Accuracy Of Double Contrast-enhanced Ultrasound Research Articles

Double contrast-enhanced ultrasound for the preoperative gross classification of gastric cancer: a comparison with multidetector computed tomography

PurposeTo compare the diagnostic performance of double contrast-enhanced ultrasound (DCEUS) and multi-detector row computed tomography (MDCT) in the gross classification of gastric cancer (GC) preoperatively.Methods54 patients with histology proved GC were included in this retrospective study. The sensitivity and specificity of DCEUS and MDCT for the gross classification of GC was calculated and compared. The area under the curve (AUC) from a receiver operating characteristic curve analysis was used to evaluate the difference of the diagnostic performance between these two methods.ResultsThere were no significant differences between DCEUS and MDCT in terms of AUC for early gastric cancer (EGC), Borrmann I, II, III and Borrmann (III + IV) (P = 0.248, 0.317, 0.717, 0.464 and 0.594, respectively). The accuracy of DCEUS in diagnosing EGC, Borrmann I, II and Borrmann (III + IV) was higher than that of MDCT (96% vs 92%; 96% vs 94%; 87% vs 80%; 83% vs 73%), while in determining Borrmann III and IV, that of DCEUS was lower than that of MDCT (72% vs 74%; 89% vs 96%).ConclusionConsidering the revolution in clinical decision, prognosis evaluation, safety and non-invasion aspects, DCEUS can be used as the main alternative method for Borrmann classification of GC preoperatively.

Double Contrast-Enhanced Ultrasonography in Preoperative T Staging of Gastric Cancer: A Comparison With Endoscopic Ultrasonography.

Objective: To compare the precision of double contrast-enhanced ultrasonography (DCEUS) to endoscopic ultrasonography (EUS) in preoperative T staging of gastric cancers.Methods: This retrospective study consisted of 158 pathologically confirmed gastric cancer patients. All patients underwent DCEUS (intravenous contrast-enhanced ultrasonography combined with oral contrast-enhanced ultrasonography) and endoscopic ultrasonography (EUS) preoperatively. The histopathological findings of resected specimens were compared with the results of DCEUS and EUS retrospectively.Results: The accuracy of DCEUS and EUS in evaluating the T staging of gastric cancer were 82.3% (T1 62.5%,T2 84.4%,T3 87.9%,T4 91.3%) and 76.6% (T1 84.4%,T2 82.2%,T3 72.4%,T4 65.2%), respectively. There were no significant differences between the methods for the overall T staging accuracy (χ2 = 1.569, P = 0.210). But EUS was superior to DCEUS for T1 stage (χ2 = 3.925, P = 0.048) and DCEUS was superior to EUS for T3 stage (χ2 = 4.393, P = 0.036) and T4 stage (χ2 = 4.600, P = 0.032).Conclusion: DCEUS is a convenient and noninvasive method with high precision, which can be used as the primary imaging technique for advanced gastric cancer T staging. In early gastric cancer, we should prefer EUS. Two methods are complementary for assessing tumor invasion depth of gastric cancer.

Comparing single oral contrast-enhanced ultrasonography and double contrast-enhanced ultrasonography in the preoperative Borrmann classification of advanced gastric cancer.

ObjectivesTo evaluate the accuracy of double contrast-enhanced ultrasonography (DCEUS) in preoperative Borrmann classification of advanced gastric cancer (AGC).Materials and MethodsA total of 162 patients histologically confirmed AGC were enrolled into this study. Single oral contrast-enhanced ultrasonography (SOCEUS) were performed in 80 patients and DCEUS (intravenous microbubbles combined with oral contrast-enhanced ultrasound) were performed in 82 patients preoperatively. The findings of the histopathologic examination of resected specimens after surgery were considered as gold standard. The accuracy of SOCEUS was compared with the accuracy of DCEUS in determining Borrmann classification. Interobserver agreement between two sonographyers of SOCEUS and DCEUS had also been assessed.ResultsThe accuracy of SOCEUS and DCEUS in Borrmann classification of advanced gastric cancer were 78.75% and 91.46% respectively. There was a significant difference between two methods (χ2 = 5.186, P < 0.05). The interobserver agreement of two methods was both excellent for assessing the Borrmann classification with a Kappa value of 0.777 by SOCEUS and 0.844 by DCEUS.ConclusionsDCEUS is a valuable method for Borrmann classification with its high accuracy preoperatively. It should be used widely.

Double contrast-enhanced ultrasonography in the detection of periampullary cancer: Comparison with B-mode ultrasonography and MR imaging

PurposeTo investigate the value of double contrast-enhanced ultrasonography (DCEUS) in the detection of periampullary cancer. Materials and methodsNinety-nine patients with surgery or biopsy-proven periampullary cancer who underwent both DCEUS and magnetic resonance imaging (MRI) examinations before operation were enrolled in our study. DCEUS in which intravenous microbubbles were used in combination with oral contrast agent and MRI were performed preoperatively to make a detection diagnosis of periampullary cancer. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of DCEUS, B-mode ultrasonography (BUS) and MRI were calculated and compared. Receiver operating characteristic (ROC) curves were used to evaluate the accuracy of BUS, DCEUS and MRI in the detection. Stratified analyses were performed for different pathological types and different sizes of periampullary lesions. The inter- and intra-observer reliability of DCEUS for cancer detection was also investigated. ResultThere were no significant differences in sensitivity, specificity, PPV, NPV or accuracy between DCEUS and MRI (all P>0.05). ROC analysis showed that the accuracy of DCEUS or MRI was higher than that of BUS (P<0.001), while no significant differences were noted in the accuracy between DCEUS and MR. In the 76 cases of periampullary cancer, DCEUS appeared to be superior to BUS for ampullary carcinoma, duodenum carcinoma and for lesions with an average diameter of less than 3cm. DCEUS appeared equal to BUS in other groups. No significant differences were noted between DCEUS and MRI in the stratified analysis. A considerably well agreement between DCEUS and MRI was obtained using Kappa analysis (k=0.649, P<0.001). The intra- and inter-observer reproducibility were both good for detection of periampullary cancer by DCEUS, with a Kappa values of 0.783 (P<0.01) and 0.732 (P<0.01), respectively. ConclusionDCEUS provides an available and useful imaging modality in the detection of periampullary cancer. This technique can aid in displaying the invisible periampullary region in BUS and may also become an effective supplemental method to MRI.

Preoperative Gross Classification of Gastric Adenocarcinoma: Comparison of Double Contrast-Enhanced Ultrasound and Multi-Detector Row CT

The aim of this study was to compare the accuracy of multi-detector computed tomography (MDCT) with double contrast-enhanced ultrasound (DCEUS), in which intravenous microbubbles are used alongside oral contrast-enhanced ultrasound, in determining the gross classification of patients with gastric carcinoma (GC). Altogether, 239 patients with GC proved by histology after endoscopic biopsy were included in this study. DCEUS and MDCT were performed pre-operatively. The diagnostic accuracies of DCEUS and MDCT in determining the gross classification were calculated and compared. The overall accuracy of DCEUS in determining the gross appearance of GC was higher than that of MDCT (84.9% vs. 79.9%, p < 0.001). There was no significant difference in accuracy between DCEUS and MDCT for Borrmann I and IV classifications of advanced gastric cancer (χ2, p = 0.323 for Borrmann type I, p = 0.141 for Borrmann type IV). The accuracy of DCEUS for early GC and Borrmann II and III classifications of GC was higher than that of MDCT (χ2, p = 0.000 for all). DCEUS may be regarded as a valuable complementary tool to MDCT in determining the gross appearance of gastric adenocarcinoma pre-operatively.

Evaluation of prediction of pathologic grade of regression to preoperative neoadjuvant chemotherapy in patients with resectable advanced gastric cancer using double contrast-enhanced ultrasound

Objective To discuss the value of double contrast-enhanced ultrasound(DCEUS) as a method to predict the pathologic grade of regression to preoperative neoadjuvant chemotherapy(NAC) in advanced gastric cancer(AGC) patients, the contrast parameters of gastric carcinoma were measured and its correlation with pathologic response degree was analyzed. Methods Fifty seven patients with endoscopic biopsy-proven AGC were considered for a complete resection of the lesion and had a DCEUS prior to and following XELOX pre-operative NAC therapy for 3 cycles. The arrival time (AT), time-to-peak (TTP), baseline intensity (BI) and peak intensity (PI) of the primary gastric tumor were measured.The enhanced intensity (EI) was defined as PI minus BI. The percentage of change of DCEUS parameters before and after NAC therapy and its correlation with phathologic grades of regression was calculated. Patients were divided into responder and nonreponder group according to different pathologic response grade. The differences of DCEUS parameters between two groups were compared. The diagnostic accuracy of DCEUS in prediction of benefit from preoperative NAC was represented by means of receive operating characteristic (ROC) curves. Results After NAC, the PI and EI values of local gastric cancer were significantly lower than before NAC. There were significant differences in PI and EI after NAC between the responder and nonresponder groups. Among the DCEUS parameters showed significant correlation with pathologic grade of regression, the correlation factor was highest in percentage of EI reduction of primary gastric tumor(ρ=-0.501, P=0.007). When the optimal cutoff value of EI reduction rate of gastric tumor determined was 27%, a sensitivity of 81.8% and specificity of 66.7% were achieved. Conclusions DCEUS might be a novel, noninvasive, liable and potential method to select the benefit responder from the preoperative NAC in AGC patient. Key words: Contrast-enhanced ultrasound; Microbubbles; Stomach neoplasms; Neoadjuvant chemotherapy

Comparison of preoperative Borrmann classification in advanced gastric carcinoma with double contrast-enhanced ultrasound and multi-detector row CT: correlation with surgical and histologic results

Objective To compare the accuracy of double contrast-enhanced ultrasound (DCEUS) and multi-detector row CT (MDCT) in determining the Borrmann classification in advanced gastric carcinoma (AGC) preoperatively. Methods Two hundred and nine patients with AGC proved by endoscopic biopsy were included. DCEUS (intravenous microbubbles combined with oral contrast-enhanced ultrasound) and MDCT were performed preoperatively. The diagnostic accuracy of DCEUS and MDCT in determining Borrmann classification was calculated and compared. Additionally, intra- and inter- observer reliability of DCEUS and MDCT were assessed using Kappa analysis and a well reliability was set as Kappa value large than 0.75. Results The overall accuracy of DCEUS in determining the Borrmann classification of AGC was 87.9%, the accuracy of DCEUS in determining Borrmann Ⅰ, Ⅱ, Ⅲ and Ⅳ was 90.3%, 86.5%, 87.1% and 88.2%, respectively. The overall accuracy of MDCT in determining the Borrmann classification of AGC was 80.9%, the accuracy of MDCT in determining Borrmann Ⅰ, Ⅱ, Ⅲ and Ⅳ was 87.1%, 78.4%, 78.6% and 85.3%, respectively.There was no significant difference in accuracy between DCEUS and MDCT for Borrmann Ⅰ and Ⅳ classification of AGC (chi-square test, P=0.349 for Borramnn Ⅰ type, P=0.094 for Borrmann Ⅳ type). The accuracy of DCEUS for Borrmann Ⅱ and Ⅲ classification of AGC was higher than the accuracy of MDCT (chi-square test, P=0.000 for Borrmann Ⅱ type, P=0.000 for Borrmann Ⅲ type). The intra- and inter-observe reproducibility were both almost perfect for assessing the Borrmann classification of AGC with a Kappa value of 0.891(P=0.000) for intra-observer and 0.860(P=0.000) for inter-observer by DCEUS. The intra- and inter-observe reproducibility were both almost perfect for assessing the Borrmann classification of AGC with a Kappa value of 0.884 (P=0.000) for intra-observer and 0.852 (P=0.000) for inter-observer by MDCT. Conclusions DCEUS could be considered as a new, reliable and noninvasive method for preoperative the Borrmann classification in AGC. Key words: Ultrasonography; Microbubbles; Tomography, X-ray computed; Stomach neoplasms; Borrmann classification

Double contrast-enhanced ultrasonography in preoperative Borrmann classification of advanced gastric carcinoma: comparison with histopathology

The purpose of this study was to investigate the accuracy of double contrast-enhanced ultrasonography (DCEUS) for assessing the Borrmann classification of advanced gastric carcinoma (AGC) preoperatively. Three hundred twenty nine patients with proved AGC were enrolled. DCEUS (intravenous microbubbles combined with combined with oral contrast-enhanced ultrasound) was performed preoperatively. The diagnostic accuracy of DCEUS in determining Borrmann classification was compared with postoperative pathological findings. The reliability of DCEUS was analyzed. The accuracy of DCEUS in determining the Borrmann classification of AGC was 91.49%. The intra- and inter-observer reproducibility was both almost perfect for assessing the Borrmann classification of AGC by DCEUS. DCEUS could be considered as an accurate, non-invasive, and reliable diagnostic method for preoperative Borrmann classification of advanced gastric carcinoma.

Double contrast–enhanced ultrasonography for the preoperative evaluation of gastric cancer: A comparison to endoscopic ultrasonography with respect to histopathology

Background This study was designed to compare the accuracy of endoscopic ultrasound (EUS) with double contrast–enhanced ultrasound (DCUS) in the staging of gastric malignancies. DCUS is a transabdominal ultrasound technique using both intravenous and intraluminal contrast to enhance sonographic visualization. Methods This retrospective study included 162 patients with biopsy-proven gastric cancer who underwent DCUS and EUS preoperatively with the ultrasound results compared with the pathologic findings of the resected specimens. Results The overall accuracy of DCUS and EUS for tumor (T) staging was 77.2% and 74.7%, respectively . Comparison of ultrasound techniques for T staging revealed that DCUS was superior to EUS only for a tumor depth of T3 (chi-square, P = .025). Lymph nodes were staged correctly with DCUS and EUS in 78.4% and 57.4% of cases, respectively (chi-square, P = .001). Conclusions DCUS offers a noninvasive approach for the staging of gastric cancer. DCUS was comparable to EUS in tumor depth evaluation but offered an advantage in lymph node detection.