-
-
Ugo Fiocco,
Francesca Oliviero,
Paolo Sfriso,
Fiorella Calabrese,
Francesca Lunardi,
Elena Scagliori, Leopoldo Rubaltelli,
Roberto Stramare,
Antonio Di Maggio,
Roberto Nardacchione,
Luisella Cozzi,
Beatrice Molena,
Mara Felicetti,
Katia Gazzola,
Alessandro Lo Nigro,
Benedetta Accordi,
Pascale Roux-Lombard,
Jean-Michel Dayer,
Leonardo Punzi
[show abstract]
[hide abstract]
ABSTRACT: To find candidate biomarkers of psoriatic arthritis (PsA). A panel of synovial fluid (SF) and synovial tissue (ST) biomarkers was analyzed in patients with resistant peripheral PsA, in relation to clinical and imaging outcomes of synovitis response following serial intraarticular (IA) etanercept injections (12.5 mg).
Fourteen PsA patients with resistant knee joint synovitis were treated with 4 IA etanercept injections in a single knee joint, once every 2 weeks. Primary outcome (Thompson's knee index: THOMP) and secondary outcomes were assessed at baseline and end of study: C-reactive protein, Knee Joint Articular Index (KJAI), Health Assessment Questionnaire disability index, maximal synovial thickness (MST) by gray-scale ultrasonography, contrast-enhanced magnetic resonance imaging (C+MRI), ST-cluster differentiation (CD)45+ mononuclear cell, ST-CD31+ vessels, and ST-CD105+ angiogenic endothelial cells, along with levels of SF interleukin 1ß (IL-1ß), IL-1 receptor antagonist (Ra), and IL-6.
At the end of the study, clinical and imaging outcomes, ST and SF biological markers were significantly reduced compared to baseline. There was a significant association between IL-6 and either THOMP or KJAI; between either ST-CD31+ or ST-CD105+ or ST-CD45+; between ST and SF biomarkers expression (CD45+ and IL-1ß) and between ST-CD45+ and both KJAI and MRI-MST. Comparing pre- versus post-IA etanercept injection changes (Δ), Δ IL-1ß was significantly correlated with both Δ IL-6 and with Δ IL-1Ra and Δ IL-6 with Δ IL-1Ra.
The association to disease activity and the changes following IA treatment indicate that ST-CD45+ and ST-CD31+, along with SF-IL-6 and SF-IL-1ß, may represent candidate biomarkers of the knee synovitis response to IA tumor necrosis factor-α blockade.
Journal of Rheumatology Supplement 07/2012; 89:61-4.
-
[show abstract]
[hide abstract]
ABSTRACT: The objective was to compare the diagnostic accuracy of conventional radiography and ultrasonography (US) for the diagnosis of suspected bone fractures.
Eighty-six patients were assessed using conventional radiography and US on the affected bone district.
Radiographic and sonographic findings were concordant in 93% of cases. In one case, US suggested a fracture not seen on radiographic assessment. Ultrasonography showed a sensitivity of 0.94 and a specificity of 0.92.
In clinical practice, US could become the first diagnostic approach.
Clinical imaging 05/2012; 36(3):203-8. · 0.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: PURPOSE.: To assess synovial microvascularity in finger joints with rheumatoid arthritis (RA) by contrast-enhanced ultrasound (CEUS), distinguishing between cases of active disease and those in remission; to standardize the technique for software analysis. METHODS.: Fifty-two finger joints of RA patients (26 with active disease and 26 in remission) were immersed in water and examined by CEUS using a fixed probe. Signal intensity curves were calculated with the software. RESULTS.: Contrast enhancement was detectable in all 26 patients with active RA (100%), but not in 25 of 26 patients in remission (96%); one of the latter patients (4%) showed minimal enhancement. The method's sensitivity and specificity in distinguishing active disease from remission were 100% and 96%. The grades of synovial enhancement correlated with clinical disease activity and software flow parameters. The peak contrast levels correlated with clinical activity, a peak of 9% representing the cutoff between remission and active disease. CONCLUSIONS.: CEUS with a fixed probe on finger joints immersed in water detected synovial vascularization in RA, producing results suitable for standardized software analysis and avoiding artifacts.
Journal of Clinical Ultrasound 03/2012; 40(3):147-54. · 0.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A system for creating structured reports (SRs) using a standardized radiology lexicon was developed and tested to facilitate automated translation of content and multidisciplinary international communications.
A database of radiology terms, RadLex developed by the Radiological Society of North America, was used to create a shared indexed multilingual radiology lexicon. A diagnostic workstation for generating structured reports (OpenEye) was implemented with a "RadLex manager" function for adding new words to the lexicon in both English and Italian. Sample reports of examinations included in the Medical Imaging Resource Center (MIRC) radiology imaging database of clinical cases were prepared using this system. The system was evaluated for teaching purposes and scientific dissemination.
The OpenEye system was able to manage the glossary to create new SRs and manually translate existing reports containing freely worded descriptions. The OpenEye system provides instant translation from Italian into English and enables clinical cases to be published in the MIRC, while making them accessible for consultation on an international scale.
The SR is advantageous compared with a freely worded report in terms of clarity and completeness of the content. Creating SRs for each clinical case enables rapid and focused analysis at multidisciplinary meetings. All our cases have been included in the MIRC database as part of a broader-based European Project for research on soft tissues sarcomas (CONTICANET).
International Journal of Computer Assisted Radiology and Surgery 10/2011; 7(4):621-33. · 1.48 Impact Factor
-
B Molena,
P Sfriso,
F Oliviero,
E Pagnin,
A Teramo,
Fr Lunardi,
R Stramare,
A Scanu,
R Nardacchione, L Rubaltelli,
F Calabrese,
L Punzi,
U Fiocco
[show abstract]
[hide abstract]
ABSTRACT: To delineate the molecular mechanisms underlying the process of the diffuse-type giant cell tumours, also called pigmented villonodular synovitis, a rare, aggressive condition of the synovium, the knee synovial tissue expression of colony-stimulating factor-1 gene, as detected by real-time polymerase chain reaction, was compared between patients affected with pigmented villonodular knee synovitis and knee meniscal tears, or persistent gonoarthitis.
Multiple synovial biopsies of the knee were performed by arthroscopy in five consecutive patients affected by diffuse pigmented villonodular knee synovitis and in 12 patients affected by knee meniscal tears (n. 6) or persistent active gonarthritis (n. 6), recruited from the patients attending the Rheumatology Day Surgery Outpatient Clinic of the University of Padova Hospital. The ethics committee approved the study protocol and the participants signed consent statements after being informed about the content of the study. The diagnosis was made on the basis of a histological examination. The colony-stimulating factor-1 gene expression was assessed by reverse transcription followed by real-time polymerase chain reaction.
The detection by RT-PCR of synovial colony-stimulating factor-1 mRNA showed a wide spectrum of expression in the three groups of distinct knee joint disease affected patients, with significantly higher level of colony-stimulating factor-1 mRNA expression in synovial tissue of pigmented villonodular synovitis, in comparison to that of knee meniscal injuries and persistent gonoarthritis patients.
Our findings point out to an important role of colony-stimulating factor-1 in pigmented villonodular knee synovitis disease process and support the idea that colony-stimulating factor-1/colony-stimulating factor-1 receptor interaction may represent a potential therapeutic target of this disease.
Clinical and experimental rheumatology 06/2011; 29(3):547-50. · 2.15 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to ascertain the utility of contrast-enhanced ultrasound in assessing the significance of focal cortical thickening in the lymph nodes of patients followed up after surgery for cutaneous melanoma.
Ultrasound was used to examine 460 consecutive patients to identify nodes with focal hypoechoic cortical thickening. Patients whose nodes revealed these features underwent contrast-enhanced ultrasound and ultrasound-guided fine-needle aspiration cytology (FNAC) focusing on the area of cortical thickening. Enhancement in the arterial and parenchymal phases was evaluated: A generalized homogeneous or intense enhancement was considered benign and the presence of a perfusion defect was considered metastatic.
After exclusion of 24 patients with frank signs of malignancy at gray-scale ultrasound, the study included 436 patients. Focal hypoechoic cortical thickening was seen in 44 of 436 nodes in as many patients. In 29 nodes, the area of focal thickening showed contrast enhancement similar to that of the remaining cortex on contrast-enhanced ultrasound. In 15 nodes, the area of cortical thickening was less well vascularized than the adjacent parenchyma in the arterial phase and there were areas with perfusion defects that were more evident in the parenchymal phase. FNAC focusing on the areas of focal cortical thickening identified 13 metastatic nodes and 31 nodes with benign features. Contrast-enhanced ultrasound compared with FNAC correctly classified 42 of 44 nodes, showing a sensitivity of 100% and a specificity of 99.5%.
Although our findings need to be confirmed in larger series, they indicate that contrast-enhanced ultrasound can be useful in clinical practice for characterizing focal cortical thickening in lymph nodes. The exclusion or identification of regional lymph node metastases is of fundamental importance in oncologic staging because this issue directly influences both the prognosis and the choice of therapeutic strategy.
American Journal of Roentgenology 01/2011; 196(1):W8-12. · 2.78 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Lymph node micrometastases are common, but too often in clinical practice lack the tools for their accurate prebiopsy detection. The gray-scale contrast-enhanced ultrasonography technique permits high-resolution imaging of both the arterial and parenchymal phase and allows visualization of diffuse and partial alterations of nodal perfusion even in lymph nodes with a maximum diameter smaller than 1 cm. The gray-scale contrast-enhanced ultrasonography can supply further useful information in case where doubt has arisen with conventional techniques. The results obtained show that it affords highly accurate differentiation between benign and metastatic lymph nodes.
Ultrasound quarterly 03/2010; 26(1):45-51.
-
Ugo Fiocco,
Paolo Sfriso,
Francesca Oliviero,
Pascale Roux-Lombard,
Elena Scagliori,
Luisella Cozzi,
Francesca Lunardi,
Fiorella Calabrese,
Maristella Vezzù,
Serena Dainese,
Beatrice Molena,
Anna Scanu,
Roberto Nardacchione, Leopoldo Rubaltelli,
Jean Michel Dayer,
Leonardo Punzi
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was the evaluation of synovial effusion (SE), synovial fluid (SF) and synovial tissue (ST) biomarkers in relation to disease activity indexes to assess the response to intraarticular (IA) tumor necrosis factor (TNF)-α blockers in psoriatic arthritis (PsA).
Systemic and local disease activity indexes (disease activity score (DAS); the Ritchie articular index (mRAI), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP); Thompson articular (THOMP) and joint articular (KJAI)-Index ) and ST samples were assessed at baseline, throughout treatment, and during the follow-up in 14 patients affected with PsA who underwent IA injections (0.5 ml to 12.5 mg) in the knee joint of etanercept (E) or placebo (P) once every two weeks for a 10-week period. Total SF white blood cell (WBC) counts (WBC/μl) and SF cytokine/chemokine (CK/CCK) levels were measured before IA-E at baseline, after IA-E, and as long as there were adequate amounts of SF for knee aspiration (post). Characterization of synovial mononuclear cell infiltration and synovial vessels was carried out in 8 out of 14 knees by staining serial sections of synovial tissue biopsies for CD45, CD3, CD68, CD31 and CD105.
At baseline, CRP and/or ESR were significantly correlated with SF-CK (interleukin- (IL-)1β, IL-1Ra, IL-6, IL-8) and CCK (CCL3). Post-IA injections, there was a decrease in SE in the knees in which aspiration following IA-E injection was possible as well as a significant reduction in SF WBC/μl and in SF-CK (IL-1β, IL-1Ra, IL-6 and IL-22). Pre- and post-IA-E injections, there were significant correlations between ST markers and SF-CK (IL-1β with CD45; IL-1β and IL-6 with CD31) and between SF-CCK (CCL4 and CCL3 with CD3). At the end of the study, there was a significant reduction in disease activity indexes (CRP, DAS, RAI, THOMP, KJAI) as well as in the ST markers (CD45; CD3).
Synovial effusion regression is a reliable indicator of the response to IA TNF-α blockers in PsA patients as it is confirmed by the correlation between SF biomarkers to disease activity and synovial tissue inflammation.
Arthritis research & therapy 01/2010; 12(4):R148. · 4.27 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to assess the performance of experimental software (Qontraxt) intended to provide automated quantification of sonographic signal intensity, which is related to the contrast enhancement of lymph node tissue, to differentiate benign from malignant lymph nodes.
In 31 patients (age range, 24-86 years; mean age +/- SD, 53.6 +/- 14.4 years) a single lymph node per patient was evaluated on sonography after the administration of sulfur hexafluoride-filled microbubbles. The stored sonographic images were analyzed and processed into chromatic maps that had numeric values related to the amount of contrast. The lymph node regions in which the increase of signal intensity values with respect to baseline were highest (maximum signal intensity value [SImax]) and lowest (minimum signal intensity value [SImin]) were identified, and the corresponding numeric data were stored. Statistical analyses were performed by means of the Student's t test; a p value of less than 0.05 was considered to be statistically significant.
Histopathologic analysis revealed metastatic lesions in 12 of the 31 lymph nodes; the remaining 19 were benign (16 reactive lymph nodes, two cases of granulomatous lymphadenitis, and one case of tubercular lymphadenitis). Values obtained from the SImax regions showed no consistent difference between benign and malignant lymph nodes; on the other hand, values from the SImin regions comparing baseline and maximal contrast-enhanced values were significantly different in the two groups (p < 0.001). Confidence for characterization of malignancy was significant using the difference between values from SImax and SImin regions, with the higher diagnostic value from 24 to 31 inclusive: sensitivity, 92% (11/12); specificity, 89% (17/19); positive predictive value, 85% (11/13); and accuracy, 90% (28/31).
The software being tested proved to be useful in differentiating benign from metastatic lymph nodes on the basis of the quantitative data it provided.
American Journal of Roentgenology 05/2007; 188(4):977-83. · 2.78 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the contribution of continuous mode contrast-enhanced harmonic ultrasonography (CE-HUS) with a second-generation contrast agent to the characterization of superficial lymphadenopathies with respect to conventional ultrasonographic techniques (B-mode and power Doppler).
Fifty-six lymph nodes from 45 patients were studied both by conventional techniques and by CE-HUS. The dimensions, intranodal architecture, margins, and location of vessels were evaluated. Subsequently, all the lymph nodes were examined by CE-HUS, and enhancement of echogenicity was evaluated. The diagnoses obtained by means of fine-needle aspiration cytologic examination, surgical biopsy, or both were compared with those obtained by ultrasonography.
Of the lymph nodes examined, 30 were benign and 26 were malignant (18 metastases and 8 non-Hodgkin lymphomas). The study using CE-HUS showed intense homogeneous enhancement in 28 of 30 reactive lymph nodes; perfusion defects in 17, of which 15 were neoplastic and 2 were inflammatory; intense but inhomogeneous speckled enhancement in the early arterial phase in 5 cases of lymphoma; and, last, scarce or absent intranodal enhancement in 4 metastases. The specificity, sensitivity, and accuracy of conventional techniques in differentiation between benign and malignant lymph nodes were 76%, 80%, and 78% versus 93%, 92%, and 92.8% for CE-HUS. The increase in correct diagnoses was significant (P = .05) when conventional ultrasonography was tested against CE-HUS.
Superficial lymph nodes can be characterized as being neoplastic or benign with a high degree of diagnostic accuracy on the basis of the perfusion characteristics evaluated by CE-HUS. This technique has been shown to afford a higher degree of accuracy than currently obtainable by any other ultrasonographic technique.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 07/2004; 23(6):829-36. · 1.25 Impact Factor
-
La radiologia medica 05/2004; 107(4):388-406. · 1.44 Impact Factor
-
Ugo Fiocco,
Federica Ferro,
Luisella Cozzi,
Maristella Vezzù,
Paolo Sfriso,
Carlo Checchetto,
Fulvia Chieco Bianchi,
Roberto Nardacchione,
Antonio Piccoli,
Silvano Todesco, Leopoldo Rubaltelli
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the reliability of contrast-unenhanced power Doppler (CUPD) and contrast-enhanced power Doppler (CEPD) ultrasound (US) assessment of synovial vascularity of knee joint synovitis by prospective comparison with the "gold standard," arthroscopy.
A total of 18 knees of 17 patients with refractory rheumatoid and psoriatic knee joint synovitis were examined by US. Recognition of PD synovial vessel flow and its spatial arrangement in relation to the pannus/cartilage interface (P/CI) or fluid/synovium interface (F/SI) were studied by CUPD- and CEPD-US after a single intravenous bolus of galactosel palmitic acid (Levovist). Arthroscopy video recordings were reanalyzed by computer image analysis to assess synovial vascular marking. CUPD and CEPD flow signal scores were compared with each other and with corresponding vascular marking scores. Using villous vascular marking as reference, CUPD and CEPD sensitivity and specificity were measured. Interobserver variability was evaluated.
Compared with the unenhanced PD method, contrast administration increased the PD flow signal score in 13/18 knees (72.2%), allowing increased detection of F/SI PD flow signal configuration (p < 0.018) and of the coexistence of P/CI and F/SI PD imaging (p < 0.0078). With arthroscopy as reference, contrast-enhanced PD was found to be more useful than the unenhanced method, showing more reproducible PD signal scores (p = 0.05 vs p = nonsignificant), as well as higher sensitivity (80% vs 30%), but lower specificity (62% vs 87%), in the recognition of increased vascularity of synovial villi. Interobserver agreement was 100%.
The prospective comparison with arthroscopy showed the reliability of the CEPD method in synovial vessel recognition and its potential clinical usefulness in assessment of knee joint synovitis.
The Journal of Rheumatology 10/2003; 30(10):2170-6. · 3.69 Impact Factor
-
Carlo Riccardo Rossi,
Simone Mocellin,
Barbara Scagnet,
Mirto Foletto,
Antonella Vecchiato,
Pierluigi Pilati,
Alberto Tregnaghi,
Giorgio Zavagno,
Roberto Stramare, Leopoldo Rubaltelli,
Cristina Montesco,
Simonetta Borsato,
Domenico Rubello,
Mario Lise
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the efficacy of preoperative ultrasound (US) scanning in identifying lymph node metastasis before sentinel node biopsy (SNB), we conducted a prospective study on 125 patients with primary cutaneous melanoma (CM).
We prospectively enrolled 125 patients with >1 mm thick CM and candidate for SNB. Preoperatively, patients underwent US scanning of regional lymphatic basins and FNA of suspected lymph nodes (LN). All patients underwent lymphatic mapping and SNB.
Combined with fine-needle aspirate (FNA) of suspect LN, US scan allowed the correct preoperative detection of 12 out of 31 histologically positive lymphatic basins, specificity and sensitivity being 100 and 39%, respectively. The false negative rate (61%) was mainly linked to tumor deposits less than 2 mm in diameter, which can be considered the current spatial resolution limit of this technique.
Preoperative US scan could reduce the number of SNB, thus avoiding the stress of this surgical procedure in approximately 10% of patients and reducing health care costs. As a non-invasive and relatively inexpensive technique, lymph node US scan can be part of the preoperative staging process of patients' candidate for SNB in order to avoid unnecessary surgical procedures.
Journal of Surgical Oncology 06/2003; 83(2):80-4. · 2.10 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: The purpose of this study is to report a new sonographic appearance of hepatic pseudotumors. These lesions had a targetlike appearance but were caused by spared areas in fatty liver. CONCLUSION: Although representing a frequent pattern in metastases and mycotic abscesses, a central hyperechoic core encircled by a hypoechoic halo has not yet been reported in relation to pseudotumors. Whereas multifocal target lesions in the liver suggest metastases or mycotic abscesses, an isolated target lesion in the fourth hepatic segment requires a differential diagnostic approach and a pseudotumor should be suspected because of its clinical relevance.
American Journal of Roentgenology 02/2002; 178(1):75-7. · 2.78 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The sensitivity of preoperative imaging was evaluated for the localization of insulinomas in 2 series of 54 and 17 patients, respectively. In the first series, diagnosis was obtained with ultrasonography (US) in 14.8%, with computed tomographic (CT) scan in 60%, and with arteriography and/or angio CT scan in 75% of patients. In the second series, US, CT scan, and arteriography were performed preoperatively showing a sensitivity of 53% of one or more of the imaging techniques. The last 17 patients all underwent intraoperative pancreatosonography, and the insulinoma was localized in each.
Considering the high reliability of intraoperative ultrasonography, and the high costs and low benefits of other current diagnostic techniques, a new management plan is suggested for patients with a definite laboratory diagnosis of insulinoma.La sensibilidad de la imagenologa preoperatoria para la localizacin de insulinomas fue evaluada en 2 series de 54 y 17 pacientes respectivamente. En la primera serie, el diagnstico fue logrado con ultrasonografa en 14.8%, con escanografa computadorizada en 60%, y con arteriografa y/o angiografa con escanografa computadorizada en 75% de los casos. En la segunda serie, la ultrasonografa, la escanografa computadorizada, y la arteriografa fueron realizadas preoperatoriamente demostrando una sensibilidad de 53% en una o ms de las tcnicas de imagenologa. En los ltimos 17 pacientes se realiz pancreatosonografa, la cual permiti la localizacin del tumor en 100% de los casos.En consideracin a la elevada confiabilidad de la ultrasonografa intraoperatoria, y los altos costos y bajo rendimiento de las tcnicas corrientes de diagnstico, se sugiere un nuevo plan de manejo para pacientes con un diagnstico de laboratorio certero de insulinoma. Se fundamenta en la localizacin ultrasonogrfica intraoperatoria del tumor, la cual puede ser aplicada en los ms comprensivos centras mdicos.La sensibilit de l'imagerie pr-opratoire permettant la localisation des insulinomes a t tudie dans 2 sries de 54 et 17 sujects. Dans la premire srie le diagnostic fut pos par l'chographie dans 14.8% des cas, par la tomodensitomtrie dans 60% des cas, par l'artriographie et/ou l'angiotomodensitomtrie dans 75% des cas. Dans la seconde srie, l'chographie, la tomodensitomtrie et l'artriographie furent pratiques avant l'intervention avec une sensibilit de 53% pour l'une ou pour plusieurs techniques. Chez les 17 derniers malades l'chographie opratoire fut systmatiquement pratique et permit la localisation de la tumeur dans 100% des cas.Considrant la haute fiabilit de l'chographie opratoire, le cot lev et les faibles rsultats des autres techniques de diagnostic, un nouveau plan d'investigation est propos pour explorer les malades qui prsentrent certains signes biologiques d'insulinome. Il repose sur la localisation per-opratoire de la tumeur par l'chographie, mthode qui peut tre pratique dans des centres spcialiss.
World Journal of Surgery 09/1987; 11(5):642-647. · 2.36 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aims of the present work were to assess the diagnostic accuracy of ultrasonographic evaluation of superficial lymph nodes in patients with cutaneous melanoma and to describe the sonographic characteristics which permit early detection of neoplastic nodal involvement. Eighty-seven patients (89 lymph node sites) were studied for approximately a 3-year period, with a minimal surveillance time of 1 year. The ultrasonographic imaging equipment utilized were a 10 MHz scanner with a mechanical and one with 10 MHz electronic linear probe. The characteristics considered indicative of possible metastatic involvement were: round shape (short to long axis ratio > 0.5), no central hilus, nodular areas within the lymph node, sinuosity of the lymph node edges and lymph node with regular morphology and echostructure but with maximum diameter greater than 3 cm. Generally inguinal and axillary lymph nodes are larger than cervical ones. Of the 89 sites explored, 32 were considered ‘suspect’. All 32 of these were subjected to cytology using ultrasound-guided, fine needle aspiration. The remaining 56 came in for a periodic control examination during a year. Thirteen of the 32 ‘suspect’ lymph nodes proved positive at the pathologic examination. Two patients whose ultrasound diagnosis was negative developed metastases within 2 to 4 months (ultrasound false negatives). Our study indicates that there are sonographic features indicative of lymph node metastases from melanoma even in the early stages of the disease. Ultrasound scanning, therefore, is a useful diagnostic tool in the follow-up of melanoma patients, identifying which should be subjected to further testing with needle biopsy.
European Journal of Radiology.
-
[show abstract]
[hide abstract]
ABSTRACT: This study was conducted to describe the various patterns of vascularity of the normal superficial lymph nodes detected using high-sensitivity power Doppler imaging according to the dimension and anatomic location of the nodes.
A total of 712 lymph nodes (416 in the neck, 205 in the groin, and 91 in the axilla) were studied in 118 patients with high-sensitivity Power doppler. Three categories of vascularity were defined: absence of vascularity (type 1), hilar and perihilar vascularity (type 2), and vascularity in the entire node (type 3). The 3 types of vascularity were correlated with the anatomic location and the dimension (maximum transverse diameter) of the nodes.
Type 3 vascularity was found in all lymph nodes with a maximum transverse diameter > 6 mm, in the 67.9% (133/196) of lymph nodes between 4 and 6 mm in diameter, and in 45.7% (42/92) of lymph nodes between 2 and 4 mm in diameter. In lymph nodes with transverse diameters of 2-6 mm, type 3 vascularity was detected in 80.7% (46/57) of the axillary nodes, in 69.0% (87/126) of the inguinal nodes, and in 40.0% (42/105) of the cervical nodes. Type 2 vascularity was seen in 14.2% (101/712) of all examined lymph nodes. The absence of vascularity (type 1) was noted in only 1.9% (8/416) of cervical and 2.0% (4/205) of inguinal nodes.
State-of-the-art power Doppler equipment can demonstrate type 3 vascularity in a high percentage of normal superficial lymph nodes. This pattern of intense, extensive-but harmonious-vascularity must be considered as an indicator of benignity.
Journal of Clinical Ultrasound 32(6):273-6. · 0.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of our study was to assess the usefulness of positioning metal wires under ultrasound guidance for localising soft tissue lesions in the preoperative phase.
We studied superficial soft-tissue lesions in 12 patients, using hooked mammographic wires of different lengths. One patient had a multifocal growth of disease which required a double localisation procedure. Correct positioning of the wire was confirmed by ultrasonography. All patients underwent surgery within five hours of hook-wire positioning.
Correct wire position was confirmed at surgery in 12 out of 13 procedures. In one case the hook-wire reached the margin of the lesion. In all cases, the preoperative localisation procedure facilitated identification and resection of the masses.
In our experience, the main indications for hook-wire positioning before surgery are: marking of small lesions, localisation of lesions in anatomic areas structurally subverted by previous surgery and consequently difficult to detect, guidance for surgical sectioning in order safeguard the noble structures close to the lesions.
La radiologia medica 110(5-6):646-54. · 1.44 Impact Factor
