Contrast-enhanced Color Research Articles

Detection of prostate carcinoma with contrast‐enhanced sonography using intermittent harmonic imaging

The purpose of this study was to assess prostate carcinoma detection and discrimination of benign from malignant prostate tissue with contrast-enhanced ultrasonography. In all, 301 subjects referred for prostate biopsy were evaluated with contrast-enhanced sonography using continuous harmonic imaging (CHI) and intermittent harmonic imaging (IHI) with interscan delay times of 0.2, 0.5, 1.0, 2.0 seconds, as well as continuous color and power Doppler. Targeted biopsy cores were obtained from sites of greatest enhancement, followed by spatially distributed cores in a modified sextant distribution. Carcinoma was detected in 363 biopsy cores from 104 of 301 subjects (35%). Carcinoma was found in 15.5% (175 of 1133) of targeted cores and 10.4% (188 of 1806) of sextant cores (P < 0.01). Among subjects with carcinoma, targeted cores were twice as likely to be positive (odds ratio [OR] = 2.0, P < 0.001). Clustered receiver operating characteristic (ROC) analysis of imaging findings at sextant biopsy sites yielded the following Az values: precontrast gray scale: 0.58; precontrast color Doppler: 0.53; precontrast power Doppler: 0.58; CHI: 0.62; IHI (0.2 sec): 0.64; IHI (0.5 sec): 0.63; IHI (1.0 sec): 0.65; IHI (2.0 sec): 0.61; contrast-enhanced color Doppler: 0.60; contrast-enhanced power Doppler: 0.62. A statistically significant benefit was found for IHI over baseline imaging (P < 0.05). The carcinoma detection rate of contrast-enhanced targeted cores is significantly higher when compared with sextant cores. Contrast-enhanced transrectal sonography with IHI provides a statistically significant improvement in discrimination between benign and malignant biopsy sites. However, given the relatively low ROC areas, this technique may not be sufficient to predict which patients have benign versus malignant disease.

Vascular damage as a risk factor for benign prostatic hyperplasia and erectile dysfunction

To assess benign prostatic hyperplasia (BPH) and erectile dysfunction (ED), both considered to be associated with urogenital ageing, in ageing men in a cross-sectional population study, comparing them with healthy controls by using symptom scores and contrast-enhanced colour Doppler ultrasonography (CDUS). Transrectal CDUS and quantitative measurement of colour pixel intensity (CPI) are excellent minimally invasive techniques for assessing normal and pathological blood flow. CDUS was performed using the microbubble-based ultrasound enhancer for evaluating prostate, bladder neck and corpus cavernosum vascularity in young healthy men, men with BPH, and men with severe vascular damage (diabetes mellitus type 2). Resistive index measurements and computer-assisted quantification of CPI were used to objectively evaluate perfusion. The International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF) were applied to quantify the symptoms. In patients with BPH, perfusion of the transition zone (TZ) of the prostate was significantly lower and the resistive index of the TZ significantly higher (both P < 0.001) than in healthy controls. The perfusion patterns of men with BPH and those who also had severe vascular damage (diabetes mellitus type 2) showed that vascularity in the latter group was lower in the prostatic TZ and the corpora cavernosa. In patients with BPH the IPSS, quality-of-life and IIEF scores were significantly worse than in the control group. Men with concomitant atherosclerosis had even worse symptom scores. These results strongly support the hypothesis that age-related impairment of blood supply to the lower urinary tract is important in the development of BPH and ED. Vascular damage may cause chronic ischaemia and thus be a contributing factor in the pathogenesis of BPH and ED.

A PROSPECTIVE RANDOMIZED TRIAL COMPARING CONTRAST-ENHANCED TARGETED VERSUS SYSTEMATIC ULTRASOUND GUIDED BIOPSIES: IMPACT ON PROSTATE CANCER DETECTION

Purpose: We performed a prospective randomized trial comparing less than or equal to 5 contrast-enhanced colour Doppler ultrasound targeted biopsy cores to 10 grey-scale ultrasound guided systematic biopsy cores to determine the impact on the cancer detection rate.

Monitoring of hepatocellular carcinoma, following proton radiotherapy, with contrast-enhanced color Doppler ultrasonography

We have reported that proton radiotherapy for hepatocellular carcinoma (HCC) is a safe and effective therapeutic option. However, it is difficult to evaluate its effect in certain cases. Recently, it has been reported that the usage of contrast-enhanced color Doppler ultrasonography (CECDU) can improve diagnostic accuracy, both in terms of the presence of hepatic tumor and in the evaluation of treatment. The aim of this study was to determine the usefulness of CECDU in assessing the therapeutic response of HCC treated with proton radiotherapy. Twenty-two patients treated with the proton radiotherapy were studied. We inspected HCC lesions by CECDU, before and after the irradiation, over time. The magnitude of blood flow in the HCC was quantified on still images by CECDU. The ratio of the number of color pixels against that of the total number of pixels in the tumor area was defined as the tumor blood flow ratio (TBFR). Immediately after the proton treatment, a transient increase of blood flow in the tumor was recognized in more than half of the patients, while the TBFR was unchanged or decreased in the remaining patients. At longer periods after irradiation, the TBFR in all HCCs gradually decreased, and this reduction of TBFR was statistically significant from 9 months after irradiation. These findings are consistent with those obtained previously by computed tomography (CT) as well as magnetic resonance imaging (MRI). We propose CECDU as a useful diagnostic option for the evaluation of HCC treated with proton radiotherapy.

Vascular damage induced by type 2 diabetes mellitus as a risk factor for benign prostatic hyperplasia

The aim of this study was to evaluate the relationship between benign prostatic hyperplasia (BPH) and arteriosclerosis shown in a model of type 2 diabetes in a trans-sectional population study using contrast-enhanced colour Doppler ultrasound for exact assessment of prostatic blood flow. Contrast-enhanced transrectal colour Doppler ultrasound was performed using a microbubble-based ultrasound enhancer SonoVue for evaluating prostate vascularity (transitional zone [TZ] and peripheral zone [PZ]) in diabetic BPH patients, non-diabetic BPH patients and healthy subjects. Computer-assisted quantification of colour pixel intensity (CPI) was used to objectively evaluate the prostate vascularity. Resistive index measurements were obtained in the TZ and the PZ. Findings were compared between these three groups. TZ-CPI was significantly lower in diabetic patients than in non-diabetic BPH men (p=0.001), whereas the CPI of the PZ showed no difference between these two groups (p=0.978). TZ-CPI of patients with diabetic and non-diabetic BPH were significantly lower than in controls (p<0.001), but no difference was found between diabetic and healthy patients in the PZ (p=0.022) and borderline significance was seen when comparing patients of the BPH group with the control patients (p=0.019). Resistive index values of the TZ in diabetic patients showed significantly higher values (p<0.001) than the BPH and control groups. The significantly lower CPI and higher resistive index values of the TZ in diabetic patients compared with patients with non-diabetic BPH and healthy subjects indicate considerable vascular damage in the TZ of these patients. Diabetic vascular damage may cause hypoxia and may contribute to the pathogenesis of BPH.

Evaluation of quantified contrast-enhanced color and power Doppler ultrasonography for the assessment of vascularity and perfusion of naturally occurring tumors in dogs

To investigate subjective and computerized methods of evaluation of color Doppler (CD) and power Doppler (PD) ultrasonographic images (obtained before and after administration of contrast medium) for quantitative assessment of vascularity and perfusion of various naturally occurring tumors in dogs. 34 tumors in 34 dogs. Tumors in dogs were examined via CD and PD ultrasonography before and after i.v. injection of a microbubble contrast agent (pre- and postcontrast examinations, respectively). Images were digitized for subjective assessment of vessel density and vascular pattern and computer-aided assessment of parameters of vascularity (fractional area [FA]) and perfusion (color-weighted FA [CWFA] and mean color-weighted FA [CWFA] and mean color level). With both analysis methods, more vessels were identified in precontrast PD ultrasonographic images than in precontrast CD ultrasonographic images. Moreover, compared with values for precontrast PD ultrasonography, FA, CWFA, and mean color level were higher for postcontrast PD ultrasonography. In postcontrast images, there was a significant association between vessel densities determined through subjective and computerized assessments. Although sample size was small, vascularity of squamous cell carcinomas was significantly greater than that of other tumor types. Ten of the 19 softer than issue that sarcomas had low vessel density with minor contrast enhancement. With increasing gross tumor volume, FA and CWFA decreased for all Doppler ultrasonographic methods. Higher values of the ultrasonographic parameters representing vascularity and perfusion of tumors in dogs were determined via PD ultrasonography after administration of contrast medium than via PD or CD ultrasonography without administration of contrast medium.

Role of contrast-enhanced color Doppler ultrasonography and dynamic flow in the evaluation of hepatic tumors treated with radiofrequency

The contribution of contrast-enhanced color Doppler ultrasonography (CDUS) and dynamic flow (DF) (Toshiba) in the evaluation following treatment of hepatic tumors with radiofrequency (RF) is discussed. Twenty-seven patients with 34 hepatic tumors were included in this prospective study. The treated tumors measured 10–58 mm in diameter (mean diameter 29 mm). Two tumors were treated twice and one three times, comprising a total of 38 target lesions treated with RF and evaluated by 127 contrast-enhanced CDUS. The results of CDUS follow-up were compared to those of the dynamic MRI at 2 months, 4 months, 6 months and 1 year. Before RF, the injection of Levovist raised the number of vascularized lesions seen with unenhanced Doppler from 44% to 79%. All the non-vascularized lesions were metastases. Twenty-four hours after RF, four tumors presented an enhancement with Levovist, in which two were insufficiently treated lesions. Twenty-one treated tumors have been followed-up jointly by CDUS and MRI at the same time at 2 months, 20 at 4 months, 12 at 6 months and nine at 1 year. Compared to the MRI and the evolution, the CDUS presented a sensitivity of 100% and a specificity of 90% for the detection of progressive recurrence. The preliminary results show that the CDUS is useful to confirm the absence of detectable vascularity after treatment with RF ablation, whereas the presence of enhancement must be confirmed by MRI.

Inflammatory low back pain: High negative predictive value of contrast-enhanced color Doppler ultrasound in the detection of inflamed sacroiliac joints

To determine the value of microbubble contrast agents for color Doppler ultrasound (CDUS) compared with magnetic resonance imaging (MRI) in the detection of active sacroiliitis. An observational case-control study of 103 consecutive patients (206 sacroiliac [SI] joints) with inflammatory low back pain according to the Calin criteria and 30 controls (60 SI joints) without low back pain was conducted at the University Hospital of Innsbruck. All patients and controls underwent unenhanced and contrast-enhanced CDUS and MRI of the SI joints. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of unenhanced and contrast-enhanced CDUS were evaluated. Forty-three patients (41%) with 70 of 206 SI joints (34%) and none of the controls nor the 60 control SI joints demonstrated active sacroiliitis on MRI. Unenhanced CDUS showed a sensitivity of 17%, a specificity of 96%, a PPV of 65%, and an NPV of 72%; contrast-enhanced CDUS showed a sensitivity of 94%, a specificity of 86%, a PPV of 78%, and an NPV of 97%. Detection of vascularity in the SI joint was increased by contrast administration (P < 0.0001). Clustered receiver operating curve analysis demonstrated that enhanced CDUS (A(z) = 0.89) was significantly better than unenhanced CDUS (A(z) = 0.61) for the diagnosis of active sacroiliitis verified by MRI (P < 0.0001; 2-sided test). Microbubble contrast-enhanced CDUS is a sensitive technique with a high NPV for detection of active sacroiliitis compared with MRI.

Imaging Features of Gray-Scale and Contrast-Enhanced Color Doppler US for the Differentiation of Transient Renal Arterial Ischemia and Arterial Infarction

ObjectiveTo characterize the imaging features on gray-scale and contrast-enhanced color Doppler US images which differentiate renal ischemia from renal infarction.Materials and MethodsThe segmental renal arteries of eight healthy rabbits were surgically ligated. In four of these rabbits, the ligated renal artery was released 60 minutes after arterial occlusion to cause transient ischemia. In the remaining four rabbits, the arterial ligation was retained to cause a permanent infarction. The gray-scale and contrast-enhanced color Doppler US imaging features of the involved renal parenchyma of both ischemia and infarction groups were compared with respect to the presence or absence of parenchymal swelling, echogenicity changes, tissue loss and perfusion defects.ResultsParenchyma swelling, echogenic changes, tissue loss and perfusion defects were found to be more extensive in the infarction than the ischemia group. The hyperechoic areas reperfused with blood flow recovered normal echogenicity and perfusion, whereas the hyperechoic areas without reperfusion became renal infarcts.ConclusionGray-scale and contrast-enhanced color Doppler US showed that the hyperechoic areas with reperfusion may reverse to normal parenchyma and allow the differentiation of renal ischemia from renal infarction.

Erratum to: Determination of peripheral color signal density using contrast-enhanced color Doppler ultrasonography in diffuse liver disease

Erratum to: Determination of peripheral color signal density using contrast-enhanced color Doppler ultrasonography in diffuse liver disease

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.

Determination of peripheral color signal density using contrast-enhanced color Doppler ultrasonography in diffuse liver disease.

The study aimed to quantify hepatic vascular changes that accompany the development of chronic liver disease using contrast-enhanced color Doppler ultrasonography and histopathological examination. A series of 62 patients with biopsy-proven chronic liver disease (31 chronic hepatitis, 31 liver cirrhosis) and 8 healthy controls were studied. Altogether, 22 livers (9 chronic hepatitis, 13 liver cirrhosis) obtained at surgery or autopsy were subjected to histopathological examination. Patients with cardiopulmonary disease or intrahepatic tumors were excluded. Intrahepatic color Doppler signals were scanned and counted at the liver surface in a 10 × 30 mm rectangle from liver segment V using color Doppler sonography (SSA 380 A) before and after contrast enhancement with SHU 508A (Levovist). Small arteries 30-1000 µm in diameter were counted on the histopathlogical specimen by microscopy. The number of color Doppler signals increased significantly after contrast enhancement in both patients and controls. The number of color Doppler signals was elevated before and after contrast enhancement when chronic liver disease was present, especially in cases of Child-Pugh grade C liver cirrhosis. Histologically, more arteries 30-125 µm in diameter were present in patients with chronic hepatitis than in those with liver cirrhosis, whereas more arteries ≦ 125 µm in diameter were present in patients with liver cirrhosis than in those with chronic hepatitis. Intrahepatic color Doppler signals are probably derived from peripheral arteries larger than 125 µm in diameter, and the signal density in these arteries increases with progression of the chronic liver disease.

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

1814: Comparison of Contrast-Enhanced Color Doppler Targeted Biopsy and Systematic Biopsy: Impact on Prost ATE Cancer Detection in Men with PSA Levels Between 4 and 10 NG/ML

1814: Comparison of Contrast-Enhanced Color Doppler Targeted Biopsy and Systematic Biopsy: Impact on Prost ATE Cancer Detection in Men with PSA Levels Between 4 and 10 NG/ML

137 Comparison of contrast-enhanced colour doppler targeted biopsy with systematic biopsy: Impact on prostate cancer detection in men with PSA between 4 to 10

137 Comparison of contrast-enhanced colour doppler targeted biopsy with systematic biopsy: Impact on prostate cancer detection in men with PSA between 4 to 10

Radiofrequency ablation of liver cancer: early evaluation of therapeutic response with contrast-enhanced ultrasonography.

The early assessment of the therapeutic response after percutaneous radiofrequency (RF) ablation is important, in order to correctly decide whether further treatment is necessary. The residual unablated tumor is usually depicted on contrast-enhanced multiphase helical computed tomography (CT) as a focal enhancing structure during the arterial and portal venous phases. Contrast-enhanced color Doppler and power Doppler ultrasonography (US) have also been used to detect residual tumors. Contrast-enhanced gray-scale US, using a harmonic technology which has recently been introduced, allows for the detection of residual tumors after ablation, without any of the blooming or motion artifacts usually seen on contrast-enhanced color or power Doppler US. Based on our experience and reports in the literature, we consider that contrast-enhanced gray-scale harmonic US constitutes a reliable alternative to contrast-enhanced multiphase CT for the early evaluation of the therapeutic response to RF ablation for liver cancer. This technique was also useful in targeting any residual unablated tumors encountered during additional ablation.

Assessment of synovial pathology by contrast-enhanced colour and power Doppler ultrasonography, can it help in differential diagnosis of synovial proliferation

Objective: Early diagnosis and early beginning of treatment in rheumatoid arthritis can be essential for better results of treatment. The aim of this study was to find out if it is possible to differentiate early stage of RA and other synovial pathology using contrast-enhanced colour and power Doppler sonography to assess synovial vessels as a sign of active inflammation.

Contrast-enhanced color Doppler targeted biopsy improves prostate cancer detection

Contrast-enhanced color Doppler targeted biopsy improves prostate cancer detection

Usefulness of contrast-enhanced color and Doppler ultrasonography in differentiation of low activity and remission of disease in patients with rheumatoid arthritis

Usefulness of contrast-enhanced color and Doppler ultrasonography in differentiation of low activity and remission of disease in patients with rheumatoid arthritis

Analysis of vascularity of breast tumors: comparison of high-frequency ultrasound and contrast-enhanced color harmonic imaging

Analysis of vascularity of breast tumors: comparison of high-frequency ultrasound and contrast-enhanced color harmonic imaging