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Objective: The purpose of this article is to retrospectively investigate in two radiology centers the role of contrast-enhanced ultrasound in the characterization of renal masses with equivocal enhancement at CT (i.e., with a density increase of 10-20 HU between unenhanced and contrast-enhanced scans) not characterized with conventional ultrasound modes., Materials and Methods: Forty-seven renal lesions (range, 0.8-7.7 cm; average, 2.6 cm) with equivocal enhancement at CT underwent contrast-enhanced ultrasound using sulfur hexafluoride-filled microbubbles. Examinations were digitally recorded for retrospective blinded evaluation by two radiologists with 20 and 10 years' experience in urologic imaging. Histologic results were available for 30 of 47 (64%) lesions (25 primary malignant tumors, two metastases, and three primary benign lesions). Two lesions increased in size and complexity during the follow-up and were considered malignant. One Bosniak category III and 14 category IIF cysts were stable after a follow-up of at least 3 years and were considered benign. ROC curve analysis was used to assess the capability of contrast-enhanced ultrasound to differentiate benign from malignant lesions., Results: Twelve likely complex cystic lesions at gray-scale ultrasound were cystic also on contrast-enhanced ultrasound and reference procedures. Eleven of 34 lesions that appeared solid at gray-scale ultrasound were cystic on contrast-enhanced ultrasound and reference procedures. One lesion considered likely solid by one radiologist and possibly cystic by the other was a solid tumor at contrast-enhanced ultrasound and histologic analysis. The diagnostic performance of contrast-enhanced ultrasound to characterize the lesions as benign or malignant was high for both readers (AUC, 0.958 and 0.966, respectively)., Conclusion: Contrast-enhanced ultrasound is effective for characterizing renal lesions presenting with equivocal enhancement at CT.

The authors present a clinical-radiographic study on two groups of patients affected with aseptic nonunion and delays in consolidation of the tibia treated by intramedullary nailing (24 cases) and Ilizarov method (29 cases). Nailing was locked in 12 cases and associated with resection of the fibula in 15 (in 8 locked nailing). Autoplastic bone grafts were applied in 3 cases of atrophic nonunion. The Ilizarov method was used with different procedures: standard assembly in 23 patients, of which 6 with the application of autoplastic grafts for atrophic nonunion. En bloc resection of the atrophic nonunion was carried out in 6 patients followed by removal (4 cases) or lengthening (2 cases). Parafocal osteotomy according to Paltrinieri was reserved for closed hypertrophic nonunion with severe varus and procurvatum. The data for this study allow the authors to conclude that intramedullary nailing is preferable in delays in consolidation and in hypertrophic nonunion without angular defects or hypometria, while the Ilizarov method is more indicated in atrophic nonunions and in hypertrophic nonunions with hypometria and angular defects.