A randomized trial of ultrasound-guided anterior subcostal liver biopsy versus the conventional Menghini technique.

An ultrasound-guided double pass biopsy technique using a large bore cutting needle via an anterior subcostal route (USAB) is described. The diagnostic adequacy of this biopsy procedure was evaluated in comparison with the traditional Menghini technique in 200 cases of suspected chronic liver disease randomly assigned to the two different procedures. Retrieval rate was better in the USAB group. The sample length was less than 15 mm in four cases in the USAB group and in 19 cases in the Menghini group. In three cases in the USAB group the second pass modified the diagnosis of the first specimen from chronic active hepatitis to active cirrhosis. In order to evaluate the safety and discomfort of the two procedures 340 patients assigned to the different techniques had liver ultrasound scans 6 and 24 h following percutaneous biopsy. USAB was associated with a reduced frequency of complications (one out of 170 patients vs. seven out of 170 patients who had the intercostal Menghini procedure). In our study, USAB seems to offer better sampling and size of individual samples, together with reduced frequency of major and minor complications.

[Percutaneous treatment under echographic guidance of toxic thyroid nodules. Technique for its performance and preliminary results]. / Trattamento percutaneo sotto guida ecografica dei noduli tossici della tiroide. Tecnica di esecuzione e risultati preliminari.

Six patients affected by toxic thyroid nodules (Plummer disease) were treated by percutaneous ethanol injection (PEI). Treatment was performed injecting under ultrasound guidance 2-4 mL of 95% sterile ethyl alcohol through a spinal needle (22 gauge, 75 mm length). Treatment was performed once-twice weekly and repeated as an outpatient procedure 4-6 times. PEI induced clinical improvement and hormonal control by the end of the treatment (one month) and no complications took place. After PEI all hyperfunctioning thyroid nodules became smaller at clinical and ultrasound examination. Three months after PEI hot areas appeared cold at 99mTc and 1311 scintiscan. Serum levels of FT3, FT4, AbT, AbM, TG reached the normal range and serum TSH levels were significantly increased and responsive to TRH stimulation.

Hepatocellular carcinoma: magnetic resonance imaging after ultrasonically guided percutaneous alcohol treatment. Preliminary report.

Percutaneous alcohol injection (PAI) is reported as a safe, inexpensive and effective method of treatment of small HCC in severely ill patients. Nevertheless, residual cancer can persist after treatment and multiple bioptic manoeveurs are needed to ascertain the actual completeness of treatment. In two cases of HCC treated by ethanol injections, MRI on T2 weighted sequences showed a characteristic change from the previous hyperintense or isointense signal to a hypointense one. This MRI pattern, quite different from the usual HCC features, was correlated to the histologic findings of complete coagulative necrosis of the tumoural mass. Further observations are needed to assess reproducibility and specificity of this finding and the MRI pattern needs to be evaluated also in unsatisfactory percutaneous alcohol treatment of HCC in order to demonstrate that cases with persistent neoplastic tissue display a different pattern. If our report should be confirmed, MRI might be a not invasive tool in evaluating the effectiveness of PAI in patients at risk for multiple histologic samplings. Furthermore MRI could be very useful in assessing the degree and extent of tissutal changes in response to local therapy also after the tumour and its margin are masked by US guided ethanol injections.

A new approach to non-invasive quantitative study of hepatic haemodynamics using radiocolloids in vivo.

A non-invasive radioisotopic method for the study of liver haemodynamics is described. Data collected by means of a computerised gamma camera for about 4 min after intravenous administration of 99Tcm human serum albumin colloids were analysed using a new mathematical model formulated on a physiopathological basis. Several quantities of possible clinical interest were determined, namely parameters related to liver blood flows, intrahepatic shunts, the intrahepatic space of distribution of the tracer, transit times and extraction efficiency. Results are not affected, within certain limits, by the shape of the radioactive bolus and, with the exception of extraction efficiency, they appear to be independent of the size of the radiocolloidal particle. The dose employed (3-4 mCi) is comparable with that used in liver scintigraphy. Results in 19 subjects with normal liver function, 45 patients with liver cirrhosis and 7 patients with focal liver lesions were in good agreement, from a quantitative viewpoint, with known physiopathological data, thus validating this method in comparison with other more traumatic and/or less practical techniques, which provide less complete information on liver haemodynamics. The method proposed appears to be sufficiently accurate, reproducible, safe and practical, and may thus be considered suitable for routine use in the assessment of functional aspects of liver perfusion for clinical purposes.