Search

Venous insufficiency of the corpora cavernosa is the second most common cause of erectile dysfunction (ED). A functional insufficiency of the venous system has been hypothesised, but the cause is still unclear. To evaluate a possible endocrine mechanism, we have studied hormone profile in a group of nine patients with pure venous-leakage (VL) compared with a control group of 15 patients with ED of different origin. Prolactin, testosterone and gonadotropin levels did not differ among the two groups, while estradiol (E2) plasma concentration was significantly higher in VL patients compared to controls. Our data support the hypothesis that the steroid environment, in particular estradiol level, can influence venous vascular tone (via VEGF or NO), thus affecting venous leakage dysfunction. This point can explain a possible link between the high estradiol levels and a functional insufficiency of the venous system in ED.

A case of a patient with the diagnosis of a neoformation of the blind intestine is discussed. On CT for staging an image at the level of the intrapancreatic tract of main bile duct of not certain interpretation was visualized. On US choledocholithiasis shown by the typical appearance of a hyperechoic image with posterior shadowing was diagnosed. In the study case US was shown to be the procedure of first choice.

Metastasis to the liver from thyroid cancer is a rare event with a reported frequency of 0.5%. Metastatic liver involvement from differentiated thyroid cancer (DTC) is nearly always multiple or diffuse and usually found along with other distant metastases (lung, bone and brain). The authors describe a patient with a solitary liver metastasis from Hürthle cell thyroid cancer, which appeared during long-term follow-up. The lesion was diagnosed by progressive increase of thyroglobulin in the serum and imaged with I-131 whole body scan, ultrasonography, magnetic resonance imaging (MRI) and F-18 fluoro-deoxyglucose positron emission tomography (FDG-PET) scan. For patients with a Tg level above some arbitrary limit, the administration of a large dose (3.7-5.5 GBq; 100-150 mCi) of I-131, in order to obtain a highly sensitive Tx whole body scan (WBS), remains the best diagnostic strategy. However, on very rare occasions, physiological enteric radioactivity can hide possible abdominal lesions and further indepth studies, such as FDG-PET scans, are sometimes necessary.

The case of a 40-year-old male patient come to the emergency service with symptoms suspicious of biliary colic, is presented. Liver sonography was requested to evaluate the parenchyma, the gallbladder and bile duct caliber in the suspicion of lithiasis. During the examination a hyper-reflecting image with posterior shadowing was detected at the level of the gallbladder infundibulum. However, the shadowing was not typical of lithiasis. This aroused some doubts and the scan was repeated after some minutes: an absolutely normal infundibulum was visualized. The shadowing was therefore an artifact probably due to a partial volume effect of the air contained in the distended duodenum, in contact with the gallbladder. The formation process of the sonographic image is carefully analyzed with particular reference to the situations generating artifacts.

Primary megaureter is visualized as a typical dilatation on urography. Adequate oblique projections should be added to depict the juxtavesical tract of normal caliber. In even the most severe forms pyelocaliectasis is absent or mild and the ureter is not tortuous. Sonography as well as fluoroscopy during urography shows hyperperistalsis in the dilated tract and aperistalsis in the juxtavesical tract. Cystography rules out vesicoureteral reflux. In prune-belly syndrome the megaureter is bilateral and massive with no evidence of obstructions. The sonographic finding of hydronephrosis or hydroureteronephrosis and the absence of vesicoureteral reflux on voiding cystography lead to the suspicion of ureteral valves, directly documented on urography as sharp and transverse filling defects. Retrograde pyelography can better define the obstructing area and documents the normality of the underlying tract. With this procedure, the valvular flaps appear with a superior convexity (like a small umbrella). MR-urography still to be validated clinically, will be able to provide novel perspectives.

Objectives: SonoVue is a new ultrasound contrast agent, which consists of stabilised microbubbles of a sulphur hexafluoride gas. The aim of the study was to assess its efficacy in the Doppler investigation of focal hepatic lesions., Materials and Methods: Seventy patients with focal liver tumours were studied. Four doses (0.3, 0.6, 1.2 and 2.4 ml) of SonoVue were administered intravenously with at least 10 min delay between each injection. A complete colour/power and spectral Doppler imaging investigation of the lesions was performed at baseline pre-dosing and after each SonoVue injection. All examinations were recorded on SVHS videotapes. Baseline and post contrast videotapes were reviewed by the on-site (un-blinded) investigators and by two off-site blinded readers (a) to grade the global quality of the Doppler scans of the focal lesions vascularity and the normal parenchymal vessels (b) to measure the duration of clinically useful Doppler signal enhancement and (c) to determine the diagnostic accuracy and performance of the enhanced versus unenhanced scans using histopathology, tumour markers, CT and/or MR as the reference standard., Results: A statistically significant improvement was observed at all four SonoVue doses in the off site assessment of global quality of the Doppler examination of tumoral and normal parenchymal vessels in comparison with the baseline (P < 0.05). The median duration of clinically useful enhancement was significantly increased with increasing doses (P < 0.001), ranging between 1.4-2.2 min for the lowest dose and 3.2-3.8 min for the highest dose for the off-site readers. On-site assessment of diagnostic accuracy showed a significant increase in the specificity of the Doppler diagnoses (P < 0.0016) with an increase in the positive and negative predictive values and in the likelihood ratio in differentiating between benign and malignant lesions. Off-site evaluation showed a significant increase in the accuracy of enhanced Doppler diagnosis in comparison with the baseline performance., Conclusion: The results suggest that SonoVue is effective in improving the display of tumoral vascularisation and may be useful in the characterisation of focal liver lesions.

The aim of this study is to assess the efficacy and accuracy of color flow-Doppler sonography (CFDS) in predicting the malignancy of thyroid nodules. Seventy eight consecutive patients (52 females and 26 males), with 78 thyroid nodules (29 single nodules and 49 in a nodular goiter) have been examined by CFDS, before surgery, evaluating the hypoechogenicity of the nodule, the presence of microcalcifications and the halo sign absent and the vascular pattern, which has been classified as follows: absence of blood flow (type I), perinodular blood flow (type II), intranodular, with or without perinodular blood flow (type III), which is considered the most typical pattern of malignancy. On histology 22 nodules as carcinoma (CA) and 56 as benign nodules (BN) have been diagnosed. The most predictive for malignancy, sonographic pattern, "microcalcifications", has been found in 13/22 CA and in 4/56 BN (P < 0.0001, specificity 93%, sensitivity 59%); "hypoechogenicity" in 16/22 CA and in 8/56 BN (P < 0.0001, specificity 86%, sensitivity 73%), "absent halo sign" in 18/22 CA and in 16/56 BN (P < 0.0001, specificity 71%, sensitivity 82%.) have been found. On CFD type III pattern has been detected in 17/22 CA and in 24/56 BN (P < 0.15, specificity 57%, sensitivity 77%); type IIIa pattern (intranodular without perinodular blood flow) has been the most predictive for malignancy (P < 0.0001, specificity 100%, sensitivity 36%). The combination of type III pattern with "hypoechogenicity" in 13/22 CA and in 2/56 BN (p < 0.0001, specificity 93%, sensitivity 59%) has been found, with "absent halo sign" in 15/22 CA and in 3/56 BN (P < 0.0001, specificity 94.6%, sensitivity 68%), has been found, with "microcalcification" in 10/22 CA and in 0/56 BN (P < 0.0001, specificity 100%, sensitivity 45%) has been found. The combination of "microcalcifications" and absent halo sign" with type III pattern has been the most specific for malignancy, being detected in 11/22 Ca and 2/56 BN (P < 0.0001, specificity 96%, sensitivity 50%). In conclusion our results suggest that CFDS has an useful role in the assessment of thyroid nodules and it may provide information highly predictive for malignancy, above all when multiple, sonographic and vascular patterns are contemporaneously present in a thyroid nodule.

Purpose: The purpose of this study was to compare contrast-enhanced gray-scale voiding urosonography (CE-VUS) and contrast-enhanced color Doppler voiding urosonography (CE-CDVUS) with voiding cystourethrography (VCUG) to verify whether the use of color Doppler imaging improves the diagnosis and grading of vesicoureteral reflux (VUR)., Methods: In 74 patients, CE-VUS and CE-CDVUS were compared with VCUG, which was used as the gold standard. SHU 508 A (Levovist) was used as the echo-enhancing contrast agent. VUR was diagnosed if hyperechoic dots or color signals were visualized in the ureter on sonograms. VUR grading was based on morphologic and dynamic findings on CE-VUS and morphologic and color findings on CE-CDVUS. VCUG was performed conventionally, and grading by VCUG was in accordance with the international system of radiographic VUR grading. Patients who voided during 1 examination only (either CE-VUS and CE-CDVUS or VCUG) were excluded from the study. Agreement between the results of CE-VUS and VCUG and between those of CE-CDVUS and VCUG in diagnosing VUR was calculated by kappa statistics. CE-VUS and CE-CDVUS were compared for diagnostic accuracy by the McNemar test., Results: The agreement between CE-VUS and VCUG in predicting VUR was 90% (kappa score, 0.77; p < 0.001). The agreement between CE-CDVUS and VCUG was 96% (kappa score, 0.91; p < 0.001). CE-CDVUS showed a significantly higher diagnostic accuracy than did CE-VUS (96% versus 90% of cases correctly classified; McNemar chi2 = 4; p < 0.05). This was mainly related to the lower number of false-negative results for grade I and grade II VUR when CE-CDVUS was used., Conclusions: The use of color Doppler imaging significantly improves the accuracy of contrast voiding urosonography in the detection and grading of VUR.

Problems concerning the use of different imaging modalities in N staging of the neck are dealt with. The peculiar features, findings, sensitivity, specificity and diagnostic accuracy of each modality in the diagnosis of nature of cervical lymphadenopathy are described, as reported in most recent reports of literature, and according to the personal experience. CT/MRI criteria commonly used to establish whether a lymph node is metastatic or benign/reactive are related to the size, morphology, density (CT), signal intensity (MRI), evidence of central necrosis and extracapsular spread. Color Doppler US is a reliable method in the diagnosis of cervical metastatic lymphadenopathy even if no parameter is highly predictive; the combination of different findings, especially cortical thickening and structural inhomogeneity with thin, compressed, displaced or non visualized hilum makes the procedure significantly sensitive and specific. Intranodal hilar vascularization on color Doppler, with high resistance arterial flow (PI > 1.5), enhances the predictive value of findings of bi-dimensional sonography. Extracapsular spread impacts on survival as well as on the number of recurrences, which increases in patients with extracapsular spread; the disease-free interval is less in these patients. The identification and definition of extracapsular spread is based on some CT/MRI criteria as: 1) lymph nodes with spiky, irregular margins; 2) loss of adipose cleavage planes around the node and thickening of adjacent fascia; 3) apparent invasion of an adjacent structures or muscles. Similarly to CT/MR, sonographic findings of extracapsular spread can be: 1) blurred margins and irregular contours; 2) invasion of an adjacent structure or muscle.

Objective: Our purpose was to compare hysterosalpingography with laparoscopy in the diagnosis of peritubal adhesions and to verify whether a combination of radiographic signs improves hysterosalpingographic accuracy., Subjects and Methods: Thirty candidates for laparoscopy underwent hysterosalpingography before surgery. Two radiologists evaluated the presence or absence and types of radiographic signs of peritubal adhesions (convoluted tubes, vertical tubes, loculation of contrast medium in peritoneum, halo effect, and fixed laterodeviation of the uterus) using two different criteria for normality or abnormality: no sign means a normal result, one or more signs mean an abnormal result (first criterion); no sign or one sign means a normal result, two or more signs mean an abnormal result (second criterion). Interpretation discrepancies were resolved by consensus. Peritubal and periovarian adhesions were evaluated by a single operating surgeon during laparoscopy (recorded on S-VHS videotape) and by a different surgeon reviewing the videotape. The radiographic results obtained using the two criteria in radiologically patent as well as in distally nonpatent tubes were compared with corresponding laparoscopic results by 2 x 2 tables and were statistically analyzed (kappa statistics)., Results: The first criterion displayed poor diagnostic accuracy. The correlation with laparoscopy was not statistically significant in either radiologically patent or distally nonpatent tubes. The second criterion greatly improved the agreement with laparoscopy, but only in patent tubes (kappa = 0.7789; p<0.001)., Conclusion: Hysterosalpingographic accuracy in peritubal adhesion diagnosis can be improved in patent tubes by taking into account more than one of the reported radiographic signs.

Medullary thyroid carcinoma is the least frequent thyroid neoplasm; it originates in thyroid parafollicular cells (calcitonin secreting C cells). In 80% of cases it is sporadic, in the remaining 20% it is familial, associated or not to other endocrinopathies as pheochromocytoma and hyperparathyroidism (MEN 2A, MEN 2B, and isolated familial medullary thyroid carcinoma). Preclinical diagnosis in relatives of affected subjects (preferably at pediatric age) is essential for successful therapy and is performed with genetic and biochemical screening tests. The genetic screening is based on DNA analysis (RET proto-oncogene mutations) of the patient, and if positive of all first degree relatives, to separate sporadic (somatic mutations) from familial (germline mutations) forms. The biochemical screening is based on calcitonin determination and its increase after pentagastrin stimulation, (a peculiar characteristic of medullary thyroid carcinoma, the first biochemical disorder in a subject at risk) and is mainly used in genetically silent familial medullary thyroid carcinoma. The principal negative prognostic factors of medullar thyroid carcinoma and the debate concerning the use of calcitonin determination in the diagnosis of the "cold" thyroid nodule have been analyzed.

The role of diagnostic imaging in differentiated thyroid carcinoma is analyzed. 99mTc-pertechnetate 123I and 131I scintigraphy allows the evaluation of nodules with their differentiation in cold (hypofunctioning) and hot (functionally autonomous) nodules; thyroid carcinomas are cold nodules even if most of them are benign. On sonography thyroid nodules are well visualized with the definition of their site, number, size (not very useful parameters for the diagnosis of malignancy), echoic structure, and vascularization on color Doppler. The sonographic findings suggestive of differentiated thyroid carcinoma are: solid and hypoechoic structure, irregular ill-defined margins, absent or discontinuous peripheral ring, microcalcification, intranodular vascularization, local lymphadenopathies. These findings are characteristic but not pathognomonic, mostly for papillary carcinoma, while in the frequently isoechoic follicular carcinoma microcalcification and lymph node metastases are rare. Only the finding, although rather infrequent, of the dissemination to adjacent structures (muscles and vessels) is a definite indication for malignancy of a thyroid nodule. Color Doppler sonography plays a major role in the postoperative staging and follow-up, in combination with thyroglobulin determination and 131I whole body scintigraphy and it allows the detection of local and/or laterocervical lymph node recurrence. The most typical sonographic findings of metastatic lymphadenopathy are the roundish shape (length/anteroposterior diameter ratio-L/A < 1.5), not visible or displaced nodal hilum, thickened cortical layer with echoic structure similar to that of thyroid parenchyma, at times with microcalcification, cortical vascularization and dismantled angioarchitecture. CT and MRI are occasionally more useful to evaluate the substernal or retrosternal extension of voluminous thyroid masses and to identify local or distant metastases.

In thyrotoxicosis, imaging mainly scintigraphy, color Doppler sonography and radioiodine uptake test are used in the differential diagnosis as well as in the morphofunctional evaluation of the thyroid before and after therapy (mainly pharmacological or with radioiodine). Radioiodine uptake test differentiates high uptake thyrotoxicosis (Graves'disease, toxic nodular goiter) and low uptake thyrotoxycosis (subacute or silent thyroiditis, ectopic thyrotoxicosis, iodine-induced hyperthyroidism). In Graves'disease scintigraphy shows thyroid enlargement with intense homogeneous tracer uptake; rarely nodules with no uptake are present. On color Doppler sonography, a part from enlargement, typical findings are: diffuse structural hypoechogenicity (at times with echoic nodules), parenchymal hypervascularization ("thyroid inferno"), high systolic velocities (PSV > 70-100 cm/sec) in inferior thyroid arteries. Scintigraphy is the only method able to evidence an autonomously functioning thyroid nodule and stage it (in association to clinical findings and TSH, FT3, FT4 determination) as: toxic, non toxic (or pretoxic) and compensated, depending on whether there is inhibition of extranodular tissue. A scintigraphically "hot" nodule appears hypervascularized on color Doppler sonography (especially in the toxic or pre-toxic phase) with high PSV (> 50-70 cm/sec) in the ipsilateral inferior thyroid artery. The most reliable parameters in the evaluation of the therapeutic efficacy are: decreases in thyroid (Graves'disease) or nodular (autonomously functioning nodule) volume; decreased radioiodine uptake (Graves'disease); functional recovery of suppressed parenchyma (autonomously functioning nodule); decreased PSV in the inferior thyroid arteries.

In diffuse or nodular euthyroid goiter, diagnostic imaging is indicated to define, by sonography, the morphology, size and structure of the goiter and to evaluate, by scintigraphy, the regional thyroid function. The instrumental diagnosis of thyroid nodule is essentially based on sonography, scintigraphy and (US-guided) needle aspiration cytology. The evaluation of some sonographic findings (echogenicity, calcification, lesion margins and presence of peripheral ring) may direct to the differentiation of a benign or malignant lesion. The role of color Doppler in the characterization of thyroid nodules is still controversial. Scintigraphy provides information on nodular function, being also the only exam able to show the presence of autonomously functioning thyroid tissue ("hot" nodule), whose diagnosis allows to rule out the presence of thyroid carcinoma with a very strong probability. In intrathoracic goiter, CT and MRI and indicated to show the continuity with the cervical thyroid and to define the relationships with adjacent structures. Radioiodine scintigraphy shows with high (> 90%) diagnostic accuracy the thyroid nature of a mediastinal mass (plunging goiter).

The role of preoperative noninvasive diagnostic procedures in the management of benign thyroid diseases is critically reviewed and on the basis of a series of more than 13,000 thyroid nodules, sequentially examined, the role of preoperative fine needle aspiration (FNA) cytology in discriminating benign from malignant lesions, is assessed. Retrospective studies were performed to determine the diagnostic accuracy of FNA adopted as routine preoperative screening procedure as compared to intraoperative frozen section (FS) analysis. US-guided FNA was shown to be more accurate allowing the preoperative identification of occult or minimal carcinoma: in fact about 3% of malignant thyroid nodules were detected. Moreover, the operation time is reduced, and unnecessary surgical treatments for benign lesions are eliminated, preventing the need of two-stage cancer surgery. FNA is a cost-effective diagnostic tool with about 20% reduction in the cost of care of patients with thyroid nodules. Most recent methods of molecular biology which seem promising in thyroid tissue sampled by FNA to detect malignant lesions missed by conventional cytology and included in the generic category of "follicular proliferation", are analyzed.

The diagnostic imaging of the thyroid is based on sonography and scintigraphy, which to-date play a unique role in the morphofunctional study of the thyroid gland. The high spatial resolution of sonography allows an accurate evaluation of the thyroid morphology, size and parenchymal structure. Color Doppler sonography allows a qualitative assessment associated with quantitative parameters of glandular vascularization. Furthermore, sonography is the simplest procedure to achieve an accurate, reproducible measurement of thyroid volume. Scintigraphy provides information unavailable by other methods on the regional thyroid function. The most common tracer for thyroid scintigraphy is 99mTc pertechnetate. 123I and 131I are essential for radioiodine uptake test. CT and MRI, while invaluable for other organs and apparatus, play a limited role in the diagnosis of thyroid disease.

Purpose: To determine the accuracy of magnetic resonance (MR) imaging in evaluating the invasive cervical carcinoma response to concurrent chemotherapy and radiation therapy., Materials and Methods: MR imaging was performed before and after concurrent chemotherapy and radiation therapy in 18 patients with locally invasive cervical carcinoma. Surgery followed neoadjuvant therapy in all patients. The presence of a lesion, signal intensity, zonal anatomy integrity, vaginal and parametrial invasion, and lymph node enlargement was determined. Posttreatment MR and histopathologic findings were correlated., Results: Fourteen patients had histopathologic confirmation of MR findings: Twelve had true-negative and two had true-positive findings. (Two had microscopic neoplastic foci beyond the spatial resolution of MR images; these foci do not change surgical treatment planning and probably do not influence prognosis. Therefore, these two patients were considered to have complete response). Four patients had false-positive findings; the hyperintense lesion on posttreatment MR images was due to a tunnel cluster pattern (focal hyperplasia of the endocervical glands with inflammation) in three patients and necrosis in one patient, without any evidence of neoplastic tissue. Thirty-three of 36 parametrial halves and 67 of 72 vaginal fornices were correctly interpreted on posttreatment images. Involvement of three parametrial halves and five fornices was overestimated at MR, because edema or inflammation was not distinguishable from tumor., Conclusion: MR imaging is 78% accurate in evaluation of tumor response; in 22% of patients, however, benign conditions were not distinguishable from tumor.

Since it serves as the site for the implantation of the fertilized ovum, it is evident that significant disorders in the uterine cavity and endometrial mucosa represent potential factors of sterility/infertility. Among the acquired pathological conditions, a possible cause of sterility, there are inflammatory (endometritis) or post-traumatic (synechiae) disorders and proliferative mucosal (endometrial hyperplasia, polyps) and muscular (fibroma) disorders. Sonography (by transabdominal or preferably endovaginal route, and sonohysterography) is the first choice procedure being in most cases adequate for clinical assessment. According to the specific disease, the diagnostic combination with hysteroscopy, hysterosalpingography, Magnetic Resonance Imaging can be suitable.

The diseases of the ovary which most frequently cause infertility are: anovulation from follicular atresia, the empty follicle syndrome, the luteinized unruptured follicle syndrome; chronic anovulation syndromes, within which polycystic ovarian syndrome plays a major role; ovarian endometriosis. Sonography and Color Doppler US are the first choice procedures in the monitoring of ovarian cycles, which combined with serum hormone values, are able to identify possible changes in the physiologic sequence of the cycle. In follicular atresia, ovaries with minute follicles (3mm or less) and early disappearance of primary follicle are observed on sonography. The empty follicle syndrome characterized by the lack of oocytes within the primary follicle, is of difficult sonographic diagnosis, a possible sign being the missed visualization of cumulus oophorus. The luteinized unruptured follicle syndrome consists in the absence of oocyte expulsion from primary follicle persisting more than 48 hours after LH blood peak. Doppler spectra of blood flow in perifollicular ovarian arteries maintain the features of the follicular phase, i.e. low diastolic velocities and high resistances. Among chronic anovulation syndromes, hyper-and hypogonadotropism cause ovarian amenorrhea where ovaries are similar to those of women in menopause: small size, very few or absent follicles. The polycystic ovarian syndrome is characterized by an abnormal pulsatile GnRH release which causes LH hypersecretion and FSH hyposecretion. The latter is not able to stimulate the growth and maturation of follicles, while the former causes hyperandrogenism with hirsutism and obesity and is responsible for hypertrophy and stromal hyperechogenicity. The sonographic diagnosis of polycystic ovarian syndrome is based on standardized morphostructural signs as increased volume of the ovaries (> 10 cm3), the presence of numerous (> or = 10) peripheral microfollicles (< or = 5 mm) with hyperechoic stroma. The endometrial cyst, usually present in ovarian endometriosis is visualized with sonography as a round neoformation with ill-defined walls, filled with a uniformly hypoechoic, corpuscular, partly hemorrhagic fluid; less frequently the appearance is that of a more complex structure posing differential diagnostic problems, mainly with the hemorrhagic corpus luteum; both pathological conditions appear poorly vascularized at Color Doppler, with tracings of high resistance arterial flow. Among the procedures of second choice, CT can show the high blood density common to the two conditions while on MRI the signal is mostly hyperintense in T1-weighted sequences with areas of lower signal intensity in T2-weighted sequences.

Considering the several suggestions regarding the future developments of echocontrast agents, there is a striking difference between the few compounds actually available on the market and used in clinical practice and those undergoing experimental clinical trials. It is therefore difficult to predict what will be the actual impact of these agents in the next future. Future developments will probably go beyond color enhancement which was the end-point till a very short time ago. They can be schematically summarized as follows: (1) development of new substances which enhance both color and gray scales; (2) use of new-generation substances, such as BR1 (Bracco, Milan, Italy) and EchoGen (Sonus, Bothell, WA), which use a gas other than air, such as perfluorate compounds which are more stable and guarantee longer and stronger effects; (3) use of more complex compounds acting at different levels. For example, SHU 536A (Sonovist) produces resonance phenomena with the second and third harmonics, and also stimulated acoustic emission which permits the morphological study of liver parenchyma. Other promising compounds are liposomes and aerosomes. Among the new possibilities in recording and observing phenomena, we can distinguish two main application fields: one is based on the physics of ultrasound and related to the presence of microbubbles in an acoustic field. These phenomena are generally obtained increasing the emission acoustic pressure, which eventually results in microbubble destruction and they are called nonlinear because there is no direct relationship between emission and return frequencies. These phenomena, which are detectable only with dedicated equipment, include: the resonance phenomenon with harmonic emission; intermittent harmonic emission and stimulated acoustic emission. The other application field is not strictly related to ultrasound physics and includes all the systems which can detect the presence of microbubles qualitatively or quantitatively. Other possible applications are related to the possibility of acquiring not only morphological but also functional data, especially in cardiology and neurology. Finally, targeted agents are potentially capable of demonstrating receptor sites or specific molecules, which may open very interesting therapeutic routes.

The mechanisms of the spread to the kidney and urinary tract of miliary tuberculosis which involves the urinary system with a rather high incidence, and, if not detected, may result in a functionless kidney for the often nonspecific symptomatology, are analyzed. These considerations account for the seriousness of the problem of urinary tuberculosis, whose great topical interest is unfortunately proven not only in the African continent where it is particularly common, but also in Europe. The lesions underlying the damage to the renal parenchyma and lower urinary tract are carefully examined for a correct interpretation of the radiologic signs. Most representative patterns of the various stages of urinary tuberculosis are described; the attention is focused on conventional radiology, still the most suitable imaging procedure for its early identification. The role of the other procedures which even if are not of first choice when urinary tuberculosis is suspected, in some cases may be useful in the approach to the disease. The mechanisms of the spread of genital tract tuberculosis, less frequent than urinary tuberculosis, but seemingly interesting for its clinical and diagnostic features, are considered. An accurate analysis of major patterns of tuberculosis of male and female genital tract is reported to better understand the various aspects of diagnostic imaging.

To investigate color-Doppler US capabilities in tissue characterization, 42 renal masses were studied from November, 1993, to July, 1994. B-mode morphologic patterns were studied first and then integrated with color flow patterns; color areas and blood flow distribution were assessed for each lesion. Color signals were used as a guide to obtain arterial and venous Doppler spectra and to calculate flow velocities and pulsatility index (PI). Based on the us morphologic appearance, the 42 lesions were divided into 3 groups: A) lesions with morphologic and volumetric patterns of malignancy; B) small lesions (< 3 cm, > 3 cm < 5 cm); C) complex cysts. Data were organized and analyzed statistically; some findings were found to be typical of malignancy: hypervascularity, intralesional arterial signals with high flow velocities (systolic peak cut-off: 0.3-0.4 m/sec), high PI values (> 1) and, finally, color signals inside complex cysts. Our results suggest that color-Doppler US is a useful tool to assess renal masses vascularity, with the color-Doppler technique increasing US diagnostic accuracy. Nevertheless, small lesions need more careful study because their features are poorly demonstrated even with CT and MRI.

The differential diagnosis of focal hepatic lesions is a current problem even though many study methods are available. Color Doppler US has been recently suggested as a diagnostic technique capable of depicting lesion vascularization patterns to better understand lesion nature. However, this examination is often difficult and long. In this study, we investigated the role of a US contrast agent SH U 508 A (Levovist) enhancing the color Doppler signals for easier and better depiction of lesion vascularization. Seventy-four patients with one or more focal hepatic lesions (mean diameter: 5.6 cm) were examined. The lesions were 38 HCCs, 4 cholangiocarcinomas, 1 intrahepatic biliary duct carcinoma, 1 case of multiple adenomas, 2 regenerations nodules in cirrhosis, 2 cases of FNH, 18 metastases and 8 hemangiomas. In 54 cases the US contrast agent allowed the visualization of some vessels inside the lesions which had been missed at baseline examinations. Moreover, the vessels which had been depicted on baseline images were better demonstrated. In all but one patient with severe hepatic steatosis, normal parenchymal vessels were markedly enhanced. Our results in the different kinds of tumors are here reported.

Adrenal cysts are an uncommon finding, in most cases unexpectedly discovered in the evaluation of nonspecific abdominal pain or at autopsy. Cystic adrenal masses can be classified into neoplastic and non-neoplastic aetiologies. The distinction between malignant and benign adrenal cysts can still be difficult. Cysts of neoplastic aetiology occur as a result of necrosis and cystic degeneration within both benign and malignant tumours. Non-neoplastic cysts have been conventionally divided into four categories: endothelial (45%), haemorrhagic or pseudocystic (39%), epithelial (9%) and parasitic (7%). Small adrenal cysts are clinically silent, while cysts of large size can cause displacement and compression of adjacent organs. The radiological aim is to detect the adrenal mass and CT is regarded as the best method available for this detection, although a differentiation between benign and malignant tumours can be difficult. Here we report our experience in nine patients with adrenal cysts. Abdominal pain was the dominant sign, two patients were hypertensive, one presented a palpable mass at abdominal examination and another presented oligomenorrhea with hypertrichosis, in five patients the adrenal mass was discovered unexpectedly during radiologic examination. All cysts in our patients were unilateral. All patients were examined by ultrasound and CT, one by RM, three by 75Se-Seleniumcholesterol cortical scintigraphy and two by 131I-MIBG medullary scintigraphy. In three patients a percutaneous aspiration of the cyst was performed via a posterior approach with CT or US guidance. This approach has been used for diagnostic and therapeutic purposes. Examination of aspirated cyst fluid for steroid hormones showed markedly elevated cortisol levels compared with normal plasma cortisol levels in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)

The diagnosis, staging, therapy and follow-up of advanced epidermoid cervical carcinoma (FIGO stages IIB-III) have been studied in our university since January 1990. By December 1992, a team of specialists including radiologists, radiotherapists, gynecologists and pathologists divided 54 patients into two random treatment groups: group A patients, after systemic chemotherapy (CDP, 2 cycles) and diagnostic reevaluation, underwent radical surgery; group B patients received conventional radiotherapy alone (ERT 45 Gy+IRT or END-RT 20-25 Gy). All patients were examined by means of transrectal US (TRUS) and CT, after clinical examination under sedation, at staging and during the follow-up. The exams were performed periodically for group B patients and after systemic chemotherapy for group A patients. Imaging findings were compared with pathology only in group A. All imaging results were filed. The results confirm some literature data--e.g., 62% diagnostic accuracy for CT and 69% for TRUS, with higher diagnostic accuracy of the latter to evaluate cervical volume and to diagnose local relapses. As for parametrial involvement, both imaging methods tend to understage the early involvement, but only CT tends to overstage the lesions, especially in irradiated patients, due to fibrosclerosis phenomena. TRUS exhibited 69% accuracy, 70% sensitivity and 69% specificity, versus 61%, 62% and 60%, respectively, for CT; clinical examination under sedation had 58%, 60% and 60%, respectively. Both TRUS and CT are faster than endoscopic methods in evaluating vesical and/or rectal involvement. Lymph node metastases at staging, especially those in lumboaortic locations, proved to be unfavorable prognostic signs, as demonstrated by lumboaortic lymph node relapses in 5 group B patients (only 2 of them presented with lymph node metastases at staging; 3 patients had micronodules near the renal vessels), in spite of good local response after radiotherapy. In conclusion, we would like to point out that our team has had an MR unit at its disposal only recently: since the method is considered as the gold standard of imaging, especially in this kind of lesions, the study is still in progress.