Combination Of Contrast-enhanced Ultrasound Research Articles

The kinetic quantitative characteristics of non-mass breast lesions with contrast-enhanced ultrasound: a prospective study.

To characterize non-mass breast lesions (NML) quantitatively by contrast-enhanced ultrasound (CEUS) and to evaluate its additional diagnostic value based on the Breast Imaging Reporting and Data System (BI-RADS) categories. A prospective study was performed among consecutive patients with NMLs. All lesions were examined by grayscale ultrasound and CEUS and diagnosed on pathology. Standard mammograms were obtained in the patients over 30 years old. Three independent radiologists assessed the features on grayscale ultrasound and mammograms and classified NMLs according to BI-RADS categories. Combined with the quantitative analysis in CEUS, the BI-RADS categories were reassessed, and the sensitivity, specificity, positive-predictive value, negative-predictive value and area under the receiver operating characteristic curve (AUC) were calculated for the evaluation of the diagnostic performance. 30 benign and 24 malignant NMLs were finally enrolled in this study, with ductal carcinoma in situ being the majority of malignant (15/24). Average contrast signal intensity (AI), wash-in rate (WiR) and enhancement intensity at 40 s (I40) were found to be the most efficient kinetic parameters to diagnose malignant NMLs. Combined with the cut-off values of 205.2 for AI, 127.8 for WiR and 136.4 for I40, the diagnostic accuracy was improved (AUC = 0.904), with the sensitivity of 95.8% and the specificity of 70.0%. The results suggested that hyperenhancement and rapid wash-in and wash-out are the characteristics of malignant NMLs. The kinetic analysis using CEUS can reflect hypervascular nature of malignant NMLs, thus improving the diagnostic performance combined with grayscale ultrasound. In this study, we quantified the enhancement characteristics of non-mass breast lesions with CEUS. We revealed that the combination of CEUS and conventional ultrasound provided higher sensitivity for diagnosing malignant NMLs.

Contrast-enhanced ultrasound and shear wave elastography in the diagnosis of ACR TI-RADS 4 and 5 category thyroid nodules coexisting with Hashimoto's thyroiditis.

This study aims to evaluate the value of contrast-enhanced ultrasound (CEUS), shear wave elastography (SWE), and their combined use in the differentiation of American College of Radiology (ACR) thyroid imaging reporting and data system (TI-RADS) 4 and 5 category thyroid nodules coexisting with Hashimoto's thyroiditis (HT). A total of 133 pathologically confirmed ACR TI-RADS 4 and 5 category nodules coexisting with HT in 113 patients were included; CEUS and SWE were performed for all nodules. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), accuracy, and the area under the receiver operating characteristic curve (AUC) of the SWE, CEUS, and the combined use of both for the differentiation of benign and malignant nodules were compared, respectively. Using CEUS alone, the sensitivity, specificity, PPV, NPV, and accuracy were 89.2%, 66.0%, 81.3%, 78.6%, and 80.5%, respectively. Using SWE alone, Emax was superior to Emin, Emean, and Eratio for the differentiation of benign and malignant nodules with the best cutoff Emax >46.8 kPa, which had sensitivity of 65.1%, specificity of 90.0%, PPV of 91.5%, NPV of 60.8%, and accuracy of 74.4%, respectively. Compared with the diagnostic performance of qualitative CEUS or/and quantitative SWE, the combination of CEUS and SWE had the best sensitivity, accuracy, and AUC; the sensitivity, specificity, PPV, NPV, accuracy, and AUC were 94.0%, 66.0%, 82.1%, 86.8%, 83.5%, and 0.80 (95% confidence interval: 0.713, 0.886), respectively. In conclusion, CEUS and SWE were useful for the differentiation of benign and malignant ACR TI-RADS 4 and 5 category thyroid nodules coexisting with HT. The combination of CEUS and SWE could improve the sensitivity and accuracy compared with using CEUS or SWE alone. It could be a non-invasive, reliable, and useful method to differentiate benign from malignant ACR TI-RADS 4 and 5 category thyroid nodules coexisting with HT.

Diagnostic accuracy of contrast-enhanced ultrasound synchronized with shear wave elastography in the differential diagnosis of benign and malignant breast lesions: a diagnostic test

Breast cancer (BC) is one of the most common malignancies affecting women. Timely and accurate diagnosis is crucial for treatment and prognosis. Some studies have found that elastography combined with microperfusion characteristics, which are mostly described by contrast-enhanced ultrasound (CEUS), could help in the diagnosis of breast lesions. This study aimed to assess the diagnostic performance of CEUS synchronized with shear wave elastography (SWE) in discriminating between benign and malignant breast lesions by using real-time contrast elastography images to analyze shell elasticity and contrast intensity. A total of 26 pathologically confirmed breast lesions in 26 patients were retrospectively reviewed. Each patient underwent conventional B-mode ultrasound, CEUS, and then SWE data was obtained from a frame of image that was almost identical to the B-mode and CEUS images when acquiring time to peak (TTP). Breast lesions were evaluated based on the Breast Imaging Reporting and Data System (BI-RADS) and quantitative characteristics that describe the stiffness and intensity of contrast of the 1.0-3.0 mm shell region. Quantitative aspects of the inner lesions and shell on the elastogram included the maximum (Emax), mean (Emean), and minimum (Emin) Young's moduli. Quantitative enhanced features included maximum (Imax) and mean (Imean) intensity. We took postoperative pathological results as the gold standard. Receiver operating characteristic (ROC) curves were used to compare the diagnostic efficacy of the 2 examination modalities, either alone or in combination. The age of the patients ranged from 23 to 76 years, with a 42.5-year average age. In all breast lesions, 19 were benign and 7 were malignant. SWE synchronized with CEUS can effectively improve the diagnostic performance of breast lesions, and Emean + Imean and Emax + Emean + Imean of shell at 1.0 mm both had the highest area under the curve (AUC) of 0.86 [95% confidence interval (CI): 0.67, 0.96], with the sensitivity and specificity of 71.43% and 89.47%, respectively. The combination of CEUS and SWE has a better diagnostic value in differentiating benign and malignant breast lesions compared to separate techniques.

3D-Arterial analysis software and CEUS in the assessment of severity and vulnerability of carotid atherosclerotic plaque: a comparison with CTA and histopathology

PurposeOur purpose is to assess Multiparametric Ultrasound (MPUS) efficacy for evaluation of carotid plaque vulnerability and carotid stenosis degree in comparison with Computed Tomography angiography (CTA) and histology.Material and methods3D-Arterial Analysis is a 3D ultrasound software that automatically provides the degree of carotid stenosis and a colorimetric map of carotid plaque vulnerability.We enrolled 106 patients who were candidates for carotid endarterectomy. Prior to undergoing surgery, all carotid artery plaques were evaluated with Color-Doppler-US (CDUS), Contrast-Enhanced Ultrasound (CEUS), and 3D Arterial analysis (3DAA) US along with Computerized Tomographic Angiography (CTA) to assess the carotid artery stenosis degree. Post-surgery, the carotid specimens were fixed with 10% neutral buffered formalin solution, embedded in paraffin and used for light microscopic examination to assess plaque vulnerability morphological features.ResultsThe results of the CTA examinations revealed 91 patients with severe carotid stenoses with a resultant diagnostic accuracy of 82.3% for CDUS, 94.5% for CEUS, 98.4% for 3DAA, respectively. The histopathological examination showed 71 vulnerable plaques with diagnostic accuracy values of 85.8% for CDUS, 93.4% for CEUS, 90.3% for 3DAA, 92% for CTA, respectively.ConclusionsThe combination of CEUS and 3D Arterial Analysis may provide a powerful new clinical tool to identify and stratify “at-risk” patients with atherosclerotic carotid artery disease, identifying vulnerable plaques. These applications may also help in the postoperative assessment of treatment options to manage cardiovascular risks.

A Combination of Contrast-Enhanced Ultrasound and Thyroglobulin Level in Fine-Needle Aspirates Improves Diagnostic Accuracy for Metastatic Lymph Nodes of Papillary Thyroid Carcinoma.

To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) combined with thyroglobulin (Tg) levels in fine-needle aspirates (FNA) washout fluid (FNA-Tg) in diagnosing cervical lymph node (LN) metastasis in papillary thyroid cancer (PTC) patients. Data from 190 LNs in 167 patients suspected of metastasis from the US between November 2018 and September 2020 were included. All subjects underwent FNA, CEUS, and FNA-Tg examinations. The final outcomes were confirmed by histopathological or cytological examination or follow-up imaging. Data were analyzed using the Wilcoxon rank-sum or chi-squared test. The diagnostic efficacy of FNA, CEUS, and FNA-Tg in diagnosing LNs was compared. A cutoff value of 6.15 ng/ml (AUC 0.925, 95% confidence interval (CI) 0.885-0.966) successfully identified metastatic LNs. FNA missed 58 LN metastases, of these, 94.8% (55/58) were correctly diagnosed using the combination of CEUS and FNA-Tg. FNA-Tg showed higher sensitivity (90.2%), NPV (86.1%) and accuracy (88.9%) than either FNA (48.2, 57.4 and 69.5%, respectively) or CEUS (82.1, 67.7 and 70.5%, respectively) alone. The combination of CEUS, FNA and FNA-Tg resulted in maximal sensitivity (100%) and NPV (100%) but reduced specificity (51.3%) and overall diagnostic accuracy (80.0%). After adding FNA-Tg to discordant samples between CEUS and FNA, 81.9% of LNs (77/94) were correctly diagnosed. The combination of FNA, FNA-Tg and CEUS was found to be a promising imaging tool in detecting metastatic LNs in PTC patients.

The value of real-time contrast-enhanced ultrasound combined with CT enhancement in the differentiation of subtypes of renal cell carcinoma.

This study aimed to evaluate the value of real-time contrast-enhanced ultrasound (CEUS) combined with contrast-enhanced computed tomography (CECT) in the differential diagnosis of clear cell renal cell carcinoma (CCRCC), papillary renal cell carcinoma (PRCC), and chromophobe renal cell carcinoma (CRCC). In the present study, 82 patients with CCRCC, 24 patients with PRCC, and 19 patients with CRCC were confirmed by pathology of the resected tumor. All patients were evaluated by CEUS and CECT before the operation. In addition, the contrast enhancement mode of CEUS and CECT and the contrast parameters of the region of interest (ROI) time-intensity curve between the lesions and the surrounding normal renal parenchyma by CEUS were compared and analyzed. Compared with the pathological results, the diagnostic accuracy of ultrasound in the 3 groups was 87.8% (72/82), 83.3% (20/24) and 73.7% (14/19). There was no significant difference between CEUS and CECT in the diagnostic accuracy of all groups (P>0.05). Meanwhile, compared with the surrounding renal parenchyma by CEUS, 82.5% (66/80) of CCRCC lesions showed "fast-forward and fast/slow-retrograde," while 83.3% (20/24) of PRCC, and 84.2% (16/19) showed "slow-forward and fast/slow-retrograde." Significant differences in the enhancement modes of CEUS were found among the CCRCC, PRCC, and CRCC lesions (P < 0.05). And the enhancement modes could be quantitatively analyzed by the ROI time-intensity curve of the lesion. Moreover, lesions enhanced by CECT and 74.4% (61/82) of CCRCC lesions showed "fast-forward and fast/slow-retrograde," while 66.7% (16/24) of PRCC and 84.2% (16/19) of CRCC showed "slow-forward and fast/slow-retrograde." The contrast modes and enhancement uniformity of CEUS and CECT showed no significant differences among the CCRCC, PRCC, and CRCC lesions (P > 0.05). CEUS and quantitative analysis of ROI time-intensity curve can be used for differential diagnosis of the 3 RCC subtypes. The combination of CEUS and CECT can help us differentiate RCC subtypes and is of great significance for clinical treatment strategies and prognostication.

Logistic regression analysis of contrast-enhanced ultrasound and conventional ultrasound of follicular thyroid carcinoma and follicular adenoma.

Follicular thyroid carcinoma (FTC) is prone to recurrence and hematogenous metastasis, preoperative accurate diagnosis is still needed to help clinicians select the best surgical methods to improve the prognosis of patients. The aim of this study was to find specific conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) characteristics of FTC and to explore their diagnostic value in the differential diagnosis between FTC and follicular adenoma (FA). This retrospective study included 258 thyroid follicular neoplasms (172 FAs and 86 FTCs) in 244 consecutive patients who underwent preoperative conventional US, and 72 of them underwent both conventional US and CEUS. Sonograms were reviewed in consensus by two experienced radiologists for various conventional US and CEUS features. Multivariate logistic regression analysis was performed to determine independent risk factors for FTC. Independent risk factors of conventional US for FTC were heterogenicity (OR =7.477, 95% CI: 2.848-19.629), unevenly thick halo (OR =5.643, 95% CI: 3.234-9.848) and calcifications (OR =1.748, 95% CI: 1.098-2.783). While independent risk factors determined with the combination of CEUS and conventional US were unevenly thick halo (OR =5.770, 95% CI: 1.310-25.409) and absent or irregular rim enhancement (OR =27.000, 95% CI: 2.445-298.178). The area under the receiver operating characteristic curve of the final two logistic regression models was 0.835 and 0.838. Conventional US is an efficient diagnostic tool in the differential diagnosis of FTC and FA to help clinicians in making appropriate decisions while CEUS failed to provide additional diagnostic value in the study, thus the value of CEUS remains to be verified by further studies with larger sample sizes.

Predictive value of contrast-enhanced ultrasound combined with conventional ultrasound in solid renal parenchymal lesions.

This study aimed to develop a model to predict the risk of malignancy in solid renal parenchymal lesions based on the imaging features of combined conventional and contrast-enhanced ultrasound (CEUS). A retrospective review was performed among patients with focal solid renal parenchymal lesions on ultrasound images. Ultrasound features were characterized by two experienced radiologists independently. A multiple logistic regression analysis was performed to determine the most relevant features and to estimate the risk of malignancy. Scoring and counting methods were developed based on the most relevant features. The diagnostic performance was evaluated by the sensitivity, specificity, positive predictive value, negative predictive value and area under the receiver operating characteristic curve (AUC). A total of 519 renal lesions were included in this study. The conventional ultrasound features of diameter, echogenicity, hypoechoic rim and the CEUS feature of heterogeneity were identified as the most relevant features for prediction of malignancy. The sensitivity and specificity for the logistic regression model, the scoring method and the counting method were 95.3 and 93.4%, 93.8 and 87.8%, 88.8 and 93.9%, respectively. The logistic model had the best performance for diagnosing malignant renal lesions with AUC of 0.978, compared with the scoring method and the counting method with AUCs of 0.958 and 0.965. The combination of contrast-enhanced ultrasound with conventional ultrasound improved the diagnostic performance of solid renal lesions based on the logistic regression model. In this study, we revealed that the combination of CEUS and conventional ultrasound provided higher accuracy for diagnosing malignant renal tumors.

The role of contrast-enhanced ultrasound in the diagnosis of malignant non-mass breast lesions and exploration of diagnostic criteria.

To assess the value of contrast-enhanced ultrasound (CEUS) for diagnosing malignant non-mass breast lesions (NMLs) and to explore the CEUS diagnostic criteria. A total of 116 patients with 119 NMLs detected by conventional US were enrolled. Histopathological results were used as the reference standard. The enhancement characteristics of NMLs in CEUS were compared between malignant and benign NMLs. The CEUS diagnostic criteria for malignant NMLs were established using independent diagnostic indicators identified by binary logistic regression analysis. The diagnostic performance of Breast Imaging Reporting and Data System-US (BI-RADS-US), CEUS, and BI-RADS-US combined with CEUS was evaluated and compared. Histopathological results showed 63 and 56 benign and malignant NMLs. Enhancement degree (OR = 5.75, p = 0.003), enhancement area (OR = 4.25, p = 0.005), and radial or penetrating vessels (OR = 7.54, p = 0.003) were independent diagnostic indicators included to establish the CEUS diagnostic criteria. The sensitivity and specificity of BI-RADS-US, CEUS, and BI-RADS-US combined with CEUS were 100 and 30.2%, 80.4 and 74.6%, and 94.6 and 77.8%, respectively; the corresponding areas under the receiver operating characteristic curve (AUC) were 0.819, 0.775, and 0.885, respectively. CEUS has a high specificity in malignant NML diagnosis based on the diagnostic criteria including enhancement degree, enhancement area, and radial or penetrating vessels, but with lower sensitivity than BI-RADS-US. The combination of CEUS and BI-RADS-US is an effective diagnostic tool with both high sensitivity and specificity for the diagnosis of malignant NMLs. In this study, we assessed the diagnostic value of CEUS for malignant NMLs and constructed a feasible diagnostic criterion. We further revealed that the combination of CEUS and BI-RADS-US has a high diagnostic value for malignant NMLs.

Evaluation of the diagnostic performance of contrast-enhanced ultrasound combined with BRAF V600E gene detection in nodules of unclear significance by thyroid fine-needle aspiration.

Our study aims to test the diagnostic performance of contrast-enhanced ultrasound (CEUS) combined with the detection of serine/threonine-protein kinase V600E (BRAF V600E) in nodules of unclear significance by thyroid fine-needle aspiration (FNA). From January 2015 to December 2019, 244 patients were subjected to ultrasonic strain imaging and elastography, CEUS, and BRAF V600E gene detection at Lishui Hospital of Zhejiang University. Thyroid FNA does not confirm the benignancy and malignancy of the thyroid nodules. With postoperative pathology as the gold standard, the diagnostic value of CEUS, BRAF V600E detection, and the combination in differentiating benign and malignant thyroid nodules were evaluated. The negative predictive value (NPV) and accuracy of CEUS, BRAF V600E detection, and the combination were calculated along with sensitivity, specificity, and positive predictive value (PPV). In this study, the sensitivity, specificity, PPV, NPV, accuracy, and AUC of CEUS alone in predicting benign and malignant thyroid nodules were 69.8%, 94.9%, 98.6%, 37.4%, 73.8% and 0.884, respectively. The sensitivity, specificity, PPV, NPV, accuracy and AUC of BRAF V600E detection alone were 65.4%, 100%, 100%, 35.5%, 70.9% and 0.827, respectively. The sensitivity, specificity, PPV, NPV, accuracy and AUC of the combination were 73.2%, 94.9%, 98.7%, 40.2%, 76.6% and 0.923, respectively. Therefore, compared with CEUS or BRAF V600E gene detection alone, the combination of CEUS and BRAF V600E gene detection has a higher sensitivity, NPV, and accuracy in the diagnosis of thyroid nodules.

Combination of CEUS and MRI for the diagnosis of periampullary space-occupying lesions: a retrospective analysis

BackgroundThe value of magnetic resonance imaging (MRI), contrast-enhanced ultrasound (CEUS), and the combination of CEUS and MRI (CCWM) for the diagnosis of periampullary space-occupying lesions (PSOL) was investigated.MethodsA total of 102 patients diagnosed with PSOLs by surgery or biopsy were recruited retrospectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MRI, CEUS, and CCWM were analyzed.ResultsMRI, CEUS, and CCWM allowed for the accurate detection of 91.17, 92.15, and 99.01% of PSOLs, respectively. The specificity, PPV, and accuracy of CCWM were significantly different from MRI and CEUS (p < 0.05). However, there the sensitivity and NPV were not significantly different among the three diagnostic technologies. In addition, the specificity, PPV, and accuracy were not significantly different between MRI and CEUS (all p > 0.05).ConclusionsCCWM is valuable for differentiating benign and malignant PSOL, which provides important guiding significances for the clinic.

Application of contrast-enhanced ultrasound in the diagnosis of small breast lesions.

Breast cancer is the most common cancer in women worldwide. The purpose of the study was to observe the features of contrast-enhanced ultrasound (CEUS) and the combination with Breast Imaging-Reporting and Data System (BI-RADS) of conventional ultrasound for assessing small breast lesions. The study was to explore the small breast lesions' features of contrast-enhanced ultrasound (CEUS) and the combination with Breast Imaging-Reporting and Data System (BI-RADS) of conventional ultrasound, in order to improve the diagnostic accuracy of early breast cancer. 105 lesions were subject to conventional US (ultrasound) and CEUS before operations or biopsies. Among 105 breast lesions, six patient diagnoses were established by thick core-needle biopsy, while the rest were all confirmed by surgery and pathology. Significant differences were found between benign and malignant lesions in qualitative and quantitative indexes (peak) of CEUS (P < 0.05). The qualitative features of malignant small breast lesions were as follows: (1) enhanced intensity within the lesion was not uniform (61/61,100%); (2) the speed of wash-in was earlier than the surrounding tissue (58/61, 95.1%); (3) lesion interior and the surrounding tissues had contrast vessel performance (61/61,100%). Peak of malignant lesions (35.77±11.45) was higher than that of benign lesions (31.96±10.76) (P < 0.05). The diagnostic performance of BI-RADS-US plus qualitative indexes (method one) in terms of area under receiver operating characteristic curve (AUROC) were the highest (i.e., AUROC = 0.817), in comparison with other combined diagnostic methods. The associated sensitivity, specificity and accuracy were 78.69%, 84.09% and 80.95%, respectively. With method one, however, was similar with US-BI-RADS in specificity, 11 malignant breast lesions were regarded as a higher classification of BI-RADS and classified into malignant group, which were identified as benign on US-BI-RADS originally. CEUS was useful to differentiate benign from malignant small breast lesions, and the combination of CEUS and BI-RADS-US can improve the early diagnosis of breast cancers.

A Preliminary Study of Contrast-Enhanced Ultrasound (CEUS) and Cytokine Expression Analysis (CEA) as Early Predictors for the Outcome of Tibial Non-Union Therapy.

The current study investigates if contrast-enhanced ultrasound (CEUS) or cytokine expression analysis (CEA) evaluating vascularization are capable of predicting the outcome of non-union therapy. Patients with tibial non-unions were surgically treated and participated in our follow-up program including perioperative collection of blood as well as CEUS analysis. Two groups were formed: Responders in group 1 (G1, N = 8) and Non-Responders in group 2 (G2, N = 5). Serum cytokine expression and local microperfusion were compared and correlated to the radiologic outcome. Evaluation of TNF-α expression revealed significantly lower values prior to first surgery in G1 (G1: 9.66 ± 0.96 pg/mL versus G2: 12.63 ± 1.2 pg/mL; p = 0.045); whereas after treatment both CEA and CEUS indicated a higher potential for angiogenesis in Responders. Logistic regression modelling revealed the highest predictive power regarding eventual osseous consolidation for the combination of both CEUS and serum CEA. The results provide first evidence regarding a link between changes in the serum expression of distinct pro-angiogenic cytokines and alterations in the local microperfusion assessed via both non-invasive and radiation-free diagnostic modalities. In addition, a combination of CEUS and CEA is a promising novel tool in early prediction of the outcome of non-union therapy.

Contrast enhanced ultrasound (CEUS) with MRI image fusion for monitoring focal therapy of prostate cancer with high intensity focused ultrasound (HIFU)1.

Reduced acceptance of radical prostatectomy in patients with low risk or intermediate risk prostate cancer has significantly changed treatment strategies in prostate cancer (PCa) during the last years. Focal therapy of the prostate with high intensity focused ultrasound (HIFU) is an organ-preserving treatment for prostate cancer with less impairment of health-related quality of life. Follow-up after HIFU therapy by imaging modalities remains a major problem as eg. MRI performs poorly. Contrast enhanced ultrasound (CEUS) allows to monitor the vascular architecture of organs non-invasively. However, only limited data are available using CEUS to define successful and complete HIFU treatment of the prostate. In this study, we aimed to evaluate short-term image findings using CEUS and image fusion before and after HIFU treatment. Prospective single arm study in patients with uni- or bilateral, low or intermediate risk prostate cancer or recurrent cancer after radiotherapy treated with HIFU at our institution between October 2016 and November 2017. HIFU hemiablation or whole gland treatment was performed using the Focal One® device. PCa was diagnosed either by multiparametric magnetic resonance imaging (mpMRI) followed by MRI fusion based targeted biopsy combined with 12 core transrectal ultrasound (TRUS) guided biopsy or 12 core random biopsy only. Monitoring of the target region before, immediately and 24 hours after the ablation was done by CEUS in combination with image fusion using an axial T2-weighted MRI sequence. 6 consecutive patients with Gleason score (GS) 6, 5 patients with GS 7a prostate cancer and one patient with biochemical recurrence after radiotherapy were included in the study. Three patients underwent whole gland treatment due to histological proven bilateral PCa or recurrent PCa after radiotherapy. Hemiablation was performed in 9 patients with unilateral tumor and no PIRADS 4 or 5 lesion in the contralateral lobe. Median patient age was 69.8 years and median PSA (prostate-specific antigen) level was 8.4 ng/ml. CEUS showed markedly reduced microbubbles in the ablated area, the prostate capsule still showed signs of perfusion. The study is limited by the short follow up and small number of patients. CEUS examination showed a reduction of microcirculation in the treated area immediately after the treatment and 24 hours later. The combination of CEUS and image fusion seems to be helpful for detecting the PCa target lesion and monitor the success of HIFU ablation treatment. Evidence for image findings after HIFU-therapy are rare. Further studies on this topic are needed.

Variation of sentinel lymphatic channels (SLCs) and sentinel lymph nodes (SLNs) assessed by contrast-enhanced ultrasound (CEUS) in breast cancer patients

BackgroundThe objective of this study was to assess the feasibility of detecting the variation of sentinel lymphatic channels (SLCs) and sentinel lymph nodes (SLNs) in breast cancer patients using contrast-enhanced ultrasound (CEUS).MethodsA total of 46 breast cancer patients were prospectively recruited in the study. All the participants received intradermal and peritumoral injection of microbubbles as contrast agent, and SLCs and SLNs were assessed preoperatively. Blue dye was injected subareolarly and peritumorally during the surgery. The SLNs detected by CEUS and blue dye were sent to the pathology laboratory for histopathological analysis.ResultsAt least one SLC and SLN were detected by CEUS in all 46 cases. Three types of SLCs were detected, including superficial sentinel lymphatic channels (SSLCs), penetrating sentinel lymphatic channels (PSLCs), and deep sentinel lymphatic channels (DSLCs). Five lymphatic drainage patterns (LDPs) were found, including SSLC, PSLC, SSLC + PSLC, SSLC + DSLC, and SSLC + PSLC + DSLC. Only SSLC was detected on CEUS in 24 cases; only PSLC was detected in 3 cases; both SSLC and PSLC were detected in 8 cases; both SSLC and DSLC were detected in 7 cases; SSLC, PSLC, and DSLC were all detected in the remaining 4 cases. An actual LDP was defined on the combination of CEUS and dissection of the specimen. The accuracy rate of CEUS was 43/46. Interestingly, a bifurcated SLC was found in 8 patients. In 3 patients, a discontinuous SLC and non-enhanced SLN were found by CEUS. Also, no dyed SLNs were detected during the surgery. The axillary lymph nodes turned out tumor involved histologically.ConclusionCEUS is feasible to assess the variation of SLCs and SLNs preoperatively in breast cancer patients. SLNB is not suggested when a discontinuous SLC and non-enhanced SLN were detected by CEUS.

An evaluation of the clinical diagnostic value of contrast-enhanced ultrasound combined with contrast-enhanced computed tomography in space-occupying lesions of the kidney.

BackgroundThere are a variety of space-occupying lesions of the kidney, and the benign lesions may be difficult to differentiate from the malignant ones. Therefore, an accurate judgment of the benign and malignant nature of the space-occupying lesions of the kidney is of high importance for the treatment and prognosis of these patients.ObjectiveTo evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) combined with contrast-enhanced computed tomography (CECT) in space-occupying lesions of the kidney.Data and methodsThree hundred and sixty-seven patients with space-occupying lesions of the kidney (378 lesions) were examined by CEUS and CECT, respectively, then, a combined diagnosis was made after the combination of CEUS and CECT by a multidisciplinary team. The diagnoses from the three methods were compared. The pathological results were taken as the gold standard. The sensitivity, specificity, positive and negative predictive values and area under the receiver operating characteristic (ROC) curve were calculated for the three methods. Thus, the diagnostic value of the three methods was assessed.ResultsOf the 378 lesions examined, there were 301 malignant lesions and 77 benign lesions. The combined examination revealed 303 malignant lesions, with 9 benign lesions mistakenly diagnosed as malignant ones; thus, the misdiagnosis rate was 11.7%. By using the combined examination, 75 benign lesions were diagnosed, with the missed diagnosis of 7 malignant lesions, so the missed diagnosis rate was 2.3%. The sensitivity, specificity, positive and negative predictive values and area under the ROC curve with the combined examination of CEUS and CECT were 97.67% (0.950–0.989), 88.31% (0.785–0.942), 97.03% (0.942–0.985), 90.67% (0.811–0.958) and 0.930 (0.887–0.973), respectively. As compared with either CEUS or CECT alone, the difference in these indicators was of statistical significance (P<0.05). The combined examination greatly improved the sensitivity, specificity and accuracy of the diagnosis of the space-occupying lesions of the kidney.ConclusionCEUS and CECT each have advantages and disadvantages in the diagnosis of the space-occupying lesions of the kidney. The two techniques can be used in combination to compensate for the respective defects. More salient benefits can be reaped from the combined examination than from either technique used alone.

Comparative study of contrast enhanced ultrasound versus contrast enhanced MRI in hepatic epithelioid hemangioendothelioma

Objective To analyze and compare the imaging characteristics of contrast-enhanced ultrasound (CEUS) and contrast enhanced magnetic resonance imaging (CEMRI) in diagnosing hepatic epithelioid hemangioendothelioma (HEHE) for improving radiological diagnostic accuracy. Methods The imaging characteristics of CEUS and dynamic CEMRI in 17 patients with histopathological diagnosis of HEHE on specimens obtained after surgical resection or fine needle biopsy were retrospectively analyzed and compared. Results On CEUS, 20 lesions in 13 patients demonstrated different enhancement patterns in the arterial phase: 13 lesions (65.0%) displayed gross enhancement and 7 lesions (35.0%) displayed a rim-like enhancement. Synchronous enhancement was observed in 17 lesions (85.0%) and rapid enhancement was observed in 3 lesions (15.0%). All these 20 lesions manifested as a hypoechoic mass in the portal venous and delayed phases. Other characteristics included speculated enhancement in the inner margin of the lesions and a vessel . On CEMRI, 45 lesions (71.4%) manifested slight enhancement in the arterial phase and continuous enhancement in the portal venous and delayed phases. The remaining 18 lesions (28.6%) manifested no enhancement in the arterial phase but progressive enhancement in the portal venous and delayed phases. 47 lesions (74.6%) displayed a rim-like enhancement and 16 lesions (25.4%) displayed gross enhancement. Other imaging characteristics included a halo , a lollipop sign, a capsular retraction or a vessel . Conclusions On CEUS, characteristic manifestations of HEHE were synchronous enhancement with a quick wash-out. At peak time, the enhancement degree was equal to the normal liver parenchyma. On CEMRI, the main radiological feature of HEHE was a rim-like enhancement. In the arterial phase, the enhancement degree was not high and there was either a continuous enhancement or a progressive enhancement in the portal venous and delayed phases. Furthermore, HEHE lesions always occurred under the liver capsule and showed a capsular retraction , a halo , a lollipop sign or a vessel . The combination of CEUS and CEMRI helped to improve the diagnostic rate and contributed to selection of clinical treatment. Key words: Hepatic epithelioid hemangioendothelioma; Contrast-enhanced ultrasound; Contrast-enhanced magnetic resonance imaging

Contrast-enhanced ultrasound and real-time elastography in the differential diagnosis of malignant and benign thyroid nodules.

The diagnostic value of contrast-enhanced ultrasound (CEUS) or real-time elastography (RTE) alone, as well as a combination of CEUS and RTE, in distinguishing benign from malignant thyroid nodules was investigated. Between August 2012 and June 2014, a total of 97 consecutive patients (50 male and 47 female patients; mean age, 48.6±12.4; age range, 27-70 years) with thyroid nodules referred for surgical treatment were examined by CEUS and RTE. The final diagnosis was obtained based on histological findings. Image analysis of the CEUS and RTE scans was performed. Considering the postoperative pathological results as the golden standard, a receiver operating characteristic (ROC) curve was constructed. Subsequently, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CEUS alone, RTE alone and CEUS + RTE combination were calculated. Pathological examination showed 66 papillary carcinomas and 43 benign lesions, including 21 adenomas and 22 nodular goiters. The sensitivity, specificity, PPV, NPV and accuracy of CEUS were 81.82, 90.70, 93.10, 90.70 and 85.32%, respectively. In the case of RTE, the sensitivity, specificity, PPV, NPV and accuracy were 80.30, 88.37, 91.38, 88.37 and 83.49%, respectively. Furthermore, the combination of CEUS + RTE had a sensitivity of 95.45%, specificity of 95.35%, PPV of 96.92%, NPV of 95.35% and accuracy of 95.41%. Therefore, the CEUS + RTE combination showed a significantly higher sensitivity and specificity compared with CEUS or RTE alone (all P<0.05). Based on ROC analysis, the area under the curve (AUC) for CEUS, RTE and CEUS + RTE combination was 0.883, 0.863 and 0.959, respectively. The AUC of RTE alone was significantly lower compared with that of the CEUS + RTE combination. In conclusion, our results demonstrate that CEUS + RTE combination significantly increases the diagnostic performance for differential diagnosis of malignant and benign thyroid nodules compared with CEUS or RTE alone.

Logistic Regression Analysis of Contrast-Enhanced Ultrasound and Conventional Ultrasound Characteristics of Sub-centimeter Thyroid Nodules

The purpose of the study described here was to determine specific characteristics of thyroid microcarcinoma (TMC) and explore the value of contrast-enhanced ultrasound (CEUS) combined with conventional ultrasound (US) in the diagnosis of TMC. Characteristics of 63 patients with TMC and 39 with benign sub-centimeter thyroid nodules were retrospectively analyzed. Multivariate logistic regression analysis was performed to determine independent risk factors. Four variables were included in the logistic regression models: age, shape, blood flow distribution and enhancement pattern. The area under the receiver operating characteristic curve was 0.919. With 0.113 selected as the cutoff value, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 90.5%, 82.1%, 89.1%, 84.2% and 87.3%, respectively. Independent risk factors for TMC determined with the combination of CEUS and conventional US were age, shape, blood flow distribution and enhancement pattern. Age was negatively correlated with malignancy, whereas shape, blood flow distribution and enhancement pattern were positively correlated. The logistic regression model involving CEUS and conventional US was found to be effective in the diagnosis of sub-centimeter thyroid nodules.

The utility and limitations of contrast-enhanced ultrasound for the diagnosis and treatment of prostate cancer.

In association with the widespread use of prostate specific antigen (PSA) screening, the numbers of men identified with early-stage prostate cancer (PCa) are increasing in the developed countries, including Japan. However, the accurate localization of PCa lesions in diagnostic imaging is still difficult because PCa has a tendency to be multifocal in the prostate gland. Contrast-enhanced ultrasound (CEUS) improves the detection of PCa by visualizing cancerous lesions in order to target a needle biopsy. CEUS has the potential to enable not only accurate diagnoses but also novel treatments such as focal therapy. The combination of CEUS and other modalities is expected to improve the diagnosis of PCa and its treatment.