G. Mazzone

Contrast-enhanced colour-Doppler sonography versus pH-metry in the diagnosis of gastro-oesophageal reflux in children

PurposeThe aim of this study was to evaluate the accuracy of contrast-enhanced colour-Doppler ultrasound (CDUS) in the diagnosis of gastro-oesophageal reflux in children.Materials and methodsOne hundred and twenty children (68 boys and 52 girls aged between 1 month and two years) with a clinical suspicion of gastro-oesophageal reflux (postprandial vomiting, weight loss, failure to thrive, anaemia, night-time coughing and crying, regurgitation, etc.) were studied by contrast-enhanced CDUS and subsequently by 24-hour pH-metry. Results of the two techniques were compared using the McNemar test.ResultsGastro-oesophageal reflux was detected on CDUS in 84 patients and with 24-h pH-metry in 86. In all cases of reflux, CDUS visualised the passage of contrast material from the stomach into the abdominal and middle and distal third of the thoracic oesophagus, enabling assessment of the segment of oesophagus involved by the reflux. Compared with pH-metry, CDUS had a sensitivity of 98% (p<0.0001 with McNemar’s test).ConclusionsIn consideration of the results obtained and particularly of the low level of invasiveness, contrast-enhanced CDUS could be used to monitor children undergoing medical or surgical treatment for the complications of gastro-oesophageal reflux disease.RiassuntoObiettivoLo scopo di questo lavoro è la valutazione dell’accuratezza diagnostica dell’eco-color Doppler con mezzo di contrasto nella diagnosi del reflusso gastroesofageo nel bambino.Materiali e metodiCentoventi bambini, 68 maschi e 52 femmine, con età compresa tra 1 mese e 2 anni, con sospetto di reflusso gastro-esofageo all’esame clinico (vomito post-prandiale, perdita di peso, ritardo di crescita, anemia, tosse e pianto notturno, rigurgiti, ecc.), sono stati sottoposti ad esame con eco-color Doppler con MdC e successivamente con pH-metria nelle 24 ore. Il confronto dei risultati è stato eseguito con il McNemar test.RisultatiIl reflusso gastro-esofageo è stato evidenziato in 84 pazienti con l’ecografia e in 86 con la pH-metria nelle 24 ore. Il color Doppler ha evidenziato in tutti i casi di reflusso il passaggio del MdC dallo stomaco nel tratto addominale e nel terzo medio e distale del tratto toracico dell’esofago permettendo la valutazione della porzione di esofago interessata dal reflusso. Confrontato con la pH-metria, l’esame ecografico ha dimostrato sensibilità del 98% (p<0,0001 con il McNemar test).ConclusioniIn base ai risultati ottenuti e soprattutto in virtù della scarsa invasività, la suddetta metodica ecografica potrebbe essere utilizzata nel monitoraggio dei bambini con malattia da reflusso gastro-esofageo sottoposti a terapia medica o chirurgica delle complicanze del reflusso gastro-esofageo.

Functional study of the transplanted kidney with power Doppler US and time/intensity curves

Purpose.Power Doppler ultrasound (US) with time-intensity curves was used to study renal graft function both in the absence of disease and with complications (acute tubular necrosis and chronic rejection) in an attempt to identify pathognomonic patterns. Time-intensity curves allow representation of the kidneys’ wash-in and wash-out phases after intravenous administration of sonographic contrast material.Materials and methods.Fifty-six asymptomatic renal transplant patients (36 men and 20 women), 19 of whom had altered creatinine clearance levels, were studied by power Doppler US with time-intensity curves followed by biopsy. Ten asymptomatic patients with normal creatinine clearance levels were used as controls.Results.Time-intensity curve analysis enabled identification of three groups of patients: group A, consisting of 27 patients showing peak enhancement between 50 and 65 s from intravenous administration of contrast material; group B, consisting of 16 patients with peak enhancement between 135 and 235 s; group C, consisting of three patients with peak enhancement between 100 and 130 s.Conclusions.Data showed significant variations according to renal graft function (no abnormality, acute tubular necrosis or chronic rejection). Although confirmation by a larger series is required, our findings appear to indicate pathognomonic patterns in patients with chronic rejection and acute tubular necrosis.

Power Doppler ultrasonography with time-signal intensity curves in monitoring hepatocellular carcinoma and liver metastases after intralesional therapy.

PurposeAnalysis of time-intensity curves allows evaluation of the patterns of lesion enhancement before and after treatment. The aim of this study was to evaluate the diagnostic accuracy of time-intensity curves in monitoring intralesional therapy of focal hepatic lesions.Materials and methodsTwenty patients underwent intralesional therapy with either radiofrequency thermal ablation or percutaneous ethanol injection. Contrast-enhanced power Doppler ultrasound with analysis of timeintensity curves was performed one day before and one day after treatment. Targeted biopsy was then obtained to confirm the imaging findings.ResultsBefore treatment, all lesions showed time-intensity curves characterised by high peaks of signal intensity and plateaus. Complete tumour necrosis, confirmed by targeted biopsy, was observed in patients showing no intralesional flow signals and time-intensity curves with low peak of signal intensity and absence of plateau after treatment. Biopsy confirmed the presence of residual neoplastic tissue in one patient exhibiting perilesional vascularity, absence of intralesional flow signals, and a time-intensity curve with high peak of signal intensity and plateau.ConclusionsAccording to our findings, time-intensity curves characterised by high peak of signal intensity and plateau might reflect the presence of perilesional or intralesional neoplastic tissue and provide important information on the effectiveness of the treatment.RiassuntoObiettivoObiettivo di questo lavoro è la valutazione dell’accuratezza diagnostica delle curve intensità/tempo nel monitoraggio del trattamento intralesionale delle lesioni focali epatiche. Le curve intensità/tempo ci permettono di studiare la dinamica di enhancement delle lesioni prima e dopo il trattamento intralesionale.Materiali e metodiVenti pazienti sono stati sottoposti a trattamento intralesionale con termoablazione mediante radiofrequenza o alcoolizzazione percutanea. Prima del trattamento e dopo 1 giorno è stato eseguito il controllo ecografico con power Doppler e curve intensità/tempo. Per verificare i dati ottenuti è stata eseguita la biopsia mirata.RisultatiPrima dei trattamenti tutte le lesioni presentavano curve intensità/tempo con elevato picco di intensità e presenza di plateau. Dopo il trattamento, nei pazienti che presentavano assenza di segnali vascolari intralesionali, curve con basso picco di intensità e assenza di plateau, la biopsia mirata confermava la necrosi completa. In un paziente che presentava, dopo il trattamento, vascolarizzazione perilesionale, assenza di segnali vascolari intralesionali e curva intensità/tempo con elevato picco di intensità e plateau, la biopsia confermava la persistenza di tessuto neoplastico.ConclusioniIn base ai risultati ottenuti, le curve con elevato picco di intensità e presenza di plateau, potrebbero rappresentare pattern del tessuto neoplastico intra o perilesionale e fornire quindi importanti informazioni sull’efficacia del trattamento.

VOIDING COLOR DOPPLER US IN THE STAGING OF VESICO-URETERAL REFLUX

Purpose: The aim of this study is to assess the accuracy of US contrast agent in ultrasonographic investigation of early diagnosis and staging of vesico-ureteral reflux. Methods and Materials: One hundredtwentytwo patients suffering of pyelocaliceal dilatation,urinary tract infections and miscellaneous diseases underwent voiding color Doppler US, followed by a cystourethrographic test. The voiding color Doppler US consists in trans-catheter introduction of a contrast agent (Levovist, Schering, AG,Berlin) into the bladder and a subsequent test with the color Doppler US to show or exclude the presence of reflux. After the introduction of the US contrast agent superpubic scans of the bladder, ureters and pielo-caliceal cavity were performed in order to evaluate reflux degree. The ultrasonographic investigations were performed with the AU 5 IDEA scan (Esaote) with a 3,5MHz convex probe. Results: In 118 patients we observed a superimposibility of results between voiding color Doppler US and cystourethrographic test (4 false positives): sensitivity 100%, specificity 90%. Conclusions: According to the data obtained, voiding color Doppler US could be used as an alternative technique to the cystourethrographic test because of the lack of risks due to ionizing radiations.