[Hepatic expansive processes in the pediatric age: angiographic diagnosis].
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Angiography↗
Biomedical subjects
A Siani
Publications and source records attributed to A Siani.
Maltase, isomaltase and glucoamylase activities of the acid alpha-D-glucoside glucohydrolase isolated from cattle liver.
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Animals↗
Hepatocellular carcinoma: spectrum of contrast-enhanced gray-scale harmonic sonography findings.
Sonography (US) is the most commonly used tool in the assessment of patients with chronic liver disease. Nevertheless, small nodules can be overlooked. Moreover, even if the lesion is readily recognizable, difficulty persists in differentiating hepatocellular carcinoma (HCC) from pre-tumoral, dysplastic stages of nodule evolution. In addition, US is the main tool in guiding percutaneous ablation therapies for HCC and in evaluating patients after treatment, but changes are not specific and difficulties persist in recognizing residual tumor during and after the ablation procedure. Contrast-enhanced, gray-scale, harmonic US offers new possibilities in the imaging of liver tumors. The real-time, low-mechanical index technique employed in our institution allows a true dynamic assessment of the tumor during the various phases of contrast medium circulation. This pictorial essay focuses on typical and atypical appearances of HCC when imaged with contrast-specific, real-time US. Findings useful for lesion detection, differential diagnosis, posttreatment assessment, and follow-up especially are illustrated. The potential role of contrast-enhanced US in various clinical settings is emphasized.
Carcinoma, Hepatocellular↗
Active abdominal bleeding: contrast-enhanced sonography.
Active contrast medium extravasation is a recognized and important angiographic and computed tomographic (CT) sign of bleeding. It is an indicator of active, ongoing, and potentially life-threatening hemorrhage and, hence, of the need for an immediate surgical or interventional treatment. Sonography (US) is frequently used as the first imaging option for screening patients with traumatic and nontraumatic abdominal emergencies. Owing to the current possibilities of low-mechanical index, real-time, contrast-specific systems, it is now possible to detect a contrast leakage by using US. This finding opens new possibilities in the assessment and management of several abdominal emergencies, including trauma (initial workup and monitoring), spontaneous hematomas, and rupture of aneurysms or masses. This article describes the technique, findings, possibilities, and limitations of contrast-enhanced US in the evaluation of active abdominal bleeding.
Angiomyolipoma↗
Multiphase helical CT findings after percutaneous ablation procedures for hepatocellular carcinoma.
BACKGROUND: Multiple-phase helical computed tomography (CT) has been regarded as the method of choice in the evaluation of patients with hepatocellular carcinoma (HCC) treated by nonsurgical procedures. The aim of this article was to report our experience in the assessment of nodular and parenchymal changes recognizable after various percutaneous ablation therapies. METHODS: We reviewed the studies of 116 consecutive patients with HCC treated with multisession percutaneous ethanol injection (56 patients, 98 nodules), single-session percutaneous ethanol injection (14 patients, 31 nodules), radiofrequency thermal ablation (32 patients, 48 nodules), and interstitial laser photocoagulation (14 patients, 25 nodules). CT had been performed 3-28 days after the last session (mean = 18 days) with unenhanced helical acquisition and with contrast-enhanced double- or triple-phase helical acquisition. RESULTS: Persisting neoplastic tissue was identified within 54.5% of the nodules. It was located centrally in 4.5% of these nodules, peripherally in 11%, and eccentrically in 84.5%, and its shape was crescent in 58%, globular in 24.5%, and other in 16%. On arterial phase scans, viable tumor was hyperdense in 97% of the lesions and isodense in 3%; on portal phase scans, the tumor was hyperdense in 20%, isodense in 28%, and hypodense in 52%; on delayed phase scans, the tumor was consistently hypodense. Tumor necrosis was always hypodense on contrast-enhanced scans. On unenhanced images, 7.4% of the nodules were undetectable. Nodule diameter appeared as unchanged in 53% of the nodules and as larger in 47%; its shape was unchanged in 54% and modified in 46%; its margins were unchanged in 36% and modified in 64%. A rim of granulation tissue was detected around 15% of the nodules, and a perilesional transient attenuation difference was detected in 21%. Perihepatic effusion was seen in 13% of the patients, segmental biliary duct dilation and local atrophy each in 9%, arterioportal fistula in 6%, portal vein thrombosis, subcapsular collection and pleural effusion each in 7%, hepatic infarction in 5%, and inferior vena cava thrombosis in 2%. CONCLUSION: Percutaneous ablation of HCC may cause several changes. Knowledge of their CT appearance is mandatory to correctly assess and manage this tumor.
Adult↗
Hepatocellular carcinoma recurrence after percutaneous ablation therapy: helical CT patterns.
BACKGROUND: To categorize the helical computed tomographic (CT) intrahepatic recurrence patterns of hepatocellular carcinoma (HCC) after treatment with percutaneous ablation procedures. METHODS: Double-phase helical CT studies of 67 patients with HCC recurrence were reviewed. The study population had undergone percutaneous ablation therapy procedures (multisession or single-session ethanol injection therapy, radiofrequency thermal ablation therapy, and interstitial laser photocoagulation therapy) for 120 HCC nodules. RESULTS: Four patterns were defined. (A) Enhancing tissue within the edge of the ablated nodule on arterial phase images (ingrowth): this pattern was seen in five treated lesions (4.2% of all treated nodules) in five patients (7.5% of all patients with recurrence) 3-7 months after treatment (mean = 4 months). (B) Enhancing tissue around the treated nodule but continuously to its border on arterial-phase images (outgrowth): this pattern was found in 12 (10%) treated lesions in 12 patients (18%) 3-6 months after ablation (mean = 4 months). (C) Enhancing tissue within the same segment of the treated nodule on arterial phase images (spread): this pattern was detected in 10 (8%) treated lesions in 10 patients (15%) 3-6 months after treatment (mean = 5 months). (D) Enhancing tissue within different segments from the treated nodule on arterial phase images (progression): this pattern was identified in 34 patients (51%) with 53 (44%) treated tumors 5-22 months after ablation (mean = 8 months). A mixed pattern was found in six subjects (9%) with seven (6%) treated nodules. Among the 61 patients with a nonmixed pattern, there were 85 treated nodules with persistent necrosis, 17 treated nodules with local recurrence (pattern A or B), and 107 new nodules due to nonlocal recurrence (pattern C or D). Portal phase enhanced images and especially unenhanced images showed a lower detection rate and a lower lesion-to-liver conspicuity score (for all patterns but mainly for pattern C). CONCLUSION: Four patterns of recurrence after percutaneous ablation procedures can be categorized on double-phase helical CT and are best depicted on arterial phase images. Knowledge of these patterns is relevant for early detection and may be helpful in understanding the recurrence mechanism.
Adult↗
Hepatocellular carcinoma treated with chemoembolization: assessment with contrast-enhanced doppler ultrasonography.
PURPOSE: To report our preliminary experience concerning the use of Doppler ultrasonography (DUS) techniques after intravenous injection of the galactose-based contrast agent Levovist in the assessment of hepatocellular carcinoma (HCC) treated with transcatheter arterial chemoembolization (TACE). The sonographic findings are correlated with those obtained using iodized oil (Lipiodol) helical computed tomography (CT). METHODS: For 7 months we studied 28 patients with cirrhosis and HCC (a total of 43 nodules) who had undergone TACE between 18 and 30 days previously. The lesions were investigated with color Doppler ultrasonography (CDUS) and power Doppler ultrasonography (PDUS), before and after infusion of the echo-contrast agent (300 mg/ml, maximum 1 injection for each nodule, administered at constant velocity within 60-90 sec), and with helical Lipiodol-CT (0-7 days after DUS). In the retrospective analysis, special attention was given to the Doppler signals related to pulsatile intra- and perinodular flow and to the detection of new vessels after contrast agent injection. The signal intensity was graded as 0 (absent), 1 (low), 2 (medium), or 3 (high), while its distribution was classified as peripheral, central, or diffuse. Oily agent retention on CT scans was assessed as 0 (absent), I (<10%), II (<50%), III (>50%), or IV (homogeneous). These scores were awarded separately, without knowledge of the other judgments. RESULTS: An hepatic global echo-enhancing effect was identified in all cases and always lasted long enough to allow an accurate analysis of all parenchymal lesions (at least 8 min). The signal scores could be evaluated in 39 of 43 HCCs, as follows: basal CDUS: grade 0 in 17 lesions, grade 1 in 16, grade 2 in 6; contrast-enhanced CDUS: grade 0 in 12 lesions, grade 1 in 10, grade 2 in 14, grade 3 in 3; basal PDUS: grade 0 in 15 lesions, grade 1 in 13, grade 2 in 9, grade 3 in 2; contrast-enhanced PDUS: grade 0 in 11 lesions, grade 1 in 9, grade 2 in 15, grade 3 in 6. Lipiodol-CT scoring was: grade 0 in 1 lesion, grade I in 7, grade II in 11, grade III in 9, grade IV in 11. In all but one nodule the difference between CDUS and PDUS scores, compared both with each other and with nonenhanced and contrast-enhanced examinations, was never greater than one grade. CONCLUSIONS: Contrast-enhanced DUS is a simple and fast procedure allowing a valuable, constant echo-enhancing effect of sufficient duration. DUS techniques, especially contrast-enhanced PDUS, offer an effective and realistic analysis of HCC nodules treated with TACE and show more evident agreement with Lipiodol-CT findings than baseline studies.
Carcinoma, Hepatocellular↗
Helical CT findings in patients with hepatocellular carcinoma treated with percutaneous ablation procedures.
Nonsurgical treatment of hepatocellular carcinoma is used worldwide as a result of the early detection and slow growth of this tumor in patients with chronic liver disease. Multiple-phase helical computed tomography is a commonly used method for evaluating the main features related to percutaneous ablation procedures: nodular changes, tumor necrosis, parenchymal changes, complications, and tumor recurrence. Knowledge of all features recognizable after local ablation therapy is mandatory to avoid diagnostic pitfalls and to optimally assess treatment response.
Carcinoma, Hepatocellular↗
[Multiple-phase spiral computerized tomography of small hepatocellular carcinoma: technique optimization and diagnostic yield].
PURPOSE: Spiral imaging has dramatically increased the diagnostic capabilities of Computed Tomography (CT) in the evaluation of small hepatocellular carcinomas (HCCs, O < 3 cm). We report our experience with multiple-phase CT of small HCC relative to both examination technique and lesion patterns. We compared the yield of biphasic (arterial-dominant + portal-dominant phases) and triphasic (arterial-dominant + portal-dominant + delayed phases) and also reviewed the literature for a meta-analysis of the techniques used. MATERIAL AND METHODS: December 1996 to July 1998, forty-eight patients with small nodular HCCs were examined--98 nodules in all (range 1-9, mean 2 per patient). After baseline CT, a nonionic contrast agent (350 mgI/mL, 130-140 mL, 4 mL/s) was administered through a power injector and a 16-gauge needle. Biphasic volume images were acquired in 19 subjects (early-phase delay 24 s, venous-phase delay 75 s) and triphasic images in 29 (early-phase delay 24 s, venous-phase delay 60 s, delayed-phase delay 100 s). Retrospectively we assessed the number of nodules detected with each protocol in every phase, nodule conspicuity (graded I-IV) relative to surrounding parenchyma, and nodule patterns in the various phases. Nodule patterns were distinguished into homogeneous, peripheral, central and mixed hyperdensity, and homogeneous hypodensity. RESULTS: Thirty-seven lesions were found in the patients examined with the biphasic technique: baseline images showed 35% of the nodules, arterial images 92%, portal images 76% and combined arterial and portal acquisitions 95%. Sixty-one lesions were found in the patients examined with the triphasic technique: baseline images showed 43% of the nodules, arterial images 93%, portal images 70%, and delayed images 77%; combined arterial and portal acquisitions detected 93% of the nodules, combined arterial and delayed images 95%, combined arterial and delayed images 80%. Finally, 95% of lesions were demonstrated when the three phases were combined. Overall conspicuity grades were I in 44% of cases, II in 28%, III in 18% and IV in 10% of cases at baseline scanning; I in 9%, II in 24%, III in 34% and IV in 33% in the arterial phase; I in 28%, II in 41%, III in 18% and IV in 13% in the portal phase; I in 23%, II in 30%, III in 26% and IV in 21% of cases in the delayed phase. At baseline, 10% of lesions were hyperdense (homogeneously and peripherally in 5% each); mixed density was seen in 8%, and hypodensity in 82%. In the arterial phase, 93% of lesions were hyperdense (homogeneously in 80%, peripherally in 10% and centrally in 3%); mixed density was seen in 5%, and hypodensity in 1%. In the portal phase, 4% of lesions were hyperdense (homogeneously in 1% and centrally in 3%); mixed density was seen in 11%, and hypodensity in 85%. In the delayed phase, the lesions appeared mixed in 11% of cases and hypodense in 89%. CONCLUSIONS: Spiral CT scanning of small HCCs requires dedicated and meticulous technique. Multipassage assessment is mandatory, with 2 or 3 dynamic acquisitions of the whole liver. No major difference in nodule detection was demonstrated between these two options and thus the choice rests with the radiologist's preference. Early CT images proved best for lesion detection, followed by delayed, venous, and baseline studies; lesion recognition depends largely on nodular diameter. The same applies to conspicuity, which however depends on tumor volume less. Lesion patterns are quite typical and constant in all phases and are independent of lesion diameter.
Adult↗
[Doppler evaluation of thyroid hemodynamics after intravenous administration of contrast media].
PURPOSE: Duplex Doppler ultrasound allows the evaluation of thyroid gland vascular flow by spectral analysis assessment. The objective of this prospective study was to employ Doppler ultrasound to evaluate the possible functional changes produced in normal subjects following intravenous iodized contrast medium injection. MATERIAL AND METHODS: The study was performed on 30 non-consecutive subjects, enrolled according to some inclusion criteria: male gender, age ranging between 19 and 70 years, absence of chronic liver disease, absence of thyroid disease, absence of sonographic changes in the thyroid gland, negative history for recent intravenous contrast medium administration. All patients were scheduled for a contrast-enhanced CT study. A non-ionic contrast medium (iomeprol) was employed at 350 mgI/mL concentration, 130-140 mL volume, and 2-4 mL/sec. injection rate. The Doppler ultrasound examination was carried out immediately before and about 30 minutes after the CT study. The systolic velocity, diastolic velocity, the resistive index, and the pulsatility index were measured at the level of one of the four thyroid arteries. RESULTS: In most cases a slightly increasing trend of the four parameters considered was noted but none of these showed a statistically significant change. The mean systolic velocity was of 33 cm/sec. in the basal measurement and of 39 cm/sec. in the post-contrast measurement. The variation was positive in 17 cases, negative in 12, and absent in 1. The mean diastolic velocity was of 13 cm/sec. in the pre-contrast evaluation and of 14 cm/sec. in the second evaluation. The change was positive in 14 cases, negative in 12, and absent in 4. The mean resistive index was of 0.55 in the basal analysis and of 0.59 in the post-contrast one. The variation was positive in 20 patients, negative in 9, and absent in 1. The mean pulsatility index was of 0.99 in the basal measurement and of 1.14 in the second measurement. The change was positive in 23 subjects, negative in 5, and absent in 2. CONCLUSION: Our series shows that no significant change in Doppler spectral analysis of thyroid flow is evident after administration of iodized contrast media, at least in euthyroid subjects and with the contrast doses and the examination intervals employed in our study. Doppler ultrasound is confirmed as an accurate and objective procedure in the evaluation of thyroid gland flow and may represent a useful tool in functional studies, as well as clinical applications in the assessment of thyroid gland disorders.
Adult↗
The role of popliteal artery embolectomy in the management of acute lower limb ischemia: our experience.
INTRODUCTION: The Authors report their experience in the management of acute lower limbs ischemia through distal popliteal artery approach. PATIENTS AND METHODS: Five popliteal embolectomy through a medial approach were performed; in one patient a posterior approach was carried out. Patients were included in two groups on the basis of ischemia duration: group A<6 hours (3 patients) and group B>6 hours (3 patients). Colour-duplex scan was performed in all the patients The arteriotomy was closed with interrupted 7/0 monofilament polypropylene sutures. RESULTS: There were no peri-operative deaths. The primary limb salvage rate was 83.3% (5 patients). In one case (16.7%) a major amputation was performed. In one case (16.7%) a drop foot occurred. CONCLUSIONS: The popliteal embolectomy is followed by excellent results and should be consider prior to thrombolysis or bypass graft revascularization. An appropriate use of duplex scan and a medial approach can lead to an high successful rates in terms of limb function and limb salvage also in cases with delayed ischemia.
Acute Disease↗
[Dominant polycystic kidney disease in children. Clinical aspects related to age and problems of early diagnosis].
Two cases of Dominant Polycystic Kidney Disease (DPKD) are reported in newborns of two different affected families. One of two infants was prenatally diagnosed by ultrasound, few cases of in utero diagnosis being previously reported. The two infants had different course: one had no symptoms (14 months now), on the contrary the other one had abdominal mass at birth and oliguria in the first 48 hours, then acute pyelonephritis at 15 months. The increasing incidence of DPKD diagnosed in infants and children by US screening in risk subjects is stressed and importance of precocious diagnosis for genetic counselling emphasized.
Female↗
[A case of primary acute eosinophilic meningitis].
The authors present a case of meningitis with a significant eosinophilic pleiocytosis in the cerebrospinal fluid in a eighteen months old girl. The rapidly favourable course and the negative parasitological research direct the diagnosis to acute primary eosinophilic meningitis. The meaning of the presence of some colonies of H. influenzae in the cerebrospinal fluid is discussed.
Diagnosis, Differential↗
Alcohol consumption and blood pressure in school children.
The present report focuses on the relationship between alcohol consumption, estimated with the use of a seven day food record, and blood pressure in a group of 203 male and female school children with a mean age of 11 year. 50.5% of the male and 39.4% of the female children reported use of alcoholic beverages. The average weekly ethanol consumption in these regular drinkers was 73.9 ml/week for boys and 53.1 ml/week for girls. The results of the analyses fail to show any significant association between alcohol consumption and blood pressure levels. The possibility of the association between alcohol and hypertension being dependent on advanced age is discussed in view of the present results and previously published reports.
Adolescent↗
[Reduced Mg/Ca ratio in the urine and risk of nephrolithiasis in essential hypertension].
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Calcium↗
[Increased urinary excretion of calcium and parathyroid hyperactivity in essential arterial hypertension. Effects of hydrochlorothiazide].
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Adult↗
[Hepatic echography, angiography and angiotomography: results of a combined study in hepatic tumors (author's transl)].
The authors demonstrate the interest of the association among echography, angiography and angiotomography in the diagnosis of the primitive or secondary expansive formation of the liver. The casuistry is based on 22 multiple metastases of the liver, 5 primitive tumours, 3 hepatic echinococcus, 1 abscess of the left lobe, 1 renal tumour and 1 retroperitoneal neuroblastoma with secondary hepatic localizations. The analysis of the comparison of the results among the various methods employed has shown that the identification of the lesion is (resolvable) by echography; the study of the intrahepatic vessels compromise pertains to angiography; echography, even giving significant help in judging about a possible engagement of the vena cava, necessarily needs cavography.
Echinococcosis, Hepatic↗
[Partial deletion of the short arm of chromosome 4 (the Wolf-Hirschhorn syndrome) with reference to the neurological and electroencephalographic aspects].
We describe a case of Wolf-Hirschhorn syndrome (partial deletion of the short arm of chromosome 4). The syndrome is characterized by mental and growth retardation and characteristic facial dysmorphism. The fetus was karyotyped for severe intrauterine growth retardation diagnosed on routine ultrasound. High resolution chromosomal analysis of infant and parents showed "de novo" deletion. Very interesting in our case are ictal phenomena and neurological development.
Abnormalities, Multiple↗