Prevalence of Atherosclerosis in Psoriatic Patients Detected with Epiaortic Color Doppler Ultrasound and Computed Tomography Angiography.

INTRODUCTION: Psoriasis (PsO), a chronic inflammatory, multisystemic, and multifactorial disease can cause endothelial dysfunction, artery calcification, and atherosclerotic disease. A higher incidence of vascular occlusive events has been observed in psoriatic patients compared to healthy controls, and multiple studies confirm the association between moderate-severe PsO and atherosclerosis, coronary artery calcification, and higher cardiovascular risk. OBJECTIVE: We sought to analyze atherosclerotic disease prevalence in epiaortic vessels of psoriatic and non-psoriatic patients to understand if PsO could represent an independent risk factor predisposing to atherosclerotic disease. METHODS: We evaluated 47 psoriatic patients without cardiovascular risk factors with color Doppler ultrasound (CDUS). If atheromatous plaques were detected, a computed tomography angiography (CTA) was performed. We evaluated 47 non-psoriatic patients without cardiovascular risk factors with CDUS. Atherosclerosis prevalence in both groups were statistically analyzed. CDUS performance was compared to CTA. RESULTS: In the psoriatic group (mean age 50.9 years), 6 had atheromatous plaques and 12 had an intima-media thickness (IMT) > 1 mm (overall prevalence of atherosclerotic disease: 38.2%). All plaques detected with CDUS were confirmed at CTA. In the control group (mean age 51.3 years), CDUS revealed atheromatous plaques in 4 patients and IMT > 1 mm in 4 ones (overall prevalence of 17%). The difference of atherosclerotic disease prevalence between the groups was statistically significant (P < 0.05). CONCLUSION: Our results highlight that PsO could be considered a predisposing factor for atherosclerotic disease development in epiaortic vessels, as it causes an increased IMT, that is also considered an independent cardiovascular risk factor.

3-T MRI and clinical validation of ultrasound-guided transperineal laser ablation of benign prostatic hyperplasia.

BACKGROUND: Transperineal laser ablation (TPLA) of the prostate is a novel, mini-invasive option for men with lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH). Our aim was to assess the impact of ultrasound-guided TPLA regarding urodynamic improvement and sexual function, monitoring clinical data, postprocedural complications and imaging findings at 3-T multiparametric magnetic resonance imaging. METHODS: Forty-four patients aged ≥ 50 affected with moderate to severe LUTS (International Prostate Symptoms score ≥ 12) due to benign prostatic obstruction and refractoriness, intolerance or poor compliance to medical therapies underwent US-guided TPLA between May 2018 and February 2020. Clinical measurements included PSA, uroflowmetry, sexual function assessment (using the International Index of Erectile Function and Male Sexual Health Questionnaire-Ejaculatory Dysfunction short form) and quality of life questionnaire. Adverse events were evaluated using the Clavien-Dindo scale. Volume changes were measured by MRI and automatic segmentation software during 1-year follow-up. Registration: NCT04044573 - May 5th, 2018, https://www.clinicaltrials.gov RESULTS: MRI assessed the changes over time with a 53% mean reduction of adenoma volume and 71% of the ablated area, associated with clinical and functional improvement and resolution of LUTS in all cases. Five of 44 patients (11.3%) had urinary blockage due to clots and required re-catheterisation for 2 weeks. The overall adverse event rate was 7%. CONCLUSION: US-guided TPLA performed as a safe, manageable and effective treatment for LUTS. It could be considered an alternative effective mini-invasive procedure to standard treatments for BPH in the outpatient setting.

Ability of a Set of Trunk Inertial Indexes of Gait to Identify Gait Instability and Recurrent Fallers in Parkinson's Disease.

The aims of this study were to assess the ability of 16 gait indices to identify gait instability and recurrent fallers in persons with Parkinson's disease (pwPD), regardless of age and gait speed, and to investigate their correlation with clinical and kinematic variables. The trunk acceleration patterns were acquired during the gait of 55 pwPD and 55 age-and-speed matched healthy subjects using an inertial measurement unit. We calculated the harmonic ratios (HR), percent recurrence, and percent determinism (RQAdet), coefficient of variation, normalized jerk score, and the largest Lyapunov exponent for each participant. A value of ≤1.50 for the HR in the antero-posterior direction discriminated between pwPD at Hoehn and Yahr (HY) stage 3 and healthy subjects with a 67% probability, between pwPD at HY 3 and pwPD at lower HY stages with a 73% probability, and it characterized recurrent fallers with a 77% probability. Additionally, HR in the antero-posterior direction was correlated with pelvic obliquity and rotation. RQAdet in the antero-posterior direction discriminated between pwPD and healthy subjects with 67% probability, regardless of the HY stage, and was correlated with stride duration and cadence. Therefore, HR and RQAdet in the antero-posterior direction can both be used as age- and-speed-independent markers of gait instability.

Ultrasound-Guided Laser Ablation After Excisional Vacuum-Assisted Breast Biopsy for Small Malignant Breast Lesions: Preliminary Results.

BACKGROUND: The purpose of this preliminary study is to evaluate the feasibility of the excisional ultrasound (US) guided vacuum-assisted breast biopsy (VAE), followed by US-guided Laser Interstitial Thermal Therapy (LITT) in the treatment of unifocal ductal breast carcinomas ≤ 1 cm and estimate the ablation rate analyzing the final histopathological results after subsequent surgical excision. METHODS: In a single session 11 female patients with unifocal less than a centimeter breast cancer underwent 2 different minimally invasive percutaneous US-guided techniques: a VAE breast biopsy with an 8 G needle to remove the lesion and, immediately after, a LITT ablation in the biopsy site. Four weeks later, all patients underwent radiological follow-up. Afterward, a systematic surgery was performed, the ablation rate was calculated, and iconographic and histological features were correlated. RESULTS: Average maximum diameter of the lesions was 7.6 mm (5-10 mm). No patient reported pain or discomfort during procedure. 1/11 patient (9.1%) reported an early minor complication (a small superficial skin burn). After surgical excision, the histopathological evaluation reported in 10/11 cases (90.9%) complete ablation of the target lesion. In only one case (9.1%) residual cancer was detected. The necrotic-hemorrhagic cavities showed a mean maximum diameter of 27.3 mm (20-35 mm). CONCLUSIONS: Laser ablation performed after excisional biopsy could be considered a valid alternative to surgical excision for the treatment of lesions ≤ 1 cm, if carried out by expert radiologists. The association of these minimally invasive percutaneous methods has proven to be reliable, fast, and safe with an ablation rate of 90.9% and excellent aesthetic results. RM and CESM are potentially able to quantifying treatment results and to follow-up the ablation effects.

Shear wave elastography and microvascular ultrasound in response evaluation to calcipotriol+betamethasone foam in plaque psoriasis.

Psoriasis (PsO) is a chronic skin disease. This study aims to evaluate clinical and subclinical response to calcipotriol+betamethasone foam, in patients with PsO, comparing, for the first time, data from microvascular ultrasound (MicroV) and shear wave elastography (SWE) with Psoriasis Area and Severity Index (PASI). METHODS: Between November 2018 and April 2019 in Tor Vergata Hospital (Roma, Italy), we enrolled 26 patients with PsO who were ageds 20-75 years, with PASI score ≥4, candidated for calcipotriol+betamethasone foam treatment. They underwent MicroV and SWE evaluation at baseline (T0) and after 4 weeks of treatment (T4). Clinical follow-up was carried on at T4, T8 and T12. Student's t-test (p values<0.05 statistically significant) was used to compare SWE and PASI values. RESULTS: At T0, SWE stiffness values of target plaques (61.5% on elbows, 23% knees, 7.7% sacrum,7.7% legs) were significantly higher than values under healthy skin. At T4, all patients showed a significant reduction of PASI; MicroV showed reduction in vascularisation of responsive plaques in 85% of cases, only in 15%, the vascularisation degree remained stable; and SWE values of target plaques were significantly lower compared with T0. Only in 7.7%, there was a relapse at T12. CONCLUSIONS: Calcipotriol+betamethasone foam is a very effective topical treatment in a short-medium term follow-up in patients with PsO. MicroV and SWE evaluate response to treatment (in term of plaque vascularisation and stiffness), so they could represent promising early indicators of therapeutic response and help the physician to establish a better clinical-therapeutic management of patients with PsO.

MR imaging-guided vacuum assisted breast biopsy: Radiological-pathological correlation and underestimation rate in pre-surgical assessment.

BACKGROUND: Magnetic Resonance(MR) guided percutaneous procedures(MRgVABB) have been developed and largely employed to reduce the need of surgical biopsies for suspicious lesions which can be detected only by MR(MR-only lesion). The present study aims to investigate correlation between imaging, histological features of MRgVABB and surgical specimens of MR-only lesions. METHODS: We retrospectively enrolled 56 patients with a total of 61 lesions. Each finding was defined as Mass-Enhancement(ME) or Non-ME(NME) and classified according to BI-RADS. MRgVABB and surgical data were collected. Concordance between MR, MRgVABB and open biopsy was calculated. Underestimation Rate(UR) of MRgVABB with surgery was obtained. RESULTS: B2 and B5b lesions were statistically associated with NME and ME, respectively. No statistical association was found to B3 nor to B5a with radiological features. UR was 10 %; underestimated lesions were strongly associated with the presence of a ME on MR imaging. Moreover, B3 lesions are associated with higher UR. CONCLUSION: Radiological features should influence patient management aiming to construct a correct diagnostic and therapeutic plan. When MR is prescribed for breast cancer staging for ME-MR-only lesions, we suggest surgical open biopsy instead of MRgVABB when upfront surgery is the treatment of choice.

Evaluation of Ultrasound-guided 8-Gauge Vacuum-assisted Excision System for the Removal of US-detectable Breast Lesions.

AIM: To assess the ability of ultrasound (US)-guided vacuum-assisted breast excision (VAE) to remove Breast Imaging Reporting and Data System (BI-RADS) ≥3 breast lesions in order to analyze US features most frequently associated with complete excision. MATERIALS AND METHODS: A total of 266 BI-RADS ≥3 lesions without microcalcifications underwent US-VAE. US-VAE and gold standard pathological results were compared. US features of lesions were analyzed. RESULTS: The complete excision rate was 93.61%; the VAE agreement rate was 99.62%. Circumscribed margins, regular shape, parallel orientation, and the absence of posterior features were favorable US features associated with complete excision. Lesions completely excised were: BI-RADS 3 ≤21.10 mm and BI-RADS 4 ≤18.70 mm with one unfavorable US characteristic, and BI-RADS 4 lesions ≤13.5 mm with two unfavorable US features hindered complete removal. Two atypical ductal hyperplasias (<10 mm, one unfavorable feature) and eight ductal carcinomas in situ (≤8.7 mm, one/two unfavorable features) were completely removed. CONCLUSION: US-VAE is highly accurate for diagnostic purpose and, in some cases, highly successful for complete lesion excision. This success also depends on the US characteristics and size of the lesion.

Biomechanical properties of optic nerve and retrobulbar structures with 2D and 3D shear wave elastography in patients affected by glaucoma.

This study consists of an elastosonography evaluation of both eyes of 40 glaucomatous patients and 40 healthy subjects. We used shear wave elastography with a one-dimensional-array probe to capture two-dimensional images in order to study the optic nerve near the papilla, chorioretinal complex, lateral rectus muscle, and periorbital fat tissue. Furthermore, we used a two-dimensional array probe to capture three-dimensional images to study the optic nerve in toto with multilevel sampling. We obtained qualitative and quantitative data ("absolute" stiffness values). Then, we have investigated these tissue also measuring the "stiffness ratio" values. Statistically significant differences (p < 0.05), between glaucomatous patients and healthy patients, were noted in "absolute" stiffness values in the two-dimensional analysis at the emergence of the optic nerve and chorioretinal complex, and in the three-dimensional analysis at the emergence of the optic nerve (level I°). This result was supported by the statistically significant differences in the "stiffness ratio" values between the optic nerve and the adjacent adipose tissue, obtained both in two- and three-dimensional analyses. Data were subsequently compared with diagnostic tests currently used for glaucoma, which showed a sensitivity of 83% and specificity of 80% relative to those of elastosonography. We propose the use of elastosonography to verify the existence of pathological changes in the mechanical and elastic properties of peri-ocular structures and their variations as a complementary tool in the diagnosis of glaucoma and for follow-up during treatment.

Recurrent MALT lymphoma presenting as renal calyceal-pelvic rupture. What is the cause of this break?

Urinary collecting system rupture is an uncommon condition that usually occurs with symptoms of acute abdomen, secondary to peritoneal irritation by urine leaking. We report a case of a 49-year-old man admitted to our emergency department because of a worsening deep lower abdominal pain started 3 days before. The abdominal computed tomography revealed urine extravasation suggesting for urinoma. Because of patient pathological history of lymphoma, despite its apparent state of remission, he underwent a positron emission tomography - computed tomography with 18[F]-FDG and magnetic resonance in order to rule out a recurrence. Imaging supported the diagnostic hypothesis of a lymphatic recurrence that had compressed "ab-extrinseco" the urinary tract so much to break it. Based on our experience we can suggest that nontraumatic calyceal-pelvic rupture is an extremely rare manifestation of an onset of lymphoma.

A Rare Case of Primary Uterine Non-Hodgkins's Lymphoma with Involvement of Right Ovary: Staging with 18F FDG PET/CT and Iodinated Contrast CT.

Primary uterine non-Hodgkin's lymphomas are extremely rare, and consequently, imaging findings of this disease have rarely been reported in the literature. We present fluorine-18-fluorodeoxyglucose (18[F] FDG) positron emission tomography/computerized tomography (CT) and iodinated contrast CT findings in a young patient with primary uterine non-Hodgkin's B-cell lymphoma with right ovary involvement.

Probably Benign Breast Nodular Lesions (BI-RADS 3): Correlation between Ultrasound Features and Histologic Findings.

The purpose of this retrospective study was to determine the validity of the BI-RADS system in ultrasound findings assigned to BI-RADS 3 category, using cytologic and histologic results as a benchmark. Our study population consisted of 122 ultrasound nodular lesions in 122 women who underwent fine-needle aspiration cytology and biopsy for probably benign lesions (Breast Imaging Reporting and Data System [BI-RADS] category 3). Contrary to what was previously reported in the literature (risk of malignancy of BI-RADS 3 <2%), malignancy was the outcome in seven of 122 cases (5.7%). Our study also found that the presence of a cellular component with a mobile fluid-fluid level in a cystic lesion and small (<3 mm) anechoic components in solid lesions is not always an indication of benignity. Our experience seems to indicate the need to consider the presence of non-homogeneous echoes in the corpuscular cyst and solid nodular lesions with cystic components as suspicious, especially in lesions with large dimensions. Therefore it would be necessary to conduct further studies to establish a dimensional criterion in the assessment of the malignant nature of the mentioned lesions. The management of probably benign nodular lesions should not only be guided by BI-RADS classification; it is also necessary to include clinical and anamnestic data and apply a multidisciplinary approach to select cases that require histologic verification instead of the usual follow-up.

Color Doppler Ultrasound with Superb Microvascular Imaging Compared to Contrast-enhanced Ultrasound and Computed Tomography Angiography to Identify and Classify Endoleaks in Patients Undergoing EVAR.

BACKGROUND: The aim of the study was to evaluate the diagnostic effectiveness of color Doppler ultrasound (CDUS) with superb microvascular imaging (SMI) compared to contrast-enhanced ultrasound (CEUS), computed tomography (CT) multislice angiography (64 slices), and angiography required for therapeutic reasons, for follow-up after endovascular aneurysm repair (EVAR). METHODS: From March 2014 to May 2015, 57 patients treated with EVAR were evaluated with CT, CEUS, CDUS, SMI, and angiography in cases requiring treatment. Evaluation included sac diameter, stent-graft integrity, identification, and classification of endoleaks. Sensitivity, specificity, accuracy, and negative and positive predictive values were evaluated for each modality of endoleak identification. RESULTS: Eight endoleaks (16.3%), all type II, were documented. Sensitivity of CT, CEUS, CDUS and SMI was 88%, 100%, 63%, and 75%, respectively. Specificity of CT, CEUS, CDUS, and SMI was 100%, 100%, 96%, and 98%, respectively With SMI, CDUS sensitivity significantly increased, whereas specificity did not register great differences. CONCLUSIONS: SMI was more accurate than CDUS but less accurate than CEUS and CT to identify endoleaks after EVAR. SMI could be concretely used in the follow-up phase to increase CDUS accuracy especially in patients who cannot be studied with CEUS or CT.