L. Calderan

US Characterization of Focal Hepatic Lesions with Intermittent High-Acoustic-Power Mode and Contrast Material

RATIONALE AND OBJECTIVES This study was performed to determine whether ultrasound (US) performed with SonoVue, a contrast agent that contains microbubbles filled with sulfur hexafluoride vapor, depicts differential patterns of contrast enhancement in focal hepatic lesions. MATERIALS AND METHODS Forty focal hepatic lesions (15 hepatocellular carcinomas [HCCs], 10 metastases, 11 hemangiomas, and four focal nodular hyperplasias) in 39 patients were evaluated by means of US, color Doppler US, and contrast-enhanced US performed by using intermittent high-acoustic-power mode. Contrast-enhanced helical computed tomography (11 patients) and US-guided fine needle aspiration (28 patients) were used as reference procedures. Contrast enhancement patterns were defined by means of both subjective and objective analysis, and baseline and contrast-enhanced US scans were reviewed offline. RESULTS Thirteen of 15 HCCs, eight of 10 metastases, and all four hemangiomas with an atypical pattern at baseline US were correctly characterized after SonoVue injection. Two of 15 HCCs and two of 10 metastases remained indeterminate, with no characteristic baseline or contrast-enhanced patterns identified. Baseline US was essential in characterizing all hemangiomas with a typical pattern (n = 7), and color Doppler US with spectral analysis of tumoral vessels was essential in characterizing focal nodular hyperplasia. The percentage of diagnostic agreement with reference procedures was significantly increased (P < .001) for contrast-enhanced US compared with baseline US. CONCLUSION Characteristic patterns of US contrast enhancement with SonoVue help in characterizing and differentiating focal hepatic lesions.

US, colour-Doppler US and fine-needle aspiration biopsy in the diagnosis of thyroid nodules

PurposeThe purpose of this study was to correlate the diagnosis of benign or malignant thyroid nodules obtained with grey-scale ultrasound (US) and colour-Doppler US with the cytological findings after US-guided fine-needle aspiration (FNA).Materials and methodsBetween January 2004 and June 2005, 516 thyroid nodules in 420 patients (181 solitary thyroid nodules and 239 multiple nodules) were prospectively evaluated with US, colour-Doppler US and US-guided FNA. The nodules were classified as sonographically benign, suspicious or malignant in accordance with established US criteria. Cytological findings were classified as inadequate, benign, indeterminate, suspicious or malignant. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of US and colour-Doppler US were evaluated using FNA as the reference procedure.ResultsThe sensitivity, specificity, PPV, NPV and overall accuracy values of grey-scale US were 46%, 73%, 34%, 82% and 67%, respectively, for solitary thyroid nodules and 35%, 72%, 14%, 90% and 68%, respectively, for multiple nodules. The evaluation of nodule vascularity with colour-Doppler US produced a slight increase in sensitivity but a slight reduction in specificity.ConclusionsThyroid nodules cannot be accurately characterised using grey-scale US or colour-Doppler US.RiassuntoObiettivoCorrelare la diagnosi ecografica ed eco-color Doppler di benignità o di malignità del nodulo tiroideo con i risultati della citologia dopo agoaspirazione ecoguidata.Materiali e metodiNel periodo tra gennaio 2004 e giugno 2005 sono stati valutati prospetticamente con ecografia, eco-color Doppler e agoaspirazione sotto guida ecografica 516 noduli tiroidei in 420 pazienti (181 pazienti portatori di un nodulo solitario e 239 pazienti con noduli multipli). I noduli sono stati classificati come ecograficamente benigni, sospetti o maligni utilizzando i criteri stabiliti in letteratura. I risultati della citologia sono stati classificati come inadeguati, benigni, indeterminati, sospetti, maligni. Sono stati calcolati i valori di sensibilità, specificità, valore predittivo positivo (VPP), valore predittivo negativo (VPN) e accuratezza diagnostica dell’ecografia e dell’ecografia associata a eco-color Doppler, utilizzando come indagine di riferimento la citologia.RisultatiNei pazienti con nodulo tiroideo solitario i valori di sensibilità, specificità, VPP, VPN e accuratezza diagnostica dell’ecografia in scala dei grigi sono risultati rispettivamente del 46%, 73%, 34%, 82% e 67%. Nei pazienti con multipli noduli i valori sono risultati rispettivamente del 35%, 72%, 14%, 90% e 68%. La valutazione della vascolarizzazione dei noduli al color Doppler ha portato ad un modesto aumento della sensibilità nella caratterizzazione dei noduli, ma ad una riduzione della specificità.ConclusioniL’ecografia e l’eco-color Doppler non consentono di caratterizzare accuratamente il nodulo tiroideo.

Imaging of penile traumas--therapeutic implications.

Injury to the penis may result from penetrating or nonpenetrating trauma. Nonpenetrating injury to the erect penis can produce albugineal tear, intracavernous hematoma or extraalbugineal hematoma from rupture of the dorsal vessels. Nonpenetrating injury to the flaccid penis usually follows blunt perineal traumas producing extratunical or cavernosal haematomas, or cavernosal artery tear followed by high flow priapism. Differential diagnosis between albugineal tear and other penile injuries must be obtained as soon as possible, since early surgical repair of albugineal tear reduces significantly the rate of postraumatic curvature and fibrosis. Ultrasonography (US) is able to detect the exact site of the tear in most patients as an interruption of the thin echogenic line of the tunica albuginea. Other imaging techniques are rarely required in the clinical practice. Color Doppler US is the imaging modality of choice to evaluate patients with high flow priapism. Focal or diffuse cavernosal fibrosis can be identified with US as echogenic areas in the cavernosal bodies. Postraumatic erectile dysfunction can result from fibrotic changes, nerve and vascular impairment or both. Doppler evaluation of penile vasculature is required in young patients with postraumatic impotence before surgical revascularization procedures.

Patologie dello scroto

Il paziente anziano e spesso coinvolto in un complesso di patologie multiorgano che possono manifestarsi con il rilievo clinico di una tumefazione scrotale o con la sintomatologia dello scroto acuto. Le tumefazioni scrotali possono essere dovute a un aumento di spessore della parete dello scroto, o ad aumento di volume del contenuto scrotale per la presenza di idrocele, di grosse cisti dell’epididimo, o di lesioni infiammatorie granulomatose o croniche. Nell’anziano le neoplasie del testicolo sono piu rare che nel giovane e i tumori non germinali prevalgono su quelli della serie germinale. Il varicocele, frequente nel giovane, e piuttosto raro nell’anziano ed e spesso secondario ad altre patologie. Mentre nel giovane con scroto acuto la diagnosi differenziale riguarda soprattutto la torsione testicolare e la patologia flogistica, nell’anziano la torsione testicolare e piu rara dell’ernia strozzata e degli infarti lobulari. L’ecografia rappresenta l’indagine di scelta nella valutazione della patologia dello scroto; la combinazione dei reperti ecografici e clinici consente di raggiungere la diagnosi corretta nella maggior parte dei casi.