The WHO ultrasonography protocol for assessing hepatic morbidity due to Schistosoma mansoni. Acceptance and evolution over 12 years.

The aim of this study is to review the worldwide acceptance of the World Health Organization (WHO) ultrasound protocol for assessing hepatosplenic morbidity due to Schistosoma mansoni since its publication in 2000. A PubMed literature research using the keywords "schistosomiasis and ultrasound," "schistosomiasis and ultrasonography," and "S. mansoni and ultrasound" from 2001 to 2012 was performed. Case reports, reviews, reports on abnormalities due to parasites other than S. mansoni, organ involvement other than the human liver, and reports where ultrasound method was not described were excluded. Six studies were retrieved from other Brazilian sources. Sixty studies on 37,424 patients from 15 countries were analyzed. The WHO protocol was applied with increasing frequency from 43.75% in the years 2001 to 2004 to 84.61% in 2009 to 2012. Results obtained using the pictorial image pattern approach of the protocol are reported in 38/41 studies, whereas measurements of portal branch walls were applied in 19/41 and results reported in 2/41 studies only. The practical usefulness of the pictorial approach of the WHO protocol is confirmed by its wide acceptance. This approach alone proved satisfactory in terms of reproducibility, assessment of evolution of pathology, and comparability between different settings. The measurements of portal branches, also part of the protocol, may be omitted without losing relevant information since results obtained by these measurements are nonspecific. This would save resources by reducing the time required for each examination. It is also more feasible for examiners who are not specialized in medical imaging. As with all protocols, incipient liver fibrosis is difficult to distinguish from normal ultrasound findings of the liver. The ability of this protocol to predict complications in severe cases should be further evaluated in a higher number of patients.

[Infrarenal aortic ectasia in retroperitoneal fibrosis (RPF)]. / Aufweitungen der infrarenalen Aorta bei retroperitonealer Fibrose (RPF).

We analysed the infrarenal aortic morphology by abdominal MR-examinations of 47 RPF patients compared to a control group. A significant larger aortic calibre and higher rates of infrarenal dilatation in male RPF patients were observed. The larger aortic diameter in male RPF patients may be due to periaortic inflammation with resulting aortic ectasia and supports the classification of RPF into the spectrum of chronic periaortitis.

The macaque inferior parietal lobule: cytoarchitecture and distribution pattern of serotonin 5-HT1A binding sites.

The inferior parietal lobule (IPL) of the macaque monkey integrates sensory information as a prerequisite for reaching and grasping movements. Electrophysiological data suggest that the convexity of the IPL is heterogeneous along its rostro-caudal axis. Cytoarchitecture reflects this functional diversity. However, various parcellations have been proposed so far, ranging from one homogeneous region to four areas. In order to obtain a more valid anatomical map of the IPL, we studied the distribution pattern of serotonin 5-HT1A binding sites (i.e., the domain of synaptic transmission and cortical information processing) and cytoarchitecture with an observer-independent technique (thus avoiding the subjectivity inherent in visually guided microstructural parcellations). We cut with a cryostat microtome four unfixed macaque hemispheres and processed sections for 5-HT1A binding sites with [3H]8-OH-DPAT receptor autoradiography or for cell bodies with a modified silver stain. We digitized the autoradiographs and the histological sections and extracted from the cortex of the IPL equidistant density profiles oriented vertically to the cortical layers. We then compared groups of neighboring profiles with multivariate statistics expecting to see a significant difference in profile shape at the interface between two cortical areas. These positions were compared between 5-HT1A autoradiographs (neurochemical borders) and adjacent histological sections (cytoarchitectonic borders). Neurochemical and cytoarchitectonic borders showed a good topographical correspondence and revealed three areas arranged in a rostro-caudal sequence along the convexity of the IPL. Dorsally, the areas extend approximately 1 mm into the depth of the lateral bank of the intraparietal sulcus. Their ventral border lies on the convexity of the IPL close to the shoulder of the lateral sulcus. The three areas are in close agreement with areas PF, PFG, and PG as defined by Pandya and Seltzer (J Comp Neurol 204:196-210, 1982) and Gregoriou et al. (Program No. 919.5, Abstract Viewer/Itinerary Planner, Washington, Society for Neuroscience, 2003). The neurochemical and cytoarchitectonic data show that a complex structural framework underlies the functional heterogeneity along the rostro-caudal axis of the IPL, e.g., the representation of different types of arm and hand actions in different sectors of the monkey's workspace.

Diffusion-weighted MRI findings of treated and untreated retroperitoneal fibrosis.

PURPOSE: We aimed to evaluate diffusion-weighted imaging (DWI) findings in patients with treated and untreated retroperitoneal fibrosis (RPF). METHODS: We analyzed magnetic resonance imaging examinations of 44 RPF patients (36 male, 8 female), of which 15 were untreated and 29 were under therapy. Qualitative DWI and T1 postcontrast signal intensities and the largest perivascular extent of RPF were compared between treated and untreated groups and correlated to erythrocyte sedimentation rate and C-reactive protein values. Quantitative DWI signal intensities and apparent-diffusion-coefficients were calculated in regions-of-interest, together with a relative index between signal intensities of RPF and psoas muscle in 15 untreated patients and 14 patients under treatment with remaining perivascular fibrosis of more than 5 mm. RESULTS: The extent of RPF in untreated patients was significantly larger compared with the extent of RPF in treated patients (P <0.0001). DWI signal intensities were significantly higher in untreated patients than in patients under therapy (mean, 27 s/mm2 vs. 20 s/mm2; P = 0.009). The calculated DWI-index was significantly higher in untreated patients than in patients under therapy (P = 0.003). CONCLUSION: Our data show significant differences in the DWI findings (b800 signal intensities and relative DWI-index) of patients with treated and untreated RPF. DWI is a promising technique in the assessment of disease activity and the selection of patients suitable for medical therapy.

The potential role of modern US in the follow-up of patients with retroperitoneal fibrosis.

PURPOSE: We aimed to evaluate a standardized ultrasonography (US) algorithm for the visualization of pathologic para-aortic tissue in retroperitoneal fibrosis (RPF). MATERIALS AND METHODS: Thirty-five patients with lumbar RPF of typical extent, as determined by abdominal magnetic resonance imaging, were included. Examinations were conducted using standardized abdominal US with axial sections obtained at the levels of the renal arteries, aortic bifurcation, and both common iliac arteries. Imaging of each section was acquired with fundamental B-mode (US) and tissue harmonic imaging, respectively. In addition, we examined RPF visualized using extended field-of-view US. RESULTS: Tissue harmonic imaging adequately visualized RPF of typical extent in 33 patients (94.2%). Excellent and good visualization with mild artifacts were achieved in 25 (71.4%) and six (17.1%) patients, respectively. When RPF spread along the iliac arteries, excellent visualization was achieved in 38.7% for the left side and 34.5% for the right side. There were significantly fewer diagnostic examinations for the right iliac (27.6%) than for the left one (9.7%) (P = 0.016). Overall, harmonic imaging achieved significantly better visualization than fundamental B-Mode (P < 0.001). CONCLUSION: We described the first systematic evaluation of RPF visualization by modern US techniques. The best imaging quality was found in the typical RPF location, at the level of the aortic bifurcation. These results advocate for the presented US algorithm as an efficient follow-up alternative to cross-sectional imaging in RPF patients.