Conclusions Contrast-enhanced Ultrasound Research Articles

CEUS in diagnosis of renal masses

Introduction and purpose Contrast enhanced ultrasound (CEUS) is a modern diagnostic method that uses ultrasound waves in combination with intravenous administration of a contrast agent. It enables obtaining high resolution and assessing microcirculation in real time, thanks to which the researcher is able to analyze the enhancement and its features, which may help in diagnosing a specific pathology. Contrast agents, similar to CT and MRI, show specific phases of enhancement after administration - arterial, venous, delayed. Their additional advantage is safety, especially for patients with impaired kidney and thyroid function, and causing fewer allergic reactions. The aim of this review is to present the CEUS examination technique and the latest reports in the field of diagnosis of renal lesions. Material and methods This review was prepared based on the literature available from recent years in the PubMed and Google Scholar scientific databases using the keywords: ultrasonography, contrast enhanced ultrasonography, kidney, renal masses. Results Studies show that CEUS can be an effective method for imaging both cystic and solid lesions in the kidney. When using a contrast agent, the lesions show characteristic features that can guide the investigator to the diagnosis. Moreover, in comparative analyses, CEUS achieved comparable or better results than other diagnostic imaging methods. Conclusions CEUS is a modern and promising diagnostic method that can successfully compete with CT and MRI. Moreover, the metabolism and pharmacokinetics of contrast agents and their safety mean that CEUS can be used for the diagnosis of unclear pathologies in elderly patients, as well as for the control and supervision of changes that require frequent imaging. Keywords: ultrasonography, contrast enhanced ultrasonography, kidneys, renal masses

Nodules Identified on Surveillance Ultrasound for HCC: CEUS or MRI as the Initial Test?

Following positive surveillance ultrasound (US), magnetic resonance imaging (MRI) is recommended for further characterization. We propose contrast-enhanced ultrasound (CEUS) shows equivalent efficacy. This prospective institutional review board approved study recruited 195 consecutive at-risk patients with a positive surveillance US. All had CEUS and MRI. Biopsy (n=44) and follow-up are gold standard. MRI and CEUS results are classified according to liver imaging reporting and data system (LI-RADS)and patient outcome. As an US-based modality, CEUS is superior in confirming findings from surveillance US, correlation in 189/195 (97%) on CEUS compared to 153/195 (79%) on MRI. Within these negative MRI examinations, there are 2 hepatocellular carcinoma (HCC) and 1 cholangiocarcinoma (iCCA) diagnosed on CEUS and proven by biopsy. From 195 patients, there are 71 malignant diagnoses from all sources, including 58 LR-5 (45 on MRI and 54 on CEUS) and 13 others, including HCC outside of LR-5 category, and LR-M with biopsy proven iCCA (3 on MRI and 6 on CEUS). CEUS and MRI show concordant results in the majority of patients (146/195,75%), including 57/146 malignant and 89/146 benign diagnoses. There are 41/57 concordant LR-5 and 6/57 concordant LR-M. When CEUS and MRI are discordant, CEUS upgraded 20 (10 biopsy-proven) from MRI LR-3/4 to CEUS LR-5 or LR-M by showing washout (WO) that MRI failed to show. Additionally, CEUS characterized time and intensity of WO and diagnosed 13/20 LR-5 by showing late and weak WO and 7 LR-M by showing fast and marked WO. CEUS is 81% sensitive and 92% specific in diagnosing malignancy. MRI is 64% sensitive and 93% specific. CEUS performance is at least equivalent if not superior to MRI for initial evaluation of lesions from surveillance US.

Application value of contrast-enhanced ultrasound in preoperative localization of microwave ablation for primary hyperparathyroidism.

Ultrasonography (US) and 99m Technetium-sestamibi scintigraphy (99m Tc-MIBI) are currently first-line imaging modalities to localize parathyroid adenomas with sensitivities of 80% and 84%, respectively. Therefore, finding other modalities to further improve the diagnostic accuracy for preoperative localization is critically needed. To evaluate the application value of contrast-enhanced ultrasound (CEUS) in the preoperative localization of microwave ablation (MWA) for primary hyperparathyroidism (PHPT). Between December 2012 and May 2021, 100 PHPT patients (34 males and 66 females; mean age, 56.31±13.43 years; age range, 25-85 years) with 130 suspected parathyroid nodules were enrolled. US, CEUS, and 99m Tc-MIBI were performed for the localization of pathological parathyroid glands. All patients were performed MWA under ultrasound guidance. All the suspected parathyroid nodules underwent core needle biopsy under ultrasound guidance during MWA to confirm the pathology. The diagnostic performance of all the imaging tests was analyzed in comparison with the pathological results. A total of 130 nodules suspected to be of parathyroid origin from preoperative localization images were confirmed by pathological results, of which 116 were of parathyroid origin, and 14 were not of parathyroid origin. The sensitivity, specificity, accuracy, and the area under receiver operating characteristic curve of CEUS in the localization of pathological parathyroid glands were 100%, 92.86%, 99.23%, and 0.964, which were significantly higher than those of US (93.10%, 42.86%, 87.69%, and 0.680) and 99m Tc-MIBI (81.90%, 42.86%, 77.69%, and 0.624) (p<0.05). The sensitivity and accuracy of CEUS were 100% and 97.22%, which were higher than those of 99m Tc-MIBI (65.62% and 63.89%) or US (75.00% and 72.22%) in patients with multiple parathyroid glands (p<0.05). For smaller parathyroid adenomas (≤2cm in diameter), the sensitivities of CEUS in locating hyperfunctioning parathyroid glands were 100%, which was significantly higher than that of 99m Tc-MIBI (73.68% and 84.31%, p<0.05). CEUS is a valuable preoperative localization method for PHPT patients performed MWA, especially for the patients with smaller pathological parathyroid gland and multiple glandular lesions.

Correlation between serum cystatin C level and renal microvascular perfusion assessed by contrast-enhanced ultrasound in patients with diabetic kidney disease

Objectives To investigate the relationship between serum cystatin C (CysC) levels and renal microvascular perfusion in patients with diabetic kidney disease (DKD). Methods A total of 57 patients with high CysC levels and 45 patients with normal CysC levels were enrolled. Data on clinical characteristics and laboratory examination results were also collected. Contrast-enhanced ultrasound (CEUS) of the kidneys was successively performed. The time-intensity curve (TIC) and related quantitative parameters of the kidneys were obtained by CEUS and the correlations between CysC and CEUS parameters were analyzed. Results Compared to the normal CysC group, the high CysC group had significantly lower wash-in area under the curve (WiAUC), wash-out area under the curve (WoAUC), and wash-in and wash-out area under the curve (WiWoAUC). In the normal CysC group, patients with Stage III chronic kidney disease (CKD) had higher AUCs than those with Stage I–II CKD (p < 0.05). In the high CysC group, patients with Stage IV–V CKD had lower wash-in AUC compared to patients with Stage I–II CKD (p = 0.023). The renal cortex microvascular perfusion parameters AUCs were positively correlated with the estimated glomerular filtration rate (GFR) (r = 0.280, 0.222, and 0.243), and CysC was inversely correlated with AUCs (r= −0.299, −0.251, and −0.273). Conclusions CEUS parameters reflected changes in renal microvascular perfusion in patients with DKD, while AUCs might be useful indicators of declining GFR in DKD patients with increased CysC.

Application Value of Contrast-Enhanced Ultrasound Combined with Enhanced MR Scanning in Patients with Intrahepatic Cholangiocarcinoma.

Objective To explore the clinical application effect of contrast-enhanced ultrasound (CEUS) combined with enhanced MR scanning in patients with intrahepatic cholangiocarcinoma (ICC). Methods 90 patients with ICC admitted to Ganyu District People's Hospital of Lianyungang City from June 2017 to June 2018 were selected as the research objects and randomly divided into control group and experimental group, with 45 cases in each group. The control group was tested by CEUS, and the experimental group was tested by CEUS combined with enhanced MR scanning. The test results of the two groups were compared, and the benign and malignant indicators of the two groups were detected. Results The rate of lesion detection, accuracy of localization qualitative accuracy, and diagnosis coincidence rate of the experimental group were significantly better than those of the control group (p < 0.05). The lesion length, tube wall thickness, and enhancement ratio of triple-phase multislice CT scan of the experimental group were lower than the control group (p＜0.05). Conclusions CEUS combined with enhanced MR scanning has high sensitivity and specificity and can significantly improve the accuracy of the detection results. It provides scientific and accurate scientific basis for clinical treatment and diagnosis of ICC, which is worthy of popularization and application.

Contrast-enhanced ultrasound is a reliable and reproducible assessment of necrotic ablated volume after radiofrequency ablation for benign thyroid nodules: a retrospective study

Purpose To investigate the intra- and inter-observer reliability and agreement of contrast-enhanced ultrasound (CEUS) in measuring ablated volume (Va) after radiofrequency ablation (RFA) for benign thyroid nodules. Materials This retrospective study evaluated 65 patients with 74 benign thyroid nodules who underwent RFA. Patients were followed up at 1, 3, 6, and 12 months and every 12 months thereafter. Two independent observers measured the Va using CEUS during the same follow-up visit. The intra- and inter-observer reliability was assessed using intraclass correlation coefficient (ICC) with 95% confidence interval. The Bland–Altman analysis was used to evaluate the inter-observer agreement, which was expressed as a mean difference with 95% limit of agreement (LOA). Results No significant difference was found in Va measurements by the two observers with a mean follow-up time of 41.17 ± 16.80 months (all p > 0.05). The intra- and inter-observer reliability were both excellent (ICC >0.90) at each follow-up period. The 95% LOA became wider over the follow-up period. The smallest 95% LOA was found at 1 month with a LOA from 0.8117 to 1.122, and the largest 95% LOA was from 0.5694 to 1.343 at 36 months. Conclusions CEUS could provide a reliable and reproducible assessment of Va after RFA for benign thyroid nodules. In clinical post-ablation follow-up, the irregular morphology of ablated area and the variation by different observers could not affect the assessment of Va by CEUS.

Association Between Contrast-Enhanced Ultrasound Characteristics and Molecular Subtypes of Breast Cancer.

This study aimed to investigate the correlation between contrast-enhanced ultrasound (CEUS) features and molecular subtypes of breast cancer (BC). A total of 116 patients (116 lesions) with pathologically diagnosed BC who received conventional ultrasound and CEUS before surgery were enrolled in this study. BC molecular subtypes were identified by postoperative pathological and immunohistochemical analysis as Luminal A (LA), Luminal B (LB), HER2 (H2) over-expression, and triple-negative (TN). Qualitative and quantitative CEUS characteristics were analyzed by one-way analysis of variance (continuous variables) or Pearson's χ2 test or Fisher's exact probability method (categorical variables). There were significant differences in enhancement speed and enhancement degree among the four subtypes (P < .05). The area under the curve (AUC), time to peak (TTP), and peak intensity (PI) differed among the four subtypes (P < .05). The AUC of the LA subtype (305.1 ± 188.4) was significantly smaller compared with the H2 (535.7 ± 222.0, P=.007) and TN subtypes (496.6 ± 254.7, P=.019). In addition, TTP was shorter in the H2 subtype (19.8± 4.9) compared with the other subtypes, and was significantly shorter than in the LA subtype (26.3 ± 7.2, P=.008) and LB subtype (23.1 ± 6.7, P=.036). The PI of the LA subtype (4.7 ± 2.3) was significantly lower than that of the LB (6.6 ± 2.3, P=.027), H2 (7.4 ± 2.2, P=.005), and TN subtypes (6.9 ± 2.6, P=.014). CEUS features differed significantly among different molecular subtypes of BC. The enhancement patterns and parameters may be important predictive features of different subtypes of BC.

Diagnostic efficacy of sentinel lymph node in breast cancer under percutaneous contrast-enhanced ultrasound: An updated meta-analysis.

BackgroundTo investigate the diagnostic efficacy of sentinel lymph nodes (SLN) in breast cancer by percutaneous contrast‐enhanced ultrasound (CEUS) through pooled analysis of relevant studies published before June 2021.MethodsWe conducted a systematic review and meta‐analysis of relevant studies by searching the electronic databases of PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang and VIP and the studies were screened according to their inclusion and exclusion criteria. Sensitivity (SEN), specificity (SPE), positive likelihood ratio (+LR), negative likelihood ratio (−LR) and diagnostic odds ratio (DOR) were calculated by Meta‐disc 1.4 software and the summary receiver operating characteristic (SROC) curve and area under the curve of ROC (AUC) were constructed.ResultsTwenty‐two publications evaluating the diagnostic efficacy of SLN in breast cancer under percutaneous CEUS were included in the meta‐analysis. The diagnostic sensitivity, specificity were 0.86 (95% CI: 0.83–0.88) and 0.89 (95% CI: 0.87–0.91) for SLN in breast cancer detected by percutaneous CEUS respectively using a random effect model. The +LR and –LR were combined in a random effect model due to significant statistical heterogeneity (p < 0.05). The pooled +LR, −LR were 7.06 (95% CI: 4.34–11.50), and 0.17 (95% CI: 0.12–0.24), respectively. The combined DOR was 53.32 (95% CI: 29.74–95.61) for SLN diagnosis in breast cancer by percutaneous CEUS under a random effect model. The AUC was 0.94 which indicated that CEUS had high diagnostic efficacy of SLN in patients with breast cancer.ConclusionsCEUS is a noninvasive method for the detection SLN in patients of breast cancer with relative high prediction efficacy.

Correlation between Contrast-enhanced Ultrasound and Risk of Tumor Recurrence in Papillary Thyroid Carcinoma

Objective To explore the association between contrast-enhanced ultrasound and risk of tumor recurrence in papillary thyroid carcinoma(PTC). Methods A total of 287 PTCs in 287 patients who underwent surgery,conventional ultrasound,and contrast-enhanced ultrasound(CEUS)were enrolled in this study.According to 2015 American Thyroid Association(ATA)Modified Initial Risk Stratification System,the patients were categorized into three groups:low risk,intermediate risk,and high risk.The CEUS patterns of PTCs were compared between different risk stratifications. Results Hypo-enhancement was presented in 57.6% of ATA low-risk PTCs,iso-enhancement in 62.3% of ATA intermediate-risk PTCs,and hyper-enhancement in 48.2% of ATA high-risk PTCs(P<0.0001).The risk stratifications and enhanced intensity in PTC showcased a positive correlation(Spearman's rho of 0.442,P<0.0001)and a linear trend(χ 2 value of 55.921,P<0.0001).Higher enhancement intensity corresponded to higher risk stratification.Ordinal logistic regression analysis indicated that PTCs with hyper-enhancement and iso-enhancement presented higher risks than those with hypo-enhancement after age and gender were adjusted,and theOR values were 17.5(8.4-36.2)and 3.4(2.0-5.8),respectively. Conclusions CEUS patterns correlate intimately with the recurrence risk in PTC.Hyper-enhancement PTCs tend to present high risks,while hypo-enhancement PTCs tend to present low risks of recurrence.

Contrast-Enhanced Ultrasound Imaging Features of Focal Splenic Tuberculosis.

BackgroundThe aim of this study was to characterize the contrast-enhanced ultrasound imaging features of focal splenic tuberculosis.Material/MethodsWe retrospectively analyzed the conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) imaging features of 22 patients with splenic TB confirmed by surgical histopathology or biopsy.ResultsConventional US demonstrated that 15 of the 22 patients had a single lesion, while 7 had multiple lesions. The maximum diameter of the lesions ranged from 1.0 to 3.7 cm. Of the 22, 17 were detected with hypoecho and 5 were detected with complex echo by conventional US. Seven (7/22) were detected with blood flow signals by color Doppler flow image (CDFI). CUES demonstrated that 18 cases (81.8%, 18/22) began to enhance in the arterial phase, mostly followed by slow wash-out in the intermediate or late parenchymal phase, and 4 (18.2%, 4/22) presented with non-enhancement during all phases. The enhancement patterns were categorized into 4 types: Type I, homogeneous enhancement (2/22); Type II, rim-like enhancement (12/22); Type III, septation-like enhancement (4/22); and Type IV, non-enhancement (4/22).ConclusionsCEUS showed that splenic TB lesions were enhanced in the arterial phase, followed by slow washed out or persistent enhancement in the intermediate and late parenchymal phases. The rim- or septation-like enhancement may be helpful for diagnosing splenic TB. The splenic lesions presenting round hypoecho by conventional US and complete non-enhancement by CEUS are highly suspicious of splenic TB.

Fusion imaging-guided radiofrequency ablation for residual hepatocellular carcinoma invisible on ultrasound after transcatheter arterial chemoembolization

Purpose This study aimed to investigate the technical efficiency and therapeutic response of fusion imaging (considered as virtual navigation) between contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography/magnetic resonance imaging (CECT/CEMRI) for the guidance of radiofrequency ablation (RFA) in patients with residual hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). Methods For this prospective study, 98 patients with residual HCC lesions after TACE treatment were enrolled between June 2017 and December 2020. All the lesions were invisible on conventional ultrasound scans. Percutaneous RFA was performed using either CEUS (CEUS group, 52 lesions) or virtual navigation (VN group, 46 lesions) guidance. The lesion display rate, disease-free survival rate, local recurrence rate, overall survival rate and complication incidence were calculated and compared. Results Fusion imaging had a significant impact on the RFA outcomes (hazard ratio, 2.629; 95% confidence interval, 1.256–5.505; p = .01). The median disease-free survival time of the VN group was significantly higher than that of the CEUS group (10.9 vs. 8.8 months; p = .007). The local recurrence rates after 3, 6 and 12 months in the VN group were significantly lower than those in the CEUS group (p = .014, .002 and .011). The minor complication rate was not significantly different between the two groups. Conclusions CEUS–CECT/CEMRI fusion imaging for guiding RFA enables an efficient and useful therapy of inconspicuous HCC lesions after TACE. The novel solution prolongs the disease-free survival time and reduces the long-term local recurrence of residual lesions treated when using virtual-navigation (VN)-guided RFA.

Contrast-enhanced ultrasound in uterine artery embolization treatment of cesarean scar pregnancy.

ObjectiveThe current study aimed to investigate the application of contrast-enhanced ultrasound (CEUS) in diagnosis and treatment of cesarean scar pregnancy (CSP).MethodsA retrospective study was performed in 35 patients with clinically suspected CSP who requested termination of pregnancy and underwent contrast-enhanced ultrasound (CEUS). The patients were classified into two groups on the basis of whether they received uterine artery embolization (UAE). The CEUS characteristics of the two groups were reviewed.ResultsCEUS features of CSP were early enhancement of the cesarean scar and continuous infusion of contrast agent between the gestational sac and cesarean scar. Myometrial thickness in the cesarean scar was thinner in the UAE group than in the non-UAE group by CEUS and transvaginal ultrasound. Myometrial thickness measured by CEUS was thinner than that measured by transvaginal ultrasound in both groups. The parameters of the time-intensity curve in the UAE group were characterized by a faster arrival time, shorter time to peak, higher peak intensity, and greater enhancement rate compared with the non-UAE group.ConclusionsCEUS may be a novel supplementary method to diagnose and assess CSP, and to help evaluate whether UAE is required.

Diagnosis of gallbladder polypoid lesions using contrast enhanced ultrasound

Purpose Effectiveness of differential diagnosis of gallbladder polypoid lesions using contrast enhanced ultrasound (CEUS) examination by perflubutane (Sonazoid®:Daiichi-Sankyo, Tokyo). Material & Methods CEUS was performed on 183 patients with gallbladder polypoid lesions.It consists of 10 adenocarcinomas, 2 adenomas, 129 benign polyps and 42 adenomyomatosis (fundal type). For benigndiseases, we examined cases where the size was 6 mm or more and could be observed for more than one year. Ultrasound was performed using TUS-A500 (Aplio 500) (Canon MedicalSystems. Tokyo) and prosound alpha10 (Hitachi Aloka Medical,Ltd.Tokyo). First, the largest cross section of a lesion was visualized using B-mode and infusion of Sonazoid. The characteristics and behavior of blood flow in the lesion in the early vascular phase were examined over approximately 30 sec. Thereafter, observation was continued accordingly for about 3 min. Sonazoid infusion using contrast harmonic imaging and real-time perfusion Imaging. Results Gallbladder carcinoma showed hypervascular staining and “eruption sign” was apparent in 60%. The “eruption sign” showed an image of a vigorously boiling water that was splashing up from the entire lesion. Blood flow imaging revealed irregular size and buckling, including tortuous vessels and erratic blood flow in 70%. Gallbladder adenoma showed “eruption sign” was apparent in 50%. The irregular size, tortuous vessels and eruption signs of blood flow imaging were 83.3% as an index of neoplastic. Gallbladder benign polyp, staining was scattered within them, and “flicker sign” was observed in 93.8%. The “flicker sign” showed an image of bubbling pre-boiled hot water. Five cases (3.9%) showed a diffused and hypervascular staining pattern. The staining time was shorter than gallbladder carcinoma. Blood flow image showed normal vessels without buckling. Linear blood flow of the stalk of gallbladder polyp was also characteristic. Gallbladder adenomyomatosis (fundal type), staining was scattered and mild flicker signs were observed in 85.7%. Blood flow at the surface of the prominence and internal Rokitansky-Aschoff sinus was observed clearity. Conclusions CEUS can clarify the hemodynamics and blood flow images and are useful for the differential diagnosis of gallbladder polypoid lesions.

PD52-02 RENAL CELL CARCINOMA ASSOCIATED WITH XP11.2 TRANSLOCATION/TFE3 GENE FUSIONS: DIFFERENTIAL DIAGNOSIS WITH CLEAR CELL RENAL CELL CARCINOMA ON CONTRAST-ENHANCED ULTRASOUND

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging III1 Apr 2017PD52-02 RENAL CELL CARCINOMA ASSOCIATED WITH XP11.2 TRANSLOCATION/TFE3 GENE FUSIONS: DIFFERENTIAL DIAGNOSIS WITH CLEAR CELL RENAL CELL CARCINOMA ON CONTRAST-ENHANCED ULTRASOUND Zhang Fan, Wang Wei, Gan Weidong, and Guo Hongqian Zhang FanZhang Fan More articles by this author , Wang WeiWang Wei More articles by this author , Gan WeidongGan Weidong More articles by this author , and Guo HongqianGuo Hongqian More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2190AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the significance of contrast-enhanced ultrasound(CEUS) in diagnosis and differential diagnosis of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusions (Xp11.2 RCC) and clear cell renal cell carcinoma (CCRCC). METHODS We retrospectively analyzed the conventional ultrasound (CUS) and CEUS data of 15 cases proved to be Xp11.2 RCC and 72 cases proved to be CCRCC by pathology after surgery. RESULTS Xp11.2 RCC more frequently affected young (32.3± 12.6 years) women (9/15, 60%) with gross hematuria (7/15, 46.7%), while CCRCC more frequently involved middle-aged (51.0 ± 14.1 years) men (47/72, 65.3%). In CUS, both Xp11.2 RCC and CCRCC tended to be quasiccircular and hypo-echoic. Lesion sizes between Xp11.2 RCC (4.6±1.6 cm) and CCRCC (5.0±1.8 cm) were unsignificant difference. In CEUS, the arrival time (AT) and time to peak intensity (TTP) of most Xp11.2 RCCs (12/15, 80%) were slower than adjacent renal cortex, while AT and TTP of most CCRCCs (52/72 80.6%) were faster than adjacent renal cortex. The difference of peak intensity (PI) between Xp11.2 RCC(hypo-enhancement 9/15, 60%) and CCRCC (hyper-enhancement 53/72, 73.6%) were significant. Contrast agent in most CCRCCs (48/72, 66.7%) was rapid-fading, but all of Xp11.2 RCCs were rapid-fading, there was significant difference between them. CONCLUSIONS CEUS provide a new and effective method in diagnosis of Xp11.2 RCC. CEUS are useful in differential diagnosis of Xp11.2 RCC with CCRCC. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e989 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Zhang Fan More articles by this author Wang Wei More articles by this author Gan Weidong More articles by this author Guo Hongqian More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP32-02 UTILITY OF CONTRAST ENHANCED ULTRASOUND IN THE DIAGNOSIS OF ACUTE COMPLICATIONS AFTER RENAL TRANSPLANT.

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II1 Apr 2016MP32-02 UTILITY OF CONTRAST ENHANCED ULTRASOUND IN THE DIAGNOSIS OF ACUTE COMPLICATIONS AFTER RENAL TRANSPLANT. Sara Alvarez Rodriguez, Enrique Sanz Mayayo, Victoria Gómez Dos Santos, Vital Hevia Palacios, Rafael Rodríguez-Patrón Rodríguez, Víctor Díez Nicolas, and Javier Fabuel Alcañiz Sara Alvarez RodriguezSara Alvarez Rodriguez More articles by this author , Enrique Sanz MayayoEnrique Sanz Mayayo More articles by this author , Victoria Gómez Dos SantosVictoria Gómez Dos Santos More articles by this author , Vital Hevia PalaciosVital Hevia Palacios More articles by this author , Rafael Rodríguez-Patrón RodríguezRafael Rodríguez-Patrón Rodríguez More articles by this author , Víctor Díez NicolasVíctor Díez Nicolas More articles by this author , and Javier Fabuel AlcañizJavier Fabuel Alcañiz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1297AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Routine diagnostic method for assess renal graft dysfunction is Doppler ultrasound. However, contrast enhanced ultrasound (CEUS) may provide more information about evaluation of parenchymal flow and vascular status of kidney allografts. The objective was to evaluate the potential application of CEUS in the immediate post-transplant period, focused on acute vascular complications. METHODS A total of 15 kidney recipients underwent CEUS and conventional Doppler ultrasound 2-4 days after transplantation. After injection of 2.5 cc of intravenous contrast we analysed intensity curves (TIC) placing three circular regions of interest (ROIs) in the medullary region, interlobar arteries and subcapsular cortex. Initial baseline analysis was performed, and TIC parameters were correlated with clinical data and results from computed tomography and gammagraphy if available. In case of biopsy or transplantectomy, pathological specimens were also analysed. Analysed parameters on CEUS were: Arrival time (time to injection to start of micro bubble uptake in seconds)(At); Time to peak (TTP) of maximum value; Intensity peak of enhancement (IP) and final intensity (FI). Difference between IP and FI was calculated to evaluate the slope of the intensity curve. Parameters were always analysed in the three areas of interest described. Macroscopic visual evaluation of renal parenchyma vascularization. RESULTS 15 kidney recipients were included, including one living donor kidney, one autotrasplant and one orthotopic transplant. 2 patients showed reduced intensity curves consistent with acute tubular necrosis. 1 infectious abscess seen as an anechoic area without contrast uptake. 2 cortical necrosis showed an anechoic cortical halo, that cannot be detected by conventional US and that results were similar to those of the computed tomography (CT) with absence of allograft perfusion. 1 patient had a renal vein thrombosis and 1 patient a focal ischemic area due to thrombosis of a polar artery. Ischemic areas appeared as a perfusion defect, reflecting the lack of contrast uptake. Patients with cortical necrosis and venous thrombosis underwent immediate transplantectomy, and pathological analysis confirmed CEUS findings. The slope in allografts without evidence of acute complication was steeper identifying a better washout of contrast CONCLUSIONS CEUS is a useful tool in the characterization of renal graft dysfunction with special interest on acute vascular complications after renal transplant. It is a feasible technique for quantitative analysis of kidney perfusion which provides information on renal tissue microcirculation and regional parenchymal flow. Findings are superimposable to those in CT and this could be replaced in patients in the immediate post-transplant period avoiding nephrotoxic effect of iodinated agents. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e428 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Sara Alvarez Rodriguez More articles by this author Enrique Sanz Mayayo More articles by this author Victoria Gómez Dos Santos More articles by this author Vital Hevia Palacios More articles by this author Rafael Rodríguez-Patrón Rodríguez More articles by this author Víctor Díez Nicolas More articles by this author Javier Fabuel Alcañiz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Value of contrast-enhanced ultrasound in the diagnosis of the local adenosis of breast

Objective To analyse appearances of contrast-enhanced ultrasound(CEUS) of breast local adenosis,and to explore the value of CEUS in the diagnosis of the local adenosis of breast.Methods The data of conventional ultrasound and CEUS of local adenosis of breast in 110 cases confirmed by operation and pathology were analysed.The enhancement patterns,border of the lesion,time-intensity curve were evaluated respectively.Results Totally 151 lesions were detected by conventional ultrasound in 110 cases,61 lesions were diagnosed by conventional ultrasound for adenopathy or adenosis tumor,the diagnosis coincidence rate was 40.4％ (61/151).By CEUS,106 lesions were diagnosed as adenopathy or adenosis tumor,the diagnosis coincidence rate was 70.2 ％ (106/151),higher than that of conventional ultrasound.The features of CEUS include:In contrast perfusion time to peak,103 lesions inhomogeneously enhanced in whole or in part (68.2 ％).The enhancement degree of 121 lesions (80.1 ％) were moderate enhancement or slightly high enhancement,a few lesions (11.9％,18/151) showed significantly enhanced,and very few lesions (7.9 ％,12/151) for low enhancement.In contrast perfusion peak,107 (70.9 ％) lesions had less clear boundary,no envelope,and had a certain continuity with the surrounding background breast tissue,in which 5 lesions were showed significantly increased in size by CEUS comparison with conventional ultrasound,and the boundary of 4 lesions was shaped like the burr,no regularity after enhancing.The boundary of 29.1％ (44/151) of the lesion was clear.In the lesions with moderate enhancement or slightly high enhancement,the time-intensity curve mainly displayed washin and same wash out (60/151,39.7 ％) and washin and fast wash-out (65/151,43.0％).Conclusions CEUS image of focal breast adenosis has certain characteristics.CEUS can provide more evidences in diagnosis and differential diagnosis of breast adenosis,which can help to improve diagnostic confidence. Key words: Ultrasonography; Microbubbles ; Fibrocystic breast disease

Sa1004 Measurement of Liver and Spleen Stiffness by ARFI Elastography: Intra-and Inter-Observer Variability and Predictors of Variability

Staging hepatocellular carcinoma (HCC) is an esential step in the decision regarding treatment options. Malignant portal vein thrombosis is a contraindication for all curative treatment, thus establishing the nature (benign or malignant) of PVT is mandatory for staging the disease. The AIM of this paper was to assess the role of contrast enhanced ultrasound (CEUS) for the staging of HCC in patients with liver cirrhosis. METHODS: We evaluated 86 consecutive patients with liver cirrhosis and known HCC, who were discovered with PVT located in different parts of the portal system. Before CEUS we performed a standard ultrasound and a Doppler examination. We used 2.4 ml of second generation contrast agent (SonoVue) for every examination. During the CEUS examination we followed the arterial, portal and late phases as defined in the EFSUMB Guidelines (1) and also the enhancement pattern as described by Rossi et al. (Type 1: thrombus enhancement is absent in all three phasesbenign thrombus; and for malign thrombus-Type 2: diffuse thrombus enhancement that is visible only during the early arterial phase; Type 3: linear or punctate enhancement; Type 4: multilinear or multipunctate enhancement)(2). RESULTS: PVT was located in the proximity of HCC in 63 of the 86 cases (73.2 %). 11 cases (12.7%) were Type 1 Rossi (benign thrombus), 44 cases (51.1%) were Type 2, 14 cases (16.2%) were Type 3 and 17 cases (19.7%) were Type 4 Rossi. Using CEUS we could characterise and obtain a conclusive diagnosis in 85 of the 86 patients (98.8%). CONCLUSIONS CEUS is a method with a good sensibility for the characterisation of PVT in patients with HCC, that allows the staging of the disease for a good therapeutic decision. BIBLIOGRAPHY: 1. M. Claudon, C. F. Dietrich, B. I. Choi, D. O. Cosgrove, M. Kudo, C. P. Nolsoe, F. Piscaglia, S. R. Wilson, R. G. Barr, M. C. Chammas, N. G. Chaubal, M.-H. Chen, D. A. Clevert, J. M. Correas, H. Ding, F. Forsberg, J. B. Fowlkes, R. N. Gibson, B. B. Goldberg, N. Lassau, E. L. S. Leen, R. F. Mattrey, F. Moriyasu, L. Solbiati, H.-P. Weskott, H.-X. Xu. Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver-Update 2012. Published online: 2012 Ultraschall in Med. 2. Rossi S. et al. Contrast-Enhanced Versus Conventional and Color Doppler Sonography for the Detection of Thrombosis of the Portal and Hepatic Venous Systems. AJR 2006; 186:763-773.

Sa1003 Diagnosis of Benign and Malignant Portal Vein Thrombosis in Cirrhotic Patients With Hepatocellular Carcinoma Using Contrast-Enhanced Ultrasound (CEUS)

Staging hepatocellular carcinoma (HCC) is an esential step in the decision regarding treatment options. Malignant portal vein thrombosis is a contraindication for all curative treatment, thus establishing the nature (benign or malignant) of PVT is mandatory for staging the disease. The AIM of this paper was to assess the role of contrast enhanced ultrasound (CEUS) for the staging of HCC in patients with liver cirrhosis. METHODS: We evaluated 86 consecutive patients with liver cirrhosis and known HCC, who were discovered with PVT located in different parts of the portal system. Before CEUS we performed a standard ultrasound and a Doppler examination. We used 2.4 ml of second generation contrast agent (SonoVue) for every examination. During the CEUS examination we followed the arterial, portal and late phases as defined in the EFSUMB Guidelines (1) and also the enhancement pattern as described by Rossi et al. (Type 1: thrombus enhancement is absent in all three phasesbenign thrombus; and for malign thrombus-Type 2: diffuse thrombus enhancement that is visible only during the early arterial phase; Type 3: linear or punctate enhancement; Type 4: multilinear or multipunctate enhancement)(2). RESULTS: PVT was located in the proximity of HCC in 63 of the 86 cases (73.2 %). 11 cases (12.7%) were Type 1 Rossi (benign thrombus), 44 cases (51.1%) were Type 2, 14 cases (16.2%) were Type 3 and 17 cases (19.7%) were Type 4 Rossi. Using CEUS we could characterise and obtain a conclusive diagnosis in 85 of the 86 patients (98.8%). CONCLUSIONS CEUS is a method with a good sensibility for the characterisation of PVT in patients with HCC, that allows the staging of the disease for a good therapeutic decision. BIBLIOGRAPHY: 1. M. Claudon, C. F. Dietrich, B. I. Choi, D. O. Cosgrove, M. Kudo, C. P. Nolsoe, F. Piscaglia, S. R. Wilson, R. G. Barr, M. C. Chammas, N. G. Chaubal, M.-H. Chen, D. A. Clevert, J. M. Correas, H. Ding, F. Forsberg, J. B. Fowlkes, R. N. Gibson, B. B. Goldberg, N. Lassau, E. L. S. Leen, R. F. Mattrey, F. Moriyasu, L. Solbiati, H.-P. Weskott, H.-X. Xu. Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver-Update 2012. Published online: 2012 Ultraschall in Med. 2. Rossi S. et al. Contrast-Enhanced Versus Conventional and Color Doppler Sonography for the Detection of Thrombosis of the Portal and Hepatic Venous Systems. AJR 2006; 186:763-773.

Contrast-enhanced Ultrasound for Detection of Traumatic Splenic Bleeding in a Canine Model During Hemorrhagic Shock and Resuscitation

Background Contrast-enhanced ultrasound (CEUS) is a highly specific and sensitive method for the detection of abdominal injury. We assessed the value of CEUS for real-time monitoring of splenic trauma and detection of bleeding in a canine model of splenic injury during hemorrhagic shock and resuscitation. Methods Forty Grades III and IV traumatic splenic lesions were created in 15 mongrel dogs. Hemorrhagic shock was induced by exsanguination via the left femoral artery. Animals in shock were then resuscitated with 6% hydroxyethyl starch. CEUS was performed continuously to investigate the imaging characteristics of splenic trauma and to monitor changes in bleeding. Results Prior to induction of hemorrhagic shock, CEUS revealed active bleeding in 36 of 40 traumatic lesions (90.0%), either as contrast medium extravasation or pooling, both in the spleen and outside the capsule. During the shock period, no traumatic lesion had active bleeding. CEUS revealed that tiny branches of splenic arteries decreased in number and became thinner. The traumatic lesions appeared as nonenhanced areas with poorly defined boundaries. After fluid resuscitation, rebleeding occurred in 30 traumatic lesions, and 28 (93.3%) of these were detectable by CEUS. Conclusions CEUS allowed real-time monitoring of splenic trauma and detection of bleeding and rebleeding in hemodynamically unstable dogs, prior to and after fluid resuscitation. This suggests that CEUS might be used in clinical intensive care for patients with traumatic hemorrhagic shock.

Clinical study on diagnosis and prognosis assessment of ischemic-type biliary lesion with contrast-enhanced ultrasound

Objective To evaluate the value of contrast-enhanced ultrasound (CEUS) in diagnosing ischemic-type biliary lesion (ITBL) and analyze the relation between the enhancement patterns of bile duct wall of ITBL and its outcome.Methods 36 patients confirmed with ITBL (24 cases),anastomotic biliary stricture (3 cases),cholangitis (4 cases),biliarysludge (1 cases),and acute rejection (4 cases),who underwent CEUS examination,were enrolled in this study.The images were retrospectively analyzed in consensus by 2 readers.After reviewing the images,the readers were asked to make a diagnosis of ITBL.The diagnostic standard was hypo-or non-enhancement of hilar bile duct wall in arterial phase on CEUS.Results The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 66.7％,83.3％,72.2％,88.9％,and 55.6％ for reader 1;62.5％,83.3％,69.4％,88.2％,and 52.6 ％ for reader 2,respectively.The interobserver agreement was good (κ =0.83).In 24 ITBL patients,the ratio of mortality or retransplantation with non enhancing hilar bile duct wall in arterial phase was much higher than that with enhancing hilar bile duct wall (non-enhancement 54.5％,hypo-enhancement 20％,hyper-or iso-enhancement 12.5％).Conclusions CEUS had diagnostic value of ITBL.Non-enhancing hilar bile duct wall in arterial phase on CEUS predicated the poor outcome. Key words: Ultrasonography; Microbubbles; Liver transplantation; Bile duct diseases; Ischemia