Muscle metastasis from hepatocellular carcinoma in a patient treated with TACE.

The authors describe a rare case of hepatocellular carcinoma that metastasized to the pectineal muscle of the right thigh. The patient had been treated with surgical procedures and with multiple sessions of transarterial chemoembolization, one of which was complicated by a right femoral artery hematoma at the catheter insertion site. It is unclear whether the muscle metastasis was caused by blood-borne spread or by tumor-cell seeding caused by the TACE procedure.

Characterization of focal liver lesions in real time using harmonic imaging with high mechanical index and contrast agent levovist.

OBJECTIVE: The aim of this study was to characterize focal hepatic lesions using agent detection imaging and Levovist. MATERIALS AND METHODS: Sixty-five patients (21 male and 44 female; age range, 8-82 years; mean +/- standard deviation, 58.1 +/- 14.5 years) were independently evaluated by two observers in a blinded manner using stored sonographic images. Seventy-five lesions were found: 15 hepatocellular carcinomas, nine focal nodular hyperplasias, two adenomas, 21 hemangiomas, 23 metastases, and five regenerative nodules. Nine patients were excluded (six because of technical failures, three with unproven diagnoses). New high-mechanical-index software was used to reveal power harmonic responses from contrast microbubble destruction. After a venous bolus injection of 4 g of Levovist at a strength of 400 mg/mL, delayed imaging was used to study lesion enhancement in the arterial, portal, and parenchymal phases. Two comparisons were made. The first was between the B-mode image and the first contrast-enhanced image after the flash. The second was between color Doppler sonograms and real-time contrast-enhanced perfusion images. RESULTS: Contrast-enhanced images after the flash and real-time contrast-enhanced images revealed more information for the characterization of the lesion than did gray-scale and color Doppler images (p < 0.0001, Wilcoxon's signed rank test). Different types of lesions showed statistically significant differences in enhancement during each of the three vascular phases (p < 0.005, Kruskal-Wallis test). Lesions with lower contrast enhancement were metastases and regenerating nodules. Good agreement was present between the two observers; differences were not statistically significant (p > 0.05). CONCLUSION: Agent detection imaging with Levovist increased diagnostic confidence in the characterization of focal hepatic lesions as compared with standard sonography.

Usefulness of 99mTc-tetrofosmin scintigraphy in different variants of Kaposi's sarcoma.

We investigated (99m)Tc-tetrofosmin scintigraphy in 27 patients with Kaposi's sarcoma: 20 had classic (CK), 5 AIDS-associated (AK) and 2 transplantation-associated (TK) variants. Twenty-three patients had clinically evident cutaneous and/or mucosal lesions, 9 of them with associated sarcomatous lymphadenopathy; 2 TK patients had only lymph nodes or other extracutaneous Kaposi sites. Both planar and SPECT (99m)Tc-tetrofosmin scintigraphies were performed in all cases and neck pinhole (P)-SPECT in selected patients. (99m)Tc-tetrofosmin uptake was observed in 88% of patients with clinically evident cutaneous and/or extracutaneous Kaposi lesions. Scintigraphy gave additional information on cutaneous lesion extent, particularly SPECT regarding deep invasion and subclinical sites in some cases. However, scintigraphy was less sensitive in the detection of small, isolated and scattered lesions. SPECT/P-SPECT were positive in 8/8 patients with sarcomatous lymph nodes, planar imaging in 5/8, ultrasonography in 7/8, while all procedures were negative in 6 other patients with reactive or HIV infection lymph nodes. SPECT demonstrated lymphadenopathy remission in 1 TK patient after immunosuppressive therapy modification and, like planar imaging, ascertained an associated lymphoma with (67)Ga-citrate combined. (99m)Tc-tetrofosmin scintigraphy, especially SPECT, can be useful both in the detection and staging of Kaposi sarcoma lesions as a complementary tool to clinical and other conventional diagnostic methods.

Conventional ultrasonography versus Tissue Harmonic Imaging for the assessment of the common bile duct in cholecystectomized patients.

PURPOSE: The ultrasonographic study of the common bile duct in cholecystectomized patients is very often hampered by the presence of meteorism, scarring tissue, and internal adhesions. The aim of this study was to assess the usefulness of Tissue Harmonic Imaging (THI) in these clinical circumstances. In this technique, the image is formed by using not only the fundamental echo but also its harmonics, which improves the signal-to-noise ratio and considerably reduces the artefacts found in conventional US images. MATERIALS AND METHODS: Seventy-six consecutive cholecystecomized patients (53 F, 23 M, average age 56.9+/-14.5 SD, range 20-81) were assessed. Patients were examined on an empty stomach. The examinations were performed with conventional ultrasonography and with THI. Based on the capability to visualise the distal portion of the common bile duct and in particular to assess the intraluminal content, the study results were rated by three radiologists blinded to each other's evaluation as insufficient (1), sufficient (2), good (3) ad excellent (4). RESULTS: The average diameter of the common bile duct was 4.74+/-2.3 mm (range 1.6-13 mm); at conventional ultrasonography, the visualisation was insufficient in 30% of the cases, sufficient in 52%, good in 18%. With THI the visualisation was sufficient in 17% of the cases, good in 59% and excellent in 24%. Ten out of 76 patients (13%) had stones in the common bile duct. In these cases, conventional ultrasonography was insufficient for diagnosis in 5 patients. All three radiologist (A, B and C) rated THI better than fundamental ultrasonographic imaging (ETG) (p-value <0.0001, Wilcoxon signed rank test). The mean (SD) of the differences between THI and ETG rating were for radiologist A, B and C respectively: 1.25 (0.57), 1.22 (0.51), 1.09 (0.57). Differences for all the radiologists did not significantly vary between older (over 74 years) and younger patients (p-value = 0.35, Wilcoxon rank-sum test). With Cohen's Kw evaluation we obtained better inter-observer agreement (0.71 and 0.80 A and B; 0.7 and 0.79 A and C; 0.71 and 0.81 B and C by conventional ultrasonography and THI). CONCLUSIONS: THI proved to be superior to conventional ultrasonography in the study of the common bile duct in cholecystecomized patients and in particular in the identification of choledocholithiasis.

[Doppler color ultrasonography in patients with erectile dysfunction]. / Eco-color Doppler in pazienti affetti da disfunzione erettiva.

The introduction of new oral therapy doesn't change the rule of color Doppler US in the screening modality of the diagnosis of vasculogenic impotence. The hemodynamic changes can be non invasively evaluated with color and energy Doppler US and with spectral analysis following injection of a vaso-active pharmacological agent. The new high sensitive US equipment allows an easy detection of the cavernous artery. Duplex Doppler can quantify the systolic-diastolic flow changes after the intra-cavernous vaso-active drugs injection. It is then possible to establish the diagnosis of arterial or venous vasculogenic impotence. The organic cause can also be excluded. The pick systolic velocity less than 0.30 m/sec is indicative of arterial origin. The absence of flow-reversal in the diastolic phase, 30 minutes after the injection, is significant for a venous type problem. Elicine arteries can be visualised and analysed using high sensitive color Doppler energy US equipment.

Portohepatic gradient and portal hemodynamics in patients with cirrhosis due to hepatitis C virus infection.

We evaluated the agreement between wedged hepatic vein pressure (WHVP), portal vein pressure (PVP), and its relationship with portal hemodynamics in 21 patients with HCV-related cirrhosis with esophageal varices. Direct measurements of the portohepatic gradient (HVPG) were obtained by ultrasound-guided fine needle puncture of the right hepatic and the portal veins. In five cases PVP was 6.4-10.4 mm Hg higher than WHVP. In 12 cases measurements were similar (WHVP - PVP < or = 3 mm Hg). In the remaining four cases WHVP was 3.6-9.6 mm Hg higher than PVP. WHVP and PVP agreement was not related to HVPG mean value, Child-Pugh score, or grading of esophageal varices. By contrast, the difference between WHVP and PVP was inversely related to the portal flow velocity (P = 0.053) and directly related to the portal vascular resistance (P = 0.02). Whereas the portal branches were visualized in patients with WHVP lower or similar to PVP, a predominant left portosystemic collateral flow was observed in patients with WHVP > PVP. Our data point out that, in patients with cirrhosis due to hepatitis C virus infection, discrepant HVPG values reflect true hemodynamic differences.

[Role of color flow mapping ultrasonography in kidney transplant monitoring]. / Ruolo dell'ecotomografia color flow mapping nel monitoraggio del rene trapiantato.

Color flow mapping and duplex ultrasonography are a more accurate technique in renal allograft monitoring by combining real time us with pulsed doppler studies of renal vasculature. Doppler spectral analysis, pulsatility and resistive index evaluation are usefull in the diagnosis of renal allograft dysfunction (I.E. rejection, cyclosporine nefroto-city and acute tubular necrosis). Cfm and duplex ultrasonography allow a non invasive and easy evaluation of the whole renal artery and vein in the diagnosis of renal artery stenosis, vein trombosys and A-V fistula.

[Role of color flow mapping ultrasonography in the study of renal tumors]. / Ruolo dell'ecotomografia color flow mapping nello studio dei tumori renali.

Tumors cm. 3 in diameter or less have revealed a high frequency of hyperecoic sonographic features mimicking angio-myolipoma. C.T. can confirm the presence of intralesion fat useful to exclude a potentially curable renal cell carcinoma. CFM and duplex ultra sonography can depict a peri and intra lesion neovascularization in small renal cell carcinoma. In the tumor langer than cm. 3 when hyper-vascular CFM and duplex sonography can detect the neovascularized blood vessels surrounding and penetrating the tumors. In the tumor staging the duplex and CFM ultrasonography is useful to demonstrate neoplastic trombosis of renal vein and inferior vena cava.

[Selective arteriography in the study of arterial vasculogenic impotence]. / L'arteriografia selettiva nello studio dell'impotenza vasculogenica arteriosa.

According to the fundamental circulatory nature of penile erection, insufficiency of the arterial blood supply to the corpora cavernosa caused by an organic arterial disease is found in a large fraction of case, overall among the patients aged more than 40. It is possible to evaluate arterial origin of erectile dysfunction by using of noninvasive methods, but to obtain the necessary panoramicity and the characterization of the lesions it needs the use of angiography. Performance of standard arteriography leads to insufficient visualization of pudendal and penile vessels and risks false positive results. Because of penile hemodynamic variability in its different states is necessary the use of pharmacologic devices to perform a diagnostic arteriography. For the selective study of the pudenda and peniena vascularization we perform a selective arteriography bilaterally, with the catheter tip placed in the proximal part of the internal iliac artery. We use a contrast medium particularly diluted and mixed with xylocaine. We perform angiographic sequences after intracavernous injection of 8-10 mgr of papaverine to obtain the maximum blood flow and to prevent spasm of the terminal arterioles. Arteriography gives a complete study of the pudenda arterial tree and its terminal ramifications, and it is able to supply all the necessary informations regarding the planning of revascularization procedures. Treatment of arterial lesions is possible with surgical and radiologic methods. As in other arteries, percutaneous transluminal angioplasty (P.T.A.) can be applied in the therapy of impotence caused by arterial insufficiency. P.T.A. is the election treatment in the stenosis of the common iliac and internal iliac arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of splenic embolization in patients with hypersplenism]. / Valore dell'embolizzazione splenica nei pazienti con ipersplenismo.

The authors describe the importance of embolization of the splenic artery by means of Gianturco coils in splenomegalic portal hypertension. They propose their first experience of six cases and the good results on the basis of clinical parameters, of bleeding of esophageal varices, of hematological values. They also show the influence of this method on hemodynamic, metabolic, and respiratory parameters, altered in cirrhotic patients.

[Role of ultrasonic tomography in the diagnosis of prostatic cysts. Our experience in l3 cases]. / Il ruolo dell'ecotomografia nella diagnosi delle cisti prostatiche. Nostra esperienza in 13 casi.

Authors describe the radiological and echographic methods of investigation of cystic structures in the prostate, remarking the great importance of echotomography. They relate upon their experience in 13 cases of prostatic cyst, a pathological condition which is still poorly known.