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Aim: Less than 5% of pancreatic masses represent metastases and differentiation from primitive tumors using endo-scopic ultrasound (EUS) is difficult. The aim of our work was to assess the diagnostic value of contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) for pancreatic metastases.Material and Methods: We retrospectively analyzed patients with pancreatic metastasis identified during a 8 year period in a tertiary medical center.Results: We included in the study 20 patients evaluated with EUS and CH-EUS. The primary tumor was localized in the kidney (6 cases), lung (5 cases), colon (3 cases), skin (2 patients) and stomach, breast, ovary and liver (1 patient each). Only 11 patients (55%) (kidney, lung, liver, ovary or skin metastases), presented hypervascularity at EUS and arterial hyperenhancement on CH-EUS, with similar diag-nostic value. All renal metastases were hyperenhanced (the negative predictive value 100%) and the stomach, colon and ovary metastases were hypoenhanced. The fast wash-out of contrast substance was encountered in all cases or renal, pulmonary and digestive metastases, but with 53.3-64.3% specificity for the different origin of pancreatic metastases.Conclusions: The vascularity assessments on conventional EUS or CH-EUS are similar for pancreatic metastases of different origin. EUS tissue acquisition remains mandatory for the diagnosis. [ABSTRACT FROM AUTHOR]

Aim: High resolution imaging methods detect a spectrum of inflammatory-like and structural modifications at joint and tendon level in healthy subjects. The knowledge of their extent and degree is important when subclinical disease activity (implying therapy reassessment) must be differentiated from normality. Musculoskeletal ultrasound (MSUS) evaluation may be challenging even for experts when borderline or low grade lesions are present. Our objective was to analyse the frequency of inflammatory-like lesions in hand joint and tendons in healthy young subjects and to evaluate the concordance between MSUSand magnetic resonance imaging (MRI) findings.Material and Methods: Ten healthy young women (age range 24-32 years) clinically asymptomatic (joints and tendons) were selected to have bilateral hand MSUS and MRI evaluation. Based on current definitions, synovitis/tenosynovitis-like lesions, erosions, osteophytes and bone edema were quantified and concordance between the two imaging methods was calculated.Results: Overall, both imaging evaluation methods showed a low frequency of inflammatory-like and structural lesions. No joint presented power Doppler signal or erosions. No abnormalities suggestive for inflammatory or structural pathology were detected at the tendon compartments level. No erosions and no signs of osteitis were detected. The concordance between MSUS and MRI findings was high except for the wrist area.Conclusion: MSUS was demonstrated to be a very accurate imaging method, mostly for hand tendon evaluation. This would allow a better discrimination between normality and pathologic findings, adding supplementary information. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to evaluate the use of pre and post-therapy transrectal and transvaginal ultrasonography (TRUS, TVUS) with contrast enhancement and strain elastography compared with clinical examination and magnetic resonance imaging (MRI) in the assessment of advanced stage cervical cancer.Material and Methods: This was a prospective study, carried out over a period of nine months on subjects with advanced-stage cervical cancer (stage >/= IIB). All included patients were examined clinically and underwent abdomino-pelvic contrast enhanced MRI and multimodal US examinations (TRUS with strain elastography and contrast enhanced TVUS) at the time of diagnosis and after radiochemotherapy. Tumor size and staging at TRUS and TVUS was compared with the same data obtained by clinical examination and MRI. Pathology was the golden standard.Results: Eight patients accomplished the inclusion criteria. In five cases the tumor stage was identical on clinical and MRI examinations. In all cases parametrial infiltration was diagnosed by all pre-treatment examinations. No significant differences were observed in tumor size between clinical, US and MRI exams either at baseline or post-therapy, in native or post-contrast examinations. The size of the tumor evaluated pre-treatment proved to be significantly smaller post-contrast in both US and MRI examinations compared with the native images. Post-therapy, no significant differences were observed on US measured tumor dimensions when comparing native with post-contrast images. Oppositely, significant smaller dimensions were observed on post-contrast MRI compared with native scans.Conclusions: TRUS is accurate in the estimation of pre-therapy cervical cancer dimension. The post therapy tumor evaluation is better performed with MRI. The use of intravenous contrast agents on both examinations did not improved the accuracy of tumor evaluation pre or post-therapy. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to explore the diagnostic value of sonoelastography for the differentiation between benign and malignant superficial lymph nodes of the neck. In this respect the utility of an original scoring system was explored. Material and Method: Over a period of 30 months the patients examined routinely for the assessment of superficial lymph nodes of the neck were recorded in a data base containing grey-scale, Doppler and sonoelastographic information and images. The sonoelastographic images of 30 benign and 39 malignant lymph nodes were assessed. The images were scored according to a new, eight pattern scoring system proposed by our group. Interobserver agreement and area under the ROC curve (AUROC) for the differentiation between benign vs. malignant and benign vs. metastatic nodes were analyzed. Results: The analysis of the interobserver agreement for the investigated score provided a weighted Kappa = 0.687, 95%CI [0.572 to 0.802] and standard error = 0.059. In the differentiation benign - malignant, the AUROC was 0.846, with sensitivity of 66.67% and specificity of 96.67% for score > 3. In the differentiation between benign and metastasis, the same criterion provided an AUROC of 0.855, with sensitivity of 71.43 and specificity of 96.67%. Conclusions: Our study suggests that applying the proposed score provides good interobserver agreement. The score also provided very good specificity and reasonable sensitivity in the differentiation between malignant and benign lymph nodes in the neck. [ABSTRACT FROM AUTHOR]