Detection of colorectal cancer hepatic metastases with contrast-enhanced ultrasound: comparison with conventional B-mode ultrasound.

The aim of this study was to assess whether contrast-enhanced ultrasound (CE-US) could provide improved diagnostic information in detecting liver metastases from colorectal cancer as compared to B-mode non-enhanced ultrasound (B-US). 32 patients (M/F 23/9, age range 48-82 years, mean 58.2 years) under chemotherapy for colorectal cancer were examined with B-US and CE-US using a second-generation ultrasound contrast agent and a dedicated protocol for contrast detection. The presence of focal liver lesions along with the number, size, pre- and post-contrast sonographic features were recorded digitally. Lesion conspicuity with a three-grade scoring scale was performed on both techniques and contrast intensity measurements were calculated for each focal lesion. CE-US detected 17% more metastases in patient-by-patient and lesion-by-lesion analysis. A statistically significant difference was found between the scoring mean values with regard to conspicuity of the lesions. Accurate characterization of the liver lesions was achievable only with contrast-enhanced technique. A quantitative contrast intensity measurement method confirmed the invariably washing-out vascular pattern in all metastases at sinusoidal-parenchymal liver phase. In conclusion, CE-US is superior to B-US and provides an effective tool in the investigation of colorectal cancer liver metastases.

High-resolution and color Doppler ultrasonography of cervical lymphadenopathy in children.

PURPOSE: To assess the frequency of high-resolution and color Doppler sonographic findings in the most common diseases of childhood manifested with cervical lymphadenopathy at initial presentation. MATERIAL AND METHODS: High-resolution and color Doppler US were performed in 103 and 43 children respectively, with cervical lymphadenopathy at initial presentation. Sonomorphology and intranodal vascularity were assessed. Final diagnoses, based on biopsy or clinical and sonographic follow-up, included: Reactive hyperplasia (n=34), infectious mononucleosis (n=20), lymphoma (n=11), bacterial (n=28), tuberculous (n=5) and cat-scratch disease (CSD, n=5) lymphadenites. RESULTS: Round shape (L/S<2) was common both in lymphoma (78%), infectious mononucleosis (85%) and bacterial lymphadenitis (73%) while 91% of reactive nodes had L/S>2. Wide hilum conforming to nodal shape characterized reactive hyperplasia (94%) and infectious mononucleosis whereas absent or narrow hilum was frequent in lymphoma (100%) and bacterial lymphadenitis (60%). Central irregular hyperechogenic areas, blurred margins and central necrosis were most frequent in bacterial, tuberculous and CSD lymphadenites. On color Doppler US, hyperplastic nodes more frequently exhibited a solitary hilar vessel (48%), whereas infectious mononucleosis nodes had a central radial pattern (75%). Bacterial lymphadenitis presented with a variety of vascular patterns. CONCLUSION: Although individual sonographic signs are not specific, the categorization and combination of findings might be highly suggestive of diagnosis of the underlying disease presenting with cervical lymphadenopathy.

MR imaging of pituitary hyperplasia in a child with growth arrest and primary hypothyroidism.

Magnetic resonance imaging of pituitary hyperplasia has been rarely described in children with primary hypothyroidism. We report a case of pituitary hyperplasia in a child presented with significant growth arrest and laboratory evidence of hypothyroidism. Magnetic resonance imaging revealed symmetrical pituitary enlargement simulating macroadenoma. After thyroid hormone replacement therapy, the child's height increased and pituitary enlargement regressed to normal. Awareness of MRI appearance of pituitary hyperplasia in children with laboratory evidence of hypothyroidism might avoid misdiagnosis for pituitary tumor, which may also manifest as growth disorder, obviating unnecessary surgery.

Relationship of gallbladder contour, fasting volume and emptying to body size indices in normal subjects and patients with gallstones.

Fasting gallbladder volume and fasting gallbladder roundness index (ratio of anteroposterior diameter to gallbladder length) were estimated by ultrasonography in 182 normal subjects and 43 patients with gallstones and correlated to body size indices. In 20 of the normal subjects, gallbladder emptying was assessed and correlated to gallbladder roundness index. Gallstone patients had a larger fasting gallbladder volume as compared to normals (42 +/- 10 vs 22 +/- 7 (SD) ml, p < 0.001). Gallbladder fasting volume was found to be significantly related to roundness index (p < 0.001) and body surface area (p < 0.0001) in normals, but not in patients with cholelithiasis. Subjects with a roundness index > 0.3 showed a less-complete gallbladder emptying as compared to those with a roundness index < 0.3 (p < 0.01). It is concluded that increased body size, but not obesity alone, is associated with an increased gallbladder fasting volume, and that a rounder gallbladder tends to empty less completely.