Results of US study in 30 children with various renal lesions are reported, and compared with clinical and surgical features. Different ultrasonographic aspects are discussed with special interest on cogenital abnormalities. US is proposed as first choice investigation in newborns with antenatal ultrasonographic demonstration of renal lesions and in all patients where a mass of renal origin is suspected. Renal function, nevertheless, must be investigated with radiologic and/or radioisotopic techniques. US have still a large indication in short term follow-up of renal lesions where surgical treatment is not indicated.

Adolescent↗

PubMedDate not supplied

Abdominal complications and monitoring of liver transplants.

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Abdomen↗

PubMedDate not supplied

[Dynamic computed tomography in the characterization of focal hepatic lesions].

The main goal of our study was to test dynamic CT capability to characterize focal liver lesions. We examined 57 patients: 6 were affected with focal nodular hyperplasia (FNH), 19 with hepatocellular carcinoma (HCC), 1 with a regenerating nodule on cirrhosis; 14 patients had metastases, 3 focal fatty infiltration, 1 a necrotic nodule, 1 a non-Hodgkin's lymphoma, 1 a cysto-adeno-cholangiocarcinoma and 11 hemangiomas. All lesions were identified with US and the diagnosis was confirmed with the gold standard technique--that is, biopsy or surgery, and red blood cell SPECT for hemangiomas. All lesions were studied with a CT multiphase protocol consisting of a single-level dynamic phase followed by an incremental dynamic phase and finally by a delayed phase to study prolonged and delayed enhancement. Single-level dynamic bolus CT requires an injection of 60 ml nonionic contrast agent administered with a power injector into a cubital vein, at a rate of 5 ml/s. Scanning begins 10 seconds after the injection and consists of 6 series of 2 scans each; each scan lasts 2 seconds and is obtained during the same respiratory apnea, with a 5-second interscan pause. In this phase, 12 scans 5 mm thick are obtained, lasting 24 seconds in all, with pauses lasting 25 seconds--in all, 49 seconds. The next phase is the dynamic incremental scanning, to study the whole liver: this phase requires a 50-ml contrast agent injection at a rate of 4 ml/s, followed by 70 ml at a rate of 1 ml/sec, using 5 mm slice thickness and 8 mm scan interval. This results in 16 scans, beginning 20 seconds after the injection, with a scan time of 2 seconds and 4 seconds of interscan delay, 92 seconds in all. In the last phase, scanning begins 5 minutes after the injection, with a maximum delay of 10-15 minutes. Enhancement variations in both the lesions and the surroundings parenchyma, as related to time, were collected together with morphological data. Time density curves were grouped according to histologic classification and red blood cells SPECT findings; the curves were analyzed with the regression analysis. The results were obtained by analyzing a series of equations describing the different densities of the lesion and the surrounding parenchyma at fixed time intervals, integrated with morphological data, and then comparing the groups of lesions with each other. The regression analysis of the density curves and of the morphological data allowed us to correctly differentiate the 4 most frequent types of lesions--that is, hemangioma, HCC, FNH and metastasis--in 89% of the patients.

Adult↗

PubMedDate not supplied

[Assessment with magnetic resonance of reconstruction of the posterior cruciate ligament. Preliminary experience].

Posterior cruciate ligament (PCL) tears are definitely less common than anterior cruciate ligament (ACL) tears: their incidence in literature ranges 3-20% of all capsuloligamentous injuries versus 45-90% for ACL tears. Recent papers reported that if these injuries are not operated on, they evolve first into medial femorotibial and femoropatellar arthrosis and then into tricompartmental arthrosis. There are several MR studies dealing with ACL reconstruction, while MR studies on PCL reconstruction are lacking, both because the frequency of the latter injuries is lower and because they are difficult to demonstrate. We report our preliminary experience with PCL reconstruction studied with MRI in 12 patients submitted to arthroscopy. We used the ipsilateral patellar tendon (11 cases) or the contralateral one (1 case). The patients were submitted to MRI 4-16 months after surgery. Axial, coronal and sagittal images were acquired, together with oblique sagittal and coronal slices to show the graft completely. We also used SE, GE and fat suppression STIR MR sequences, trying to identify which of them are the most useful in patients with healing or exudative reaction in the intercondylar notch. MR exams were performed with a dedicated permanent magnet (0.2 T) and a permanent total body unit (0.3 T). The graft was clearly depicted on all images in 11 patients, while graft retear was shown in 1 patient. MRI did depict the whole graft in all patients, which finding is useful to study the signal intensity changes which indicate graft trophism. MRI also depicted correctly the femoral and tibial tunnel position and alignment, the presence of possible impingement with bone, the presence and extent of the healing reaction or of serum-hematic material in the intercondylar notch. The latter factor prevents the graft depiction, in which case the MR techniques providing the highest possible contrast in the different structures under examination are mandatory. Finally, MRI permitted to study possible associated capsuloligamentous or meniscal injuries and the state of femorotibial and femoropatellar chondral covering, the presence of articular synovia changes and the amount of possible joint effusion. We believe that MRI exhibited a high standard of sensitivity, versatility and diagnostic accuracy in the examination of surgical patients submitted to arthroscopic PCL reconstruction. Further studies and long-term follow-up will help define the use of MRI in these patients.

Adolescent↗

PubMedDate not supplied

[Integrated diagnosis of liver angioma: comparison of Doppler color ultrasonography, computerized tomography, and magnetic resonance].

Hemangiomas are the most frequent benign tumors of the liver which are diagnosed at clinics only when they are very big. Their differentiation from primary or secondary liver tumors is a very difficult step. To investigate the capabilities of color Doppler US, CT and MRI in characterizing liver hemangiomas, we retrospectively examined 27 patients with 35 hemangiomas of the liver, all identified with US from January, 1995, to March, 1996, plus 26 patients with color Doppler US, 23 with dynamic CT and 19 with MR findings; 16 patients had been examined with all imaging techniques. Our gold standard was red blood cell SPECT in 16 patients, clinical-diagnostic follow-up in 8 and surgical specimens in 3 patients. Morphological data, the number, size and segmental site were investigated for all lesions. Doppler US was used to study the qualitative and quantitative data of intralesional color patterns, according to a modified Tanaka's classification, and of intralesional max, systolic velocity and pulsatility index (PI). Dynamic CT was performed with the polyphasic technique, that is unenhanced scans followed by selective, dynamic sequential and delayed scans. Morphological data and dynamic time/density curves of lesion/parenchyma were studied. MRI was performed at 0.5 T with T1-weighted SE (TR/TE 280/18), T2-weighted SE (TR/TE 2000/45-90-120) and T2-weighted fast SE (TR/TE 5000/160) sequences. Dynamic T1-weighted GE sequences were performed after Gd-DTPA bolus injection, using the same times as those of dynamic CT. US showed 1.3 lesion/patient, while CT and MRI showed 1.5 and 1.7 lesion/patient, respectively. No differences were observed in lesion size with the three imaging techniques and there was 78% agreement on segmental site. As for morphological patterns, US had 46% sensitivity, considering medium-small lesions only. Intralesional color signals, with spot and branch patterns, were seen in 6/20 lesions (mean phi; 8.4 cm), with a mean intralesional systolic velocity of 0.30 m/s (1.46 KHz); mean intralesional PI value was 0.83. Color Doppler sensitivity was 23%. Combined B-mode and color Doppler US had 69% sensitivity. The typical CT pattern (ring or globular enhancement with centripetal progression and late hyperdensity) had 66% sensitivity. Hyperintensity on T2-weighted images had 96% sensitivity; Gd-DTPA MRI combined with dynamic CT had 100% sensitivity. In conclusion, the US findings of a suspected hemangioma should be diagnostically integrated with MR studies to make the correct diagnosis.

Adult↗