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Background: To assess inter-reader agreement for US BI-RADS descriptors using S-Detect: a computer-guided decision-making software assisting in US morphologic analysis. Methods: 73 solid focal breast lesions (FBLs) (mean size: 15.9mm) in 73 consecutive women (mean age: 51years) detected at US were randomly and independently assessed according to the BI-RADS US lexicon, without and with S-Detect, by five independent reviewers. US-guided core-biopsy and 24-month follow-up were considered as standard of reference. Kappa statistics were calculated to assess inter-operator agreement, between the baseline and after S-Detect evaluation. Agreement was graded as poor (≤ 0.20), moderate (0.21–0.40), fair (0.41–0.60), good (0.61–0.80), or very good (0.81–1.00). Results: 33/73 (45.2%) FBLs were malignant and 40/73 (54.8%) FBLs were benign. A statistically significant improvement of inter-reader agreement from fair to good with the use of S-Detect was observed for shape (from 0.421 to 0.612) and orientation (from 0.417 to 0.7) (p < 0.0001) and from moderate to fair for margin (from 0.204 to 0.482) and posterior features (from 0.286 to 0.522) (p < 0.0001). At baseline analysis isoechoic (0.0485) and heterogeneous (0.1978) echo pattern, microlobulated (0.1161) angular (0.1204) and spiculated (0.1692) margins and combined pattern (0.1549) for posterior features showed the worst agreement rate (poor). After S-Detect evaluation, all variables but isoechoic pattern showed an agreement class upgrade with a statistically significant improvement of inter-reader agreement (p < 0.0001). Conclusions: S-Detect significantly improved inter-reader agreement in the assessment of FBLs according to the BI-RADS US lexicon but evaluation of margin and echo pattern needs to be further improved, particularly isoechoic pattern.

Background: Umbilical Venous Catheter (UVC) are commonly used in neonatal period; they can be not correctly positioned and could be associated with complications. The purpose of this article is to suggest a flow-chart to evaluate the placement of UVC, testing it in young radiologists-in-training. Method: We developed a simple flow-chart to asses, steps by step, UVC placement considering its course and tip location (ideally placed in the atriocaval junction). We tested the flow-chart impact asking to 20 residents to evaluate the placement of 10 UVC before and after they familiarized with the flow-chart and the anatomical findings of a newborn. The agreement among the 20 students was evaluated too. Results: The number of correct characterizations was different due to the administration of the flow-chart. One hundred and six correct UVC assessments at the beginning switched to 196 after the administration of the flow-chart (p=0.0001). The observed agreement among the twenty radiology residents was statistically significant, both before (kappa=0.41, p&nbsp

Objective: To investigate diagnostic performance of 3D contrast-enhanced ultrasound (CEUS) compared with 2D CEUS in the assessment of therapeutic response of hepatocellular carcinoma (HCC) treated with locoregional therapies (LRT). Materials and methods: Twenty-three consecutive patients (13 men and 10 women; mean age 65.5years) with 23 HCCs (size range 1.2–7.2cm; mean size 2.9±1.4cm) treated by means of radiofrequency ablation (RFA n=9), transarterial chemoembolization (TACE n=8), combined RFA and TACE (n=3), percutaneous alcoholization (n=2), and wedge resection (n=1) underwent 2D and 3D CEUS 1month (30±2days) after treatment. Magnetic resonance (n=17) and computed tomography (n=6) acted as standard of reference (SOR). Two radiologists assessed the absence (complete response CR) or presence (residual tumor RT) of any nodular arterially enhancing area within or along the margin of the treated HCC. Results: Both 2D and 3D CEUS observed CR in 10/23 (43.5%) HCCs and RT in 11/23 (47.8%) HCCs. In 1/23 (4.3%) HCC, RT was documented by SOR and 2D CEUS, but it was not appreciable at 3D CEUS. In 1/23 (4.3%) HCC, the presence of peripheral residual tumor was suspected by both 2D and 3D CEUS, but it was not confirmed by SOR. No statistically significant difference between 2D and 3D CEUS in depicting either CR or RT was found (p>0.05). Sensitivity, specificity, positive and negative predictive values, and accuracy of 3D CEUS were 91.7% [95% confidence interval (CI) 0.760–1.073], 90.9% (95% CI 0.739–1.079), 91.7, 90.9, and 91.3%, respectively. Conclusion: 2D and 3D CEUS provided similar diagnostic performance in the assessment of therapeutic response of HCC treated with LRT.

Purpose. The authors sought to assess the incidence of new foci of hepatocellular carcinoma (HCC) using multidetector computed tomography (MDCT) in patients treated with radiofrequency ablation (RFA). Materials and methods. Two readers retrospectively reviewed by consensus the follow-up MDCT studies of 125 patients (88 men and 37 women; mean age 68 years) with 141 HCCs (size 1–5.2 cm; mean 2.2 cm) treated with RFA. MDCT follow-up was performed at 1 and 3 months and every 6–12 months thereafter. Reviewers assessed: (1) the presence of new HCC foci in the same liver segment or in a different segment; (2) complete or incomplete tumor ablation; (3) tumour progression. Results. A total of 113 new HCCs (size 0.7–4.8 cm; mean 1.7 cm) were detected in 69/125 (55.2%) patients (mean follow-up 30.38±19.14 months). Of these, 86 (76.1%) new HCCs were multiple (p

To correlate contrast-enhanced ultrasound (CEUS) findings of hepatic focal nodular hyperplasia (FNH) with lesion size, depth and liver echogenicity and to compare CEUS with baseline US. Two radiologists evaluated baseline US and CEUS examinations of 92 FNHs (mean size: 3.1 +/- 1.7 cm) in 71 patients (59 women and 12 men) to detect the "spoke-wheel" sign, central scar and feeding vessel. The FNHs were grouped and analysed by dimension, depth and liver echogenicity. At least one sign could be detected at CEUS in 27 out of 36 (75%) FNHs larger than 3 cm and in 17 out of 56 (30%) FNH measuring 3 cm or less (p < 0.0001). No statistically significant differences were noted between lesion depth or liver echogenicity and detection rate of these signs at CEUS (p > 0.05) as well as between CEUS or baseline US/CD with regard to lesion size, depth or liver echogenicity (p > 0.05). The detection rate of the central scar and spoke-wheel sign in FNH at CEUS is strongly dependent on lesion size and CEUS can confidently diagnose most FNHs larger than 3 cm.

The objective of this study was to assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) to characterize hypoechoic focal hepatic lesions (HFHL) in fatty liver (FL). A study group of 105 patients with FL and 105 HFHLs (52 malignant and 53 benign) underwent CEUS after SonoVue administration. Two blinded readers independently reviewed baseline ultrasound (US) and CEUS scans and classified each lesion as malignant or benign on a five-point scale of confidence, and recorded whether further imaging work-up was needed. Sensitivity, specificity, areas under the receiver operating characteristic (ROC) curve (A (z)), and interobserver agreement were calculated. We observed that the diagnostic confidence improved after reviewing CEUS scans for both readers (A (z)=0.706 and 0.999 and A (z)=0.665 and 0.990 at baseline US and CEUS, respectively; p

Introduction: Adequate brushing of oral mucosa is important for accurate human papillomavirus (HPV) detection in potentially malignant (oral leukoplakia [OL], oral lichen planus [OLP]) and malignant (oral squamous cell carcinoma [OSCC]) lesions. Since various factors may limit the adequacy of oral brushing and, consequently, the accuracy of HPV detection, modified sampling procedures should be evaluated for their effect on HPV frequency and/or types detected. Aim: To compare the HPV frequency in samples obtained by brushing the lesion site with the frequency in samples obtained by brushing an apparently normal adjacent site. The correlation between HPV frequency and keratinization of the site affected by the lesion, as well as sociodemographic variables (age, sex, smoking and drinking habits), was also examined. Methods: HPV DNA was detected in brushing samples from 50 patients with OL, 49 with OLP, and 17 with OSCC. Polymerase chain reaction (PCR) amplification was performed by MY09/MY11 and GP05+/GP06+ primers; the HPV type was identified by DNA sequencing and a reverse hybridization (line probe) assay. Data were analyzed by the Z test, the Fisher’s exact test, the chi-square test, odds ratio (OR), and a logistic regression model. Results: HPV DNA was detected in 22% of samples from lesion sites and in 16% of samples from adjacent sites (p = 0.22) in patients with OL, in 24.5% and 22.4% of samples from lesion and adjacent sites, respectively, in patients with OLP (p = 0.40), and in 35.3% and 41.2% of samples from lesion and adjacent sites, respectively, in patients with OSCC (p = 0.36). Lesions adjacent to HPV-positive normal sites had an increased rate of HPV detection (OR = 30; 95% CI 9.57, 94.1). HPV-18 was the most frequent genotype, followed by HPV-6, -16, -33, and -53. HPV prevalence was reduced in lesions at keratinized sites (14.5%) compared with non-keratinized sites (34.4%; p = 0.007; OR = 0.32; 95% CI 0.13, 0.81). Discussion: In patients with OL, OLP, or OSCC, a high prevalence of HPV infection was shown in apparently normal sites adjacent to lesion sites infected by HPV. The lower HPV frequency in lesions at keratinized sites suggests that HPV detection by lesion brushing is affected by keratinization. The keratinized epithelium may be less susceptible to HPV infection or, alternatively, the highly proliferative activity in non-keratinized sites may predispose to HPV infection. Conclusion: Results from this study indicate that taking samples from normal sites adjacent to oral lesions may be of value in HPV detection, particularly when the lesions are located at keratinized sites. This sampling procedure may allow more accurate diagnosis of HPV infection compared with sampling only the lesion site, and may also represent a reliable method to investigate the biological characteristics of HPV infection and related oral carcinogenesis.