[The incidence of disk changes in volleyball players. The magnetic resonance findings]

In order to evaluate the to potential hazards related to athletic functional overload on the intervertebral disk we studied with MRI the incidence of intervertebral disk abnormalities in a group of 45 volunteers who had been playing professional volleyball for 3-7 years. As a control group we examined with MRI 30 professional swimmers as well. Among the volley-ball players the incidence of intervertebral disk alterations was 44.4%; they were represented by 8 cases of disk degeneration, 11 cases of bulging and 9 disk herniations (in 8 patients the simultaneous presence of more than one lesion was observed). In the control group the incidence of such lesions was 20%. The obtained results were correlated with the clinical findings and the age of the athletes. Among the 26 athletes with back pain only 13 had positive findings at MRI, while among the 19 asymptomatic athletes 7 showed lesions detectable with MRI. As for age, we observed that the younger athletes (17-19 years) had positive MRI findings in 38.5% of cases, while the players in the age group ranging from 23 to 26 years, had positive MRI findings in 56.2% of cases. The analysis of the different types of training of the volley-ball players and the control group, showed that 19 volley-ball players who followed appropriate training procedures had positive MRI findings in 21.1% of cases (in the control group the percentage was 20%). Among the 26 athletes who were trained with exercises that caused significant functional overload, 16 had intervertebral disk lesions at MRI (61.5%). Moreover, our data showed that the correlation of the incidence of disk lesions with the type of training (and relative varying degree of overload) is definitely more important than the one existing with the age of volley-ball players and the overall period of their athletic activity. MRI proved to be a useful technique for the early assessment of the intervertebral disk damage caused by an incorrect training in young athletes, even when asymptomatic.

[The continent perineal colostomy after abdominoperineal resection of the rectum. A digital defecographic study]

For 10 years, in the Surgery Dept. of the University of Pisa, perineal colostomies have been performed on patients who had undergone abdominoperineal rectal amputation. The gracilis muscles of the thighs, transposed to the perineum, are used for building a continent muscular apparatus. Seventeen of 40 patients operated with this procedure have been submitted to defecographic studies, by means of digital fluoroscopic image acquisition. This modality allowed the visualization of anastomotic colon morphology as well as of the functionality of the transposed gracilis muscles during the various phases of defecography. The muscle surrounding the colostomy acts as a sphincter and relaxes only during evacuation; the one positioned as a sling acts as the normal puborectalis muscle. In two patients a perineocele was documented, causing problems in the evacuation phase, which were solved after surgical intervention.

[Problems and errors of magnetic resonance in the diagnosis of renal masses]

Since the impact of MRI on the diagnostic evaluation of renal masses is affected by the intrinsic complexity of the modality, the problems related to the specific knowledge, on the part of the radiologist, of the examination itself to make a correct diagnosis are carefully analyzed. The problems related to the technical features of the equipment are presented as well, with a special emphasis on the still inadequate spatial resolution of MRI, and on its long acquisition time and unfavorable signal-to-noise ratio. On the other hand, its good contrast resolution is mentioned, which will be further improved by the new gradient-echo sequence (GRE) and by the use of paramagnetic contrast media. As for diagnostic problems, the results are analyzed of a series of 62 patients showing US "solid" renal mass. MRI allowed lesion detection in 59/62 cases, with 95.1% sensitivity. False negatives were due solely to the poor image quality determined by motion artifacts. MRI did not provide significant information in the structural evaluation of the lesions when tissue characterization was concerned, but was helpful in the correct assessment of necrotic foci (thus allowing the calculation of viable neoplastic mass) and in the detection of collateral vessels. Finally, the spatial relationships of the mass could be easily assessed by MRI, thanks to both its multiplanarity and to its good capabilities in the visualization of vascular involvement.

Neurological damage in patients irradiated twice on the spinal cord: a morphologic and electrophysiological study

We reviewed the files of 950 patients treated for Hodgkin's disease since 1966 and were able to find five patients treated with radiochemotherapy and irradiated twice on volumes including a cord segment, at various time intervals, and surviving until now. Seven patients with comparable clinical and therapeutic features, but not reirradiated on the cord, were chosen as a control group and were examined with the same diagnostic procedures. The cumulative cord dose in the reirradiated patients was recalculated and ranged from 50 to 70 Gy. All these patients and the control cases were followed up for more than 10 years and presented no or only minor neurological symptoms. We compare the results of both magnetic resonance imaging (MRI) and electrophysiological studies (spinal and scalp recorded somatosensory evoked potentials--SEPs) in an attempt to define the characteristics of the subclinical damage present in these patients. While no cord abnormality was demonstrated with MRI, electrophysiological studies evidenced a clear difference between cases and controls, as far as the D10-P1 conduction time and SEPs average amplitude are concerned. Advantages and drawbacks of a wider use of electrophysiological methods in research work on cord radiation damage are presented, along with the possible implications of the results obtained for the understanding of the pathogenesis and of the dose dependence of radiation myelitis (RM).

Hematopoietic bone marrow recovery after radiation therapy: MRI evaluation

Magnetic resonance imaging (MRI) is able to detect the increase of adipocytes in the hematopoietic bone marrow that occurs as a consequence of radiotherapy and is indicative of the loss of myeloid tissue. By monitoring this process, it is also possible to determine the recovery of the bone marrow. The amount of viable hematopoietic tissue plays a fundamental role in determining whether the patient is able to undergo further antineoplastic therapy, particularly chemotherapy. We examined 35 patients who had been treated with radiotherapy for Hodgkin's lymphoma (12), uterine cervix carcinoma (nine), ovarian dysgerminoma (six), testicular seminoma (four), and non-Hodgkin's lymphoma (four). We observed that radiation-induced modifications of the MRI pattern in the bone marrow are tightly linked to two parameters; the administered radiation dose and the length of time passed after the treatment. Bone marrow recovery was observed only when patients were treated with doses lower than 50 Gy. The earlier radiation-induced modifications of the bone marrow MRI pattern occurred 6 to 12 months after irradiation, and they were most evident 5 to 6 years after the treatment. From 2 to 9 years after radiotherapy, we observed partial recovery. Complete recovery, when it occurred, was observed only 10 to 23 years after the treatment. Our results indicate that MRI studies are likely to be useful in the assessment of radiation-induced injuries.

Brain damage after treatment for acute lymphoblastic leukemia. A report on 34 patients with special regard to MRI findings

In 34 patients treated for acute lymphoblastic leukemia (ALL), central nervous system (CNS) damage was assessed by clinical evaluation and brain magnetic resonance imaging (MRI). Twenty-seven of them had been off therapy from 5 to 109 months (median 64 months) while 7 had not completed the maintenance phase of their treatment. All the patients were disease-free when evaluated. None of the 3 patients who showed clinical CNS damage during the follow-up was symptomatic when submitted to MRI, while periventricular hyperintensity in T2-weighted images, suggestive of leukoencephalopathy, was present in 8 of the 34 patients. These subclinical abnormalities appear to be more frequent, transient in nature and treatment-related in patients evaluated shortly after the induction phase. Similar MRI findings seem, on the contrary, to be consequences of the disease on the CNS when appearing in long-term survivors.