Ultrasound findings in paediatric cholestasis: how to image the patient and what to look for

Paediatric biliary tract and gallbladder diseases include a variety of entities with a wide range of clinical presentations. Cholestasis represents an impaired secretion of bilirubin by hepatocytes, manifesting with high blood levels of conjugated bilirubin and jaundice. Various causes may be involved, which can be recognised analysing blood tests and hepatobiliary imaging, while sometimes liver biopsy or surgery may be necessary. High-resolution real-time ultrasonography is an important tool for differentiation of obstructive and non-obstructive causes of jaundice in infants and children. In this paper, we briefly review the normal anatomy and the ultrasound aspects of main pathologies affecting gallbladder and biliary tree in neonatal and paediatric age

Paediatric liver ultrasound: a pictorial essay

Ultrasound scan is a painless and radiation-free imaging modality and, therefore, it is widely considered the first-choice diagnostic tool in the setting of hepatopathies in paediatric patients. This article focuses on the normal ultrasound anatomy of the liver in neonatal and paediatric age and reviews the ultrasound appearance of the most common diffuse and focal liver affections

Magnetic Resonance Imaging in the Pre-Surgical Staging of Breast Cancer: Our Experience

Purpose: To investigate the clinical impact of magnetic resonance imaging (MRI) in the detection of multifocal\u2013multicentric breast cancers, already identified by mammography and ultrasound, and analyzed histologically, to evaluate its role in preoperative staging. Materials and methods: From January 2012 to February 2014, 188 patients, aged 28 to 74\ua0years, newly diagnosed with breast cancer on conventional imaging (mammography and ultrasound) were enrolled. They underwent preoperative contrast-enhanced 3T MRI. Patients underwent surgery according to international guidelines. Results of all diagnostic procedures were compared. Results: Among the 188 patients, 163 (87%) had a unilateral and unifocal tumor at both conventional imaging; MRI diagnosed 22/22 (100%) of multifocal and multicentric tumors, the combination of mammography and ultrasound diagnosed 12/22 (54%), and mammography alone diagnosed 8/22 (36%) multifocal and multicentric tumors. MRI prompted a change in surgical strategy in 10/188 (5%) patients. This change comprised mastectomy instead of conservative surgery (n = 7) and more extensive conservative surgery (n = 3). Conclusions: MRI was confirmed to show higher sensitivity than conventional imaging in detecting multifocal and multicentric breast cancers

Can Diffusion-Weighted Imaging and Related Apparent Diffusion Coefficient be a Prognostic Value in Women With Breast Cancer?

Purpose: To analyze diffusion-weighted imaging (DWI) and the related apparent diffusion coefficient (ADC) in women with breast cancer, correlating these values with the presence at 3years of distant metastases, and to demonstrate that DWI-Magnetic Resonance Imaging (MRI) and related ADC values may represent a prognostic value in the study of women with breast cancer. Materials and methods: Sixty women (aged 45-73 years) affected with breast cancer with a follow-up in 3years were enrolled. On DWI, we obtained the ADC values, and these were correlated with the clinical condition of patients at 3years. Moreover, tumour size, lymph node status, and molecular markers, including estrogens receptor, progesterone receptor, Ki-67 index, and human growth factor receptor 2 protein, were correlated with ADC values. This study was approved by the Scientific Committee of our institution. Results: We considered patients with metastasis at 3years (12 patients - 20%) and without metastasis (48 patients - 80%). The mean ADC value in patients with no metastases at 3years was 1.06 +/- 0.38, while for patients with metastases it was 0.74 +/- 0.34 (p = .011). The receiver-operator curve analysis identified a value of 0.75 (<0.75 with risk to develop metastasis) as the best predictive cutoff for ADC values, with the highest sensitivity (81.25%) and higher specificity (66.67%). After regression analysis, ADC value, positivity to estrogen-progestin receptors, and presence of lymph nodes were the only prognostic factors found to be statistically significant. Conclusions: DWI-MRI and related ADC values may represent a prognostic value in women with breast cancer

Can Diffusion-Weighted Imaging and Related Apparent Diffusion Coefficient be a Prognostic Value in Women With Breast Cancer?

Purpose: To analyze diffusion-weighted imaging (DWI) and the related apparent diffusion coefficient (ADC) in women with breast cancer, correlating these values with the presence at 3 years of distant metastases, and to demonstrate that DWI-Magnetic Resonance Imaging (MRI) and related ADC values may represent a prognostic value in the study of women with breast cancer. Materials and methods: Sixty women (aged 45–73 years) affected with breast cancer with a follow-up in 3 years were enrolled. On DWI, we obtained the ADC values, and these were correlated with the clinical condition of patients at 3 years. Moreover, tumour size, lymph node status, and molecular markers, including estrogens receptor, progesterone receptor, Ki-67 index, and human growth factor receptor 2 protein, were correlated with ADC values. This study was approved by the Scientific Committee of our institution. Results: We considered patients with metastasis at 3 years (12 patients – 20%) and without metastasis (48 patients – 80%). The mean ADC value in patients with no metastases at 3 years was 1.06 ± 0.38, while for patients with metastases it was 0.74 ± 0.34 (p = .011). The receiver–operator curve analysis identified a value of 0.75 (<0.75 with risk to develop metastasis) as the best predictive cutoff for ADC values, with the highest sensitivity (81.25%) and higher specificity (66.67%). After regression analysis, ADC value, positivity to estrogen–progestin receptors, and presence of lymph nodes were the only prognostic factors found to be statistically significant. Conclusions: DWI-MRI and related ADC values may represent a prognostic value in women with breast cancer