Adelfio Elio Cardinale

Benign focal liver lesions: spectrum of findings on SonoVue-enhanced pulse-inversion ultrasonography

The prevalence of benign focal liver lesions (BFLL) is high both in the general population and in patients with known malignancies. The gray-scale ultrasound (US) technique is usually the first-line imaging modality used in the radiological workup of such lesions, but unfortunately it lacks specificity. Furthermore, Doppler examination may often be unsatisfactory owing to motion artefacts, or when small or deeply located lesions are evaluated. Recently, microbubble-based contrast agents used in combination with gray-scale US techniques, which are very sensitive to nonlinear behavior of microbubbles, have led to a better depiction of both microvasculature and macrovasculature of focal hepatic masses, thus improving the reliability of using US in the assessment of liver tumors. This review illustrates the spectrum of enhancement patterns of BFLL on contrast-enhanced ultrasonography with SonoVue, a second-generation microbubble-based contrast agent.

Characterization of benign hepatic tumors arising in fatty liver with SonoVue and pulse inversion US

BackgroundWe describe the spectrum of contrast-enhancement patterns of benign hepatic tumors arising in fatty liver on contrast-enhanced ultrasound (US).MethodsSixteen patients (12 women and four men) with 27 benign hepatic tumors (17 hemangiomas, eight focal nodular hyperplasias, and two hepatocellular adenomas) arising in fatty liver underwent baseline and pulse inversion US after administration of SonoVue. Two experienced radiologists evaluated baseline echogenicity and dynamic enhancement pattern of each lesion in comparison with adjacent liver parenchyma.ResultsAfter administration of SonoVue, in the arterial phase 13 of 17 hemangiomas showed peripheral globular enhancement and one showed a rim of peripheral enhancement, followed by progressive centripetal fill-in, which was complete in 10 of 14 cases and incomplete in four. Three of 18 hemangiomas showed rapid and complete fill-in in the arterial phase. Eight of eight focal nodular hyperplasias became hyperechoic in comparison with adjacent liver parenchyma in the arterial phase and slightly hyperechoic or isoechoic in the portal venous and delayed phases. Both adenomas showed strong arterial contrast enhancement that became less intense in the portal venous and delayed phases.ConclusionContrast-enhanced US after administration of SonoVue enables depiction of typical contrast-enhancement patterns in most benign hepatic tumors arising in fatty liver, thus providing useful clues for characterization.

Prevalence of myocardial bridging and correlation with coronary atherosclerosis studied with 64-slice CT coronary angiography.

PurposeThis study aimed to assess the prevalence and characteristics of myocardial bridging in patients who underwent multislice computed tomography coronary angiography (MSCT-CA) and to evaluate the correlation between bridged coronary segments and atherosclerosis.Materials and methodsA total of 277 patients (mean age 60±11 years) we consecutively examined with 64-slice MSCT-CA for suspected or known coronary atherosclerosis were retrospectively reviewed for myocardial bridging. Segments proximal and distal to the bridging were evaluated for atherosclerotic plaque, as were the remaining coronary segments.ResultsMyocardial bridging was present in 82 patients (30%, mean age 59±12). Bridges were of variable length (<1 cm 58%; 1-2 cm 32%; >2 cm 10%) and depth (superficial 69%, intramyocardial 31%) and frequently localised in the mid-distal segment of the left anterior descending artery (95%). Myocardial bridging cannot be considered a significant risk factor for coronary atherosclerosis (odds ratio 0.49) compared with traditional cardiovascular risk factors. Coronary segments proximal to the bridge showed no atherosclerotic disease (33%), positive remodelling (27%), <50% stenosis (20%) or >50% stenosis (20%). We identified 12 noncalcified, 32 mixed and 17 calcified plaques. The distal segments were significantly less affected (p<0.0001).ConclusionsMSCT-CA is a reliable, noninvasive method that is able to depict myocardial bridging and associated atherosclerotic plaque in the proximal segments.RiassuntoObiettivoScopo del nostro lavoro è stimare la prevalenza e le caratteristiche dei ponti miocardici in una popolazione consecutiva di pazienti sottoposti ad angiografia coronarica mediante tomografia computerizzata multistrato (AC-TCMS), nonché valutare la relazione tra i decorsi miocardici e l’aterosclerosi coronarica.Materiali e metodiIn una popolazione di 277 pazienti (età media 60±11), sottoposti consecutivamente ad AC-TCMS con scanner a 64-strati per malattia aterosclerotica coronarica sospetta o nota, è stata ricercata la presenza di decorsi miocardici. Sono state valutate le placche aterosclerotiche presenti nei segmenti prossimali e distali al decorso miocardico, nonché nei restanti segmenti coronarici.RisultatiOttantadue pazienti (30%, età media 59±12) presentano decorso miocardico superficiale (69%) o intramiocardico (31%), con lunghezza variabile (<1 cm: 58%; 1–2 cm: 32%; >2 cm: 10%), frequentemente localizzato nel tratto medio-distale dell’arteria coronaria discendente anteriore (95%). Il ponte miocardico non rappresenta un fattore di rischio significativo di aterosclerosi coronarica (odds ratio 0,49) rispetto ai tradizionali fattori di rischio cardiovascolare. I segmenti prossimali mostrano: assenza di malattia (33%), rimodellamento positivo (27%), stenosi <50% (20%) o >50% (20%). Sono state visualizzate 12 placche non calcifiche, 32 miste e 17 calcifiche. Nei segmenti distali l’aterosclerosi non è rilevante (p<0,0001).ConclusioniLa AC-TCMS è una metodica non invasiva efficace nel dimostrare i ponti miocardici e le placche aterosclerotiche associate presenti nei segmenti prossimali.

Digital cineradiographic study of swallowing in patients with amyotrophic lateral sclerosis

PurposeThis study was performed to evaluate the usefulness of digital cineradiography in detecting swallowing disorders in dysphagic patients affected by amyotrophic lateral sclerosis (ALS) with a view to planning an adequate therapeutic approach.Material and methodsFrom January 2005 to September 2006, 23 patients (10 men and 13 women; mean age 41.3±8.6 years) affected by ALS were evaluated with digital cineradiography to assess the grade of dysphagia. All patients were classified using the Hillel ALS Severity Scale (ALSSS). All examinations were performed with radiocontrolled equipment provided with a digital C-arm.ResultsThe cineradiographic technique enabled us to differentiate patients with disorders of the oral (17/23) and/or pharyngeal (19/23) swallowing phase from those without swallowing dysfunction (4/23). In 14/23 patients, passage of contrast medium into the upper airways was observed during swallowing, whereas in 5/23 cases, aspiration of contrast medium into the lower airways was recorded.ConclusionsThe videofluoroscopic swallowing study has high diagnostic capabilities in the evaluation of swallowing disorders, as it is able to identify the degree and causes of impairment. In addition, the study proved useful for planning speech therapy and for follow-up in patients with ALS.RiassuntoObiettivoScopo del nostro lavoro è quello di valutare il ruolo della videofluorografia (VDFG) nell’identificazione delle alterazioni deglutitorie dei pazienti disfagici affetti da sclerosi laterale amiotrofica (SLA), anche al fine di programmare una adeguata pianificazione terapeutica.Materiali e metodiDal gennaio 2005 al settembre 2006, 23 pazienti (10 uomini e 13 donne; età media 41,3±8,6 anni) affetti da SLA e classificati secondo la classificazione ALS Severity Scale (ALSSS) di Hillel sono stati sottoposti a studio videofluorografico della deglutizione. Tutti gli esami sono stati eseguiti utilizzando un apparecchio telecomandato con arco a C digitale.RisultatiLa tecnica videofluorografica utilizzata ha permesso di differenziare i pazienti con alterazioni deglutitorie, 17/23 con alterazioni della fase orale e 19/23 con alterazioni della fase faringea (19/23 pazienti), da quelli che non presentavano alterazioni 4/23. In 14/23 pazienti sono stati evidenziati fenomeni di penetrazione del bolo in laringe, ed in 5/23 pazienti fenomeni di aspirazione del bolo al di sotto del piano glottico.ConclusioniLo studio videofluorografico della deglutizione è una tecnica dotata di elevata capacità diagnostica per la valutazione dei deficit deglutitori, essendo in grado di identificarne il grado di compromissione e le cause determinanti. Lo studio dinamico della deglutizione si è inoltre dimostrato utile nell’approccio alla terapia logopedica e nel follow-up dei pazienti affetti da SLA.

Pancreatic carcinoma versus chronic focal pancreatitis: contrast-enhanced power Doppler ultrasonography findings

BackgroundWe assessed the potential usefulness of contrast-enhanced power Doppler ultrasonography (US) for differentiating pancreatic carcinoma from chronic focal pancreatitis.MethodsTwenty-six consecutive patients with ductal carcinoma (n = 16) and chronic focal pancreatitis (n = 10) underwent power Doppler US examinations before and after intravenous injection of an air-based contrast agent (Levovist, Schering, Berlin, Germany). Final diagnosis was obtained by surgery in all patients. The following parameters before and after intravenous administration of contrast agent were evaluated for each lesion: number, morphology and course of the vessels within the lesion and time to maximum detectable enhancement. Number of the lesion vessels and time to maximum enhancement for each lesion were compared by with Student t test.ResultsAfter injection of contrast agent, nine of 16 (56.2%) carcinomas showed a larger total number of vessels (p < 0.005) and faster enhancement (p < 0.0001) compared with chronic focal pancreatitis. Irregular vessels with a serpiginous course that penetrated the tumor was predominant in carcinoma (eight of 16 cases), whereas focal pancreatitis presented mostly as avascular masses (five of 10 cases).ConclusionContrast-enhanced power Doppler US provides useful findings for differentiating pancreatic carcinoma from chronic focal pancreatitis.

Reversible effect of MR and ELF magnetic fields (0.5 T and 0.5 mT) on human lymphocyte activation patterns

Purpose: The aim of this study was to investigate the effects of magnetic fields (MF) of different intensity generated by a magnetic resonance (MR) unit (0.5 Tesla) and a double cylindrical coil (0.5 mTesla) on human CD4+ T cell lines. Materials and methods: CD4+ T cells were exposed for two hours under isothermal conditions (37 ± 0.5°C) to the above mentioned MF; a control group was provided for each exposed sample. After exposure, the samples were analysed in the laboratory for the following endpoints: Release of cytokines, expression of surface markers, cell proliferation and levels of cytosolic free-calcium. Results: Exposure to MF for 2 h and subsequent in vitro stimulation in the presence of the appropriate mitogen, caused a decrease of interferon-γ production, a decrease of cell proliferation, a decrease of expression of CD25 and a decrease of cytosolic free calcium concentration in exposed CD4+ T cell lines. Data obtained, were statistically significant when evaluated after 24 h of in vitro culture, but were not significant, for both types of MF, when the experimental groups were analysed after prolonged in vitro culture. Conclusion: These results indicate that static magnetic fields (SMF) can give rise to transient biological effects on T lymphocytes and the present system is a sensitive model for understanding the effects of MF on the immune system.

Prognostic outcome of routine clinical noninvasive multidetector-row computed tomography coronary angiography in patients with suspected coronary artery disease: a 2-year follow-up study

PurposeThe aim of the study was to assess the prognostic value of multidetector-row CT coronary angiography (MDCT-CA) in patients with suspected coronary artery disease (CAD) in a routine clinical context.Materials and methodsA total of 125 patients (82 men, age 57.4±10.3 years) with suspected CAD underwent MDCT-CA. All patients were assessed for cardiovascular risk factors, symptoms and coronary calcium score. A 2-year follow-up study for the occurrence of major adverse cardiac events was performed.ResultsAccording to the Morise pretest score, 76 patients (60.8%) were at intermediate risk. Patients with suspected CAD presented the following prognostic outcome (p<0.0001): in 41 patients with normal coronary arteries at MDCT-CA, the event rate was 0%; five of 49 patients with nonobstructive CAD had major cardiac events; two of 35 patients with obstructive CAD suffered cardiac death and 19 underwent revascularisation. At multivariate analysis, the presence of obstructive CAD is the only significant independent prognostic variable (hazard ratio, 10.1393; 95% confidence interval 3.2189–31.9379; p<0.0001).ConclusionsRoutine clinical MDCT-CA provides an excellent prognostic value at 2-year follow-up in patients with normal coronary arteries. The cardiac event rate increases with CAD severity.RiassuntoObiettivoScopo del nostro lavoro è stato quello di definire il valore prognostico della angiografia coronarica mediante tomografia computerizzata multistrato (AC-TCMS) in pazienti con sospetta malattia aterosclerotica coronarica (MAC) nella routine clinica.Materiali e metodiCentoventicinque pazienti (82 uomini, età media 57,4±10,3 anni) con sospetta MAC sottoposti ad AC-TCMS sono stati inclusi in un follow-up a 2 anni per eventi cardiaci maggiori. È stata effettuata una valutazione dei fattori di rischio, della sintomatologia ed una quantificazione del calcio coronarico.RisultatiSulla base del Morise pre-test score, 76 pazienti (60,8%) presentano rischio intermedio. I pazienti presentano il seguente outcome prognostico (p<0,0001): nessun evento in 41 pazienti con coronarie normali alla AC-TCMS; 5 eventi cardiaci maggiori fra i 49 pazienti con MAC non ostruttiva; 2 morti cardiache e 19 rivascolarizzazioni fra i 35 pazienti con MAC ostruttiva. La presenza di MAC ostruttiva è l’unica variabile prognostica indipendente significativa messa in evidenza dall’analisi multivariata (hazard ratio 10,1393, 95% intervallo di confidenza 3,2189–31,9379, p<0,0001).ConclusioniNella routine clinica la AC-TCMS presenta un eccellente valore prognostico a 2 anni in caso di coronarie normali. Il numero di eventi cardiaci maggiori aumenta con la severità della patologia riscontrata.

Heterogeneous delayed enhancement of hepatic parenchyma after intravenous infusion of sonographic contrast agent: a new hypothesis

Purpose.The aim of this paper was to report a heterogeneous latephase hepatic enhancement pattern observed after administration of a sonographic contrast agent and to present an aetiological hypothesis for the phenomenon.Materials and methods.A total of 1,729 (1,012 women and 717 men; age range 28–82; mean age 51) patients underwent contrastenhanced sonography of the liver. The examination was performed with a low mechanical index (MI <0.09) after injection of sulphur-hexafluoride-filled microbubbles, using different sonographic equipment and different contrast-specific algorithms.Results.Heterogeneous delayed liver enhancement was observed in six patients in the late phase (180 s), with the presence of multiple, partially confluent, hyperechoic areas peripheral to the portal vessels. The pattern appeared spontaneously between 1 and 4 h after the examination and was associated with the presence of an anomalous echogenicity in the superior mesenteric vein. No patient experienced adverse reactions.Conclusions.The phenomenon of heterogeneous hepatic enhancement may be related to gas from the intestinal microcirculation being transported to via the enteroportal circulation and becoming trapped in the hepatic sinusoids.

Biologic Effects of Ultrasound on Liver Cells of Rat Embryos

Experiments on the biologic effects of ultrasound (US) were carried out on rat embryos exposed for 120 s to a US beam showing features similar to those already employed for diagnostic purposes. Electron microscopic investigation of the liver parenchyma of rat embryos confirmed results obtained from adult guinea pigs with the same duration of exposure, i.e. diffuse vacuolization of cytoplasma and varying degrees of mitochondrial damage.

Orbital varices: a tricky diagnosis in MRI

Orbital varix (OV) is a rare condition causing intermittent positional exophthalmos. Because of low venous pressure, OVs tend to collapse, being frequently undetectable in routine CT or MRI examinations. We describe one case of giant intraorbital varix studied with CT and MRI techniques.