Search

Purpose: The purpose of this study was to correlate the diagnosis of benign or malignant thyroid nodules obtained with grey-scale ultrasound (US) and colour-Doppler US with the cytological findings after US-guided fine-needle aspiration (FNA)., Materials and Methods: Between January 2004 and June 2005, 516 thyroid nodules in 420 patients (181 solitary thyroid nodules and 239 multiple nodules) were prospectively evaluated with US, colour-Doppler US and US-guided FNA. The nodules were classified as sonographically benign, suspicious or malignant in accordance with established US criteria. Cytological findings were classified as inadequate, benign, indeterminate, suspicious or malignant. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of US and colour-Doppler US were evaluated using FNA as the reference procedure., Results: The sensitivity, specificity, PPV, NPV and overall accuracy values of grey-scale US were 46%, 73%, 34%, 82% and 67%, respectively, for solitary thyroid nodules and 35%, 72%, 14%, 90% and 68%, respectively, for multiple nodules. The evaluation of nodule vascularity with colour-Doppler US produced a slight increase in sensitivity but a slight reduction in specificity., Conclusions: Thyroid nodules cannot be accurately characterised using grey-scale US or colour-Doppler US.

Purpose: The increasing use of ultrasound (US) for both diagnostic and interventional procedures has not been supported yet by proper and adequate planning of dedicated rooms. Therefore we studied both the organization and the design of such areas., Methods and Discussion: As for organization, we considered: a) the kind of examination performed; b) the main department activity (in-/outpatients, diagnostic or interventional procedures); c) the schedule for each room by examination type and timing (patient preparation, actual examination and read-out times). As for room design, we studied the size and location of the diagnostic unit, dressing rooms, entrances and restrooms, as well as the furniture in general. We also studied the location of waiting rooms and corridors, the location and size of the read-out areas, and the room for post-interventional monitoring, as well as all the details about microclimate and lighting. Then we designed two different modules with the relevant planimetry: one featuring two adjacent diagnostic rooms and the other featuring a single diagnostic room. Some ergonomic solutions are also proposed concerning the location of the US system relative to the stretchers entrance and the location of the post-interventional monitoring room relative to the radiologic room(s). Finally, we evaluated the size of some peculiar pieces of equipment of a radiologic room by their function., Conclusions: The functional arrangement of the diagnostic US unit and its space requirements, permits to optimize the use of the whole structure complying with the ergonomic criteria for operators and enabling the rapid throughout of patients with no waste of time.

Introduction: Virtual endoscopy is a new 3D technique which permits to depict the inner surface of anatomic cavities. We report our experience in the study of the nasal cavity and paranasal sinuses., Material and Methods: CT examinations of the maxillofacial region were obtained using 1.5 or 3.0 mm slices, 1.5 or 3.0 mm table feed, 120 kV, 140 mA, 2 s scan time, standard and high resolution algorithms for bony structures and a field of view of 14-16 cm. The images were transferred on a workstation and processed with the Navigator virtual endoscopy software (General Electric). A threshold value ranging -300 to -550 UH was applied., Results: We report a series of virtual images of the nasal cavity which includes rhinopharynx vault, torius tubarius, choanae, turbinates, tubal orifice and osteomeatal complex. Moreover, images of frontal sinus and tear duct, of polyps and fracture of maxillary sinus are also presented. 3D virtual endoscopy provides a clear visualization of the anatomic structures of the nasal cavity and sinuses. The images are similar to those of conventional endoscopy. Moreover virtual endoscopy visualizes the paranasal sinuses, which are not accessible at conventional endoscopy. The main limitations of this new technique are the arbitrary choice of the threshold value and the homogenization of different tissue densities, which reduces the contrast resolution., Conclusions: Virtual endoscopy can presently be considered a complementary technique of the standard axial and coronal CT examination. It provides an effective demonstration of the anatomy of these structures and shows areas which are difficult to visualize with conventional endoscopy. This technique could be of help in didactical activity; its clinical application has to be verified.

Introduction: We applied the new technique of virtual endoscopy to the middle ear because this anatomical area is characterized by favorable contrast., Materials and Methods: CT examinations of the petrous bone were obtained using 1.5 mm thick 1 coronal axis slices, with 1 mm or 1.5 mm table feed, 120 kV, 140-170 mA and 2 s scan time. The images were reconstructed with the high resolution algorithm for bony structures and a small field of view (9.6 cm), separately for the right and left petrous bone. The images were then transferred on a workstation and processed with the Navigator virtual endoscopic software (General Electric). A threshold value ranging -350 to -600 HU was applied., Results: A series of images is acquired as the virtual endoscope moves from the external auditory canal to the middle ear cavity. Images of the anterior, medial, and posterior surfaces of the middle ear are presented. Different views of the ossicles are also presented. High quality images were always obtained for the middle ear structures, including the ossicles. CT endoscopy of the middle ear provides a new view of the anatomy of this complex area. It has some advantages and disadvantages; the former can be summarized as follows: -demonstration of areas which are difficult to show with endoscopy because of the presence of membrana tympani; -the virtual endoscope can be placed in several positions and therefore it can be inserted in all sites and tortuous places of anatomical cavity; -nice and effective demonstration of the ossicular chain including the stapes. The disadvantages are related to the fact that the endoscopic reconstruction (such as any other three-dimensional reconstruction) is a representation of surfaces where different densities are necessarily homogenized., Conclusions: CT virtual endoscopy of the middle ear can currently be considered a complementary technique to conventional CT because it permits better anatomical detailing of this complex region.

A case of familiar bilateral multicentric RCC in a young woman is an ideal model to evaluate preoperative and intraoperative diagnostic and surgical tools in order to achieve two distinct goals: the oncologic radicalness and the renal function preserved. Radical bilateral nephrectomy, the renal hypothermia by perfusion of both kidneys, the bench high resolution sonography of parenchyma, the choose of one kidney suitable for conservative surgery, the resection of suspect lesions with intraoperative pathology, the reconstructive bench surgery, the autotransplantation, are the steps accurately performed with particular concern to eradication of all the tumoral lesions present in the kidneys. The results confirm that renal function has been preserved with this method. Radicalness should be appointed by a longlasting follow up. However, as it is discussed, conservative surgery, when accurately performed can give results not different from radical demolitive surgery. In this paper tools to improve diagnostic and therapeutic methods are described in order to increase the diagnostic accuracy and the therapeutic efficacy. The possibility that this multiple RCC can be a part of the abnormalities occurring in the Von Hippel-Lindau syndrome does not change the surgical approach, being the RCC the worst prognostic factor of the syndrome.