Mara Bonardi

Breast elastography: A literature review.

Breast elastography is a new sonographic imaging technique which provides information on breast lesions in addition to conventional ultrasonography (US) and mammography. Elastography provides a noninvasive evaluation of the stiffness of a lesion. Today, two technical solutions are available for clinical use: strain elastography and shear wave elastography. Initial evaluations of these techniques in clinical trials suggest that they may substantially improve the possibility of differentiating benign from malignant breast lesions thereby limiting recourse to biopsy and considerably reducing the number of benign breast biopsy diagnoses. This article reviews the basics of this technique, how to perform the examination, image interpretation and the results of major clinical studies. Although elastography is easy to perform, training and technical knowledge are required in order to obtain images permitting a correct interpretation. This paper will highlight the technique and point out common pitfalls. Breast elastography is a new sonographic imaging technique which provides information on breast lesions in addition to conventional ultrasonography (US) and mammography. Elastography provides a noninvasive evaluation of the stiffness of a lesion. Today, two technical solutions are available for clinical use: strain elastography and shear wave elastography. Initial evaluations of these techniques in clinical trials suggest that they may substantially improve the possibility of differentiating benign from malignant breast lesions thereby limiting recourse to biopsy and considerably reducing the number of benign breast biopsy diagnoses. This article reviews the basics of this technique, how to perform the examination, image interpretation and the results of major clinical studies. Although elastography is easy to perform, training and technical knowledge are required in order to obtain images permitting a correct interpretation. This paper will highlight the technique and point out common pitfalls.

Sonographic anatomy of the ankle

Ankle sonography is one of the most commonly ordered examinations in the field of osteoarticular imaging, and it requires intimate knowledge of the anatomic structures that make up the joint. For practical purposes, the examination can be divided into four compartments, which are analyzed in this pictorial essay: the anterior compartment, which includes the tibialis anterior, extensor hallucis longus, and extensor digitorum longus tendons; the accessory peroneus tertius tendon; and the extensor retinaculum; the medial compartment (tibialis posterior, flexor digitorum longus, and flexor hallucis longus tendons; the flexor retinaculum; the medial collateral—or deltoid—ligament, and the neurovascular bundle); the lateral compartment (peroneus longus, peroneus brevis, and peroneus quartus tendons; superior and inferior peroneal retinacula, lateral collateral ligament); and the posterior compartment (Achilles tendon, plantaris tendon, Kagar’s triangle, superficial, and deep retrocalcaneal bursae). Scanning techniques are briefly described to ensure optimal visualization of the various anatomic structures.RiassuntoL’esame ecografico della caviglia è tra gli esami più richiesti nell’ambito dell’ecografia osteoarticolare; ne deriva la necessità di una conoscenza approfondita delle strutture anatomiche che la compongono. L’approccio ecografico per lo studio della caviglia è, per scopi pratici, organizzato per comparti; si analizzano nel presente pictorial essay le strutture del comparto anteriore (tendine tibiale anteriore, tendine estensore lungo dell’alluce, tendine estensore lungo delle dita, tendine peroneo tertius, retinacolo degli estensori), del comparto mediale (tendine tibiale posteriore, tendine flessore lungo delle dita, tendine flessore lungo dell’alluce, retinacolo dei flessori, legamento collaterale mediale o deltoideo, fascio vascolo-nervoso), del comparto esterno (tendini peronei breve e lungo, tendine peroneo quarto, retinacolo superiore ed inferiore dei peronei, legamento collaterale esterno), del comparto posteriore (tendine d’Achille, tendine del muscolo plantare, triangolo di Kager, borse sinoviali calcaneali superficiale e profonda). Si riporta inoltre qualche breve cenno di tecnica ecografica necessaria per l’ottimale visualizzazione delle strutture descritte.

Lymphoma of the scrotum in patients with Down’s syndrome: US appearance. Mini-pictorial essay

Downs syndrome is relatively common, and patients who are affected have an increased risk of developing acute leukemia, but not solid tumors. Studies performed in larger patient populations have shown that solid tumors, including lymphomas, are significantly less frequent in Down patients than in children and adults who are not Trisomy 21-affected.Testicular lymphomas are rare and extremely aggressive. Ultrasound (US) combined with color Doppler is essential in the diagnosis and evaluation of treatment results in these lesions. As they are very rare, it was decided to publish this mini-pictorial essay.

Unroofed coronary sinus and persistent left superior vena cava: A case report

The unroofed coronary sinus is a spectrum of cardiac anomalies in which part or all of the common wall between the coronary sinus and the left atrium is absent. Most cases are associated with anomalous systemic venous return, such as persistent left superior vena cava.The diagnosis of this lesion is important to the prognosis of the patient, but it is often difficult because of nonspecific clinical features.Here we report a case of a complete unroofed coronary sinus and persistent left superior vena cava discovered during a computed tomographic investigation for pulmonary hypertension.

Ultrasound guided fine-needle aspiration cytology of breast lesions

Breast biopsy consists in the collection of cells or tissue fragments from a breast lesion and their analysis by a pathologist. There are several types of breast biopsy defined on the basis of the type of needle used: fine-needle aspiration and biopsy performed with a spring-based needle. This article focuses on fine-needle aspiration performed under sonographic guidance.It is used mainly to assess cysts that appear to contain vegetations or blood or that are associated with symptoms; lesions and solid nodules that are not unequivocally benign; and axillary lymph nodes that appear suspicious on physical examination and/or sonography.In addition to distinguishing between benign and malignant lesions, ultrasound guided fine-needle aspiration also plays an important role in tumor grading and in immunocytochemical identifying specific tumor markers. This article describes the technique used and the possible causes of false negative and false positive findings. Despite its limitations, fine-needle aspiration has become a fundamental tool for the identification and preoperative management of malignant breast lesions.

US and MRI appearance of a collagenous fibroma (desmoplastic fibroblastoma) of the shoulder

Collagenous fibroma (desmoplastic fibroblastoma) is a recently described rare benign tumor. Since this tumor was characterized by Evans in 1995, fewer than 100 cases have been reported in English literature with the largest series published by Miettinen and Fetsch. Preoperative radiological diagnosis is important to avoid over-treatment and unnecessary extensive procedures, but is difficult because diagnostic imaging findings for collagenous fibroma have not been established. Here we report the US and MRI appearance of a lesion localized deep under the deltoid muscle in a 34-year-old woman with a palpable painless mass. Histological findings were consistent with a collagenous fibroma. As far as we know, this is the first description of US appearance of a collagenous fibroma in English literature.RiassuntoIl fibroma collagenico (fibroblastoma desmoplastico) è un tumore benigno raro di recente descrizione. A partire dalla sua caratterizzazione da parte di Evans nel 1995, meno di 100 casi sono stati riportati nella letteratura inglese con la più larga casistica pubblicata da Miettinen e Fetsch. La diagnosi radiologica preoperatoria è importante per evitare eccessivi trattamenti e procedure non necessari, ma è difficoltosa perché non sono ancora stati definiti dei reperti imaging diagnostici per il fibroma collagenico. Qui presentiamo l’aspetto ecografico e RM di una lesione localizzata in profondità rispetto al muscolo deltoide in una donna di 34 anni con una massa palpabile non dolente. I reperti istologici erano indicativi di un fibroma collagenico. Per quanto è a nostra conoscenza, si tratta della prima descrizione dell’aspetto ecografico di un fibroma collagenico riportata nella letteratura in lingua inglese.

Testicular ischemia after inguinal hernia repair

Testicular ischemia is a rare complication of inguinal hernia repair. It results from the injury to the vessels that course along the inguinal canal. Typically it is painful at the beginning and asymptomatic later. Ultrasonographic appearance and aspects of testicular ischemia result in diffusely hypoechoic and disomogeneous testis, with complete lack of intratesticular vascular signal on color-Doppler and cremasteric vessels hypertrophy in chronic cases.This report describes a testicular ischemia seen in a patient referred to because of hernia recurrence, without any sign or symptom of acute scrotum. Ultrasound examination showed the most frequent complications after inguinal hernia repair: both hernia recurrence and testicular ischemia.

NEGATIVE T WAVES AFTER REPERFUSED MYOCARDIAL INFARCTION ARE A MARKER OF MYOCARDIAL STUNNING AND PREDICT REGIONAL RECOVERY OF CONTRACTILE FUNCTION

Background: ST elevation myocardial infarction (MI) typically evolves with negative T waves. The signiicance and clinical correlate of these “post-ischemic” T waves is uncertain. This study tested the hypothesis that in patients with a reperfused MI, prevailing negative voltages in the ST-T segment correlate with myocardial stunning and with late recovery of contractile function (CF). Methods: We enrolled 32 patients with anterior MI, treated with primary PCI (age 57±12 years, peak CK 2860 ± 1555 U/L, LVEF 43± 8%). ECGs were digitized with a dedicated system (ECGScan v3, AMPS-LLC) and analyzed with a semi-automated on-screen software (CalECG v2, AMPS-LLC) which quantiies the area of positive and negative waves during repolarization from J point to T-wave end in each cardiac lead. Regional CF was assessed blindly by means of 1.5 T cardiac MR 4 days and 4 months after MI. Recovery of CF was evaluated comparing percentage thickening between the 2 tests. We prospectively correlated repolarization in V3 and V4 48 h after MI (peak of negative T waves) and speciically the ratio of negative/total area (%negTA) with the recovery of CF in the anterior middle and apical LV (segments 7 and 13, corresponding to leads V3 and V4), estimated as sum of the differences in % thickening in both segments. Results: Repolarization analysis showed that %negTA was 54±32% (median 53%) and 62±31% (median 70%) in V3 and V4, respectively. Acute CMR showed an ischemic area corresponding to 39 ± 14% of LV mass. Segments 7 and 13 were ischemic in all patients and showed an average thickening of 12.2±12.5% and 8.4±8.7%, respectively. CMR after 4 months showed a signiicant recovery of regional thickening to 27.8±14.3% and 17.3±15.1% in segment 7 and 13, respectively. Contractile recovery correlated signiicantly with %negTA in both V3 and V4 (r=0.50, p=0.004 and r=0.46, p=0.009). Compared to patients with less negative T waves, those with %negTA >50% in V3 and >70% in V4 had a total recovery of 34±27 vs 13±14% (p<0.01) and of 41±25 vs 10±13% (p<0.001), respectively.

Post-traumatic hematoma of the epididymis: Case-report.

Scrotal trauma accounts for less than 1% of all trauma-related injuries. Traumatic injuries of the epididymis are extremely rare.Here we report a rare case of hematoma of the epididymis, diagnosed with US, in a 10-year-old boy after a sport injury.

ROLE OF MYOCARDIAL HAEMORRHAGE IN PREDICTING ADVERSE LEFT VENTRICULAR REMODELING AFTER REPERFUSED ACUTE MYOCARDIAL INFARCTION. CAN WE OUTPERFORM MICROVASCULAR OBSTRUCTION

Abstract Category: MRIPresentation Number: 0911-07Authors: Claudia Raineri, Annalisa Turco, Sergio Leonardi, Mara Bonardi, Michela Cottini, Guido Tavazzi, Margherita Calcagnino, Gabriele Crimi, Maurizio Ferrario, Mario Previtali, Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy Background: Microvascular obstruction (MVO) detected by contrast-enhanced cardiac magnetic resonance (CE-CMR) is a well-known predictor of adverse left ventricular remodeling (aLVR) after reperfused acute myocardial infarction (AMI), while the influence of myocardial haemorrhage (MH) on aLVR is still unclear. Aim of the present study was to test the hypothesis that MH can improve the ability to identify patients at risk of aLVR beyond MVO.Methods: Sixty-two AMI patients (88% males, 57±11 years, 64% anterior location) reperfused with primary percutaneous coronary intervention were referred for a CE-CMR assessment during index hospitalization and at 4 months. Left ventricular remodeling was defined as the difference between acute and 4-month LV end-systolic volume index. MVO and MH were semi-quantitatively estimated using a per-segment basis (presence or absence) score on a 16-segment model of the LV. The ability of MVO, MH and other potential predictors, including age, sex, MI location, TIMI flow pre- and post-reperfusion, acute LV ejection fraction, MI size (extent of delayed enhancement at CE-CMR), CK-MB peak, pain-to-balloon time, to predict aLVR was assessed by linear regression, with univariable and multivariable analysis.Results: MH and MVO were observed in 24 (39%) and 46 (74%) patients respectively. MH was always associated with MVO and the extent of MVO was significantly larger in the MH group (3.9±1.5 vs 2.3±1.2 segments, p<.0001). Compared to patients with MVO only, those with both MH and MVO had similar acute end-systolic LV volume index (MVO only:44.2±15.4 vs MVO+MH:48.8±16 ml/m2, p=.77 respectively), MI size (28±7 vs 27.5 ±12 %, p=.99), acute LV ejection fraction (46.7±9.1 vs 45.4±10 %, p=.96). At univariable analysis MVO (F=9.8, r=.36, p=.003), MH (F=10.2, r=.38, p=.002), peak CK-MB (F=6.3, r=.30, p=.015), MI size (F=5.3, r=.27, p=.025) were significant predictors of aLVR. In multivariable analysis only MVO retained the ability to predict aLVR (F=11.7, r=.41, p=.001).Conclusion: MH is always associated with MVO and can predict aLVR in univariable analysis but did not show independent predictive value beyond MVO.