiomas and five small cysts. SPIO-LUDA were present in five patients, thus limiting the identification, characterisation or assessment of the real size of the lesions. SPIO-LUDA were the result of vascular thrombosis in one case and fibrosis in four cases. In all of these cases, DC-MRI proved useful for diagnosis. The sensitivity of unenhanced MRI, SPIO-MRI and DC-MRI for lesion detection was 57.3%, 67.6% and 75%, respectively. The results obtained in the characterisation of the lesions were 20.5%, 63.2% and 73.5% for unenhanced MRI, SPIO-MRI and DC-MRI, respectively. The diagnostic increment of SPIO-MRI over unenhanced MRI for lesion identification and characterisation was 9% and 42.7%, respectively, whereas the diagnostic increment of DC-MRI over SPIO-MRI was 7.4% and 10.3%, respectively., Conclusions: In our study, the combined use of two contrast agents, negative and positive, provided greater diagnostic confidence and caused no side effects in the patients.

Purpose: The aim of this study was to evaluate the study of intra- and extra-biliary ducts by contrast-enhanced colour-Doppler in patients who have undergone laparoscopic cholecystectomy., Materials and Methods: Contrast-enhanced colour-Doppler US was performed in 15 patients who had undegone laparoscopic cholecystectomy. The US contrast agent was introducted into the Kehr or Pedinelli tube to allow visualisation of the bile ducts and duodenum., Results: The colour-Doppler study enabled visualisation of the contrat agent in the intra- and extra-hepatic bile ducts and in the duodenum in all patients, thereby permitting the accurate study of the post-operative course. The data obtained were confirmed by conventional radiology., Conclusions: The advantages of this US ultrasound technique are the complete absence of ionising radiation and no intolerance to the US contrast agent. This technique could therefore be used in selected patients as an alternative to trans-Kehr and trans-Pedinelli cholangyography.

Purpose: Cardiomyopathy is one of the major complications of b thalassaemia major as a result of transfusional iron overload. The aim of our study is to evaluate with MR if there is any difference of iron deposition signal intensity (SI) or distribution between non-cardiopathic and cardiopathic thalassaemic patients in order to establish if there is a relationship between cardiopathy and iron deposition., Materials and Methods: We studied 20 patients affected by b thalassaemia major, of whom 10 cardiopathic and 10 non-cardiopathic, and 10 healthy volunteers as control group. Serum ferritin and left ventricular ejection fraction were calculated in thalassaemic patients. All patients were examined using a 1.5 MR unit with ECG-gated GE cine-MR T2*-weighted, SE T1-weighted and GE T2*-weighted sequences. In all cases, using an adequate ROI, the myocardial and skeletal muscle signal intensity (SI), the myocardial/skeletal muscle signal intensity ratio (SIR) and the SI average of the myocardium and skeletal muscle were calculated for every study group. The qualitative evaluation of iron deposition distribution was independently performed by three radiologists who analyzed the extension, the site and the morphology of iron deposition on the MR images and reported their observations on the basis of a four-level rating scale: 0 (absent), 1 (limited), 2 (partial), 3 (widespread deposition). The result of quantitative and qualitative evaluations were analysed with statistical tests., Results: Cardiac iron deposition was found in 8/10 non-cardiopathic thalassaemic patients and in all cardiopathic thalassaemic patients. We noticed a significant SI difference (p>0.05) between the healthy volunteer control group and the thalassaemic patients with iron deposition, but no significant SI difference in iron deposition between non-cardiopathic and cardiopathic thalassaemic patients in the areas evaluated. The qualitative evaluation revealed a different distribution of iron deposition between the two thalassaemic groups, with more widespread distribution in cardiopathic patients., Conclusions: We found cardiac iron deposition also in non-cardiopathic b thalassaemic patients and a qualitative difference in cardiac iron distribution between non-cardiopathic and cardiopathic patients. The qualitative evaluation of cardiac iron deposition was useful for an easier classification of the disease, bypassing the SI quantitative value which is affected by the extremely uneven distribution of iron deposition and by the sampling technique used. MR evaluation of non-cardiopathic thalassaemic patients may be useful to evaluate early iron deposition and to establish the most suitable chelation therapy.

Purpose: We report on the importance of the integration of data obtained from digital coronary angiography and stress/rest 99mTc sestamibi myocardial perfusion single photon emission tomography in evaluating the hemodynamic significance of coronary arteriovenous fistulae., Material and Methods: Coronary fistulae were detected with coronary angiography in 9 patients. All patients underwent clinical examination, transthoracic echocardiography, stress electrocardiogram and stress/rest 99mTc sestamibi myocardial perfusion single photon emission tomography., Results: Stress/rest 99mTc sestamibi myocardial perfusion single photon emission tomography and stress electrocardiogram showed stress-induced myocardial ischemia in 2 patients. The first patient with familial predisposition and risk factors for ischemic heart disease presented a mesocardic heart murmur on clinical examination. At stress ECG (125 Watt, 153 b/m' max frequency 93%, arterial pressure 230 mmHg, max frequency pressure product 35,200) ischemic alterations were recorded at the first minute of the second stage of the Bruce protocol. Coronary angiography detected a circumflex artery fistula in the coronary sinus. Stress/rest 99mTc sestamibi myocardial perfusion single photon emission tomography for the evaluation of stress/rest perfusion detected a reversible perfusion defect of the proximal portion of the posterolateral and lateral walls, thus confirming the hemodynamic importance of the flow through the fistula during stress cycloergometric testing. In the second patient familial predisposition to ischemic heart disease and previous inferior wall myocardial infarction and non-significant stress ECG, coronary angiography identified a subocclusive stenosis of the right coronary artery and an anomaly between the anterior interventricular artery and the left pulmonary artery. The presence of the contrast medium in the left pulmonary artery identified a flow from the left ventricle to the left pulmonary artery. Good angiographic results were obtained after percutaneous coronary angiography of the right coronary artery stenosis. Due to the onset of angina stress/rest 99mTc sestamibi myocardial perfusion single photon emission tomography was performed to evaluate stress/rest perfusion (75 Watt, 125 b/m', 88% max frequency, arterial pressure 200 mmHg, double max product 25,000 with ST depression of 1.5 mm in V1-V4) and identified an irreversible perfusion defect due to infarction and a reversible perfusion defect of the anterior wall and apex due to ischemia caused by the anomalous flow through the coronary fistula. The correspondence between the site of the coronary artery where the fistula originates, identified by coronary angiography, and the reversible perfusion defects, identified by stress/rest 99mTc sestamibi myocardial perfusion single photon emission tomography, indicates that the anomalous flow through the fistula may cause myocardial ischemia. The irreversible perfusion defects of the inferior wall are the result of right coronary artery subocclusive stenosis., Conclusions: Coronary fistulae cause myocardial ischemia only in a small number of patients. Data obtained from single photon emission tomography in evaluating stress/rest myocardial perfusion, correlated with data from coronary angiography, have shown that changes in patients with terminal coronary anomalies may be due to different coronary diseases: ischemia to anomalous flow through the fistula and myocardial infarction to subocclusive right coronary artery stenosis. Stress/rest 99mTc sestamibi single photon emission tomography for the evaluation of myocardial perfusion is a reliable means of assessing the functional importance of the terminal coronary anomalies detected by coronary angiography. Evaluation of the hemodynamic importance of the coronary fistulae is indispensable in programming corrective surgery.

Purpose: We report our experience relative to transcatheter percutaneous embolization of post-biopsy renal intraparenchymal arteriovenous fistulas in patients with chronic renal insufficiency., Material and Methods: We observed 5 patients affected with post-bioptic fistulas for possible embolization. In three cases the symptoms were represented by intermittent macro-microhematuria; one patient had hypertension of nephrovascular origin and one patient was asymptomatic. In all cases we performed angiography and it was possible to catheterize the peripheral afferent branch of the fistula with a superselective technique using a hydrophilic guide of 0.035 F and a hydrophilic Cobra catheter of 4-5 F. The occlusion was obtained by the positioning of Granturco metal coils: in 1 case we adapted a coil of 3 mm diameter and 1 cm length; in 3 cases 2 coils of 3 mm and in 1 case 2 coils of 3 mm and 1 coil of 5 mm diameter and 1 cm length were necessary. The success of the procedure was always checked with an immediate angiogram and color Doppler US after 48 hrs., Results: The diagnosis of arteriovenous fistulas was always confirmed by a preliminary angiography that demonstrated the normal anatomic disposition of the renal arteries except in one case in which the fistula was fed by a peripheral branch originating from an inferior polar artery. All the lesions were localized in the inferior pole, the site of biopsy, and ranged from 3 mm to 2.5 cm in diameter. We never had any difficulties in the positioning and placement of the coils. The arterial occlusion and exclusion of the fistula was accomplished in all cases. The induced parenchymal loss ranged from 10 to 30% of the renal volume. There was a complete disappearance of symptoms in 3 of the patients, with hematuria without any modification of the blood pressure values in the patient with hypertension. Considering the patient status renal function did not worsen after the embolization. Each patient was followed-up with color Doppler US every two months., Conclusions: The intrarenal arteriovenous fistula represents a relative frequent complication of renal needle biopsy in patients with arterial hypertension and nephroangiosclerosis as risk factors. Embolization is a valid alternative therapeutic option to surgical treatments. The use of small size catheters permits the successful embolization also of peripheral lesions, reducing the induced parenchymal ischemia. We believe that among the embolization material available metal coils represent a valid solution as they are easily positioned and permit definitive occlusion without any risks of systemic venous microembolization.

Purpose: The diagnosis of pulmonary sequestration is based on demonstration of mal-developed lung tissue, feeding on abnormal systemic level. We investigate the role of angiography in the diagnosis of pulmonary sequestration in adult patients., Material and Methods: 1987 to 1998 we examined 9 patients with suspected pulmonary sequestration who were subsequently submitted to surgery. The patients were 3 women and men; 6 of them were symptomatic and 3 asymptomatic. Six patients were examined with CT of chest and upper abdomen, thoracoabdominal aortography and selective arteriography of the abnormal vessel; one patient also submitted to left angiopneumography. One patient underwent bronchography and another one MRI., Results: An unquestionable diagnosis was made in 8 cases, namely 6 of intralobar and 2 of extralobar sequestration, and confirmed surgically. The only questionable case was diagnosed at histology as extralobar pulmonary sequestration atypically fed by thin branches from the left diaphragmatic artery., Conclusions: Angiography demonstrated the abnormal arterial feeding typical of pulmonary sequestration in all cases but one. The evidence of venous drainage was the key sign to diagnose extra-versus intralobar sequestration. Therefore we conclude that angiography remains an essential tool in the diagnosis of pulmonary sequestration, notwithstanding the great potentials of Helical CT of MR angiography.

The study of the temporal region has been improved by technologic progress from conventional radiography to linear tomography, then to pluridirectional tomography, CT and, finally, MRI. Twenty-five patients were examined with MRI--50 temporal regions in all. MRI was performed with a brain coil, SE T1-weighted sequences (TR 500 ms, TE 25 ms, FOV 180 mm, matrix 256 x 512, 2 acquisitions, slice thickness: 3 mm, acquisition time: 5.30 minutes) before and after Gd-DTPA administration. SE T2-weighted sequences (TR 2000 ms, TE 20-80 ms, FOV 180 mm, matrix 256 x 256, 1 acquisition, slice thickness: 4 mm, acquisition time: 8.30 minutes), 3D CISS sequences (TR 20 ms, TE 8 ms, FOV 180 mm, matrix 256 x 256, acquisition time: 2.46 minutes) and MRA 3D TOF TONE sequences (TR 33 ms, TE 8 ms, FOV 180 mm, matrix 256 x 256, acquisition time: 9.30 minutes) were performed. Neither the temporal bone, made of compact tissue, nor the air spaces (mastoid, antrum, middle ear cavity) exhibit any MR signal. On the contrary, the fluid filling the membranous labyrinth (endolymph and perilymph) and the cerebrospinal fluid filling the internal acoustic canal and the cerebello-pontine angle have high signal. This pattern allows a detailed study, unfeasible with CT, of the inner ear structures (cochlea, vestibule and semicircular canal) and of the internal acoustic canal. Moreover, MRI allows the whole VII and VIII cranial nerves to be studied from their origin at the brain stem to the internal acoustic porus and into the internal acoustic canal. Finally, MRI permits the noninvasive study of temporal region vessels. To conclude, MRI yields new anatomical details of the temporal region useful to address major diagnostic issues--e.g., labyrinth, internal acoustic canal and cerebello-pontine angle lesions.

Some 5-20% of gastrointestinal (GI) bleeding cases are of obscure origin because bleeding is difficult to diagnose or locate with conventional imaging methods. The authors suggest arterial spiral CT (ASCT) of the abdomen as an original tool to study GI bleeding of obscure origin. This diagnostic method consists of two subsequent phases: first, after abdominal aorta catheterization, the catheter is positioned in the celiac artery; then, CT of the abdomen is performed before and after intra-arterial contrast agent injection. In 6 of 10 patients with GI bleeding of obscure origin, ASCT depicted small high-intensity areas in the intestinal lumen, which indicate a source of bleeding. The site of bleeding was studied only with topographic criteria according to scanning planes, and the morphological features of the intestinal segments were investigated. All patients were submitted to surgery: when ASCT identified a bleeding site, angiography was limited to the involved arterial district. Angiography alone could locate the source of bleeding in 5 patients; angiography and ASCT were in agreement in 4 patients. The combined techniques located the source of bleeding in 7/10 patients and the nature of bleeding was diagnosed in 3/10 patients (angiodysplasia). Even though their experience is limited, the authors believe that ASCT can be useful in locating GI bleeding of obscure origin, as well as in guiding subsequent selective angiography.

During knee arthroscopy, the transtendinous approach best visualizes articular structures, even though it may cause patellar tendinitis, following the surgical procedures. Thirty patients (22 men and 8 women) who had undergone transtendinous arthroscopy of the knee were submitted to clinical and US follow-up at 3, 6, 12 months. This monitoring was aimed at correlating clinical and instrumental findings of the above iatrogenic condition. Painful symptoms were present in 30% of the cases in group I, in 10% of group II and in no patient in group III. US demonstrated thickening of the patellar tendon in all the three groups of patients, with reduced echogenicity and blurred margins at the arthroscopic portal, plus decreasing gravity over time. The US pattern of arthroscopic surgical gap was observed in all patients in group I, in 10% of patients in group II and in none of the patients in group III. In conclusion because of its clinical course and of its US findings, in our experience patellar tendinopathy following transtendinous arthroscopy of the knee is not to be considered as a iatrogenic inflammatory or degenerative sequela, but as a physiological cicatricial evolution of the surgical transtendinous breach. The US follow-up of the latter allows the correct assessment of the recovering process.

Tietze's syndrome is an uncommon disease characterized by the absence of any systemic symptom; imaging techniques play a major role in the diagnosis of this condition. A control group including 10 normal subjects and 4 patients with clinical evidence of Tietze's syndrome were submitted to US; 3/4 patients underwent CT too. In the lesion site, US demonstrated thickened cartilage and inhomogeneously increased echogenicity in 4 patients, blurred outline in 3 patients and a hypoechoic halo in 1 patient. CT showed thickened cartilage and blurred outline in 3 patients and hypodense cartilage in 1 patient. Both methods were very useful to diagnose the disease in all cases. The authors conclude that US plays a major role in the diagnosis of Tietze's syndrome thanks to its harmlessness, repeatability and cost-effectiveness.

For the study of painful patello-femoral syndromes, the authors suggest the use of US for the evaluation of the so-called Insall-Salvati ratio--i.e., length of patellar ligament/patellar length--whose alteration is suggestive of vertical patello-femoral malalignement (patella alta and patella infera). Ten normal volunteers (20 knees) were examined by means of both US and conventional radiology, and the Insall-Salvati ratio was calculated for each knee. US and radiologic measurements were statistically compared by the correlation-coefficient method: the result was 0.802. US measurements were repeated twice with 0.778 interobserver variability according to the Spearman correlation index. Based on their results, the authors conclude that, in the evaluation of the Insall-Salvati ratio, the diagnostic accuracy of US is almost the same as that of conventional radiology; the former method may even be preferred for it is a simple, quick and repeatable technique not needing ionizing radiations.

Acute cervical sprain traumas can be divided into simple and severe, depending on the presence of organic lesions which can be documented by conventional radiologic techniques. Persistent painful symptomatology of the nape and the precise localization of pain, led us to suspect the presence of organic lesions due to tearing of the neck muscles in 94 patients who had suffered a simple cervical sprain. To demonstrate these post-traumatic lesions, the patients were subjected to US examinations of both the nape and the muscles at the base of the neck. In 13 cases (13.8%) muscular tearing lesions were demonstrated, which were characterized by hypoechoic lacunae (6 cases), by hyperechoic stripes (5 cases), and by muscular hernia (1 case); in 1 case, partial disconnection of a muscular insertion was demonstrated. Thus, we believe muscle-tendon US to be a valuable technique for both diagnostic and nosologic purposes, for the method allows simple cervical sprain to be discriminated from sprains which are complicated by organic muscular lesions. We suggest that the cervical sprain traumas where a muscular lesion due to tearing can be demonstrated be defined as "complex" traumas.

Sonography is suitable to recognize fluids in the suprapatellar bursa, which can represent an indirect sign of intra-articular knee effusion. In order to obtain the physiologic parameters of suprapatellar bursa, 50 healthy volunteers, 38 sedentary and 12 sportsmen, were evaluated by means of US. The bursa was recognizable in 8/50 cases (16%) with quadriceps in prolapse (mean thickness: 1.8 mm, mean length: 20.5 mm), and in 23/50 cases (46%) with quadriceps in contraction (mean thickness: 2.6 mm, mean length: 22.6 mm). Suprapatellar bursal thickness ranged 1-4 mm, and its length ranged 12-44 mm. The suprapatellar bursa appeared as a well-defined hypoechoic band, cranial to patella, anterior to the distal femoral shaft, and posterior to quadriceps tendon. Quadriceps contraction increases both thickness and length of bursal swelling (1 and 2 mm, respectively, on the average). When sportsmen were compared with sedentary subjects, suprapatellar bursa diameters were observed not to change, but the bursal itself was evident in 3/12 (25%) and in 8/12 (66%) of cases, according to whether the quadriceps was in prolapse or in contraction. Bursal contents were homogeneously anechoic and bursal outline smooth and regular in all cases (23/23). Bursal morphology was symmetric, in 23/23 cases, in length, regularity of outline, and echogenicity of contents. Thickness alone resulted asymmetrical in 2/23 subjects (8%), even though variations were less than or equal to 2 mm. In conclusion, we can consider as pathologic features: thickness greater than 3-4 mm, asymmetry greater than 2 mm, irregular outline, and inhomogeneous contents. These parameters must be examined in pathologic subjects and further research is mandatory.

The Echinococcus granulosus disease, or hydatidosis, is endemic in Italy; it has high incidence in Sardinia, Latium and Apulia. The CT findings were examined of 120 patients with hydatid cysts in the liver, lungs, kidney, spleen, peritoneal cavity, retroperitoneal space, and spine. The smallest cyst demonstrated by CT had diameter = 1 cm; CT was also more sensitive than conventional radiology and US in demonstrating unusual localizations of hydatid cysts. CT findings alone allowed a correct diagnosis of the nature of the cyst to be made in 61.5% of cases and, when combined with immunodiagnostic tests for hydatid disease, in 94.5% of patients. Moreover, CT is essential not only for a correct treatment planning, but also during follow-up.

Abdominal CT yields several pieces of information for the diagnosis of secondary neoplastic involvement of the peritoneum (peritoneal carcinosis). Peritoneal carcinosis may be the first clinical sign of an occult primary tumor. CT scans of 120 patients with peritoneal carcinosis confirmed by pre/peri-operative biopsy or at autopsy, were retrospectively reviewed. The CT patterns of peritoneal carcinosis were detected in 20 of 44 patients with an occult malignancy. In 16 of 76 cases with a known malignancy there was no evidence of secondary peritoneal involvement. The incidence of CT findings and their correlation with the primary tumor are critically discussed. The authors have assessed the utility of CT in detecting peritoneal carcinosis, even though in their experience CT findings of secondary neoplastic peritoneal involvement could not be correlated with primary tumor.

Pancreatic necrosis is a possible complication of acute pancreatitis. It is characterized by diffuse inflammation associated with exudation or leakage of pancreatic juice with its proteolytic enzymes into the peripancreatic tissues. Colonic complications of acute pancreatitis are uncommon events. The main purpose of our study was to correlate radiological findings of pancreatic necrosis as observed during barium enema to CT patterns. A retrospective study was therefore carried out on 40 patients affected with acute pancreatitis with local and systemic complications. The analysis of the results allowed different patterns to be observed, with the two techniques, in the acute and in the chronic phases. In the acute phase, barium enema of the colon showed inflammatory extrinsic processes involving the wall, with a typical localization related to the spread of pancreatic enzymes along mesenteric pathways, as described by Meyers. CT allowed a thorough evaluation of both the pathologic process and its spatial balance. In the chronic phase, barium enema showed fibrotic strictures and fistulas. CT demonstrated pseudocystic masses and irregular focal areas of decreased attenuation or irregular pancreatic margins. This correlation shows how an extrinsic inflammatory involvement of the colon with a characteristic topography may help make a diagnosis and plan therapy.

The growth of a middle ear cholesteatoma behind a normal tympanic membrane is a rare though possible event. In such cases, CT may provide useful information for diagnosis. The results are presented of a CT study carried out on 14 patients affected with unilateral conductive hearing loss and with normal tympanic membrane. CT allowed the diagnosis of middle ear cholesteatoma to be made in all cases. All patients were treated with surgery: 8 of them underwent tympanoplasty and 6 explorative tympanotomy. While the diagnosis of cholesteatoma was confirmed in 13 patients, in 1 case tympanosclerosis was diagnosed. CT diagnosis of middle ear cholesteatoma is based on the demonstration of a low-density soft-tissue mass, in association with bone erosion or ossicular dislocation. The author emphasizes the difficulty of a CT diagnosis of cholesteatoma in the patients with middle ear soft-tissue masses in the absence of bone alterations.

Ascites can be found in a variety of diseases and may represent either a late complication or the clinical sign of a pathologic condition. The presence of even small fluid collections in peritoneal recess can be easily detected by CT. A number of reports confirm CT prediction of the benign/malignant nature of ascites. The CT scans of 100 patients affected with histologically confirmed ascites were reviewed to evaluate CT contribution to the assessment of the benign/malignant nature of ascites. On the basis of our results, it can be concluded that the only highly predictive CT finding of malignant ascites is the presence of a coexisting mass. Other findings do not allow the two types of collections to be discriminated.

As yet, the role of Computed Tomography (CT) as a routine imaging technique in the staging and follow-up of thoracic Hodgkin's disease has not been assessed. The authors report the results obtained in 120 patients affected with thoracic Hodgkin's disease, staged and followed by means of chest X-rays and CT. CT better identified intrathoracic involvement of mediastinal nodes, of lung parenchyma, of pleura, and of pericardial and chest walls in 54/120 patients (45%), with staging modifications in 18 (15%) of them only. Treatment was changed only in 12 patients (10%) where radiation therapy had been planned. The clinical value of the additional information yielded by CT was especially evident in the follow-up: CT allowed the correct evaluation of persistent/recurrent disease in 51/117 patients (43.5%), a figure high enough to suggest the use of CT in the routine follow-up of patients affected with thoracic Hodgkin's disease.

Four-hundred eighty-five patients underwent US examination; 183 of them had gastric cancer, 239 colorectal cancer, 38 pancreatic cancer, 11 esophageal cancer, and 14 had gastric lymphoma. All patients underwent surgery. In 95 cases fine-needle biopsy under US guidance was performed. Lymphadenopathies were classified by the criteria proposed by Yoshinaka et al., type I: poorly-defined borders, diffuse internal echoes; type II: well-defined borders, diffuse internal echoes; type III: well-defined borders, notchings, strong internal echoes. Twenty/twenty-nine type I, 66/98 type II, and 39/43 type III adenopathies were found to be neoplasm-positive. Of 73 patients with adenopathy from gastric cancer, 9 were type I, 42 were type II, and 22 were type III (183 patients examined); of 9 patients with adenopathy from esophageal cancer, 7 were type II and 2 were type III (11 patients examined); of 48 patients with adenopathy from colorectal cancer, 5 were type I, 28 were type II, and 15 were type III (239 patients examined); of 29 patients with adenopathy from pancreatic cancer, 7 were type I, 18 were type II, and 4 were type III (38 patients examined); finally, of 11 patients with adenopathy from gastric lymphoma, 8 were type I, and 3 were type II (14 patients examined). The relationship between US and pathology was possible from a statistical point of view only. Type I lymphadenopathies seem to suggest lymphomatous involvement, whereas type III ones suggest metastatic involvement. US is a valid approach method, which must be supported by other investigation techniques--e.g., CT and lymphography--in order to avoid high false-negative percentages.

A preliminary report is presented on a new technique for the detection and the diagnosis of intracanalicular acoustic neuromas. The technique consists of preliminary CT scans on petrous bones, after iv administration of a bolus of contrast medium. The scans are performed at a predetermined level of the middle portion of the internal auditory canals. The early enhancement is then evaluated of the soft tissues contained into the auditory canal on the side with retrocochlear neurosensory hypoacusis. The images obtained are then processed by an image processing program, thus enhancing the contrast resolution and allowing an optimal depiction of the lesion. In the past 10 months, 67 patients with clinical suspicion of acoustic neuromas were studied. This technique allowed the diagnosis of 2 acoustic neuromas with a purely intracanalicular involvement.

The authors report the results of the lymphographic examinations performed on 123 patients affected with melanoma of the limbs. The patients were divided into 2 groups according to the different clinical stages; they all had pathologic confirmation. The following lymphographic parameters were considered: sensitivity, specificity, efficacy and positive/negative predictive value. The results obtained in the first group of patients (clinical stage: I) demonstrated lymphography to have low sensitivity, specificity and efficacy in the staging of melanomas (37%, 50% and 45%, respectively). On the contrary, lymphography could be trusted in the study of stage II melanomas thanks to its high sensitivity. As for stage III, the methodology had a clinical indication only in the follow-up of melanomas treated with radiochemotherapy.