The usefulness of intraoperative ultrasonography (IOUS) has been documented in the Literature since the Eighties and, although its main applications are in hepatobiliary and pancreatic surgery, it has been used also in neurosurgery, cardiovascular and endocrine surgery. The continuous technical developments have led to an increase in the diagnostic accuracy of IOUS from the Eighties to now. The use of IOUS has increased in time together with the technical innovations until, mainly in the midnineties, its value was recognized by many surgeons. This results have been obtained with scanners that allow to depict fine anatomical details and detect small lesions in real time with extremely high spatial resolution. IOUS is able to shows fine details, such as primary or secondary lesions not detectable with other preoperative imaging modalities or tumor extension and its relationship with vessels. Assessment of resectability by IOUS may determine important changes in therapeutic planning. The role of IOUS, however, has recently been down-sized, especially in those centers where preoperative imaging is advanced. This article will review the clinical role of pancreatic IOUS in the different pancreatic pathologies.

Enhancement discrepancy between delayed-phase CEUS (hypoechogenicity) and CT (hyperdensity) is common semiological findings in the study of IPCC.

No abstract

The study shows that the sensitivity of the mammography programme was good, complying with European guideline recommendations. Assessment of IC-based early indicators of screening efficacy is feasible in a current screening programme and should become a routine procedure.

OBJECTIVE-The purpose of this study was to assess the diagnostic value of hepatocellular nodule vascularity after microbubble injection for characterization of malignancy in patients with cirrhosis of the liver.MATERIALS AND METHODS-After sulfur hexafluoride-filled microbubble injection, the vascularity of 236 hepatocellular nodules (1-5 cm in diameter) in 215 patients with cirrhosis (151 men, 64 women; mean age, 62 ± 11 [SD] years) was evaluated by consensus of three reference radiologists. The relation between nodule vascularity in the arterial (10-40 seconds from injection) and portal venous (45 seconds to microbubble disappearance) phases and dimension of malignancy was evaluated by multivariate U statistical analysis. Two blinded independent reviewers using reference criteria classified nodules as benign or malignant after review of unenhanced and contrastenhanced sonograms. RESULTS-The final diagnoses were 96 malignant (84 hepatocellular carcinoma, 12 tumors not hepatocellular carcinoma) and 140 benign nodules (57 regenerative and 13 dysplastic nodules, 70 other benign lesions). Nodule hypervascularity during the arterial phase and hypovascularity during the portal venous phase (odds ratio, 27.78) and nodule diameter greater than 2 cm combined with hypervascularity during the arterial phase and isovascularity or hypervascularity during the portal venous phase (odds ratio, 3.3) were related to the presence of malignancy. Contrast-enhanced sonography improved diagnostic accuracy (unenhanced sonography vs contrast-enhanced sonography, 32% vs 71% for reviewer 1 and 22% vs 66% for reviewer 2; p < 0.05, McNemar test) even though hypervascular nodules 2 cm or smaller (malignant, n = 2; benign, n = 40) that appeared isovascular or hypervascular during the portal venous phase were misclassified.CONCLUSION-Assessment of hepatocellular nodule vascularity after microbubble injection allowed characterization of malignancy, but characterization was limited for hypervascular nodules 2 cm or less in diameter. © American Roentgen Ray SocietyAddress correspondence to E. Quaia (equaia@yahoo.com).. Results indicate that because it allows reliable characterization of liver tumors, contrastenhanced sonography can be used for noninvasive diagnosis of HCC [7][8][9][10]. Sulfur hexafluoride-filled microbubbles can be insonated continuously with low transmit power (mechanical index, 0.08-0.21), which allows depiction of lesion vascularity in real time with better temporal resolution and contrast sensitivity than achieved with CT [11]. Although the diagnostic capabilities of contrast-enhanced sonography with real-time insonation for characterization of liver tumors have been analyzed in numerous studies [12][13][14][15][16][17][18][19][20], no previous study, to our knowledge, has been conducted to extensively analyze the diagnostic capabilities of contrast-enhanced sonography of patients with cirrhosis and biopsy-proven hepatic nodules. The aim of this study was to assess the diagnostic value of the vascularity of hepatocel...