Quantitative MRCP assessment of pancreatic exocrine reserve and its correlation with faecal elastase-1 in patients with chronic pancreatitis.

PURPOSE: This retrospective study was done to correlate a quantitative assessment of the pancreatic exocrine reserve by dynamic secretin magnetic resonance cholangiopancreatography (MRCPQ) with the faecal elastase-1 (FE-1) test in patients with chronic pancreatitis. MATERIALS AND METHODS: Thirty-five patients with a clinical diagnosis of chronic (CP) or acute recurrent (ARP) pancreatitis were enrolled. FE-1 was indicative of the pancreatic exocrine reserve. Subsequently, the patient population was subdivided into two groups according to a clinical threshold value of 200 µg/g. All patients underwent MRCP examination during secretin administration. Duodenal filling volume was calculated on T2-weigthed rapid acquisition with relaxation enhancement (RARE) MRCP images obtained 10 min after secretin injection. Duodenal filling volumes were compared with FE-1 values. Scatter plots, Pearson correlation coefficient and the Mann-Whitney U test were performed. RESULTS: Thirty-five paired MRCPQ-FE1 data sets were analysed. MRCPQ was significantly different (p=0.007) between patients with impaired and preserved pancreatic function; median and interquartile range (IQR) were 150.7 ml (137.3-205.5 ml; n=9) and 332.4 ml (190.6-506.9 ml; n=26). Both Pearson correlation coefficient (p<0.001) and the Mann-Whitney U test (p=0.007) were significant. CONCLUSIONS: MRCPQ significantly correlates with FE-1 values. It is possible to discriminate impaired and preserved pancreatic exocrine function using MRCPQ.

Cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of complex phalangeal fractures: economic simulation.

PURPOSE: The purpose of this study was to evaluate the cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of the complex finger fractures with articular involvement. METHODS: We created a decision tree model simulating the diagnostic pathway of complex finger fractures, suggesting the use of CBCT as alternative to multi-slice computed tomography (MSCT), and we compared their clinical outcomes, costs, and cost-effectiveness for a hypothetical cohort of 10,000 patients. Measures of effectiveness are analysed by using quality-adjusted life years, incremental cost-effectiveness ratio, and net monetary benefit. RESULTS: Diagnosis of a complex finger fracture performed with CBCT costed 67.33€ per patient, yielded 9.08 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 29.94€ and a net monetary benefit of 9.07 € at 30,000€ threshold. Using MSCT for diagnosis costed 106.23 €, yielded 8.18 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 371.15 € and a net monetary benefit of 8.09 €. CBCT strategy dominated the MSCT strategy. The acceptability curve shows that there is 98% probability of CBCT being the optimal strategy at 30,000€ threshold (1 EUR equal to 1.11 USD; updated on 02/02/2020). CONCLUSION: CBCT in complex finger fractures management is cost saving compared with MSCT and may be considered a valuable imaging tool in preoperative assessment, allowing early detection and appropriate treatment. It shortens the time to completion of diagnostic work-up, reduces the number of additional diagnostic procedures, improves quality of life, and may reduce costs in a societal perspective.

A simplified approach to virtual colonoscopy using different intestinal preparations: preliminary experience with regard to quality, accuracy and patient acceptability.

PURPOSE: The authors assessed the quality, diagnostic accuracy and patient acceptability of computed tomography (CT) colonography performed using a simplified bowel preparation and software for post-processing digital elimination of stool and fluid data from images compared with the examination obtained with conventional preparation. MATERIALS AND METHODS: Two groups of 40 consecutive asymptomatic patients aged between 48 and 72 years underwent CT colonography. In group A, the CT scan was performed with conventional bowel preparation (a full cathartic dose and oral contrast medium to tag any residue in the 3 days preceding the study). In the second group, CT colonography was performed after a reduced bowel preparation, with the oral contrast medium for residue tagging being administered only on the day of the investigation. Examination quality, diagnostic performance and patient acceptability (rated with a self-completed questionnaire) in the two groups of patients were compared by using the McNemar test. RESULTS: No significant difference was obtained with regard to examination quality (180 vs. 165 segments free from stools and fluid, p>0.05) and overall diagnostic accuracy (16/17 colonic polyps detected in group A and 12/13 in group B, p>0.05). The questionnaires revealed a greater acceptability of the reduced bowel preparation compared with the standard procedure (p=0.01). CONCLUSIONS: In asymptomatic patients, the use of software for post-processing digital elimination of residue from images in conjunction with reduced bowel preparation does not reduce examination quality or diagnostic performance when compared with the conventional CT colonography technique and is more acceptable to and better tolerated by the patient.

Role of echocardiography and cardiac MRI in depicting morphological and functional imaging findings useful for diagnosing hypertrophic cardiomyopathy.

PURPOSE: Hypertrophic cardiomyopathy (HCM) is a hereditary disease characterised by primary hypertrophy of the left and/or right ventricle. The reference standard for imaging diagnosis is echocardiography. The aim of our study was to prospectively compare the diagnostic accuracy of echocardiography and cardiac magnetic resonance (MR) imaging in patients with HCM. MATERIALS AND METHODS: Twenty-two consecutive patients with a known diagnosis of HCM were prospectively evaluated, with echocardiography and cardiac MR imaging performed within 2 weeks of each other (mean interval 7 days, range 2-14 days). Two experienced radiologists blinded to the previous clinical and imaging findings separately reviewed the images. The following parameters were calculated for both techniques: myocardial mass, wall thickness, end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), systolic anterior motion (SAM) of the mitral valve and degree of myocardial fibrosis (based on the ultrasonic reflectivity at echocardiography and degree of late enhancement at cardiac MR imaging). The statistical correlation was calculated with Student's t test, Spearman coefficient and Fisher's exact test. A value of p<0.05 was considered significant. RESULTS: The diagnosis of HCM was confirmed in all patients with both techniques, with absolute agreement in terms of the site of disease. The mean value of myocardial mass presented a statistically significant difference between the two techniques (114 g, p<0.001). In contrast, a nonsignificant difference between echocardiography and cardiac MR imaging was found for EDV (102 ml vs 111 ml; p=0.31), ESV (30 ml vs 38 ml; p=0.1), EF (74% vs 68%, p=0.5), SAM (p=0.1) and myocardial fibrosis (p=0.15). CONCLUSIONS: Cardiac MR imaging correlates well with echocardiography in defining the morphological and functional parameters useful for the imaging diagnosis of HCM and therefore, in selected cases (poor acoustic window, doubtful echocardiography findings), it may be a valid alternative to echocardiography.

Evaluation of colonic involvement in endometriosis: double-contrast barium enema vs. magnetic resonance imaging.

BACKGROUND: The purpose of the study was to compare the accuracy of double-contrast barium enema (DCBE) and magnetic resonance imaging (MRI) in the diagnosis of intestinal endometriosis using the histological examination on resected specimen as comparative standard. METHODS: Eighty-three consecutive patients with suspected intestinal endometriosis, resected between 2005 and 2007, were prospectively evaluated. All of the women underwent preoperative DCBE and MRI on the same day. We evaluated number, site (rectum, sigmoid, cecum), and size of the lesions. The imaging findings were correlated with those resulting at pathology. RESULTS: Among the 65 women who underwent surgery, 50/65 (76.9%) were found to have bowel endometriosis, with 9/50 (18%) patients presenting two lesions; DCBE allowed to detect 50/59 (84.7%) lesions. MRI allowed to detect 42/59 (71.1%) lesions. DCBE showed sensibility, specificity, PPV, NPV, and accuracy of respectively 84.7, 93.7, 98.0, 62.5, and 86.6%, MRI of 71.1, 83.3, 93.3, 46.8, and 74.6%. CONCLUSION: DCBE is more accurate than unenhanced MRI in the diagnosis of bowel endometriosis, and should be preferred in the preoperative management of this disease, since it usually enables a proper surgical planning.

Evaluation of a method of computer-aided detection (CAD) of pulmonary nodules with computed tomography.

PURPOSE: The authors sought to compare the sensitivity and reading time obtained using computer-aided detection (CAD) software as second reader (SR) or concurrent reader (CR) in the identification of pulmonary nodules. MATERIALS AND METHODS: Unenhanced CT scans of 100 consecutive cancer patients were retrospectively reviewed by four readers to identify all solid, noncalcified pulmonary nodules ranging from 3 to 30 mm in diameter. The sensitivity and reading time of each reader and of CAD alone were calculated at 3-mm and 5-mm thresholds with respect to the reference standard, consisting of a consensus reading by the four radiologists involved in the study. The McNemar test was used to compare the sensitivities obtained by reading without CAD (readers 1 and 2), with CAD as SR (readers 1 and 2 with a 2-month delay), and with CAD as CR (readers 3 and 4). The paired Student's t test was used to compare reading times. A value of p<0.05 was considered statistically significant. RESULTS: A total of 258 and 224 nodules were identified at 3-mm and 5-mm thresholds, respectively. The sensitivity of CAD alone was 62.79% and 67.41% at the 3-mm and 5-mm threshold values respectively, with 4.15 and 2.96 false-positive findings per examination. CAD as SR produced a significant increase in sensitivity (p<0.001) in nodule detection with respect to reading without CAD both at 3 mm (12.01%) and 5 mm (10.04%); the average increase in sensitivity obtained when comparing CAD as SR to CAD as CR was statistically significant (p<0.025) both at the 3-mm (5.35%) and 5-mm (4.68%) thresholds. CAD as CR produced a nonsignificant increase in sensitivity compared with reading without CAD (p>0.05). Mean reading time using CAD as SR (330 s) was significantly longer than reading without CAD (135 s, p<0.001) and reading with CAD as CR (195 s, p<0.025). CONCLUSIONS: The use of CAD as CR, without any significant increase in reading time, produces no significant increase in sensitivity in pulmonary nodule detection when compared with reading without CAD (p>0.05); CAD as SR, at the cost of longer reading times, increases sensitivity when compared with reading without CAD (p<0.001) or with CAD as CR (p<0.025).

MR imaging findings of elastofibroma dorsi in correlation with pathological features: our experience.

PURPOSE: This paper describes the role of magnetic resonance (MR) imaging for characterising elastofibroma dorsi in correlation with pathological findings. MATERIALS AND METHODS: Over a period of 9 years, 1,233 MR examinations of the periscapular region assessed for the presence of elastofibroma dorsi with superconductive 1.5-T MR scanners at three different radiology institutes were retrospectively reviewed. RESULTS: Our study population included 15 patients (12 women, three men; mean age 58 years, range 28-82 years) presenting with 17 lesions. Two patients had bilateral elastofibroma dorsi. Thirteen of 15 patients underwent MR examination for clinical suspicion of a lesion located in the periscapular region, whereas in 2/15 cases it was an incidental finding during MR examination performed for other diseases. Diagnosis of elastofibroma dorsi was confirmed by histopathology in 11/17 cases. The remaining lesions were considered benign, as their size and morphology did not change over a mean follow-up period of 1.5 years. CONCLUSIONS: MR imaging with its multiplanar capabilities and high-contrast resolution has a high level of accuracy in characterising elastofibroma dorsi and may avoid the need for biopsy or surgical operation.

Cardiac computed tomography in the evaluation of left anterior descending coronary artery with vein patch reconstruction.

PURPOSE: This study evaluated the morphological and functional results of surgical reconstruction of the left anterior descending (LAD) coronary artery with an autologous vein patch, associated with left internal mammary artery (LIMA) grafting onto the patch. MATERIALS AND METHODS: Cardiac computed tomography (CT) images were assessed in terms of functional and morphological parameters. Function was evaluated by assessing patency at 36 months of the reconstructed LAD (based on the attenuation of the native vessel distal to the anastomosis). Morphology was evaluated by studying vein-patch diameters, profiles and margins, shape and structure to categorise the patches into three groups (A, B, C). Within 1 month of CT, all patients underwent functional testing (bicycle ergometry). RESULTS: CT imaging correctly depicted the LAD graft, revealing it to be fully patent in all cases. On the basis of our morphological classification, 21 patients were classed as group A, two as group B and two as group C. At bicycle ergometry, 23 patients were negative and two were positive. Group C patients had the worst functional results. CONCLUSIONS: Cardiac CT allowed adequate evaluation of the LAD graft patency and morphology, and in consideration of its noninvasive nature, it may become the imaging tool of choice for evaluating extended LAD reconstruction.

Radiation dose saving through the use of cone-beam CT in hearing-impaired patients.

PURPOSE: Bionic ear implants provide a solution for deafness. Patients treated with these hearing devices are often children who require close follow-up with frequent functional and radiological examinations; in particular, multislice computed tomography (MSCT). Dental volumetric cone-beam CT (CBCT) has been reported as a reliable technique for acquiring images of the temporal bone while delivering low radiation doses and containing costs. The aim of this study was to assess, in terms of radiation dose and image quality, the possibility of using CBCT as an alternative to MSCT in patients with bionic ear implants. MATERIALS AND METHODS: One hundred patients (mean age 26 years, range 7-43) with Vibrant SoundBridge implants on the round window underwent follow-up: 85 with CBCT and 15 with MSCT. We measured the average tissue-absorbed doses during both MSCT and CBCT scans. Each scan was focused on the temporal bone with the smallest field of view and a low-dose protocol. In order to estimate image quality, we obtained data about slice thickness, high- and low-contrast resolution, uniformity and noise by using an AAPM CT performance phantom. RESULTS: Although the CBCT images were qualitatively inferior to those of MSCT, they were sufficiently diagnostic to allow evaluation of the position of the implants. The effective dose of MSCT was almost three times higher than that of CBCT. CONCLUSIONS: Owing to low radiation dose and sufficient image quality, CBCT could be considered an adequate technique for postoperative imaging and follow-up of patients with bionic ear implants.

Role of fistulography in evaluating pancreatic fistula after pancreaticoduodenectomy.

OBJECTIVE: To evaluate the usefulness of fistulography as a diagnostic and management tool for clinically suspected pancreatic fistulas (PF) after pancreaticoduodenectomy (PD). METHODS: 84 consecutive fistulographies were performed for clinical suspicion of PF and retrospectively analysed. We radiologically defined two types of PF by means of fistulography, PF1 in the case of primary filling with contrast agent of the jejunal loop or stomach and PF2 in the case of secondary filling of the jejunal loop or stomach through a fistulous tract or a fluid collection. RESULTS: In 35/84 (41.7%) of the fistulograms, a PF1 was demonstrated owing to an instantaneous opacification of the intestinal lumen or the stomach, without evidence of a fistulous tract or fluid collection. In 49/84 (58.3%) fistulograms, a PF2 was demonstrated by the depiction of a fluid collection and/or a fistulous tract and a communication with the intestinal loop or the stomach anastomised with the pancreas. The mean healing time of a PF after PD was 2.7 days for PF1, and 9.8 days for PF2. CONCLUSION: Fistulography helps in the confirmation of clinically suspect PF, and can distinguish PF1 and PF2, thus decreasing post-operative morbidity significantly.

The diagnostic contribution of CT volumetric rendering techniques in routine practice.

Computed tomography (CT) volumetric rendering techniques such as maximum intensity projection (MIP), minimum intensity projection (MinIP), shaded surface display (SSD), volume rendering (VR), and virtual endoscopy (VE) provide added diagnostic capabilities. The diagnostic value of such reconstruction techniques is well documented in literature. These techniques permit the exploration of fine anatomical detail that would be difficult to evaluate using axial reconstructions alone. Although these techniques are now widely available, many radiologists are either unfamiliar with them or do not fully utilize their potential in daily clinical practice. This paper is intended to provide an overview of the most common CT volumetric rendering techniques and their practical use in everyday diagnostics.

Proper use of common image file formats in handling radiological images.

This paper highlights the differences among the most common file formats used for storing digital radiological images. It promotes the proper use of these formats to guarantee easy manipulation in handling the most typical practical applications in daily radiological practice. The authors provide a simple yet exhaustive introduction to the concept of "file format" and describe the algorithms and main features of the most common formats (BMP, JPEG, GIF, DICOM, TIF, PNG) and Portable Network Graphics (PNG).The different formats are compared in terms of dimension, quality, portability and with reference to the following specific needs: electronic communications, publication on the World Wide Web, presentation of electronic posters, video presentations for teaching and manuscript publishing. We also illustrate how to handle the various formats with the programmes supplied with standard software installations.The large number of digital applications of image file formats calls for a simplification in daily radiological practice. We recommend the use of JPEG and PNG for electronic communications; PNG and GIF for publication on the worldwide web; JPEG and PNG for electronic poster presentations; DICOM, PNG and JPEG for teaching presentations; TIF and PNG for printing on paper.

Resectable pancreatic adenocarcinoma: is the enhancement pattern at contrast-enhanced ultrasonography a pre-operative prognostic factor?

The aim of our study was to determine whether the enhancement pattern of pancreatic adenocarcinoma at contrast-enhanced ultrasonography (CEUS) is related to patient prognosis after resection. CEUS of 42 resected adenocarcinomas were retrospectively reviewed. Tumors were divided into two groups: group A=poorly vascularized (presence of avascular areas) or group B=well vascularized (absence of avascular areas). All lesions were resected and underwent pathological examination assessing tumor differentiation as: undifferentiated (poorly differentiated) or differentiated (moderately and well differentiated). Mean vascular density (MVD) was also evaluated. CEUS enhancement and pathology were correlated (Spearman's test). Survival was analyzed with the Kaplan-Meier method. Multivariate analysis was performed with the Cox regression model. There were 30 differentiated and 12 undifferentiated adenocarcinomas at pathology. At CEUS, 10 lesions were poorly vascularized, whereas 32 lesions were well vascularized. Positive correlation was observed between CEUS groups and tumoral differentiation (rs=0.51; p=0.001) and between CEUS and MVD (rs=0.74; p<0.0001). Median survival in patients with group A vascularization at CEUS was significantly lower than in group B (p=0.015). Cox proportional hazard model revealed the presence of poorly vascularized tumor at CEUS (p=0.0001) as a predictor of higher mortality. In conclusion, CEUS enables accurate depiction of the vascularization of adenocarcinoma, with positive correlation to histology grade and MVD.

Detection of focal liver lesions: from the subjectivity of conventional ultrasound to the objectivity of volume ultrasound.

PURPOSE: This study was undertaken to establish the reliability of automated volumetric liver scans in detecting focal liver lesions by evaluating the degree of agreement between conventional and volume ultrasound (US) examinations. MATERIALS AND METHODS: Over a period of 3 months, we prospectively studied 100 consecutive patients (36 men and 64 women; age range 15-87 years; mean age 63 years) referred to our institute for US imaging of the liver. Volumetric acquisition of the liver was achieved with a 3D transducer (2.0-5.0 MHz) and a Logiq 9 US scanner. All patients underwent both 2- and 3D US studies performed by two expert radiologists. Volumetric acquisitions were subsequently reviewed by the second radiologist, who was blinded to the first radiologist's report. Three categories were established: 1=presence of focal liver lesions; 2=doubtful finding; 3=absence of focal liver lesions. Concordance between volume US and conventional US was calculated by using the k statistic. RESULTS: Out of 100 patients examined, 39 were found to be affected by focal liver lesions. All volume US examinations were technically adequate, allowing exploration of all hepatic sectors, except for five cases that were marred by major respiratory motion artefacts. Conventional and volume US identified the same number of focal liver lesions, with the exception of four cases of doubtful findings at volume US. Concordance between automated volume US and conventional US of the liver was high (k=0.92). CONCLUSIONS: The identification of focal liver lesions on automated volume US is possible, and the examination shows a high level of concordance with conventional US.

Focal liver lesions in cirrhosis: value of contrast-enhanced ultrasonography compared with Doppler ultrasound and alpha-fetoprotein levels.

PURPOSE: This study aimed to evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in characterising focal liver lesions in cirrhosis and to validate its use in lesions discovered during surveillance for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Between 2003 and 2006, 128 cirrhotic patients with focal liver lesions at baseline ultrasonography (US) were studied by power colour Doppler US (Doppler US) and CEUS. Serum alpha-fetoprotein (AFP) levels were assessed in all patients. Fine-needle biopsy or other reference modalities such as computed tomography (CT), magnetic resonance imaging (MRI) or digital subtraction angiography (DSA) were used as the gold standard. The accuracy of baseline US, Doppler US, AFP levels, combined US and AFP levels and combined US, Doppler US and CEUS in characterising focal liver lesions was assessed. Diagnostic performance was compared using the McNemar test. RESULTS: A total of 207 focal liver lesions (101 benign and 106 malignant) were identified in 128 patients. CEUS sensitivity and specificity for lesion characterisation were 96.2% and 97.0%, respectively, whereas its positive and negative predictive values were 97.1% and 96.1%. CEUS accuracy was 96.6%, higher than that of US (72.0%), Doppler US (70.0%), AFP levels (65.7%), combined US and Doppler US (70.0%) and combined US and AFP levels (90.3%). The differences between US and CEUS were statistically significant (p<0.05). CONCLUSIONS: CEUS can characterise focal liver lesions with 96.6% accuracy, a value higher than US, Doppler US, AFP levels, combined US and AFP levels and combined US and Doppler US. CEUS should therefore be used to characterise focal liver lesions detected during HCC surveillance of cirrhotic patients.

Bionic ear imaging.

PURPOSE: The aim of this study was to illustrate the different imaging features of middle and inner ear implants, brainstem implants and inferior colliculus implants. MATERIALS AND METHODS: We retrospectively reviewed the computed tomography (CT) images of 468 patients with congenital or acquired transmissive or neurosensory hearing loss who underwent surgery. The implants examined were: 22 Vibrant Soundbridge implants, 5 at the long limb of the incus and 17 at the round window, 350 cochlear implants, 95 brainstem implants and 1 implant at the inferior colliculus. All patients underwent a postoperative CT scan (single or multislice scanner) and/or a Dentomaxillofacial cone-beam CT scan (CBCT) (axial and multiplanar reconstruction), and/or a plain-film radiography to visualise the correct position of the implant. RESULTS: The CBCT scan depicts Vibrant site of implant better than plain-film radiography, with a lower radiation dose compared to CT. For cochlear implants, a single plain radiograph in the Stenvers projection can directly visualise the electrodes in the cochlea. All patients with brainstem or inferior colliculus implants underwent postoperative CT to exclude complications and the assess correct implantation, but the follow-up of these implants can be performed by plain radiography alone. CONCLUSIONS: CT and CBCT scans are reliable and relatively fast methods for precisely determining the location of middle ear implants. CBCT is preferable to CT because of the lower radiation dose administered; a single plain-film radiograph is enough to visualise and follow-up cochlear, brainstem and inferior colliculus implants.

Intrahepatic peripheral cholangiocarcinoma (IPCC): comparison between perfusion ultrasound and CT imaging.

PURPOSE: This study was done to compare the perfusion patterns of intrahepatic peripheral cholangiocarcinoma (IPCC) on contrast-enhanced ultrasound (CEUS) and dynamic computed tomography (CT). MATERIALS AND METHODS: We retrospectively reviewed 23 histologically proven cases of IPCC. All lesions were studied by CEUS with sulfur hexafluoride-filled microbubbles coated with a phospholipid capsule, and by dynamic CT. Contrast-enhancement patterns were evaluated in the arterial phase (CEUS 10-20 s after the injection; CT 25-30 s after the injection) and in the delayed phase (CEUS 120 s after the injection; CT>2-3 min after the injection). RESULTS: Lesions were single in 18/23 cases (78%), single with nearby satellite lesions in 1/23 (4%) cases and multifocal with distant secondary lesions in 4/23 (17%) cases. Lesion diameter was 2-5 cm in 7/23 cases (30%), 5-7 cm in 13/23 cases (57%) and >7 cm in 3/23 (13%) cases. On CEUS, lesions were hypervascular in 16/23 cases (70%). On delayed-phase CEUS, 22/23 lesions (96%) were markedly hypoechoic. CT showed that the lesions were hypovascular in the arterial phase in 15/23 cases (66%) and hypervascular in 7/23 (30%) cases; one lesion (1/23; 4%) was isovascular. On delayed-phase CT, lesions were hyperdense in 17/23 cases (74%), hypodense in 5/23 (22%) cases and isodense in 1/23 (43%) cases. CONCLUSIONS: Enhancement discrepancy between delayed-phase CEUS (hypoechogenicity) and CT (hyperdensity) is common semiological findings in the study of IPCC.

Contrast-enhanced ultrasonography in the characterization of benign focal liver lesions: activity-based cost analysis.

PURPOSE: The aim of this study was to perform a cost analysis of contrast-enhanced ultrasonography (CEUS) in the study of benign focal liver lesions (BFLL) with indeterminate appearance on ultrasonography (US). MATERIALS AND METHODS: A decision model of patients with suspected BFLL on baseline US who subsequently underwent CEUS between 2002 and 2005 was constructed. We analysed the cost effectiveness of CEUS, considering whether or not computed tomography (CT) was necessary for the diagnosis. There were 398 patients with 213 angiomas, 41 focal nodular hyperplasias (FNH) and 154 pseudolesions (focal fatty sparing, focal fatty areas). Each patient underwent CEUS, and 98 of them were also studied by CT. All lesions were followed up. RESULTS: The cost of a single CEUS examination was 101.51 euros, and that of a single CT scan was 211.48 euros. For diagnosis of haemangiomas, we saved 1,406.97 euros in 2002, 5,315.22 euros in 2003, 10,317.78 euros in 2004 and 9,536.13 euros in 2005. For diagnosis of focal nodular hyperplasias, we saved 781.65 euros in 2003, 781.65 euros in 2004 and 1,406.97 euros in 2005. For diagnosis of pseudolesions, we saved 2,813.94 euros in 2002, 5,158.89 euros in 2003, 5,158.89 euros in 2004 and 4,220.91 euros in 2005. In the period 2002-2005, the introduction of CEUS allowed us to save a total of 47,055.33 euros in the diagnosis of benign focal hepatic liver lesions. CONCLUSIONS: This cost analysis shows that CEUS is the least expensive second-line modality after baseline US for the diagnosis of BFLL.

Autologous chondrocyte implantation: prospective MRI evaluation with clinical correlation.

PURPOSE: This study was done to assess the progression of cartilage repair after autologous chondrocyte implantation (ACI) with magnetic resonance imaging (MRI) and to correlate the findings with the clinical outcome. MATERIALS AND METHODS: Forty-one patients (mean age 30 years) affected by chondral defects of the knee (27 patients) and ankle joint (14 patients) who underwent arthroscopic autologous osteochondral grafting were studied 6 months and 1 year postoperatively with MRI. Cartilage repair after chondrocyte implantation was studied by assessing the degree of defect filling, graft integration, graft signal intensity, integrity of the subchondral lamina and trabecular oedema underneath the graft. MR findings were correlated with clinical data. RESULTS: Postoperative MRI evaluation at 6 months demonstrated complete filling of the osteochondral defect in 12/41 cases, complete integration in 18/41, mild hyperintensity in 28/41, intact subchondral lamina in 38/41 and trabecular oedema in 11/41. Postoperative MRI evaluation at 1 year demonstrated complete filling of the osteochondral defect in 9/41 patients, complete integration in 22/41, mild hyperintensity in 23/41, intact subchondral lamina in 36/41 and trabecular oedema in 8/41. Filling of the osteochondral defect and incomplete integration, nonintact subchondral lamina, high signal intensity and absence of oedema were found to correlate with worse clinical-functional outcomes. CONCLUSIONS: MRI shows direct prognostic signs of the clinical outcome of ACI.

Ultrasonography of the pancreas. 7. Intraoperative imaging.

The usefulness of intraoperative ultrasonography (IOUS) has been documented in the Literature since the Eighties and, although its main applications are in hepatobiliary and pancreatic surgery, it has been used also in neurosurgery, cardiovascular and endocrine surgery. The continuous technical developments have led to an increase in the diagnostic accuracy of IOUS from the Eighties to now. The use of IOUS has increased in time together with the technical innovations until, mainly in the midnineties, its value was recognized by many surgeons. This results have been obtained with scanners that allow to depict fine anatomical details and detect small lesions in real time with extremely high spatial resolution. IOUS is able to shows fine details, such as primary or secondary lesions not detectable with other preoperative imaging modalities or tumor extension and its relationship with vessels. Assessment of resectability by IOUS may determine important changes in therapeutic planning. The role of IOUS, however, has recently been down-sized, especially in those centers where preoperative imaging is advanced. This article will review the clinical role of pancreatic IOUS in the different pancreatic pathologies.