Contrast-Enhanced Ultrasound: A Useful Tool to Study and Monitor Hepatic Tumors Treated With Histotripsy.

Histotripsy is a novel noninvasive nonthermal, nonionizing, and precise treatment technique for tissue destruction. Contrast-enhanced ultrasound (CEUS) improves the detection, characterization, and follow-up of hepatic lesions because it depicts accurately the vascular perfusion of both normal hepatic tissue and hepatic tumors. We present the spectrum of imaging findings of CEUS after histotripsy treatment of hepatic tumors. CEUS provides real-time information, a close approximation to the dimension of the lesion, and a clear definition of its margins. Hepatic tumors detected by ultrasound can be potentially treated using B-mode ultrasound-guided histotripsy and characterized and monitored with CEUS. CEUS has shown to be very useful after tissue treatment to monitor and assess the evolution of the treated zone. Histotripsy treated zones are practically isoechogenic and slightly heterogeneous, and their limits are difficult to establish using standard B-mode ultrasound. The use of CEUS after histotripsy showing uptake of contrast protruding into the treated zone is clinically relevant to identify residual tumors and establish the most appropriate management strategy avoiding unnecessary treatments. We here describe CEUS findings after histotripsy for hepatic tumors.

Active bleeding after kidney biopsy: Successful ultrasound-guided direct thrombin embolization into the cortical fistula.

A 27-year-old man, previously diagnosed with IgA nephropathy, was referred for native kidney biopsy. After the procedure, the patient presented active bleeding revealed by Doppler and contrast-enhanced ultrasonography at the biopsy site. Successful embolization of the cortical fistula, the focus of bleeding, was achieved using ultrasound-guided thrombin injection and confirmed by Doppler ultrasonography, contrast-enhanced ultrasonography, and CT angiography. This case report shows that contrast-enhanced ultrasonography is useful for detecting active bleeding after a solid organ biopsy. Moreover, ultrasound-guided thrombin embolization is a safe and minimally invasive treatment and an alternative to angiography-guided embolization.

A Pictorial Review of Postpartum Complications.

The postpartum period, also known as the puerperium, begins immediately after delivery of the neonate and placenta and ends 6-8 weeks after delivery. The appearance of physiologic uterine changes during puerperium can overlap with that of postpartum complications, which makes imaging interpretation and diagnosis difficult. Obstetric and nonobstetric postpartum complications are a considerable source of morbidity and mortality in women of reproductive age, and the radiologist plays an important role in the assessment of these entities, which often require a multimodality imaging approach. US and contrast material-enhanced CT are the techniques of choice in the emergency department, and they can show characteristic radiologic findings that enable differentiation between normal and abnormal features to help radiologists and emergency department practitioners to reach a correct diagnosis and provide timely treatment. The spectrum of postpartum complications ranges from relatively self-limiting to life-threatening conditions that can be divided into six categories: infectious conditions (endometritis), thrombotic complications (eg, deep vein thrombosis, ovarian vein thrombophlebitis, HELLP [hemolysis, elevated liver enzymes, and low platelet count] syndrome, or cerebral sinus thrombosis), hemorrhagic conditions (eg, uterine atony, trauma of the lower portion of the genital tract, retained products of conception, uterine artery arteriovenous malformations, or uterine artery pseudoaneurysm), cesarean delivery-related complications (eg, bladder flap hematoma, subfascial hematoma, rectus sheath hematoma, abscess formation, uterine dehiscence, uterine rupture, vesicovaginal fistula, or abdominal wall endometriosis), iatrogenic conditions (eg, uterine perforation), and nonobstetric complications (eg, acute cholecystitis, acute appendicitis, uterine fibroid degeneration, renal cortical necrosis, pyelonephritis, posterior reversible encephalopathy syndrome, or pituitary gland apoplexy). The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2020.

Retrospective Study of Cystic Echinococcosis in a Recent Cohort of a Referral Center for Liver Surgery.

BACKGROUND: Cystic echinococcosis (CE) is a zoonosis endemic in Spain caused by the larval stage of the cestode Echinococcus granulosus and is one of the 18 neglected tropical diseases recognized by the WHO. The aim of this study was to describe the epidemiological and clinical data of CE in a surgical referral hospital. METHODS: A retrospective descriptive study of all adults' patients diagnosed with CE and followed at Vall d'Hebron University Hospital in Barcelona, Spain, between 2000 and 2015. RESULTS: We found 151 cases, 78 (51.7%) women, and median age at diagnosis was 68 (range, 15-92) years. Diagnosis was a radiological finding in 97 (64.2%) and the most frequent location was the liver [135 (89.4%) patients]. Nearly 80% of the cysts were calcified and serology was positive in 48 (51.6%). The WHO-IWGE classification was only available in 70 of the 104 (67.3%) cases of liver cysts that had an ultrasound. First therapeutic plan was "watch and wait" followed by surgery. International recommendations were not always followed, particularly in CE4 and CE5 stages, and 20% needed a change of treatment because of progression or recurrence. Patients treated surgically were younger, more symptomatic, and had larger and less calcified cysts in multiple sites. Serology was not useful for CE diagnosis and neither serology nor calcification of the cyst helped to predict viability. CONCLUSIONS: The formation of multidisciplinary teams in reference hospitals could help to improve CE diagnosis, its management, and follow-up, since international recommendations are not usually followed.

Utilidad de la inhibina A en el cribado de síndrome de Down en el segundo trimestre / Inhibin A in second trimester screening of Down's syndrome

Objetivo. Comprobar la eficacia de la incorporación de la inhibina A en el cribado de segundo trimestre del síndrome de Down en términos de tasa de detección y porcentaje de cribados positivos. Métodos. Estudio retrospectivo de 3.380 embarazadas, que se sometieron al cribado de segundo trimestre, clasificadas en 2 grupos en función de la incorporación de la inhibina A (1.921 mujeres) o no (1.459 mujeres).Resultados. La tasa de detección con un punto de corte de 1:250 fue del 90% en el grupo de inhibina A y 84,6% sin inhibina A, pero con un porcentaje de cribados positivos significativamente menor en el primero (11 vs. 15,9%; p < 0,001). Este concepto también se refleja al comparar el likelihood ratio positivo entre ambos grupos (8,47 vs. 5,54; p <0,001). Conclusión. Es aconsejable la incorporación de la inhibina A en el cribado de segundo trimestre, ya que se observa un menor porcentaje de casos positivos, con la consiguiente reducción en el número de amniocentesis a realizar(AU)

Objective. To evaluate the efficacy of inhibin A in second trimester screening of Down's syndrome in terms of detection rate and percentage of positive results. Methods. A retrospective study of 3380 pregnant women who underwent second trimester screening, classified into 2 groups, one which included inhibin A (1921 pregnant women) and one that did not (1459 pregnant women). Results. The detection rate (cut-off: 1:250) was 90% in the group with inhibin A and 84.6% in the other group, but the percentage of positive results was significantly lower in the first group (11% vs. 15.9%, P<.001). The results were similar if we compared the positive likelihood ratio between groups (8.47 vs. 5.54, P<.001). Conclusion. Inhibin A is a useful marker in second trimester screening due to the low percentage of positive cases observed, thereby reducing the number of amniocentesis(AU)