Battolla L

Crohn disease of the small bowel: spiral CT evaluation after oral hyperhydration with isotonic solution.

Purpose Our aim was to evaluate the accuracy of spiral CT study of small-bowel Crohn disease with use of oral hyperhydration with isoosmotic solution. Method We prospectively analyzed 33 consecutive patients and 10 control subjects with spiral CT after oral administration of 2,000 ml of polyethylene glycol electrolyte-balanced solution. The CT diagnoses were compared with the results of conventional radiologic oral barium examination (33 cases), ileum colonoscopy (8 cases), and surgery (4 cases). Results The final diagnoses were Crohn disease (14 cases), no small-bowel disease (16 cases), cancer of ileocecal valve (1 case), carcinosis of mesenteric root (1 case), and intestinal lymphangiectasia (1 case). In the control group, no abnormalities of the small bowel were found. The sensitivity of spiral CT was 85.7%, specificity 100%, positive predictive value 100%, negative predictive value 90%, and diagnostic accuracy 93.9%. Conclusion Our method allowed adequate distension of the small bowel for spiral CT studies, thus resulting in a safe and effective alternative to small-bowel spiral CT enema, which can be used in patients that refuse the nasojejunal balloon catheter.

Urinary desmosine excretion is inversely correlated with the extent of emphysema in patients with chronic obstructive pulmonary disease.

An enhanced proteolysis of lung interstitium is key event in the pathogenesis of emphysema, a major constituent of chronic obstructive pulmonary disease. To assess whether urinary desmosine and/or hydroxyproline may be used as a marker of lung destruction we studied urinary excretions of these products in 20 patients with chronic obstructive pulmonary disease and in 19 appropriate controls in 24h urine collection samples. For desmosine measurements, we developed a new indirect competitive enzyme-linked immunosorbent assay. The extent of emphysema was measured in high resolution computed tomography (CT) scans, by considering lung area with CT numbers <-950 Hounsfield units (HU). Urinary desmosine excretion was significantly higher in patients with chronic obstructive pulmonary disease than in controls (294+/-121 microg versus 183+/-93 microg, P=0.003), and was unrelated with both age and smoking habits. In patients with no evidence or only mild emphysema, desmosine excretion values were significantly higher (P=0.006) than those of patients with moderate to severe emphysema. In patients with chronic obstructive pulmonary disease, urinary hydroxyproline excretion was positively correlated with urinary desmosine excretion but on the average, it was not different from that of controls. These data indicate that urinary desmosine is a sensitive biological marker of lung elastin catabolism. The relatively low levels of urinary desmosine observed in patients with severe emphysema may be accounted for a decrease in elastin catabolism due to reduced lung elastin mass. Urinary desmosine may be used to identify subjects at risk of developing emphysema and to assess the efficacy of therapeutic interventions.

Comparison of spirometric-gated and -ungated HRCT in COPD.

Purpose: The purpose of this work was to evaluate feasibility of spirometric‐gated high‐resolution computed tomography (HRCT) in patients with chronic obstructive pulmonary disease (COPD) and to compare the lung density CT measurements obtained with and without spirometric control of lung volume. Method: Twenty‐nine patients with COPD underwent pulmonary function tests and spirometric‐gated (3 slices at 10% and 90% of vital capacity) and ‐ungated (12 slices at maximum expiration and inspiration) HRCT in the same day. Four lung density measurements (inspiratory pixel index, expiratory pixel index, inspiratory and expiratory mean lung density) derived from gated and ungated acquisitions were compared using the nonparametric Wilcoxon test, the line of equality, and the Bland and Altman test. Results: The vital capacity measured at pulmonary function tests and on the CT table showed a substantial agreement. All but one patient completed the gated and ungated examination, but only 8 (28%) of 28 patients reached the expiratory and inspiratory gating level for CT acquisitions at the first attempt. Only the inspiratory mean lung density derived from the 3 gated and 12 ungated slices showed borderline agreement. Other CT measurements, and notably all those from the 3 gated and ungated scans, acquired at the same anatomic level, did not agree. Conclusions: Although the procedure can be difficult for individual patients, spirometric gating significantly influences the lung density CT measurements and might improve standardization of CT evaluation of COPD. Index Terms: high‐resolution computed tomography, chronic obstructive pulmonary disease, spirometric gating

Spontaneous epidural emphysema and pneumomediastinum during an asthmatic attack in a child

Abstract CT revealed the presence of epidural emphysema as an incidental finding in a 13-year-old boy in whom mild infrequent coughing during an asthmatic attack resulted in a pneumomediastinum and subcutaneous emphysema. Epidural emphysema was not associated with neurological symptoms. The CT images demonstrated the pathway of air leakage from the posterior mediastinum through the intervertebral foramina into the epidural space. Repeat CT showed spontaneous resolution of the epidural emphysema.

High-resolution computed tomography (HRCT) in the detection of “early asbestosis”

Two radiologists reviewed in masked fashion 144 standard chest radiographs, previously judged as normal by other readers, within a cohort of asymptomatic shipyard workers exposed to amosite. Among the 144 workers we selected subjects (n = 72) who fitted the following criteria: (1) documented occupational exposure to asbestos; (2) absence of any clinical symptomatology suggestive of asbestosis or of any other lung disease. Thirty-eight of them had standard chest radiogrphs that were confirmed as normal by both our radiologists, while 34 showed suspected pleural plaques or a very slight parenchymal involvement. These 72 subjects underwent high-resolution CT (HRCT): pleural plaques were shown in 33, parenchymal alterations in 7, and both pleural and parenchymal involvement in 13. HRCT findings were strictly correlated to the duration of amosite exposure and to the latency time since first exposure. Sensitivity, specificity and diagnostic accuracy values of standard chest radiographs were calculated with respect to HRCT and found to be, for pleural and parenchymal findings respectively: sensitivity 53% and 19%; specificity 72% and 94%; accuracy 60% and 72%. In conclusion, pleural and/or pulmonary involvement in asbestos-exposed workers can be shown by HRCT before the appearance of any symptomatology and abnormality on chest radiography. Furthermore the HRCT findings are correlated to the duration of exposure and latency time. time.

Sonographic Volume Processing of Malignant Prostatic Lesions

The aim of this study was to investigate the possibility of a precise definition of the volumetric and spatial features of malignant prostatic lesions needing radiation therapy and a later follow-up. The modeling procedure is mainly composed of three sequential phases: a) automatic acquisition of time sequences of 2D echotomograms; b) 3D reconstruction of images; c) generation of a spatial geometrical model.

Recognition of Densities in Digital X-Ray Images

The correct evaluation of radiographic densities and gradients is a fundamental process in the interpretation of radiological images. Our aim was to develop a system able to perform an automatic understanding of such densities in a set of X-ray films of the abdomen.