3D Contrast-enhanced Ultrasound Research Articles

3D fusion is superior to 2D point-to-point contrast-enhanced US to evaluate the ablative margin after RFA for hepatocellular carcinoma.

To compare the efficiency of three-dimensional (3D) and two-dimensional (2D) contrast-enhanced ultrasound (CEUS)-derived techniques in evaluating the ablative margin (AM) after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). In total, 98 patients with 98 HCCs were enrolled. The 2D CEUS point-to-point imaging (2D CEUS-PI) was conducted by comparing the pre- and post-RFA 2D CEUS images manually, and the 3D CEUS fusion imaging (3D CEUS-FI) was conducted by fusing the pre- and post-RFA 3D CEUS images automatically. These two techniques were compared in distinguishing an adequate AM ≥ 5mm. Risk factors for local tumor progression (LTP) after RFA were analyzed by the Kaplan-Meier method with log-rank test. The mean registration time of 3D CEUS-FI and 2D CEUS-PI was 5.0 and 9.3min, respectively (p < 0.0001). The kappa coefficient was 0.680 for agreement between 2D CEUS-PI and 3D CEUS-FI in the evaluation of AM (p < 0.0001). Tumors with AM < 5mm by 2D CEUS-PI were all identified as AM < 5mm by 3D CEUS-FI. Nonetheless, 16 (26%) tumors identified as AM ≥ 5mm by 2D CEUS-PI were re-classified as AM < 5mm by 3D CEUS-FI. During a median follow-up time of 31.2months (range, 3.2-66.0months), LTP was identified in 8 tumors. The estimated 1-/2-/3-year cumulative incidence of LTP was 4.4%, 8.1%, and 10.3%, respectively. Higher estimated cumulative incidence of LTP was identified in tumors with AM < 5mm by 2D CEUS-PI (at 3-year, 27.2% vs 0%; p < 0.001), and by 3D CEUS-FI (at 3-year, 20.7% vs 0%; p = 0.004). 3D CEUS-FI excelled in the evaluation of AM when compared with 2D CEUS-PI. With equivalent efficacy in the prediction of LTP, 3D CEUS-FI was superior to 2D CEUS-PI for its automatic and time-saving procedure. 3D CEUS fusion imaging may serve as an effective tool in evaluating ablative margin and predicting local tumor progression after RFA in HCC. • Both 2D and 3D CEUS-derived techniques could evaluate ablative margin (AM) after RFA for hepatocellular carcinoma. • 3D CEUS fusion imaging was more precise in the evaluation of AM compared to 2D CEUS point-to-point imaging, with advantages of its automatic and time-saving procedure. • An inadequate AM < 5mm evaluated by CEUS-derived techniques was the only risk factor of LTP after RFA for hepatocellular carcinoma (p < 0.001 for 2D CEUS point-to-point imaging, and p = 0.004 for 3D CEUS fusion imaging).

MP33-04 CONTRAST-ENHANCED ULTRASONOGRAPHY FOR THE EVALUATION OF COMPLEX RENAL CYSTS

You have accessJournal of UrologyCME1 May 2022MP33-04 CONTRAST-ENHANCED ULTRASONOGRAPHY FOR THE EVALUATION OF COMPLEX RENAL CYSTS Cassra Clark, Corinne Wessner, Shuo Wang, Andrew Denisenko, Andrew Shumaker, Joonyau Leong, Andrea Quinn, Erica Mann, Lydia Glick, Timothy Han, Kibo Nam, Katherine Smentkowski, John Eisenbrey, Leonard Gomella, Edouard Trabulsi, Costas Lallas, Mark Mann, James Mark, Flemming Forsberg, Andrej Lyshchik, Ethan Halpern, and Thenappan Chandrasekar Cassra ClarkCassra Clark More articles by this author , Corinne WessnerCorinne Wessner More articles by this author , Shuo WangShuo Wang More articles by this author , Andrew DenisenkoAndrew Denisenko More articles by this author , Andrew ShumakerAndrew Shumaker More articles by this author , Joonyau LeongJoonyau Leong More articles by this author , Andrea QuinnAndrea Quinn More articles by this author , Erica MannErica Mann More articles by this author , Lydia GlickLydia Glick More articles by this author , Timothy HanTimothy Han More articles by this author , Kibo NamKibo Nam More articles by this author , Katherine SmentkowskiKatherine Smentkowski More articles by this author , John EisenbreyJohn Eisenbrey More articles by this author , Leonard GomellaLeonard Gomella More articles by this author , Edouard TrabulsiEdouard Trabulsi More articles by this author , Costas LallasCostas Lallas More articles by this author , Mark MannMark Mann More articles by this author , James MarkJames Mark More articles by this author , Flemming ForsbergFlemming Forsberg More articles by this author , Andrej LyshchikAndrej Lyshchik More articles by this author , Ethan HalpernEthan Halpern More articles by this author , and Thenappan ChandrasekarThenappan Chandrasekar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002587.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Complex renal cysts are evaluated using the Bosniak classification system. However, they remain difficult to manage because inter-reader variability and subjective interpretation of the Bosniak system. This pilot study intends to evaluate the use of contrast-enhanced ultrasonography (CEUS) to differentiate the solid and cystic components of complex renal cysts and compare these results to the final surgical pathology report. METHODS: 23 patients undergoing surgery for Bosniak 2F-4 lesions participated in this IRB-approved pilot study. Patients were scanned prior to surgery with both 2D and 3D ultrasound exams. Each injection consisted of a 2.0 mL bolus injection of Lumason contrast (Bracco Imaging, Monroe Township, NJ) followed by a 10 mL saline flush. A custom MATLAB program was used for selection of regions of interest (ROIs) (Figure 1). Fractional tumor vascularity (FTV in %) was then calculated and compared to estimated solid component on the final pathology report.Fractional Tumor Vascularity = 1 − (Total Non-enhancing area/Total lesion area) The primary endpoint of this study was the correlation of 2D/3D-derived fractional vascularity with pathological estimation and tumor staging on explant. RESULTS: No adverse events were observed during any contrast agent administration. Data was analyzed on 22 of 23 patients (Patient 22 excluded due to poor image quality). Mean age was 60.9±15.0 years (range 30 to 85) and mean preoperative lesion size was 4.0±1.6 cm (range 1.2 to 8.3 cm). Nine patients had radical nephrectomies and 14 had a partial nephrectomy. On final pathology, 4 lesions were benign and 19 were malignant. The results of 2D and 3D analysis as well as final pathology are included in Table 1. In general, malignant lesions and more aggressive histology had higher FTV. CONCLUSIONS: Quantitative 2D and 3D CEUS can evaluate FTV of potentially malignant complex cystic renal masses, which may be able to augment current radiographic classification systems. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e570 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cassra Clark More articles by this author Corinne Wessner More articles by this author Shuo Wang More articles by this author Andrew Denisenko More articles by this author Andrew Shumaker More articles by this author Joonyau Leong More articles by this author Andrea Quinn More articles by this author Erica Mann More articles by this author Lydia Glick More articles by this author Timothy Han More articles by this author Kibo Nam More articles by this author Katherine Smentkowski More articles by this author John Eisenbrey More articles by this author Leonard Gomella More articles by this author Edouard Trabulsi More articles by this author Costas Lallas More articles by this author Mark Mann More articles by this author James Mark More articles by this author Flemming Forsberg More articles by this author Andrej Lyshchik More articles by this author Ethan Halpern More articles by this author Thenappan Chandrasekar More articles by this author Expand All Advertisement PDF DownloadLoading ...

State of the Art: Contrast Enhanced 4D Ultrasound to Monitor or Assess Locoregional Therapies

AbstractLocoregional therapies (LRTs) are an essential management tool in the treatment of primary liver cancers or metastatic liver disease. LRTs include curative and palliative modalities. Monitoring treatment response of LRTs is crucial for maximizing benefit and improving clinical outcomes. Clinical use of contrast-enhanced ultrasound (CEUS) was introduced more than two decades ago. Its portability, cost effectiveness, lack of contraindications and safety make it an ideal tool for treatment monitoring in numerous situations. Two-dimensional dynamic CEUS has been proved to be equivalent to the current imaging standard in the guidance of LRTs, assessment of their adequacy, and detection of early tumor recurrence. Recent technical advances in ultrasound transducers and image processing have made 3D CEUS scanning widely available on most commercial ultrasound systems. 3D scanning offers a broad multiplanar view of anatomic structures, overcoming many limitations of two-dimensional scanning. Furthermore, many ultrasound systems provide real-time dynamic 3D CEUS, also known as 4D CEUS. Volumetric CEUS has shown to perform better than 2D CEUS in the assessment and monitoring of some LRTs. CEUS presents a valid alternative to the current imaging standards with reduced cost and decreased risk of complications. Future efforts will be directed toward refining the utility of 4D CEUS through approaches such as multi-parametric quantitative analysis and machine learning algorithms.

Diagnostic accuracy of three-dimensional contrast-enhanced ultrasound for focal liver lesions: A protocol for systematic review and meta-analysis.

Background:Contrast-enhanced ultrasound (CEUS) examination is a well-established technique for this purpose with several unique advantages. It is a real-time technology with high temporal resolution. With its unique ability to detect microvascular perfusion, it helps in better characterization of FLL.[1–4] Three-dimensional (3D) CEUS with quantitative analysis is updated in recent years. 3D-CEUS is a new ultrasonic diagnostic technique, which can observe the nourishing vessels of lesions from multiple angles. Previous studies showed that 3D-CEUS can detect tumor nourishing vessels to differentiate benign from malignant focal liver lesions (FLLs). However, the results of these studies have been contradictory. Therefore, this meta-analysis tested the hypothesis that 3D-CEUS is accurate in distinguishing benign and malignant FLLs.Methods:We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the April 30, 2021, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software will be used for data analysis.Results:This systematic review will determine the accuracy of 3D-CEUS in the differential diagnosis between benign and malignant FLLs.Conclusion:Its findings will provide helpful evidence for the accuracy of 3D-CEUS in the differential diagnosis between benign and malignant FLLs.Systematic review registration:INPLASY202150096.

Contrast-enhanced ultrasound with dispersion analysis for the localization of prostate cancer: correlation with radical prostatectomy specimens.

To determine the value of two-dimensional (2D) contrast-enhanced ultrasound (CEUS) imaging and the additional value of contrast ultrasound dispersion imaging (CUDI) for the localization of clinically significant prostate cancer (csPCa). In this multicentre study, subjects scheduled for a radical prostatectomy underwent 2D CEUS imaging preoperatively. CUDI maps were generated from the CEUS recordings. Both CEUS recordings and CUDI maps were scored on the likelihood of presenting csPCa (any Gleason ≥ 4 + 3 and Gleason 3 + 4 larger than 0.5mL) by five observers and compared to radical prostatectomy histopathology. An automated three-dimensional (3D) fusion protocol was used to match imaging with histopathology. Receiver operator curve (ROC) analysis was performed per observer and imaging modality. 133 of 216 (62%) patients were included in the final analysis. Average area under the ROC for all five readers for CEUS, CUDI and the combination was 0.78, 0.79 and 0.78, respectively. This yields a sensitivity and specificity of 81 and 64% for CEUS, 83 and 56% for CUDI and 83 and 55% for the combination. Interobserver agreement for CEUS, CUDI and the combination showed kappa values of 0.20, 0.18 and 0.18 respectively. The sensitivity and specificity of 2D CEUS and CUDI for csPCa localization are moderate. Despite compressing CEUS in one image, CUDI showed a similar performance to 2D CEUS. With a sensitivity of 83% at cutoff point 3, it could become a useful imaging procedure, especially with 4D acquisition, improved quantification and combination with other US imaging techniques such as elastography.

555 - Contrast enhanced ultrasound for the localization of prostate cancer – correlation with radical prostatectomy specimens

Introduction & Objectives: Trans Rectal UltraSound (TRUS) is an affordable, portable and safe imaging platform well known to the urologist for prostate imaging. However, prostate cancer (PCa) cannot be visualized with Greyscale TRUS. In Contrast-Enhanced UltraSound (CEUS), an intravenous Ultrasound Contrast Agent (UCA) consisting of gas filled microbubbles is used to visualize PCa-associated vascular anomalies. Contrast-ultrasound dispersion imaging (CUDI) analyses the UCA dispersion patterns as the UCA spreads through the prostate, with the intention to objectify and simplify the interpretation of CEUS. The aim was to determine the value of 2D CEUS imaging and the additional value of CUDI derived parametric maps for the localization of significant PCa.

Long Term Surveillance of Renal Cell Carcinoma Recurrence Following Ablation using 2D and 3D Contrast-Enhanced Ultrasound

ObjectiveTo evaluate efficacy of using 2D and 3D contrast enhanced ultrasound (CEUS) for surveillance of RCC recurrence in patients post-ablation and identify imaging hallmarks of recurrence. Methods53 patients >8 months post ablation of RCC provided informed consent for this IRB approved study. Patients received 2D and 3D CEUS examinations with Optison (GE Healthcare). Three radiologists of varying CEUS experience described enhancement characteristics, made a diagnosis of recurrence/no-recurrence, and quantified their diagnostic confidence levels. ResultsCases of RCC recurrence showed full ablation cavity enhancement with equal arrival times and intensity compared to the renal cortex. Lack of recurrence was characterized as a complete lack of enhancement within the cavity, or delayed enhancement stemming from the periphery of the ablation cavity. Sensitivity for detecting RCC recurrence was 100% for all readers and specificity was 90%-94%. Reader agreement ranged from 88% to 96%. No significant improvements were achieved with the addition of 3D CEUS, and its inclusion resulted in decreased reader confidence. ConclusionContrast-enhanced ultrasound successfully identified all cases of RCC recurrence in this study. Importantly, some patients with complete response to treatment developed delayed enhancement at the periphery of the ablation cavity over time, corresponding to fat necrosis, scarring or granulation tissue within the ablation cavity.

Evaluation of hepatocellular carcinoma transarterial chemoembolization using quantitative analysis of 2D and 3D real-time contrast enhanced ultrasound

Quantitative 2D and 3D contrast-enhanced ultrasound (CEUS) was assessed to evaluate early transarterial chemoembolization (TACE) treatment response. Seventeen patients scheduled for TACE for the treatment of hepatocellular carcinoma participated in the study. 2D and 3D CEUS were performed for each patient at three time points: prior to TACE, 1–2 weeks post TACE, and 1 month post TACE. Peak-intensities of the tumor and surrounding liver tissue were calculated from 2D and 3D data before and after TACE and used to evaluate tumor treatment response. Residual tumor percentages were calculated from 2D and 3D CEUS acquired 1–2 weeks and 1 month post TACE and compared with results from MRI 1 month post TACE. Nine subjects had complete response while 8 had incomplete response. Peak-intensities of the tumor from 3D CEUS prior to TACE were similar between the complete and incomplete treatment groups (p = 0.70), while 1–2 weeks (p < 0.01) and 1 month post treatment (p < 0.01) were significantly lower in the complete treatment group than in the incomplete treatment group. For 2D CEUS, only the peak-intensity values of the tumor from 1 month post TACE were significantly different (p < 0.01). The correlation coefficients between 2D and 3D residual tumor estimates 1–2 weeks post TACE and the estimates from MRI were 0.73 and 0.94, respectively, while those from 2D and 3D CEUS 1 month post TACE were 0.66 and 0.91, respectively. Quantitative analysis on 2D and 3D CEUS shows potential to differentiate patients with complete versus incomplete response to TACE as early as 1–2 weeks post treatment.

Preliminary application of quantitative analysis of focal liver lesions with dynamic 3D contrast-enhanced ultrasonography

Objective To assess the ability of three-dimensional contrast-enhanced ultrasonography (3D-CEUS) and quantitative analysis in differential diagnosis of focal liver lesions (FLL). Methods The quantitative analysis technique was used to deal with the dynamic 3D-CEUS raw data of FLL, which were confirmed by clinical or pathological diagnosis. The corresponding time-intensity curve and parameters were obtained. The parameters were compared to confirm whether there existed any difference in the parameters between benign and malignant FLL. Results Seventy-three FLL were enrolled including 59 malignant and 14 benign lesions. The differences of the parameters between benign and malignant groups were statistically significant, including area under the curve (A)(169.58±95.46 vs 71.26±64.13), area under the curve of wash-in (AWI)(22.84±18.37 vs 9.96±10.01), and area under the curve of wash-out (AWO)(146.73±82.03 vs 61.29±55.06)(all P 0.05). Conclusions The quantitative analysis can be used to identify benign and malignant FLLs on 3D-CEUS. Key words: Ultrasonography, three-dimensional; Quantitative analysis; Focal liver lesions

The prevalence and significance of renal perfusion defects in early kidney transplants quantified using 3D contrast enhanced ultrasound (CEUS).

Vascular complications are one of the most common causes of early kidney transplant dysfunction. Contrast enhanced ultrasound increases sensitivity to vascular changes. The aim of this study was to assess the prevalence and size of vascular abnormalities in early renal transplants using 3D CEUS and the significance of perfusion defects on renal function. Ninety-nine renal transplant patients underwent 3D CEUS after surgery to quantify perfusion defects as percentage total renal volume (TRV). Serum creatinine and estimated glomerular filtration rate (eGFR) were recorded up to 3months post-surgery. Twenty participants had focal perfusion defects (0.2-43%TRV). There was a meaningful difference in patients with perfusion defects in eGFR at 1month (90% CI 2.7-19.2mL/min/1.73m2) and 3months (90% CI 1.9-19.6mL/min/1.73m2) and creatinine at 3months (90% CI -56 - -8μmol/L) using a predetermined clinical threshold. Perfusion defect size correlated well with both serum creatinine and eGFR at 3months (R = 0.80, p ≤ 0.000 and 0.58, p = 0.038). No correlation was seen prior to 3months. Perfusion defects in kidney transplants were more common than expected and were highly likely to reduce renal function at 1-3 months, and the size of the defect affected the degree of functional change at 3months. • Perfusion defects were more common than previously thought. • Perfusion defects could be quantified using 3D CEUS. • The presence of even small perfusion defects may affect kidney function. • Size of perfusion defects correlated with subsequent kidney function at 3months. • Potentially useful in informing clinician expectations of kidney function post-surgery.

The role of quantitation of real-time 3-dimensional contrast-enhanced ultrasound in detecting microvascular invasion: an in vivo study.

This study was to evaluate the role of quantitative perfusion analysis of 3-dimensional (3D) contrast-enhanced ultrasound (CEUS) in detecting microvascular invasion (MVI) of liver tumor in vivo. VX2 tumors were implanted in the livers of sixteen New Zealand rabbits. On day 10, real-time 3D CEUS was performed, and the real-time dynamic images were analyzed using online quantification software. The animals were sacrificed and sent for pathology examinations. According to the gold standard of pathology, the animals were divided into an MVI group and a group without MVI (non-MVI group). Time-intensity curves (TICs) were obtained for the VX2 tumors and the surrounding liver parenchyma, and the parameters peak intensity (PI), mean transit time (MTT), and time to peak (TTP) were compared within and between the MVI and non-MVI groups. The TTP and MTT of the VX2 tumors were significantly faster than those of the surrounding liver parenchyma in both MVI and non-MVI groups. The PI of the VX2 tumors was significantly lower than that of the surrounding liver parenchyma in the non-MVI group but not the MVI group. The TTP and MTT of the VX2 tumors and surrounding liver parenchyma were not significantly different in the MVI group compared with the non-MVI group, whereas the ΔPI (the PI ratio between the VX2 liver tumors and the reference liver parenchyma) of the VX2 tumors in the MVI group was larger than that in the non-MVI group. VX2 tumors with MVI present different hemodynamic parameters, with a larger ΔPI than tumors without MVI. Our data suggest that quantitative perfusion analysis of 3D CEUS might be a promising method for predicting MVI in liver tumors.

Differential diagnostic value of real-time tissue elastography and three dimensional ultrasound imaging in breast lumps

To investigate the real-time tissue elastography and 3D contrast-enhanced ultrasonography(CEUS) in breast lumps differential diagnostic value. A total of 126 patients (180 lumps) with breast mass were retrospectively analyzed from December 2012 to December 2014 in Tumor Hospital Affiliated To Xinjiang Medical University.All patients were divided into three groups by using stratified random method.Each group was detected by real-time tissue elastography, 3D CEUS and two joint inspection.Each group of 42 cases (60 lumps) was confirmed by the pathological results as gold standard.Diagnostic sensitivity, specificity and coincidence rate of different methods were compared. The benign masses of ultrasound contrast showed the punctate, linear and nodular enhancement, and the border of enhancement was smooth.The malignant tumors were mainly dominated by uneven and high enhancement. There was no statistical difference in sensitivity, specificity and coincidence rate between elastography group and 3D CEUS group (64.7% vs 73.5%, 69.2% vs 76.9%, 66.7% vs 75.0%, all P>0.05). The sensitivity, specificity and coincidence rate of two joint inspection group were higher than those of elastography group and 3D CEUS group, the differences were statistically significant (97.1%, 92.3% and 98.3% , all P<0.05). 3D CEUS combined with real-time tissue elastography is of high value in the diagnosis of breast masses.

3D analysis is superior to 2D analysis for contrast-enhanced ultrasound in revealing vascularity in focal liver lesions – A retrospective analysis of 83 cases

ObjectiveTo examine whether dynamic 3D contrast-enhanced ultrasound (CEUS) is superior to 2D imaging in revealing vascularization of focal liver lesions (FLLs). MethodsDynamic 2D and 3D CEUS were used to assess the vascularity of FLLs in 83 patients. The two analyses were carried out sequentially following a bolus intravenous injection of SonoVue contrast agent, one injection of 1.5–2mL was given for each part of the study (one for the 2D and another for the 3D). Due to the large data volume for 3D analysis, only the arterial phase (20–25s) was recorded and analyzed. The data were analyzed by two independent analysts. ResultsThe current study included a total of 83 patients with FLL. The diagnosis was established based on histopathology, Computed Tomography (CT), and magnetic resonance imaging (MRI). Among the 83 cases, 61 were hepatocellular carcinomas (include 10 metastasis, 51 HCCs), and the remaining 22 were benign lesions: hemangiomas (n=15), focal nodular hyperplasias (n=4), and inflammatory lesions (n=3). The overall analysis showed similar patterns of enhancement between the 2D and 3D CEUS in the following features: morphological characteristics, and spatial relationships. In comparison to 2D imaging, 3D CEUS reveal more details of the boundary and feeding arteries of the lesions, as well as distorted features of supply vessels of hepatocellular carcinomas. ConclusionsDynamic 3D-CEUS is superior to 2D-CEUS in displaying the spatial relationship of FLLs and their vascularity patterns, and simultaneous imaging of FLL perfusion and anatomic features.

Vascular Structure Identification in Intraoperative 3D Contrast-Enhanced Ultrasound Data.

In this paper, a method of vascular structure identification in intraoperative 3D Contrast-Enhanced Ultrasound (CEUS) data is presented. Ultrasound imaging is commonly used in brain tumor surgery to investigate in real time the current status of cerebral structures. The use of an ultrasound contrast agent enables to highlight tumor tissue, but also surrounding blood vessels. However, these structures can be used as landmarks to estimate and correct the brain shift. This work proposes an alternative method for extracting small vascular segments close to the tumor as landmark. The patient image dataset involved in brain tumor operations includes preoperative contrast T1MR (cT1MR) data and 3D intraoperative contrast enhanced ultrasound data acquired before (3D-iCEUS) and after (3D-iCEUS) tumor resection. Based on rigid registration techniques, a preselected vascular segment in cT1MR is searched in 3D-iCEUS and 3D-iCEUS data. The method was validated by using three similarity measures (Normalized Gradient Field, Normalized Mutual Information and Normalized Cross Correlation). Tests were performed on data obtained from ten patients overcoming a brain tumor operation and it succeeded in nine cases. Despite the small size of the vascular structures, the artifacts in the ultrasound images and the brain tissue deformations, blood vessels were successfully identified.

3D versus 2D contrast-enhanced sonography in the evaluation of therapeutic response of hepatocellular carcinoma after locoregional therapies: preliminary findings.

To investigate diagnostic performance of 3D contrast-enhanced ultrasound (CEUS) compared with 2D CEUS in the assessment of therapeutic response of hepatocellular carcinoma (HCC) treated with locoregional therapies (LRT). Twenty-three consecutive patients (13 men and 10 women; mean age 65.5 years) with 23 HCCs (size range 1.2-7.2 cm; mean size 2.9 ± 1.4 cm) treated by means of radiofrequency ablation (RFA n = 9), transarterial chemoembolization (TACE n = 8), combined RFA and TACE (n = 3), percutaneous alcoholization (n = 2), and wedge resection (n = 1) underwent 2D and 3D CEUS 1 month (30 ± 2 days) after treatment. Magnetic resonance (n = 17) and computed tomography (n = 6) acted as standard of reference (SOR). Two radiologists assessed the absence (complete response CR) or presence (residual tumor RT) of any nodular arterially enhancing area within or along the margin of the treated HCC. Both 2D and 3D CEUS observed CR in 10/23 (43.5 %) HCCs and RT in 11/23 (47.8 %) HCCs. In 1/23 (4.3 %) HCC, RT was documented by SOR and 2D CEUS, but it was not appreciable at 3D CEUS. In 1/23 (4.3 %) HCC, the presence of peripheral residual tumor was suspected by both 2D and 3D CEUS, but it was not confirmed by SOR. No statistically significant difference between 2D and 3D CEUS in depicting either CR or RT was found (p > 0.05). Sensitivity, specificity, positive and negative predictive values, and accuracy of 3D CEUS were 91.7 % [95 % confidence interval (CI) 0.760-1.073], 90.9 % (95 % CI 0.739-1.079), 91.7, 90.9, and 91.3 %, respectively. 2D and 3D CEUS provided similar diagnostic performance in the assessment of therapeutic response of HCC treated with LRT.

Use of three-dimensional contrast-enhanced duplex ultrasound imaging during endovascular aneurysm repair

Iodinated contrast during endovascular aneurysm repair (EVAR) is used with caution in patients with chronic kidney disease. Contrast-enhanced ultrasound (CEUS) imaging using nonnephrotoxic sulphur hexafluoride microbubble contrast is a novel imaging modality that accurately identifies and characterizes endoleaks during EVAR follow-up. We report our initial experience of using three-dimensional (3D) CEUS imaging intraoperatively as completion imaging after endograft deployment. Our aim was to compare intraoperative 3D CEUS against uniplanar angiography in the detection of endoleak, stent deformity, and renal artery perfusion during EVAR. The study enrolled 20 patients undergoing elective conventional infrarenal EVAR, after which a completion angiogram was performed and the presence of endoleak, renal artery perfusion, or device deformity were recorded. With the patient still under anesthetic, a vascular scientist blinded to angiographic findings performed 3D CEUS and reported on the same parameters. Three endoleaks, one type I and two type II, were detected on uniplanar angiography and 13 endoleaks, 11 type II and two type I, were found using 3D CEUS imaging. Of note, one of these type I endoleaks was not seen on angiography, and this patient underwent balloon moulding of the neck with resolution of the endoleak on repeat imaging. Of the 11 type II endoleaks seen with 3D CEUS imaging, the inflow vessel was identified in nine cases. No graft deformity or limb kinking was seen in any patient. Both renal arteries could be visualized in 10 patients, whereas the target renal artery was seen in 11 patients. In the remaining patients, the renal arteries could not be visualized, mainly due to intra-abdominal gas or patient body habitus. 3D CEUS imaging detected endoleaks not seen on uniplanar digital subtraction angiography, including a clinically important type I endoleak, and was also more sensitive than 2D CEUS imaging for the detection of the source of endoleak. This technology has the potential to supplement or replace digital subtraction angiography for completion imaging to reduce the use of x-ray contrast. Intraoperative 3D CEUS has been applied to allow safe EVAR with ultralow or no iodinated contrast usage in selected cases, without compromising completion imaging.

Non-invasive automated 3D thyroid lesion classification in ultrasound: A class of ThyroScan™ systems

Ultrasound-based thyroid nodule characterization into benign and malignant types is limited by subjective interpretations. This paper presents a Computer Aided Diagnostic (CAD) technique that would present more objective and accurate classification and further would offer the physician a valuable second opinion. In this paradigm, we first extracted the features that quantify the local changes in the texture characteristics of the ultrasound off-line training images from both benign and malignant nodules. These features include: Fractal Dimension (FD), Local Binary Pattern (LBP), Fourier Spectrum Descriptor (FS), and Laws Texture Energy (LTE). The resulting feature vectors were used to build seven different classifiers: Support Vector Machine (SVM), Decision Tree (DT), Sugeno Fuzzy, Gaussian Mixture Model (GMM), K-Nearest Neighbor (KNN), Radial Basis Probabilistic Neural Network (RBPNN), and Naive Bayes Classifier (NBC). Subsequently, the feature vector-classifier combination that results in the maximum classification accuracy was used to predict the class of a new on-line test thyroid ultrasound image. Two data sets with 3D Contrast-Enhanced Ultrasound (CEUS) and 3D High Resolution Ultrasound (HRUS) images of 20 nodules (10 benign and 10 malignant) were used. Fine needle aspiration biopsy and histology results were used to confirm malignancy. Our results show that a combination of texture features coupled with SVM or Fuzzy classifiers resulted in 100% accuracy for the HRUS dataset, while GMM classifier resulted in 98.1% accuracy for the CEUS dataset. Finally, for each dataset, we have proposed a novel integrated index called Thyroid Malignancy Index (TMI) using the combination of FD, LBP, LTE texture features, to diagnose benign or malignant nodules. This index can help clinicians to make a more objective differentiation of benign/malignant thyroid lesions. We have compared and benchmarked the system with existing methods.

Era of diagnostic and interventional ultrasound

It is an era of diagnostic and interventional ultrasound (US). Various new techniques such as three-dimensional US (3D US), interventional US, and contrast-enhanced US (CEUS) have been introduced into clinical practice. Dr. Xu and his colleagues have taken advantage of these techniques and carried out a series of relevant studies. Their use of 3D US in the liver, gallbladder, liver tumor volumetry, guidance for ablation, and 3D CEUS has widened the application of 3D US in the clinic. They found that prognosis in patients with hepatocellular carcinoma (HCC) after thermal ablation with curative intent was determined by treatment response to ablation, pretreatment serum AFP, and liver function reserve. Tumor response to treatment was the most predictive factor for long-term survival. They compared the use of percutaneous microwave ablation and radiofrequency ablation for the treatment of HCC and found that both are effective methods in treating HCCs. The local tumor control, complications related to treatment, and long-term survival were equivalent for the two modalities. They first compared the enhancement patterns of HCC and intrahepatic cholangiocarcinoma (ICC) and proposed the diagnostic clues for ICC, liver angiomyolipoma (AML), gallbladder cancer, renal carcinoma, and renal AML, which have greatly enhanced the role of CEUS in the clinic. They also evaluated the diagnostic performance of CEUS in characterizing complex cystic focal liver lesions and the agreement between two investigators with different experience levels; and found that CEUS is especially useful for the young investigator. They assessed the effect of anti-angiogenic gene therapy for HCC treated by microbubble-enhanced US exposure and concluded that gene therapy mediated by US exposure enhanced by a microbubble contrast agent may become a new treatment option for HCC.

0605: Treatment Response Evaluation with 3D Contrast-Enhanced Ultrasound for Liver Cancer after Local Therapies

To investigate the potential usefulness of three-dimensional contrast-enhanced ultrasound (3D-CEUS) in evaluating the treatment response for liver cancer after local therapies. A total of 107 lesions in 95 consecutive patients with liver cancer underwent local therapies and thereafter received low acoustic power 3D-CEUS examination. The LOGIQ 9 ultrasound scanner and a volume transducer were used and the ultrasound contrast agent was SonoVue. The image quality of 3D-CEUS images was evaluated and the influence of 3D-CEUS to clinical outcome was investigated. The image quality of 3D-CEUS was defined as high in 102 (102/107, 95.3%) lesions and common in 5 (5/107, 4.7%) lesions. 3D-CEUS did not change the diagnosis in any patient compared with 2D-CEUS. However, 3D-CEUS changed the management in 3 (2.8%) of 107 lesions, increased confidence but made no change in diagnosis in 85 (79.5%) lesions, added some information but did not change management or diagnosis in 15 (14.0%), and made no change in 4 (3.7%), respectively, in comparison with 2D-CEUS. 3D-CEUS enhances the diagnostic confidence in the majority of the patients and even changes the management in some patients. 3D-CEUS has potential usefulness in evaluating treatment response for liver cancer after local therapies.

1037: The Reconstruction of 3D Contrast-Enhanced Ultrasonography in the Evaluation of Vascular Complications in Transplanted Liver

1037: The Reconstruction of 3D Contrast-Enhanced Ultrasonography in the Evaluation of Vascular Complications in Transplanted Liver