In the assessment of polytrauma patient, an accurate diagnostic study protocol with high sensitivity and specificity is necessary. Computed Tomography (CT) is the standard reference in the emergency for evaluating the patients with abdominal trauma. Ultrasonography (US) has a high sensitivity in detecting free fluid in the peritoneum, but it does not show as much sensitivity for traumatic parenchymal lesions. The use of Contrast-Enhanced Ultrasound (CEUS) improves the accuracy of the method in the diagnosis and assessment of the extent of parenchymal lesions. Although the CEUS is not feasible as a method of first level in the diagnosis and management of the polytrauma patient, it can be used in the follow-up of traumatic injuries of abdominal parenchymal organs (liver, spleen and kidneys), especially in young people or children.

Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) provides clinical guidelines for multiparametric magnetic resonance imaging (mpMRI) [T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)] of prostate. However, DCE-MRI seems to show a limited contribution in prostate cancer (PCa) detection and management. In our experience, DCE-MRI, did not show significant change in diagnostic performance in addition to DWI and T2WI [biparametric MRI (bpMRI)] which represent the predominant sequences to detect suspected lesions in peripheral and transitional zone (TZ). In this article we reviewed the role of DCE-MRI also indicating the potential contribute of bpMRI approach (T2WI and DWI) and lesion volume evaluation in the diagnosis and management of suspected PCa.

bpMRI can be used alternatively to mpMRI to detect and localize index prostate cancer.

Biparametric Magnetic Resonance Imaging (bpMRI) of the prostate combining both morphologic T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) is emerging as an alternative to multiparametric MRI (mpMRI) to detect, to localize and to guide prostatic targeted biopsy in patients with suspicious prostate cancer (PCa). BpMRI overcomes some limitations of mpMRI such as the costs, the time required to perform the study, the use of gadolinium-based contrast agents and the lack of a guidance for management of score 3 lesions equivocal for significant PCa. In our experience the optimal and similar clinical results of the bpMRI in comparison to mpMRI are essentially related to the DWI that we consider the dominant sequence for detection suspicious PCa both in transition and in peripheral zone. In clinical practice, the adoption of bpMRI standardized scoring system, indicating the likelihood to diagnose a clinically significant PCa and establishing the management of each suspicious category (from 1 to 4), could represent the rationale to simplify and to improve the current interpretation of mpMRI based on Prostate Imaging and Reporting Archiving Data System version 2 (PI-RADS v2). In this review article we report and describe the current knowledge about bpMRI in the detection of suspicious PCa and a simplified PI-RADS based on bpMRI for management of each suspicious PCa categories to facilitate the communication between radiologists and urologists.

Percutaneous ethanol injection (PEI) by ultrasound-guided fine-needle technique is a widely employed procedure in the treatment of hepatocellular carcinoma (HCC),1-3 and, in many cases, it is certainly preferable to other types of therapy, including ~u r g e r y~-~ and organ transp l a n t a t i~n .~ The most common complication of PEI are pain at the site of injection, fever, and a slight rise in aminotransferases. 8 We report a case of HCC in a patient with liver cirrhosis in which abscess formation was documented at the site of the neoplasia 7 months after PEI treatment. The accumulation of pus was drained by an ultrasound-guided percutaneous technique, with a late relapse. A second drainage associated with systemic antibiotic therapy resolved the infection. CASE REPORTA 74-year-old man with cryptogenic liver cirrhosis and a histologically confirmed, single, 3.4-cm HCC nodule in the right lobe (Figure 1) underwent PEI. The patient had a low platelet count (70,000 cells/mm3) and a prolonged prothrombin time (17 seconds). Ten injections using 2 mL to 5 mL of 92% to 95% ethanol were given between May and July 1990 through a 0.78-mm diameter, 17.78-cm long spinal needle (Becton-DickinsonRutherford, NJ). A computed tomography (CT) scan performed at the completion of therapy showed that the contrast enhancement in the area of the lesion had completely disappeared; a-fetoprotein levels, more than 400 ng/mL at the beginning of treatment, dropped to within the normal range (normal = 0 ng/mL to 15 ngimL). Subsequent ultrasound follow-up studies revealed no sign of relapse of the neoplastic disease.The patient was seen again in March 1991, seven months after the last PEI, due to fever (38" C to 38.5" C) preceded by shivers and pain in the right hypochondrium. Ultrasound evaluation disclosed an anechogenic collection of fluid in the area previously occupied by the neoplasm. The tumor appeared as a hyperechogenic, roundish image in the center of a fluid collection (Figure 2A,B). A liver CT scan confirmed these findings.

KEYWORDSLipoblastoma; Tumors of the neck and mediastinum; Ultrasonography; Computed tomography; Magnetic resonance imaging. Abstract Lipoblastomas are rare, benign tumors of mesenchymal origin that contain adipose tissue. They usually develop in the soft tissues of an extremity in infants, children, and young adolescents. We report the case of a 22-month old girl referred to our staff for swelling in the supraclavicular fossa, which was observed when the child cried. The ulstrasonographic examination revealed a mass in the anterosuperior portion of the mediastinum that extended into the right supraclacular fossa. The lesion was weakly hyperechoic with clear-cut margins and did not appear to invade surrounding tissues. On CT, it appeared inhomogeneously hypodense with denitometric characteristics of adipose tissue. On MRI, it was hyperintense on both T1-and T2-weighted sequences and reduced signal intensity in FAT SAT sequences. In light of the imaging features and predominant adipose tissue component, the mass was diagnosed as a mediastinal lipoblastoma, and this diagnosis was confirmed by surgical histology.Sommario Il lipoblastoma è una rara neoplasia mesenchimale, benigna, contenente tessuto adiposo, che colpisce l'infanzia e la prima adolescenza e che si localizza preferenzialmente nelle parti molli delle estremità. Nel nostro caso una bambina di 22 mesi è giunta alla nostra osservazione per una tumefazione della fossetta sovraclaveare che si rendeva manifesta durante il pianto. L'esame ecografico ha evidenziato una neoformazione del mediastino anterosuperiore a parziale sviluppo nella fossetta sovraclaveare destra, che appariva tenuemente iperecogena a margini netti. Tale neoformazione non presentava caratteristiche infiltrative nei confronti delle strutture limitrofe. La massa appariva alla TC disomogeneamente ipodensa, a densitometria adiposa, mentre alla RM risultava iperintensa nelle immagini T1 e T2-pesate, con abbattimento del segnale nelle sequenze FAT SAT. Le caratteristiche d'imaging ed in particolare la prevalenza di tessuto adiposo ci hanno suggerito l'ipotesi diagnostica di un lipoblastoma mediastinico, che è stata confermata dall'esame istologico eseguito sul pezzo operatorio. ª

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Objective: The aim of our research was to evaluate the usefulness of real-time ultrasound elastography (RTE) in the differential diagnosis between benign and malignant non-palpable and palpable testicular lesions in children and adults. Methods: B-mode ultrasonography, color/power Doppler, and RTE of 54 patients with 54 unilateral testicular lesions were retrospectively investigated. The imaging results were supported by histopathological examination in all cases. On RTE, the value of tissue rigidity was reported in a chromatic scale and categorized into three patterns: Soft (red), medium (green), and hard (blue). Results: Among the 54 testicular lesions, 35 measured more than 2 cm in diameter (32 malignant and 3 benignant tumors) while 19 were <2 cm (9 malignant and 10 benignant lesions). In the group of the 41 proved malignant tumors, RTE demonstrated hard pattern in 32 cases. Immature teratomas exhibited a mixed pattern, likely related to their heterogeneous content. In the testicular lesion diagnosis, RTE showed a 78% sensitivity, an 85% specificity, a 94% positive predictive value, a 55% negative predictive value, and an 80% accuracy in differentiating malignant from benignant lesions. The integration of ultrasound (US) with color/power Doppler and RTE showed a diagnostic accuracy of 100% and 90%, respectively. Conclusion: Integrated with conventional US methods, RTE increases the diagnostic accuracy of US and color/power Doppler in the differential diagnosis between benignant and malignant testicular lesions.