Francesco Giovagnorio

Evaluation of vascular patterns of cervical lymph nodes with power Doppler sonography

Power Doppler sonography was used to evaluate 105 benign and malignant cervical lymph nodes in 60 patients. Three main vascular patterns were identified: type I (single vascular pole), type II (hypertrophic vascular pole), and type III (mainly peripheral vascularity). The first one was related to chronic inflammation (sensitivity 85%, specificity 90%); the second and third were related, to a lesser extent, to acute inflammation and neoplasm (sensitivity 68% and 55%, specificity 47% and 91%, respectively). The authors conclude that the sensitivity and specificity of power Doppler sonography cannot compete with those of fine‐needle aspiration biopsy in the diagnosis of adenopathy.

Color Doppler sonography of focal lesions of the skin and subcutaneous tissue.

We evaluated with color Doppler sonography 71 visible and palpable nodules of the skin and subcutaneous tissue from 51 patients. The nodules were classified as avascular (type I), hypovascular with a single vascular pole (type II), hypervascular with multiple peripheral poles (type III), and hypervascular with internal vessels (type IV). Of the 32 malignant nodules, 9% showed a type I pattern, 50% had a type III pattern, and 41% had a type IV pattern; of the 39 benign nodules, 86% showed a type I pattern and 14% had a type II pattern. The sensitivity and specificity of hypervascularity in malignant lesions were 90% and 100%, respectively, whereas the sensitivity and specificity of hypovascularity in benign lesions were 100% and 90%, respectively. The authors conclude that color Doppler sonography is able to increase the specificity of ultrasonography in the evaluation of nodular lesions of the skin.

Ultrasonographic evaluation of de Quervain disease.

De Quervain disease is a job‐related tenosynovitis that affects the synovial sheath of the tendons of the abductor pollicis longus and extensor pollicis brevis muscles; it is associated with pain and functional impairment and progresses to cause local fibrosis with blockage or triggering of the thumb. High‐resolution ultrasonography of the wrist was performed in eight patients with de Quervain disease; the examination was performed in axial and coronal scans with a 13 MHz linear transducer. The evaluation of normal wrists helped to define the normal sonographic anatomy of the first extensor compartment; obvious changes of the tendon sheath were noted in all cases of de Quervain disease (thickening and edema of the synovial sheath and fluid within the sheath). We conclude that ultrasonography is able to confirm the clinical diagnosis of de Quervain disease and may have a role in the follow‐up of this disorder.

Color Doppler Sonography in the Evaluation of Superficial Lymphomatous Lymph Nodes

We performed a retrospective study to document the sonographic and color Doppler characteristics of lymphomatous superficial lymph nodes.

Color and pulsed Doppler evaluation of benign and malignant adenopathy

A color and pulsed Doppler evaluation of 140 benign and malignant lymphnodes in 85 patients has been performed: The nodes have been classified into non-vascularized (flow-), normal-vascularized (flow +), and hypervascularized (flow +2); we also considered the presence of central or peripheral flow. Resistivity index was also measured. The only parameters showing statistical significance were flow - and flow +. The authors conclude that there is a higher probability of benignancy than malignancy in an avascular node, while the opposite is true in a node with moderate flow.

Ultrasonography in Follow-up of Soft Tissue Augmentation of the Face with Synthetic Materials: a Pilot Study

Purpose: To assess ultrasonography in the evaluation of reactions after soft tissue augmentation of the face with synthetic materials. Material and Methods: Six female patients (mean age 39±8 years) treated for facial tissue augmentation noticed unpleasant or painful effects in the intervention site after a mean of 24 months were evaluated with ultrasonography. Two patients had been treated with injections of microparticles, two with Gore-Tex implants, and two had been injected with liquid silicone. Fifteen female patients (age 27-55 years, mean 41±14 years) who had received the same treatment 14-48 months before without any complications were also evaluated and used as controls. Biopsy was performed in all patients, while four underwent re-intervention. Results: In all patients with Gore-Tex implants, a thick, homogeneous hypoechoic halo was seen surrounding the implants. Small hypoechoic nodules were noticed in the patients who had been treated with microparticles and with liquid silicone. In two cases treated with liquid silicone the subcutaneous tissue was invaded by an irregular area of marked inhomogeneity. Conclusion: Sonography must be considered the method of choice for producing instrumental evidence of foreign body reactions after soft tissue augmentation of the face with synthetic materials.

Sonography of lacrimal glands in Sjögren syndrome.

This study evaluates the potential role of high resolution sonography and color Doppler sonography in the evaluation of the lacrimal glands in Sjögren syndrome. We examined 15 women (age range, 52‐73 years) affected by Sjögren syndrome and 15 women with no history and signs of lacrimal disease (age range, 47‐75 years). The lacrimal glands were visualized bilaterally in 6 of 15 patients. The lacrimal artery was detectable in all patients; the resistive index was higher than normal (0.72±0.04). An abnormal Schirmer test was present in six of six patients with visible glands and in two of nine patients with invisible glands; xerophthalmia was present in six of six patients with visible glands and in four of nine patients with invisible glands; high levels of serum immunoglobulins were present in six of six patients with visible glands and in three of nine patients with invisible glands. Sonography is able to provide noninvasively much of the information needed by the clinician.

US and color Doppler findings in angiolymphoid hyperplasia with eosinophilia involving the superficial temporal artery.

Reported here is a 60-year-old man with multiple localizations of angiolymphoid hyperplasia with eosinophilia (ALHE) in the temporal region, involving the superficial temporal artery, detected and analyzed with ultrasound and color Doppler. The usefulness of this diagnostic technique and the peculiar signs of ALHE are discussed.

64-slice MDCT arthrography in shoulder instability: our experience

PurposeThis study was performed to assess the diagnostic accuracy of air-contrast 64-slice multidetector computed tomography (MDCT) arthrography in the evaluation of glenohumeral joint instability by comparison with conventional arthroscopy.Materials and methodsFifty patients with a history of shoulder instability underwent MDCT arthrography with thin collimation scans. The raw data were transferred to a workstation and processed using multiplanar reformation (MPR) and volume rendering (VR) algorithms. All patients subsequently underwent conventional arthroscopy. The results of the two techniques were compared and their sensitivity and specificity calculated.ResultsWe diagnosed eight anterosuperior labrum lesions (group 1), 32 anteroinferior labrum lesions (group 2) and two posterior labrum lesions (group 3). Overall sensitivity and specificity (groups 1, 2, 3) were 88% and 100%, respectively. In group 1, sensitivity was only 66% (four false negatives), whereas in groups 2 and 3, it was 94% (two false negatives) and 100%, respectively. The labrum lesions were also found to be associated, with 100% sensitivity and specificity, with 20 lax capsules, 17 Hill-Sachs lesions, five Bankart lesions, two Perthes lesions and three complete rotator-cuff tears.ConclusionsAir-contrast MDCT arthrography is fast, reproducible, well tolerated and very accurate in the evaluation of lesions causing shoulder instability.RiassuntoObiettivoValutare l’accuratezza diagnostica dell’artro-TCMD gassosa di spalla, con TC volumetrica 64 strati, a confronto con l’artroscopia.Materiali e metodiAbbiamo eseguito 50 artro-TC gassose per instabilità di spalla, utilizzando scansioni a collimazione sottile; i dati grezzi sono stati trasferiti ad una workstation e rielaborati con algoritmi di riformattazione multiplanari (MPR) e di rendering volumetrici (VR). Successivamente è stato eseguito l’esame artroscopico convenzionale e i risultati delle due metodiche sono stati confrontati calcolando sensibilità e specificità.RisultatiAbbiamo diagnosticato 8 lesioni del cercine anterosuperiore (I gruppo); 32 lesioni del cercine antero-inferiore (II gruppo); 2 lesioni del cercine posteriore (III gruppo). La sensibilità e specificità complessive (I-II-III gruppo) sono risultate rispettivamente dell’88% e del 100%. Nel I gruppo la sensibilità è stata solo del 66% (4 falsi negativi). La sensibilità nel II e III gruppo è risultata rispettivamente del 94% (2 falsi negativi) e del 100%. Associate alle varie lesioni del cercine, abbiamo inoltre riscontrato con una sensibilità e specificità del 100%: 20 capsule ampie; 17 lesioni di Hill-Sachs; 5 fratture di Bankart ossea; 2 lesioni di Perthes; 3 rotture complete della cuffia dei rotatori.ConclusioniL’artro-TCMD gassosa è rapida e ripetibile, ben tollerata panoramica e molto accurata nella valutazione delle lesioni inducenti un quadro di instabilità.

Primary colonic lymphoma: An incidental finding in a patient with a gallstone attack

We report a case of primary colonic lymphoma incidentally diagnosed in a patient presenting a gallbladder attack making particular attention on the diagnostic findings at ultrasound (US) and total body computed tomography (CT) exams that allowed us to make the correct final diagnosis. A 85-year-old Caucasian male patient was referred to our department due to acute pain at the upper right quadrant, spreaded to the right shoulder blade. Patient had nausea and mild fever and Murphys maneuver was positive. At physical examination a large bulky mass was found in the right flank. Patient underwent to US exam that detected a big stone in the lumen of the gallbladder and in correspondence of the palpable mass, an extended concentric thickening of the colic wall. CT scan was performed and confirmed a widespread and concentric thickening of the wall of the ascending colon and cecum. In addition, revealed signs of microperforation of the colic wall. Numerous large lymphadenopathies were found in the abdominal, pelvic and thoracic cavity and there was a condition of splenomegaly, with some ischemic outcomes in the context of the spleen. No metastasis in the parenchimatous organs were found. These imaging findings suggest us the diagnosis of lymphoma. Patient underwent to surgery, and right hemicolectomy and cholecystectomy was performed. Histological examination confirmed our diagnosis, revealing a diffuse large B-cell lymphoma. The patient underwent to Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisone chemotherapy showing only a partial regression of the lymphadenopathies, being in advanced stage at the time of diagnosis.