Prevalence of extravascular collateral findings during 64-slice CT angiography of the abdominal aorta and lower limbs.

PURPOSE: The aim of this study was to assess the prevalence of extravascular collateral findings during 64-slice CT angiography of the abdominal aorta (AA-CTA) and lower limbs (LL-CTA). MATERIALS AND METHODS: The images of 536 AA-CTA and LL-CTA examinations performed for suspected aortic and peripheral vascular disease in 500 patients were retrospectively reviewed. Two radiologists evaluated the 5-mm axial images independently using appropriate window settings for the area under investigation. Collateral findings were divided according to their clinical significance into significant, nonsignificant and meriting further investigation. RESULTS: No collateral findings were identified in 97/500 patients (19.4%). In the remaining patients, 821 collateral findings were detected, of which 43 (5.24%) were classified as significant, 135 (16.44%) as meriting further investigation and 643 (78.32%) as nonsignificant. The findings indicative of the presence of a malignant lesion totalled 36 (4.5%). CONCLUSIONS: AA-CTA and LL-CTA demonstrate a nonnegligible prevalence of collateral findings, many of them major. It therefore appears that the evaluation should focus not only on the image reconstructions to identify vascular disease, but also on the native axial images to detect incidental findings.

Effect of Tadalafil on prostate haemodynamics: preliminary evaluation with contrast-enhanced US.

PURPOSE: Phosphodiesterase-5 (PDE-5) inhibitors have an established role in the treatment of erectile dysfunction, but there is increasing evidence that these drugs are effective also for the treatment of lower urinary tract symptoms and benign prostatic hyperplasia (BPH). The mechanism of action of PDE-5 inhibitors in the prostate, however, is poorly understood. It is conceivable that these drugs act by reducing the smooth muscle tone of the organ, but this effect could produce vascular changes as well. The aim of this study was to investigate whether administration of Tadalafil, a PDE-5 inhibitor, in patients with BPH produces haemodynamic changes in the prostate that can be assessed using contrast-enhanced US (CEUS). MATERIALS AND METHODS: Twelve consecutive patients with BPH underwent transrectal CEUS before and 90 min after administration of 20 mg Tadalafil. CEUS was performed during bolus injection of SonoVue (4.8 ml) using a nondestructive US mode. The same scan plane, imaging parameters and technique were used before and after Tadalafil administration. Digital clips were recorded and processed using dedicated software (QontraXt v.3.60. Signal intensity (SI) changes in a region of interest (ROI) encompassing the entire prostate were fitted to a gammavariate curve. Changes in enhancement peak, time to peak (TTP), sharpness of the bolus transit and area under the curve (AUC) were considered for further analysis. RESULTS: After Tadalafil administration, the enhancement peak and AUC increased significantly (p<0.01), reflecting changes in prostate vascularity. TTP and sharpness did not change significantly. CONCLUSIONS: In patients with BPH, vascular changes are observed in the prostate after Tadalafil administration, which can be detected with CEUS.

Differential diagnosis between splenic nodules and peritoneal metastases with contrast-enhanced ultrasound based on signal-intensity characteristics during the late phase.

PURPOSE: This study was done to assess the enhancement characteristics of splenic implants and to evaluate whether contrast-enhanced ultrasound (CEUS) after SonoVue injection allows the differential diagnosis with peritoneal metastases. MATERIAL AND METHODS: Thirteen consecutive patients with splenosis and 13 consecutive patients with peritoneal metastases were investigated with CEUS after injection of 2.4 ml of SonoVue. Lesion enhancement was evaluated in real time for 240 s. All examinations were recorded digitally and analysed retrospectively. Frames were selected at different time intervals ranging from 0 to 4 min after injection. Average signal intensity was evaluated by measuring the average grey level in a region of interest encompassing the entire nodule. Results were evaluated using the Mann-Whitney test and interobserver variability using the Bland and Altmann method. RESULTS: Splenic grafts presented with intense enhancement and without significant washout. Metastases presented with variable enhancement and progressive washout. Signal intensity values were significantly higher for splenic grafts, starting from 40 s after microbubble administration. Starting from 90 s after injection, there was no overlapping between enhancement of splenic grafts and peritoneal metastases, and only splenic grafts showed a percent of enhancement higher than 60% of the maximum enhancement. CONCLUSIONS: CEUS after SonoVue injection may be considered a valuable alternative to scintigraphy for characterising peritoneal splenic grafts without radiation.

Comparison of conventional ultrasound and real-time spatial compound imaging in evaluation of patients with severe Peyronie's disease.

BACKGROUND: Real-time spatial compound imaging (C-US) is an ultrasound (US) method which effectively reduces image artifacts and noise. In contrast to conventional techniques, multiple frames are acquired from different viewing angles and combined to form a single compound image. PURPOSE: To evaluate whether C-US improves ultrasound evaluation of patients with severe Peyronie's disease. MATERIAL AND METHODS: 60 consecutive patients with severe Peyronie's disease underwent conventional US and C-US after intracavernous prostaglandin E1 injection. Corresponding images of the same scan plane were obtained with both methods, and subjective image quality was scored retrospectively using a four-point scale by two blinded readers with different experience in penile imaging. Readers focused on evaluation of the tunica albuginea, plaques, involvement of the penile septum, and overall image quality. Also, presence of large albugineal calcifications or microcalcifications was considered. To assess intrareader agreement, both readers repeated evaluation after a 1-month interval. Statistical analysis was performed using the Wilcoxon signed-rank test and McNemar test. Weighted kappa values were calculated to assess intra- and inter-reader agreement. RESULTS: Average scores were significantly higher for reader 1 (P<0.001). Both readers rated C-US better (P<0.001) than conventional US. Despite higher image quality scores, C-US was as effective as conventional grayscale US in assessing involvement of the penile septum. No differences were found between the two methods for visualization of large calcifications, while microcalcifications were better visible with compound imaging. Intrareader agreement was higher for the more experienced reader 1. CONCLUSION: C-US is subjectively superior to conventional US in evaluating patients with severe Peyronie's disease.

Color Doppler appearance of penile cavernosal-spongiosal communications in patients with high-flow priapism.

BACKGROUND: Superselective embolization of the torn artery is currently considered the treatment of choice for patients with high-flow priapism. After embolization, however, the arterial-sinusoidal fistula is still patent in a significant percentage of patients, despite arteriographic evidence of occlusion. PURPOSE: To investigate the prevalence and flow characteristics of penile cavernosal-spongiosal communications (CSCs) in patients with high-flow priapism, and to establish whether the recognition of these vessels before and after angiographic embolization has a role in predicting the outcome of therapy. MATERIAL AND METHODS: Twelve consecutive patients with high-flow priapism underwent penile color Doppler ultrasound before and after angiographic embolization of the arterial-sinusoidal fistula. The prevalence of CSCs feeding the fistula was evaluated before and after embolization. RESULTS: Before angiographic embolization, color Doppler ultrasound identified five CSCs in 3/12 patients. One CSC was proximal to the fistula, and 4/5 were distal. After angiographic embolization, the fistula was not completely closed in these patients, fed by the distal CSCs. However, spontaneous closure occurred within 1 month. The fistula was also fed by CSCs in another two patients in whom these vessels were not evident before embolization. In one case, the fistula closed spontaneously within 1 week, while in the other case the fistula remained patent, fed by other collateral vessels. CONCLUSION: The type of vessels that are involved in refilling the fistula after embolization is of concern for the outcome of the patients. In our series, the fistulas supplied only by CSCs closed spontaneously within 1 month. Watchful waiting should be preferred to repeated embolization to avoid the risk of unnecessary procedures.

The radiologist and the cytologist in diagnosing thyroid nodules: results of cooperation.

PURPOSE: This study was done to evaluate the effectiveness of cooperation between the radiologist and the cytopathologist in ultrasound-guided fine-needle aspiration biopsy (FNAB) of thyroid nodules. MATERIALS AND METHODS: Since 1995, FNAB of thyroid nodules at our department has been performed under ultrasound guidance by the radiologist with a cytopathologist present on-site. The results of ultrasound-guided FNAB procedures performed at our department in 1995, 1999, and 2005 were retrospectively evaluated and compared with those of other departments in the Trieste Province where thyroid nodules are sampled by palpation-guided FNAB performed by a clinician. RESULTS: From 1995 to 2005, the number of ultrasound-guided FNAB procedures performed at our department rose steadily, whereas the number of inadequate samples fell progressively. In patients who underwent surgery, the number of discrepancies between the cytological findings and the final histological diagnoses decreased progressively. CONCLUSIONS: Ultrasound-guided FNAB performed by the radiologist with a cytopathologist present on-site is superior to palpation-guided FNAB. The results are optimised by cooperation between the radiologist and cytologist.