Search

Aim: To assess if software assisted-contrast-enhanced ultrasonography (CEUS) provides reproducible perfusion parameters of hepatic parenchyma in patients affected by chronic liver disease., Methods: Forty patients with chronic viral liver disease, with (n = 20) or without (n = 20) cirrhosis, and 10 healthy subjects underwent CEUS and video recordings of each examination were then analysed with Esaote's Qontrast software. CEUS dedicated software Qontrast was used to determine peak (the maximum signal intensity), time to peak (TTP), region of blood value (RBV) proportional to the area under the time-intensity curve, mean transit time (MTT) measured in seconds and region of blood flow (RBF)., Results: Qontrast-assisted CEUS parameters displayed high inter-observer reproducibility (κ coefficients of 0.87 for MTT and 0.90 TTP). When the region of interest included a main hepatic vein, Qontrast-calculated TTP was significantly shorter in cirrhotic patients (vs non-cirrhotics and healthy subjects) (71.0 ± 11.3 s vs. 82.4 ± 15.6 s, 86.3 ± 20.3 s, P < 0.05). MTTs in the patients with liver cirrhosis were significantly shorter than those of controls (111.9 ± 22.0 s vs. 139.4 ± 39.8 s, P < 0.05), but there was no significant difference between the cirrhotic and non-cirrhotic groups (111.9 ± 22.0 s vs. 110.3 ± 14.6 s). Peak enhancement in the patients with liver cirrhosis was also higher than that observed in controls (23.9 ± 5.9 vs. 18.9 ± 7.1, P = 0.05). There were no significant intergroup differences in the RBVs and RBFs., Conclusion: Qontrast-assisted CEUS revealed reproducible differences in liver perfusion parameters during the development of hepatic fibrogenesis.

The authors performed US-guided biopsy on 30 consecutive patients with prostatic masses of an undefined nature. Two samples were taken from each patient, one using an aspirating needle and another using a cutting needle. The two techniques proved to be quite complementary, even in the light of subsequent diagnostic follow-ups. Moreover, the possibility of comparing the cytological findings with the pathologic ones, with a "double blind" technique, greatly increased bioptic reliability.

In order to assess the clinical efficacy of percutaneous echo-guided biopsy (PBE), the authors evaluated its contribution to the diagnostic work-up and therapy selection in 165 cases of confirmed focal hepatic lesions. The cases were studied prospectively using a survey form. PBE yielded a significant contribution to the diagnosis in 79.4% of the cases. It was of substantial or conclusive value to therapeutic selection in 65% of the cases. Moreover, PBE allowed a high number of diagnoses which were unsuspected considering the previous standard clinical and instrumental work-ups. The clinical usefulness of PBE in focal hepatic lesion diagnoses is stressed. Its use saves time in the diagnostic management with considerable cost saving.

The echoencephalographic examinations of 127 neonates were analysed to verify the role of US in the study of neonatal cerebral pathology, and to compare it with CT. US was of value in identifying the existence of a cerebral lesion and for follow-up. CT was more reliable for the characterization of the lesion and in establishing the surgical indications.

The echotomographic patterns in 22 patients with hepatic neoplasms are reported and discussed. Ultrasonography has a high sensitivity in detecting the solid echopattern of the tumour and its origin from liver parenchyma; gray-scale B-scan and a meticulous technique are very helpful for this purpose. Echotomography plays an important part in the diagnostic evaluation of this pathology, to better select the patients for more invasive techniques, after the screening procedures, as scintigraphy.

An anatomical study of uterine malformations has become quite frequent in obstetrics and gynaecology because of the increasing use of corrective surgery. More than 100 cases were reviewed and the authors discuss some examples in order to present all kinds of uterine malformations which can be detected by ultrasound together with hysterosalpingography. A comparison of the diagnostic data obtained with the two methods shows US to be able to solve several cases. Hysterosalpingography is mandatory in female infertility when there is a need for examining Fallopian tube patency in addition to the morphological characteristics of the uterine cavity. The results obtained with the two methods in the study of uterine malformations allow the formulation of a diagnostic protocol concerning the study of infertile women. First of all, US must be performed, in order to exclude some causes of ovarian infertility and major uterine malformations. Hysterosalpingography should be performed when US does not prove to be totally reliable.

The sonographic findings observed in four patients with spontaneous rupture of a renal angiomyolipoma and perinephric haemorrhage are presented. In all cases, a hyperechoic renal mass surrounded by a large hypoechoic haematoma was identified. Furthermore, the actual site of rupture of the tumour could be seen in one case as a wedge-shaped hypoechoic structure extending from the periphery to the centre of the mass. CT has been suggested as the method of choice in the assessment of both the presence and extent of haemorrhagic complications of angiomyolipomas. However, since such lesions can be demonstrated and identified by ultrasound, which is often used as the first imaging procedure in abdominal complaints, the technique may also prove of value in planning further diagnostic tests and in choosing the appropriate therapeutic approach to these patients.

47 consecutive patients underwent a ultrasound examination: they had suspect clinical-laboratorial picture caused from traumatic lesions of the abdominal viscera. We considered two kinds of visceral lesions: alterations of the parenchimal organs and of the empty ones. In the first group we analyzed direct signs of the lesion; in the second group we considered the indirect signs (hemothorax, hemoperitoneum and so on). Sometimes meteorism and the patient's conditions limited the reliability of the examination. We registered three false negative in volumetrically regular spleens, the seat hampering the complete exploration of the organ; on the contrary the lack of experience may cause interpretative mistakes (false positive). The obtained results induce to consider the employment of the ultrasound diagnostic imaging in abdominal traumas as a first approach, efficient test because, very often, it can condition surgical decisions, avoiding more aggressive diagnostic investigations.

Eleven cases of pancreatic cystadenocarcinoma were studied with respect to the differential diagnosis from that of pancreatic pseudocysts, using diagnostic ultrasound as the initial investigative technique. Most of the cases presented an ultrasonic picture that correlated well with the gross pathology, but this correlation was not reliable enough to be considered characteristic in differentiating such masses from pseudocysts. The authors divide the cystadenocarcinomas of the pancreas into four echographic classes. In all but one of the classes, diagnostic ultrasound was insufficient by itself to render an accurate diagnosis. In such cases other techniques, i.e. CT, tissue biopsy, and especially angiography, were required for a reliable diagnosis.

Twenty-one cases of hepatic hemangioma were examined by ultrasound, and three main sonographic patterns were identified. In 14 cases hyperechoic focal areas were observed, in five cases larger hemangiomas exhibited a complex pattern, and in two cases hemangiomas appeared as rounded sonolucent areas with distal enhancement mimicking cysts. Hemangiomas may have significantly variable ultrasonographic features. According to the authors' experience, only in cases of hyperechoic well-defined lesions in asymptomatic patients can a definite diagnosis of hemangioma be made.