Giuseppe Salvaggio

Bladder Tumor Staging: Comparison of Contrast-Enhanced and Gray-Scale Ultrasound

OBJECTIVE The purpose of this study was to evaluate the effectiveness of contrast-enhanced sonography in comparison with conventional sonography in differentiating muscle-infiltrating and superficial neoplasms of the urinary bladder. SUBJECTS AND METHODS Conventional and contrast-enhanced sonography were performed on 34 consecutively registered patients with bladder tumors. All examinations were reviewed by two independent sonologists. At gray-scale sonography, interruption of the hyperechoic bladder wall was considered the main diagnostic criterion for differentiating superficial and infiltrating tumors. At contrast-enhanced sonography, a tumor was considered superficial when the hypoenhancing muscle layer of the bladder wall was intact; disruption of the muscle layer by enhancing tumor tissue was considered diagnostic of infiltration. A level of confidence in the diagnosis of tumor infiltration of the muscle layer was assigned on a 5-degree scale. Receiver operating characteristic analysis was used to assess overall confidence in the diagnosis of muscle infiltration by tumor at both conventional and contrast-enhanced sonography. Histologic diagnosis was obtained for all patients. RESULTS Final pathologic staging revealed 25 superficial tumors (Ta-T1 disease) and nine muscle-infiltrating tumors (>T1). Conventional sonography depicted five of nine muscle-infiltrating tumors, and contrast-enhanced sonography depicted all nine. The diagnostic performance of contrast-enhanced sonography approached that of the reference standard (area under the receiver operating characteristic curve, 0.996), but the diagnostic performance of gray-scale ultrasound was worse (area under curve, 0.613). CONCLUSION Our study showed that contrast-enhanced sonography is better than conventional sonography for differentiating muscle-infiltrating and superficial neoplasms of the urinary bladder.

Imaging appearance of treated hepatocellular carcinoma

Surgical resection and imaging guided treatments play a crucial role in the management of hepatocellular carcinoma (HCC). Although the primary end point of treatment of HCC is survival, radiological response could be a surrogate end point of survival, and has a key role in HCC decision-making process. However, radiological assessment of HCC treatment efficacy is often controversial. There are few doubts on the evaluation of surgical resection; in fact, all known tumor sites should be removed. However, an unenhancing partial linear peripheral halo, in most cases, surrounding a fluid collection reducing in size during follow-up is demonstrated in successfully resected tumor with bipolar radiofrequency electrosurgical device. Efficacy assessment of locoregional therapies is more controversial and differs between percutaneous ablation (e.g., radiofrequency ablation and percutaneous ethanol injection) and transarterial treatments (e.g., conventional transarterial chemoembolization, transarterial chemoembolization with drug eluting beads and radioembolization). Finally, a different approach should be used for new systemic agent that, though not reducing tumor mass, could have a benefit on survival by delaying tumor progression and death. The purpose of this brief article is to review HCC imaging appearance after treatment.

Imaging of Hepatic Focal Nodular Hyperplasia: Pictorial Review and Diagnostic Strategy

Focal nodular hyperplasia (FNH) is the second most common benign solid liver lesion after hemangioma, occurring more frequently in young women. The prime differential diagnoses include hepatocellular adenoma, hepatocellular carcinoma, and hypervascular metastasis. As the management of FNH is typically conservative, imaging plays a key role in diagnostic pathway, and misdiagnosis may have a major clinical effect. In this article, we describe the ultrasound, computed tomography, and magnetic resonance imaging features of FNH, underlining the importance of typical radiological features that allow a specific noninvasive diagnosis. We present a large spectrum of a typical imaging findings that FNH may present and discuss the up-to-date diagnostic strategy.

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.

Nuclear Medicine Methods in Scrotal Imaging

In patients with acute scrotal pain scrotal scintigraphy can be used to exclude torsion of the testicle, which presents with unilateral decrease in activity on the affected side.The role of nuclear medicine methods, however, faded in the last years after the introduction of high performance color Doppler ultrasound equipment. Lymphoscintigraphy can be used in patients with testicular cancer to demonstrate the lymphatic drainage pathway of the neoplasm. Several studies suggest that 18FDG-PET/CT might have a role in the staging germ cell tumors, in identification of recurrent/residual disease, to monitor the treatment response and during the follow-up. Other investigations, however, did not confirm these results.