胰腺恶性肿瘤的 CT 诊断

目的：探讨胰腺恶性肿瘤的ＣＴ诊断。方法：分析了５４例胰腺恶性肿瘤的ＣＴ表现，其中４１例胰腺癌、８例胰囊腺癌、５例胰转移癌。年龄２７～８６岁。扫描自脾门部至十二指肠水平部，层厚１０ｍｍ，连续扫描，必要时追加５ｍｍ层厚及层距。结果：胰腺恶性肿瘤ＣＴ表现为胰腺软组织肿块；平扫呈等密度、低密度或不均匀密度，肿块强化不明显；胆管及胰管扩张；胰腺萎缩；血管受侵犯；脏器及淋巴结转移；周围脏器及组织的直接浸润，腹水等。结论：熟悉胰腺恶性肿瘤ＣＴ的直接及间接征象，利于胰腺恶性肿瘤的诊断及鉴别诊断。     

Ruthenium brachytherapy for uveal melanomas: Factors affecting the development of radiation complications

PurposeTo investigate how treatment complications are related to dosimetric parameters after ruthenium-106 brachytherapy for uveal melanoma, in a large, clinically homogeneous population.Methods and MaterialsA retrospective review was performed to evaluate patients affected by small and medium size uveal melanoma, treated with ruthenium-106 brachytherapy from December 2006 to December 2014. We excluded tumors with posterior margin within 1 mm from the edge of the optic disc and foveola. Main outcome measures were occurrence and time to radiation-related maculopathy, cataract, and optic neuropathy. Secondary end points included local recurrence and distant metastases. Kaplan–Meier analysis with log-rank test and univariate Cox proportional hazards model at 3 years were performed to identify the covariates affecting the outcome of radiation complications.ResultsTwo hundred thirty-nine patients, with sufficient data to evaluate the end points, were enrolled. Three years after plaque treatment, radiation maculopathy was found in 61 (25.5%) patients, cataract developed in 10 patients (4.2%) receiving a dose of 27 Gy or higher to the lens, and optic neuropathy was observed in 13 patients (5.4%) with an optic nerve dose exceeding 50 Gy and tumor proximity to optic disc of less than 4 mm. Tumor recurrences and tumor-related metastasis were found respectively in 20 (8.36%) and 14 (5.85%) patients.ConclusionsRadiation maculopathy occurs within a median time of 31 months in 25% of cases after plaque treatment for uveal melanoma. The most significant risk factors are total dose and distance of tumor margin from the fovea. If the distance is greater than 11.22 mm, no signs of retinal damage are detected.     

Influence of tumor shape and location in eye plaque brachytherapy dosimetry

PurposeA common treatment planning technique for eye plaque brachytherapy is to model the tumor as an ellipse. For posterior tumors near the optic disc and fovea, this approach may lead to overlap between tumor and the organ at risk (OAR). We hypothesized that a superior plan can be generated by modeling the actual tumor shape.Materials and MethodsForty eye plaque patients with tumors <1 cm from the optic disc and fovea were selected. Two treatment plans were generated for each patient: an elliptical tumor model plan and a true tumor model plan. Dosimetric data were collected for each plan, and Wilcoxon signed-rank tests were used to asses any statistically significant differences.ResultsEquivalent tumor coverage was confirmed between the elliptical and true tumor plans for all patients. Qualitative analysis showed greater dosimetric differences between plans as the distance from the OARs increased from 0 to 2 mm but the largest differences were observed between 2 and 4 mm. Minimal differences between models were seen beyond 4 mm. Statistically significant dosimetric improvements were found for tumors <4 mm from the fovea and <2 mm from the optic disc.ConclusionsIntuitively, accurate modeling of the tumor accounting for irregularities in the shape should result in a more conformal plan and an overall reduction in OAR dose. However, this technique is only beneficial for tumors that are within 4 mm of the fovea or optic disc. An elliptical tumor model allows for an acceptable plan unless the tumor is located posteriorly and has an irregular shape.     

Proton or Stereotactic Photon Irradiation for Posterior Uveal Melanoma?

BACKGROUND AND PURPOSE: Proton and stereotactic radiotherapy with photons (SRT) are both used to treat choroidal melanomas in proximity to optic disk and fovea centralis, a situation where plaque therapy is prone to complications. A comparative treatment- planning study was done to assess the capability of both modalities to preserve vision. PATIENTS AND METHODS: In ten patients treated with 68-MeV protons, SRT with 6-MV photons was planned. Structures most important for visual acuity (fovea and optic disk, optic nerve) were contoured identically for both therapies. Safety margins of 1.5 mm for proton therapy were reduced to 1.0 mm for SRT. RESULTS: Proton-beam therapy was superior in eight of ten situations, and this result did not differ significantly by changes in the weighting of the different parameters analyzed. CONCLUSION: When dose deposition to those structures most important for the preservation of vision is taken into account, under the conditions examined proton therapy offers an advantage in the majority of the patients evaluated.     

Review of the Poster “Dosimetric Comparison of Gamma Knife Radiosurgery vs. 125I Plaque Brachytherapy in a Cohort of Choroidal Melanomas”

Historically, treatment for choroidal melanomas was surgical enucleation. Currently, treatment methods such as stereotactic radiosurgery and brachytherapy are being used to spare the eye. The poster “Dosimetric Comparison of Gamma Knife Radiosurgery vs. I-125 Plaque Brachytherapy in a Cohort of Choroidal Melanomas” presented at ASTRO 2007 by Anderson et al. provides a comparison of these methods. The dose to disk, fovea and lens in 29 patients from a simulated I-125 treatment and a delivered Gamma Knife radiosurgery was compared. Thirty Gy was prescribed to the 50% Isodose line in the radiosurgery and 85 Gy was prescribed to the apex of the tumor in the I-125 simulation. It was found that the Gamma Knife spares the disk better in 59% of the tumors, including those ≥6.5 mm in height; spares the fovea better in 69% of the tumors, including those ≥5.5 mm; and spares lens better in only 30% of the tumors, with no distinction in size. Tumor location was not taken into account for this study, which could explain the variations in smaller tumors. For larger tumors, gamma knife will protect most organs at risk more effectively. This study shows how a tumor's parameters can be used in selecting treatment modality.     

Hepatic metastases: perilesional enhancement on dynamic MRI

OBJECTIVE: Our purpose was to determine whether the perilesional parenchymal enhancement of hepatic metastases could be correlated with tumoral enhancement on arterial phase images or tumor size on dynamic MRI. MATERIALS AND METHODS: One hundred thirty-four lesions of hepatic metastases in 44 patients were subjected to a retrospective analysis of the dynamic MR images obtained with 3D spoiled gradient-echo sequences. The thickness of the enhancing rim on arterial phase images was regarded as a summation of the enhancing component of tumor periphery and perilesional enhancement, which were estimated by the tumor size on precontrast T1-weighted images. The presence of wedge-shaped perilesional enhancement was also correlated with the lesion size. RESULTS: Except for 17 diffusely enhanced lesions, lesion size was comparable between the lesions with (n = 87; 26 +/- 19 [SD] mm) and without rim enhancement (n = 30; 27 +/- 23 mm) on the arterial phase dynamic MR images (p > 0.05). The degree of peripheral tumoral enhancement showed an inverse correlation (r = -0.389) with the thickness of the circumferential perilesional enhancement (p < 0.001). The mean size of the lesions with wedge-shaped perilesional enhancement (n = 44; 33 +/- 20 mm) was larger than that of the other lesions (n = 90; 25 +/- 19 mm) (p = 0.016). CONCLUSION: The degree of circumferential perilesional enhancement of hepatic metastases on arterial phase dynamic MR images would be independent of the lesion size but inversely correlated with the degree of peripheral tumoral vascularity. An understanding of these features may help tumor characterization and should prompt hypotheses and studies of microvascular phenomena in tumoral and epitumoral environments.     

Impact of Different CT Slice Thickness on Clinical Target Volume for 3D Conformal Radiation Therapy

The purpose of this study was to present the variation of clinical target volume (CTV) with different computed tomography (CT) slice thicknesses and the impact of CT slice thickness on 3-dimensional (3D) conformal radiotherapy treatment planning. Fifty patients with brain tumors were selected and CT scans with 2.5-, 5-, and 10-mm slice thicknesses were performed with non-ionic contrast enhancement. The patients were selected with tumor volume ranging from 2.54 cc to 222 cc. Three-dimensional treatment planning was performed for all three CT datasets. The target coverage and the isocenter shift between the treatment plans for different slice thickness were correlated with the tumor volume. An important observation from our study revealed that for volume < 25 cc, most of the cases were underdosed by 18% with 5-mm slice thickness and 27% with 10-mm slickness. For volume > 25 cc, the target underdosage was less than 6.7% for 5-mm slice thickness and 8% for 10-mm slice thickness. For 3D conformal radiotherapy treatment planning (3DCRT), a CT slice thickness of 2.5 mm is optimum for tumor volume < 25 cc, and 5 mm is optimum for tumor volume > 25 cc.     

Spectrum of MRI appearances of untreated metastases of the liver

OBJECTIVE: The purpose of our study was to identify the spectrum of MRI appearances of untreated liver metastases from different primary origins. MATERIALS AND METHODS: Over a period of 52 months, we used our clinical information system to retrospectively identify the first MRIs obtained in 165 consecutive patients who had untreated liver metastases. All patients had histologic confirmation of the primary tumor. Liver metastases were confirmed at histologic examination, on imaging, or at clinical follow-up. MR sequences used included T1-weighted spoiled gradient-echo, T2-weighted half-Fourier acquisition single-shot turbo spin-echo, and serial gadolinium-enhanced spoiled gradient-echo imaging. Size, signal intensity characteristics, and pattern of enhancement of the metastases on MRIs were evaluated by two radiologists in consensus. Lesions were categorized by size: smaller than 1.5 cm, between 1.5 and 3.0 cm, and larger than 3.0 cm. RESULTS: A total of 516 metastases (size range, 5-120 mm; mean, 28 mm) were assessed. Fifty-nine patients had hypervascular lesions, and 106 patients had hypovascular lesions. A significant difference in proportion of tumor vascularity was observed between the primary tumors described as classically hypervascular and those described as classically hypovascular (chi-square test for proportions of 70.8, p < 0.0001). The most common pattern was peripheral ring (72% of patients) seen on the arterial dominant phase images, with incomplete central progression (63%) seen on the delayed phase images. A hypointense ring seen in the periphery of the tumor during the delayed phase was the most common appearance in hypervascular metastases (27% patients) and was particularly conspicuous in patients with neuroendocrine and carcinoid tumors. Perilesional enhancement was common (47%), mostly seen in hypovascular metastases (92%). Generally, large lesions tended to show a peripheral ring or heterogeneous enhancement, and small lesions showed homogeneous enhancement. CONCLUSION: MRI allows the identification of a wide spectrum of appearances of untreated liver metastases. The extent and pattern of enhancement of various histologic types of tumor are depicted on MRI.     

结肠造影CT扫描对大肠肿瘤性病变的应用评价

目的 评价口服大剂量甘露醇螺旋CT结肠造影(spiral CT colonography, SCTC)对大肠肿瘤性病变的诊断价值.方法 27例志愿者及68例疑有结、直肠病变患者每人口服约1500 ml等渗甘露醇后,肌注20 mg山莨菪碱注射液,随后行螺旋CT三期扫描,并在工作站上进行多平面重建、最大密度投影, 对正常组大肠进行准确分区,测量各区肠壁厚度、大肠管径和肠壁强化程度,并与病变肠管进行对照,对其结果进行统计学处理.根据肠道准备效果将SCTC分为3级.对手术病理证实的61例大肠肿瘤性病变进行回顾分析.结果 所有受试者都成功完成了SCTC检查,其中1级52例,占54.7%, 2级39例,占41.1%,3级4例,占4.2%,总满意度为95.8%.61例病人中有60例清晰显示病变,其中结直肠癌30例,淋巴瘤8例,脓肿8例 ,结肠息肉8例,转移瘤4例,盲肠类癌3例.1例＜5 mm结肠息肉SCTC未检出.SCTC对病变的敏感度为98.36%,特异度为76.9%.30例大肠癌SCTC正确分期27例,Duke分期的准确性为90%(27/30).结论 SCTC是一种简便、易行、经济实惠,能全方位、多维显示大肠肿瘤性病变的方法.     

Evaluation of the internal mammary nodes by lymphoscintigraphy and ultrasonography in patients with breast cancer]

The efficacy of lymphoscintigraphy and ultrasonography was evaluated in the detection of internal mammary lymph node (IMN) metastases in patients with breast cancer. On histological examination of IMN, 10 patients had metastases (positive group) and 47 did not (negative group). On lymphoscintigraphy, lack of uptake in the parasternal region of the affected side was classified as abnormal. The frequency of this abnormal finding was not significantly different between both groups. On sonography, the thickness of the sonolucent internal mammary area was measured. The thickness of the affected side was 6 mm or more in two patients of the positive group and only one of the negative group. A thickness of over 6 mm on the affected side was statistically significant (p less than 0.05). The difference in thickness between the affected side and the healthy side was 3 mm or more in four patients of the positive group, and was less than 3 mm in all patients of the negative group. A difference in thickness of more than 3 mm between the two sides was extremely significant (p less than 0.001). In conclusion, sonography is valuable in detecting IMN metastases, while lymphoscintigraphy is not useful. Sonography is recommended as an efficient diagnostic modality for IMN metastases.     

Correlating MRI and histologic tumor thickness in the assessment of oral tongue cancer

OBJECTIVE: Tumor thickness in oral tongue cancer is an important independent prognostic factor for local recurrence, nodal metastasis, and patient survival. An accurate preoperative assessment of tumor thickness is therefore essential for optimal treatment planning. The aim of our study was to evaluate the accuracy of MRI findings for the preoperative measurement of tumor thickness. SUBJECTS AND METHODS. Eighteen patients with oral tongue cancer underwent preoperative MRI of the tongue. After surgery, the glossectomy specimens were serially sectioned. The radiologic tumor thickness of contrast-enhanced T1-weighted and T2-weighted images was compared with the histologic tumor thickness using our proposed tumor thickness staging classifications. These included stage I (tumor < or = 3 mm), stage II (> 3 mm but < or = 9 mm) and stage III (> 9 mm). RESULTS: The overall accuracy in assessment of proposed tumor thickness staging using contrast-enhanced T1-weighted and T2-weighted images was 83% and 56%, respectively. The radiologic tumor thickness as measured on contrast-enhanced T1-weighted and T2-weighted images had significant correlation with histologic tumor thickness (R = 0.938 and 0.941, respectively). CONCLUSION: MR images provide satisfactory accuracy for the measurement of tumor thickness and staging of oral tongue cancer. Preoperative MRI is recommended to assist in treatment planning for patients with this disease.     

甲状腺肿瘤的CT诊断

目的：笔者收集1989年来经我院手术诊治的甲状腺肿瘤137例，其中甲状腺癌120例，甲状腺瘤16例和甲状腺淋巴瘤1例，就其CT表现与鉴别作回顾性分析。材料和方法：本组甲状腺扫描层厚层距各5—8cm．其中平扫6例，平扫加增强扫描5例．余125例均为直接增强扫描。结果：甲状腺肿瘤CT表现无特征性，伴有囊性变时甲状腺癌可见瘤壁和瘤结节不均匀增强．壁厚薄不均；而腺瘤则瘤壁呈环状均匀增强，壁厚薄较均匀．57．5%甲状腺癌颈深下淋巴结转移，多为等高密度，尤以高密度为其特征．颈总动脉部位对鉴别肿瘤与伴结外浸润的淋巴结有意义．60．74％甲状腺肿瘤出现钙化。结论：CT为甲状腺肿瘤的诊断、分期和手术提供信息．     

侧脑室肿瘤的CT、MR诊断

目的 分析侧脑室肿瘤的CT与MRI影像学特征,提高对侧脑室各种肿瘤的诊断准确性。资料与方法 回顾性分析25例经手术与病理证实的侧脑室肿瘤的CT与MRI表现,其中CT检查5例,MRI检查7例,13例同时行CT和MRI检查。结果 25例中,脑膜瘤6例,室管膜瘤5例,星形细胞瘤4例,转移瘤3例,脉络丛乳头状瘤、中央性神经细胞瘤、室管膜囊肿各2例,室管膜下巨细胞瘤1例。CT显示肿瘤钙化较佳,MR定位准确性高,可以准确显示肿瘤的位置及邻近情况。结论 不同种类的侧脑室肿瘤与发病部位、患者年龄有一定的关系,结合发生部位和年龄特征,可提高诊断率。     

Tumor thickness and paralingual distance of coronal MR imaging predicts cervical node metastases in oral tongue carcinoma

BACKGROUND AND PURPOSE: The presence of cervical lymph node metastases is an important prognostic factor for oral tongue cancer. The accurate preoperative assessment is essential for treatment. Several studies have suggested that histologic tumor thickness is related to the metastases. The aim of this study was to determine whether MR images of oral tongue tumor have the potential to predict cervical lymph node metastases.MATERIALS AND METHODS: A total of 43 patients with squamous cell carcinoma of the oral tongue were investigated. Tumor thickness, sublingual distance between tumor and sublingual space, and paralingual distance between tumor and paralingual space, as determined from coronal MR imaging, were preoperatively estimated. Logistic regression analysis was used to identify independent predictors of lymph node metastases.RESULTS: Univariate logistic regression analysis showed that T classification, N classification, and 3 measured MR imaging distances (millimeters) were significantly associated with lymph node metastases. Multivariate logistic regression analysis showed that tumor thickness (odds ratio, 1.34; 95% confidence interval [CI], 1.11–1.63; P < .005) and paralingual distance (odds ratio, 0.53; 95% CI, 0.35–0.82; P < .005) were significant predictors for lymph node metastases. The probability of metastases was estimated with these models. The preoperative decision (20% probability) as to whether to perform neck dissection could be based on tumor thickness of >9.7 mm and paralingual distance of <5.2 mm.CONCLUSION: MR images provide satisfactory accuracy for the preoperative estimation of the tumor thickness and the paralingual distance, which are valuable for predicting cervical lymph node metastases.

Squamous cell carcinoma (SCC) of the oral tongue has a relatively high propensity for cervical lymph node metastases, which ranges 37%–58%.^1,2 The presence of cervical lymph node metastases is the most important prognostic factor for survival.^3–5 Clinical assessment of the neck is an essential part of the examination. Advances in imaging techniques such as CT, MR imaging, and sonography have improved the accuracy of detection of cervical lymph node metastases, but patients with N0 classification may still harbor occult metastases. The incidence of occult metastases varies from 20% to 50%,^1,2,6–10 and the management of the clinically negative (N0) neck remains a controversial issue. Several studies have suggested that histologic tumor thickness is related to cervical metastases of oral tongue cancer.^2,10–18 This finding indicates that presurgical determination of tumor thickness might be useful for neck treatment planning. More recent studies have demonstrated that tumor thickness on MR imaging directly correlates with histologic thickness.^19–21 MR imaging thickness in patients with metastatic lymph nodes tended to be greater than that in metastases-free patients, though the difference was not significant between patients with and without metastasis.²¹ Tongue carcinoma varies in the tumor shape (reductive or expansive) and in the growth pattern (endophytic or exophytic). Therefore, how far tumor cells invade and which structures these cells infiltrate, rather than tumor thickness, may be important. The surface epithelium on the lateral side of the tongue is supported by submucosa; underlying the submucosa are intrinsic tongue muscles. The sublingual space is below the intrinsic tongue muscles and contains the sublingual gland. The genioglossus muscle lies medial to the sublingual space and the paralingual space, between the genioglossus and the intrinsic tongue muscles. Therefore, the distances between these spatia and tumor might be a more reliable predictor for lymph node metastases than tumor thickness.We performed a retrospective study of the ability of preoperative MR images to estimate the tumor thickness and the distances between the tumor and the sublingual/paralingual space, and we assessed the relationship between these variables and cervical lymph node metastases.     

Bleeding after percutaneous radiofrequency ablation: Successful treatment with transcatheter embolization

PURPOSE: This knowledge will provide an ability to earlier detect bleeding complications after radiofrequency ablation (RFA), to manage these complications appropriately with endovascular procedures and minimize the sequelae. MATERIALS AND METHODS: From 2002 to 2005, 96 patients with 150 hepatic tumours underwent 126 RFA sessions. Fifty-eight patients had HCC, 34 had liver colorectal metastases and 4 had cholangiocellular carcinoma. Sixty-one patients were men and 35 were women (mean age 69.82 years, age range 39-89). The lesions number ranged from 1 to 7 per patients (mean 1.6 nodules) with a mean diameter of 28.5 mm (range 80-10 mm). Seventy-seven patients underwent a single ablative session, 13 patients underwent 2 sessions, 4 patients underwent 3 sessions and 2 patients underwent 4 sessions. The number of tumours treated in each ablative session was 1 in 106, 2 in 18 and 4 in 2 patients. RESULTS: Two cases of serious haemorrhages occurred after the procedures in two patients treated for liver metastases. An endovascular embolization was proposed for both patients using polyvinyl-alcohol and micro-coils. The absence of bleeding was first confirmed during angiography and then by CT performed the day after the angiographic procedure. CONCLUSION: Transarterial embolization (TAE) represents the treatment of choice in the management of iatrogenic bleeding after RFA since it is minimally invasive, have a high success rate and a low incidence of complications compared to the more complex and dangerous surgical or laparoscopic options in patients who are often haemodynamically unstable and therefore at high anaesthetic and surgical risk.     

Predicting the Prognosis of Oral Tongue Carcinoma Using a Simple Quantitative Measurement Based on Preoperative MR Imaging: Tumor Thickness versus Tumor Volume

BACKGROUND AND PURPOSE:Several studies indicated that tumor thickness or tumor volume might be helpful predictors for the prognosis of oral tongue squamous cell carcinoma. Our aim was to compare the value of tumor thickness versus tumor volume measurement based on preoperative MR imaging in predicting the prognosis of oral tongue squamous cell carcinoma, especially focusing on lymph node metastases and local recurrence.MATERIALS AND METHODS:Clinical, pathologic, and imaging data of patients with 46 oral tongue squamous cell carcinomas were retrospectively studied. Logistic regression analysis was used to evaluate the prognostic value of tumor thickness and tumor volume based on MR imaging. Receiver operating characteristic analysis was applied for the optimal cutoff value for the identified risk variable for prognosis.RESULTS:A higher intraclass correlation coefficient was achieved for the measurement of tumor thickness compared with tumor volume (0.990 versus 0.972). Multivariate analysis showed that tumor thickness was a significant predictor of lymph node metastases (P = .024), while tumor volume was not a significant predictor of either lymph node metastases or local recurrence (P > .05). Receiver operating characteristic results indicated that setting a tumor thickness of 8.5 mm as a cutoff value could achieve the optimal diagnostic efficiency for predicting lymph node metastases (area under the curve, 0.753; sensitivity, 0.889; specificity, 0.536).CONCLUSIONS:Tumor thickness based on preoperative MR imaging was useful in predicting the prognosis of oral tongue squamous cell carcinoma, especially lymph node metastases, in our patient population, while tumor volume was not.

Patients with oral tongue squamous cell carcinoma (SCC) are at risk of cervical lymph node metastases and local recurrence, with the risk increasing with the size and extent of tumor, defined by T stage, and influencing treatment strategy.^1–3 Previous studies indicated that tumor thickness or tumor volume might also be helpful predictors for the clinical outcomes of patients with oral tongue SCC, such as cervical lymph node metastases, local recurrence, or survival rate.^2–10 Which one of these 2 parameters has a better prognostic value is still unclear, however, with only a few studies focusing on this issue. Yuen et al⁴ compared the prognostic value of these 2 parameters, tumor thickness and tumor volume, together with other parameters such as tumor diameter, length, width, and area. Their measurements were based on surgical histologic specimens that were unavailable before the procedure, however, and tumor shrinkage during specimen preparation might also influence its precision in measurement.MR imaging has been increasingly used in the preoperative evaluation of oral tongue SCCs, due to its excellent soft-tissue resolution. Preoperative MR imaging could help us to define tumor extent and volume accurately.¹¹ Therefore, our study aimed to clarify the better predictor for the short-term prognosis of oral tongue SCCs between tumor thickness and tumor volume based on preoperative MR imaging, specifically focusing on lymph node metastases and local recurrence.     

Benign and malignant gastric ulcer: CT findings]

PURPOSE: To evaluate the differential CT aspects of benign and malignant gastric ulcers. MATERIALS AND METHODS: We retrospectively reviewed the CT findings of 54 patients with gastric ulcerative lesions, 47 with malignant lesions (38 adenocarcinomas, 9 lymphomas) and 7 with benign lesions. All patients underwent histological examination. CT scanning was performed with a helical scanner Picker PQ 2000, before and after intravenous contrast material administration and after adequate stomach distension, achieved by drinking at least 400 ml of water; 2 ml/kg of intravenous contrast was injected at a rate of 3.5 ml/s. After contrast administration two-phase dynamic scans were performed with a scan delay of 30O and 50O. The parameters considered were: lesion size and localization, extension of the ulcer into or beyond the body of the stomach, focal wall thickness, contrast enhancement of the ulcer, perigastric tissue morphology, presence of lymphoadenopathies and liver metastases. RESULTS: The ulcer size and localization were not significative in the differential diagnosis of benign or malignant ulcers. In 46 patients the ulcer extended within the body of the stomach (38 adenocarcinomas and 8 lymphomas), in 8 cases beyond (7 benign ulcers and 1 initial lymphoma). In 46 cases of malignant ulcers there were focal wall thickenings (> 5mm), in 1 case of initial lymphoma and in all cases of benign ulcers the thickness of the wall was normal. Contrast enhancement of the lesion was observed in 25 cases, all of which were adenocarcinomas. 33 patients had perigastric tissue abnormalites (32 with malignant lesions and 1 with benign ulcer). Lymphoadenopathies and liver metastases were detected in 30 cases and always associated to malignant ulcers. DISCUSSION AND CONCLUSIONS: The improved CT technology allows to recognize gastric ulcer. Ulcer extension into stomach body; focal wall thickening; contrast enhancement of the lesion, lymphoadenopaties and liver metastases are significative in malignant gastric ulcers. The lack of these abnormalities is characteristic of benign gastric ulcers but can be also observed in early malignant lesions.     

Relationship between histologic thickness of tongue carcinoma and thickness estimated from preoperative MRI

Several studies have shown that the thickness of tongue carcinoma is related to prognosis and to the likelihood of cervical node metastases. We investigated whether preoperative estimates of tumor thickness and volume, as determined from magnetic resonance imaging (MRI), correlated with histologic thickness and might therefore predict the presence of neck metastases. We assessed relationships between histologic tumor thickness and MRI tumor thickness and volume in a retrospective series of 33 patients with squamous cell carcinoma of the tongue. Thicknesses were determined by direct measurement and by considering corrections for ulceration or tumor vegetation (reconstructed thickness). Relationships between MRI thickness and the presence or absence of homolateral and contralateral nodal metastases were also investigated. We found that MRI thicknesses correlated strongly and directly with histologic tumor thicknesses, although mean MRI thicknesses were significantly greater than histologic thicknesses. MRI thicknesses were significantly greater in patients with contralateral neck involvement than in those with no neck involvement. We conclude that MRI provides an accurate and reproducible means of estimating the thickness of tongue carcinomas, paving the way for further studies on more extensive series of patients to determine whether preoperatively determined MRI thickness can reliably predict homolateral and bilateral neck involvement.     

Electron therapy of malignant parotid tumors

Between 1968 and 1984, 61 patients with malignant parotid tumors were irradiated with fast electrons. The irradiation was performed after surgery in 58 patients, 37 out of them had tumor reresidues at the beginning of radiotherapy. The local recurrence rate was 16%, and there were no differences between patients operated in sano and patients operated non in sano. The survival at five years, however, was only 43%. This is explained by the preponderance of tumor histologies with unfavorable prognoses. Distant metastases were observed in 38% of patients. 8/10 patients with local recurrences developed distant metastases. It is noticeable that polymorphous adenomas were found in the anamneses of ten patients and histologically different secondary carcinomas in 9/61 cases.