Size of pancreas in children and adolescents with type I (insulin-dependent) diabetes.

PURPOSE: The aim of this study was to evaluate the influence of insulin-dependent diabetes mellitus (IDDM) on the size of the pancreas in children. METHODS: Pancreas size was evaluated sonographically in a group of 60 diabetic children and adolescents, aged 3-15 years, and 60 sex- and age-matched healthy controls. RESULTS: A significant reduction in pancreatic area and other parameters was found in diabetic patients particularly in children aged 8-12 and 13-15 years. The pancreas was larger in children 3-7 years old who had had IDDM for 2 years of less (mean size, 8.61 cm2) than in children 8-12 and 13-15 years old who had had IDDM for more than 5 years (mean size, 8.06 and 8.40 cm2, respectively). An inverse correlation between area of the pancreas and duration of IDDM was seen in all age groups (p < 0.05). CONCLUSIONS: Diabetes affects the growth of the pancreas in children with IDDM. Sonography can be used to noninvasively evaluate the influence of the disease on pancreas size.

Color Doppler flow imaging of renal disease. Value of a new intravenous contrast agent: SH U 508 A (Levovist).

This study was aimed at assessing the diagnostic value of a new intravenous contrast agent SH U 508 A (Levovist) in improving color Doppler detection of renal mass vascularity. The study included 30 patients with renal masses: 22 adenocarcinomas, 1 sarcoma, 1 leiomyosarcoma, 1 urothelioma, 1 hemorrhagic cyst and 4 angiomyolipomas. The vascularization of the renal masses was investigated by means of color Doppler US, before and after the intravenous injection of SH U 508 A (Levovist), on the basis of blood flow patterns within and around the lesions. At precontrast scanning, low color Doppler signal at the periphery or within the lesions was observed in 13/30 patients only. After contrast administration, the signal-to-noise ratio increased, which allowed the visualization of tumor vessels in 26/30 patients. In 4/30 patients only no major enhancement of tumor vessels was observed. Our experience suggests that SH U 508 A (Levovist) improves color Doppler sensitivity in depicting the tumor vessels which were missed at baseline exams and in evaluating renal vein and inferior vena cava involvement.

[Reproducibility of Doppler ultrasonography in the study of hepatic blood flow]. / Valutazione della ripetibilità dell'ecografia Doppler nello studio del flusso epatico.

The reproducibility of hepatic blood flow measurement with pulsed Doppler US was assessed in 6 healthy volunteers. All subjects underwent two different study sessions and were examined by three different operators after overnight fasting. Each operator was blind to his measurements. Hepatic arterial and portal venous blood flow and hepatic arterial maximum velocity were measured; resistive index (RI), pulsatility index (PI) and hepatic perfusion index (HPI) were calculated. Each measurement was repeated three times per session. The data from repeated measurements were analyzed with the analysis of variance (ANOVA) method to assess the intra- and intersubject variations for each variable. The Scheffe test was used to evaluate intra- and interobserver variations. Significant differences among the 6 examined subjects were found for all the variables measured, except for hepatic arterial maximum velocity. The same subject exhibited significant differences in mean velocity of the main portal vein trunk and of its right branch, in maximum hepatic arterial velocity, RI, portal vein section area and blood flow. No significant interobserver variation was observed in the same session and no intraobserver variation detected for all the measurements performed in different sessions. Thus, we conclude that pulsed Doppler US is a repeatable method for measuring hepatic blood flow and may therefore be useful to detect changes in hepatic perfusion.

Reproducibility of ultrasound measurement of pancreatic size with new advanced high-resolution dynamic image scanners.

The reproducibility of ultrasound measurements of the pancreas was investigated in 10 healthy volunteers. All subjects underwent three different evaluations, each consisting of three ultrasound examinations, at 8:00 after overnight fasting, at 12:00 after a solid, standard meal, and at 14:00. The longitudinal and anteroposterior (AP) diameters of the head, body, and tail, as well as the total areas of the gland, were measured in longitudinal and axial scans. Significant differences were observed in the head and body longitudinal diameters measured at 12:00 and in the tail AP diameter at 14:00. We conclude that ultrasonography of the pancreas should be performed in the morning with patients in the fasting state. In these conditions, the reliability of ultrasound measurements of the gland appears to be the highest.

[Hydronephrosis and peripelvic cysts. A new echographic sign for the differential diagnosis]. / Idronefrosi e cisti peripieliche. Un nuovo segno ecografico per la diagnosi differenziale.

The differential diagnosis of peripelvic cysts and hydronephrosis by means of US sometimes presents some problems; in fact, the use of urography to solve a diagnostic doubt is not uncommon. This study was aimed at demonstrating that another US sign, which we have called the "convexity" sign, can be useful in allowing peripelvic cysts to be distinguished from hydronephrosis. Thus, cysts exhibit convex walls and curved outline, whereas in hydronephrosis the walls of the dilated calices are linear. The latter feature is present in all degrees of hydronephrosis, except in severe cases. Forty-nine adult patients, a total of 98 kidneys, were examined with US and urography; 69 kidneys were found to be pathologic: 48 presented with cysts, and 21 with hydronephrosis. In addition to the new sign, the classic signs of peripelvic cysts were also considered, that is the separate areas and the non-visualization of the ureter. The sensitivity of the new sign was 97% and its specificity was 95%. The sensitivity and the specificity of the classic signs were 97% and 95%, respectively for the separated areas, and 100% and 91% for the non-visualization of the ureter. The cumulative sensitivity of the 3 signs was 99%, and their specificity 96%. Our results show how the integrated analysis of the considered signs (especially those with high specificity) is useful for the differential diagnosis, and therefore to avoid the indiscriminate use of urography.

[Echographic evaluation of pancreatic dimensions in type 1 diabetes mellitus]. / Valutazione ecografica delle dimensioni del pancreas nel diabete di tipo I.

Aim of this study was to determine whether pancreatic size is altered in patients suffering from type I diabetes mellitus. Twenty-five diabetics (14 males and 11 females) and twenty-five healthy controls entered the study. All patients and controls were scanned by the same operator with the same US equipment after overnight fasting. The longitudinal and antero-posterior diameters of the head, body and tail and the transverse diameter of the head as well as the total area of the gland were measured through longitudinal and axial scans. The two groups were homogeneous relative to age, sex, distribution, height, weight and body mass index. All measured diameters as well as the total area of the gland were significantly smaller in diabetic patients than in controls (1-way ANOVA: p less than 0.001). These results may open new perspectives to US identification of possible changes in pancreatic size by a new US study including high-risk subjects without clinical signs.

[Congenital luxation of the hip. Clinico-echographic correlations]. / Lussazione congenita dell'anca. Correlazioni clinico-ecografiche.

The authors report their experience with US of the hip in 1000 children aged 1 day to 8 months. US study was carried out following Graf's method. All the children were previously examined by a pediatrician, who recorded all the clinical signs on a chart. After US examination, the radiologist recorded US findings on the same chart. Thus, US findings could be compared to clinical ones: there was agreement in 71% of cases, and disagreement in the extant 29%. Furthermore, clinics exhibited a high false-negative rate (64%) and a low false-positive rate (23%). This suggests US as an useful screening method able to show early morphological and functional alterations in the infant hip. The authors also examined the incidence of the single clinical signs and risk factors, and correlated them with US findings.

[Hepatic steatosis: combined echography-computerized tomography imaging]. / Steatosi epatica: imaging integrato ecografia-tomografia computerizzata.

The authors report their experience with the combined use of US and CT in the study of diffuse and subtotal fatty infiltration of the liver. An apparent disagreement was initially found between the two examinations in the study of fatty infiltration. Fifty-five patients were studied with US and CT of the upper abdomen, as suggested by clinics. US showed normal liver echogenicity in 30 patients and diffuse increased echogenicity (bright liver) in 25 cases. In 5 patients with bright liver, US demonstrated a solitary hypoechoic area, appearing as a "skip area", in the quadrate lobe. In 2 patients with bright liver, the hypoechoic area was seen in the right lobe and exhibited no typical US features of "skip area". Bright liver was quantified by measuring CT density of both liver and spleen. The relative attenuation values of spleen and liver were compared on plain and enhanced CT scans. In 5 cases with a hypoechoic area in the right lobe, CT findings were suggestive of hemangioma. A good correlation was found between bright liver and CT attenuation values, which decrease with increasing fat content of the liver. Moreover, CT attenuation values confirmed US findings in the study of typical "skip areas", by demonstrating normal density--which suggests that CT can characterize normal tissue in atypical "skip areas".

[Congenital hip dislocation. The clinico-echographic correlations]. / Lussazione congenita dell'anca. Correlazioni clinico-ecografiche.

The authors report their experience with US of the hip in 200 children aged 9 days to 8 months. All the children previously were under-gone physical examination. The sonographic study was carried out with Graf's method. The clinical-sonographic correlation proves the utility of US as a screening method able to show early morphological and functional alterations in the hip. US is thus suggested as a valid alternative to conventional methods to use in those cases where either plastering or surgery is required.

Comparison of ultrasonic scanning and scintiscanning in the evaluation of thyroid hemiagenesis.

Seven female subjects in whom thyroid hemiagenesis was suspected on the basis of clinical findings and scintiscanning before and after TSH administration were studied with ultrasound. Ultrasonic scanning confirmed true hemiagenesis in only three cases. In the other four it revealed a nonfunctional hypoplastic lobe contralateral to the assumed single lobe.

[Image diagnosis and Doppler ultrasound in the functional study of portal circulation]. / Diagnostica per immagini ed Eco-Doppler nello studio funzionale del circolo portale.

The authors, after mentioning physiologic appearance of portal circulation and physical principles governing the interrelationship of pressure, flow and flow velocity in blood vessels, report the results of a study about trend of haemodynamic values in 23 normal subjects and 13 cirrhotic patients. Values of portal blood flow and fluid speed were measured using a pulsed "Linear-Doppler" system, before and after dinner. Statistical analysis of results proves the diagnostic value of examination that appears qualified as the method of first choice in the patients with suspected changes of portal circulation.

[Renal echography as a preliminary to the urographic study. Considerations on 839 cases and proposals]. / L'ecografia renale come primo momento dell'esame urografico. Considerazioni su 839 casi e prospettive.

The same radiologist, on 839 patients who were to be subjected to urography, did also preliminary ultrasonography in order to have at his disposal a greater amount of informations than those furnished by a simple abdominal X-ray. The clinical-radiological integration with such a procedure gains significance; consequently the succeeding urographic phases can be better arranged so as to improve their aim and purpose.

[Comparative study of traditional radiology, echography and computerized tomography in chest pathology]. / Studio comparativo tra radiologia tradizionale, ecografia e tomografia computerizzata in patologia toracica.

The authors have examined 57 cases of thoracic pathology by conventional radiology, ultrasounds and computed tomography (CT). The conventional radiology remains the test of first choice; the ultrasounds proved sometimes useful to distinguish between solid and cystic lesions while CT is the method in the evaluation of the extension.