Characterization of fortuitously discovered focal liver lesions: additional information provided by shearwave elastography.

OBJECTIVES: To prospectively assess the stiffness of incidentally discovered focal liver lesions (FLL) with no history of chronic liver disease or extrahepatic cancer using shearwave elastography (SWE). METHODS: Between June 2011 and May 2012, all FLL fortuitously discovered on ultrasound examination were prospectively included. For each lesion, stiffness was measured (kPa). Characterization of the lesion relied on magnetic resonance imaging (MRI) and/or contrast-enhanced ultrasound, or biopsy. Tumour stiffness was analysed using ANOVA and non-parametric Mann-Whitney tests. RESULTS: 105 lesions were successfully evaluated in 73 patients (61 women, 84%) with a mean age of 44.8 (range: 20‒75). The mean stiffness was 33.3 ± 12.7 kPa for the 60 focal nodular hyperplasia (FNH), 19.7 ± 9.8 k Pa for the 17 hepatocellular adenomas (HCA), 17.1 ± 7 kPa for the 20 haemangiomas, 11.3 ± 4.3 kPa for the five focal fatty sparing, 34.1 ± 7.3 kPa for the two cholangiocarcinomas, and 19.6 kPa for one hepatocellular carcinoma (p < 0.0001). There was no difference between the benign and the malignant groups (p = 0.64). FNHs were significantly stiffer than HCAs (p < 0.0001). Telangiectatic/inflammatory HCAs were significantly stiffer than the steatotic HCAs (p = 0.014). The area under the ROC curve (AUROC) for differentiating FNH from other lesions was 0.86 ± 0.04. CONCLUSION: SWE may provide additional information for the characterization of FFL, and may help in differentiating FNH from HCAs, and in subtyping HCAs. KEY POINTS: • SWE might be helpful for the characterization of solid focal liver lesions • SWE cannot differentiate benign from malignant liver lesions • FNHs are significantly stiffer than other benign lesions • Telangiectatic/inflammatory HCA are significantly stiffer than steatotic ones.

Vertebral rotation in adolescent idiopathic scoliosis calculated by radiograph and back surface analysis-based methods: correlation between the Raimondi method and rasterstereography.

PURPOSE: The aim of the present research is to evaluate the relationship between an X-ray-based method (i.e. the Raimondi method) and rasterstereography in the evaluation of vertebral rotation (VR) in a sample of adolescent idiopathic scoliosis (AIS) patients. METHODS: A total of 25 patients (9 males; mean age 14 ± 3 years; mean height 160.7 ± 11.9 cm; mean weight 52.4 ± 10.7 kg) were considered for the present analysis. The mean Cobb angle was 30° ± 9°. The evaluation of VR on radiographs was made using the Raimondi method regolo (Marrapese Editore--Demi S.r.1., Rome). Rasterstereography was performed by means of Formetric 4D(®) (Diers International GmbH, Schlangenbad, Germany). Correlations between rasterstereographic and radiographic measurement of VR were calculated, both for the whole sample and for thoracic and lumbar spinal segments considered separately, as well as for subgroups of patients with a Cobb angle <30° and ≥ 30° using Spearman's correlation coefficient by rank (r (s)). RESULTS: When applied to the entire spine, measurement of VR by means of the two methods highlighted a significant correlation in the whole group (r = 0.52; p < 0.0001), as well as in the <30° Cobb (r = 0.47; p = 0.0001) and ≥ 30° Cobb (r = 0.42; p < 0.0001) subgroups. A significant correlation was found also when lumbar and thoracic VR were considered as separated groups (r = 0.30, p = 0.024 and r = 0.47, p = 0.002, respectively). CONCLUSIONS: Rasterstereographic evaluation of VR shows a good correlation with the Raimondi method, thereby confirming the possibility to use this non-invasive method for deformity assessment in AIS patients.

A new evaluation system for early and successful conservative treatment for acute ischial tuberosity avulsion.

In this report we analyse a case of ischiatic tuberosity avulsion. A 15-year-old patient who came to our first aid department two days after a football match accident was treated conservatively and examined at month 1-4, 6 and 12. In order to examine patient condition, a new index was formulated: the inability score index (ISI), which is based on hip range of motion and scales for rest, walking, running pain and compared to other parameters such as oedema area, fragment diastasis evaluated by X-ray and CT accordingly. ISI defines the inability as severe, moderate and mild. It guides the rehabilitative program in the right way. In this case, the patient was able to run softly after 35 days and to go back to the full agonist activity after 4 months. At the end of treatment the patient referred to the complete pain remission, full range of motion recovery and a good fracture consolidation. After 1 year we discuss about therapeutic strategies used and results obtained.

Is magnetic resonance imaging of hepatic hemangioma any different in liver fibrosis and cirrhosis compared to normal liver?

PURPOSE: To compare qualitative and quantitative magnetic resonance (MR) imaging characteristics of hepatic hemangiomas in patients with normal, fibrotic and cirrhotic livers. MATERIALS AND METHODS: Retrospective, institutional review board approved study (waiver of informed consent). Eighty-nine consecutive patients with 231 hepatic hemangiomas who underwent liver MR imaging for lesion characterization were included. Lesions were classified into three groups according to the patients' liver condition: no underlying liver disease (group 1), fibrosis (group 2) and cirrhosis (group 3). Qualitative and quantitative characteristics (number, size, signal intensities on T1-, T2-, and DW MR images, T2 shine-through effect, enhancement patterns (classical, rapidly filling, delayed filling), and ADC values) were compared. RESULTS: There were 160 (69%), 45 (20%), and 26 (11%) hemangiomas in groups 1, 2 and 3, respectively. Lesions were larger in patients with normal liver (group 1 vs. groups 2 and 3; P=.009). No difference was found between the groups on T2-weighted images (fat-suppressed fast spin-echo (P=.82) and single-shot (P=.25)) and in enhancement patterns (P=.56). Mean ADC values of hemangiomas were similar between groups 1, 2 and 3 (2.11±.52×10(-3) mm(2)/s, 2.1±.53×10(-3) mm(2)/s and 2.14±.44×10(-3) mm(2)/s, P=87, respectively). T2 shine-through effect was less frequently observed in cirrhosis (P=.02). CONCLUSION: MR imaging characteristics of hepatic hemangioma were similar in patients with normal compared to fibrotic and cirrhotic livers. Smaller lesion size was observed with liver disease and less T2 shine-through effect was seen in hemangiomas developed on cirrhosis, the latter being an important finding to highlight in these patients at risk of developing hepatocellular carcinoma.

Accuracy of high-resolution MRI with lumen distention in rectal cancer staging and circumferential margin involvement prediction.

OBJECTIVE: To evaluate the accuracy of magnetic resonance imaging (MRI) with lumen distention for rectal cancer staging and circumferential resection margin (CRM) involvement prediction. MATERIALS AND METHODS: Seventy-three patients with primary rectal cancer underwent high-resolution MRI with a phased-array coil performed using 60-80 mL room air rectal distention, 1-3 weeks before surgery. MRI results were compared to postoperative histopathological findings. The overall MRI T staging accuracy was calculated. CRM involvement prediction and the N staging, the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were assessed for each T stage. The agreement between MRI and histological results was assessed using weighted-kappa statistics. RESULTS: The overall MRI accuracy for T staging was 93.6% (k = 0.85). The accuracy, sensitivity, specificity, PPV and NPV for each T stage were as follows: 91.8%, 86.2%, 95.5%, 92.6% and 91.3% for the group ≤ T2; 90.4%, 94.6%, 86.1%, 87.5% and 94% for T3; 98,6%, 85.7%, 100%, 100% and 98.5% for T4, respectively. The predictive CRM accuracy was 94.5% (k = 0.86); the sensitivity, specificity, PPV and NPV were 89.5%, 96.3%, 89.5%, and 96.3% respectively. The N staging accuracy was 68.49% (k = 0.4). CONCLUSION: MRI performed with rectal lumen distention has proved to be an effective technique both for rectal cancer staging and involved CRM predicting.

Kinematic and kinetic modifications in walking pattern of hip osteoarthritis patients induced by intra-articular injections of hyaluronic acid.

BACKGROUND: A growing body of evidence points to the efficacy of intra-articular injections of hyaluronic acid, in dealing with pain and function in hip osteoarthritis. To date, however, no data exist as to this treatment's effect on walking pattern. METHODS: We performed a prospective, open study in order to verify, in a group of 20 hip osteoarthritis patients (12 men, 8 women, mean age 60.5, range 47-73), the clinical effects of 3 intra-articular injections of 2 ml of hyaluronic acid in the hip (1/week) in terms of pain and function at 1 (T1), 3 (T2) and 6-month (T3) follow-ups, as well as changes in the kinematics and kinetics of gait at 6-month follow-up. FINDINGS: Pain as measured with visual analog scale significantly dropped after this procedure (P<0.0001). A significant improvement was noted regarding stiffness (P=0.005) and disability (P=0.04), as measured by the Western Ontario and McMaster Universities osteoarthritis index. As regards gait analysis, patients at T3 walked with higher cadence (P=0.004) and stride length (P=0.02) compared to T0. Moreover, a significant increase for the pelvic tilt at heel contact (P=0.0004) and for hip flexion-extension moment at loading response sub-phases of gait cycle (P=0.02) was noted at T3. INTERPRETATION: In line with current literature, our patients display clinical improvement 6 months after intra-articular injections of hyaluronic acid, accompanied by changes in walking pattern, as measured by instrumental gait analysis. The kinematic and kinetic changes observed may be the consequence of the therapeutic effect of intra-articular injections of hyaluronic acid.

Ultrasound-guided aspiration and corticosteroid injection of Baker's cysts in knee osteoarthritis: a prospective observational study.

OBJECTIVE: To determine the effect on pain, function, and ultrasonographic findings of ultrasonography-guided Baker's cyst aspiration followed by corticosteroid injection in a group of patients with Baker's cyst secondary to knee osteoarthritis. DESIGN: Prospective observational study. RESULTS: Twenty-six subjects participated in this study. Clinical and instrumental evaluations were performed at baseline (T0), 1 wk (T1), and 4 wks (T2) after procedure. Mean Visual Analog Scale scores significantly dropped after the procedure (T0 = 6.2 [1.2]; T1 = 4.48 [1.5]; T2 = 4.32 [1.3]; T0 vs. T1 and P < 0.0001). A significant difference between preprocedure and postprocedure Western Ontario and McMaster Universities scores was found for pain (P < 0.0001) but not for joint stiffness (P = 0.7239) and disability (P = 0.6318). Ultrasonographic evaluation showed a significant reduction for both axial (P = 0.006) and sagittal (P = 0.01) areas of Baker's cyst, but no correlation was found between pain relief and Baker's cyst volume reduction. CONCLUSIONS: Cyst aspiration with corticosteroid injection give pain relief and cyst volume reduction in patients with Baker's cyst and concomitant knee osteoarthritis. However, when compared with current literature, our results are similar to those obtained with intra-articular knee corticosteroid injection.