[Computed tomography evaluation of urothelial carcinomas of the upper urinary tract]

Computed Tomography (CT) is an indispensable noninvasive method for staging transitional cell carcinomas of renal pelvis and ureter. Twenty-seven patients with upper urinary tract tumors were examined and the CT results correlated with histopathologic findings. These tumors exhibit three different development patterns: in our series we identified 17 intraluminal sessile lesions, 6 focal or concentric wall thickenings and finally 7 infiltrating masses; soft-tissue density lesions exhibited in all cases mild contrast enhancement (mean density increase: 38 HU). Even though the attenuation values of tumors do not allow the accurate demonstration of the depth of renal pelvis and ureteral wall invasion, CT can differentiate the lesions which are still confined within the external wall layers (CT1, 17 cases) from those invading the peripelvic-ureteral fat (CT2, 9 cases) or spreading to other organs as well as distant metastases (CT3, 4 cases). Delayed scans can also demonstrate intraluminal lesion extent and sometimes changes of patients' position allow better differentiation of wall outlines from peripheral fat. The overall staging accuracy of CT was 76.66% and its sensitivity was 93.33%. The assessment of lymph node metastases was the major cause of error in the CT evaluation of these tumors.

[Magnetic resonance in the study of the facial nerve: methodological approach and normal anatomy]

The authors report their experience in the study of facial nerve anatomy by means of MR Imaging. The seventh pair of cranial nerves was studied in 6 healthy and informed volunteers with a super-conductive MR unit at 0.5 T using surface and head coils. Slices were 3 mm thick and were acquired on the axial and sagittal planes, when the petrous and the mastoid bones were studied. The parotid gland was studied with 5-mm slices acquired on the axial, angled axial, and sagittal planes. In all cases T1-weighted images (TR 450, TE 30) were performed. If the above research protocol, which is relatively simple and direct, is applied, the whole course of the facial nerve up to its main distal branches can be almost completely demonstrated.

[Magnetic resonance in the evaluation of parametrial involvement in carcinoma of the cervix uteri]

Cervical carcinoma is one of the most frequent gynecologic malignancies. Its prognosis depends on both tumor volume at diagnosis and its stage. Staging accuracy is important not only for prognosis but also for optimal treatment planning. According to FIGO criteria, carcinomas without parametrial involvement (stage I and limited stage IIA disease) can be surgically treated. For more advanced stages, treatment, in most cases, consists of radiation therapy or chemotherapy alone. The authors evaluated MR accuracy in the diagnosis of parametrial involvement; to this purpose, 32 patients with histologically proven lesions were referred for MR imaging, which was performed with a 0.5 T superconductive magnet. Transverse and sagittal SE images were obtained with T2 weighting (TR 1800 ms, TE 30-100 ms); transverse and sometimes sagittal images were obtained with T1 weighting (TR 450/300 ms, TE 20/30). T1-weighted images distinguished neoplasm from cervical stroma or dense parametrial connective tissue in 40% of cases only. T2-weighted images, instead, demonstrated the difference in all cases, showing tumor as a hyperintense area in 90% of patients. Neoplastic involvement of pericervical connective tissue was diagnosed, with those sequences, on the basis of focal disruptions of the outer hypointense fibrous cervical stroma; findings were correlated with those from a previous clinical staging and in 26/32 patients with pathologic findings. MR accuracy in demonstrating parametrial involvement was 88%, sensitivity was 77% and specificity was 94%. Clinical staging accuracy in the evaluation of this parameter was 66%. In 6 cases with no surgical findings, MR confirmed extensive parametrial and vesical or rectal neoplastic involvement, as diagnosed at clinics. MR imaging, thanks to its multiplanar and multiparametric imaging capabilities is a very reliable technique in the preoperative staging of cervical carcinoma. Moreover, since clinical staging can sometimes underestimate pericervical connective spread, the higher accuracy of MR imaging can help avoid useless interventional procedures.