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OBJECTIVE: To evaluate the role of hepatic arterial phase (HAP) spiral computed tomography (CT), as compared with iodized oil (Lipiodol ultrafluid [LUF]) CT for revealing nodular hepatocellular carcinomas (HCC). METHODS: Twenty-four cirrhotic patients underwent two-phase HCT examination: HAP 25 seconds and portal phase 70 seconds after injection of 1.5 mL/Kg contrast medium. All patients also underwent hepatic angiography and intraarterial infusion of iodized oil; LUF CT was performed 3-4 weeks after infusion. HCT images were compared with LUF CT images for detection of hepatic nodules. RESULTS: We found no significant difference between the sensitivity of HAP CT and LUF CT for nodules >10 mm, while HAP CT was more sensitive than LUF CT in revealing nodules <10 mm (47 vs. 27, p < 0.001). CONCLUSIONS: HCT should be considered as the first method for the detection of HCC, whereas LUF CT should be used only for therapy.

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Few pancreatic carcinomas (5-22%) are resectable at the time of diagnosis because this lesion is seldom diagnosed in an early stage. A considerable improvement in the rate of survival is described only for resectable tumors: it is extremely necessary to find an imaging technique for early diagnosis and for accurate staging of pancreatic carcinoma to discern operable from inoperable cancer. The sensitivity of CT in predicting that pancreatic carcinoma is unresectable has been described as approaching 100%. However the reverse is not true. More than one third of the tumors revealed with CT and interpreted as resectable cannot be excised. The major reason for errors with CT are failure to detected liver metastases, peritoneal implants, lymph node involvement and encasement of the great vessels by tumor. Significant progress has recently been made to improve the detection of these details with the recent introduction of helical CT with infusion of a bolus of contrast material and thin section collimation. Traditionally, when a single sequence of images was acquired during abdominal CT, the time of the acquisition was dominated by the requirement to scan during maximal hepatic enhancement, which unfortunately may not be optimal for evaluation of the pancreas. With the advent of helical CT, the acquisition of two sets of images after infusion of contrast material is now possible; the first one takes place during the arterial enhancement; it is useful to detect tumor vascular encasement and the maximum difference of tissue attenuation between normal greater pancreatic enhancement and hypodense pancreatic mass, less vascularizated. It appears that the peak parenchymal enhancement achieved with helical CT may improve the sensitivity of CT scanning in detecting pancreatic carcinoma, especially small tumors confined within the organ. The second phase takes place during the venous or portal enhancement and provides useful information about venous encasement and hepatic metastasis. Extraglandular extension with invasion of adjacent major arterial (celiac axis or its branches, superior mesenteric artery) and venous (portal, splenic, superior mesenteric) appear as soft-tissue attenuation thickening obscuring the perivascular fat, with deformity, thrombosis or occlusion of the vessels. In cases of venous occlusion, collateral vein can be identified. Dilatation of the small veins that surround the head of the pancreas might be used as an additional criterion of extrapancreatic extension of neoplasia. With the features of spiral CT (contrast material optimization and continuous scanning), the detection of small lesions in the liver and peritoneal implants has been increased. Helical CT seems not to detect anything else about lymph node involvement than conventional CT, limited by the same morphologic criteria. The only CT means of detection of node involvement by pancreatic carcinoma is the pathologic enlargement of lymph nodes without specificity for neoplastic or not neoplastic ones. In many cases 2D, 3D and MIP imaging are helpful to evaluate vasculature encasement, especially for visualization of vessels which lie in oblique, coronal or sagittal plane. Consequently helical CT has the potential to become an alternative angiographic technique. Many studies have been done to evaluate spiral CT potential impact and to compare the value of this technique with other ones in the initial diagnosis and staging of pancreatic carcinoma. One of these studies compares dual-phase helical CT and endoscopic endo-sonography. The Authors observe that the two techniques do not differ significant statistically in detecting pancreatic carcinoma, except endoscopic sonography is more sensitive than helical CT for tumors smaller than 15-20 mm. They found the accuracy to predict unresectable carcinoma is 100% for dual-phase helical CT and less for endoscopic endosonography (86%). (ABSTRACT TRUNCATED)

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The real utility of high resolution computed tomography (HRCT) for early detection of lung involvement was investigated in eighteen patients affected with systemic sclerosis (SSc). The results obtained from HRCT have been compared with traditional (chest radiographs, pulmonary function tests (PFT)) and nontraditional (ventilation and perfusion scintiscan) modalities of lung investigation. A significant statistical correlation (p < 0.001) between HRCT scans and chest radiographs was observed. Moreover, HRCT was more sensitive in the detection of early pulmonary interstitial involvement and more accurate in the assessment of interstitial fibrosis in cases with severe lung involvement. A statistical correlation (P < 0.001) between HRCT and the modalities of investigation of alveolo-capillary membrane--as PFT and ventilation scintiscan--was also observed. These results indicate that in SSc HRCT may be a useful technique for assessing early pulmonary involvement and for complementing other methodologies of investigation of lung function.

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Ninety-seven patients affected with nasopharyngeal carcinoma (NPC) were examined with both conventional and Computed Tomography (CT) to evaluate the involved sites with both methods. CT staging was more accurate, showing involvement in more locations than conventional tomography, so that staging was modified in 23 of 97 patients. Two hundred and seventeen patients treated from 1970 to 1985 were subdivided into group A (111 patients who underwent conventional tomography only) and group B (106 patients examined with CT, from 1978 on). A trend toward more advanced stages at presentation was observed in group B; nevertheless, local control at 5 years was higher in group B (59%) than in group A (42%). The role of Magnetic Resonance (MR) imaging in NPC staging was also evaluated in 30 patients: there was disagreement in 2 cases. Involvement of different structures was shown in 10 of 28 cases with the same CT and MR staging. MR imaging proved a valuable tool in the follow-up as well: in fact, it clarified 12 questionable opacities on CT in a group of 35 followed patients as inflammatory lesions in 10 patients and tumors in 2.

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Twenty-five patients with ovarian carcinoma who had been operated and treated with chemotherapy underwent clinical examination and CT before reintervention (second-look laparotomy) to detect the presence of eventual recurrences. The prediction of recurrence based on CT and clinical findings was compared with the surgical findings at reintervention. CT proved to be more accurate than clinical examination in detecting recurrences; this was especially true for masses in the abdominal cavum, with the exception of small peritoneal nodules. The authors suggest the use of CT for staging the patients candidate to reintervention. This might help to avoid reintervention in patients with persistent disease and to plan treatment.

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Two hundred seventeen consecutive patients were treated with radiotherapy alone, with curative intent, from 1970 to 1985 at the Radiotherapy Unit of the University and Hospital of Florence. The distribution according to T and N staging with polytomography was compared to patients (106 out of 217) who had CT scans done at presentation. T1 cases were less frequent (6.6% vs 27%) in the CT-staged series, whereas T3 showed a higher incidence (30.2% vs 12.6%). The advantages of CT over conventional tomography were quantitated in a subset of 97 patients who underwent both staging procedures. Site-by-site, CT displayed a higher percentage of involvement than polytomography: parapharyngeal spread 18% vs 2%, oropharynx 16% vs 8%, choanae and nasal cavities 28% vs 13%, ethmoid and maxillary sinus 29% vs 13%. Information provided by CT caused a T-stage conversion in 23 out of 97 cases (23%): 4 out of 11 T1, 16 out of 44 T2, 3 out of 16 T3.

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Two hundred and seventeen consecutive patients affected by nasopharyngeal carcinoma (NPC) were treated with radiotherapy alone, with curative intent, from 1970 to 1985 at the Radiotherapy Unit of the University and Hospital of Florence. A group (A) of 111 patients staged with conventional clinical and radiological method was compared to a second group (B) of 106 patients who underwent CT staging before treatment. Group B showed better 5-year NED survival and local control; only the differences in local control were significant (p less than 0.01). As to primary control statistically significant differences were observed in T2 and T4 cases. We feel that CT could have contributed to the improvement, probably through a more reliable display of the primary extent and a more adequately planned radiotherapeutic treatment. With CT staging we could not increase our skills in prognostically separating stages according to UICC criteria (1978); in Group B only T2 patients presented significant differences in primary control when compared to T3 and T4 patients. However, a multivariate analysis of prognostic factors showed that nodal involvement, primarily, and histology, secondarily, were the most important factors; T stage showed a minor influence on prognosis.

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In order to evaluate the reliability of thoraco-mediastinal CT in the preoperative evaluation of primary lung cancer, regarding "N" (lymph nodes) parameter, we compared CT data with those obtained at histopathology of mediastinal lymph nodes. We re-examined 130 patients who had undergone lobectomy or pneumonectomy combined with mediastinal node dissection. CT criterion of neoplastic nodal involvement is morphological, based on size of the node as related to its location. CT is very sensitive in evaluating both normal and pathological nodes but not likewise specific; in fact, it does not allow differential diagnosis between neoplastic and phlogistic causes. This limitation must be kept in mind in the preoperative evaluation of the "N" parameter. Moreover, CT findings of mediastinal involvement on the opposite side (N3) must be confirmed with mediastinoscopy or CT-guided biopsy before ruling radical surgery out.

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The Angelchik prosthesis is used in the surgical treatment of gastroesophageal reflux. Operated patients are primarily examined with imaging techniques, but manometric and acidometric techniques are also used. Although the conventional esophagogram still maintains its diagnostic significance, computed tomography (CT) has become the first-choice imaging modality. CT allows the correct evaluation of both the state of the prosthesis and its relationship to the esophagus and the gastric fundus. The possible postoperative complications following an incorrect placement of the prosthesis can be accurately diagnosed too. The authors report their experience in the study of 5 patients examined with both conventional radiology and CT.

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CT-guided percutaneous fine-needle biopsy (FNB) is the method of choice in the histological characterization of mediastinum and lung lesions in which a diagnosis could not be reached through noninvasive methods such as cytology of the sputum, or biopsy during bronchoscopy. FNB represents an alternative to diagnostic thoracotomy: it is, in fact, less invasive, it can be carried out with no need for hospitalization, and has a low incidence of complications. FNB diagnostic accuracy is very high, as our results prove: accuracy 89.6%, sensitivity 87.6% and specificity 98%. Our series includes 419 percutaneous fine-needle biopsies.

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Magnetic resonance (MR) imaging and high resolution computed tomography (CT) have been compared in 37 patients who had expansive processes of the lung and the mediastinum. MR imaging and CT scanning gave identical results in 32 patients; in 5 patients, CT scanning has proved more useful in evaluating the stag e of primary lung tumors. MR imaging often gives more information about the actual size of the tumor, and the involvement of close structures, although it does not modify staging of the tumor. MR imaging has the advantage to differentiate hilar adenopathy from blood vessel structures. Evaluation of T2 relaxing time (that we have performed in the same location of thin-needle biopsy aspiration), however, did not prove to be of diagnostic significance; this indicates that MR imaging at the moment is not suitable for tissue typification.

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CT findings regarding chest wall recurrences in 19 breast cancers previously treated with radical mastectomy are reported. CT provides detailed information on the endothoracic extension of the tumoral spread.

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Magnetic resonance evaluation of 28 cases of pituitary adenomas has shown remarkable accuracy. Compared with HR-CT, MR gives comparable results in tumour identification. MR better demonstrates the suprasellar extension of macroadenomas and their relationship to the visual pathway and is more effective in showing direct and indirect signs of microadenomas. HR-CT however better recognized bone abnormalities of the sella turcica, due to adenomas. A typical increased signal intensity has been demonstrated in most of the adenomas studied.

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The authors achieved the "in vivo" identification of the coeliac ganglia (C.G.), using computerised tomography (CT). This result was confirmed by autopsies and by CT scans of an anatomical specimen in which the coeliac ganglia had been previously marked. CT allows an exact location of the coeliac ganglia and can be very useful for a precise alcoholic neurolysis of the coeliac plexus.

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In 12 X-ray and gastroenterology departments 1570 patients, clinically suspected to have a gastric pathology, have been examined by double contrast (surface) examination of the stomach followed by gastroscopy. Diagnostic accuracy was 93% in respect of endoscopic data, assumed correct by hypothesis. On the basis of a cost and benefit evaluation, made according to the well known criteria, a wider routine use of the double contrast technique is proposed.

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