Maria Giulia Bernieri

Liver metastases: Contrast-enhanced ultrasound compared with computed tomography and magnetic resonance

The development of ultrasound contrast agents with excellent tolerance and safety profiles has notably improved liver evaluation with ultrasound (US) for several applications, especially for the detection of metastases. In particular, contrast enhanced ultrasonography (CEUS) allows the display of the parenchymal microvasculature, enabling the study and visualization of the enhancement patterns of liver lesions in real time and in a continuous manner in all vascular phases, which is similar to contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging. Clinical studies have reported that the use of a contrast agent enables the visualization of more metastases with significantly improved sensitivity and specificity compared to baseline-US. Furthermore, studies have shown that CEUS yields sensitivities comparable to CT. In this review, we describe the state of the art of CEUS for detecting colorectal liver metastases, the imaging features, the literature reports of metastases in CEUS as well as its technique, its clinical role and its potential applications. Additionally, the updated international consensus panel guidelines are reported in this review with the inherent limitations of this technique and best practice experiences.

Stone disease in pregnancy: imaging-guided therapy

AbstractRenal colic is the most frequent nonobstetric cause for abdominal pain and subsequent hospitalization during pregnancy. The physio-anatomical changes in the urinary tract and the presence of the fetus may complicate the clinical presentation and management of nephrolithiasis. Ultrasound (US) is the primary radiological investigation of choice. Magnetic resonance urography (MRU) and low-dose computed tomography (CT) have to be considered as a second- and third-line test, respectively. If a study that uses ionizing radiation has to be performed, the radiation dose to the fetus should be as low as possible. The initial management of symptomatic ureteric stones is conservative during pregnancy. Intervention will be necessary in patients who do not respond to conservative measures. Therefore, it is crucial to obtain a prompt and accurate diagnosis to optimize the management of these patients. Teaching Points • In pregnancy, renal colic is the most frequent nonobstetric cause for abdominal pain and hospitalization. • Magnetic resonance urography should be considered when ultrasound is nondiagnostic. • Low-dose CT should be considered as a last-line test during pregnancy.

Fibroblast Growth Factor Receptor-2 Expression in Thyroid Tumor Progression: Potential Diagnostic Application

Fibroblast growth factor receptor-2 (FGFR-2) plays an important role in tumorigenesis. In thyroid cancer it has been observed a FGFR-2 down-modulation, but the role of this receptor has not been yet clarified. Therefore, we decided to examine the expression of both FGFR-2 isoform, FGFR-2-IIIb and FGFR-2-IIIc, in different histological thyroid variants such as hyperplasia, follicular adenoma and papillary carcinoma. Immunohistochemistry and quantitative Real-Time PCR analyses were performed on samples of hyperplasia, follicular adenoma and papillary carcinoma, compared with normal thyroid tissue. Thyroid hyperplasia did not show statistically significant reduction in FGFR-2 protein and mRNA levels. Interestingly, in both follicular adenoma and papillary carcinoma samples we observed a strongly reduced expression of both FGFR-2 isoforms. We speculate that FGFR-2 down-modulation might be an early event in thyroid carcinogenesis. Furthermore, we suggest the potential use of FGFR-2 as an early marker for thyroid cancer diagnosis.

Spider surgical system versus multiport laparoscopic surgery: performance comparison on a surgical simulator

BackgroundThe rising interest towards minimally invasive surgery has led to the introduction of laparo-endoscopic single site (LESS) surgery as the natural evolution of conventional multiport laparoscopy. However, this new surgical approach is hampered with peculiar technical difficulties. The SPIDER surgical system has been developed in the attempt to overcome some of these challenges. Our study aimed to compare standard laparoscopy and SPIDER technical performance on a surgical simulator, using standardized tasks from the Fundamentals of Laparoscopic Surgery (FLS).MethodsTwenty participants were divided into two groups based on their surgical laparoscopic experience: 10 PGY1 residents were included in the inexperienced group and 10 laparoscopists in the experienced group. Participants performed the FLS pegboard transfers task and pattern cutting task on a laparoscopic box trainer. Objective task scores and subjective questionnaire rating scales were used to compare conventional laparoscopy and SPIDER surgical system.ResultsBoth groups performed significantly better in the FLS scores on the standard laparoscopic simulator compared to the SPIDER.Inexperienced group: Task 1 scores (median 252.5 vs. 228.5; p = 0.007); Task 2 scores (median 270.5 vs. 219.0; p = 0.005).Experienced group: Task 1 scores (median 411.5 vs. 309.5; p = 0.005); Task 2 scores (median 418.0 vs. 331.5; p = 0.007).Same aspects were highlighted for the subjective evaluations, except for the inexperienced surgeons who found both devices equivalent in terms of ease of use only in the peg transfer task.ConclusionsEven though the SPIDER is an innovative and promising device, our study proved that it is more challenging than conventional laparoscopy in a population with different degrees of surgical experience. We presume that a possible way to overcome such challenges could be the development of tailored training programs through simulation methods. This may represent an effective way to deliver training, achieve mastery and skills and prepare surgeons for their future clinical experience.

Metastatic signet ring cell carcinoma presenting as a thyroid diffuse involvement: report of a case studied with Q-elastographic and acoustic radiation force impulse imaging features

Metastatic carcinomas to the thyroid are rare in daily clinical practice. However, when encountered they represent a diagnostic challenge, since it is difficult to distinguish them from primary thyroid lesions, especially when occurring in patients with occult malignant history. Nevertheless, it is critical to differentiate a metastatic tumor from primary thyroid lesions, as the clinical management and the prognosis are different for the two entities. More recently, elastosonography opened new possibilities to ultrasound in different fields, such as thyroid nodule differentiation. Herein, we report a case of metastatic signet ring cell carcinoma to the thyroid studied with quantitative elastography and acoustic radiation force impulse imaging.

Magnetic Resonance Imaging and H-proton Spectroscopy assessment of maternal and foetal brains in a case of pregnancy-associated Wernicke encephalopathy

Gabriele Masselli, Maria Giulia Bernieri, Maria Grazia De Stefano, Anna Maria Maragno, Simona Patti, Paola Galoppi, Francesca Laghi, Vincenzo Cardinale, Gianfranco Gualdi and Roberto Brunelli Radiology Department, Umberto I Hospital, Sapienza University of Rome, Rome, Italy; Department of Obstetrics and Gynecology, Umberto I Hospital, Sapienza University of Rome, Rome, Italy; Department of Medico-Surgical Sciences and Biotechnologies, Umberto I Hospital, Polo Pontino, Sapienza University of Rome, Italy

Modern Imaging in the Initial Diagnosis: The Role of the Radiologist in an MDT

Despite recent advances in prostate cancer (PC) detection and treatment, PC continues to be one of the leading causes of cancer-related mortality in men. Thus, accurate diagnosis and appropriate treatment are crucial. The detection of PC is traditionally based on digital rectal examination (DRE), clinical stage and the measurement of serum prostate-specific antigen (PSA), followed by transrectal ultrasound (TRUS)-guided biopsies. However, PSA has a poor specificity and low predictive value, and therefore, many biopsies may be tumour negative. Moreover, with the current biopsy scheme, only a small portion of the prostate gland is sampled, with the risk of missing a significant lesion. Random TRUS-guided biopsy misses about 30 % of cancerous lesions, 23 % of which are high risk of PC [1]. Nowadays, there is a real need for clinicians to base therapeutic decisions not only on PSA serum level, DRE and TRUS-biopsy results, but also on imaging findings. In recent years, various imaging modalities have been developed to improve diagnosis, staging and localisation of early-stage PC. Conventional TRUS is mainly used to guide prostate biopsy. Contrast-enhanced US (CEUS) is based on the assumption that PC tissue is hypervascularised and might be better identified after intravenous injection of a microbubble contrast agent. Real-time elastography (RTE) seems to have higher sensitivity (Se), specificity (Spe) and positive predictive value (PPV) than conventional TRUS. However, the method still awaits prospective validation.