Contrast-enhanced Color Doppler Imaging Research Articles

Prostate cancer imaging: what the next decade holds

Prostate carcinoma is the most commonly diagnosed malignancy and the second most common cause of male cancer death in the USA [1]. Autopsy and early observational studies have shown that approximately one out of three men above the age of 50 years has histologic evidence of prostate carcinoma. While a portion of these tumors may be very aggressive and lethal, others are possibly clinically insignificant [2]. Identifying the lethal form of this tumor remains a challenge in this heterogeneous malignancy. The clinical presentation of prostate cancer may range from an asymptomatic condition to a rapidly progressive systemic illness. Prostate specific antigen (PSA) screening has resulted in earlier detection and a downstaging of prostate cancer at diagnosis. At the same time, the commonly used PSA cutoff of 2.5 ng/ml, used by urologists for biopsy, also leads to a significant number of unnecessary biopsies, leading to over diagnosis and overtreatment of indolent disease [3]. Thus far, imaging has only played a relatively small role in the management of localized prostate cancer. The current standard imaging techniques, such as transrectal ultrasound (TRUS), MRI, computed tomography (CT) and nuclear medicine studies, are not able to detect early disease, and only provide limited information for tumor, node, metastasis staging [4]. However, the role of imaging in patients with prostate cancer is evolving. New techniques are under investigation, either alone or combined with standard imaging techniques. TRUS is usually used to guide biopsies and to place brachytherapy seeds, but it does not reliably differentiate healthy from malignant prostate gland tissue. Contrast-enhanced color Doppler imaging, intermittent harmonic imaging and contrast-enhanced flash-replenishment imaging are now combined with standard TRUS. Contrast-enhanced ultrasound takes advantage of an increased density of micro vasculature in cancerous tissue compared with benign prostate tissue. Using micro bubble contrast agents, which diffuse into microvessels, this technique selectively enhances areas with increased vascularity. However, because of the relatively large size of microbubbles (~5–10 μm), leakage into the tumor cannot be well visualized and enhancement can also be due to benign conditions, such as prostatitis [5]. In a recent study of 114 patients with elevated PSA levels and previous negative biopsy contrast-enhanced advanced dynamic flow, Tina Islam

Status of Transrectal Ultrasound Imaging of the Prostate

To describe the current and new developments in transrectal ultrasound (US) imaging of the prostate. Grayscale imaging of the prostate is the standard method for diagnostic evaluation and biopsy guidance. Color Doppler (CD) imaging, including CD and power Doppler US, allows for detection of macrovascularity and may therefore be helpful for assessment of prostatic blood flow. The use of US microbubbles for CD imaging and new contrast-specific techniques enable assessment of prostate microvascularity associated with prostate cancer (PCa). Recently, real-time elastography has been introduced to improve detection of cancer based upon changes in tissue stiffness. Contrast-enhanced CD imaging has shown to enable PCa detection by performing targeted biopsies into suspicious areas. Comparisons between systematic and contrast-enhanced targeted biopsies have shown that the targeted approach detects more cancers and cancers with higher Gleason scores with a reduced number of biopsy cores. New microbubble-specific US techniques can improve sensitivity and specificity of US imaging for PCa detection. Real-time elastography has been demonstrated to be useful for the detection of PCa, and may further improve PCa staging. The new US techniques seem to have the potential to improve PCa detection, and also PCa grading and staging. As these diagnostic methods improve, the ultimate hope is to eliminate biopsy in patients without cancer.

Comparison of Contrast-Enhanced Color Doppler Imaging (CDI), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) for the Detection of Crossing Vessels in Patients with Ureteropelvic Junction Obstruction (UPJO)

ObjectiveTo assess the use of contrast-enhanced color Doppler imaging (CDI), computed tomography (CT), and magnetic resonance imaging (MRI) for the detection of crossing vessels at the ureteropelvic junction (UPJ) in patients with ureteropelvic junction obstruction (UPJO). Materials and methodsForty-eight patients aged 18–69 yr (mean age, 52) who had been diagnosed with an UPJO on intravenous pyelography and diuretic renography were included. Contrast-enhanced CDI was performed by using both color Doppler frequency and color Doppler amplitude (“Power”) modes. Spiral CT was performed by using a three-phase CT (arterial, venous, and excretory phases) allowing for CT angiography. MRI technique included dual-phase magnetic resonance angiography (arterial, venous) for the assessment of respective arteries and veins. The type (ie, arterial or venous) and position of the vessel relative to the UPJ (ie, anterior or posterior) were assessed. The CDI, CT, and MRI findings were correlated with the surgical findings at laparoscopic pyeloplasty. ResultsForty-four of 48 patients (92%) demonstrated crossing vessels at subsequent laparoscopy. Altogether a total of 60 vessels were detected. Contrast-enhanced CDI and MRI correctly detected all crossing vessels (accuracy, 100%), whereas CT missed four posterior crossing veins (accuracy, 93%). ConclusionContrast-enhanced CDI is recommended as first-line imaging modality for the detection of crossing vessels in patients with UPJO.

Editorial Comment on: Comparison of Contrast-Enhanced Color Doppler Imaging (CDI), Computerized Tomography (CT), and Magnetic Resonance Imaging (MRI) for the Detection of Crossing Vessels in Patients with Ureteropelvic Junction Obstruction (UPJO)

Objective: To assess the use of contrast-enhanced color Doppler imaging (CDI), computed tomography (CT), and magnetic resonance imaging (MRI) for the detection of crossing vessels at the ureteropelvic junction (UPJ) in patients with ureteropelvic junction obstruction (UPJO). Materials and methods: Forty-eight patients aged 18-69 yr (mean age, 52) who had been diagnosed with an UPJO on intravenous pyelography and diuretic renography were included. Contrast-enhanced CDI was performed by using both color Doppler frequency and color Doppler amplitude (Power) modes. Spiral CT was performed by using a three-phase CT (arterial, venous, and excretory phases) allowing for CT angiography. MRI technique included dual-phase magnetic resonance angiography (arterial, venous) for the assessment of respective arteries and veins. The type (ie, arterial or venous) and position of the vessel relative to the UPJ (ie, anterior or posterior) were assessed. The CDI, CT, and MRI findings were correlated with the surgical findings at laparoscopic pyeloplasty. Results: Forty-four of 48 patients (92%) demonstrated crossing vessels at subsequent laparoscopy. Altogether a total of 60 vessels were detected. Contrast-enhanced CDI and MRI correctly detected all crossing vessels (accuracy, 100%), whereas CT missed four posterior crossing veins (accuracy, 93%). Conclusion: Contrast-enhanced CDI is recommended as first-line imaging modality for the detection of crossing vessels in patients with UPJO.

Editorial Comment on: Comparison of Contrast-Enhanced Color Doppler Imaging (CDI), Computerized Tomography (CT), and Magnetic Resonance Imaging (MRI) for the Detection of Crossing Vessels in Patients with Ureteropelvic Junction Obstruction (UPJO)

Editorial Comment on: Comparison of Contrast-Enhanced Color Doppler Imaging (CDI), Computerized Tomography (CT), and Magnetic Resonance Imaging (MRI) for the Detection of Crossing Vessels in Patients with Ureteropelvic Junction Obstruction (UPJO)

Serum bFGF and VEGF correlate respectively with bowel wall thickness and intramural blood flow in Crohn's disease.

Serum levels of basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF)--two factors known to promote tissue repair, fibroblast proliferation, and angiogenesis--were measured in Crohn's disease patients and correlated with bowel wall thickness (BWT), measured by conventional grey scale ultrasonography, and with the ileal intramural vessel flow, measured by contrast-enhanced color Doppler imaging. Serum samples were obtained from 25 patients with active Crohn's disease and 22 healthy volunteers, all sex- and age-matched. Serum bFGF and VEGF levels were measured by ELISA assay. All the patients were examined with conventional transabdominal bowel sonography. Color Doppler of the intramural enteric vessels was then performed after the intravenous injection of Levovist, a galactose-based sonographic contrast agent. In Crohn's disease patients, serum bFGF and VEGF were significantly higher compared with healthy volunteers. A positive correlation between serum bFGF and BWT and between serum VEGF and color Doppler signal intensity was found. The raised serum bFGF levels in Crohn's disease patients with intestinal strictures compared with patients with other phenotypes (fistulizing, inflammatory), together with the correlation observed between serum bFGF and BWT, suggests a possible involvement of bFGF in the process of transmural fibrogenesis in Crohn's disease. The higher levels of VEGF in those patients with increased intramural blood flow suggests that VEGF may be considered a marker of angiogenesis in this condition.

1968: Comparison of Contrast-Enhanced Color Doppler Imaging, Computerized Tomography and Magnetic Resonance Imaging for Detection of Crossing Vessels in Patients with Ureteropelvic Junction Obstruction

1968: Comparison of Contrast-Enhanced Color Doppler Imaging, Computerized Tomography and Magnetic Resonance Imaging for Detection of Crossing Vessels in Patients with Ureteropelvic Junction Obstruction

Laparoscopic pyeloplasty for UPJ obstruction with crossing vessels: contrast-enhanced color Doppler findings and long-term outcome

Objectives. To evaluate, in the present long-term follow-up study, contrast-enhanced color Doppler imaging (CDI) findings and the clinical outcome of patients with crossing vessels at the obstructed ureteropelvic junction (UPJ), who underwent laparoscopic pyeloplasty. In a previous study, contrast-enhanced CDI proved capable of detecting crossing vessels at the UPJ. Methods. A total of 23 patients, who had undergone laparoscopic pyeloplasty and displacement of crossing vessels for UPJ obstruction at least 2 years before this study (mean 27 months), underwent contrast-enhanced CDI, intravenous urography, and renography. Contrast-enhanced CDI was performed using intravenously administered Levovist to assess the displacement of the vessels relative to the UPJ. All patients completed analog follow-up pain scales and quality-of-life assessment questionnaires. Results. Contrast-enhanced CDI revealed a cranial displacement (mean 1.3 cm) of the crossing vessels from the UPJ in all 23 cases. Intravenous urography showed a decrease in the degree of hydronephrosis, with a success rate of 100% in low-grade and 86% in high-grade hydronephrosis. The split renal function improved from 39.7% to 48.1%. Analog pain scale measurements demonstrated a mean improvement in pain of 92% (range 73% to 100%) and a mean quality-of-life score of 94 (range 78 to 100). Conclusions. Our series of patients with crossing vessels at the UPJ treated by laparoscopic pyeloplasty showed an excellent long-term successful outcome. Contrast-enhanced CDI allows for preoperative detection, as well as postoperative assessment, of the displacement of the crossing vessel. We recommend that the presence of a crossing vessel be routinely determined preoperatively, because it may influence the choice of treatment modality and thereby the clinical outcome.

Small renal masses: value of contrast-enhanced color Doppler imaging

Small renal masses: value of contrast-enhanced color Doppler imaging

Crossing Vessels at the Ureteropelvic Junction: Detection With Contrast-Enhanced Color Doppler Imaging

No AccessJournal of UrologyUrological Survey: Abstracts1 Oct 1999Crossing Vessels at the Ureteropelvic Junction: Detection With Contrast-Enhanced Color Doppler Imaging F. Frauscher, G. Janetschek, G. Helweg, H. Strasser, G. Bartsch, D. Zur Nedden, and Patrick C. Walsh F. FrauscherF. Frauscher More articles by this author , G. JanetschekG. Janetschek More articles by this author , G. HelwegG. Helweg More articles by this author , H. StrasserH. Strasser More articles by this author , G. BartschG. Bartsch More articles by this author , D. Zur NeddenD. Zur Nedden More articles by this author , and Patrick C. WalshPatrick C. Walsh More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)68370-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Crossing Vessels at the Ureteropelvic Junction: Detection With Contrast-Enhanced Color Doppler Imaging." The Journal of Urology, 162(4), p. 1556 Baltimore, MarylandDepartments of Radiology and Urology, University Hospital Innsbruck, Innsbruck, Austria© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 162Issue 4October 1999Page: 1556 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.MetricsAuthor Information F. Frauscher More articles by this author G. Janetschek More articles by this author G. Helweg More articles by this author H. Strasser More articles by this author G. Bartsch More articles by this author D. Zur Nedden More articles by this author Patrick C. Walsh More articles by this author Expand All Advertisement PDF DownloadLoading ...

Crossing Vessels at the Ureteropelvic Junction: Detection With Contrast-Enhanced Color Doppler Imaging

Crossing Vessels at the Ureteropelvic Junction: Detection With Contrast-Enhanced Color Doppler Imaging