ObjectivesTo assess the ability of Real-time Elastography (RTE) to differentiate malignant from benign testicular lesions.MethodsIn 88 testicles ultrasound identified 144 lesions, which were examined by RTE. Elasticity images of the lesions were assigned the colour-coded score of Itoh (Radiology 2006), according to the distribution of strain induced by light compression. RTE findings were analysed considering shape (nodular/pseudo-nodular), size (<5 mm, 6–10 mm, >11 mm) and score (SC1-5) of the lesions.Results93.7% of all benign lesions showed a complete elastic pattern (SC1). 92.9% of benign nodules <5 mm and 100% of the pseudonodules showed a nearly complete elastic pattern (mainly SC1). 87.5% of malignant nodules showed a stiff pattern (SC4-5). RTE gave 87.5% sensitivity, 98.2% specificity, 93.3% positive predictive value, 96.4% negative predictive value and 95.8% accuracy in differentiating malignant from benign lesions.ConclusionsRTE is a useful technique in assessing small testicular nodules and pseudo-nodules. This is relevant in clinical practice allowing expectant management in RTE selected cases. The role of RTE seems less relevant for larger lesions because most of them are malignant at clinical and ultrasound assessment, limiting RTE to simply confirmation role.Key Points• An emerging role for Elastography in allowing surveillance for small testicular lesions• Elastography can better differentiate benign from malignant testicular lesions• Follow up can be reduced for elastic testicular lesions at Elastography.

Primary and metastatic tumors of the liver can be treated successfully with transcatheter chemoembolization (TACE) during selective arterial catheterism. Arteritis is a possible referred side effect which can lead to tortuosity of the arteries, stenosis and occlusion of vessels. In our hospitals 117 consecutive patients were treated with TACE from January 1990 to December 1992; 61 patients were affected by hepatocellular carcinoma (HCC) and 56 were affected by metastases from colorectal carcinoma. Each patient received from 1 to 4 treatments at monthly intervals using epirubicin/Lipiodol ultrafluid (E/LUF) or a mixture of epirubicin and mitomicin C (MC)/LUF and followed by gelatine sponge injection in the hepatic artery. Selective angiography performed 30-62 days after the first chemoembolization showed artery stenosis in 7 patients and thrombosis in 2 cases related to toxic arteritis due to chemoembolization. Reports about arteritis during TACE treatments are discussed.

Vector flow imaging is as effective as color Doppler imaging in the detection of flow disturbances, but it is more powerful in the assessment of complex flow patterns.

Real-time elastography can distinguish the elastic properties of the prostate and define the normal patterns associated with increases in gland volume.

Parole chiave: lesioni intracerebrali -ecografia intraoperatoria RIASSUNTO -Gli autori hanno utilizzato un sistema ecografico durante interventi chirurgici sull'encefalo al fine di identificare l'esatta topografia ed i limiti delle lesioni intraparenchimali.Tutte le lesioni sono state facilmente riconosciute dagli ultrasuoni. In tutti i pazienti e stato possibile limitare il traumatismo chirurgico sui parenchima sano e ridurre il tempo di intervento.Gli autori prendono in considerazione alcuni aspetti tecnici di questa metodica ed i primi risultati raggiunti in una casistica di 32 pazienti. SUMMARY-The authors describe their experience in identifging topography and limits of intracranial lesions , by means of ultrasound devices, during neurosurgical procedures. All the lesions have been easily identified by US. In all patients it was possible to reduce both the surgical trauma, on healthy brain parenchima, and the time of intervention.The authors describe so.me technical points of the method and the first results on a series of 32 patients. IntroduzioneSono state proposte svariate tecniche di centratura preoperatoria delle lesioni cerebrali sfruttando le metodiche di formazione delle immagini quali TC e RMN.Piu recentemente e stata suggerita l'introduzione degli ultrasuoni (US) nell'identificazione direttamente in sede intraoperatoria delle lesioni cerebrali 3,6,9, 10, 12, 14 . Tutto cio e stato consentito dallo sviluppo tecnologico delle apparecchiature US che permettono una facile identificazione bidimensionale di lesioni sia superficiali che profonde con ottima risoluzione spaziale 7 • 12 • 14 • L'uso intraoperatorio in neurochirugia richiede alcuni specifici accorgimenti per rendere l'esame di facile comprensione e senza danno peril paziente.In questa nota ci proponiamo di presentare le nostre prime esperienze sull'uso intraoperatorio degli US in 32 pazienti operati presso la Divisione di Neurochirurgia dell'Ospedale di Varese. Materiali e metodiDal giugno 1986 al dicembre 1987 abbiamo effettuato 32 ecografie intraoperatorie in altrettanti interventi neurochirurgici cerebrali. Si trattava di 21 pazienti maschi e 11 femmine con eta media di 38,5. Sono state utilizzate apparecchiature real time (Diasonics DRF 100, SPA 1000) dotate di sonde «small parts» da 7,5 e 10 MHz con scansione settoriale meccanica. Si tratta di apparecchiature e di sonde non specifiche per l'uso intraoperatorio.Gli esami US sono sempre stati eseguiti in due tempi: una prima fase a dura madre chiusa (transdurale) ed una successiva dopa l'apertura ed il ribaltamento della dura (transcorticale). 63