Riccardo Sartoris

Percutaneous Radiofrequency Ablation of Benign Thyroid Nodules Assisted by a Virtual Needle Tracking System

Our aim was to assess the feasibility and outcome of ultrasound (US)-guided percutaneous radiofrequency (RF) ablation of benign thyroid nodules assisted by a real-time virtual needle tracking (VT) system. Forty-five patients (34 females, mean age ± standard deviation (SD): 44 ± 16 y, range: 29-68 y) with 45 benign non-functioning thyroid nodules (mean volume ± SD: 13.5 ± 6.7 mL, range: 12-22 mL) underwent VT-assisted US-guided RF ablation. Nodule volume was evaluated before treatment and during 6-mo of follow-up. Complication rates and patient satisfaction after treatment were also evaluated. By use of the VT system, the tip of the RF electrode was identified during all ablation procedures. The overall mean volume reduction and complication rate were 72.6 ± 11.3% and 2.5%, respectively. Overall satisfaction at the 6-mo follow-up was rated by patients as positive in 42 cases (93%). The VT system could be useful in thyroid nodule ablation procedures because it is able to track the RF electrode tip even when the tip is obscured by the bubbles produced by the ablative process. VT-assisted RF ablation can be a tolerable, non-surgical treatment for patients with benign non-functioning thyroid nodules.

Dynamic high-resolution ultrasound of the shoulder: How we do it

Ultrasonography (US) is an established and well-accepted modality that can be used to evaluate articular and peri-articular structures around the shoulder. US has been proven to be useful in a wide range of rotator cuff diseases (tendon tears, tendinosis, and bursitis) as well as non-rotator cuff abnormalities (instability problems, synovial joint diseases, and nerve entrapment syndromes). Diagnostic accuracy of shoulder US when evaluating rotator cuff tears can reach 91-100% for partial and full thickness tears detection, respectively, having been reported to be as accurate as magnetic resonance imaging in experienced hands. US is cheap, readily available, capable to provide high-resolution images, and does not use ionizing radiations. In addition, US is the only imaging modality that allows performing dynamic evaluation of musculoskeletal structures, that may help to further increase diagnostic performance. In this setting, a standardized imaging protocol is essential for an exhaustive and efficient examination, also helping reducing the intrinsic dependence from operators of US. Furthermore, knowledge of pitfalls that can be encountered when examining the shoulder may help to avoid erroneous images interpretation. In this article we use detailed anatomic schemes and high-resolution US images to describe the normal US anatomy of soft tissues, articular, and para-articular structures located in and around the shoulder. Short video clips emphasizing the crucial role of dynamic maneuvers and dynamic real-time US examination of these structures are included as supplementary material.

The Ankle: Focused US Anatomy and Examination Technique

The standard US protocol includes the evaluation of four compartments of the ankle: lateral, medial, posterior, and anterior.

Bursitis and Cysts Around the Knee

Synovial bursae are anatomical structures that are located in critical regions where tendons run in close relationship with other tendons or bones and act as friction attenuators between such structures during movement. In the knee, several bursae can be found, but three of them are those mostly commonly involved by pathologic conditions: the bursa between the medial gastrocnemius muscle and the semimembranosus tendon, the goose’s foot bursa, and the prepatellar bursa.

Ultrasound Basic Anatomy

Muscle ultrasound is a convenient, non-invasive and real-time technique able to visualize normal and pathological muscle tissues.

Ankle Intra-articular Injections

Intra-articular injections of the ankle can be performed to treat a variety of pathological conditions. The drugs administered in these cases may be anti-inflammatory agents, such as steroids that may be indicated for patients with ankle osteoarthritis (OA) refractory to non-pharmacologic or analgesic and NSAIDs therapy or viscosupplements, such as hyaluronic acid, which are injected to decelerate the physiological process of OA. Analgesic drugs can be injected for diagnostic purposes in the differential diagnosis between intra- and extra-articular pathology.

Doppler Technologies and Ultrasound Elastography

Doppler imaging is an established ultrasonographic method employed for the accurate non-invasive evaluation of the blood flow. As the name implies, US Doppler technique uses the Doppler effect to assess how blood flows through the major blood vessels.

Treatment of Flexor and Extensor Tendon Sheath Tenosynovitis

Ankle tendons provided by a synovial sheath (e.g., peroneal, tibialis posterior tendons) can be affected by acute or chronic tenosynovitis, which can cause pain and functional limitations. Acute tenosynovitis is characterized by fluid effusion within the tendon sheath, while chronic tenosynovitis usually presents with synovial thickening or proliferation. The lateral compartment differs from the others, as, in case of calcaneofibular ligament tear, there could be a communication between joint space and synovial sheath. In this case, sheath effusion frequently occurs in conjunction with joint effusion and should not be treated alone. Even in these cases, steroid injection is a valid option, as it is able to reduce pain and effusion. Sometimes, hyaluronic acid may be injected to improve tendon sliding and to stretch a retinaculum.

Post-Processing, 2D/3D Reformat, and Dedicated Software for Implantology

Our chapter aims to illustrate the processing of CBCT software: This software allows the reconstruction of 2D and 3D images. We show that, thanks to these reconstructions, you can generate panorex and cross-sectional images and the path of the maxillary nerve and we provide a detailed “how to do” guide. We illustrate that, through the software, it is possible to measure the density of alveolar bone, useful for preimplantology evaluation.