Giuseppe Tognini

Diagnostic Imaging of Diffuse Infiltrative Disease of the Lung

Plain chest radiography remains the first diagnostic approach to diffuse infiltrative lung disease but has limited diagnostic sensitivity and specificity. Many diseases remain occult or are not correctly assessed using chest X-ray, appearing as a nonspecific ‘reticulonodular pattern’. High-resolution CT (HRCT) is actually the recommended imaging technique in the diagnosis, assessment, and follow-up of these diseases, allowing also the evaluation of the effectiveness of the medical therapy and the selection of the type and the location of the biopsy when required. Appropriate techniques must be used to acquire high-quality HRCT scans, with the thin collimation and high spatial reconstruction algorithm being the most important factors. A nodular pattern, linear and reticular opacities, cystic lesions, ground-glass opacities and consolidations are the most common HRCT patterns of diffuse infiltrative lung disease. This article reviews the role of chest radiography and HRCT in the diagnosis and assessment of these diseases, the technical aspects of HRCT, its clinical indications and the radiological pattern of the most common types of chronic diffuse infiltrative lung disease.

Brain apparent diffusion coefficient evaluation in pediatric patients with neurofibromatosis type 1

Objective: The most frequent intracranial appearance in children with neurofibromatosis type 1 (NF1) is represented by the presence of hyperintense lesions on T2-weighted images, the so-called “unidentified bright objects” (UBOs). Di Paolo demonstrated that these lesions represent foci of myelin vacuolization with increased water content. The aim of this study was to investigate the isotropic apparent diffusion coefficient (ADC) values within the UBOs and normal-appearing brain and at the regressed UBO sites. Methods: Fifteen consecutive children with NF1 underwent magnetic resonance diffusion evaluation of the brain. Fifteen healthy age- and sex-matched children constituted the control group. Apparent diffusion coefficient maps were obtained, and regions of interest were placed bilaterally in 8 different areas. Two cortical areas were evaluated using single-pixel analysis. Apparent diffusion coefficient values within the UBOs were calculated by using irregular regions of interest. Regressed UBO sites were investigated by using circular regions of interest. Apparent diffusion coefficient values within the different areas were compared using a t test. Results: Compared with the controls, NF1 patients showed higher ADC values (P < 0.001) in all locations. In the NF1 group, the mean ADC value in the UBOs was higher than in other locations (P < 0.001). The mean ADC value within the regressed UBO sites was higher than in the normal-appearing locations (P < 0.001). Conclusions: The higher ADC values in children with NF1 suggest an increase in water content of the normal-appearing brain. The UBOs are the areas with the highest water content. The regressed UBOs sites show higher water content than the normal-appearing areas.

Non-Hodgkin lymphomas of the ovaries: MR findings.

PURPOSE The goal of this work was to describe MR findings (morphology, structure, signal intensity) of ovarian non-Hodgkin lymphoma (NHL). METHOD We reviewed the MR images of five female patients aged 13-70 years (mean 46 years) with histologically proven NHL of the ovaries. We evaluated morphological and signal intensity findings of the lesions. MR features were correlated with pathologic parameters. RESULTS All the patients were affected by B-cell NHL; one patient showed a primary involvement of the ovaries; in one patient, ovarian disease was diagnosed 30 months after surgical resection of a primary uterine lymphoma; the remaining three had a systemic lymphoma. In three cases, the ovarian involvement was bilateral. The mean size of the lesions was 7.9 cm. All the lesions showed homogeneous low signal intensity on T1-weighted images and intermediate to high intensity on T2-weighted images. The postgadolinium images showed mild to moderate heterogeneous enhancement. The peripheral enhancement was better demonstrated in fat-suppressed images. CONCLUSION The diagnosis of primary ovarian lymphoma should be considered in the presence of large bilateral solid ovarian masses with homogeneous appearance (low signal on T1 and mildly high on T2) without infiltrative pattern of growth or regressive changes (necrosis, hemorrhage, calcifications) and with little contrast enhancement.

Lipomatous tumors of the stomach: CT findings and differential diagnosis.

This article reviews the computed tomography imaging features of a variety of gastric tumors containing fatty tissue. Lipoma, angiolipoma, liposarcoma, and teratoma are described. Differential diagnosis includes primary and reactive lipomatosis, carcinoma engulfing the perivisceral fat thus mimicking differentiated liposarcoma, and mesenchymal gastric and peritoneal neoplasms.

Pseudotumoral bilateral involvement of the breast in Erdheim-Chester disease: CT appearance.

We report a case of pseudotumoral involvement of the breast in Erdheim-Chester disease. CT shows an enlargement of both breasts with inhomogeneous structure, microcalcifications, and foci of fatty density.

Focal Castleman disease of the lung MRI findings

Castleman disease is an uncommon benign disorder mainly affecting mediastinal lymph nodes and rarely visceral organs. The most typical structural finding is hypervascularity which can be well demonstrated both by CT and MRI. We report MR findings of an unusual case of solitary parenchymal lung involvement.

Primary effusion lymphomas in AIDS: CT findings in two cases

Abstract Primary effusion lymphomas represent an unusual subset of AIDS-related non-Hodgkins lymphomas. They are associated with herpes virus 8 and Epstein-Barr virus and characterized by predominant involvement of the serous body cavities (pleura, pericardi

Small cell carcinoma of the uterine corpus: CT appearance.

We report a rare case of small-cell carcinoma of the uterine corpus. To our knowledge, this is the first radiological report. Computed tomography (CT) demonstrates a hypodense lesion within the endometrial cavity with nonhomogeneous contrast enhancement.

Enlarging tongue masses in neurofibromatosis type 1 ☆: MR findings of two cases

Plexiform neurofibromas usually occur in the neck, pelvis, and extremities. Jaws and oral cavity plexiform neurofibromas have also been described. Magnetic resonance (MR) patterns for neurofibromas are typical. They include low-to-intermediate signal intensity on T1-weighted images, enhancement of the solid component of the tumor after contrast medium administration, heterogeneity on T2-weighted images, and in some cases, multiple target signs due to a collagen central area. We report MR findings of two neurofibromatosis type 1 (NF1) patients with enlarging tongue plexiform neurofibromas.

Diabetes mellitus: CT findings of unusual complications related to the disease: A pictorial essay

Diabetes mellitus is a common multisystemic disorder with serious effects on the gastrointestinal tract, genitourinary system and soft tissues. The long-term effects of diabetes are mainly related to macro- and microvascular disease, neuropathy, both autonomic and somatic, and to an increased susceptibility to infections, which generally develop 15-20 years after the appearance of overt hyperglycemia. Herein, we discuss the unusual long-term complications related to the disease that can display a characteristic CT pattern. CT, together with clinical findings, proved useful in the identification and characterization of such unusual pictures. Knowledge of the specific pathology and imaging features of unusual late effects related to the disease is of paramount importance for the correct management of diabetic patients.