18F-FDG PET/CT metabolic activity assessment in infective and neoplastic diseases: a patient with systemic hydatidosis and concomitant Burkitt lymphoma.

We report a case of a 73-year-old-man with systemic hydatidosis and concomitant Burkitt lymphoma. He came at our attention for fever and weight loss suspected for parasitic cyst discharge and also for lymphoproliferative disorder. We performed US, which showed disseminated parasitic cysts. CECT showed parasitic cysts and also several abdominal and thoracic lymphnodes and adrenal hypodense tissue. 18F-FDG PET/CT was performed and showed lack of 18F-FDG uptake in cysts and high 18F-FDG uptake in lymphnodes and adrenal glands. These findings permitted us to exclude the cyst discharge, to localize a site for biopsy, and to define and stage the Burkitt lymphoma.

[Ultrasound assessment in renal infections]. / L'ecografia nelle infezioni del rene.

Urinary tract infections (UTIs) are a common clinical problem, especially among women. Ultrasound assessment is indicated in case of complicated UTIs, in particular in children, pregnant women and patients with chronic kidney disease. Even though B-mode imaging alone is rarely diagnostic in case of particular kidney infections such as focal and multifocal acute pyelonephritis, Doppler and power-Doppler (PD) techniques are able to increase its sensitivity. Contrast-enhanced ultrasound (CEUS) further improves the signal-to-noise ratio, thus increasing the diagnostic accuracy of ultrasound in case of renal infectious disease. Recent studies performed on kidney transplant recipients have indeed demonstrated the high sensitivity and specificity of CEUS in diagnosing acute pyelonephritis. Moreover, ultrasonography is a useful diagnostic tool in case of kidney abscesses, emphysematous pyelonephritis, early phases of pyonephrosis, and in the evaluation and monitoring of echinococcal cysts. Ultrasound imaging is less specific in diagnosing xanthogranulomatous pyelonephritis, malacoplakia and renal tuberculosis. Finally, several authors recommend routine ultrasound assessment in HIV patients, given the high incidence of renal complications in this population of patients.

Metabolic viability assessment of cystic echinococcosis using high-field 1H MRS of cyst contents.

Cystic echinococcosis is a worldwide disease caused by larval stages of the parasite Echinococcus granulosus (canine tapeworm). In clinical practice, staging of cyst development by ultrasonography (US) has allowed treatment options to be tailored to individual patient needs. However, the empirical correlation between cyst morphology and parasite viability is not always dependable and has, until now, required confirmation by invasive assessment of cyst content by light microscopy (LM), for example. Alternatively, high-field 1H MRS may be used to examine cyst fluid ex vivo and prepare detailed quantitative metabolite profiles, enabling a multivariate metabolomics approach to cyst staging. One-dimensional and two-dimensional 1H and 1H/13C MRS at 600 MHz (14.1 T) was used to analyze 50 cyst aspirates of various US and LM classes. MR parameters and concentrations relative to internal valine were determined for 44 metabolites and four substance classes. The high concentrations of succinate, fumarate, malate, acetate, alanine, and lactate found in earlier studies of viable cysts were confirmed, and additional metabolites such as myo-inositol, sorbitol, 1,5-anhydro-D-glucitol, betaine, and 2-hydroxyisovalerate were identified. Data analysis and cyst classification were performed using univariate (succinate), bivariate (succinate vs fumarate), and multivariate partial least squares discriminant analysis (PSL-DA) methods (with up to 48 metabolite variables). Metabolic classification of 23 viable and 18 nonviable cysts on the basis of succinate alone agreed with LM results. However, for seven samples, LM and MRS gave opposing results. Reclassification of these samples and two unclassified samples by PLS-DA prediction techniques led to a set of 50 samples that could be completely separated into viable and nonviable MRS classes with no overlap, using as few as nine variables: succinate, formate, malate, 2-hydroxyisovalerate, acetate, total protein content, 1,5-anhydro-D-glucitol, alanine, and betaine. Thus, future noninvasive in vivo applications of MRS would appear promising.

Assessment of liver hydatid cyst cases--10 years experience in Turkey.

We analysed 73 hydatid cyst patients according to their age, gender, localization, number of cysts, infectivity, symptoms, physical examination findings, presence of accompanying diseases, and diagnostic methods. Female/male ratio was 1.6/1. In total, 69% of cases had a single cyst and 31% multiple cysts. Of the cysts, 61% were in form of "eau de roche" and the rest infective. The mean age was 42.3 years, ranging from 18 to 85 years. The most common symptom was abdominal pain in 74% of patients. Right lobe involvement was encountered in 65% of cases, left lobe in 13%, and left and right in 8%. In 27% of patients, cholelithiasis was the most common accompanying disease. As an imaging technique ultrasound was the most commonly used diagnostic technique.

The value of ultrasonography alone in screening surveys of cystic echinococcosis in children in Turkey.

A total of 1,205 primary school children were examined for cystic echinococcosis in five villages of Manisa, Turkey, to evaluate the efficacy of diagnostic methods of this infection in community-based screening surveys. Six hundred and thirty children from three villages, examined by a portable ultrasound scanner, chest microfilm and serological methods (ELISA, indirect hemagglutination) in our previous study, were designated as Study Group 1; and 575 children, from two adjacent villages, examined by ultrasonography alone in the present study, were designated as Study Group 2. In Study Group 1, hepatic cystic echinococcosis was detected in two cases (0.3%) by ultrasonography, while 43 (8.9%) and 49 (10.1%) cases were found to be positive for cystic echinococcosis by ELISA and indirect hemagglutination, respectively. Three of 575 children (0.5%) were diagnosed with cystic echinococcosis (two hepatic and one renal involvement) by ultrasonography alone in Study Group 2; and lung lesions were later detected in both cases with liver involvement by chest radiography. Our results suggested that serological tests may be beneficial in suspected cases for confirmation and differential diagnosis, but have some drawbacks, such as discrepancy in results and high false seropositivity rates. Chest microfilm is not easy in field studies and exposure to X-ray is undesirable. As a reliable, simple, inexpensive and rapid technique, ultrasonography alone is recommended to be used in community-based screening surveys for cystic echinococcosis with confirmatory tests for suspected cases found during the screening program.

Live three-dimensional transthoracic echocardiographic assessment of left ventricular hydatid cyst.

We report an adult patient in whom live three-dimensional transthoracic echocardiography (3DTTE) complemented two-dimensional transthoracic echocardiography (2DTTE) in making a definitive diagnosis of a hydatid cyst located in the left ventricular cavity. The parent hydatid cyst, as well as the daughter cysts, contained within it could be delineated by both 2DTTE and live 3DTTE. However, the tertiary or granddaughter cysts originating from the daughter cysts as well as great-granddaughter cysts budding from tertiary cysts could be visualized only when the live 3DTTE data sets were cropped and sectioned sequentially using multiple cutting planes. In addition, apparent intrinsic mobility of some of the tertiary cysts implying viability was detected only by 3DTTE.

Retrobulbar hydatid cyst: assessment of two cases.

A 54-year-old man with a unilocular hydatid cyst within the infero-posterior angle of the orbit and a 6-year-old male child with a unilocular hydatid cyst within the supero-medial angle of the orbit are presented. The retrobulbar cysts were diagnosed with computed tomography and ultrasonography and were treated after serologic confirmation.

Assessment of the diagnostic value of 99mTc-radiolabelled specific antibodies in experimental hydatidosis.

We assessed the potential of 99mTc labelled specific polyclonal antibodies (99mTc-PoAb) for the diagnosis of hydatid disease by immunoscintigraphy. Experimentally infected mice and rabbits were used for this purpose. A specific rabbit antibody recognizing total somatic antigen from hydatid membranes (HCMA) was obtained. PoAb biological activity before labelling was checked according to Barbieri et al. 99mTc-PoAb labelling was performed according to Thakur et al.; the radiochemical purity was higher than 90%. The following studies of 99mTc-PoAb were made: post-labelling biological activity; in vitro stability; blood and renal kinetics in normal mice up to 24 hours after intravenous (i.v.) and intraperitoneal (i.p.) administration; biodistribution in normal and infected mice after i.p. or i.v. injection, and in rabbits after i.v. administration. Biodistribution studies in normal mice, after both administration routes, showed considerable hepatic uptake of activity. An important uptake in cysts after i.p. administration in mice, indicating successful targeting, was also confirmed by autoradiography images. Intravenously administered 99mTc PoAb was not significantly targeted to peritoneal cysts in either animal species, due to inherent limitations to these animal models. Results obtained with i.p. administration suggest that specific hydatid imaging may be possible. Both the mice and rabbit models revealed hepatic uptake which, combined with the short isotope half-life, prevent the drawing of any final conclusions regarding the usefulness of 99mTc-labelling in hydatid disease.

Orbital hydatid cyst: assessment of two cases.

Two cases of unilateral proptosis due to orbital hydatid disease are reported. In both cases CT scans showed well-defined, thin-walled cystic masses whose densitometric values were similar to that of the globe.

Spinal involvement in alveolar echinococcosis: assessment of two cases.

Two cases of spinal involvement in alveolar echinococcosis are reported. Conventional radiographs showed bone lysis and spondylitis; computed tomographic scans showed detail of local spread to the ribs, other vertebrae, and soft tissues. Differential diagnosis, which includes other infections and hydatidosis, is difficult, and the diagnosis may be suggested by evidence of a primary hepatic focus, geographic propensity to the infection, and laboratory findings.

The use of computed tomography in the assessment of cardiac masses.

Computed tomography has been found to be a useful tool in the evaluation of cardiac masses. It can be most effacious in the detection of a lesion and in the delineation of its size and location, as well as the demonstration of its relationships to intra- and extracardiac structures. It can be especially useful in areas of the heart where echocardiography can be difficult. This is particularly true for the left atrium, where lesions such as small thrombi can be missed.

Vertebral hydatid disease: radiological assessment.

The computed tomographic (CT) appearance and the pain radiographic and myelographic findings of vertebral hydatid disease (caused by Echinococcus granulosus) in two patients are presented. CT proved to be more useful in the initial assessment and measurement of progress of this disease than conventional radiography and myelography.