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Desmoid-type fibromatosis (DF), also known as aggressive fibromatosis, is a locally aggressive benign fibroblastic neoplasm that can infiltrate or recur but cannot metastasize. It is rare, with an estimated annual incidence of two to four new cases per million people. Most DFs occur sporadically, but it may also be associated with the hereditary syndrome familial adenomatous polyposis. Treatment is necessary when the disease is symptomatic, especially in case of compression of critical structures. When possible, surgical resection is the treatment of choice; however, recurrence is common. Due to the high rate of recurrence, imaging plays an important role not only in diagnosis, but also in the management of DF. Although there are a number of studies describing CT and MRI findings of DF, there is no description of contrast-enhanced ultrasound findings.

To date, the treatment of patients affected by head and neck squamous cell carcinoma (HNSCC) is highly challenging for clinicians. Possible therapies are surgical resection of the tumor mass, radiotherapy, chemotherapy or, more often, a combined treatment that inevitably affects both normal and tumor cells. Consequently, patients' anatomy and functions become reduced or altered. Nowadays the functional restoration is significantly improved thanks to the innovation in prosthetic rehabilitation and in radiotherapy. The current IMRT (Intensity Modulated Radiation Therapy) allows planning adequate treatments evaluating different tissues' involvement and radiation dosage. It is possible to define the most suitable sites for implant insertion, using data provided by dose-volume histogram (DVH). This study aims to illustrate the idea of obtaining a unique CT image by blending radiation-planning CT and Cone Beam CT.Five patients among 54 candidates were selected for this study. Selection criteria were: good general health (PS0-1), age between 18 and 72 years, absence of metastatic disease or local recurrence, disease-free interval of at least 18 months. Radiation planning CT scan and maxillo-facial CT Cone Beam of every patient were overlapped and merged. Only one CT for every evaluated patient was obtained in order to plan the most suitable areas for implant placement.The placement of 10 implants in 5 patients was programmed using the explained method. Patients (all male) were aged between 48 and 72 years old, with a median age of 64.4 years. In every case of this study, a modification of the initial program of implant placement was necessary. The new imaging method we are proposing was able to provide information about radiation isodoses received in the planned osseointegrated implants' positions.This new method allows operators to correct their own therapy plans and choices, customizing the treatment plan on the actual condition of the patient. Moreover, it makes all the rehabilitation process safer and can reduce the risk of failure, side effects and inconveniences for the patients.

The aim of this study was to evaluate the same kidney before and after transplantation to assess the ability of the allograft to restore blood flow, time required to achieve functional recovery after surgery and the possibility of differentiating normal from pathological allografts using color Doppler ultrasound (CDUS) flow indices: resistive index (RI)/renal cortical ratio (RCR) and scintigraphy.79 living donors and 79 recipients. Donors underwent renal CDUS and scintigraphy. CDUS was repeated on the allograft 24 h, 3, 15 and 30 days after transplantation, and scintigraphy 3-5 days after transplantation. Recipients were divided into two groups on the basis of clinical and biochemical values: (A) well-functioning allografts and (B) acute pathology. Results of CDUS, RI and RCI were compared to results of scintigraphy, biochemical values and biopsy.Group (A) n = 60 (76 %), group (B) n = 19 (24 %); RI sensitivity was 93 %, specificity 83 %. In group (A) positive predictive value (PPV) was 94 % and in group (B) 90 %. RCR using receiver operating characteristic curve analysis yielded sensitivity 100 % and specificity 98.3 %. Scintigraphy mean values of glomerular filtration ratio and T max before transplantation were in group (A): 50.32 ml/min and 4.87 min; after transplantation 46.88 ml/min and 4.96 min; in group (B): 48.68 ml/min and 4.63 min, after transplantation 27.89 ml/min and 10.53 min, respectively. Pearson's correlation coefficient between preoperative and postoperative results of scintigraphy was significant in group (A) (glomerular filtration ratio = 0.85, T max = 0.70) and not significant in group (B) (glomerular filtration ratio = 0.40, T max = 0.08).This study shows that CDUS, RI and RCR are useful in postoperative evaluation of transplanted kidneys as these parameters can, after only 24 h, confirm the good condition of the allograft despite still excessive blood parameter values.Scopo di questo studio è stato di valutare lo stesso rene prima e dopo il trapianto al fine di valutare la capacità dell’organo trapianto di ripristinare il flusso sanguigno, il tempo richiesto per raggiungere il recupero funzionale dopo l’intervento chirurgico e per differenziare nell’innesto il tessuto normale dal patologico con l’uso degli indici di flusso del color Doppler (CD): l’indice di resistenza (IR)/renal cortical ratio (RCR) e la scintigrafia.79 donatori viventi e 79 riceventi. I donatori sono stati sottoposti a CD renale e a scintigrafia. Il CD è stato ripetuto sul tessuto trapiantato 24 ore, 3, 15 e 30 giorni dopo il trapianto e la scintigrafia, 3-5 giorni dopo il trapianto. I pazienti sono stati divisi in due gruppi sulla base dei dati clinici e biochimici: A) trapianto ben funzionante e B) patologia acuta. I risultati del CD, IR e RCR sono stati confrontati con i risultati della scintigrafia, i valori biochimici e la biopsia.Gruppo A) n = 60 (76 %), gruppo B) n = 19 (24 %); la sensibilità del IR è stata del 93 %, la specificità del 83 %. Nel gruppo A) il valore predittivo positivo (VPP) è stato: 94 %, gruppo B): 90 %. Utilizzando una analisi delle curve ROC (Receiver Operating Characteristic) lo RCR ha prodotto una sensibilità del 100 % e una specificità del 98,3 %. I valori medi della scintigrafia del rapporto di filtrazione glomerulare eQuesto studio dimostra che CD, IR e RCR sono utili nella valutazione postoperatoria dei reni trapiantati in quanto tali parametri possono, dopo solo 24 ore, confermare la buona condizione del tessuto trapiantato nonostante i valori ematochimici ancora alterati.

Nowadays ultrasound elastosonography is an established technique, although with limited clinical application, used to assess tissue stiffness, which is a parameter that in most cases is associated with malignancy. However, although a consistent number of articles have been published about several applications of elastosonography, its use in certain human body districts is still not well defined. In this paper we write on the use of elastosonography in prostate, testicle and musculo-skeletal apparatus. We report and compare the work of several authors, different type of elastosonography (shear wave, strain elastography, etc.) and instrumental data obtained in the study of both benign and malignant lesions.

Nowadays ultrasound elastosonography is an established technique, although with limited clinical application, used to assess tissue stiffness, which is a parameter that in most cases is associated with malignancy. However, although a consistent number of articles have been published about several applications of elastosonography, its use in certain human body districts is still not well defined. In this paper we write on the use of elastosonography in prostate, testicle and musculo-skeletal apparatus. We report and compare the work of several authors, different type of elastosonography (shear wave, strain elastography, etc.) and instrumental data obtained in the study of both benign and malignant lesions.

Testis sparing surgery (TSS) is a well-known technique in the treatment of small testicular masses. Grayscale ultrasound (US), color/power Doppler US (CPDUS) and contrast-enhanced ultrasound (CEUS) are considered the best diagnostic imaging tools in those patients. Aim of this study was to assess the role of US imaging in the detection of small testicular masses in monorchid patients after orchiectomy for malignant neoplasm, and in guiding surgery to reach the target and also to differentiate lesions which presented vascular activity within the mass.From January 2011 to October 2014, 18 patients were enrolled in this study. They had previously undergone orchiectomy and were investigated for suspected contralateral disease. During routine follow-up, all patients underwent grayscale US. If findings were positive, CPDUS and CEUS were performed and eventually all patients underwent surgery. After exteriorization of the testis, the small mass was identified by intraoperative US, and a needle was placed under US guidance. After excision of the mass, frozen section examination was performed. When malignancy was found, radical orchiectomy was performed; if histological outcome was negative, the healthy testis was conserved.All patients underwent grayscale US examination, which showed small hypoechoic masses. Each mass identified at US imaging was confirmed at surgery. All patients underwent CPDUS; 12/19 lesions showed blood flow while 7/19 showed absence of blood flow. At CEUS, 16/19 lesions showed enhancement and subsequent histological examination revealed that 8 were seminomas and 3 were Leydig cell tumors. In 5/19 cases CEUS showed the presence of lesions (focal inflammatory lesions) and in 3/19 cases CEUS was negative.TSS in monorchid patients may be a safe procedure leading to excellent results. We therefore consider it a valid alternative to radical orchiectomy, and US imaging is essential to guide the resection of non-palpable neoplasms and to exclude concomitant lesions.La testis sparing surgery (TSS) è una tecnica ben nota nel trattamento di piccole masse testicolari. L’ecografia in scala di grigi (US), il color/power Doppler (CPDUS) e l’ecografia con mezzo di contrasto (CEUS) sono considerati i migliori strumenti di diagnostica per immagini in questi pazienti. Scopo di questo studio è stato quello di valutare il ruolo dell’imaging ecografica nell’individuazione delle piccole masse testicolari nei pazienti monorchidi dopo orchiectomia per neoplasia maligna, nel ruolo di guida durante l’intervento chirurgico e nella differenziazione delle lesioni che presentavano attività vascolare dentro la massa.Da Gennaio 2011 a Novembre 2014, 18 pazienti (19 lesioni), orchiectomizzati per neoplasia, durante il follow-up di routine, sono stati sottoposti a ecografia. Se positivi, venivano sottoposti a CPDUS e CEUS ed ad intervento chirurgico. La piccola massa, era identificata e sotto guida ecografica marcata con ago. Dopo l’asportazione della massa, è stato eseguito l’esame istologico estemporaneo. In caso di malignità, veniva eseguita una orchiectomia radicale; se l’esito istologico era negativo, il testicolo sano veniva conservato.In tutti i pazienti l’ecografia ha mostrato 19 piccole masse ipoecogene confermate all’intervento chirurgico. Al CPDUS; 12/19 hanno mostrato presenza di flusso ematico, 7 hanno mostrato assenza di segnale. Alla CEUS, 16/19 sono risultate positive e l’esame istologico ha dimostrato 8 seminomi, 3 tumori a cellule di Leydig. In 5 casi la CEUS ha mostrato la presenza di lesioni (lesioni infiammatorie focali) e in 3 è stata negativa.La TSS nei pazienti monorchidi può essere una procedura sicura che porta a eccellenti risultati. Tale tecnica può essere una valida alternativa all’orchiectomia radicale. L’imaging ecografico è essenziale per il riconoscimento e la caratterizzazione della lesione, per guidare la resezione delle neoplasie non palpabili e per escludere lesioni concomitanti.

Purpose: Ultrasound (US) is the main imaging technique in the assessment of testicular masses, as it has proved to be highly accurate in the visualization of these pathologies. Identification of a Leydig cell tumor is essential since the lesion is benign in 90 % of cases. The aim of this multicenter study is to assess the effectiveness of contrast-enhanced ultrasound (CEUS) in differentiating Leydig cell tumors from seminoma using qualitative and quantitative features. Materials and Methods: From February 2011 to December 2013, 31 patients (mean age: 34 years; range: 25 – 52) were recruited for this prospective study. Three of them were monorchid. Therefore, a total of 59 testicles were assessed. All patients underwent grayscale US, color Doppler ultrasound (CDUS), CEUS and orchiectomy. The paired one-tailed Student‘s t -test was carried out to differentiate between Leydig cell tumors and seminomas. Results: 31 lesions suspicious for malignancy were hypoechoic on grayscale US while they did not show a typical pattern on CDUS. CEUS qualitative analysis, based on contrast enhancement pattern, during the arterial and venous phases, did not allow discrimination of Leydig cell tumors from seminoma. Quantitative analysis of time-intensity curves (TICs) demonstrated that only three parameters presented statistical significance, i. e. wash-in rate (WiR) p = 0.014, peak enhancement (PE) p = 0.001 and time to peak (TTP) p = 0.003. Conclusion: The vascular bed of a Leydig cell tumor is wider and the blood flow velocity is higher than that of a seminoma due to more regular neovascularization. In contrast, a seminoma presents large areas of necrosis due to irregular neovascularization. This explains the different PE and WiR values. Further studies involving larger patient populations are mandatory to confirm these encouraging preliminary results.

Polysplenism and accessory spleen are congenital, usually asymptomatic anomalies. A rare case of polysplenism with ectopic spleen in pelvis of a 67-year-old, Caucasian female is reported here. A transvaginal ultrasound found a soft well-defined homogeneous and vascularized mass in the left pelvis. Patient underwent MRI evaluation and contrast-CT abdominal scan: images with parenchymal aspect, similar to spleen were obtained. Abdominal scintigraphy with 99mTc-albumin nanocolloid was performed and pelvic region was studied with planar scans and SPECT. The results showed the presence of an uptake area of the radiopharmaceutical in the pelvis, while the spleen was normally visualized. These findings confirmed the presence of an accessory spleen with an artery originated from the aorta and a vein that joined with the superior mesenteric vein. To our knowledge, in the literature, there is just only one case of a true ectopic, locally vascularized spleen in the pelvis.Il polisplenismo e la milza accessoria sono anomalie congenite generalmente asintomatiche. Riportiamo un raro caso di polisplenismo con milza pelvica ectopica in una donna bianca di 67 anni. Nella pelvi di sinistra all’ecografia transvaginale è stata ritrovata una massa soffice, ben definita, omogenea e vascolarizzata. La paziente è stata quindi sottoposta a valutazione con RM e TC addominale con contrasto: sono state ottenute immagini con aspetto parenchimale simile alla milza. E’ stata eseguita una scintigrafia addominale con albumina umana colloidale radiomarcata con tecnezio sulla regione pelvica con scansioni planari e SPECT. I risultati hanno mostrato la presenza di un’area di captazione del radiofarmaco nella pelvi, mentre la milza è stata normalmente visualizzata. Questi ritrovamenti hanno confermato la presenza di una milza accessoria con una arteria originante dall’aorta ed una vena che si anastomizzava con la vena mesenterica superiore. Alla nostra conoscenza, nella letteratura, esiste solo un caso di vera milza ectopica localmente vascolarizzata nella pelvi.

Contrast-enhanced ultrasound (CEUS) is the application of ultrasound contrast agents (UCAs) to traditional medical sonography. The development of UCAs allowed to overcome some of the limitations of conventional B-mode and Doppler ultrasound techniques and enabled the display of the parenchymal microvasculature. Purpose of this paper is to delineate the elements of a solid and science-based technique in the execution of urinary bladder CEUS.We describe the technical execution of urinary bladder CEUS and the use of perfusion softwares to perform contrast enhancement quantitative analysis with generation of time-intensity curves from regions of interest.During CEUS, normal bladder wall shows a wash-in time of 13 s, a time to peak (TTP)40 s, a signal intensity (SI)45 % and a wash-out time80 s; Low-grade urothelial cell carcinoma (UCC) shows a wash-in time of 13 s, a time to peak TTP28 s, a SI45 % and a wash-out time of 40 s; High-grade UCC shows a wash-in time of 13 s, a TTP28 s, a SI50 % and a wash-out time of 58 s.CEUS is a useful tool for an accurate characterization of bladder UCC although it has some drawbacks. To avoid misunderstandings, a widely accepted classification and a standardized terminology about the most significant parameters of this application should be adopted in the immediate future.l'ecografia con mezzo di contrasto (CEUS) è l'ecografia medica tradizionale con l'utilizzo di mezzi di contrasto ecografici (MDCe). Lo sviluppo di MDCe ha consentito di superare alcune delle limitazioni dell'ecografia B-mode e Doppler convenzionali ed ha consentito la visualizzazione del microcircolo parenchimale. Scopo di questo lavoro è quello di delineare gli elementi di una tecnica solida e basata sull'evidenza scientifica per l'esecuzione della CEUS della vescica urinaria.Descriviamo l'esecuzione tecnica della CEUS della vescica urinaria e l'utilizzo di software di perfusione per l’esecuzione dell'analisi quantitativa dell’enhancement contrastografico con la generazione di curve intensità tempo (TIC) delle regioni di interesse (ROI).Durante la CEUS, la parete della vescica normale mostra un tempo di wash-in di 13 sec., un tempo di picco (TTP)40sec., una intensità di segnale (SI)45% e un tempo di wash-out80 sec.; il carcinoma uroteliale (CU) di basso grado mostra un tempo di wash-in di 13 sec., un tempo di picco (TTP)28sec., un’intensità di segnale (SI)45% e un tempo wash-out di 40 sec.; il CU di alto grado mostra un tempo di wash-in di 13 sec., un tempo di picco (TTP)28sec., un’intensità di segnale (SI)50% e un tempo di wash-out di 58 sec.La CEUS è uno strumento utile per una caratterizzazione accurata del CU della vescica anche se possiede alcuni svantaggi. Al fine di evitare incomprensioni, dovrebbero essere adottate in futuro, una classificazione largamente accettata e una terminologia standardizzata sui parametri più significativi di questa applicazione.