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The term “calcific tendinitis” refers to the intratendinous deposition of calcium, predominantly hydroxyapatite, that can affect every tendon in the body and especially the rotator cuff. This pathological condition is a dynamic process that evolves through four stages: pre-calcific, calcific, resorptive, and post-calcific. In the precalcific stage, microtraumatic factors associated with a local decrease in blood supply can lead to intratendinous fibrocartilaginous metaplasia, with resulting calcification. The subsequent calcific phase is considered as a resting period. Eventually, triggered by unknown factors, there is resorption of the deposit, accompanied by vascular invasion, the migration of phagocytic cells with dissolution of the calcific focus (resulting in a “toothpaste” appearance of the calcific deposit), and edema from intratendinous pressure, such that the condition becomes symptomatic. After resorption, in the post-calcific or reparative phase, fibroblasts restore the normal tendinous collagen pattern.

We used ultrasound to evaluate iliopsoas bursitis (IB) prevalence in 860 patients (568 males, 292 females, 62 ± 7 years) suffering from symptomatic Kellgren-Lawrence grade II-III-IV hip osteoarthritis. Lequesne index and visual analogue scale (VAS) were recorded. Anterior hip was scanned and images recorded. Maximum IB diameter was measured and drained (volume recorded). Two radiologists evaluated the presence of IB, joint effusion, synovial hypertrophy, communication between bursa and articular space. IB was found in 19/860 (2.2%) patients (16 males, 3 females, 65 ± 11 years; grade II osteoarthritis = 4; III = 9; IV = 6). Mean bursa diameter = 2.9 ± 0.9 cm, volume = 35 ± 34 mL. Effusion was present in 9/19 patients, hypertrophy in 6/19 and communication in 9/19. In patients with no IB, effusion was detected in 27/860 and hypertrophy in 25/860 (p < 0.001 compared with IB patients). κ = 1 for all. VAS index and Lequesne index were not significantly different between patients with or without IB (p ≥ 0.468). Ultrasound can detect associate findings in grade II-IV hip osteoarthritis patients with high reproducibility.

To evaluate the ultrasound features of the extrinsic wrist ligaments in rheumatoid arthritis (RA) patients in comparison with healthy volunteers.Twenty-one consecutive patients affected by RA (12 men, 9 women; mean age 57 ± 14.6 years) were compared with 21 controls (12, 9; 54 ± 12.1, respectively). Wrists were evaluated using ultrasound on both palmar and dorsal sides along each ligament, using carpal bones as references. The following ligaments were studied: radioscaphocapitate, radiolunotriquetral, palmar ulnolunate, palmar ulnotriquetral, dorsal radiotriquetral, dorsal ulnotriquetral, and radial collateral ligament. Ligament number and thickness were noted. Echotexture was rated as fibrillar, fragmented, or heterogeneous; the surface was rated as smooth or blurred.The number of palmar ulnolunate and palmar ulnotriquetral ligaments detected by ultrasound in patients was significantly lower than in controls (P = 0.031 and P = 0.037, respectively). All ligaments had significantly more fragmented or heterogeneous echotexture and blurred surface and were significantly thinner in patients than in controls (P 0.001). No correlation was found between ligament thickness and RA duration or clinical parameters.Extrinsic wrist ligaments were less detectable and thinner in patients affected by RA compared with healthy volunteers matched for age and sex. Ligament thinning did not directly correlate with RA duration and clinical parameters.• Ultrasound is increasingly used to evaluate normal anatomy of extrinsic wrist ligaments. • Extrinsic wrist ligaments are thinner in rheumatoid arthritis patients than in controls. • Extrinsic wrist ligaments are less easy to detect in rheumatoid arthritis patients. • Ligament thinning and detectability are not related to clinical parameters.

Our aim was to characterize rotator cable ultrasound appearance in shoulders of different-aged asymptomatic volunteers, also estimating interobserver reproducibility. We studied 83 shoulders in 42 young volunteers (mean age 26 ± 7.0 years, range 21-35 years) and 66 shoulders in 36 elderly volunteers (65-81 years, 73 ± 4.9 years), noting rotator cable visibility and its minimum thickness and width. Interobserver reproducibility was tested in elderly volunteers by two blinded observers. χ(2), U Mann-Whitney, t-test, Bland-Altman, and κ statistics were used. Rotator cable was less frequently detected in younger than elderly volunteers (25/83 vs. 36/66 shoulders; p = 0.002). Young subjects had thicker (1.5 ± 0.2 mm, range 1.3-1.8 mm vs. 1.1 ± 0.1 mm, 0.9-1.3 mm; p < 0.001) and wider rotator cable (5.8 ± 0.7 mm, 4.5-7.1 mm vs. 4.0 ± 1.2 mm, 2.5-7.1 mm; p < 0.001) than elderly volunteers. Thickness and width reproducibility index were 89% and 94%, respectively; κ = 0.87. Ultrasound demonstrated different rotator cable consistency in younger and elderly asymptomatic patients, with high interobserver reproducibility.

Objectives To assess the clinical feasibility of 3-dimensional (3D) proton magnetic resonance spectroscopy (MRS) of ovarian masses at 1.5 T. Materials and methods We prospectively evaluated 16 patients with 23 ovarian masses using contrast-enhanced magnetic resonance imaging and 3D chemical shift imaging MRS (time of reception/time of echo = 700/135 ms, number of excitations = 6, interpolated voxel = 5 × 5 × 5 mm(3), water and fat suppression). Spectral editing consisted of water reference, filtering, zero-filling, Fourier transformation, frequency shift, automatic baseline and phase correction, and curve fitting. The volume of interest was placed to encompass both solid and cystic tumor components as well as apparently healthy pelvic tissues. The presence of a choline peak at 3.14 to 3.34 ppm was considered as a marker of malignancy. All patients underwent surgery and histopathological evaluation. Results Of 23 masses, 19 were malignant and the remaining 4 benign lesions were a fibrothecoma, an endometriosis, a cyst, and a cystadenofibroma. A choline peak was detected in 17/19 malignant tumors (sensitivity 89%), absent in 2 G1 tumors. It was visible in 16 solid components of 19 malignant tumors (in one of them, a choline peak was detected only in the cystic component, in 6 in both solid and cystic components). The choline peak was absent in 20/21 apparently healthy pelvic tissues, with a very low choline peak being detected in one intraperitoneal fluid collection with malignant cells at cytologic analysis; 3/4 benign tumors showed a choline peak (overall specificity 21/25 = 84%). A significant difference between the mean choline peak integral detected within the solid component and that within the cystic component was observed (P = 0.002). No correlation between the choline peak integral and the tumor size was found (r = 0.120, P = 0.615). Conclusions 3D MRS of ovarian masses is clinically feasible at 1.5 T. This opens new research strategies for early diagnosis of ovarian cancer.

To compare the abstract structure in the 70 highest-rank imaging journals with that of the two highest-rank journals in each of 35 non-imaging biomedical categories, according to 2008 impact factors. We searched on MEDLINE for articles published in high-ranking imaging and non-imaging journals. Abstract format was considered as: IMRaD (Introduction, Methods, Results, and Discussion/conclusion); extended structured (ES), when including headings other than IMRaD; or narrative (without headings). Abstracts of the 70 highest-rank imaging journals were: IMRaD, n = 43 (61%); narrative, n = 27 (39%); ES, n = 0. Abstracts of the 70 highest-rank non-imaging journals were: IMRaD, n = 26 (37%); narrative, n = 35 (50%); ES, n = 9 (13%) (p = 0.001). Additional headings were: study design, n = 7; measurements, n = 7; context/setting, n = 4; interventions, n = 2; rationale, n = 1; level of evidence, n = 1; clinical relevance, n = 1. Study design was declared in 12/23 abstracts (57%) and 21/23 (91%) article bodies in Radiology, 6/21 (29%) and 10/21 (48%) in Investigative Radiology, 11/24 (46%) and 18/24 (75%) in European Radiology, and 12/30 (40%) and 23/30 (77%) in American Journal of Roentgenology, respectively. Although about 60% of imaging journals adhere to IMRaD format, 13% of non-imaging journals requires additional headings; ES abstracts may assist readers in selecting full articles to be read.

Objective We evaluated safety and potential diagnostic value of magnetic resonance (MR) imaging of the knee treated with medial unicompartmental arthroplasty (MUA). Methods The treated knee of 8 patients who underwent MUA was studied with four different 1.5-T MR sequences. Two radiologists independently evaluated eleven anatomical items using a score from 0 (not assessable) to 3 (completely assessable). The sum of the scores for each sequence was divided by the potential maximal sum, obtaining a percentage visibility index (PVI) for each item. Results No adverse effect was reported during or within 30 min after the exam. Posterior cruciate ligament was unseen in all patients by both observers. The following PVIs were reported for the remaining ten items: femoral–patellar relationship 83–100%; femoral–patellar cartilage 92–100%; Hoffa's fat pad 75–92%; patellar ligament 79–100%; lateral meniscus 100%; femoral–tibial lateral joint 100%; lateral collateral ligament 96–100%; anterior cruciate ligament 54–83%; femoral–tibial lateral cartilages 92–100%; posterolateral corner 100%. Agreement between readers was found in 331/352 (94%) evaluations ( k = 0.74–0.78). Conclusions MR imaging after MUA offers a safe and reproducible evaluation of residual knee anatomy except for cruciate ligament, and can be used to follow-up these patients.

To evaluate ultrasound (US)-guided treatment of capsular contracture (CC) in patients with reconstructed/augmented breast. Twenty-five patients with grade IV CC were treated with peri-implant US-guided injection of triamcinolone acetonide. Before/after treatment, maximum capsular thickness (MCT) was measured by ultrasound and pain assessed with visual analogue score (pain-VAS). Patients with pain relief at 1 month were considered early responders (ERs). Another injection was performed in patients without pain relief at 1 month (late responders, LRs). One patient (treated with chemo-radiotherapy) experienced severe pain and local reaction after the second injection, requiring surgery. Twenty-four patients had baseline MCT of 1.8 ± 0.3 mm and pain-VAS of 4.9 ± 0.5, the baseline MCT of 19 ERs (1.7 ± 0.2 mm) being significantly lower than that of 5 LRs (2.1 ± 0.2 mm) (p = 0.030). ERs had significantly reduced MCT and pain-VAS at one (1.1 ± 0.3 mm; 1.5 ± 0.5) and 6 months (1.1 ± 0.2 mm; 0.9 ± 0.7, respectively) (p

To assess if ultrasound (US)-guided viscosupplementation can reduce pain and improve function in elderly patients with cuff tear arthropathy.Ninety-three patients aged over 65 with grade 3 or above cuff tear arthropathy were included in this prospective open-label non-randomized trial. Institutional review board approval and informed consent were obtained. Thirty-three patients received intra-articular injections of sodium hyaluronate under US guidance. Sixty patients constituted the control group. Shoulder joint function was assessed with Constant scores (CS) and pain with a visual analogue scale (VAS).Compared with controls, treated patients reported a significant decrease in symptoms at 1 (mean CS 66±3.1 vs 37±6.9; mean VAS 1.9±1.2 vs 6.9±2.2), 2 (mean CS 65±3.2 vs 35±7.2; mean VAS 1.7±1.2 vs 6.8±2.5), 3 (mean CS 66±3.4 vs 33 6.1; mean VAS 2.3±1.2 vs 6.6±1.9), and 4 (mean CS 62±3.0 vs 34±6.5; mean VAS 3.3±1.4 vs 7.8±3.1) months, p0.001. After 5 months there were no differences.US-guided viscosupplementation is a beneficial therapeutic option in the first months of treatment.

To review the contrast-enhanced ultrasound (CEUS) and 3D ultrasound findings (3D-US) in various pathologies involving the eye and orbit and to compare them with high-resolution US (HRUS) findings.CEUS is a valid diagnostic tool for study several districts. There are numerous pathological conditions of the eye in which CEUS can be very helpful or detrimental. IMAGE FINDINGS: We review a wide range of ocular lesions, traumatic (retinal and choroidal detachments) and malignant (choroidal melanoma, tumors inside and outside the muscle cone) evaluated alternatively with CEUS and 3D and compare these findings with those obtained with HRUS. Dysthyroid orbitopathy is not included in this review.CEUS plays a central role in the differentiation of detached retina (vascular) and vitreous membranes (avascular). It is also helpful in the assessment of tumor of the eye, in planning treatment for choroidal melanoma, and in assessing orbital masses for neovascularization. HRUS is highly effective in the detection of traumatic and non-traumatic lesions of the eye, but it is less effective for the assessment of orbital lesions. The 3D module has increased the diagnostic value of CEUS. CEUS is cost-effective and can be used when CT and MR cannot be performed.Sommario OBIETTIVI: Illustrare i reperti ecocontrastografici (CEUS) e di ecografia in tre dimensioni (3D) di un ampio spettro di patologie del globo oculare, confrontandole con l’ecografia ad alta risoluzione (HRUS). INTRODUZIONE: La CEUS è un valido strumento nella valutazione di numerosi distretti corporei. Nella patologia del bulbo oculare esistono una serie di situazioni in cui la CEUS può essere dirimente o molto utile. IMAGING: In questo lavoro presentiamo uno spettro di lesioni traumatiche (distacchi di retina e della coroide) e di patologia maligna del bulbo oculare (melanoma della coroide, tumori intra- ed extra conali) valutate con CEUS ed ecografia 3D. I risultati sono stati confrontati con HRUS. L’orbitopatiadistiroidea è stata esclusa dal presente studio. CONCLUSIONE: CEUS gioca un ruolo centrale nella diagnosi differenziale tra distacchi di retina (vascolari) e membrane vitreali (avascolari). Inoltre CEUS è molto utile nella valutazione dei tumori bulbari, nel percorso terapeutico del melanoma della coroide e nella valutazione della neovascolarizzazione delle lesioni orbitarie. HRUS è molto efficace nel riconoscimento di lesioni traumatiche e non traumatiche, ma non è utile nella valutazione delle lesioni della parete dell’orbita. L’utilizzo delle ricostruzioni 3D ha aumentato la confidenza diagnostica della CEUS. Infine, CEUS ha un ottimo rapporto costo-beneficio e può essere utilizzata quando la TC e la RM non possono essere eseguite.

Entrapment neuropathies can manifest with confusing clinical features and therefore are often underrecognized and underdiagnosed at clinical examination. Historically, electrophysiologic evaluation has been considered the mainstay of diagnosis. Today, cross-sectional imaging, particularly magnetic resonance (MR) imaging and specifically MR neurography, plays an increasingly important role in the work-up of entrapment neuropathies. MR imaging is a noninvasive operator-independent technique that allows identification of the underlying cause of injury, differentiation between surgically treatable and untreatable causes, and guidance of selective diagnostic anesthetic nerve blocks. Pathologic conditions affecting the lumbosacral plexus and major motor and mixed nerves of the pelvis and hip include neuropathies of the lumbosacral plexus, femoral nerve, lateral femoral cutaneous nerve, obturator nerve, and sciatic nerve; piriformis muscle syndrome; and injury of the gluteal nerves. Diagnosis of entrapment neuropathies of the pelvis and hip with MR imaging requires familiarity with the normal MR imaging anatomy and awareness of the anatomic and pathologic factors that put peripheral nerves at risk for injury.

The diagnosis of gout is usually based on clinical presentation and laboratory findings. Imaging plays a role in the assessment and grading of articular damage related to chronic, long-standing disease, which is characterized by granulomatous synovitis, tophi, and erosions. Multimodality imaging of chronic tophaceous gout may be useful in clinical practice for a variety of purposes, including assessment of disease-related anatomical changes and monitoring of articular and soft-tissue lesions over time, especially in response to urate-lowering therapy. Radiography remains the primary imaging technique. Ultrasonography may detect monosodium urate crystals on cartilage, is helpful to assess small joint effusion, to guide to joint aspiration, and to evaluate the volume of tophi. Computed tomography is considered to be more sensitive than plain radiography in the detection and evaluation of cortical bone erosions associated with tophi. MRI represents the only imaging modality which provides visualization of bone marrow oedema associated with erosions and may be useful to characterize and distinguish tophi from other soft tissue nodules.

Vascularity influences the characteristics of gynecologic tumors observed with direct imaging techniques that reveal the macrovascular component of these lesions (color and power Doppler) and with indirect imaging involving the administration of contrast agents to examine the microcirculation and interstitial perfusion (contrast-enhanced computed tomography [CT] and magnetic resonance [MR] imaging). The purpose of this study was to determine whether contrast-enhanced ultrasonography (CEUS) of ovarian lesions provides useful information that cannot be obtained with conventional US.We used CEUS to assess 72 nonspecific adnexal lesions in 61 patients. CEUS was performed with a 4.8-ml bolus of a second-generation ultrasonographic contrast agent and dedicated imaging algorithms. For each lesion, B-mode morphology, CEUS morphology, and time/intensity curves were evaluated.In 8/61 cases (13.1%) CEUS offered no additional morphovascular information. In 38/61 cases (62.3%), it provided additional information that did not modify the management of the lesion, and in 15/61 cases (24.6%) it gave additional information that modified the management of the lesion. Malignant lesions were characterized by significantly shorter times to peak enhancement (11.9 ± 3.1 s vs 19.8 ± 4.0 s p 0.01) and significantly higher peak intensity (24.7 ± 4.2 dB vs 17.8 ± 3.3 dB p 0.01) compared with benign lesions.CEUS improves diagnostic confidence in the characterization of liquid-corpuscular lesions where conventional US is inconclusive. CEUS can be proposed as a valid alternative to CT and MR. However, information obtained by CEUS influences the therapy in a limited percentage of cases (24.6%).Sommario INTRODUZIONE: La ricchezza della componente vascolare dei tumori ginecologici influenza le caratteristiche dell'imaging diretto, utilizzando metodiche che evidenziano la componente macrovascolare delle lesioni (color e power Doppler), e di quello indiretto, mediante somministrazione di mezzi di contrasto (MdC) per lo studio del microcircolo e della perfusione interstiziale. Lo scopo di questo lavoro è di valutare l'aggiunta di informazioni diagnostiche fornite dalla valutazione ecografica con MdC nello studio delle lesioni ovariche. MATERIALI E METODI: Abbiamo valutato 72 lesioni annessiali in 61 pazienti con lesioni ovariche di incerta interpretazione mediante somministrazione di 4,8 ml di MdC ecoamplificatore di II generazione. Per ogni lesione, abbiamo valutato la morfologia basale, quella contrastografica e le curve intensità/tempo. RISULTATI: La valutazione post-contrasto confrontata con la basale non ha apportato informazioni aggiuntive morfovascolari in 8 pazienti (13,1%); in 38 pazienti (62,3%) ha apportato informazioni senza modifiche del comportamento clinico; in 15 soggetti (24,6%) ha apportato elementi che hanno modificato il comportamento clinico. Le lesioni maligne presentavano valori di tempo massimo di enhancement significativamente minori (11,9 ± 3,1 s vs 19,8 ± 4,0 s p 0,01) e intensità di picco massimo significativamente maggiore (24,7 ± 4,2 dB vs 17,8 ± 3,3 dB p 0,01) rispetto alle lesioni benigne. CONCLUSIONI: La CEUS consente di migliorare la confidenza diagnostica nelle lesioni liquide corpuscolate in cui l'indagine convenzionale non risulta dirimente, proponendosi nella diagnosi differenziale di un limitato numero di lesioni complesse, in alternativa a TC ed RM. Le informazioni ottenute influenzano tuttavia il successivo iter diagnostico e terapeutico in una limitata percentuale di casi (24,6%).

To compare short- and long-term outcomes of patients with rotator cuff calcific tendonitis who did and did not undergo ultrasonographically (US)-guided percutaneous treatment.Institutional review board approval and informed patient consent were obtained. Of patients referred for US-guided treatment of rotator cuff calcific tendonitis, 219 (86 men, 133 women; mean age, 40.3 years +/- 10.9 [standard deviation]) were treated; 68 (31 men, 37 women; mean age, 40.2 years +/- 11.3) patients refused treatment and served as control subjects. After local anesthesia was induced, two 16-gauge needles were inserted into the calcific deposit. Saline solution was injected through one needle, and the dissolved calcium was extracted through the other needle. Shoulder joint function was assessed by using Constant scores, and pain was assessed by using visual analogue scale (VAS) scores. Mann-Whitney U and chi(2) tests were performed.At baseline, no significant difference in age or sex distribution, Constant score, or VAS score was detected between treated and nontreated (control) patients. Compared with control subjects, treated patients reported a significant decrease in symptoms at 1 month (mean Constant score, 73.2 +/- 6.2 vs 57.5 +/- 3.9; mean VAS score, 4.8 +/- 0.6 vs 9.1 +/- 0.5), 3 months (mean Constant score, 90.2 +/- 2.6 vs 62.6 +/- 7.2; mean VAS score, 3.3 +/- 0.4 vs 7.3 +/- 1.8), and 1 year (mean Constant score, 91.7 +/- 3.1 vs 78.4 +/- 9.5; mean VAS score, 2.7 +/- 0.5 vs 4.5 +/- 0.9) (P.001). Symptom scores were not significantly different between the groups at 5 years (mean Constant score, 90.9 +/- 3.6 vs 90.5 +/- 4.8; mean VAS score, 2.6 +/- 0.5 vs 2.8 +/- 0.7) (Por= .795) and 10 years (mean Constant score, 91.8 +/- 5.0 vs 91.3 +/- 9.6; mean VAS score, 2.5 +/- 0.6 vs 2.7 +/- 0.6) (Por= .413).US-guided percutaneous treatment facilitated prompt shoulder function recovery and pain relief. Treated patients had better outcomes than did nontreated patients at 1 year. However, 5 and 10 years after the procedure, the nontreated group reported outcomes similar to those of the treated group.

Infection after total hip arthroplasty is an orthopaedic surgeon major concern. Overall infection incidence has not been reduced in the last few decades (Charnley 1972) assessing its incidence between 0.5% and 2% for primary total hip replacement and around 4% for partial hip arthroplasty (Wilson et al. 2008) and for revision. Diagnosis and treatment are often long and difficult and final results unpredictable.

Introduction: Functional dyspepsia and non-erosive reflux disease (NERD) are prevalent gastrointestinal conditions with accumulating evidence regarding an overlap between the two. Still, patients with NERD represent a very heterogeneous group and limited data on dyspeptic symptoms in various subgroups of NERD are available. Aim: To evaluate the prevalence of dyspeptic symptoms in patients with NERD subclassified by using 24 h impedance-pH monitoring (MII-pH). Methods: Patients with typical reflux symptoms and normal endoscopy underwent impedance-pH monitoring off proton pump inhibitor treatment. Oesophageal acid exposure time (AET), type of acid and non-acid reflux episodes, and symptom association probability (SAP) were calculated. A validated dyspepsia questionnaire was used to quantify dyspeptic symptoms prior to reflux monitoring. Results: Of 200 patients with NERD (105 female; median age, 48 years), 81 (41%) had an abnormal oesophageal AET (NERD pH-POS), 65 (32%) had normal oesophageal AET and positive SAP for acid and/or non-acid reflux (hypersensitive oesophagus), and 54 (27%) had normal oesophageal AET and negative SAP (functional heartburn). Patients with functional heartburn had more frequent (p

Purpose: TVUS and SHG are two important techniques that can give a precise evaluation of submucous fibroids. The purpose of our work is to assess the diagnostic accuracy of TVUS and SHG in the preoperative staging of such lesions. Materials and methods: 71 women with submucous fibroids diagnosed with TVUS were assessed by SHG within 30 days from surgical treatment. Fibroids were staged according to the angle between the fibroid margins and the endometrium: G090°. Results were compared with findings at the operative hysteroscopy or on pathologic examination of the uterus. Results: TVUS allowed staging of the fibroid in 27/71 cases (38%). SHG changed staging in 12/71 cases (17%). In those 44 women where TVUS did not allow staging of fibroids, SHG was successful in 39. Overall, SHG was considered diagnostic in 66/71 cases (92%) and, in all of these, the accuracy of staging was confirmed. In 5 cases, SHG was considered non diagnostic due to technical difficulties in obtaining a sufficient distension of the endometrial cavity. No patient experienced any severe pains, vasovagal reactions or infections. Conclusions: SHG is more effective than simple TVUS in the preoperative staging of submucous fibroids. SHG showed complete concordance with hysteroscopy and pathologic findings.

Purpose: Plantar plate tears are often unidentified causes of hindfoot discomfort. The purpose of our work is to describe the normal and pathologic appearance of plantar plate, assessed with dynamic high resolution ultrasound (D-HRUS). Methods and Materials: We used D-HRUS to assess 22 patients (age range 38–71) with an orthopaedic diagnosis of plantar plate tear. A Magnetic Resonance (MR) control was performed in all cases. Moreover, we performed D-HRUS on 10 healthy volunteers to understand the correct scan technique of the plantar plate and to determine the correct dynamic manoeuvres that allow to depict the normal ultrasound anatomy of this structure. Results: Normal plantar plate is a triangular structure, with homogeneous echogenic appearance; it can be easily assessed with plantar longitudinal scan on the metatarsophalangeal joint (MTPJ) and passive flexion/extension of foot fingers. The dynamic scan allows to depict the relations among the plantar plate and the flexor tendons and the articular cartilage. In our study, D-HRUS has detected a plantar plate tear in 21/22 patients (14 on MTPJ II, five on MTPJ III, two on MTPJ II and III). They appear like small hypoechoic defects of the distal insertional fibres and can be divided into partial (eight patients) and full thickness tears (13 patients). In all patients, MR confirmed the diagnosis of plantar plate rupture but in nine cases it has not been able to differentiate a partial from a full thickness tear. Conclusion: D-HRUS allows to assess the plantar plate in detail and to detect its lesions. In particular, the dynamic analysis is able to differentiate a partial from a full thickness tear.

AIM: To investigate the prevalence of relevant incidental findings (RIFs) detected during routine abdominal contrast-enhanced computed tomography (CeCT). METHODS: We retrospectively evaluated the reports of a consecutive series of abdominal CeCT studies performed between January and May 2013. For each report, patients’ age and sex, admission as inpatient or outpatient, clinical suspicion as indicated by the requesting physician, availability of a previous abdominal examination, and name of the reporting radiologist were recorded. Based on the clinical suspicion, the presence and features of any RIFs (if needing additional workup) was noted. RESULTS: One thousand forty abdominal CeCT were performed in 949 patients (528 males, mean age 66 ± 14 years). No significant difference was found between inpatients and outpatients age and sex distribution (P > 0.472). RIFs were found in 195/1040 (18.8%) CeCT [inpatients = 108/470 (23.0%); outpatients = 87/570 (15.2%); P = 0.002]. RIFs were found in 30/440 (6.8%) CeCT with a previous exam and in 165/600 (27.5%) without a previous exam (P < 0.001). Radiologists’ distribution between inpatients or outpatients was significantly different (P < 0.001). RIFs prevalence increased with aging, except for a peak in 40-49 year group. Most involved organs were kidneys, gallbladder, and lungs. CONCLUSION: A RIF is detected in 1/5 patients undergoing abdominal CeCT. Risk of overdiagnosis should be taken into account.

Background Shoulder pain is a common condition in rheumatologist’s practice. Ultrasound (US) gained a central role in diagnosis of painful shoulder. However, in literature there aren’t guidelines on how to report shoulder US examination and it is plausible that radiologists and rheumatologists could describe the same findings in different ways, due to different cultural background Objectives To compare US technique and reports of shoulder examination performed by radiologists and rheumatologists, to identify the main discrepancies and resolve them. Methods Five rheumatologists and 2 radiologists, experienced in US, participated. The study was divided in 2 phases, in the first one each participant performed an US of 3 patients (one shoulder each) and reported the findings, blinded to the patients diagnosis and to the other operators technique and findings. US technique of each operator was observed and reported by other 3 doctors. Subsequently, the reports along with the images were compared to identify the main discrepancies and to propose solutions in order to uniform both technical aspects and reporting of the findings. In the second phase a US exam of a fourth patient was performed in plenary, to assess feasibility and efficacy of the “common approach” as defined previously. Results The US scanning technique adopted was similar for all operators, differing only for the sequence of the scans. During the exam, rheumatologists paid more attention on US findings suggestive of inflammatory disease, while radiologists were more interested in rotator cuff pathology, in line with the ESSR recommendations for US shoulder (1). The main differences in reporting emerged in description of rotator cuff pathology. Radiologists are more imprinted in a detailed description of lesions (measurements in 2 axis and scoring of lesions according to the feedback obtained by the interaction with orthopedists), whereas rheumatologists provided a careful description of inflammatory changes to distinguish between acute and chronic disorders. Experts concluded that both approaches are important and lesions should be measured in 2 axes and grade of degeneration, concomitant disorders and the age of lesion should be reported. Another major difference emerged in the description of the “irregularities” of bone surface. Experts concluded that the irregularities should not be reported as “erosions” because such term could evocate an inflammatory joint disease (i.e rheumatoid arthritis) when it is known that the irregularities of the cortex can be found in other conditions (osteoarthritis of the shoulder). The term erosion should be used only when an inflammatory joint disease is strongly suspected. Other minor points that have been discussed and addressed will be presented in the extended work. Conclusions This study allowed to clarify some points of divergence in US reporting and represented an interesting experience of collaboration between radiologists and rheumatologists. References Klauser AS, Tagliafico A, Allen GM et al. Clinical indications for musculoskeletal ultrasound: a Delphi-based consensus paper of the European Society of Musculoskeletal Radiology Eur Radiol. 2012 May;22(5):1140-8. Epub 2012 Mar 28 Disclosure of Interest None Declared

Background: Gastroesophageal reflux (GER) and microaspiration of gastric contents has been proposed as an important mechanism in the pathogenesis of ventilator associated pneumonia (VAP) but properties of GER in patients receiving acid suppresive therapy in intensive care unit (ICU) and its effect on VAP and respiratory function in these patients is not elucidated. Aim: This study aims to assess the association between GER and VAP by defining the differences between VAP and non-VAP patients in ICU in terms of proximal extension and chemical properties of GER assessed by 24 hour combined esophageal intraluminal electrical impedance/pH measurements. We also aimed to study the association of impedance/pH values with respiratory function (PaO2/FiO2 ratio) and gastropulmonary microaspiration assessed by pepsin measurements in deep tracheal aspirates(DTA). Methods: 20 intubated patients on acid suppressive medication for stress ulcer prophylaxis in a neurological and medical ICU were included in this study. Patients who had pneumonia at the time of intubation or who were diagnosed with pneumonia during the first 48 hours after intubation were excluded. Pepsinmeasurements weremade onDTA samples on the third day. Afterwards esophageal impedance/pHmetry catheters were placed and 24 hour recordings were analyzed. Patients were followed throughout their stay in ICU for VAP and daily PaO2/FiO2 ratios were recorded for one week. Impedance/pH values and pepsin levels were compared between VAP and nonVAP patients. Results: 8 patients were diagnosed with VAP. VAP patients had more proximal reflux compared to non-VAP patients (7(2-14) vs. 3,5(0-8))(p=0,003). Proximal weakly acidic reflux was again more common in VAP patients (4,5(2-9) vs 2(04)(p=0,006). Pepsin levels in DTA samples were correlated with the number of weakly acidic reflux episodes(r=0,615;p=0,004). Pepsin levels were also correlated with the number of proximal reflux episodes, especially with proximal weakly acidic reflux(r=0,489;p=0,029 ; r=0,651,p=0,002 ). PaO2/FiO2 ratios were negatively correlated with both pepsin levels and proximal weakly acidic reflux (r=-0,585,p=0,007 ; r=-0,620;p=0,004). Conclusion: Proximal extension of GER, especially proximal weakly acidic reflux is associated with microaspiration, VAP and worsening of respiratory function in intubated ICU patients on acid suppressive therapy.

Dear Editor, We read with great interest the article by Krokidis and colleagues [1] recently published in Insights into Imaging. In this well-presented pictorial review, the authors point out the crucial role of interventional radiology as a minimally invasive approach to treat benign strictures, to divert the bile away from the site of the fistula, and to seal the leaking tract. Balloon dilation was reported as the strategy of choice in the percutaneous treatment of benign biliary strictures (although burdened by 29–58 % re-stenosis), while the role of stent placement was reported to still be controversial. A different approach can be the use of novel bioabsorbable biliary stents [2], which may limit the number of balloon dilations in bilioplasty, also overcoming the problem of stent withdrawal. Regarding bile leaks, the authors discuss—inter alia—the role of percutaneous drainage of biliary collections, of coil/gelfoam embolisation of bilio-vascular fistulas, and of covered stents. However, we underline that the most commonly used technique for treating postsurgical biliary leak is percutaneous transhepatic biliary drainage, which allow for bile diversion from the site of the fistula [3]. Moreover, an occlusion balloon placed above the site of the fistula has been demonstrated to allow for complete external drainage of the bile, thus representing a valuable option to treat post-surgical biliary leaks [3, 4]. In case of direct communication between a collection and the biliary system, it may happen that percutaneous drainage is not enough to allow for full healing and surgery may be required, as the authors show in Figure 3 [1]. We note that, in this particular setting, percutaneous cyanoacrilyc glue embolisation has been reported as a feasible technique, which may lead to fistula sealing, avoiding the morbidity related to surgical re-intervention [5].