Contrast-enhanced Ultrasound Findings Research Articles

Macro- and microcirculation patterns of intrahepatic blood flow changes in patients with hereditary hemorrhagic telangiectasia.

AIMTo evaluated vascular dynamic processes in the liver of hereditary hemorrhagic telangiectasia (HHT) patients by ultrasound (US) considering quantitative analytic methods.METHODSThe imaging features on US and contrast-enhanced ultrasound (CEUS) in 18 patients diagnosed with HHT were retrospectively analyzed. Regarding CEUS, real-time contrast harmonic imaging and sulfur hexafluoride-filled microbubbles were used.RESULTSHVaMs were identified in all 18 patients. By US, the two major Caselitz criteria could be detected in 55.6% patients. "Color spots" were detected in 72.2% of the cases. Respecting sonographic grading criteria by Buscarini, grade 3 could be demonstrated most frequent (40%). By CEUS, all the patients showed quick and early hyperenhancement during the arterial phase. Significant lowest time to peak (TTP) and highest area under the curve (AUC) values were identified in the hepatic artery (TTP: 69.8%; AUC: 100%) and highest TTP and lowest AUC in the hepatic parenchyma and the portal vein.CONCLUSIONFor the first time we analyzed CEUS findings of a group of HHT patients regarding macro- and microcirculation. Our data demonstrate significant differences in TTP and AUC values in the four selected regions: hepatic artery, shunt region, portal vein and hepatic parenchyma.

Contrast-Enhanced Ultrasound: Applications to Hepatic Diseases

It is well-known that contrast-enhanced ultrasound (CEUS) is most widely used for the evaluation of various hepatic diseases, especially for focal hepatic lesions. Of two 2nd generation US contrast agents, e.g., SonazoidTM (GE Healthcare, USA) and SonoVueTM (Bracco Imaging, Italy) that are available in Korea, SonazoidTM provides more information in characterizing various hepatic tumors, and even in guiding for interventional procedures, e.g., radiofrequency ablation of hepatocellular carcinoma, because it allows acquisition of the Kupffer phase, during which it is taken up actively by Kupffer cell, after acquisition of conventional multi-phase dynamic imaging. SonoVueTM is also easily applicable to evaluate various vascular compromises for which the Kupffer phase is unnecessary. In this lecture, we demonstrate essential characteristics of both US contrast agents, CEUS findings of various hepatic tumors with differential points, guiding methods using CEUS for radiofrequency ablation of hepatocellular carcinoma with brief introduction of fusion imaging techniques, and other applications for vascular compromises.

経時的に造影超音波検査所見が変化した肝炎症性偽腫瘍の1例

症例は40歳代女性．主訴なし．前医にて肝S6の孤立性壊死性結節を経過観察中であった．造影CTにて，肝S6結節は経時的にほぼ消失したが，新たに肝S5に早期濃染を伴う10 mmの腫瘤性病変を指摘された．超音波検査（US）とGd-EOB-DTPA造影MRIを施行し，悪性病変を否定できず，切除希望のため当院紹介となった．当院での初回USにて，肝S5に境界不明瞭な低エコー腫瘤を認め，Sonazoid®造影超音波検査（CEUS）では，動脈相で微細点状の豊富な造影効果を認め，その後，結節状に強く造影された．門脈相で造影効果は遷延し，後血管相で造影効果は認めなかった．半年後のUSにて，肝S5腫瘤に増大はみられず，CEUS動脈相，後血管相に著変はなかったが，門脈相で早期の造影効果減弱を認めた．造影CTでも門脈相，平衡相の洗い出しが明瞭化した．これらの変化は肝細胞癌の脱分化など悪性病変を否定できず，腹腔鏡下肝部分切除術が施行された．病理組織学的所見では，被膜を有さない境界明瞭な腫瘤で，炎症細胞浸潤を背景に小血管の増生を伴っていた．免疫染色でαSMA陽性，ALK陰性，EBER陰性，IgG4陽性細胞をほとんど認めず，炎症性偽腫瘍（IPT）と診断された．IPTは特徴的な画像所見に乏しく，CEUSでIPTを経過観察し得た報告は少ない．今回，経時的にCEUS所見が変化したIPTの1症例を経験したので，若干の文献的考察を含めて報告する．

A Novel Approach to Detecting Postpartum Hemorrhage Using Contrast-Enhanced Ultrasound

The aim of this study was to estimate the efficacy of contrast-enhanced ultrasound (CEUS) in detecting postpartum hemorrhage (PPH) after cesarean section. This is the first study of CEUS in obstetric hemorrhage. A total of 37 patients, operated at Nagoya University Hospital, underwent CEUS. We evaluated the findings of CEUS, which were qualitatively defined as positive when pooling or leakage of contrast agent was observed in the uterine cavity, by measuring the amount of bleeding during the first 4 h after cesarean section. The time–intensity curve patterns of leaked contrast agents were also analyzed for quantitative prediction of the amount of blood loss. Significant differences between the excessive hemorrhage (N = 7) and non-excessive hemorrhage groups (N = 30) were noted in the occurrence of positive CEUS (p = 0.011). Additionally, mean postpartum blood loss markedly increased in patients with a positive CEUS (p = 0.002). From a quantitative perspective, the time until leakage of contrast agents was detected correlated with the amount of bleeding, but the other characteristics of the time–intensity curve pattern did not provide valuable information. In conclusion, CEUS, which enables bedside assessment and rapid diagnosis, is a promising strategy for the detection of PPH.

Evaluation of hepatocellular carcinoma tumor vascularity using contrast-enhanced ultrasonography as a predictor for local recurrence following radiofrequency ablation

PurposeThe purpose of this study was to evaluate whether the hypervascularity of hepatocellular carcinomas (HCCs) on contrast-enhanced ultrasonography (CEUS) prior to radiofrequency ablation (RFA) is a significant risk factor for local recurrence after RFA. Materials and methodsInstitutional review board approval and informed consent were obtained. Overall, 208 patients (mean age, 71.7 years; range, 50–87 years; 137 men, 71 women) with 282 HCCs treated with RFA were analyzed retrospectively. The mean maximum tumor diameter was 15.7mm. We compared the abilities of CEUS and contrast-enhanced computed tomography (CECT) to detect hypervascularity in HCCs. We then classified the HCCs into two groups according to the arterial-phase CEUS findings: a “hypervascular group” with whole or partial hypervascular areas within the lesions compared with the surrounding liver parenchyma, and a “non-hypervascular group” with isovascular or hypovascular areas within the lesions. We assessed the cumulative rate of local recurrence after RFA, and we also evaluated the risk factors for local recurrence using a univariate analysis. ResultsThe detection rate for hypervascular HCCs was significantly higher using CEUS (78%, 221/282) than that using CECT (66%, 186/282) (P<0.001). Using the CEUS findings, the cumulative rate of local recurrence was significantly higher in the hypervascular group (41.2%, 56/221) than in the non-hypervascular group (18.4%, 6/61) (P=0.007). A univariate analysis revealed that hypervascularity on CEUS was an independent risk factor for local recurrence (P=0.010). ConclusionHypervascularity in HCCs as observed using CEUS is a significant risk factor for local recurrence after RFA.

EVALUATION OF CONTRAST-ENHANCED ULTRASONOGRAPHY AS A METHOD FOR DETECTING GALLBLADDER NECROSIS OR RUPTURE IN DOGS.

Gall bladder necrosis and rupture are life-threatening conditions in dogs requiring surgical intervention and early diagnosis is essential. Human patients with suspected gall bladder necrosis/rupture are commonly evaluated with contrast-enhanced ultrasonography (CEUS), however this procedure has not been described in dogs with suspected gall bladder necrosis/rupture. In a prospective diagnostic cohort study, CEUS (using SonoVue contrast medium) was performed in 93 dogs with gallbladder lesions identified by abdominal conventional ultrasonography. Necrosis/rupture was identified by CEUS as a focal lack of enhancement of the gallbladder wall. Dogs with positive CEUS finding for necrosis/rupture (complete lack of regional wall enhancement) underwent immediate surgery as did dogs with other biliary disorders requiring surgery. Dogs with negative CEUS findings or those not requiring surgery were managed medically. In cases undergoing surgery, necrosis/rupture was confirmed intraoperatively (and via histopathology). Absence of necrosis/rupture was confirmed either intraoperatively (via histopathology) or was assumed to be absent by complete recovery with medical management. Forty-nine dogs underwent surgery and cholecystectomy: 24 had necrosis/rupture. CEUS was more accurate (100% sensitive and specific) in diagnosing gallbladder wall necrosis/rupture than conventional ultrasonography (75% sensitive and 81% specific) (P < 0.03). In conclusion, CEUS provides accurate characterization of gallbladder wall integrity that can impact decisions regarding clinical management, either surgical or medical.

Focal nodular hyperplasia: our experience of 53 Japanese cases.

Contrast-enhanced ultrasound (CEUS) is a very sensitive diagnostic tool in characterizing liver tumors. It is especially useful in the diagnosis of focal nodular hyperplasia (FNH) of the liver. According to the previous reports, FNH is common in young women, and it is usually diagnosed by MRI. The majority of the previous reports come from European countries, and a very few studies of large series designed to describe the clinical features in Japanese patients have been reported. The aim of this study was to (a) describe the clinical features in 53 patients (59 lesions) diagnosed with CEUS and (b) compare the data with those from the previous reports. The medical data from 53 patients diagnosed on the basis of typical CEUS findings at our institution and affiliated hospitals were reviewed, and their clinical data were analyzed. (1) The medical data from 53 cases showed a slight male predilection, with 30 male cases (57%) and 23 female cases (43%), although the occurrence in both sexes was equal. FNH cases were distributed throughout all generations in both sexes, mostly concentrated in the age of 30-60years old, and metabolic cases were more common in men than in women (4 vs 0). (2) The lesions were small (mean: 23mm) and distributed throughout the whole liver. (3) Lesion size was not influenced by age in either sex. (4) A rapid draining to the hepatic vein was recognized in five out of 59 lesions (8%). Our data indicate that FNH occurs slightly more frequently in men than in women in Japan. It occurs also at any age in both sexes, but the mean lesion size was smaller in our series than in the previous reports. Metabolic disease was seen only in male FNH patients. A direct communication between the FNH lesion and the hepatic vein is diagnostically worth noting.

Contrast-Enhanced Ultrasonography in Patients with Adhesive Capsulitis: Preliminary Experience

Background: Imaging findings of adhesive capsulitis (AC) have been reported widely with the use of magnetic resonance imaging (MRI) and ultrasonography (US), although diagnosing AC is still based on clinical finding. However, the use of contrast-enhanced ultrasonography (CEUS) has not yet been reported in patients with AC. Objectives: To validate the application of CEUS in patients with AC, and to compare CEUS findings with those of MRI. Patients and Methods: Both shoulders of five patients with unilateral AC, who underwent MRI on the affected shoulder, were examined using CEUS (2 men, 3 women; mean age, 54.2 ± 8 years). CEUS was performed after bolus administration of the contrast agent, SonoVue (Bracco, Milan, Italy), followed by a saline flush. Enhancement of the rotator interval was evaluated using a visual enhancement score (0 to 2) and compared with the contrast-enhanced MRI findings. For quantitative analysis, an region of interest was established for each rotator interval, and time-intensity curves were analyzed with parameters including time-to-peak and peak intensity. The difference of peak intensity between the affected and unaffected shoulders was compared. Results: Contrast enhancement of the rotator interval was notable in all CEUS of affected shoulders, whereas no evident enhancement was detected in all asymptomatic shoulders. The mean visual enhancement score of affected shoulders was 1.4 in CEUS and 2.0 in contrast-enhanced MRI. In quantitative analysis, the mean peak intensity was 5.45 ± 2.80 dB (mean time to peak, 30.6 ± 5.39 seconds) in affected shoulders, and 0.72 ± 0.91 dB in unaffected shoulders (P < 0.05). Conclusion: CEUS was capable of demonstrating capsular inflammation in patients with AC, and this was comparable to MRI. CEUS could be a feasible imaging tool for evaluating patients with AC.

Case Report of Contrast-Enhanced Ultrasound Features of Primary Hepatic Neuroendocrine Tumor: A CARE-Compliant Article.

Primary hepatic neuroendocrine tumors (PHNETs) are very rare and their clinical features and treatment outcomes are not well understood. It is difficult to reach a proper diagnosis before biopsy or resection. The aim of this study was to analyze the imaging features of PHNETs on contrast-enhanced ultrasound (CEUS). The clinical characteristics, CEUS findings, pathological features, treatment and prognosis of 6 patients with PHNET treated in our hospital were retrospectively analyzed.Most PHNETs occurred in middle-aged patients, and the most common clinical manifestation was right upper quadrant palpable mass and abdominal pain. Multiple small anechoic intralesional cavities occurred frequently in PHNET. Multilocular cystic with internal septation or monolocular with wall nodule could also be detected. On contrast-enhanced ultrasonography (CEUS), heterogeneous hyperenhancement in the arterial phase and wash-out hypoenhancement were observed in most patients, while computed tomography scanning yielded similar results. Diagnosis of PHNET was confirmed by immunohistochemical result and follow-up with the absence of extrahepatic primary sites. Five patients received surgical resection and 2 cases exhibited recurrence. Transcatheter arterial chemoembolization was performed in 1 patient with recurrence. Only 1 patient received conservative care. The median overall survival in 5 patients who underwent surgical treatment was 27 months (18–36 months). PHNET is a rare tumor, and its diagnosis is difficult. The CEUS features reported in this series may enrich the knowledge base for characterization of PHNET.

Utility of combined gray-scale and perflubutane contrast-enhanced ultrasound for diagnosing early hepatocellular carcinomas: Comparison of well differentiated and distinctly nodular types.

To clarify the value of gray-scale ultrasound (US) combined with contrast-enhanced US (CEUS) with perflubutane in diagnosing early hepatocellular carcinoma (HCC). A total of 57 surgically resected, well differentiated HCCs were analyzed. Hepatocellular carcinomas were macroscopically diagnosed as vaguely nodular or distinctly nodular types, which correspond to early HCC or progressed HCC, respectively. Gray-scale US findings were evaluated in terms of shape (round or roundish, or irregular), border and contour (well-defined and smooth, or poorly defined), and intratumor echo levels (hyper, hypo, iso, heterogeneous, or mosaic). Contrast-enhanced US findings were evaluated during the arterial phase (vascularity [finely homogeneous, dendritic, or chaotic] and perfusion enhancement [homogeneous or heterogeneous]), portal phase (presence or absence of washout), and post-vascular phase (echo intensity level [defect, incomplete defect, or iso-enhancing]). Eighteen HCCs were categorized as early HCCs and the remaining 39 were categorized as progressed HCCs. Receiver operating characteristic curve analysis for the diagnosis of early HCC yielded area under the receiver operating characteristic curve (Az ) values for border and contour on gray-scale US and echo intensity level in the CEUS post-vascular phase of 0.782 and 0.828, respectively. Multiple logistic regression analysis also indicated that both of these gray-scale US and CEUS findings were independently associated with early HCC. The Az value for the combination of border and contour and echo intensity for the diagnosis of early HCC was 0.907, corresponding to a high diagnostic value. The combination of gray-scale US and CEUS can provide high-quality imaging assessment for diagnosing early HCC.

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 ...

Ability of contrast-enhanced ultrasonography to determine clinical responses of breast cancer to neoadjuvant chemotherapy.

We aimed to determine whether contrast-enhanced ultrasonography can predict the effects of neoadjuvant chemotherapy on breast cancer. The clinical responses of 63 consecutive patients with breast cancer (T1-4, N0-1, M0) to neoadjuvant chemotherapy between October 2012 and May 2015 were assessed using contrast-enhanced magnetic resonance imaging, positron emission tomography/computed tomography and contrast-enhanced ultrasonography. Perfusion parameters for contrast-enhanced ultrasonography were created from time-intensity curves based on enhancement intensity and temporal changes to objectively evaluate contrast-enhanced ultrasonography findings. The sensitivity, specificity and accuracy of contrast-enhanced ultrasonography, magnetic resonance imaging and positron emission tomography/computed tomography to predict a pathological complete response were compared after confirming the pathological findings of surgical specimens. Twenty-three (36.5%) of the 63 patients achieved pathological complete response. The sensitivity, specificity and accuracy of contrast-enhanced ultrasonography for predicting pathological complete response were 95.7% (82.5-99.2%), 77.5% (69.9-79.5%) and 84.1% (74.5-86.7%). The sensitivity of contrast-enhanced ultrasonography was significantly greater than that of magnetic resonance imaging (95.7 vs. 69.6%, P = 0.047). The specificity and accuracy were significantly greater and tended to be greater, respectively, for contrast-enhanced ultrasonography than positron emission tomography/computed tomography (specificity, 77.5 vs. 52.5%, P = 0.02; accuracy, 84.1 vs. 69.8%, P = 0.057). Contrast-enhanced ultrasonography might serve as a new diagnostic modality when planning therapeutic strategies for patients with breast cancer after neoadjuvant chemotherapy.

Ultrasound features of hepatocellular adenoma and the additional value of contrast-enhanced ultrasound

Hepatocellular adenoma (HCA) is a rare benign tumor of the liver. It is of clinical importance to differentiate HCA from other liver tumors, especially hepatocellular carcinoma (HCC). This study aimed to evaluate the characteristic features of HCA by conventional ultrasound and contrast-enhanced ultrasound (CEUS) findings. Twenty-six patients (10 males and 16 females; mean age 36.2+/-5.0 years) with 26 histopathologically proven HCAs were retrospectively identified. According to the maximum diameter of HCAs, they were divided into three groups: <30 mm, 30-50 mm, and >50 mm. Ultrasound examinations were performed with C5-2 broadband curved transducer of Philips iU22 unit (Philips Bothell, WA, USA). For each lesion, a dose of 2.4 mL SonoVue® (Bracco Imaging Spa, Milan, Italy) was injected as a quick bolus into the cubital vein. Lesions' echogenicity, color-Doppler flow imaging and contrast enhancement patterns were recorded. Grayscale ultrasound revealed that most of HCAs were hypoechoic (73.1%, 19/26). Spotty calcifications were detected in 26.9% (7/26) of the lesions. Color-Doppler flow imaging detected centripetal bulky color flow in 46.2% (12/26) of the HCAs. CEUS showed that 73.1% (19/26) of the HCAs displayed as rapid, complete and homogenous enhancement, and 53.8% (14/26) showed decreased contrast enhancement in the late phase. There was no significant difference in enhancement patterns among different sizes of HCAs (P>0.05). Centripetal enhancement with subcapsular tortuous arteries was common in larger HCAs. CEUS combined with grayscale and color-Doppler flow imaging helped to improve preoperative diagnosis of HCAs. The characteristic imaging features of HCAs included: rapid homogeneous enhancement and slow wash-out pattern on CEUS; heterogeneous echogenicity on grayscale ultrasound; and centripetal enhancement with subcapsular tortuous arteries in large HCAs.

Contrast-enhanced ultrasound of the spleen

Abnormalities in the spleen are less common than in most other abdominal organs. However, they will be regularly encountered by ultrasound practitioners, who carefully evaluate the spleen in their abdominal ultrasound studies. Conventional grey scale and Doppler ultrasound are frequently unable to characterise focal splenic abnormalities; even when clinical and laboratory information is added to the ultrasound findings, it is often not possible to make a definite diagnosis. Contrast-enhanced ultrasound (CEUS) is easy to perform, inexpensive, safe and will usually provide valuable additional information about splenic abnormalities, allowing a definitive or short differential diagnosis to be made. It also identifies those lesions that may require further imaging or biopsy, from those that can be safely dismissed or followed with interval ultrasound imaging. CEUS is also indicated in confirming the nature of suspected accessory splenic tissue and in selected patients with abdominal trauma. This article describes the CEUS examination technique, summarises the indications for CEUS and provides guidance on interpretation of the CEUS findings in splenic ultrasound.

Sonographic imaging of extra-testicular focal lesions: comparison of grey-scale, colour Doppler and contrast-enhanced ultrasound.

Extra-testicular lesions are usually benign but present with nonspecific grey-scale sonography findings. This study assesses conventional sonographic characteristics in the differentiation of extra-testicular tumoural from inflammatory lesions and whether contrast-enhanced ultrasound has a role. A retrospective database analysis was performed. All patients were examined by experienced sonographers employing standard techniques combining grey-scale, colour Doppler sonography and contrast-enhanced ultrasound. Features recorded were: clinical symptoms, size, location, echogenicity, colour Doppler sonography and contrast-enhanced ultrasound enhancement. Vascularity on colour Doppler sonography and contrast-enhanced ultrasound was graded and compared. The lesions were classified as tumoural or inflammatory. The Chi-square test was used to analyse the sonographic patterns and kappa coefficient to measure the agreement between colour Doppler sonography and contrast-enhanced ultrasound. A total of 30 lesions were reviewed (median diameter 12 mm, range 5-80 mm, median age 52 years, range 18-86 years), including 13/30 tumoural and 17/30 inflammatory lesions. Lesions were hypoechoic (n = 12), isoechoic (n = 6), hyperechoic (n = 2) or mixed (n = 10). Grey-scale characteristics of tumoural vs. inflammatory lesions differed significantly (P = 0.026). On colour Doppler sonography, lesions had no vessels (n = 16), 2-3 vessels (n = 10) and ≥4 vessels (n = 4). On contrast-enhanced ultrasound, lesions showed no vascularity (n = 17), perfusion similar to testis (n = 7) and higher (n = 6). All abscesses identified (n = 9) showed no vascularity on both colour Doppler sonography and contrast-enhanced ultrasound. There was good agreement between these techniques in evaluating vascularity (κ = 0.719) and no significant difference between colour Doppler sonography and contrast-enhanced ultrasound of tumoural vs. inflammatory lesions (P > 0.05). The grey-scale appearances of extra-testicular lesions are essential for characterisation. Colour Doppler sonography and contrast-enhanced ultrasound findings are not useful in that respect. Contrast-enhanced ultrasound is excellent in establishing absence of vascularity.

Comparison of CT and contrast-enhanced ultrasound findings in hepatic angiomyolipoma with pathological correlations

To compare imaging findings of CT and contrast-enhanced US (CEUS) in hepatic angiomyolipoma (HAML) and investigate their pathological correlations. Imaging findings and preoperative diagnosis of CT and CEUS were retrospectively compared head to head in 46 patients with 54 histologically proven HAMLs. Correlations between imaging features and preoperative diagnosis with pathological types of HAMLs were analyzed. Fat was detected in 100% of lipomatous type, 84.6% of mixed type, and 7.1% of myomatous type (p = 0.000) of HAML at unenhanced CT. Well-defined hyper-echogenicity was displayed in 100% of lipomatous type, 88.5% of mixed type, 50% of myomatous type, and 66.7% of angiomatous type of HAMLs at unenhanced US. More arterial hyper-enhancement was noted on CEUS (100%) than on CT (73.1%) in mixed type (p = 0.015) and in lipomatous type (90.9% vs. 9.1%, p = 0.000) of HAMLs. Washout was present in more HAMLs on CT than on CEUS (42.6% vs. 18.5%, p = 0.007). Correct preoperative diagnosis was suggested in more HAMLs of myomatous type on CEUS than on CT (42.9% vs. 0%, p = 0.016) but showed no difference in other types of HAMLs. There are considerable discrepancies between CT and CEUS findings of HAMLs, and the imaging appearance and preoperative diagnosis of HAMLs on CT and CEUS are significantly affected by pathological types of HAMLs.

Contrast enhanced ultrasound in urothelial carcinoma of urinary bladder: An underutilized staging and grading modality.

IntroductionTo evaluate contrast enhanced ultrasound (CEUS) as a modality to predict T stage of cancer of urinary bladder (CAUB) and to predict the grade of the tumor preoperatively.Material and methods110 patients with CAUB presenting to the Department of Urology at our institution between July 2014 and December 2015 underwent CEUS prior to endoscopic resection and the CEUS findings were compared with histopathology results.ResultsCEUS had a sensitivity of 75, 65 and 90% and specificity of 95, 85 and 92% in detecting Ta, T1 and muscle invasion respectively. CEUS had a sensitivity of 78% and specificity of 85% in detecting the grade of the lesion.ConclusionsCEUS is a good alternative for T staging and grading of CAUB preoperatively. It is uniquely advantageous in detecting clots or necrosis and in patients with low eGFR where other imaging modalities are contraindicated.

Contrast-enhanced ultrasonography of the hepatic vein in normal dogs.

Contrast-enhanced ultrasonography (CEUS) of the hepatic vein can assess intrahepatic hemodynamic changes and has been studied as a noninvasive method to assess the severity of portal hypertension and hepatic fibrosis in humans. However, few reports have described its usefulness in veterinary medicine. The purpose of this study was to characterize CEUS findings of the hepatic vein in normal dogs and assess the repeatability of this method both in a conscious group (n=6) and a sedated group (n=6). Sonazoid® (0.01 ml/kg) was used as a contrast agent, and scanning of the hepatic vein was performed for 2 min. Time-intensity curves were generated from regions of interest in the hepatic vein. Four perfusion parameters were measured for quantitative analysis: hepatic vein arrival time (HVAT), time to peak (TTP), time to peak phase (TTPP) and wash-out ratio (WR). CEUS examinations were performed three times in each dog. The median (range) values of HVAT, TTP, TTPP and WR in the conscious group were 13.5 sec (9–22 sec), 12.5 sec (6–24 sec), 8 sec (6–13 sec) and 78.0% (60.7–91.7%), respectively. Median (range) values of HVAT, TTP, TTPP and WR in the sedated group were 12 sec (8–17 sec), 12.5 sec (9–17 sec), 9 sec (7–13 sec) and 84.1% (63.0–94.4%), respectively. The coefficients of variation of these parameters in the conscious and sedated groups were 7.6–29.7% and 11.8–14.8%, respectively.

Diagnosis of BI-RADS 4 breast lesion using contrast-enhanced ultrasonography

Objective To assess the value of contrast-enhanced ultrasonography(CEUS) in diagnosing BI-RADS 4 breast lesion. Methods The CEUS findings of 79 breast lesions of BI-RADS 4 were analyzed, and the CEUS diagnosis was made according to our preliminary study results. Histology results were served as golden reference. Results Of all the 79 breast lesions that were confirmed by histopathology results, 36 were malignant and 43 were benign. The differences of morphologic features of area variety, margin, heterogeneous or homogeneous distribution between benign and malignant lesions were significant(P<0.05). The area under ROC curve of correction BI-RADS classification in the diagnosis of breast cancer was 0.938, and it was significantly higher than that of the BI-RADS classification (0.889, Z=2.209, P=0.0272). Conclusions CEUS can improve the diagnostic accuracy of breast lesions preoperatively. Key words: Contrast-enhanced ultrasonography; Breast diseases; Breast imaging reporting and data system

Percutaneous irreversible electroporation (IRE) of prostate cancer: Contrast-enhanced ultrasound (CEUS) findings.

To evaluate the use of contrast-enhanced ultrasound (CEUS) after irreversible electroporation (IRE) of prostatic cancer tissue to assess the ablation status by depicting microvascularisation in the ablation area. Retrospective evaluation of CEUS of 13 patients (mean age: 61.4 ± 7.5 years) with histologically confirmed prostatic cancer who underwent percutaneous IRE. In the course of clinical routine, the tumor lesions were documented before, immediately after, and 1 day after the ablationusing color-coded transabdominal and transrectal CEUS. The obtained image data (DICOM loops and images) were subsequently evaluated by 2 experienced radiologists and assessed with regard to micro vascularisation by means of a 5-point scale. CEUS images showed significantly reduced microcirculation of the lesions (mean 0.9 ± 0.6 cm (0.5-1.5 cm) after IRE. Microcirculation was reduced from 2.15 ± 0.56 prior to ablation to 0.65 ± 0.63 (p < 0.001) immediately after the ablation and to 0.27 ± 0.44 one day after IRE (p < 0.001). This study showed rapid and significant reduction of the microcirculation in the ablation area afterpercutaneous IRE of prostatic cancer tissue.