M. De Filippo

Ultrasound and magnetic resonance imaging in sports-related muscle injuries

Purpose.The objective of this study was to evaluate the role of magnetic resonance imaging (MRI) and ultrasonography (US) in the diagnosis of traumatic muscle injuries.Materials and methods.From June 2003 to June 2004, 81 football players with a history of traumatic muscle injuries to the lower limbs were examined. US was performed shortly after the trauma (from 6 to 72 h afterwards) and MRI within a maximum of 5 days.Results.MRI revealed 26 minor and 55 major traumas. MRI and US showed complete concordance in 71 patients (site, type and extent of injury). US produced ten false negative results, including six minor lesions and four major lesions. US had a sensitivity of 87.65% in the correct identification of muscle injuries; its sensitivity was 92.72% for major lesions and 76.92% for minor lesions, 57% for delayed-onset muscle soreness (DOMS), 80% for lengthenings, 83% for contractures, 84% for strains, 87.5% for mild contusions and 100% for severe contusions.Conclusions.US is the first-line technique for examination of muscle injuries. MRI is able to reveal lesions that may be missed at US and provide a more accurate assessment of site and extent of injury.

Congenital anomalies and variations of the bile and pancreatic ducts: magnetic resonance cholangiopancreatography findings, epidemiology and clinical significance

PurposeThe objective of this paper is to document the magnetic resonance cholangiopancreatography (MRCP) findings and the epidemiology of congenital anomalies and variations of the bile and pancreatic ducts and to discuss their clinical significance.Materials and methodsThree-hundred and fifty patients of both sexes (150 females, 200 males, age range 0–76 years, average age 38 years) underwent MRCP for clinically suspected lithiasic, neoplastic or inflammatory disease of the bile and pancreatic ducts. Patients were imaged with a 1.5-T superconductive magnet (Magnetom Vision, Siemens, Erlangen, Germany), a four-channel phased-array body coil, breath-hold technique, with multislice T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE), MIP reconstructions, and a single-shot T2-weighted turbo-spin-echo sequence rapid acquisition with relaxation enhancement (RARE) with different slice thicknesses. Studies in oncological patients were completed with fat saturation 3D T1 gradient-echo sequences during the intravenous injection of gadolinium diethylene triamine pentaacetate acid (DTPA) (0.2 ml/kg).ResultsMRCP demonstrated recurrent and therefore normal bile and pancreatic ducts in 57% of patients. In the remaining 42.3%, it documented anatomical variants (41%) and congenital anomalies (1.3%). Variants of the intrahepatic bile duct were seen in 21% of cases: crossover anomaly (6.7%), anterior branch of the right hepatic duct draining the IV and VII segments that flow together with the left bile duct (3.1%) and anterior and posterior branches of the right hepatic duct that flow together with the common hepatic duct (3.3%). Variants of the extrahepatic bile ducts were present in 8.8% of patients: low insertion of the cystic duct into the common hepatic duct (4.5%), emptying of the cystic duct into the right hepatic duct (2.7%) and a second-order large branch draining into the cystic duct (1.6%). MRCP identified a double gall bladder in 3% of patients and anatomical variants of the biliopancreatic system in 8.2%: pancreas divisum (5.2%) and a long sphincter of Oddi (3%). Finally, congenital anomalies were diagnosed in 1.3% of cases: bile duct cysts (0.3%), atresia of the bile ducts (0.3%) and multiple biliary hamartomatosis (0.7%).ConclusionsThe congenital anomalies and anatomical variants of the bile and pancreatic ducts present a complex spectrum of frequent alterations, which are worthy of attention in both the clinical and surgical settings and are readily identified by MRCP.RiassuntoObiettivoDocumentare gli aspetti colangiopancreato-RM (CPRM), valutare l’epidemiologia e discutere il significato clinico delle varianti e delle anomalie congenite delle vie biliari e pancreatiche.Materiali e metodiTrecentocinquanta pazienti di entrambi i sessi (150 F e 200 M; range di età 0-76 anni, età media 38 anni) sono stati sottoposti a CPRM per i sospetti clinici di patologia litiasica, neoplastica e flogistica delle vie biliari e pancreatiche. È stato impiegato un magnete superconduttivo da 1,5 T con bobina body phased-array a quattro canali, tecnica breath-hold, acquisizioni half-fourier con T2-W (HASTE) multislice, ricostruzioni MIP, e single shot T2-W turbo-spin-echo (RARE) con differente spessore di strato. Alcuni esami, in pazienti oncologici, sono stati completati con sequenze gradient echo 3D T1w fat-sat durante somministrazione in vena periferica di mezzo di contrasto gadolinium-DTPA (0,2 ml/kg).RisultatiLa CPRM ha documentato vie biliari e pancreatiche ricorrenti e pertanto considerate normali nel 57,7% dei pazienti; nel restante 42,3% ha rilevato varianti anatomiche (41%) ed anomalie congenite (1,3%). Nel 21% dei casi le varianti interessavano le vie biliari intraepatiche: crossover anomaly (6,7%), dotto bisegmentario anteriore destro confluente nel dotto biliare di sinistra (3,1%), dotto bisegmentario posteriore destro confluente nel dotto epatico sinistro (7,9%) e nel dotto epatico comune (3,3%). La presenza di varianti anatomiche delle vie biliari extraepatiche è stata riscontrata nell’8,8% dei pazienti: bassa inserzione del dotto cistico nel dotto epatico comune (4,5%), sbocco del dotto cistico nel dotto epatico destro (2,7%), grosso ramo di secondo ordine drenante nel dotto cistico (1,6%). La CPRM ha identificato un 3% di pazienti con colecisti doppia ed un 8,2% di pazienti con varianti anatomiche del sistema bilio-pancreatico: pancreas divisum (5,2%) e sfintere di Oddi lungo (3%). Infine anomalie congenite sono state diagnosticate nell’1,3% dei casi: cisti coledocica (0,3%), atresia delle vie biliari (0,3%) ed amartomatosi biliare multipla (0,7%).ConclusioniLe anomalie congenite e le varianti anatomiche delle vie biliari e pancreatiche costituiscono uno spettro complesso di frequenti alterazioni, documentabili agevolmente in CPRM e meritevoli di attenzione in ambito sia clinico sia chirurgico.

Multidetector Computed Tomography Arthrography of the Shoulder: Diagnostic Accuracy and Indications

Background: The presence of subcutaneous implants, such as permanent defibrillators, is an absolute contraindication to the use of magnetic resonance imaging (MRI). Moreover, MRI is unadvisable in subjects with metallic hardware near the area of study, as artifacts generated by such materials distort image quality. Purpose: To evaluate the diagnostic accuracy and indications of arthrography with multidetector computed tomography arthrography (arthro-MDCT) of the shoulder in patients with absolute or relative contraindications to MRI and in patients with periarticular metal implants using diagnostic arthroscopy as the gold standard. Material and Methods: After intraarticular injection of iodixanol and volumetric acquisition, 70 shoulders in 70 patients (30 females, 40 males, age range 32–60 years) were examined with a 16-detector-row CT scanner. The patients had arthralgia but no radiologically detected fractures. They could not be studied by MRI because of absolute contraindications (subcutaneous electronic implants), surgical metal implants, or claustrophobia. In 28 of the 70 patients who had had previous shoulder surgery, the arthro-CT examination was preceded by an MRI on the same day. All examinations were interpreted by two experienced musculoskeletal radiologists. The findings were compared with arthroscopic findings carried out within 28 days of the CT study. Results: In the 42 non-operated patients, the comparison between arthro-MDCT and arthroscopy showed sensitivity and specificity ranging between 87% and 100%. In the 28 operated shoulders, arthro-MDCT had an accuracy of 94% compared with 25% with MRI. Interobserver agreement was almost perfect (κ=0.95) in the evaluation of all types of lesions, both on MDCT and MRI. When arthro-MDCT was compared with MRI in the postoperative patients by a McNemar test, a significant difference (P<0.05) was found between these two techniques. Conclusion: Arthro-MDCT of the shoulder is a safe technique that provides accurate diagnosis in identifying chondral, fibrocartilaginous, and intraarticular ligamentous lesions in patients who cannot be evaluated by MRI, and in patients after surgery.

Detection of incidental vertebral fractures on routine lateral chest radiographs.

PurposeThis study sought to assess the usefulness of routine lateral chest radiographs for detecting unrecognised vertebral compression fractures.Materials and methodsWe prospectively selected outpatients without symptoms or risk factors for osteoporosis who underwent chest radiography for different clinical indications. Two independent reviewers with different levels of experience assessed the radiographs for vertebral deformities and graded them as mild, moderate and severe according to the semiquantitative Genant Index. The kappa statistic was used to evaluate interobserver agreement and verify the reproducibility of this method. The prevalence of vertebral fractures observed was compared with that recorded in the official radiology reports.ResultsOur study involved 145 patients (73 men, 72 women; age range 50–86 years, mean age 67.5). Clinically relevant vertebral fractures were seen in 18/145 patients (12.4%). These were moderate in 13 patients and severe in five, and single in 12 patients and multiple in six. Interobserver agreement was very high (κ=0.9). Only 11% of these fractures were recorded in the official reports.ConclusionsLateral chest radiographs could be effective for assessing previously unknown vertebral compression fractures in individuals without clinical evidence or risk factors for osteoporosis.RiassuntoObiettivoVerificare l’utilità del radiogramma laterale del torace eseguito per altre indicazioni nella identificazione di fratture vertebrali osteoporotiche non note.Materiali e metodiAbbiamo prospetticamente selezionato i pazienti ambulatoriali senza sintomi né fattori di rischio per osteoporosi sottoposti ad esame radiografico del torace per varie indicazioni. Due radiologi con differenti livelli di esperienza hanno separatamente ricercato le anomalie vertebrali presenti in tali pazienti e le hanno classificate in lievi, moderate e severe secondo l’indice semiquantitativo di Genant. Abbiamo usato il k statistico per valutare la variabilità interosservatore e verificare la riproducibilità del metodo. Abbiamo paragonato la prevalenza delle fratture vertebrali osservata con quella delle fratture menzionate nei referti ufficiali.RisultatiLa nostra popolazione risulta composta da 145 pazienti (73 M, 72 F; range di età 50–86 anni, età media 67,5 anni). Diciotto pazienti (18/145=12,4%) presentavano fratture vertebrali clinicamente rilevanti: moderate 13 pazienti, severe 5; fratture singole in 12 pazienti, multiple in 6. La concordanza tra i due esaminatori e stata molto elevata (κ=0,9). Solo l’11% di tali fratture era stata riportata nei referti ufficiali.ConclusioniIl radiogramma toracico laterale può rappresentare un vantaggioso sistema per identificare le fratture vertebrali osteoporotiche non note in una popolazione asintomatica e senza fattori di rischio per osteoporosi.

Erdheim-Chester disease: clinical and radiological findings

PurposeThe authors retrospectively reviewed six cases of histologically proven Erdheim-Chester disease (ECD) to evaluate organ involvement and clinical and radiological findings.Materials and methodsThrough a search of the pathology databases of four Italian hospitals, we identified six men (mean age, 56 years) with a histological diagnosis of ECD. Histology was performed on retroperitoneal or pulmonary biopsy, depending on disease involvement on imaging. Patients underwent plain radiography of the lower limbs and chest, total-body computed tomography (CT) and bone scintigraphy. Magnetic resonance (MR) imaging was performed in two patients to evaluate the lower limbs and in one patient to study the brain, the chest and the abdomen.ResultsClinical manifestations included dyspnoea (n=2), hydronephrosis (n=2) and bone pain (n=1). Bilateral symmetrical osteosclerosis of the metaphyseal and diaphyseal portions of the lower-limb long bones was present in five patients. Imaging studies revealed extraskeletal manifestations in all patients, including involvement of the retroperitoneal space (n=4), the lung (n=4) and the heart (n=2).ConclusionsECD is a multiorgan disease that displays constant involvement of the bones and retroperitoneum; in particular, of the perirenal fat. Although the diagnosis of ECD is histological, imaging can raise suspicion and help to establish a presumptive diagnosis.RiassuntoObiettivoValutare retrospettivamente la prevalenza dell’impegno nei differenti organi e gli aspetti clinico-radiologici in 6 pazienti con diagnosi istologica di malattia di Erdheim-Chester.Materiali e metodiSono stati identificati nel data base dell’unità operativa di anatomia patologica di quattro ospedali italiani, sei pazienti con ECD, di sesso maschile, con età media di 56 anni. L’esame istologico era stato effettuato mediante biopsie retroperitoneali o polmonari, a seconda dell’impegno della patologia, valutato sull’imaging radiologico. I pazienti erano stati sottoposti a: indagine radiografica standard degli arti inferiori e del torace, tomografia computerizzata toracica e addominale e scintigrafia ossea. In due pazienti è stata eseguita risonanza magnetica (RM) per una valutazione degli arti inferiori. Un paziente fu sottoposto ad RM dell’encefalo, del torace e dell’addome.RisultatiLe manifestazioni cliniche comprendevano: dispnea (2 pazienti), idronefrosi (2 pazienti) e dolore osseo (1 paziente). L’osteosclerosi bilaterale simmetrica delle metafisi e delle diafisi degli arti inferiori era presente nella maggior parte dei pazienti (5). Gli esami radiologici documentavano localizzazioni extraossee in tutti i pazienti: retroperitoneale (4 pazienti), polmonare (4 pazienti) e cardiaco (2 pazienti).ConclusioniL’ECD è una malattia multiorgano che coinvolge sempre, nella nostra esperienza, il tessuto scheletrico ed il retroperitoneo, in particolare gli spazi perirenali. La diagnosi di natura dell’ECD è istologica, tuttavia il sospetto diagnostico può essere agevolmente posto con l’imaging radiologico.

How much do GOLD stages reflect CT abnormalities in COPD patients

PurposeSeverity of chronic obstructive pulmonary disease (COPD) can be graded using the classification released in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report. Such classification is essentially based on spirometry and does not recognise the role of other measures. The aim of this study was to assess whether the GOLD stages correlate with the extent of pulmonary emphysema and other ancillary computed tomography CT features in a population of smokers with stable COPD.Materials and methodsBased on clinical assessment and lung-function testing, patients were classified according to the GOLD criteria. CT scans were visually evaluated for extent of emphysema and airway abnormalities.ResultsA total of 43 patients were enrolled. The amount of emphysema was described as minimal in six patients with stage 0, and as moderate in seven patients with stage 0. In stages I and II, the extent of emphysema ranged from minimal to severe, whereas we observed the presence of severe emphysema in most patients in stages III and IV. According to the regression model, only CT emphysema extent independently predicted the GOLD stage (r2=0.58; p<0.001). The cutoff value of emphysema extent of 31.5% allowed us to distinguish patients with a GOLD stage ≥III.ConclusionsAlthough we found a significant correlation between CT emphysema extent and GOLD stages, different percentage of emphysema extent can be observed among each GOLD stage. The upper limit of 31.5% of emphysema extent may indicate a boundary for a clinically worsening status.RiassuntoObiettivoLa gravità della broncopneumopatia cronica ostruttiva (BPCO) può essere classificata impiegando una stadiazione stilata dal Progetto Mondiale per la Diagnosi, il Trattamento e la Prevenzione della Broncopneumopatia Cronica Ostruttiva (Global Iniziative for the diagnosis, Management and Prevention of Chronic Obstructive Lung Disease — GOLD). Tale classificazione è basata essenzialmente sulla spirometria e non riconosce il ruolo di altri parametri. Lo scopo del nostro studio è valutare se le classi GOLD correlano con l’estensione dell’enfisema polmonare ed altre caratteristiche rilevabili alla TC in una popolazione di fumatori con BPCO in fase stabilizzata.Materiali e metodiSulla base dei test di funzionalità polmonare e sulla valutazione clinica, i pazienti sono stati classificati secondo i criteri GOLD. Le scansioni TC sono state studiate visivamente per valutare l’estensione dell’enfisema e le anomalie delle vie aeree.RisultatiSono stati esaminati 43 pazienti. La quantità di enfisema era minima in 6 pazienti in stadio 0, mentre in 7 pazienti nella stessa classe era moderata. Nelle classi I ed II, l’estensione dell’enfisema variava da minima a severa, mentre nella maggior parte dei pazienti in stadio III e IV abbiamo osservato enfisema di grado severo. Secondo il modello di regressione, soltanto il valore di estensione dell’ enfisema, valutato alla TC, ha predetto in modo indipendente la classe GOLD (r2=0,58; p<0,001). Il valore cut-off di estensione dell’enfisema pari a 31,5% ci ha permesso di distinguere i pazienti appartenenti ad uno stadio GOLD superiore a III.ConclusioniAnche se abbiamo trovato una correlazione significativa fra l’estensione dell’ enfisema alla TC e le classi GOLD, una percentuale differente di enfisema può essere osservata in ciascuna di esse. Il cut-off di 31,5% nell’estensione dell’enfisema può indicare un valore limite per una condizione di peggioramento clinico del paziente.

Visual score and quantitative CT indices in pulmonary fibrosis: Relationship with physiologic impairment

PurposeThe aim of this study was to assess the accuracy of some computed tomography (CT) quantitative indices (histogram features, ranges of density and one novel volumetric index) in the discrimination between normals and patients affected by lung fibrosis, and to compare their morphologic-functional relationship with the visual score one.Materials and methodsWe analysed thin-section CTs and pulmonary function tests (PFTs) of six healthy subjects and 31 patients affected by lung fibrosis, including 17 with a usual interstitial pneumonia pattern (UIP group), and 14 with a predominant pattern of ground-glass opacities without honeycombing (non-UIP group). Presence and extent of various CT findings were assessed by the visual score as well as by CT computer indices.ResultsTogether with the histogram features, fibrosis ratio (defined as the ratio of nonfibrotic CT lung volume divided by total CT lung volume) contributed to objectively differentiate fibrotic lungs from normal lungs. The range of density 700 to 400 HU showed the greatest degree of correlation with physiologic abnormality in the non-UIP group. In the UIP group, the lone visual score provided prediction of functional impairment.ConclusionsThe visual score is still the main radiological method of quantifying the extent of abnormalities in patients with UIP, whilst the range of density 700 to 400 HU can be helpfully applied in a predominant pattern of ground-glass and reticular opacities without honeycombing.RiassuntoObiettivoValutare l’accuratezza di alcuni indici quantitativi utilizzati in tomografia computerizzata (TC) (istogrammi, intervalli di densità ed indici volumetrici) nel discriminare pazienti normali da pazienti affetti da fibrosi polmonare e confrontare la loro relazione morfologica-funzionale con lo score visivo.Materiali e methodiAbbiamo analizzato scansioni TC a strato sottile di sei soggetti sani e di 31 pazienti con fibrosi polmonare, compresi 17 con un pattern di polmonite interstiziale usuale (gruppo di UIP) e 14 con un pattern predominante di ground-glass senza honey-combing (gruppo non-UIP). La presenza e l’estensione dei vari reperti TC sono stati valutati sia con score visivo che con indici TC quantitativi.RisultatiInsieme agli istogrammi, l’indice fibrotico volumetrico (definito come il rapporto tra il volume di polmone non fibrotico e il volume polmonare totale) ha contributio nel differenziare in modo obiettivo i polmoni fibrotici dai polmoni normali. Il range di densità −700–400 HU ha mostrato la maggiore correlazione con i parametri funzionali nel gruppo dei pazienti non-UIP. Nel gruppo UIP, solo lo score visivo ha fornito una corretta previsione del danno funzionale.ConclusioniLo score visivo è ancora il metodo radiologico principale per quantificare l’estensione della patologia in pazienti con UIP, mentre l’intervallo di densità −700–400 HU può essere vantaggiosamente applicato in un pattern predominante a ground-glass e reticolare senza honey-combing.

Advantages of multidetector-row CT with multiplanar reformation in guiding percutaneous lung biopsies

PurposeThis study aimed to assess the usefulness of multiplanar reformations (MPR) during multidetector-row computed tomography (MDCT)-guided percutaneous needle biopsy of lung lesions difficult to access with the guidance of the native axial images alone owing to overlying bony structures, large vessels or pleural fissures.Materials and methodsMDCT-guided transthoracic needle biopsy (TNB) was performed on 84 patients (55 men and 29 women; mean age 65 years) with suspected lung neoplasm by using a spiral MDCT scanner with the simultaneous acquisition of six slices per rotation. We determined the site of entry of the 22-gauge Chiba needle on native axial images and coronal or sagittal MPR images. We took care to ensure the shortest needle path without overlying large vessels, main bronchi, pleural fissures or bony structures; access to the lung parenchyma as perpendicular as possible to the pleural plane; and sampling of highly attenuating areas of noncalcified tissue within the lesion.ResultsDiagnostic samples were obtained in 96% of cases. In 73 patients, lesions appeared as a solid noncalcified nodule <;2 cm; 11 lesions were mass-like. In 22, the biopsy required MPR guidance owing to overlying ribs (18), fissures (2) or hilar-mediastinal location (2).ConclusionsMDCT MPR images allowed sampling of pulmonary lesions until now considered unreachable with axial MDCT guidance because of overlying bony structures (ribs, sternum and scapulae) or critical location (hilar-mediastinal, proximity to the heart or large vessels). Compared with the conventional procedure, the use of MPR images does not increase the rate of pneumothorax or the procedure time.RiassuntoObiettivoValutare l’utilità delle immagini multiplanar reformations (MPR), durante agobiopsia percutanea TC spirale multidetettore (TCMD) guidata, nelle lesioni polmonari difficilmente raggiungibili con la sola guida delle immagini assiali, in quanto coperte da strutture scheletriche, grossi vasi o scissure pleuriche.Materiali e metodiEseguita agobiopsia transtoracica (TNB, transthoracic needle biopsy) TCMD-guidata in 84 pazienti (55 maschi e 29 femmine, età media 65 anni) con lesione polmonare sospetta per neoplasia. Impiegato scanner TCMD a scansione elicoidale, con acquisizione simultanea di sei strati per ogni rotazione completa. Sulla base di immagini assiali native ed MPR sagittali o coronali è stato introdotto un ago “Chiba Point” centimetrato da 22 gauge (G) scegliendo: il tragitto più breve in cui non si sovrappongano grossi vasi, bronchi principali e lobari, scissure pleuriche e strutture scheletriche; ingresso nel parenchima polmonare il più perpendicolare possibile al piano pleurico; le zone di tessuto non calcifico più dense della lesione da sottoporre a biopsia.RisultatiNel 96% dei casi si è ottenuto un prelievo diagnostico. In 73 pazienti le lesioni sottoposte ad agobiopsia avevano caratteristiche di nodulo solido non calcifico di dimensioni inferiori ai 2 cm; 11 lesioni erano masse neoplastiche. In ventidue noduli è stato necessaria la guida bioptica con immagini MPR in quanto lesioni “coperte” da coste (18 noduli), da scissure (2 noduli) o a localizzazione ilo-mediastinica (2 noduli).ConclusioniLe immagini MPR ottenute con TCMD hanno permesso di raggiungere lesioni polmonari considerate un tempo inaccessibili con la sola guida delle immagini TCMD assiali. L’impiego della immagini MPR, inoltre, non incrementa, rispetto alla procedura convenzionale né i casi di pneumotorace (PNX) né il tempo di esecuzione del prelievo.

Follow-up in pulmonary sarcoidosis: comparison between HRCT and pulmonary function tests

PurposeThe authors assessed the clinical usefulness of high-resolution computed tomography (HRCT) for monitoring sarcoidosis by comparing changes on HRCT with those on pulmonary function test (PFT) results over time.Materials and methodsThe baseline and follow-up (after 13 months, range 15–63 months) HRCT scans of 14 consecutive patients with sarcoidosis were reviewed by a single observer. Each follow-up HRCT examination was assessed as stable, improved (when the extent of HRCT findings was reduced compared with baseline) and worsened (when the extent of HRCT findings was increased and/or when HRCT pattern had become fibrotic compared with baseline). Any increase or decrease in forced vital capacity (FVC)≥10% from baseline was considered significant. Changes on HRCT were then compared with those on FVC.ResultsDuring a median follow-up of 33 (range 15–63) months, HRCT findings worsened in 8/14 (58%) cases, improved in 3/14 (21%) and remained stable in 3/14 (21%). Agreement between changes on HRCT and FVC was moderate (κ=0.49). In 9/14 (64%) cases, HRCT changes were in line with those on FVC. In 4/5 discordant cases, the worsened HRCT findings were not mirrored by FVC changes.ConclusionsDespite the small size of our study population, our results suggest that HRCT may provide clinicians with additional information about the evolution of sarcoidosis.RiassuntoObiettivoScopo del presente lavoro è stato valutare l’utilità clinica della tomografia computerizzata ad alta risoluzione (HRCT) nel monitorare l’evoluzione della sarcoidosi, mettendo a confronto i cambiamenti della malattia alla HRCT con quelli delle prove di funzionalità respiratoria nel tempo.Materiali e metodiAbbiamo valutato i reperti ed i pattern HRCT di 14 pazienti con sarcoidosi all’esame iniziale ed a distanza di 33 (15–63 mesi) mesi di tempo. La malattia è stata valutata come: stabile, migliorata (per riduzione in estensione delle alterazioni) e peggiorata (per aumento in estensione delle alterazioni e/o evoluzione verso un pattern fibrotico). Una variazione del 10% della capacità vitale forzata (FVC) al follow-up rispetto al basale è stata considerata significativa. L’evoluzione nel tempo del quadro HRCT è stata posta a confronto con quella della FVC.RisultatiAll’esame HRCT di follow-up (mediana 33 mesi, intervallo 15–63 mesi), la malattia è apparsa peggiorata in 8/14 pazienti (57%), mentre è migliorata in 3/14 (21%) ed invariata in 3/14 (21%). La concordanza tra le variazioni HRCT e quelle della FVC è risultata moderata (k=0,49). In 9/14 pazienti (64%), i reperti HRCT e le FVC sono risultati concordanti circa l’evoluzione della malattia. In 4/5 casi discordanti, alla HRCT è stato riscontrato un peggioramento del quadro non dimostrato dalla variazione della FVC.ConclusioniI nostri risultati, sebbene ottenuti su una popolazione di studio limitata, suggeriscono che la HRCT può fornire al clinico informazioni complementari circa l’evoluzione della sarcoidosi.

Osteolytic lesions, cytogenetic features and bone marrow levels of cytokines and chemokines in multiple myeloma patients: Role of chemokine (C-C motif) ligand 20

The relationship between bone marrow (BM) cytokine and chemokine levels, cytogenetic profiles and skeletal involvement in multiple myeloma (MM) patients is not yet defined. This study investigated a cohort of 455 patients including monoclonal gammopathy of uncertain significance (MGUS), smoldering MM and symptomatic MM patients. Skeletal surveys, positron emission tomography (PET)/computerized tomography (CT) and magnetic resonance imaging (MRI) were used to identify myeloma bone disease. Significantly higher median BM levels of both C-C motif Ligand (CCL)3 and CCL20 were found in MM patients with radiographic evidence of osteolytic lesions as compared with those without, and in all MM patients with positive PET/CT scans. BM levels of CCL3, CCL20, Activin-A and Dickkopf-1 (DKK-1) were significantly higher in patients with high bone disease as compared with patients with low bone disease. Moreover, CCL20 BM levels were significant predictors of osteolysis on X-rays by multivariate logistic analysis. On the other hand, DKK-1 levels were related to the presence of MRI lesions independently of the osteolysis at the X-rays. Our data define the relationship between bone disease and the BM cytokine and chemokine patterns highlighting the tight relationship between CCL20 BM levels and osteolysis in MM.