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Magnetic resonance imaging (MRI) is a pivotal radiological examination in clinical practice, being widely applied for musculoskeletal examinations. In this setting, strict adherence to standardized protocol is crucial to increase diagnostic performance and minimize variability among different diagnostic centres and readers. The aim of this paper is to provide standardized technical recommendations for musculoskeletal MRI scans proposed by the Italian College of Musculoskeletal Radiology. These recommendations are designed to give a uniform application of MRI protocols over the national territory, to increase reproducibility and improve diagnostic performance.

Percutaneous vertebroplasty (PVP) is a minimally invasive, image-guided procedure consisting of an injection of acrylic cement into a vertebral body to reinforce the compressed segment and achieve pain relief. The use of PVP is a minimally invasive option in the treatment of osteoporotic or metastatic vertebral collapses. Our personal experience, using a CT-guided technique, confirms the efficacy and safety of PVP with a lower risk for complications compared with conventional fluoroscopic approaches because of a precise placement of the instruments in the vertebral body and an early detection of small cement leakages.

Gemcitabine is considered the gold standard treatment for unresectable pancreatic adenocarcinoma. Intra-arterial drug administration had shown some interesting results in small phase II studies. In this study, patients were randomly assigned to receive gemcitabine at a dose of 1,000 mg/m2 over 30 minutes intravenously weekly for 7 weeks, followed by 1 week of rest, then weekly for 3 weeks every 4 weeks or FLEC: 5-fluoruracil 1,000 mg/m2, leucovorin 100 mg/m2, epirubicin 60 mg/m2, carboplatin 300 mg/m2 infused bolus intra-arterially into celiac axis at a 3-week interval 3 times or 5-fluorouracil 400 mg/m2 plus folinic acid 20 mg/m2 for 5 days every 4 weeks for 6 cycles. The primary endpoint was overall survival, while time to treatment failure, response rate, clinical benefit response were secondary endpoints. Sixty-seven patients were randomly allocated gemcitabine and 71 were allocated FLEC intra-arterially. Patients treated with FLEC lived for significantly longer than patients on gemcitabine (p=0.036). Survival at 1 year increased from 21% in the gemcitabine group to 35% in the FLEC group. Median survival was 7.9 months in the FLEC group and 5.8 months in the gemcitabine group. Median time to treatment failure was longer with FLEC (5.3 vs 4.2 months for FLEC vs gemcitabine respectively; p=0.013). Clinical benefit was similar in both groups (17.9% for gemcitabine and 26.7% for FLEC; p=NS). CT-scan partial response was similar in both groups (5.9% for gemcitabine and 14% for FLEC; p=NS). Toxicity profiles were different. Compared with gemcitabine, the FLEC regimen given intra-arterially improved survival in patients with unresectable pancreatic adenocarcinoma.

Objective: To investigate the efficacy of gadobenate dimeglumine (GdBOPTA) enhanced MR imaging for the detection of liver lesions in patients with primary malignant hepatic neoplasms. Materials and Methods: Thirty-one patients with histologically proven primary malignancy of the liver were evaluated before and after administration of GdBOPTA at dose 0.05 or 0.10 mmol/kg. T1-weighted spin echo (T1W-SE) and gradient echo (T1W-GRE) images were evaluated for lesion number, location, size and confidence by three off-site independent reviewers and the findings were compared to reference standard imaging (intraoperative ultrasound, computed tomography during arterial portography or lipiodol computed tomography). Results were analyzed for significance using a two-sided McNemar’s test. Results: More lesions were identified on Gd-BOPTA enhanced images than on unenhanced images and there was no significant difference in lesion detection between either concentration. The largest benefit was in detection of lesions under 1 cm in size (7 to 21, 9 to 15, 16 to 18 for reviewers A, B, C respectively). In 68% of the patients with more than one lesion, Gd-BOPTA increased the number of lesions detected. Conclusion: Liver MR imaging after Gd-BOPTA increases the detection of liver lesions in patients with primary malignant hepatic neoplasm.

To investigate enhancement with gadolinium benzyloxypropionictetraacetate (BOPTA) at magnetic resonance (MR) imaging to detect focal malignant hepatic lesions.A phase II trial was performed in 34 patients. Gd-BOPTA-enhanced spin-echo (SE) and gradient-recalled-echo (GRE) T1-weighted MR imaging were performed at 40 and 90 minutes after intravenous injection of 0.05 and 0.10 mmol/kg Gd-BOPTA.The percentage of enhancement in liver parenchyma was significantly (P.05) increased on GRE T1-weighted compared with SE T1-weighted images at 40 and 90 minutes after injection of the higher dose and compared with SE and GRE T1-weighted images obtained with the lower dose. The contrast-to-noise ratio of metastases was significantly increased on GRE T1-weighted images (0.10 mmol/kg) at 90 minutes compared with precontrast images. Significantly more small primary metastases were detected on GRE T1-weighted images (0.10 mmol/kg) at 90 minutes compared with precontrast SE T1-weighted images.Gd-BOPTA is a safe hepatobiliary contrast agent that helps detection of small metastases.

Il guadagno diagnostico offerto dalla RM nella diagnosi dei meningiomi intra-cranici risiede nella precisa localizzazione della lesione all'interno del cranio e nella definizione dei suoi rapporti con le adiacenti strutture, in particolare arterie e vene. Le caratteristiche morfo-strutturali possono essere comparate con gli aspetti istologici ed operatori in modo da identificare possibili caratteri clinico-radiologici associati ad un comportamento biologico ed evolutivo diverso da quello usualmente benigno dei meningiomi non aggressivi (MNA). 64 meningiomi intra-cranici sono stati valutati retrospettivamente, tutti sottoposti ad esame RM ed operati. In 16/64 pazienti (25%) è stato asportato un meningioma «aggressivo» (MA), caratterizzato cioè istologicamente da pleomorfismo ed alta cellularità, prominenza di nucleoli, frequenti mitosi e foci necrotici, e macroscopicamente da invasione locale della dura, dell'osso e dei tessuti epicranici. MA sono stati riscontrati più frequentemente nei maschi (9/16) di età avanzata con localizzazione alla convessità (12/16). All'esame RM presentavano accentuazione disomogenea (7/14), e marcatamente estesa alla dura adiacente alla base d'impianto («string sign») (10/16), scarsa demarcazione dal tessuto cerebrale circostante (6/14), edema marcato (11/16) e presenza di numerosi foci necrotici all'interno della lesione (7/16). La valutazione statistica ha permesso di individuare quei parametri (accentuazione disomogenea, necrosi, «string sign» ed edema marcato) la cui presenza o meno influisce probabilisticamente sulla diagnosi di MA. In particolare, quando nessuno dei parametri è presente, si tratta di un MNA; quando, al contrario, 3 o 4 parametri sono presenti, la lesione in esame rappresenta un MA; quando solo 1 o 2 parametri sono presenti, è impossibile stabilire con certezza la natura del meningioma.

Nell'ambito delle numerose possibilità di localizzazione articolare dell'artrite reumatoide, il coinvolgimento del rachide cervicale presenta aspetti peculiari legati soprattutto alle conseguenze della instabilità articolare sul contenuto mielo-radicolo-midollare. Nella valutazione diagnostica è pertanto oggi indispensabile l'apporto della risonanza magnetica che va ad integrare lo spettro informativo relativo al contenente osseo, fornito dalla radiologia convenzionale e dalla tomografia assiale computerizzata. Sulla base di tali considerazioni, gli autori propongono una metodologia di studio che prevede la utilizzazione integrata di tali indagini diagnostiche, sottolineando l'importanza dello studio dinamico del rachide in flesso-estensione. Successivamente, vengono analizzate le tappe del coinvolgimento reumatoide del rachide cervicale, allo scopo di fornire gli elementi che consentano di comprendere la logica di svolgimento di tale invalidante artronatia infiammatoria

L’approccio diagnostico al rachide traumatizzato rappresenta per il radiologo argomento quotidiano con il quale confrontarsi per fornire tutte le informazioni che consentano di effettuare una scelta terapeutica ottimale. Si tratta di un tema molto dibattuto nell’ambito della radiologia d’emergenza, soprattutto per quanto riguarda la scelta della metodica di studio ottimale. Spesso, infatti, riguarda pazienti politraumatizzati, in condizioni cliniche molto critiche per quanto riguarda lo stato di coscienza, la sintomatologia neurologica e l’equilibrio emodinamico, nei quali il tempestivo trattamento rappresenta l’obbiettivo principale. E noto, infatti, che in questa tipologia di pazienti la percentuale di sopravvivenza aumenta quando la terapia viene iniziata entro la prima ora dal trauma, secondo il concetto della golden hour. Poste queste premesse, la tempestivita della diagnosi nei traumi del rachide rappresenta per il radiologo un obbiettivo assai importante, nel quale e fondamentale la corretta scelta della metodologia di studio. A questo proposito, nella Comunita Europea, l’esame radiografico rappresenta ad oggi la prima indagine sulla quale si basa l’iter diagnostico per la valutazione del rachide traumatizzato. A fronte di questo consolidato protocollo, e pero da considerare che la TC puo sostituire l’esame radiografico nel politraumatizzato in condizioni cliniche gravi, in quanto e piu accurata, piu rapida e non richiede eccessiva manipolazione del paziente. Ancora una volta, dunque, la scelta del radiologo deve essere guidata dal quadro clinico. Pertanto, nella seguente trattazione, verranno affrontati i seguenti argomenti: la scelta metodologica adeguata nello studio del rachide traumatizzato; l’interpretazione dei quadri imaging mediante identificazione e classificazione delle lesioni traumatiche del contenente.

This study was performed to evaluate the results and complications of percutaneous vertebroplasty (PVP) performed under CT guidance. We treated 106 patients (182 PVP): 67 for osteoporotic vertebral compression fracture, and 39 for osteolytic metastases. The first 78 patients were treated using computed tomography (CT) combined with conventional fluoroscopy as an imaging guide (135 PVP). In 28 patients, the procedure was performed with multislice CT fluoroscopy (47 PVP). Partial or complete pain relief was obtained in 98% of patients within 24 h from the treatment; significant results were also obtained with regard to improvement in functional mobility and reduction of analgesic use. CT allowed the detection of cement leakage in 43.9%. Severe complications were one case of pneumothorax and two cases of symptomatic cement leakage. Mild complications included two cases of cement pulmonary embolism. During the follow-up, eight osteoporotic patients presented a new vertebral fracture, and new vertebral metastases appeared in two oncological patients. Our personal experience confirms the efficacy of PVP treatment for both osteoporotic and oncological patients. The use of CT guidance reduces the risk of complications in comparison with conventional fluoroscopy alone, as well as facilitates the detection of small cement leakages.

Standard treatment for transitional cell carcinoma confined to the bladder is radical cystectomy that allow to obtain an overall 5-year disease-free survival rate only of 50-70%. It has been demonstrated that intra-arterial chemotherapy produces the same survival outcomes as radical cystectomy. This study aimed to evaluate the activity and toxicity of a bladder-sparing loco-regional treatment. Five patients with transitional cell carcinoma of the bladder (4 locally advanced and 1 pelvic relapse) were treated with doxorubycin 25 mg/m2, cisplatin 40 mg/m2 and methotrexate 50 mg/m2, all infused bolus via internal iliac arteries on day 1, every three weeks. We obtained 3 complete responses, 1 stable disease and 1 progression of disease. The treatment was well tolerated with a minimal hematological toxicity and no others major toxicity. Median disease free survival was 8 months (1-17), median overall survival was 22 months (2-55). This loco-regional regimen of chemotherapy is active and safe in locally advanced bladder cancer patients and permits a prolonged good quality of life regarding the maintenance of the physiological functions of the lower urinary tract.

Gemcitabine is considered the golden standard treatment for unresectable pancreatic adenocarcinoma. Intra-arte-rial drug administration had shown a deep rationale with some interesting results. In a multicenter phase III trial, we compared gemcitabine given weekly with a combination of 5-fluoruracil, leucovorin, epirubicin, carboplatin (FLEC) administered intra-arteriously as first-line therapy in unresectable pancreatic adenocarcinoma. Patients were randomly assigned to receive gemcitabine at a dose of 1,000 mg/m2 over 30 minutes intravenously weekly for 7 weeks, followed by 1 week of rest, then weekly for 3 weeks every 4 weeks or 5-fluoruracil 1,000 mg/m2, leucovorin 100 mg/m2, epirubicin 60 mg/m2, carboplatin 300 mg/m2 infused bolus intra-arteriously at three-weekly interval for 3 times. The primary end point was overall survival, while time to treatment failure, response rate, clinical benefit response were secondary endpoints. Sixty-seven patients were randomly allocated gemcitabine and 71 were allocated FLEC intra-arterially. Patients treated with FLEC lived for significantly longer than patients on gemcitabine (p=.036). Survival at 1 year was increased from 21% in the gemcitabine group to 35% in the FLEC group. Median survival was 7.9 months in the FLEC group and 5.8 months in the gemcitabine group. Median time to treatment failure was longer with FLEC (5.3 vs 4.2 months for FLEC vs gemcitabine respectively; p=.013). Clinical benefit was similar in both groups (17.9% for gemcitabine and 26.7% for FLEC; p=NS). CT-scan partial response was similar in both group (5.9% for gemcitabine and 14% for FLEC; p=NS). Toxicity profiles were different. Compared with gemcitabine, FLEC regimen given intra-arteriously, improved survival in patient with unresectable pancreatic adenocarcinoma.

Unresectable biliary tract cancers have a very poor prognosis. No good systemic chemotherapeutic regimen is available. This study aimed to evaluated the activity and toxicity of a novel approach of combined loco-regional and systemic chemotherapy. Twenty four patients with advanced or metastatic biliary tumors were treated with epiadriamycin 50 mg/m2 and cisplatin 60 mg/m2 administered bolus in proper hepatic artery on day 1, combined with systemic continuous infusion of 5-fluorouracil 200 mg/m2/day, from day 1 to day 14, every 3 weeks. The overall response rate was 8/24 (33%), including one complete response and 7 partial responses (stable disease 46%, progression 21%). The treatment was well tolerated with a minimal hematological toxicity; the major clinical problem was the deep venous thrombosis related to central venous catheter, that occurred in 5 patients (21%). Median overall survival was 14,6 months and 1-year and 2-year survival were 54% and 38% respectively. Performance status improved in 33% of patients and weight gain more than 7% was observed in 17%. This novel combined loco-regional and systemic chemotherapeutic regimen is active and safe for advanced biliary tract cancer patients.

The rationale for the use of Gadolinium (Gd) in the MRI evaluation of non surgically treated herniated disk is based on the known presence of inflammatory granulation tissue and neoangiogenesis which plays an important role in both pain and the spontaneous resorption of the hernia.of this study was to determine the usefulness of Gd in MRI examination for detecting the inflammatory reaction around the discal hernia.Thirty-eight patients (mean age 45 years; range 20-70 years) with non surgically treated herniated disk were evaluated with MRI between January 2000 and July 2004. T2w-FAST-SE sagittal and T1w-SE transaxial and sagittal images were acquired before and after the administration of Gd.Twenty out of 22 patients with acute sciatic pain (symptoms =/40 days) showed significant peri-hernial enhancement which facilitated the differential diagnosis with other extradural lesions, such as synovial cysts (2/22 cases), as well as the correct definition of the extension of discal hernia in the spinal canal. In the remaining 16 with chronic sciatic pain (symptoms6 months) the discal hernia did not show peri-hernial enhancement.In MRI evaluation of the herniated disk, peri-hernial enhancement is correlated with inflammatory reaction around the hernia which is associated with acute symptoms. The absence of peri-hernial enhancement in chronic herniated disk is due to the poorly vascular fibrotic tissue. Therefore, peri-hernial enhancement facilitates the differential diagnosis in uncertain cases and represents a reliable prognostic index of response to non-surgical therapy and of the possible spontaneous resorption of discal hernia.

Gemcitabine is considered the gold standard treatment for unresectable pancreatic adenocarcinoma. Intra-arterial drug administration had shown some interesting results in small phase II studies. In this study, patients were randomly assigned to receive gemcitabine at a dose of 1,000 mg/m2 over 30 minutes intravenously weekly for 7 weeks, followed by 1 week of rest, then weekly for 3 weeks every 4 weeks or FLEC: 5-fluoruracil 1,000 mg/m2, leucovorin 100 mg/m2, epirubicin 60 mg/m2, carboplatin 300 mg/m2 infused bolus intra-arterially into celiac axis at a 3-week interval 3 times or 5-fluorouracil 400 mg/m2 plus folinic acid 20 mg/m2 for 5 days every 4 weeks for 6 cycles. The primary endpoint was overall survival, while time to treatment failure, response rate, clinical benefit response were secondary endpoints. Sixty-seven patients were randomly allocated gemcitabine and 71 were allocated FLEC intra-arterially. Patients treated with FLEC lived for significantly longer than patients on gemcitabine (p=0.036). Survival at 1 year increased from 21% in the gemcitabine group to 35% in the FLEC group. Median survival was 7.9 months in the FLEC group and 5.8 months in the gemcitabine group. Median time to treatment failure was longer with FLEC (5.3 vs 4.2 months for FLEC vs gemcitabine respectively; p=0.013). Clinical benefit was similar in both groups (17.9% for gemcitabine and 26.7% for FLEC; p=NS). CT-scan partial response was similar in both groups (5.9% for gemcitabine and 14% for FLEC; p=NS). Toxicity profiles were different. Compared with gemcitabine, the FLEC regimen given intra-arterially improved survival in patients with unresectable pancreatic adenocarcinoma.

RATIONALE AND OBJECTIVES. To correlate the appearance of hepatocellular carcinoma on delayed (60 minutes) postcontrast T1-weighted gradient echo images with the mode of action of gadobenate dimeglumine (Gd-BOPTA) and the anatomic and pathologic characteristics of the lesions. METHODS. A total of 34 patients with hepatocellular carcinoma and varying degrees of diffuse liver disease were studied. T2-weighted spin echo and T1-weighted spin echo and gradient echo images were acquired before and 60 minutes after the intravenous administration of 0.1 mmol/kg Gd-BOPTA. Qualitative and quantitative evaluations of the images were performed and correlated with histologic findings. The quantitative evaluation, performed on T1-weighted gradient echo images, looked at the percentage increase of liver enhancement after Gd-BOPTA administration, the lesion-to-liver contrast/noise (C/N) ratio before and after Gd-BOPTA administration, and the C/N variation after Gd-BOPTA administration. Qualitative assessment considered the morphologic features of the lesions as well as the visual variation of contrast before and after Gd-BOPTA administration. Finally, a histologic evaluation was made of the degree of differentiation of the lesions and of the presence of fatty metaplasia, necrosis, bile, or intratumoral peliosis. RESULTS. Among the parameters affecting lesion identification were the extent of liver function, degree of vascularization, residual functionality of the tumor cells, and characteristics of the neoplastic tissue. Positive correlations (Spearman coefficients = 0.359 and 0.393, respectively) were observed precontrast between the degree of liver failure and the amount of contrast noise, and postcontrast between the amount of intralesional fatty metaplasia and the extent to which lesion conspicuity worsened after Gd-BOPTA administration. An inverse correlation (Spearman coefficient = −0.330) was observed between the degree of lesion differentiation and the visible appearance after Gd-BOPTA administration, with well-differentiated lesions tending toward worsened conspicuity postcontrast. A statistically significant difference (P = 0.001) was observed in the mean precontrast C/N ratio for lesions later showing unchanged conspicuity and worse conspicuity on postcontrast images, respectively. Marked variation (P = 0.019) was also observed between Child A and B cirrhotic patients for the degree of hepatic enhancement on postcontrast images. CONCLUSIONS. The results suggest that liver parenchyma signal intensity is influenced by the extent to which liver function is compromised, that residual hepatocytic functionality permits Gd-BOPTA uptake by certain lesions and that this uptake might subsequently impair the observed C/N ratio on delayed images, and that the worsening of lesion conspicuity on postcontrast images is influenced also by high quantities of intralesional fatty metaplasia.

The presence of liver metastases has a remarkable impact on the survival rate. Such an event is relatively frequent: for instance, hepatic secondaries are found in approximately 40% of patients with colorectal cancer (Ferrucci 1994). In the diagnostic approach to liver metastases, the imaging plays a fundamental role in selecting those patients who can benefit from surgical resection. This treatment, performed with the correct indication, drastically improves the survival rate: 5-year survival rate of 20%–40% for metastases from colorectal carcinoma (Butler et al. 1986; Hughes et el. 1988; Ferrucci and Stark 1990; Fegiz et al. 1991; Scheeleet al. 1991; Nakamura et al. 1992) with a risk of morbidity and mortality of 2%–7% (Holm et al. 1989; Scheele et al. 1991; Vetto et al. 1990). Conversely, in untreated colorectal hepatic metastases, the mean survival rate is drastically reduced (Wagner et al. 1984): 21 months for solitary lesions with a 5-year survival of 16% (Greenway 1988), 15 months for multiple metastases confined within a single liver lobe and 10 months for diffuse involvement of the liver.

In corso di artrite reumatoide l'interessamento del rachide cervicale riguarda circa il 60–70% dei pazienti affetti dalla patologia. Le strutture colpite dalla flogosi reumatoide sono le articolazioni cartilaginee e sinoviali, le cosiddette articolazioni di Luschka, l'inserzione di tendini e legamenti e i tessuti molli della regione cervicale. Il coinvolgimento del tratto cervicale può essere asintomatico o rendersi responsabile di importante dolore, limitazione funzionale e di varie manifestazioni neurologiche, quali parestesie, paresi, ipotrofia muscolare, fino alla quadriplegia e morte, soprattutto in caso di malattia particolarmente aggressiva e perdurante da molto tempo. In questo lavoro si è cercato di individuare i caratteri clinico-radiologici più significativamente associati a sintomatologia neurologica in corso di artrite reumatoide. Particolare attenzione è stata prestata per definire i caratteri morfologici ed il valore degli indici lineari indicatori di compressione midollare per lussazione atlo-assiale. Dei 27 pazienti (24 donne e 3 uomini, età media di 61 anni) appartenenti alla casistica in esame, solo 3 (11,1%) presentavano esclusivo interessamento del tratto sub-assiale; 19 (70,3%) presentavano esclusivo interessamento radiologico della cerniera atlo-assiale, mentre in 5 (18,6%) era rilevabile coinvolgimento radiologico sia del tratto sub-assiale che della cerniera. In base alla nostra esperienza, più della metà di questi pazienti sviluppa lussazione atlo-assiale; di questi, a loro volta, circa la metà presenta interessamento neurologico: è a questo gruppo, in cui più frequentemente ricorre la lussazione anteriore pura (nel 57% dei casi, contro il 37,5% di quelli privi di interessamento neurologico), cui deve essere prestata particolare attenzione in quanto suscettibile di trattamento chirurgico decompressivo (odontoidectomia) che può eliminare la causa di compressione midollare altrimenti destinata a «fissarsi» in maniera irreversibile con conseguenti gravissimi disturbi neurologici. Questo gruppo di pazienti, in base alla nostra casistica, comprende una relativa maggior rappresentazione del sesso maschile, ed una durata media di malattia significativamente inferiore, con conseguente più breve periodo di accertata positività al FR; anche l'età media è significativamente inferiore, situandosi attorno ai 58 anni contro i 64,9 dei pazienti senza interessamento neurologico. In questi pazienti il valore critico di 9 mm di distanza atlo-dentale è stato raggiunto e superato in più della metà dei casi, contro solo il 12,5% dei pazienti senza interessamento neurologico. Parimenti, più frequente è risultata la presenza di cospicuo panno infiammatorio; l'iper-intensità midollare, spia di mielopatia, è stata osservata solo in questi pazienti, nell'86% dei quali l'angolo bulbo-midollare era ristretto per impronta compressiva esercitata dal dente dell'epistrofeo. La RM si è dimostrata eccellente strumento diagnostico per la valutazione del coinvolgimento del rachide cervicale in corso di artrite reumatoide: è l'unica indagine, infatti, che consente contemporaneamente la visualizzazione diretta del panno infiammatorio, del coinvolgimento del legamento trasverso e dei segni della mielopatia da compressione midollare.

Mucocele of the appendix is an unusual clinical entity. Despite a recognized constellation of findings, the diagnosis is not usually made prior to surgical exploration. A 35 year old man is reported in whom clinical evaluation, including US and CT scans, resulted in the correct preoperative diagnosis confirmed at surgery and leading to appropriate operative decisions.

A total of 107 temporomandibular joints (TMJ) were examined with two superconductive MR units at 1T and 1.5T. In 73 TMJs, MR revealed 55 disk displacements, 7 disk perforations, 10 joint space adhesions, 33 osteoarthrities, 3 avascular necroses of the mandibular condyle, and 25 joint effusions. These abnormalities are described and discussed. In spite of some limitations--e.g., motion artifacts and patients' claustrophobia--MR imaging is the procedure of choice in abnormal TMJs, because it yields useful information as to therapeutic choice (conservative versus surgical). Arthrography can be used as a complementary study technique in the patients with marked disagreement between clinical and MR findings. Arthroscopy should be used as a surgical procedure in abnormal TMJs selected by previous MR studies.

A 13-year-old female presented after repeated trauma with pain of the distal end of the thigh. The findings on plain films, bone scan, and CT were indeterminate. MRI accurately demonstrated a fracture line with bone marrow edema, suggesting the diagnosis of stress fracture. MRI patterns of stress fracture were considered and the importance of establishing the correct diagnosis was emphasized.

Thirty-four temporomandibular joints (TMJ) were examined in 17 normal subjects with two superconductive MR units at 1T and 1.5T. TMJ evaluation was performed with both SE sequences in occlusal position and with "fast" sequences (flash) during the gradual opening of the mouth. Therefore, both the anatomic features of the TMJs and their dynamic behavior during mouth opening were analyzed. The information acquired allowed the complete and non-invasive evaluation of TMJ function. The knowledge of the normal anatomic and functional patterns is of paramount importance for the diagnostic approach to TMJ pathologic conditions.

The aim of this study is to analyze with MRI the normal anatomy of TMJ in 12 volunteers from 30 to 35 years old. The anatomical components are described in order to provide the information for their functional evaluation with MRI. MRI is thought to be the most helpful examination in the clinical analysis of both normal and pathologic TMJ.

A total of 474 histologically proved Lung Cancers (LC) were evaluated by Conventional Radiology (CR) and Computed Tomography (CT) in order to assess the role of these two diagnostic modalities in the staging of LC. In 196/474 LC it was possible also to refer, for the evaluation of the diagnostic reliability, to the surgical control. The CR features of LC both at stage III (13% of the global series) and at stage I-peripheral T1 (16% of the global series) presented very high positive and negative predictive values (90% and 95%, retrospectively); in these cases it was considered useless to perform CT. The CT grading showed a high negative predictive value in excluding stage III caused respectively by grade T3 (91.5%) and grade N2 (93.5%). As to the staging, the CT assessment of the stage I and II showed a high predictive value (91.5%). On the other hand, the CT assessment of stage III presented an unsatisfactory predictive value (71%), due to the low predictive value in grade T3 (71.5%), poor in grade N2 (57.5%). The increase of the value threshold mediastinal adenopathies from 1 to 2 cm, leads to a great improvement of this predictive value (92%). The CT reliability was matched with the two different surgical "philosophies" (non aggressive or aggressive); surgery was excluded or performed according to the presence of omo-lateral mediastinal adenopathy. A correct advice to perform surgery was achieved in 33.5% (non aggressive "philosophy") and 43.8% (aggressive "philosophy") of cases; surgery was correctly excluded respectively in 49.6% and 45.9%. The resort to mediastinoscopy was advised in 7.8% and 1.3% of the cases respectively. In both "philosophies" the error of under-staging was lower (2.5%), than that of over-staging (6.6%).

This personal series of 44 primary retroperitoneal masses (P.R.P.M.) studied by C. T. is analyzed. The reliability of C. T. in the identification (44/44), characterization (43/44) and origin evaluation (41/44) of P.R.P.M. has been absolutely satisfactory. In particular, those criteria of C. T. diagnosis which may be utilized in the evaluation of the origin of upper abdominal masses are thoroughly described. The evaluation of the involvement (non invasive; invasive) of adjacent viscera has been achieved in 22/38 P.R.P.M. verified at operation. The evaluation of tumour resectability has been less reliable due to the high incidence of under-diagnosis (60% in our personal experience). C. T. may be used in addition as an aid to different diagnostic techniques (percutaneous guided needle biopsy) or to therapy (drainage of retroperitoneal abscesses). C. T. is absolutely necessary in the follow-up of P.R.P.M. after surgery, radiotherapy or chemotherapy.

Out of 33 cases of retroperitoneal tumours (TRP), collected throughout 11 years (1970-1981), 8 (24%) resulted benign, 25 (76%) malignant. Liposarcoma resulted the most frequent tumour. In 11 of the 25 cases of malignant TRP (44%), a radical removal of the tumour was performed; in 8 (32%), a palliative demolition, and in the remaining 6 (24%) a simple diagnostic laparotomy. In 10 of the 19 demolitive operations (53%) the removal was extended to contiguous organs: kidney, adrenal glands, colon, pancreas, spleen, bladder, stomach. The postoperative mortality was 6%. The cases of recurrence after operations considered radical were 5 (45%). Out of the 8 patients suffering from benign neoformations, 7 underwent simple removal, and result recovered. The global survival for malignant TRP was 20% after 5 years and 8% after 10 years; as related to the cases subjected to radical removal, it results 45% and 18% respectively. The Authors maintain the essential function of computerized axial tomography (TAC) in the preoperative anatomo-topographic outlining of the retroperitoneal mass and in the early recognition of the remote recurrences. An aggressive surgical behaviour seems to be presently the primary therapeutical solution; nevertheless, the encouraging results obtained through the complementary treatment (radiotherapy and chemotherapy) command the necessity of a pluridisciplinary management of the treatment of TRP as an essential condition for the improvement of the remote results.

The splenic traumatic from a retrospective study of splenic traumatic lesions, they had the opportunity to observe in the last 2 years, emphasize the importance of T.A.C. (Computed Axial Tomograph). Such inspection, quick to be executed and non-invading, allows a thorough study of abdomen, and is a guide to a correct surgical option.