[Retrospective analysis of color Doppler ultrasonography and flowmetry findings in solid nodular pathology of the breast]. / Analisi retrospettiva dei rilievi con eco color Doppler e flussimetrici nella patologia nodulare solida della mammella.

The authors tried to identify useful flowmetric values and color-Doppler patterns for the differential diagnosis between benign and malignant solid breast lesions. To this purpose, 106 patients with breast nodules detected at mammography and/or high resolution US were examined. A US scanner with a linear 7.5 MHz transducer, a narrow sample volume, a PRF ranging (650-800 Hz) and a wall filter value of 50 Hz were used. Three parameters were considered: the number vascular sites, systolic peak velocity and pulsatility index. All these parameters related to tumor volume. Several (> 2) vascular sites, high peak velocity and quite high pulsatility index were demonstrated in malignant tumors (46 lesions). Among benign tumors no vascular site was identified in 32 of 60 lesions and no more than 2 sites were identified in 26 of 60 lesions, except for 2 phylloides tumors. Sensitivity, specificity, positive and negative predictive values and overall accuracy rates were, as for the "vascular sites" parameter, 78%, 96%, 94%, 85%, 88%, respectively; as regards the "peak systolic velocity" 81%, 86%, 89%, 75%, 83% respectively; as regards the "pulsatility index" 100%, 85%, 100%, 85%, 94% respectively.

[Treatment of malignant occlusions of bile ducts by one-step technique using metallic endoprostheses. A multicenter study of 50 cases]. / Trattamento delle occlusioni maligne delle vie biliari mediante endoprotesi metalliche con tecnica "one-step". Studio policentrico di 50 casi.

Long-term patency and ease of insertion of self-expandable metallic stents seem to overcome the disadvantages of plastic stents, changing the therapeutic approach to unresectable biliary tree malignancies. Their high cost is the main problem of metallic stents and reducing hospitalization time is a real opportunity to overcome this problem. Self-expandable stents could be the turning point to reduce overall costs. Fifty patients with malignant biliary tree obstruction (Zubrod performance status < 3) were treated with percutaneous placement of 58 Wallstent endoprostheses by the one-step technique. All patients had undergone thorough diagnostic exams - i.e., US, CT, PTC, ERCP with biopsy or brushing. Two major complications occurred in this series: a iatrogenic pseudoaneurysm requiring selective catheterization and embolization with Gianturco coils and a hepatic abscess six months after stent placement. Late stent occlusion occurred in six patients (12%) and was resolved by balloon dilatations. All patients were followed-up with clinical examinations, US and laboratory tests until death; median survival after stent placement was 122 days (range: 70 to 510 days). Average hospitalization time was 7 days with an acceptable cost reduction.

[Doppler color-echo and flowmetric evaluations in ovarian tumors in postmenopausal patients]. / Eco-color-Doppler e valutazioni flussimetriche nei tumori ovarici nelle pazienti nell'età postmenopausale.

The use of color Doppler techniques in transvaginal sonography (US) permitted the identification of some typical flowmetric patterns of malignant ovarian cancers, because of such characteristics of neoplastic vessels as no media in the vessel wall, the presence of A-V shunts, and so on. These features reduce vascular impedance, from which low pulsatility index and resistance index values result. Eighty-one patients with ovarian masses were examined: in 19 of them histopathology revealed malignant lesions in different stages. Eighteen of those lesions exhibited suspect transvaginal patterns; in one case only the US patterns suggested a benign lesion, which was a serous cystadenocarcinoma with thin and regular septa. In all the malignant lesions flow could be sampled in six sites at least; the lowest pulsatility index values, obtained by multiple samplings in the same lesion, were considered as the most representative of the histologic features of the lesion. The average of the lowest pulsatility index values in 18 of 19 malignant lesions was 0.75. In one case only (the only false negative in the series) the lowest pulsatility index value was 1.20. Doppler signals were detected in 58 of 62 benign lesions only and the average of the lowest pulsatility index values was 1.80. The only kind of condition with low pulsatility index was the inflammatory disease (all the 6 sampled cases). If we consider a pulsatility index < 1 as the cut-off value for malignant lesions, the sensitivity and the specificity of color Doppler US were 95% and 91%, respectively, in our series. The positive predictive value of the exam was 75% and its negative predictive value was 95%.

Carotid body tumors: US evaluation.

The ultrasound (US) findings in 20 patients with 23 carotid-body chemodectomas were reviewed. Twenty-two of 23 tumors could be seen at US; the remaining lesion could not be differentiated from surrounding enlarged lymph nodes resulting from thyroid cancer. The lesions were solid, slightly heterogeneous masses that ranged in size from 1.2 to 5.0 cm and were located within the carotid bifurcation. Pulsed Doppler analysis of blood flow within the tumor mass was possible in eight patients with nine chemodectomas, and low-resistance waveforms were obtained from multiple sites within the mass in all cases. The diagnostic possibility of a chemodectoma has to be considered when a solid mass is detected within the carotid bifurcation. On the basis of these findings, as US diagnosis was possible in 18 of 20 patients in the authors' series. Doppler analysis of the mass to evaluate intratumor blood flow is helpful in differentiating chemodectomas from other solid, nonhypervascular masses.

[Digital videoangiography of the hand]. / Vidéoangiographie digitalisée de la main.

We have been using digital subtraction angiography for a year. The advantages as compared with customary angiography are pointed out. Some examples are used to illustrate its use.

[The echotomographic patterns of the normal liver. (A comparison between real-time and gray-scale images) (author's transl)]. / Gli aspetti ecotomografici del fegato normale. Studio comparativo fra immagini real-time e scala dei grigi.

The echotomographic anatomy of the right hypocondrium and of the epigastrium is considered, with special regard to the many anatomical structures which can be evaluated in the different scanning planes. This anatomic study has been accomplished by means of real-time and manual gray-scale scanners. Echotomograms obtained with both types of equipment are presented. A special emphasis has been given to the topographical relationships between parenchymal and vascular structures.