Francesco Saverio Ferrari

Supraspinatus tendon tears: comparison of US and MR arthrography with surgical correlation

Abstract. The aim of this study was to compare the diagnostic reliability of US with MR arthrography in diagnosing supraspinatus tendon tears. Surgical findings were used as the gold standard in detecting tears. A total of 44 patients were assessed with transverse and longitudinal US scans with respect to the long axis of the rotator cuff tendons and then examined with MR arthrography. This technique involved free-hand injection of contrast medium into the shoulder joint. At surgery 20 incomplete and 24 complete tears were observed. Ultrasound offered good results for the large tears, but its sensitivity decreased proportionally with the size of the tears. Magnetic resonance arthrography correctly diagnosed 43 tears, whereas only one false-negative diagnosis of tendinosis was made for a partial tear on the bursal side. Since it improves the diagnosis of small tears, MR arthrography must be performed on all patients for whom surgical repair is necessary in order to restore normal functions.

Treatment of small HCC through radiofrequency ablation and laser ablation. Comparison of techniques and long-term results

AbstractPurpose.The aim of this trial was to compare the results obtained using laser ablation (LA) and radiofrequency ablation (RFA) to treat small hepatocellular carcinomas (HCC).Materials and methods.From 2003 to 2005, a total of 81 cirrhotic patients (59 Child-Pugh A, 22 Child-Pugh B) presenting a total of 95 HCC nodules (mean diameter 27.9 mm) were treated with LA (41) and RFA (40).Results.Computed tomography (CT) revealed complete tumour ablation in 78% of nodules treated with LA and in 94% of those treated with RA; the disease-free interval was 16.50±8.1 months. The cumulative survival rates were 91.8%, 59% and 28.4% at 12, 36 and 60 months, respectively. The patients treated with RFA had better survival rates than those treated with LA, although this difference was not statistically significant (p=0.3299). Univariate analysis of survival revealed statistically significant differences between the Child-Pugh A and B groups (p<0.0001), between HCC nodules measuring ≤25 mm and >25 mm (p=0.0001) and between patients with a single nodule and with two nodules (p=0.0484).Conclusions.We found LA and RFA to be equally effective. However, RA appears more suited to patients with small HCC nodules and in Child-Pugh class A.

Ultrasound and magnetic resonance imaging in sports-related muscle injuries

Purpose.The objective of this study was to evaluate the role of magnetic resonance imaging (MRI) and ultrasonography (US) in the diagnosis of traumatic muscle injuries.Materials and methods.From June 2003 to June 2004, 81 football players with a history of traumatic muscle injuries to the lower limbs were examined. US was performed shortly after the trauma (from 6 to 72 h afterwards) and MRI within a maximum of 5 days.Results.MRI revealed 26 minor and 55 major traumas. MRI and US showed complete concordance in 71 patients (site, type and extent of injury). US produced ten false negative results, including six minor lesions and four major lesions. US had a sensitivity of 87.65% in the correct identification of muscle injuries; its sensitivity was 92.72% for major lesions and 76.92% for minor lesions, 57% for delayed-onset muscle soreness (DOMS), 80% for lengthenings, 83% for contractures, 84% for strains, 87.5% for mild contusions and 100% for severe contusions.Conclusions.US is the first-line technique for examination of muscle injuries. MRI is able to reveal lesions that may be missed at US and provide a more accurate assessment of site and extent of injury.

Treatment of small hepatocellular carcinoma: a comparison of techniques and long-term results.

Objective The aim of this study was to compare the results over time of transcatheter arterial chemoembolization (TACE), percutaneous ethanol injection (PEI), laser thermal ablation (LTA) and combined therapy in the treatment of small hepatocellular carcinoma. Methods Between 1998 and 2004, 131 cirrhosis patients (99 Child–Pugh class A, 32 Child–Pugh class B) with a small hepatocellular carcinoma were included in the study; 34 were treated with PEI, 46 with LTA, 18 with TACE and 33 with combined therapy. Results No major complication occurred during any procedure. Computed tomography scan showed that complete necrosis was achieved in 81% of treated nodules (120 out of 148); as a whole, the disease relapsed in 42 (32.0%) patients (with a disease-free interval of 17.0±13.7 months). The cumulative survival rates were 81.9, 35.7 and 20.8% at 12, 36 and 60 months respectively. A univariate analysis of survival showed statistically significant differences in the comparison between Child–Pugh class A with respect to Child–Pugh class B (P<0.0001) and between nodules with a diameter of 20 mm or less as opposed to larger than 20 mm (P=0.001). Patients subjected to LTA showed a statistically significant longer survival than those treated with TACE and PEI. Conclusions LTA proves to be the most effective treatment, affording reduced invasiveness, a limited number of sessions, complete necrosis in almost all cases and better total survival in the treated patients.

Pancreatic cystadenocarcinoma: diagnostic problems

Eleven cases of pancreatic cystadenocarcinoma were studied with respect to the differential diagnosis from that of pancreatic pseudocysts, using diagnostic ultrasound as the initial investigative technique. Most of the cases presented an ultrasonic picture that correlated well with the gross pathology, but this correlation was not reliable enough to be considered characteristic in differentiating such masses from pseudocysts. The authors divide the cystadenocarcinomas of the pancreas into four echographic classes. In all but one of the classes, diagnostic ultrasound was insufficient by itself to render an accurate diagnosis. In such cases other techniques, i.e. CT, tissue biopsy, and especially angiography, were required for a reliable diagnosis.

Interstitial Laser Photocoagulation of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the most frequently occurring type of primary liver tumor. It may appear ex novo in an apparently healthy liver without previous evidence of macro regeneration nodules or, more frequently, in cases of chronic liver disease, especially cirrhosis (Franco 1990). In Italy HCC is found to occur in approximately 3% of cirrhotic patients, while the liver tumors most frequently observed in oncology are metastatic. Autopsy-based research performed between 1905 and 1973 confirmed the presence of hepatic metastases in 24–36% of patients deceased due to malignancies (Bengmark and Hafstrom 1969; Wilkes 1973; Colombo et al. 1991; Wolf et al. 1991).