Francesco Iaselli

Differential diagnosis between fibroadenoma, giant fibroadenoma and phyllodes tumour: sonographic features and core needle biopsy

PurposeThe aim of this study was to analyse mammographic and ultrasound (US) features of fibroadenoma and phyllodes tumour and assess the diagnostic accuracy of mammography, US and US-guided core needle biopsy (CNB) in the differential diagnosis of these two lesions.Materials and methodsThe results of the pathological analysis of excision biopsy of 83 lesions (67 fibroadenomas and 16 phyllodes tumours) were correlated with the findings of mammography, US and US-guided CNB performed on 83 women with a mean age of 45.4 years (range 18–75 years).ResultsSensitivity, specificity and positive predictive values compared with histology were 45%, 50% and 79% for mammography, 34%, 69% and 82% for US and 81%, 97% and 87% for US-guided CNB (p=0.001).ConclusionsThe almost complete overlap between mammographic and US parameters of fibroadenomas and phyllodes tumours and the absence of pathognomonic features preclude the differential diagnosis between the two histological types. US-guided CNB is a valuable tool in the differential diagnosis between fibroadenoma and phyllodes tumour.RiassuntoObiettivoScopo del nostro lavoro è stato analizzare le caratteristiche mammografiche e ultrasonografiche di fibroadenoma e tumore filloide e calcolare láccuratezza diagnostica della mammografia, dellécografia e della core needle biosy (CNB) ecoguidata nella diagnosi differenziale tra fibroadenoma e tumore filloide.Materiali e metodiI risultati anatomopatologici della biopsia escissionale (BE) di 83 lesioni (67 fibroadenomi e 16 tumori filloidi) sono stati confrontati con i risultati dellésame mammografico, ecografico e della CNB ecoguidata, eseguita in 83 donne di età media di 45,4 anni (range 18–75 anni).RisultatiI valori di sensibilità, specificità, valore predittivo positivo erano del 45%, 50%, 79% per la mammografia, del 34%, 69%, 82% per lécografia e dell’81%, 97% e 87% per la CNB ecoguidata, confrontate con lístologia definitiva (p=0,001).ConclusioniLa sostanziale sovrapposizione tra i parametri mammografici e ultrasonografici dei fibroadenomi e dei tumori filloidi e lássenza di caratteristiche patognomoniche non consentono di fare diagnosi differenziale tra i due istotipi. La CNB ecoguidata rappresenta un valido strumento nella diagnosi differenziale tra fibroadenoma e tumore filloide.

Lipomatous lesions of the head and neck region: imaging findings in comparison with histological type

PurposeAim of the study is to demonstrate the main role of magnetic resonance imaging in the identification and characterization of lipomatous lesions of the head and neck.Materials and methodsCT and MRI findings of 78 patients (43 male, 35 female) aged 12–80 (mean 47.5) years surgically treated for lipomatous lesions of the head and neck region between January 1995 and June 2005 were retrospectively analysed and correlated with the histological results.ResultsOn CT images, lipomas and fibrolipomas appeared as smooth (38/50 cases) or lobulated (12/50 cases) well-defined masses associated with moderate displacement of surrounding tissues; tumours had high signal intensity on MR T1-weighted images, with relative decreasing signal on T2-weighted images. Infiltrating lipomas appeared as expansile ill-defined masses with heterogeneous signal. Angiolipomas showed a characteristic contrast enhancement on both CT and MRI. In one case of sialolipoma, the lesion appeared markedly heterogeneous in signal. MR and CT images of Madelung’s disease showed multiple symmetrical lipomatous masses involving the neck region. Intraosseous fatty lesions appeared as well-defined hypodense masses sometimes associated with cortical expansion and disruption.ConclusionsBoth CT and MRI exams are useful for detecting lipomatous lesions. MRI, however, is more accurate in the evaluation of their extent and in the characterisation of uncommon lipomatous lesions of the head and neck, and intravenous administration of gadolinium better depicts the margins of the tumour and its vascularisation.RiassuntoObiettivoLo scopo del lavoro è dimostrare il ruolo primario della risonanza magnetica nell’identificazione e nella caratterizzazione dei lipomi della regione testa-collo.Materiali e metodiGli esami di tomografia computerizzata e risonanza magnetica di 78 pazienti (43 M, 35 F) di età compresa tra i 12 e gli 80 anni (media: 47,5), sottoposti ad intervento chirurgico per l’asportazione di lipomi del distretto testa-collo tra gennaio 1995 e giugno del 2005, sono stati valutati retrospettivamente e correlati successivamente ai risultati dellesame istologico.RisultatiNelle immagini di tomografia computerizzata i lipomi ed i fibrolipomi appaiono come masse ben definite con margini lisci (38/50 casi) o lobulati (12/50 casi) associate, con modesta dislocazione dei tessuti circostanti; le lesioni appaiono iperintense nelle immagini di risonanza magnetica ottenute con sequenze T1-pesate con riduzione proporzionale del segnale nelle immagini T2-pesate. I lipomi infiltranti appaiono come masse espansive scarsamente definite e dotate di segnale eterogeneo. Le immagini di tomografia computerizzata e di risonanza magnetica della malattia di Madelung mostrano lesioni multiple e simmetriche nel distretto testa-collo. Le lesioni intraossee appaiono come aree ipodense ben definite talora associate ad espansione e distruzione della corticale.ConclusioniLa tomografia computerizzata e la risonanza magnetica sono entrambe utili per la diagnosi dei lipomi; la risonanza magnetica, tuttavia, costituisce la tecnica più leaccurata nella valutazione della loro estensione e nella caratterizzazione delle lesioni rare del distretto testa-collo. La somministrazione intravenosa di mezzo di contrasto definisce con maggiore dettaglio i margini del tumore ed il suo pattern di vascolarizzazione.

Magnetic resonance imaging in the evaluation of anatomical risk factors for pediatric obstructive sleep apnoea–hypopnoea: A pilot study

OBJECTIVE Aim of our study was to identify anatomical risk factors involved in the development of pediatric OSAHS through a MRI-based case-control pilot study. METHODS MRI exams of the head and neck of 40 children affected by OSAHS were retrospectively evaluated. 25 indices referring to the air lumen, soft tissues and craniofacial skeleton were measured. Subsequently, the same process of measurement of indices was performed on MRI exams of 40 controls. For each index, then, we calculated in both groups mean, standard deviation, standard error and t value. Comparing the two series we finally calculated the degree of significance of each difference between children with OSAHS and controls through the Students t-test. RESULTS Besides the expected and previously described differences of minimum retropharyngeal cross-sectional area (CSA), nasopharyngeal airway, combined upper airway volume, tonsillar and adenoid cross-sectional and volumetric indices, we found a higher midsagittal CSA of the soft palate and lower position of the hyoid bone, SNB angle and mandibular volume. CONCLUSIONS Results from our study population, certainly limited in terms of number of patients and considered age range, showed that not only adeno-tonsillar hypertrophy is important in determining the clinical syndrome: soft palate enlargement and certain skeletal pattern can even assume greater importance in the genesis and in the progression of the obstruction. MRI proved to be an accurate technique in the evaluation of the prevalent risk factor in children affected by OSAHS, leading to the most appropriate surgical approach.

Maxillofacial fibrous dysplasia: personal experience with gadoliniumenhanced magnetic resonance imaging

PurposeThe authors sought to identify radiological criteria assisting in the diagnosis of craniofacial fibrous dysplasia and differential diagnosis of fibro-osseous lesions by comparing computed tomography (CT) and magnetic resonance imaging (MRI) findings and histological results in 23 patients with presumed fibrous dysplasia.Materials and methodsFrom February 2000 to March 2005, 23 patients (17 women and six men, aged 9–66 years) with facial bone disease underwent CT and MRI studies. Imaging findings were compared with the results of histological examination performed within 1 month of the radiological diagnosis.ResultsThe combination of CT and MRI led to a presumptive diagnosis of fibrous dysplasia in all cases, but histology confirmed the diagnosis in 18 cases only. In two cases that had initially been considered cyst-like variants of fibrous dysplasia and were associated with irregular enhancement at MRI, histology characterised the lesions as single locations of multiple myeloma. In one case, targeted biopsy of areas showing intense enhancement led to a diagnosis of low-grade fibrosarcoma; in the remaining two cases, the definitive diagnoses were ossifying fibroma and myeloproliferative disease.ConclusionsMRI proved useful in differentiating fibrous dysplasia from other bone diseases, defining clinical behaviour, identifying neoplastic foci within dysplastic tissue and distinguishing benign from malignant bone lesions. The authors suggest a broader use of contrast-enhanced MRI for the diagnosis and follow-up of dysplastic lesions of the facial bones and for planning appropriate surgical treatment.RiassuntoObiettivoLo studio si propone di confrontare i reperti di TC e RM di 23 pazienti presumibilmente affetti da displasia fibrosa con i risultati dell’indagine istologica, definendo criteri radiografici utili nella diagnosi delladisplasia fibrosa craniofacciale e nella distinzione delle lesioni fibro-ossee da altre patologie ossee, con particolare rilievo per la RM con mezzo di contrasto.Materiali e metodiDal febbraio 2000 al marzo 2005 sono stati sottoposti ad esami di TC e RM 23 pazienti (17 F, 6 M) di età compresa tra i 9 ed i 66 anni affetti da patologie delle ossa del massiccio facciale. I reperti radiologici sono stati quindi confrontati con i risultati degli esami istologici eseguiti successivamente e comunque entro un mese dalla diagnosi radiologica.RisultatiL’integrazione TC-RM ha permesso di ipotizzare la diagnosi di displasia fibrosa nei casi selezionati, ma l’esame istologico ha confermato la diagnosi solo in 18 casi; in 2 casi, inizialmente ritenuti varianti similcistiche della displasia fibrosa ed associati ad un enhancement irregolare rilevabile all’esame RM, l’istologia ha definito le lesioni come localizzazioni uniche di mieloma multiplo. In 1 caso l’esecuzione di prelievi bioptici a livello di aree di intenso enhancement ha condotto alla diagnosi di fibrosarcoma di basso grado e nei 2 casi restanti si è giunti alle diagnosi definitive di fibroma ossificante e di patologia mieloproliferativa.ConclusioniLa RM si è rivelata utile nella diagnosi differenziale tra la displasia fibrosa ed altre affezioni del tessuto osseo, nella definizione del suo comportamento clinico, nell’identificazione di focolai neoplastici all’interno del tessuto displastico e nella distinzione dellelesioni ossee benigne da quelle maligne. Gli autori suggeriscono un più ampio utilizzo della RM con mezzo di contrasto nella diagnosi e nel follow-up delle lesioni displastiche del massiccio facciale, anche in preparazione di un eventuale trattamento chirurgico.

Value of diffusion-weighted magnetic resonance imaging in the characterization of complex adnexal masses

AIMS AND BACKGROUND The aim of the study was to define the role of diffusion-weighted imaging in the characterization of adnexal complex masses, with particular regard to the distinction between benign and malignant lesions. Conflicting results on this topic have emerged from studies in the last decade, with a consequent substantial limitation to the use of this relatively novel technique in clinical practice. METHODS AND STUDY DESIGN Magnetic resonance imaging examinations performed on 91 patients with ovarian masses (56 benign, 35 malignant) were retrospectively evaluated by two observers unaware of the final histopathological diagnosis. Diffusion-weighted sequences with b values of 0, 500 and 1000 were performed in all cases, and apparent diffusion coefficient maps were automatically generated. The signals of both the cystic and solid components of the ovarian masses were evaluated on T2-weighted and diffusion-weighted images acquired with a b value of 1000. Apparent diffusion coefficient values were measured in all cases. RESULTS With regard to the solid components, hypointensity on both the T2-weighted and diffusion-weighted images has proved to be a reliable indicator of benignancy. In contrast, hyperintensity on both sequences was suggestive of malignancy. Signal intensity of the cystic components and apparent diffusion coefficient values of both components have not proven useful in characterization of the masses. CONCLUSIONS Only the definition of the signal intensities on diffusion-weighted images obtained with the use of high b values on the solid component of a complex adnexal mass is useful to characterize an ovarian mass as benign or malignant.

Bowel and mesenteric injuries from blunt abdominal trauma: a review

The bowel and the mesentery represent the third most frequently involved structures in blunt abdominal trauma after the liver and the spleen. Clinical assessment alone in patients with suspected intestinal and/or mesenteric injury from blunt abdominal trauma is associated with unacceptable diagnostic delays. Multi-detector computed tomography, thanks to its high spatial, time and contrast resolutions, allows a prompt identification and proper classification of such conditions. The radiologist, in fact, is asked not only to identify the signs of trauma but also to provide an indication of their clinical significance, suggesting the chance of conservative treatment in the cases of mild and moderate, non-complicated or self-limiting injuries and focusing on life-threatening conditions which may benefit from immediate surgical or interventional procedures. Specific and non-specific CT signs of bowel and mesenteric injuries from blunt abdominal trauma are reviewed in this paper.

Computed tomography and magnetic resonance angiography in the evaluation of aberrant origin of the external carotid artery branches

Aim of our study was to evaluate the prevalence of aberrant origin of the branches of the external carotid artery (ECA) in 97 patients by computed tomography (CTA) and magnetic resonance angiography (MRA) and to compare the accuracy of these two techniques in the visualization of the ECA system. All patients underwent CTA and MRA examination of the head and neck. Multiplanar and volumetric reformations were obtained in all cases. For each set of images, the presence of aberrant origin of the branches of the external carotid artery was investigated. MRA and CTA images of each patient were compared to define their information content. Anatomical anomalies were found in 88 heminecks, with a prevalence of 53.3%. In the 61 patients in whom the CTA was performed before the MRA, the latter method showed only 92% of abnormalities detected at the first examination; in the 36 patients in whom MRA was performed first, CTA identified all of the anomalies highlighted by the former, adding 12 new. Knowledge of the anomalies of origin of the ECA branches is essential for the head and neck surgeon; the high prevalence of anomalies found in our series as in the previous studies indicates the opportunity to perform a CTA or a MRA of the head and neck before any surgical or interventional procedure. CTA is the method of choice in the evaluation of anomalies of origin of the branches of the ECA and in the definition of their course.

Imaging of Drug Smuggling by Body Packing

Body packing, pushing, and stuffing are hazardous practices with complex medicolegal and social implications. A radiologist plays both a social and a medicolegal role in their assessment, and it should not be limited only to the identification of the packages but must also provide accurate information about their number and their exact location so as to prevent any package remains in the body packer. Radiologists must also be able to recognize the complications associated with these risky practices. Imaging assessment of body packing is performed essentially through plain abdominal X-ray and computed tomography scans. Ultrasound and magnetic resonance imaging, although with some advantages, actually have a limited use.

Errors in imaging of traumatic injuries.

Abstract The advent of multi-detector computed tomography (MDCT) has drastically improved the outcomes of patients with multiple traumatic injuries. However, there are still diagnostic challenges to be considered. A missed or the delay of a diagnosis in trauma patients can sometimes be related to perception or other non-visual cues, while other errors are due to poor technique or poor image quality. In order to avoid any serious complications, it is important for the practicing radiologist to be cognizant of some of the most common types of errors. The objective of this article is to review the various types of errors in the evaluation of patients with multiple trauma injuries or polytrauma with MDCT.

A computed tomography-based comparative cephalometric analysis of the Italian craniofacial pattern through 2,700 years

The aim of our study was to define the changes in morphovolumetric features of neurocranium, basicranium and splanchnocranium in the population of Campania, southern Italy, over the last 2,700 years. This was a very intense period for this region from both historical and evolutionary perspectives and was marked by the succession of colonisations, dominations and invasions by several European and non-European peoples, events that profoundly influenced the original genetic heritage, which subsequently became more complex. Unlike most previous authors, we based our craniometric comparative analysis on multidetector computed tomography (MDCT) studies of contemporary and ancient series dating to between the seventh and fifth centuries B.C. of skulls found in the Etruscan necropolis of Pompei and Pontecagnano. MDCT is extremely reliable in identifying landmarks and measuring linear and angular indices through the use of multiplanar and tridimensional reformations. While highlighting a remarkable stability of 22/32 of the indices considered, as an effect of the role of the genetic heritage in preserving morphovolumetric features in a given population, statistical analysis showed some interesting results: the main changes concerned the splanchnocranium and the occlusion, indicating a higher sensitivity of these districts to environmental factors, mainly related to diet. Conversely, neurobasicranial complex morphovolumetric features remained amazingly intact. In particular, the neurocranium increased in overall capacity in response to the growing brain and changed shape with a progressive shift to a dolichocranic, flattened frontal pattern; the basicranium shape was preserved, as indicated by the stability of the cranial base (NSBa) angle over time. The splanchnocranium, on the contrary, has undergone a dramatic involution, even conditioning gnathic structures with changes in palatal shape (more acute) and in the relationship between the jaws on the sagittal plane, resulting in increased prevalence of Angle’s class I and III malocclusions.RiassuntoScopo del nostro studio è stato quello di definire le variazioni occorse a carico delle caratteristiche morfovolumetriche del neurocranio, del basicranio e dello splancnocranio nella popolazione della Campania, Italia meridionale, negli ultimi 2700 anni, periodo straordinariamente intenso dal punto di vista storico ed evolutivo per questa regione, caratterizzato dalla successione di colonizzazioni, dominazioni ed invasioni da parte di diverse popolazioni europee e non-europee, eventi che hanno profondamente influenzato e condizionato l’originale patrimonio genetico, divenuto più complesso. A differenza della maggior parte degli autori che ci hanno preceduto, abbiamo basato la nostra analisi craniometrica — che vede il confronto tra una serie contemporanea ed una antica, risalente al VII–V secolo prima di Cristo e composta di crani ritrovati nelle antiche necropoli etrusche di Pompei e Pontecagnano — sulla tomografia computerizzata multidetettore, estremamente affidabile nell’identificazione di punti craniometrici e nella misurazione di indici lineari ed angolari grazie all’impiego delle ricostruzioni multiplanari e tridimensionali. I risultati statistici del nostro lavoro, pur evidenziando una sostanziale stabilità di ben ventidue dei trentadue indici considerati, effetto del ruolo dell’eredità genetica nella conservazione di determinate caratteristiche morfo-volumetriche, hanno mostrato alcuni risultati interessanti: le principali modificazioni hanno interessato lo splancnocranio e l’assetto gnatico, indicando una maggiore sensibilità di questi distretti all’influenza di fattori ambientali, in primo luogo correlati alla dieta; il complesso neurobasicranico, invece, ha mantenuto le sue caratteristiche morfo-volumetriche straordinariamente intatte. Il neurocranio, in particolare, ha aumentato la sua capacità complessiva in risposta alla crescita del cervello e ha modificato la sua forma con un progressivo spostamento al pattern dolicocranico, con riduzione della convessità esterna dell’osso frontale; il basicranio ha mantenuto la sua forma nel tempo, come indicato dalla stabilità dell’angolo nasion (n)-sella turcica (s)-basion (ba). Lo splancnocranio, al contrario, ha subito una drammatica involuzione, che ha coinvolto pure le strutture coinvolte nella masticazione, con variazioni della forma del palato, diventata più acuta, e del rapporto delle due ossa mascellari sul piano sagittale, con conseguente incremento del rischio di sviluppare malocclusioni di classe III secondo Angle.