Maspes F

Palliative treatment of neoplastic strictures by self-expanding nitinol Strecker stent

The purpose of this study was to evaluate technical and clinical results of self-expanding esophageal stent implanted in patients with malignant esophageal strictures and clinically significant dysphagia. From June 1992 to September 1994, 27 patients with inoperable tumors of the esophagus or gastric cardiac were treated by placement of 37 self-expanding nitinol stents. Water-soluble contrast and endoscopy studies were performed after the procedure and during the follow-up period. Successful stenting of the stricture was achieved in 27 patients. The mean dysphagia grade dropped from 2.3 to 1 (SD ± 0.54) immediately after the procedure. After the insertion of the stent, 16 patients died in a period of time ranging from 0 to 13 months (mean 5.6 months), whereas at the end of the study 11 patients were alive 4–15 months after the procedure (mean 8.3 months). No major complications were observed. The results of this study are encouraging because esophageal stent placement was technically easy and clinically effective.

MR angiography in abdominal neoplasms

The role of magnetic resonance angiography (MRA) in the evaluation of vascular involvement was studied in 55 patients with abdominal neoplasms. A 2-D time-of-flight (TOF) technique was used in 18 patients. All patients underwent CT and MR examinations before MRA. Also, MR angiograms were compared with digital subtraction angiography in 22 cases, with Doppler US in 13 cases, and with surgical findings in 20 cases. In all patients with liver neoplasms (n = 29) MRA demonstrated the absence of flow in the infiltrated segments. Pericapsular neovascularization was observed in 12 patients. Portal vein involvement was correctly detected in 27 patients. In all cases MRA demonstrated the relationship between the tumor and venous structures. Portosystemic shunts were visualized in 20 of 21 patients with portal hypertension. Vena cava thrombosis (3 cases), compression (5 cases), and displacement (2 cases) were correctly demonstrated. In renal (n = 6) and adrenal gland (n = 3) tumors renal vein compression was correctly detected in 2 cases, displacement in 1 case, and thrombosis in 3 cases, with only 1 false-positive finding. In 7 patients with pancreatic tumors MRA demonstrated splenic vein thrombosis in 2 cases and compression in 2 cases, with one false-positive finding. Our results indicate that MRA provides precise information regarding venous vascular involvement in abdominal neoplasms, but preoperative arterial mapping is still problematic.

Characterization of adenomas and metastases in the adrenals: comparison between spin-echo sequences and Gd-DTPA enhanced dynamic studies

Nineteen patients with adrenal masses (9 metastases and 10 adenomas) were studied with magnetic resonance spin-echo sequences and with dynamic perfusion with gradient-echo (GE) sequences after gadolinium diethylenetriamine-pentaacetic acid injection. In studies following Gd-DTPA injection, sequential imaging during suspended respiration was obtained. Signal intensities of adrenal masses and retroperitonel fat were measured in the region of interest. The relative signal intensities of lesion and fat were determined and compared in dynamic contrast-enhanced studies. Results were tabulated and plotted in diagrams as a function of time. Sixteen lesions out of 19 were correctly classified by means of SE sequences, with an 84% diagnostic accuracy, whereas 18 out of 19 lesions were characterized by means of GE sequences, with a 95% accuracy. In the dynamic study, adenomas showed mild enhancement and quicker washout than metastases which, in turn, showed a strong enhancement and a much slower washout. The most significant values were obtained in scans taken after 10 min, where adenomas showed signal to lesion/signal to fat values lower than 1.1, whereas metastases showed much higher values in all cases.

Computed Tomography of Liver Metastases

The developments in computed tomograpy (CT) that have taken place over the last 2 decades have dramatically increased the capability to detect and characterize focal liver lesions and have made CT the technique of choice in the evaluation of hepatic metastases. At the same time, advances in the medical and surgical treatment of secondary liver tumors have continued to be a challenge to these advances in radiology. It is clear that a successful outcome depends on knowledge of the size and location of the tumor burden, and accurate radiological assessment is crucial in identifying the subgroups of patients who may benefit from surgery and also in preventing unnecessary radical surgery, with its high morbidity, in those likely to gain only a short term benefit. The correct choice between different CT techniques is crucial to performing an accurate evaluation of liver metastases. The authors focus on specific CT techniques, including bolus dynamic CT, dual and triple phase spiral CT, CT arteriography and arterioportography, delayed CT, high-dose CT and Lipiodol CT. The clinical applications and results of these different techniques are also discussed.

Percutaneous transluminal renal angioplasty in patients with solitary kidney

We report our experience with percutaneous transluminal angioplasty of renal arteries (PTRA) in solitary kidney patients. Our series includes 31 patients (mean age: 52 years). 7 with solitary kidney following surgical nephrectomy and 24 with functioning solitary kidney. PTR indicated in presence of stenoses ranging from 60–95 % of vessel lumen. Procedure, with 29 patients were technically successful and mean values for stenosis dropped from 77 % to 33 %. In order to assess the results technically, changes in arterial blood pressure (according to Martins classification) and creatinine levels were considered. Of 25 followed-up patients, 13 were cured (52%), 8 improved (32%),and 4 were unchanged (16%%). Complications were observed during procedures in five patients (16. 1 % ), superimposing that of nonsolitary kidney patients. Good revasculariiation, reduction of blood pressure, preservation or even improvement of renal function and low complications, make PTRA the best procedure with solitary kidney patients.