Locally advanced squamous cervical carcinoma (M0): management and emerging therapeutic options in the precision radiotherapy era

Squamous cervical carcinoma (SCC) requires particular attention in diagnostic and clinical management. New diagnostic tools, such as (positron emission tomography-magnetic resonance imaging) PET-MRI, consent to ameliorate clinical staging accuracy. The availability of new technologies in radiation therapy permits to deliver higher dose lowering toxicities. In this clinical scenario, new surgical concepts could aid in general management. Lastly, new targeted therapies and immunotherapy will have more room in this setting. The aim of this narrative review is to focus both on clinical management and new therapies in the precision radiotherapy era.

Serial scanning with 99mTc-3, 3-diphosphono-1, 2-propanodicarboxylic acid (99mTc-DPD) for early detection of cardiac amyloid deposition and prediction of clinical worsening in subjects carrying a transthyretin gene mutation

BACKGROUND

To determine the capability of 99mTc-DPD scintigraphy to detect early cardiac involvement and predict clinical worsening in transthyretin (TTR) gene mutation patients.

METHODS

Eleven mutated subjects with normal interventricular septum (IVS) thickness, NT-proBNP level and no cardiac symptoms underwent three seriate 99mTc-DPD scans (visually and semiquantitatively analyzed), and was followed-up for 5-8-years.

RESULTS

Six patients showed no myocardial accumulation in all scans. Increased IVS thickness occurring in one patient 4 years after the last scan was the only abnormal finding in these patients; no cardiac symptoms developed during the follow-up. In three patients, cardiac radiotracer uptake was found at enrollment; other laboratory/instrumental abnormal findings occurred later and cardiac symptoms developed during the follow-up period. Two patients had a negative 99mTc-DPD scan at enrollment and showed cardiac uptake in the following scans. Increased mean left-ventricular (LV) wall thickness was found 3 years after positive scintigraphy; NT-proBNP increased later in one patient. These patients developed cardiac symptoms during the follow-up period.

CONCLUSIONS

99mTc-DPD scan detects cardiac involvement in subjects with TTR gene mutation earlier than ECG, echocardiography and biochemical markers, occurring some years before the fulfillment of current diagnostic criteria for cardiac amyloidosis. A positive 99mTc-DPD scan predicts cardiac symptoms onset.

MR pyelography in 115 patients with a dilated renal collecting system

Purpose: To evaluate the accuracy of MR pyelography in the assessment of hydroureteronephrosis.

Material and Methods: One hundred and fifteen patients, with variable degree of hydroureteronephrosis demonstrated by US and urography were subjected to MR pyelography obtained by means of two ultra-fast sequences.

Results: Of the 228 kidneys examined, the collecting systems of 130 kidneys were dilated and correctly identified on MR pyelography, with only 2 false-positive results. The specificity of MR pyelography in detecting hydronephrosis was 98%. Accuracy in revealing level of obstruction was 100%. Sensitivity in detecting stones, strictures and congenital ureteropelvic junction obstructions was respectively 68.9%, 98.5% and 100%.

Conclusion: MR pyelography can rapidly and accurately depict the morphological features of dilated urinary tracts with information regarding the degree and level of obstruction, without using contrast medium or ionizing radiation.

Calcified disease of the mitral annulus: a spectrum of an evolving disease

Mitral annulus calcification may appear under different forms depending from its evolution stage: mitral annulus calcification; homogeneous calcified mass of the mitral valve; liquefaction necrosis of the mass; reduction or stability of the mass dimension. We report a large calcified mass located in between the posterior mitral valve leaflet and adjacent left ventricular myocardium suggesting the homogeneous calcified phase of the disease.

[186Re]HEDP in the palliation of painful bone metastases from cancers other than prostate and breast

AIM

Palliative therapy using [186Re]hydroxyethylidene diphosphonate (HEDP) has been widely tested in patients with bone metastases from prostate and breast cancers. Whereas, to the best of our knowledge, only few cases of bone metastases from tumors other than prostate and breast treated with [186Re]HEDP have been reported. The aim of this paper is to report our experience with 186Re-HEDP in the palliation of painful bone metastases from tumors other than prostate and breast.

METHODS

In this study 41 patients (17 non-small cell lung cancer-NSCLC, 1 small cell lung cancer, 1 lung neuroendocrine tumor, 8 bladder cancer, 3 kidney cancer, 3 gastric cancer, 1 uterine carcinoma, 1 colon cancer, 1 rhinopharynx carcinoma, 1 medullary thyroid carcinoma, 1 ovarian cancer, 1 esophagus cancer, 2 carcinoma of unknown origin) are evaluated. All patients had lesions with increased [99mTc]MDP uptake and none had radiological findings of mainly osteolytic lesions. A total of 46 therapeutic cycles were performed using a [186Re]HEDP activity of 1 295 MBq for each administration. After treatment, patients were followed up for 3 months or to the time of pain recurrence (if longer than 3 months). Responses were evaluated using a validated method considering the modifications of pain index, analgesic intake and performance status.

RESULTS

Treatment efficacy was complete in 49% (20/41) of patients, partial in 36% (15/41) and negative in 15% (6/41). Namely, we observed 35% (6/17) complete, 41% (7/17) partial and 24% (4/17) negative responses in patients with NSCLC and 63% (5/8) complete, 25% (2/8) partial and 12% (1/8) negative responses in patients affected by bladder cancer. The median duration of pain relief in responder patients was 10 weeks. A mild platelet toxicity occurred in 32% (13/41) of patients.

CONCLUSIONS

Pain palliation with [186Re]HEDP seems highly effective and safe also in patients with bone metastases from cancers other than prostate and breast. Patients who can benefit from the treatment with [186Re]HEDP can be selected on the basis of [99mTc]MDP bone scan and radiological examination findings.

Lithiasic Obstructive Uropathy

OBJECTIVES

The purpose of this study was to evaluate the role of magnetic resonance (MR) pyelography in patients affected by hydronephrosis due to ureteric stones, in order to identify a pyonephrotic condition.

MATERIALS AND METHODS

In the last 3 years, 315 patients, who had originally been investigated by ultrasonography, were evaluated with MR pyelography in order to define the etiology of obstruction. In 67 patients hydronephrosis was referred as caused by lithiasis.

RESULTS

MR pyelography not only confirmed urinary tract dilatation in all patients, but also identified grade and site of obstruction, both in acute dilatation (25 patients) and in chronic obstructions (42 patients). In 7 patients, MR pyelography documented pyonephrosis that was obviously confirmed by nephrostomic drainage.

CONCLUSION

MR pyelography, made with ultrafast breath-hold sequences, has a great value in identifying hydronephrosis in patients with ureteric stones. Furthermore, it provides the chance to identify pyonephrosis requiring an immediate drainage of the kidney before major complications develop.

MR pyelography in the assessment of hydroureteronephrosis: single-shot thick-slab RARE versus multislice HASTE sequences

BACKGROUND

We used magnetic resonance (MR) pyelography to compare the value of thick-slab single-shot rapid acquisition with relaxation enhancement (RARE) sequence with that of multislice half-Fourier acquisition single-shot turbo-spin-echo (HASTE) sequence in evaluating the full spectrum of morphologic features in a group of patients with hydronephrosis.

METHODS

MR pyelographic images, with the use of thick-slab RARE and multislice HASTE sequences in 90 patients, were evaluated for image quality, presence of hydronephrosis, and level and cause of obstruction.

RESULTS

HASTE sequences provided images of better quality than did RARE sequences (p < 0.001). There was no statistically significant difference in demonstrating the presence of hydronephrosis (p = 0.5) and level of obstruction (p = 0.125). Sensitivity, specificity, and accuracy in diagnosing cause of obstruction were 61.7%, 62.5%, and 62%, respectively, for RARE sequences and 80%, 82.5%, and 81%, respectively, for HASTE sequences, with a statistically significant difference (all p < 0.05).

CONCLUSION

Multislice HASTE sequence provides better diagnostic information than does thick-slab RARE sequence, particularly in evaluating the cause of obstruction.

Investigation of brain tumours with (99m)Tc-MIBI SPET

The aim of this paper is to give the reader an updated overview of (99m)Tc-MIBI SPET applications in investigating brain tumours. Elements determining MIBI uptake at the level of the brain are first mentioned. (99m)Tc-MIBI SPET features in different malignant and benign brain lesions (low and high grade gliomas, glioblastoma multiforme, metastasis, lymphoma, meningioma, neuroma, radiation necrosis and other rarer brain lesions) are reviewed. The ability of 99mTc-MIBI SPET, alone or in combination with other radiotracers, in the differential diagnosis of brain lesions is discussed. We outline (99m)Tc-MIBI SPET value in determining brain tumours grading and in distinguishing tumour recurrence from radiation necrosis. Clinical applications of 99mTc-MIBI in the management of AIDS patients, where discrimination between lymphoma and several different lesions only on the basis of CT or MRI findings is often impossible, are reported. In addition the relationships among (99m)Tc-MIBI SPET, P-glycoprotein (MDR-1 gene product) expression in brain neoplasms and chemotherapy response are mentioned.

Twisted ovarian fibroma with high signal intensity on T1-weighted MR image: a new sign of torsion of ovarian tumors?

Torsion of ovarian tumors is often difficult to diagnose, because of non-specific clinical, laboratory, and imaging findings. We report a case of twisted ovarian fibroma whose main characteristic was the presence of large areas of high signal intensity on both T1- and T2-weighted MR images due to the passive congestion of the mass. This previously unreported finding should be considered a sign of ovarian torsion and may facilitate prompt surgical intervention.

Ossifying lipoma of the parapharyngeal space: CT and MRI findings

Ossifying lipomas independent of bone tissue are very rare. A literature review revealed that only few cases of ossifying lipoma independent of bone tissue have been reported. None of the cases have been reported in the international radiology literature. In addition, there are no reports concerning the MRI features of this entity. We describe CT and MRI findings in a case of ossifying lipoma of the parapharyngeal space.

MR white lung sign: incidence and significance in pulmonary consolidations

PURPOSE

The presence of a pulmonary consolidation with a signal intensity comparable with that of the static fluid on heavily T2-weighted MR images has been named the "MR white lung sign." This sign has been described in mucinous bronchioloalveolar carcinoma (BAC). Our purpose was to establish the frequency and significance of this sign in pulmonary consolidations of varied causes.

METHOD

In this prospective study, 83 patients with pulmonary consolidation underwent MR examination between January and December 1999. Segmental or lobar consolidations were due to pneumonia without central obstruction (n = 22), pneumonitis with central obstruction (n = 21), cicatricial atelectasis (n = 8), passive atelectasis (n = 10), radiation pneumonitis (n = 8), mucinous BAC (n = 5), infarction (n = 3), bronchiolitis obliterans organizing pneumonia (n = 3), nonmucinous BAC (n = 2), and lymphoma (n = 1). The MR white lung sign was considered present when the signal intensity of a pulmonary consolidation was comparable with that of the static fluid on heavily T2-weighted images obtained with MR hydrography sequences. Interobserver agreement, sensitivity, and specificity of the white lung sign in diagnosing mucinous BAC were calculated.

RESULTS

The MR white lung sign was present in 7 (8%) of 83 consolidations, including 5 (100%) of 5 cases of mucinous BAC and 2 (10%) of 21 cases of obstructive pneumonitis. The frequency of the white lung sign was 100% in mucinous BAC and 2.6% in consolidations due to other causes. The difference was statistically significant (p < 0.05).

CONCLUSION

The white lung sign is an uncommon finding in pulmonary consolidations evaluated with heavily T2-weighted sequences. However, the sign is characteristic of mucinous BAC and adds specificity to the radiologic diagnosis.

Gallbladder duplication: MR cholangiography demonstration

Gallbladder duplication is a rare anatomic malformation. We present a case of gallbladder duplication in a patient who underwent laparoscopic cholecystectomy in which breath-hold magnetic resonance cholangiography showed the biliary anomaly, allowing a correct preoperative differentiation of the specific type of duplication.

CT and MR findings in neoplastic perineural spread along the vidian nerve

The aims of this article are to describe the findings of perividian tumor spread and to compare the accuracy of MRI and CT in diagnosing perineural metastasis along the vidian nerve. Moreover, the frequency of perividian metastasis in patients with head and neck cancer was evaluated. The CT and MR examinations of 98 consecutive untreated patients with histologically proven head and neck cancer were retrospectively reviewed. We considered as criteria for perineural tumor spread along the vidian nerve the following CT and MR findings: For CT (a) enlargement of the pterygoid canal, (b) erosion of its bony wall, and (c) obliteration of its normal fatty content; and for MR (a) enlargement of the vidian nerve, (b) enhancement of the nerve, and (c) obliteration of fat, particularly in the anterior part of the pterygoid canal. Ten patients met the selected criteria for perineural metastasis, which was bilateral in 3 patients, with a total of 13 vidian metastases. The CT scans demonstrated unilateral involvement of the vidian nerve in 9 patients. The MRI scans showed 13 perineural metastases. In 3 patients MR scans demonstrated involvement of four vidian nerves that appeared normal on CT examinations. The diagnostic difference between CT and MRI was statistically significant (Fisher's exact test; p = 0.04). Perineural spread along the vidian nerve is an event more frequent than previously reported and must be investigated with a careful imaging technique. Although a major limitation of our study is the lack of histological proof, the MR finding of a significant enhancement of the nerve, whether enlarged or normal in size, could be considered very suggestive of this kind of metastatic spreading, particularly if associated with simultaneous involvement of the neighboring structures (pterygopalatine fossa, foramen lacerum, trigeminal branches, etc.).

Chronic infiltrative lung diseases: value of gadolinium-enhanced MRI in the evaluation of disease activity--early report

STUDY OBJECTIVE

To determine the value of gadolinium-enhanced MRI in the assessment of disease activity in chronic infiltrative lung diseases (CILDs).

DESIGN

Retrospective study.

SETTING

University hospital.

MATERIALS AND METHODS

Twenty-five consecutive patients with CILD were studied. The following diseases were diagnosed: sarcoidosis (n = 10), bronchiolitis obliterans organizing pneumonia (n = 3), usual interstitial pneumonia (n = 4), radiation pneumonia (n = 2), desquamative interstitial pneumonia (n = 1), rheumatoid lung (n = 1), vasculitis (n = 1), alveolar proteinosis (n = 1), bronchioloalveolar carcinoma (n = 1), and chronic eosinophilic pneumonia (n = 1). In each patient, the disease activity was assessed by one or more of the following studies: BAL (n = 18), gallium-radioisotope lung scanning (n = 6), serum angiotensin-converting enzyme assay (n = 10), and open lung biopsy (n = 4). T1-weighted breath-hold MRI studies were obtained before and after IV injection of gadolinium. The MRI examinations were analyzed to assess the presence or absence of lesional enhancement.

RESULTS

The presence of enhanced pulmonary lesions was seen in 14 patients. All of these patients had active disease. Of the 17 patients with active disease, 14 had enhanced lesions, and 3 had unenhanced lesions. Pulmonary lesions were not enhanced in any patients with inactive disease. The difference was statistically significant (Fisher Exact Test, p < 0.05).

CONCLUSION

Gadolinium-enhanced MRI may prove to be a useful tool in assessing disease activity in CILDs.

Magnetic resonance imaging of bronchioloalveolar carcinoma

The purpose of this study is to describe the magnetic resonance (MR) features of bronchioloalveolar carcinoma. MR examinations of 18 patients with proven bronchioloalveolar carcinoma were reviewed. Detection at computed tomography (CT) and pathologic confirmation were the entry criteria. Nine patients had a solitary nodule, three patients a lobar consolidation, and six patients had diffuse disease. For each patient, both breath-hold T2-weighted fast spin-echo, and breath-hold T1-weighted gradient-echo images, before and after injection of gadolinium, were available. Nine patients with pulmonary consolidation or diffuse disease had also heavily T2-weighted MR imaging (Haste or TSE 240; Siemens, Erlangen, Germany). MR imaging showed pulmonary abnormalities in 17 of 18 patients. Unenhanced T1-weighted and T2-weighted images depicted tumor in 16 of 18 patients. Contrast-enhanced T1-weighted images showed tumor in 17 of 18 patients. In no case did MR imaging depict abnormalities corresponding to the ground-glass opacities seen on CT scans. In three patients with mucinous bronchioloalveolar carcinoma, heavily T2-weighted images showed lesions isointense with respect to static fluid of the human body. In conclusion, the ability of MR imaging in detecting small nodules and ground-glass opacities is limited. However, heavily T2-weighted sequences are able to show the presence of mucin. This is useful information because mucinous bronchioloalveolar carcinoma carries a poor prognosis.

Diagnostic pitfalls of breath-hold MR urography in obstructive uropathy

Breath-hold MR urography (MRU) is being used with increasing frequency to evaluate urinary tract pathology. Although multiple studies have documented the accuracy of breath-hold MRU in the evaluation of obstructive uropathy, pitfalls associated with this technique may result in diagnostic errors. This essay illustrates both technical and interpretive pitfalls of MRU and suggests strategies for their recognition and avoidance.

Sudden unilateral deafness with endolymphatic sac adenocarcinoma: MRI

A 30-year-old man presented with sudden left deafness and vertigo. CT showed an osteolytic retrolabyrinthine tumour of the left temporal bone. High signal from the tumour and labyrinth was seen on fat-suppressed T 1-weighted images. At surgery, a haemorrhagic papillary-cystic adenocarcinoma of the endolymphatic sac was found.

Mucinous cystadenocarcinoma of the lung: CT-pathologic correlation in three cases

Mucinous cystadenocarcinoma (MCA) is a rare tumor that is considered to be a cystic variant of mucin-producing lung adenocarcinoma. MCA expands grossly by storing mucus and contains few neoplastic cells. We present the CT images of three patients with MCA and correlate them with pathologic specimens. The CT findings of MCA include a uniform low-attenuation, focal thickening of the cystic wall and enhancing septa.

Computed tomography halo sign in pulmonary nodules: frequency and diagnostic value

On computed tomography (CT) scanning, a ground-glass opacity zone surrounding a pulmonary nodule has been named the computed tomography (CT) halo sign. To investigate the frequency and diagnostic value of the CT halo sign, the authors reviewed the CT examinations of 305 patients with proven diseases producing solitary or multiple nodules. The CT halo sign was seen in 22 patients (7%). Eleven patients had a solitary nodule; five patients had multiple nodules; and six patients had nodules associated with areas of pulmonary consolidation, or ground-glass opacity, or both. Solitary nodules were the result of bronchioloalveolar carcinoma (n = 5), tuberculoma (n = 2), squamous cell carcinoma, non-Hodgkin lymphoma, myxovirus infection, and metastasis (n = 1 each). Multiple nodules were the result of metastasis (n = 2), Kaposi sarcoma (n = 2), and Wegener granulomatosis (n = 1). Nodules associated with areas of consolidation or ground-glass opacity were the result of metastasis (n = 2), bronchioloalveolar carcinoma, bronchiolitis obliterans organizing pneumonia, eosinophilic pneumonia, and invasive pulmonary aspergillosis (n = 1 each). The data showed that the CT halo sign is a nonspecific finding. It is known that in immunocompromised patients the CT halo sign should suggest invasive pulmonary aspergillosis, Kaposi sarcoma, and lymphoproliferative pulmonary disorders. However, in immunocompetent patients, the authors found that a solitary nodule with the CT halo sign and pseudocavitations has a high likelihood of being a bronchioloalveolar carcinoma.

[Magnetic resonance pyelography: clinical use of ultrafast breath-hold sequences in obstructive uropathy. Personal experience]

INTRODUCTION

We investigated the diagnostic yield of MR pyelography (MRP) performed with two ultrafast breath-hold sequences in obstructive uropathy patients.

MATERIAL AND METHODS

Thirty-four patients with US demonstration of urinary tract dilation were examined with MRP at 1.5 T and with a standard body coil. HASTE sequences (TE 66, ETL 128, FA 180 degrees, 1 NEX, MA 240 x 256, slice thickness 4 mm, TA 13 s) were always performed and 26/34 patients were also examined with single-shot TSE sequences (TE 1100, ETL 240, FA 150 degrees, 1 NEX, slice thickness 7 cm, MA 240 x 256, FS, TA 7 s); 20/34 patients were given 500 mL superparamagnetic contrast agent (Lumirem). MRP findings were interpreted independently by two radiologists and analyzed for image quality, the presence/absence of dilation, the obstruction grade (mild, moderate, severe), site (intrarenal; ureteropelvic junction; proximal, mid-, distal ureter; indeterminate) and cause (intrinsic obstruction from a stone or other conditions; stenosis; indeterminate cause). The sensitivity, specificity, positive and negative predictive values for the detection of urinary tract dilation were calculated for each reviewer and interobserver agreement was calculated with the k analysis relative to the presence, grade, site and cause of urinary tract dilation.

RESULTS

MRP examinations were considered technically adequate in all cases by both observers. As for the presence of urinary tract dilation, the values were 100% for the first observer and 97%, 100%, 100%, and 95%, respectively, for the second observer. Interobserver agreement was .98 for dilation presence (excellent), .80 for dilation degree (excellent), .62 for dilation site (good) and finally .69 for dilation cause (good).

DISCUSSION AND CONCLUSIONS

MRP performed with the ultrafast breath-hold technique provides very good results in diagnosing urinary tract dilation, as well as the obstruction grade, site and cause, with results equal or even superior to those of non-breath-hold sequences. Ultrafast MRP lasts only 10 minutes, meaning it occupies the magnet shortly and costs less: it can be thus considered a routine alternative to conventional diagnostic imaging, especially ivp, in the evaluation of obstructive uropathy.

[Contrast-enhanced study of solitary pulmonary nodules with thin-section computed tomography]

INTRODUCTION

Since many benign and malignant pathologic conditions can appear as solitary pulmonary nodules, to establish nodule nature is always necessary for correct patient management. Recently, some authors have demonstrated the effectiveness of incremental dynamic CT in distinguishing cancerous from noncancerous lesions. The purpose of this work is to report our personal experience in this field.

MATERIAL AND METHODS

We reviewed the incremental dynamic CT scans of 21 patients with a solitary pulmonary nodule < 3.5 cm phi without any calcifications, cavities and fat--namely, 15 carcinomas, 3 granulomas, 2 hamartomas, 1 abscess. Lesion density was evaluated before and 30 s, 1, 2, 3 and 5 min after contrast agent administration; we used a circular region of interest consisting of the central portion of the nodule in all cases and of 60-70% of its area in most cases. We subdivided the nodules into two groups, according to their enhancement: the nodules with > 20 HU and those with < 20 HU. All the lesions were submitted to surgery and histologic studies.

RESULTS

Fourteen of 15 carcinomas and one hamartoma had contrast enhancement > 20 HU; an abscess exhibited marked ring-shaped contrast enhancement (positive predictive value: 87%). One carcinoma, three granulomas and one hamartoma had no contrast enhancement, or else it was < 20 HU (negative predictive value: 80%).

DISCUSSION

Recently, some authors have demonstrated that malignant nodules, studied with incremental dynamic CT, have higher contrast enhancement than benign nodules. A value > 20 HU is a good predictor of malignancy (positive predictive value: 90%) and, conversely, a value < 20 HU is an unquestionable sign of benignity (negative predictive value: 100%). Our findings confirm the positive predictive value of enhancement > 20 HU, but not its negative predictive value because we found a malignant nodule without contrast enhancement.

CONCLUSIONS

Incremental dynamic CT is an effective indicator of solitary pulmonary nodule nature, but its predictive value is not absolute and therefore this technique should be integrated with biopsy in the cases which are clinically or radiologically suspicious.

[Computed tomography in endobronchial mucus accumulation]

To investigate the value of CT in depicting endobronchial mucoid collections, the authors retrospectively reviewed the CT scans of 22 patients, 14 with mucous plugs, 7 with mucoid pseudotumors, and one with a bronchocele due to bronchial atresia. Atelectasis could be seen in 11 of 14 patients with mucous plugs. In 12 of 14 patients with mucous plugs CT showed the involved bronchi filled by fluid representing abnormal mucus accumulation. In the patients with atelectasis CT showed mucus-filled bronchi as low-attenuation branching structures (mucoid bronchogram). All the mucoid pseudotumors appeared as low-attenuation (< 20 HU) polypoid wall lesions with no involvement of the bronchial walls. In a patient with bronchial atresia CT showed a solitary pulmonary nodule (representing the obstructed and dilated bronchus filled by mucus) surrounded by peripheral pulmonary hyperinflation. Characteristically, the endobronchial mucoid collections never enhanced after bolus contrast medium. Endobronchial mucoid collections had to be differentiated from endobronchial neoplasms. In some cases bronchoscopy was necessary to make the differential diagnosis. In conclusion, CT is a valuable tool with good sensitivity and specificity in diagnosing endobronchial mucoid collections.

Venous plethysmography values in patients with spinal cord injury

To determine whether venous hemodynamics differ fundamentally between patients with spinal cord injury (SCI) and the abled-bodied population, quantitation of lower extremity venous plethysmography values was performed in 14 SCI patients and ten able-bodied subjects. The control group had an average maximum venous outflow (MVO) of 59.3 +/- 2.75 mL/min/100mL of tissue, mean +/- SE, and an average venous capacitance (VC) of 3.2 +/- 0.13mL/100mL. In contrast, the SCI patients had an average MVO of 32.5 +/- 2.57mL/min/100mL and an average VC of 2.3 +/- 0.17mL/100mL. The differences between the two groups were statistically significant, suggesting that the standard venous function index of plethysmography values used in the general population may not be applicable to the SCI population and that, therefore, a new standard for SCI patients derived from a larger data base should be sought.