Abstract
BackgroundThis study describes the feasibility of Contrast Enhanced Ultrasonography (CEUS) in the diagnostic work-up of non-cardiac thoracic disorders of small animals. The second aim is to assess the usefulness of CEUS as a direct guide for sample procedures.ResultsForty animals, 28 dogs and 12 cats, were included in the study. Thoracic disorders included 23 pulmonary lesions [primary carcinoma (14), lymphoma (1), sarcoma (1), histiocytic sarcoma (1), abscess (1) and pneumonia (5)] and 17 mediastinal lesions [lymphoma (8), thymoma (3), mesothelioma (1), melanoma (1), carcinomatous lymphadenopathy (1), mixsosarcoma (1), lipoma (1), and abscess (1)]. The majority of neoplastic pulmonary lesions showed an inhomogeneous distribution of contrast medium, whereas inflammatory lesions had a homogenous distribution with typical pulmonary vessels ramification. The majority of mediastinal malignant lesions showed an inhomogeneous distribution pattern. The lung and mediastinal abscesses had peripheral enhancement of the wall with an avascular center. All cytological and biopsy samples obtained after CEUS were diagnostic. Quantitative analysis, performed in 19/23 pulmonary lesions, showed a statistically significant difference (P < 0.0001) between the arrival time of the malignant (7.27 s - range 4.46–13.52 s) and benign (4.52 s - range 2.87–6.06 s) pulmonary lesions.ConclusionsCEUS may be a useful tool for the evaluation of non-cardiac thoracic lesions. The contrast medium allows for the precise definition of lesion edges, the presence of necrotic areas, and the distribution of pulmonary vessels.Based on our preliminary results, the use of ultrasonographic contrast medium can be recommended for improving the diagnostic usefulness of cytology and biopsy sampling, because CEUS may help to define necrotic areas from viable tissue.
Highlights
This study describes the feasibility of Contrast Enhanced Ultrasonography (CEUS) in the diagnostic work-up of non-cardiac thoracic disorders of small animals
The following perfusion variables were recorded: arrival time (AT, expressed in sec), defined as the time when the contrast signal is increasing to greater than about 10% of the peak intensity; time to peak from injection (TTPinj, expressed in sec); time to peak from initial rise (TTPinr, expressed in sec) calculated as TTPinj – Arrival time (AT); peak intensity (PI, expressed in arbitrary units [a.u.]) was defined as the highest intensity value minus baseline intensity before the initial rise; and wash-in rate (Wi, expressed in a.u./sec) was calculated with the data 10% above baseline intensity (BI) up to 85% of the peak value using a linear regression
In conclusion, we have demonstrated the feasibility of CEUS in the evaluation of canine and feline lung and mediastinal disorders
Summary
This study describes the feasibility of Contrast Enhanced Ultrasonography (CEUS) in the diagnostic work-up of non-cardiac thoracic disorders of small animals. The role of contrast-enhanced ultrasonography (CEUS) in the diagnosis of pathological conditions of the thorax and the appearances of different non-cardiac thoracic lesions have been reported [10,11,12,13,14,15]. Based on the dual arterial blood supply of the lung (i.e., pulmonary and bronchial arteries), the behavior of contrast medium in the lung parenchyma is similar to the liver (i.e., dual vascular supply characterized by arterial and portal feeding). The two most important parameters used in human medicine to discriminate benign from malignant lesions is the time until contrast enhancement and the distribution of the contrast medium Benign lesions such as pneumonia commonly have a short time to enhancement and show intense and homogenous tissue enhancement with a regular, tree-like distribution of pulmonary arterial vessels. Neoplastic lesions often present neoangiogenesis originating mainly from the bronchial arteries, creating an inhomogeneous tissue enhancement because of chaotic vascularization [11, 15]
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