ABSTRACT
PURPOSE: To evaluate the diagnostic performance of ultrasonography using second-generation contrast agent in the study of patients with focal prostate lesions and increased serum prostate-specific antigen (PSA) level. MATERIALS AND METHODS: SIX CONSECUTIVE PATIENTS (AGE RANGE: 72-87 years) with increased PSA (≥4 ng/ml) underwent transrectal ultrasonography (TRUS) followed by contrast-enhanced ultrasonography (CEUS) with injection of second-generation contrast agent. All patients showed areas of abnormal echostructure suspicious for neoplastic lesions. On the basis of CEUS, a time/intensity curve of the suspected area was compared to that of a normal-appearing distant area of the gland and to the results of biopsy of the hypoechoic area. RESULTS: AT CEUS TWO DIFFERENT PATTERNS OF ENHANCEMENT WERE IDENTIFIED AND CONSIDERED TO BE SIGNIFICANT: pattern 1 characterized by a rapid rise in the time/intensity curve of the suspected area compared with the normal gland. Two out of six patients had this pattern and biopsy showed cancer in the biopsied area. Pattern 2 was characterized by a similar rise in the time/intensity curve of the suspected area compared with the normal gland. Four out of six patients had this pattern and biopsy showed prostatitis in the biopsied area. CONCLUSIONS: CEUS using second-generation contrast agent can on the basis of time/intensity curves show differences in vascularization in normal and pathological tissue. Evaluation of the two patterns seems to be useful for identifying areas requiring biopsy, particularly when peripheral hypoechoic areas are observed at TRUS. Our data need to be confirmed in a larger patient population.
ABSTRACT
PURPOSE: Mason's vertical banded gastroplasty (VBG) is one the most popular surgical techniques for the treatment of morbid obesity because it is effective and easy to perform and presents a low incidence of long-term complications. We report our personal results in 322 Mason's VBG patients who were followed-up radiologically. MATERIAL AND METHODS: 322 patients submitted to modified Mason's VBG underwent radiological follow-up, preferably with single contrast, to assess the shape and volume of the pouch and the presence of postoperative complications. The patients were 272 women and 50 men whose average weight was 124 kg (range: 78 to 218 kg). The women's average age was 37 years (range: 17 to 69) and the men's 36 (range: 19 to 64). We performed a double contrast examination, adapting the dosage of effervescent powders to the gastric pouch capacity, only in particular cases where a more detailed study of pouch surface was required. The examinations were performed at 1 month and 12 months postoperatively to evaluate the pouch shape and volume, in order to correlate surgical results with weight loss. Premature or unscheduled examinations were necessary only in some cases due to suspected complications or unsatisfactory weight loss. First we perform right anterior oblique projections with the patient standing, with a direct preliminary study of the epigastric region to locate the two metal clips. The patient is given barium in small swallows because large amounts might obscure the pouch by filling the fundus of the excluded stomach. Then we take left anterior oblique views to depict the neopylorus and the staple lines, and left posterior oblique projections in lateral and supine recumbency. RESULTS: We observed early postoperative complications such as pseudopylorus edema (8 patients) and intragastric hemorrhage (1 patient), and late complications such as pseudopylorus adherence to the gallbladder bed (1 patient), pseudodiverticular extroversion (1 patient), and axial enlargement (4 patients) of the pouch. The only two cases of staple-line dehiscence were both identified radiographically. In 305 patients with satisfactory weight loss no complications were observed with a pouch size of 45-70 mL (at 1 month) and 58-70 mL (at 12 months). DISCUSSION AND CONCLUSIONS: Upper gastrointestinal radiological studies permit to detect both early and late postoperative complications in Mason's VBG patients. They also provide data on the neostomach and permit to correlate the pouch volume with weight loss.
