Laura Romanini

Acoustic Radiation Force Impulse (ARFI) ultrasound imaging of solid focal liver lesions

OBJECTIVE The aim of this paper was to evaluate the application of ARFI ultrasound imaging and its potential value for characterizing focal solid liver lesions. MATERIALS AND METHODS In this multicentric prospective study, over a total non-consecutive period of four months, all patients underwent ARFI US examination. Two independent operators performed 5 measurements per each lesion and 2 measurements in the surrounding liver. According to the definitive diagnosis, a mean velocity value and standard deviations were obtained in each type of focal solid lesion, compared by using t-test, and the inter-operator evaluation was performed by using the Students t-test. A comparison between the total mean values of each type of lesion and the mean value of the parenchyma was performed. RESULTS 40 lesions were evaluated and a total of 400 measurements were obtained. The lesions were: 6/40(15%) hepatocellular carcinomas, 7/40(17.5%) hemangiomas, 5/40(12.5%) adenomas, 9/40(22.5%) metastases and 13/40(32.5%) focal nodular hyperplasias. The total mean values obtained were: 2.17 m/s in HCCs, 2.30 m/s in hemangiomas, 1.25 m/s in adenomas, 2.87 m/s in metastases and 2.75 m/s in FNHs. The inter-operator evaluation resulted non-statistically different (p>0.05). A significant difference (p<0.05) was always found by comparing adenomas to the other lesions. 160 measurements were obtained in the surrounding parenchyma, with a no significant difference between values measured in adenomas and in the surrounding liver. CONCLUSIONS ARFI technology with Virtual Touch tissue quantification could non-invasively provide significant complementary information regarding the tissue stiffness, useful for the differential diagnosis of focal solid liver lesions.

Which is the best MRI marker of malignancy for atypical cirrhotic nodules: Hypointensity in hepatobiliary phase alone or combined with other features? Classification after Gd‐EOB‐DTPA administration

To investigate whether the malignancy of atypical nodules in cirrhosis can be identified at gadoxetic‐acid‐disodium(Gd‐EOB‐DTPA)‐MRI by their hypointensity in the hepatobiliary(HB)‐phase alone or combined with any other MR imaging features.

Radiofrequency Ablation of Hepatocellular Carcinoma: Long-Term Experience with Expandable Needle Electrodes

OBJECTIVE Our objective was to determine the efficacy of radiofrequency ablation, using expandable electrodes, in the treatment of patients with hepatocellular carcinoma (HCC). SUBJECTS AND METHODS In a 5-year period (1998-2003), 68 HCCs in 59 patients (age range, 47-88 years) were treated percutaneously with radiofrequency ablation using expandable needle electrodes. The mean lesion diameter was 3.1 cm (range, 1-12 cm). Fifty-one of 59 patients were in Child-Pugh class A, and eight were in class B. Follow-up was performed by helical CT at 1, 4, and 6 months and every 6 months after that. The mean follow-up was 24.1 months (range, 6-60 months). Survival and disease-free survival rates were evaluated separately by statistical analysis. Any complications were reported during follow-up. RESULTS Cumulative survival rates were 94.4%, 65%, and 43.1% at 1, 3, and 5 years, respectively. Median survival time was 23.6 months (range, 4-62 months). Maximum tumor diameter was associated with the probability of survival: 73% among patients with lesion diameters of 3 cm or less, 76.5% among patients with lesion diameters of 3-5 cm, and only 40% among patients with lesion diameters of more than 5 cm (p = 0.05, log-rank test; p = 0.07, Tarone-Ware test). In 34 (57.6%) of 59 patients during follow-up, new nodules noncontiguous with the treated nodule developed in the liver (tumor recurrences). Median disease-free survival rates were 32.1%, 28.1%, and 17.5% at 1, 2, and 3 years, respectively. One major complication occurred (hemoperitoneum that required transfusion). CONCLUSION Radiofrequency ablation with expandable electrodes is safe and effective in the treatment of HCC.

MRI of focal nodular hyperplasia (FNH) with gadobenate dimeglumine (Gd-BOPTA) and SPIO (ferumoxides): An intra-individual comparison

To compare the efficacy of two different MR contrast agents for the detection and diagnosis of focal nodular hyperplasia (FNH).

Quantitative analysis of contrast-enhanced ultrasonography of the bowel wall can predict disease activity in inflammatory bowel disease

PURPOSE To evaluate the accuracy of quantitative analysis of bowel wall enhancement in inflammatory bowel disease (IBD) with contrast enhanced ultrasound (CEUS) by comparing the results with vascular density in a biopsy sample from the same area of the intestinal tract, and to determine the usefulness of this analysis for the prediction of disease activity. MATERIALS AND METHODS This prospective study was approved by our institutes ethics committee and all patients gave written informed consent. We enrolled 33 consecutive adult patients undergoing colonoscopy and biopsy for IBD. All patients underwent CEUS and the results were quantitatively analyzed. Vessel count per high-power field on biopsy specimens was compared with colonoscopy, baseline ultrasonography, and CEUS findings, and with analysis of peak intensity, time to peak, regional blood volume, mean transit time, and regional blood flow. Results in patients with high and low vascular density were compared using Fishers test, t-test, Pearsons correlation test, and receiver operating characteristic curve (ROC) analysis. Cutoff values were determined using ROC analysis, and sensitivity and specificity were calculated. RESULTS High vascular density (>265 vessels per field) on histological examination was significantly correlated with active disease on colonoscopy, baseline ultrasonography, and CEUS (p<.0001). Quantitative analysis showed a higher enhancement peak, a shorter time to peak enhancement, a higher regional blood flow and regional blood volume in patients with high vascular density than in those with low vascular density. Cutoff values to distinguish between active and inactive disease were identified for peak enhancement (>40.5%), and regional blood flow (>54.8 ml/min). CONCLUSION Quantitative analysis of CEUS data correlates with disease activity as determined by vascular density. Quantitative parameters of CEUS can be used to predict active disease with high sensitivity and specificity.

Superparamagnetic iron oxide-enhanced liver MRI with SHU 555 A (RESOVIST): New protocol infusion to improve arterial phase evaluation--a prospective study.

To compare the arterial enhancement of hypervascular hepatic lesions by T1‐weighted 3D‐GRE (gradient‐recalled echo) fat‐sat sequence after slow (0.5 mL/sec) and fast (2 mL/sec) RESOVIST® infusion.

Evaluation of incidence of acute transient dyspnea and related artifacts after administration of gadoxetate disodium: a prospective observational study

AimsTo evaluate motion artifacts, breath-hold failure, acute transient dyspnea, and clinical parameters during hepatic arterial phase of gadoxetate disodium-enhanced magnetic resonance (MR) imaging.MethodsThis was an institutional review board-approved observational prospective study (written informed consent acquired) performed in 250 consecutive patients, who underwent liver MR with a multiarterial phase technique. Oxygen saturation (SatO2) and heart rate (HR) were monitored, while patients reported subjective symptoms. Breath-holds were assessed using prospective acquisition correction technique (PACE) monitors. Three readers independently analyzed all images to establish the presence of motion artifacts. Nonparametric statistical testing and Fleiss’ kappa were used.ResultsNo statistical differences in SatO2 and HR values were observed during the entire length of MR examination. The PACE graphs showed an altered breath-hold in 16/250 patients (6.4%), however only 6 patients self-reported symptoms during the procedure, and among these 6 subjects, only 2 suffered from acute transient dyspnea (0.8%). Motion-related artifacts increased mostly in the third arterial phase of gadoxetate disodium acquisition (p < 0.0001): The artifacts incidence was 2.9% in the first phase; 4.0% in the second; and 19.5% in the third. This increase was mainly due to patients’ inability to hold their breath for the entire duration of the examination. However, at least one gadoxetate disodium arterial phase without motion artifacts and adequate for acquisition timing, was acquired in all MR examinations.ConclusionThe incidence of breath-hold failure and acute transient dyspnea after gadoxetate disodium administration increased during the third arterial phase only. Our protocol allowed the acquisition of at least one arterial phase not compromised by motion artifacts and adequate for acquisition timing, in all patients.