Ultrasound evaluation of the first finger's sesamoid bones: diagnostic value of sesamoid and subsesamoid indices.

PURPOSE: Our analysis focuses explicitly on applying two sonographic and morphological indexes (sesamoid index and subsesamoid index) to better evaluate post-traumatic consequences to the sesamoids of the first finger. METHODS: In 2 years, we enrolled 75 patients, divided into two groups: 60 without any history of trauma and 15 reporting hyperextension trauma of the first finger. We performed clinical and instrumental examinations (sonography and X-ray) on patients with one or more symptoms compatible with sesamoiditis, while an MRI scan was performed only on patients with an acute onset and severe symptomatology. We measured both the short and long-axis diameter (in mm) for each sesamoid as well as the relation between the two parameters (sesamoid index, SI and subsesamoid index, SubI). RESULTS: All 15 patients showed sonographic alterations of the SI above the reference range, while the alterations of SubI varied according to the acuteness and gravity of trauma. In all cases, the X-ray did not show any relevant alterations. MRI scans in patients with acute symptoms confirmed the sonographic findings. CONCLUSION: Sonography enabled diagnosis of micro-injuries which were invisible to X-Ray and allowed to detect possible damages to the sesamoid complex, providing a qualitative and quantitative evaluations of the post-traumatic alteration of the metacarpophalangeal joint of the 1st finger and is therefore valid, combined with clinical examination and hand X-ray, in the evaluation of sesamoiditis without the need to perform further examinations.

Comparative US-MRI evaluation of the Insall-Salvati index.

PURPOSE: To investigate whether the universally accepted range of normal patellar height ratio derived from MRI for the Insall-Salvati (IS) method could be similarly applied to ultrasound (US). MATERIALS AND METHODS: This study included 52 patients (age range 11-75 years) who underwent a bi-modality (US and MRI) examination, with a total of 60 knees evaluated. IS index (ratio of the patella tendon length to length of the patella) was acquired with both methods. Two operators, with different experiences of musculoskeletal imaging and blinded to the results of other investigators, separately performed the MRI and US measurements. RESULTS: For the two operators, MRI reported a mean value of patellar height ratio of 1.10 ± 0.16 (mean ± standard deviation SD), while US a mean value of 1.17 ± 0.16 (mean ± SD). For comparable results, the small addition of 0.16 is needed for the measurements on US compared with MRI. Inter-observer agreements using intra-class correlation coefficient (ICC) was, respectively, 0.97 for MRI and 0.98 for US. The difference of mean values in patellar height ratios between MRI and US was not statistically significant (p = 0.15). The ICC between the two modalities was 0.94. CONCLUSION: According to our experience, IS index can be appropriately evaluated on US images, reducing the need of other imaging techniques.

Primary colonic lymphoma: An incidental finding in a patient with a gallstone attack.

We report a case of primary colonic lymphoma incidentally diagnosed in a patient presenting a gallbladder attack making particular attention on the diagnostic findings at ultrasound (US) and total body computed tomography (CT) exams that allowed us to make the correct final diagnosis. A 85-year-old Caucasian male patient was referred to our department due to acute pain at the upper right quadrant, spreaded to the right shoulder blade. Patient had nausea and mild fever and Murphy's maneuver was positive. At physical examination a large bulky mass was found in the right flank. Patient underwent to US exam that detected a big stone in the lumen of the gallbladder and in correspondence of the palpable mass, an extended concentric thickening of the colic wall. CT scan was performed and confirmed a widespread and concentric thickening of the wall of the ascending colon and cecum. In addition, revealed signs of microperforation of the colic wall. Numerous large lymphadenopathies were found in the abdominal, pelvic and thoracic cavity and there was a condition of splenomegaly, with some ischemic outcomes in the context of the spleen. No metastasis in the parenchimatous organs were found. These imaging findings suggest us the diagnosis of lymphoma. Patient underwent to surgery, and right hemicolectomy and cholecystectomy was performed. Histological examination confirmed our diagnosis, revealing a diffuse large B-cell lymphoma. The patient underwent to Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisone chemotherapy showing only a partial regression of the lymphadenopathies, being in advanced stage at the time of diagnosis.

US and color Doppler findings in angiolymphoid hyperplasia with eosinophilia involving the superficial temporal artery.

Reported here is a 60-year-old man with multiple localizations of angiolymphoid hyperplasia with eosinophilia (ALHE) in the temporal region, involving the superficial temporal artery, detected and analyzed with ultrasound and color Doppler. The usefulness of this diagnostic technique and the peculiar signs of ALHE are discussed.

Sonographic evaluation of anterior cervical lymph nodes.

PURPOSE: In this study we evaluated the role of ultrasound in diagnosis of anterior cervical lymph (ACL) node disease. METHODS: Three-hundred and sixty-six patients were included in the study. When ACL nodes were found, we noted the station(s) involved, the number, and the short and long axis of each. Patients had their thyroid investigated and were then divided into four groups: no sonographic signs of thyroid abnormality, already diagnosed autoimmune thyroiditis, probable new diagnosis of autoimmune thyroiditis, and thyroid nodules. RESULTS: ACL nodes were found in 127 out of 366 patients examined. The 127 patients with ACL nodes were classified into group 1 (2 patients), group 2 (97 patients), group 3 (23 patients), and group 4 (5 patients). The only differences were the presence and number of lymph nodes in the prelaryngeal and/or prethyroidal and/or pretracheal stations, and the number of "acutely inflamed" nodes in group 3 compared with all the other groups. CONCLUSION: We observed a strong association between anterior cervical lymphadenopathy and autoimmune thyroiditis; this is certainly a good reason to justify thorough evaluation of anterior cervical lymph nodes for all patients with suspected thyroiditis.

Ultrasound findings in intersection syndrome.

OBJECTIVE: The purpose of our study is to demonstrate the role of ultrasound as a first-line technique in the evaluation of intersection syndrome, reporting and illustrating its typical and atypical findings. METHODS: In a 2-year period, we reviewed nine patients who received an ultrasound examination for non-specific inflammatory signs in the distal forearm: four men (28-53 years old) and five women (34-57 years old), with a mean age of 44.1 years. RESULTS: The ultrasound examination revealed, in all patients, the presence of peritendinous oedema and a small amount of synovial fluid within the tendon sheaths at the crossing intersection point between the first and the second dorsal extensor tendon compartments, with loss of the hyperechoic cleavage plane between the two tendon groups. In two patients, we observed an irregularly thickened tendon sheath, with small hyperechoic nodules within the fluid, related to proliferation of the synovial membrane. In one case, we detected a relevant thickening of the extensor carpi radialis longus and brevis tendon. Only one patient showed moderate muscle oedema within the first extensor compartment muscles, while another one had significant subcutaneous oedema. CONCLUSION: Ultrasound is effective in the first-level diagnosis of intersection syndrome.

Fatty changes as a misleading factor in the evaluation with ultrasound of superficial lymph nodes.

The object of this paper was to investigate lipoplastic lymphadenopathy in superficial locations with ultrasound. We selected 110 patients with a total number of 247 nodes with a central hyperechoic area extended for more than one third of the transverse diameter. We considered gender, age, body mass index (BMI), and associated disease such as thyroid disorders and diabetes. For each lymph node, we measured the long:short axis ratio and the parenchyma:fat (P:F) ratio. Differences between mean P:F ratio in diabetic and nondiabetic patients were significant (p=0.045). Mean P:F ratio was negatively related to BMI (r=0.62, p=0.015) and age (r=0.54, p=0.024). All of the nodes examined with a mean P:F ratio

Color Doppler ultrasound in renal transplant: role of resistive index versus renal cortical ratio in the evaluation of renal transplant diseases.

BACKGROUND/AIMS: Ultrasound (US) and color Doppler are not sensitive enough to detect anomalies in cortical perfusion, which is affected in most graft dysfunctions. The renal cortical ratio (RCR) is a variation in the resistive index (RI) values from the renal artery to cortical vessels, expressed in percent. The aim of this study was to compare the RI and RCR in the differentiation of normal and pathological grafts, to assess the positive predictive value of RCR and show that RCR enables earlier diagnosis than RI. METHODS: Based on clinical, biochemical and histological examinations, 494 renal allografts were divided into 3 groups (normal grafts, acute and chronic pathologies). All patients underwent US color Doppler. RI was measured and RCR calculated. Follow-up confirmed the initial division in groups. Statistical significance was calculated using the two-tailed Student's t test. The positive predictive value was calculated for each group. RESULTS: 24 h after transplant, RCR differentiated normal grafts from acute dysfunctions despite confusing biochemical values and clinical symptoms. In chronic patients, RCR variations occurred later but always before the serum creatinine level increased. CONCLUSION: RCR presented a higher positive predictive value than RI. RCR curves were already altered in the early stages of transplant pathologies. RCR calculation is easy and makes a significant contribution towards a correct early diagnosis.

High-resolution and color doppler sonography in the evaluation of skin metastases.

OBJECTIVE: To evaluate high-resolution sonography in differentiating cutaneous metastases from other benign dermatologic diseases with the final objective of proposing high-resolution sonography in the diagnostic protocol for asymptomatic patients and those with neoplasms who have 1 or more rapidly growing skin nodules. METHODS: We selected 57 patients (24 women and 33 men; mean age +/- SD, 53 +/- 25 years) who underwent high-resolution and color Doppler sonography because they recently noticed 1 or more superficial nodules. Patients were mostly asymptomatic, but 15 had previously diagnosed malignancies. Each nodule was classified by measurement of fundamental sonographic parameters (major diameter, shape, borders, echo texture, and homogeneity) and by assessment of vascularity (presence or absence of flow and vascular pattern) with color Doppler sonography. All nodules were ablated and histologically examined. RESULTS: Of 68 nodules, 23 were malignant (21 metastases and 2 B-cell lymphomas), and 45 were benign (22 sebaceous cysts, 18 granulomas of different origins, 3 fibromas, and 2 neurofibromas). The nodules were all localized in the subcutaneous space, had clearly demarcated borders, and were hypoechoic; a circular or oval shape was predominant, but 7 metastases had an irregular, polycyclic shape. On color Doppler sonography, none of the benign nodules or B-cell lymphomas showed signs of vascularity, whereas the metastatic nodules were all vascularized, with 1 or more peripheral poles (21 of 21 nodules) and internal vessels (11 of 21 nodules). CONCLUSIONS: A polycyclic shape and hypervascularity, with multiple peripheral poles and, eventually, internal vessels, should be considered the most indicative signs of metastasis.

Transrectal ultrasound color Doppler in the evaluation of recurrence of anal canal cancer.

OBJECTIVE: aim was to obtain elements for a differential diagnosis between post-radiation fibrosis and residual tumor or local relapse in anal canal cancer through detection of presence/absence of intralesional blood flow. Transrectal ultrasound and color Doppler were compared. METHODS: 43 patients underwent transrectal ultrasound sonography and color Doppler before and after therapy to assess intralesional blood flow and flow pattern (spotty and linear signals). All diagnostic imaging results were compared to histological analysis. Specificity was submitted to statistical analysis using McNemar test. RESULTS: before therapy 34 lesions (79%) showed color signal; no signal in 9 (21%), which were excluded from our analysis. Eighteen of the 34 patients considered, presented complete response to therapy, 14 partial response and two no response. After therapy, signal disappeared in 17 patients (94%); one false-positive (6%) presented spotty signals; 16 of 34 patients presented changed color signal. Color Doppler showed higher specificity than grey scale transrectal ultrasound in the differentiation of fibrosis from tumor. Response was confirmed by histological examination, considered gold standard. McNemar test demonstrated the significance of color Doppler (P < 0.0001). CONCLUSION: color Doppler considerably increases transrectal ultrasound specificity in differentiating tumor relapse from fibrosis in anal canal cancer.

Color Doppler sonography in the evaluation of superficial lymphomatous lymph nodes.

OBJECTIVE: We performed a retrospective study to document the sonographic and color Doppler characteristics of lymphomatous superficial lymph nodes. METHODS: We selected 130 individuals who underwent sonography, color Doppler imaging, fine-needle aspiration biopsy, and surgical removal of the nodes with the final diagnosis of lymphoma (87) and chronic adenitis (43). During sonography, for each node we considered the longitudinal and axial diameters, long/short axis ratio, visibility of the hilum, and the internal echogenicity of the node. During the color and power Doppler examination, we classified the nodes into 3 patterns: type I, "hilar normal"; type II, "hilar activated"; and type III, "peripheral." RESULTS: Sonographic evidence was not significant. With color Doppler sonography, 97% of nodes affected by non-Hodgkin lymphoma, 94% of nodes affected by Hodgkin lymphoma, and 100% of non-neoplastic nodes showed hilar vascularity. Type I seemed more frequently associated with inflammation, and type II was more frequently associated with lymphoma. CONCLUSIONS: The presence of peripheric subcapsular vessels, which is typical of metastasis, is definitely rare in lymphoma (with the possible exception of the uncommon subtypes of high-grade lymphomas). The differential diagnosis between lymphoma and lymphadenitis is frequently impossible on the basis of sonographic and color Doppler patterns alone; therefore, clinical evaluation and biopsy are generally mandatory.