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BACKGROUND: Information on interference injuries in racehorses is lacking. OBJECTIVE: To describe clinical findings and prognosis of palmar forelimb interference injuries in Standardbreds. STUDY DESIGN: Retrospective cohort study. METHODS: Records of 74 racehorses sustaining palmar forelimb interference injuries were studied; 7 occurred during training and 67 during racing. The number of starts before injury, hind shoeing status, gait penalties and racing speeds in cases occurring during racing were compared with negative controls (67 age, sex and speed category matched horses) from the same races. The number of starts and racing speed in 30 racing days preceding recruitment were compared with those following recruitment (negative controls) or return to racing (cases). Clinical aspects and outcome in interference-induced superficial digital flexor (SDF) tendonitis were compared with 77 horses with overstrain-induced SDF tendonitis. RESULTS: In 89% of cases, there was SDF tendonitis and this was associated with a longer time to return to racing (6 months vs. 1 months; P<0.001). The presence of gait penalties (odds ratio (OR) 11.13; 95% CI 3.74, 41.64; P<0.001) and unshod hind feet (OR = 6.26, 95% CI 2.26, 19.62; P<0.001) increased risk of interference injuries. After recruitment/return to racing, horses with interference injuries participated in a lower number of races (24 starts per racing day, interquartile range [IQR] 20-32) compared with controls (49, IQR 43-55, P<0.0001). Interference-induced tendonitis cases (n = 58) had a shorter time to return to racing (245 ± 137 days) than overstrain-induced tendonitis cases (331 ± 118 days, P<0.001). MAIN LIMITATIONS: Data were collected retrospectively; time of ultrasonographic assessment varied and health status of the racing controls is unknown. CONCLUSIONS: SDF tendonitis is common with palmar forelimb interference injuries in Standardbreds and increases time to return to racing. Interference-induced SDF tendonitis has a better prognosis than overstrain-induced tendonitis.

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REASONS FOR PERFORMING STUDY: In equine castration, application of a ligature on the spermatic cord to prevent complications such as haemorrhage and evisceration has been reported with controversial results. Characteristics of commonly used knots have not been studied. OBJECTIVES: To compare the modified transfixing and giant knots and the emasculator in open and closed equine castration techniques. STUDY DESIGN: Ex vivo experiment. METHODS: A total of 144 testicles were randomly assigned to 2 groups for open or closed castration. Both groups were divided into 3 subgroups of 18 specimens each: emasculator only, emasculator plus giant knot and emasculator plus transfixing knot and the open castration group also contained 2 further subgroups of 18 testicles each: giant knot only and transfixing knot only. The length of suture material used was measured for each knot and the leaking pressure of the testicular artery measured using dye injection. In the closed castration group, parietal tunic tensile strength was measured with a tensiometer. RESULTS: Leaking pressure was higher in open compared with closed castration, with no significant difference among subgroups. In the closed castration group, minimum leaking pressure for the emasculator plus transfixing knot and emasculator only subgroups were close to standard physiological arterial pressures. The giant knot required less suture material than the transfixing knot. Parietal tunic tensile strength was higher when ligatures were applied. CONCLUSIONS: The giant and transfixing knot techniques have comparable haemostatic capability and parietal tunic tensile strength, but the giant knot requires less suture material. In open castration, using the emasculator alone may produce adequate haemostasis. In closed castration, using the giant knot in combination with the emasculator increases the bursting pressure and possibly reduces the incidence of haemorrhage. In closed castration, application of a ligature may reduce the risk of evisceration.

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PURPOSE: To compare ultrasound (US), low-mechanical index contrast enhanced US (CEUS) and multidetector-CT (MDCT) for the detection of hepatic metastases from colorectal cancer. METHODS AND MATERIALS: From January to June 2006, 110 patients (65 males, 45 females; mean age 62 years; range 39-78) with suspected hepatic lesions from colorectal cancer were prospectively evaluated with US, CEUS and MDCT by two independent readers. Intraoperative ultrasonography (IOUS, n = 45) or a follow-up up for at least 6 months by using MDCT or Gd-BOPTA-enhanced MRI was considered the gold standard. McNemar test was employed. RESULTS: Reference standards revealed 430 metastases in 110 patients. On a patient-by-patients analysis, CEUS improved US sensitivity from 67.4-71.6% to 93.4-95.8% (p < 0.05). On a lesion-by-lesion analysis, CEUS improved the sensitivity of US from 60.9-64.9% to 85.3-92.8% (p < 0.001). The specificity increased from 50-60% to 76.7-83.3%. No significant differences in sensitivity or specificity between CEUS and MDCT were found. Contrast-enhanced US was significantly more sensitive than baseline US in the detection of metastases smaller than 1 cm (p < 0.001) with an increase in sensitivity from 29.1-35% to 63.3-76.6% no significant statistical difference was identified when compared with MDCT (sensitivity of 73.3-75.8%). CONCLUSIONS: CEUS is significantly more accurate than US and highly comparable with MDCT in the detection of liver metastases from colorectal cancer. Therefore, in the evaluation of patients with suspected hepatic metastases from colorectal tumour, US examination must be performed after contrast administration.

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PURPOSE: Fascioliasis is a rare zoonotic disease caused by the trematode Fasciola hepatica. We present the typical patterns of hepatobiliary fascioliasis observed in ten patients studied with multimodality imaging. MATERIALS AND METHODS: Between 2002 and 2005, ten women with fascioliasis were admitted to the Brigham and Women's Hospital, Harvard Medical School (BWH), with abdominal pain and mild fever. All imaging modalities, including ultrasound (US), computed tomography (CT), magnetic resonance (MR) imaging (n = 2) and endoscopic retrograde cholangiopancreatography (ERCP) (n = 1) were reviewed by two expert radiologists working in consensus. RESULTS: In all patients (10/10, 100%), US showed parenchymal heterogeneity characterised by multiple subcapsular and peribiliary hypoechoic nodular lesions that were ill-defined and coalesced into tubular or tortuous structures. In six patients (6/10, 60%), the lesions appeared hypoechoic, whereas in four patients (4/10, 40%), there was an alternation of hyperechoic and hypoechoic nodules. On CT, all patients (10/10, 100%) showed hypodense patchy lesions in subcapsular, peribiliary or periportal locations, which coalesced to form tubular structures and were more evident during the portal phase. Lesion diameter ranged from 2 cm to 7 cm. Capsular enhancement was seen in four cases on CT (4/10, 40%) and in one also at MR imaging. MR imaging, performed in two patients, confirmed the presence of the lesions, which appeared hyperintense on T2-weighted images and were characterised by mild peripheral enhancement after gadolinium administration. Four patients had gallbladder wall thickening (4/10, 40%), with parasites in the gallbladder lumen. CONCLUSIONS: Although rare, hepatobiliary fascioliasis should be considered in the differential diagnosis in the appropriate clinical scenario, especially in patients coming from endemic areas. The typical imaging pattern of fascioliasis is the presence of subcapsular, peribiliary or periportal nodules that are usually ill-defined and coalesce, giving rise to a tubular or tortuous appearance.

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PURPOSE: The present study was conducted to assess the efficacy of contrast-enhanced ultrasound with low mechanical index in evaluating the response of percutaneous radiofrequency ablation treatment of hepatocellular carcinoma by comparing it with 4-row spiral computed tomography. MATERIALS AND METHODS: 100 consecutive patients (65 men and 35 women; age range: 62 - 76 years) with solitary hepatocellular carcinomas (mean lesion diameter: 3.7 cm +/- 1.1 cm SD) underwent internally cooled radiofrequency ablation. Therapeutic response was evaluated at one month after the treatment with triple-phasic contrast-enhanced spiral CT and low-mechanical index contrast-enhanced ultrasound following bolus injection of 2.4 ml of Sonovue (Bracco, Milan). 60 out of 100 patients were followed up for another 3 months. Contrast-enhanced sonographic studies were reviewed by two blinded radiologists in consensus. Sensitivity, specificity, NPV and PPV of contrast-enhanced ultrasound examination were determined. RESULTS: After treatment, contrast-enhanced ultrasound identified persistent signal enhancement in 24 patients (24 %), whereas no intratumoral enhancement was detected in the remaining 76 patients (76 %). Using CT imaging as gold standard, the sensitivity, specificity, NPV, and PPV of contrast enhanced ultrasound were 92.3 % (95 % CI = 75.9 - 97.9 %), 100 % (95 % CI = 95.2 - 100 %), 97.4 % (95 % CI = 91.1 - 99.3 %), and 100 % (95 % CI = 86.2 - 100 %). CONCLUSION: Contrast-enhanced ultrasound with low mechanical index using Sonovue is a feasible tool in evaluating the response of hepatocellular carcinoma to radiofrequency ablation. Accuracy is comparable to 4-row spiral CT.

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PURPOSE: To assess the efficacy of low mechanical index (MI) real time grey scale contrast-enhanced US (CEUS) in the differentiation of breast lesions in comparison to Magnetic Resonance Imaging (MRI). MATERIALS AND METHODS: 50 lesions previously detected at mammography or conventional US were evaluated by means of CEUS and MRI. Contrast-enhanced examinations were performed with a dedicated equipment (Esatune, Esaote, Genoa, Italy), before and after injection of 4.8 ml of Sonovue (Bracco, Milan, Italy). MRI was conducted with a 1.5 T equipment (Siemens Vision Plus, Erlangen, Germany) with bilateral dedicated superficial coil, on T2w STIR and 3D Flash T1w before and 1, 2, 3, 4, 5 minutes after the administration of contrast agent (Gd-DTPA, 1.5 ml/kg). Wash-in and wash-out curves were assessed for both procedures. A specific sonographic quantification software (Qontrast, Bracco, Milan, Italy), based on pixel by pixel signal intensity over time, was used to obtain contrast-enhanced sonographic perfusion maps for each lesion. Mc Nemar test was then calculated. RESULTS: 24 invasive ductal carcinomas, 18 fibroadenomas, 4 fibro-cystic dysplasias, 1 mucinous carcinoma, 1 invasive ducto-lobular carcinoma, 1 intraductal florid papillomatosis and 1 phylloides tumour were diagnosed. Contrast-enhanced sonographic patterns correlated well with those provided by MRI. Sensitivity, specificity, and accuracy of US were: 69.2 %, 66.7 %, and 68 %, respectively. According to the different contrast enhancement patterns and the resulting perfusion maps, all the malignant lesions and 9 out of 12 benign lesions were correctly diagnosed, thus resulting in 87.5 % of specificity and 100 % of sensitivity. Regarding the specificity, there is no difference between US and CEUS with McNemar (p = 0.18). Regarding sensitivity, the difference between contrast-enhanced US and US is significant as calculated with McNemar test (p = 0.013). The three lesions which were incorrectly classified as malignant were two hypervascularised fibroadenomas in young women and a phylloides tumour. CONCLUSION: CEUS seems to be a reliable method to differentiate breast lesions, since it provides typical enhancement patterns. Contrast sonographic perfusion curves correlate well with MRI wash in--wash out curves.

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Transplantation is considered definitive therapy for acute or chronic irreversible pathologies of the liver, and the increased survival rates are mainly due to improved immunosuppressive therapies and surgical techniques. However, early diagnosis of possible graft dysfunction is crucial to liver graft survival. Diagnostic imaging plays an important role in the evaluation of the liver before and after transplant and in the detection of complications such as vascular and biliary diseases, acute and chronic rejection and neoplastic recurrence. Integrated imaging using color-Doppler, CT, MRI and traditional x-ray reach a high level of sensitivity and specificity in the management of transplanted patients.

SommarioIl trapianto epatico è il migliore trattamento per l'insufficenza epatica terminale.Il miglioramento della sopravvivenza postoperatoria è dovuta soprattutto al perfezionamento della terapia immunosoppressiva e delle tecniche chirurgiche.L'imaging radiologico riveste un ruolo importante sia per la valutazione preoperatoria dei pazienti, identificando eventuali varianti anatomiche che richiedono una modifica della tecnica chirurgica, sia per la diagnosi e la terapia precoce delle complicanze post trapianto, contribuendo alla riduzione della mortalità e della morbilità.

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