[Show abstract][Hide abstract] ABSTRACT: The aim of our study was to evaluate the accuracy of multidetector computed tomography (MDCT) on a 16-row CT scanner in the detection and differentiation of adnexal masses.
We prospectively examined 102 consecutive women with clinically or sonographically detected adnexal masses. Preoperative CT examination was performed, including scanning of the abdomen during the portal phase, using a detector collimation of 16 x 0.75 mm and a pitch of 1.2. Multiplanar reformatted images were evaluated for the presence of an adnexal mass and differentiation between benign and malignant ones, using the surgical and pathologic results as standard of reference. CT findings used to diagnose malignancy were: diameter greater than 4 cm, presence of masses bilaterally, cystic-solid mass, necrosis in a solid lesion, cystic lesion with thick, irregular walls or septa and/or with papillary projections. Presence of ascites, peritoneal metastases and lymphadenopathy was used to confirm malignancy. Multiple logistic regression analysis of the MDCT findings was performed to determine those more predictive of malignancy.
Histopathologic examination demonstrated 143 adnexal mass lesions, 96 (67%) of which were benign and 47 (33%) malignant. Multidetector CT detected 129 (90%) of the 143 adnexal masses, with an overall accuracy for the diagnosis of malignancy of 89.15%. The MDCT findings that found more predictive of malignancy were the presence of papillary projections in a cystic lesion, necrosis in solid mass and peritoneal metastases.
Multidetector computed tomography on a 16-row CT scanner proved accurate in the detection and characterization of adnexal masses.
[Show abstract][Hide abstract] ABSTRACT: A 70-year-old man presented with fever, left flank pain and scrotal enlargement. CT scan of the thorax and abdomen revealed findings compatible with pulmonary and kidney tuberculous involvement. Sonographic and MRI examination of the scrotum showed bilateral testicular enlargement and the presence of multiple nodules involving both the testis and the epididymis. Urine cultures obtained from a percutaneous left nephrostomy were positive for tuberculous bacilli, and the patient was placed on anti-tuberculous treatment.
The British journal of radiology 07/2008; 81(966):e166-9. · 2.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose was to evaluate the accuracy of multidetector CT (MDCT) on a 16-row CT scanner in local staging of endometrial carcinoma and more specifically in the assessment of the depth of myometrial invasion and presence of cervical infiltration. This prospective study includes 21 women with newly diagnosed endometrial carcinoma. All CT examinations were performed on a 16-row CT scanner, and the protocol included scanning of the abdomen after intravenous administration of iodinated contrast material, during the portal phase, using a detector collimation of 16 x 0.75 mm and a pitch of 1.2. Sagittal, parasagittal and oblique reformatted images were evaluated for the depth of myometrial invasion, whether superficial or deep, and the presence of cervical infiltration. Imaging findings were correlated with the histopathologic results. The sensitivity, specificity and accuracy of MDCT in evaluating myometrial invasion were 100%, 80% and 95%, respectively, and for assessing cervical infiltration were 78%, 83% and 81%, respectively. In conclusion, MDCT on a 16-row CT scanner proved accurate in local staging of endometrial carcinoma.
European Radiology 06/2008; 18(5):1043-8. · 4.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose was to compare the accuracy of multidetector CT (MDCT) on a 16-row CT scanner and magnetic resonance (MR) imaging in the characterization of ovarian masses. Preoperative CT examination of the abdomen and MR imaging of the pelvis was performed in 67 women, with clinically or sonographically detected adnexal masses. The CT examinations were performed on a 16-row CT scanner, and the protocol included scanning of the abdomen during the portal phase, using a detector collimation of 16 x 0.75 mm and a pitch of 1.2. We used a 1.5-T magnet unit to perform T1, T2 and fat-suppressed T1-weighted sequences, before and after intravenous administration of gadolinium chelate compounds. The accuracy of multidetector CT and MR imaging in the differentiation between benign and malignant ovarian masses was evaluated, using histopathologic results as the standard of reference. The sensitivity, specificity and accuracy of MDCT in the characterization of ovarian masses were 90.5%, 93.7% and 92.9%, respectively, and that of MR imaging 95.2%, 98.4% and 97.6%, respectively. Although MRI performed slightly better, this did not reach statistical significance. In conclusion, both MDCT on a 16-row CT scanner and MR imaging demonstrated satisfactory results in the characterization of ovarian masses.
European Radiology 06/2008; 18(5):1049-57. · 4.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate the utility of 16-MDCT cystoscopy in the detection of urinary bladder neoplasms in a high-risk population.
Fifty patients who presented with hematuria and a recent diagnosis or a history of bladder carcinoma underwent CT cystoscopy. All patients were examined in the supine and prone positions after bladder distention with room air. A detector configuration of 16 x 0.75 mm and a pitch of 1.2 was used. Virtual images were obtained with volume-rendered algorithms. Transverse tomographic slices, multiplanar reformatted images, and virtual images were prospectively evaluated separately and in combination. Conventional cystoscopy was considered the standard of reference for assessing the efficacy of MDCT cystoscopy in the detection of urinary bladder tumors.
Fifty-five (96%) of 57 urinary bladder lesions recognized at conventional cystoscopy were detected with MDCT cystoscopy. The size of the lesions ranged from 0.3 to 9.7 cm in diameter, including 18 lesions with a diameter of 0.5 cm or less. Transverse, multiplanar reformatted, and virtual images proved complementary for lesion detection.
MDCT cystoscopy is an accurate technique for the detection of urinary bladder neoplasms in patients at high risk, yielding satisfactory results in the identification of lesions smaller than 0.5 cm.
American Journal of Roentgenology 04/2008; 190(3):729-35. · 2.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of our study was to investigate the potential role of MRI in the preoperative characterization of the histologic type of testicular tumors and, more specifically, to differentiate seminomatous from nonseminomatous testicular neoplasms.
Twenty-one patients with histologically proven germ cell testicular tumors underwent MRI of the scrotum on a 1.5-T unit. T2- and T1-weighted sequences before and after i.v. administration of gadolinium chelate were performed. MRI studies were retrospectively reviewed by two radiologists and findings were correlated with the histopathologic diagnosis. An attempt was made to differentiate seminomatous from nonseminomatous testicular tumors on the basis of signal intensity and homogeneity of the lesions, presence of fibrovascular septa, tumor encapsulation, and patterns of contrast enhancement. Interobserver agreement was assessed using weighted kappa statistics.
MRI findings correctly characterized 19 (91%) of 21 testicular neoplasms (nine seminomatous and 10 nonseminomatous testicular tumors), with excellent interobserver agreement. The presence of an intratesticular lesion of predominantly low signal intensity on T2-weighted images, with septa enhancing more than tumor tissue after contrast material administration, was more suggestive for the diagnosis of a seminoma. Tumors that were markedly heterogeneous both on unenhanced and contrast-enhanced images were indicative of a nonseminomatous neoplasm.
Our study shows that MRI provides a credible preoperative differentiation of seminomatous from nonseminomatous testicular tumors, with excellent interobserver agreement.
American Journal of Roentgenology 01/2008; 189(6):W331-7. · 2.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PURPOSE
To evaluate the accuracy of 16-slice CT in local staging of endometrial carcinoma and more specifically in the assessment of the depth of myometrial invasion and presence of cervical infiltration
METHOD AND MATERIALS
This prospective study includes 20 consecutive women with newly diagnosed endometrial carcinoma referred for CT examination of the abdomen. All examinations were performed on a 16-slice CT scanner and the protocol included scanning of the abdomen after intravenous administration of iodinated contrast material, during the portal phase, using a detector collimation of 16 X 0.75 mm and a pitch of 1.2. Sagittal, parasagittal and oblique reformatted images were evaluated by two radiologists in consensus for the depth of myometrial invasion, whether superficial or deep and the presence of cervical infiltration. Imaging findings were correlated with the histopathologic results. For statistical analysis the Fischer exact test was used.
The sensitivity, specificity and overall diagnostic accuracy of multislice CT in evaluating myometrial invasion were 100%, 75% and 95%, respectively; for assessing cervical infiltration were 78%, 82% and 80%, respectively. There was significant agreement between CT findings and histopathologic results in assessing both myometrial invasion and cervical infiltration (p < .05).
16-slice CT proved accurate in local staging of endometrial carcinoma.
: Multislice CT scanners improved greatly the diagnostic performances of CT in detection and local staging of gynecologic malignancies
Radiological Society of North America 2007 Scientific Assembly and Annual Meeting; 11/2007
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to assess the role of multi-detector row CT urography (MDCTU), on a 16-row CT scanner in the evaluation of patients with painless hematuria, with emphasis placed in the detection of urothelial tumors. We retrospectively reviewed the MDCT urographies of 75 patients, referred for painless hematuria. The CT protocol included unenhanced images, obtained with a detector configuration of 16x1.5 mm and pitch of 1.2, nephrographic and excretory-phase images, obtained with a detector collimation of 16x0.75 mm and pitch of 1.2. Axial and coronal reformatted images were evaluated. Three-dimensional reformation of the excretory-phase images was performed using the volume-rendering technique. The standard of reference included clinical and imaging follow-up, cystoscopic, surgical and histologic findings. In 55 (73%) of 75 patients, the cause of hematuria was identified on MDCTU; the most common cause was urothelial cancer, including seven tumors with a diameter equal or smaller than 0.5 cm in diameter. Sixteen-row MDCTU provided satisfactory results in the investigation of patients with painless hematuria. The main advantage of the technique is its ability to detect uroepithelial malignancies.
European Radiology 05/2007; 17(4):1046-54. · 4.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate whether a second cycle of contrast-enhanced voiding urosonography (VUS) with no added contrast medium (CM) can increase the detection rate of vesicoureteral reflux (VUR). One hundred twelve consecutive children with a mean age of 2.9 years with 224 kidney-ureter units (KUU) underwent two cycles of contrast-enhanced harmonic VUS. The first cycle of VUS was performed with 3.5-12.5 ml of suspension 300 mg/ml SH U 508 A and was followed immediately by a second cycle with only saline without adding CM. VUR was detected in 57 KUU from 44 children (39%) at the first cycle of VUS. Eight of the remaining 68 non-refluxing children (12%) demonstrated VUR at the second cycle (P=0.045). Most cases of missed reflux at the first cycle were grade II (75%). However, in two KUU from two children missed reflux was grade III. In one child reflux (grade II) was missed on the second cycle. Comparing the second cycle of VUS with the first cycle, concordant findings regarding the presence or absence as well as the grade of reflux were found in 94% of KUU. A second cycle of contrast-enhanced harmonic VUS with no added CM discloses significantly more cases of VUR at no additional cost for the examination.
European Radiology 12/2006; 16(11):2521-6. · 4.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: LEARNING OBJECTIVES
1. To present the CT protocol for the evaluation of an adnexal mass. 2. To discuss CT findings used for the differentiation between benign and malignant ovarian masses. 3. To present the possible limitations of MDCT in the characterization of adnexal lesions.
Characterization of an ovarian mass is important in the preoperative evaluation of an ovarian neoplasm. It enables the surgeon to anticipate ovarian carcinoma, and employ adequate manipulations. Recently, laparoscopic surgery has been used to manage benign adnexal masses, with minimal surgical morbidity. Transvaginal sonography is the most practical modality for the assessment of adnexal masses, although its sensitivity for the diagnosis of benignity varies from 60-98%. MR imaging is a highly accurate technique in the detection and characterization of adnexal masses, but due to its high cost is still reserved for problem solving cases. The advantages of multidetector CT scanners, especially those with 16-rows, namely the acquisition of thin collimation and the ability to create high-resolution multiplanar and three-dimensional reformatted images gave a new aura in diagnostic performance of CT to detect adnexal masses and differentiate between benign and malignant ones.
Radiological Society of North America 2005 Scientific Assembly and Annual Meeting; 11/2005
[Show abstract][Hide abstract] ABSTRACT: We present a case of a solitary fibrous tumour, located at the epididymis, in a 65-year-old man, presented with a scrotal mass. Ultrasound and MRI of the scrotum revealed a paratesticular mass, with rich vascularity, arising in the left epididymis. Radiological findings were non-specific and the patient underwent surgery.
British Journal of Radiology 07/2005; 78(930):565-8. · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the role of computed tomographic virtual cystoscopy (CTVC) in the detection of bladder neoplasms and to compare CTVC at conventional and reduced milliAmperes-second (mAs) settings.
Twenty-four patients with known bladder neoplasms from previous conventional cystoscopy were examined with CTVC. The urinary bladder was insufflated with room air and helical CT data were obtained. Virtual images were created using volume rendering algorithms. In eight patients we used both regular (240) and reduced (70) mAs values. The lesions were recorded on transverse tomographic slices and virtual images and compared with conventional cystoscopy, operative and pathology results.
All bladder lesions (30) seen on conventional cystoscopy were demonstrated with CTVC. Two lesions detected on imaging studies and subsequently found at operation were not seen on conventional cystoscopy. In a third case of a neobladder, conventional cystoscopy was impossible due to neoplastic involvement of the penis. In all cases the lesions were equally conspicuous with conventional and low mAs values.
Computed tomographic virtual cystoscopy is a minimally invasive technique that can provide comprehensive information about urinary bladder tumors. Furthermore, low mAs studies are equally effective for the examination of such patients.
European Urology 12/2004; 46(5):579-85. · 12.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Subarachnoid haemorrhage due to cauda equina tumour is rare. We report two myxopapillary ependymomas of the conus terminalis, presenting with in this way. Rims of low signal were observed at their upper and lower borders, mainly on T2-weighted images. This finding has been described in ependymomas of the cervical region but not, to our knowledge, in myxopapillary ependymomas of the conus terminalis.
[Show abstract][Hide abstract] ABSTRACT: In thalassaemic patients, neurophysiological disturbances have been associated with high serum ferritin levels and desferrioxamine therapy. In the presence of a magnetic field, ferritin, the main iron storage protein, induces a preferential decrease of the T(2) relaxation time. The purpose of this study was to evaluate thalassaemic patients for brain iron deposition by assessing the T(2) relaxation rate (1/T(2)) of the grey matter. 41 thalassaemic patients (age range 8.5-44 years, mean 24 years) and 58 age- and sex-matched controls were included in the study. Current serum ferritin levels were obtained. The 1/T(2) values of the cortex (motor and temporal) (mean 0.0122 ms(-1), SD 0.0004), putamen (mean 0.0137 ms(-1), SD 0.0004) and caudate nucleus (mean 0.0132 ms(-1), SD 0.0003) were higher in patients compared with the controls (mean 0.0110 ms(-1), SD 0.0004; mean 0.0120 ms(-1), SD 0.0005; mean 0.0117 ms(-1), SD 0.0003, respectively) (p<0.001 for all parameters). No statistically significant differences were found in the globus pallidus. No correlation was found between 1/T(2) and serum ferritin. The higher values of 1/T(2) in the cortex, putamen and caudate nucleus of thalassaemic patients probably reflect a higher iron deposition. The lack of differences in 1/T(2) of the globus pallidus might suggest that even in thalassaemic patients iron cannot exceed a saturation level.
British Journal of Radiology 05/2001; 74(881):407-10. · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Deep vein thrombosis (DVT) is a common problem in clinical practice causing severe complications. In this retrospective study, the distribution and extent of DVT in the lower limb in symptomatic patients were evaluated. Certain risk factors were also investigated.
The venograms of 187 symptomatic individuals (postoperative, medical, and out-patient) with suspected DVT and symptoms having been present for less than 6 days, were reviewed. Seventy-seven limbs of 76 patients had DVT. Twenty-seven were male (age range 14-82 years, mean 57) and 49 female (age range 12-82, mean 56).
Age over 40 years and gender (female) were significant predisposing factors, (Z = 4.23, p < 0.001 and Z = 2.19, p < 0.05 respectively). Isolated calf DVT alone was the most common pattern (46%, 36 of 77 limbs), and no difference was seen between postoperative and medical patients (chi 2-test, p = 0.7). Postoperative DVT was found in 29 (38%) limbs. Prophylaxis with LMWH had been given in only 15 of them (52%). No difference was seen in the distribution and extent of thrombosis in relation to the prophylaxis with LMWH (chi 2-test, p = 0.34).
Identification of the predisposing factors may enable us to distinguish patients at high risk of developing DVT. The majority of the thrombi commenced in the calf veins and thus meticulous investigation of these veins in symptomatic patients with suspected DVT is necessary.
International angiology: a journal of the International Union of Angiology 10/1998; 17(3):151-4. · 1.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We have recently reported that methotrexate (MTX) is an effective treatment of patients with refractory rheumatoid arthritis (RA) to second line medication. We showed that 54% of our patients continued having clinical benefit after 24 months therapy with MTX. In this study we evaluated pairs of hand radiographs from 35 patients taken before and after 24 months treatment. We used a scale scoring similar to Larsen's standard radiographs with minor modifications. No significant changes were observed in the overall scoring of the radiographs before (14.84 +/- 13.05) and after treatment (18.77 +/- 15.60) (p greater than 0.5). Of these 35 patients, 23 had a clinical remission and 12 had a good response. Twenty patients have shown a stabilization of erosions in radiographs while 15 showed a deterioration. No correlation was found between clinical response and radiological changes. We conclude that MTX does not appear to be a disease modifying agent, but may inhibit joint damage progression.