Contrast-enhanced Ultrasound Parameters Research Articles

Diagnostic and prognostic values of contrast-enhanced ultrasound in breast cancer: a retrospective study.

This study aimed to explore the diagnostic and prognostic values of contrast-enhanced ultrasound (CEUS) in breast cancer. Between September 2009 and October 2011, a total of 143 breast cancer patients and 161 healthy people were selected as case group and control group, respectively. After the identification of lesions by conventional ultrasound, all patients underwent CEUS. The CEUS images were analyzed, and time–intensity curves (TICs) were obtained. Hematoxylin–eosin and immunohistochemistry staining was performed on tissue specimens, according to which the expressions of estrogen receptor (ER), c-erb-B2, p53, and Ki-67 were measured. Multivariate logistic regression analysis was used to compare CEUS and TIC parameters between the two groups. Compared with the control group, cancer patients showed high enhancement, heterogeneous enhancement or defects in the central region, expansion of lesion diameter after enhancement and crab-like blur lesion edges. The peak intensity (PI), relative start time of enhancement, relative PI, and relative area under the curve in the case group were significantly higher than those in the control group. Logistic analysis showed that the uniformity of enhancement, expansion of lesion diameter, and relative PI were significant diagnostic parameters of breast cancer, with area under the curve being 0.798, 0.776, and 0.919, respectively. There were strong associations between CEUS characteristics and expressions of prognostic factors in breast cancer: the heterogeneous enhancement was common in c-erb-B2-positive tumors; the centripetal enhancement occurred more in ER-negative tumors; perforator vessels were often seen in tumors at high histological grade; perfusion defects were common in ER-negative, c-erb-B2-positive, and Ki-67-positive tumors. CEUS is a useful tool for the early diagnosis and prognosis of breast cancer.

Correlations of microvascular blood flow of contrast-enhanced ultrasound and HGF/c-Met signaling pathway with clinicopathological features and prognosis of patients with hepatocellular carcinoma.

The study is designed to explore the correlations of microvascular blood flow of contrast-enhanced ultrasound (CEUS) and hepatocyte growth factor (HGF)/c-Met signaling pathway with clinicopathological features and prognosis of patients with hepatocellular carcinoma (HCC). One hundred and eighteen patients pathologically diagnosed as primary HCC were selected. All HCC patients underwent CEUS examination before operation. HCC tissues and adjacent normal tissue specimens were obtained to detect the protein rates of HGF and c-Met expressions by immunohistochemistry. The mRNA expressions of HGF and c-Met were detected by quantitative real-time polymerase chase reaction assay. The microvessel density (MVD) was tested by CD34 immunohistochemistry. Compared with liver parenchyma, the HCC lesions had higher MVD, preoperative peak intensity (PI), area under the curve (AUC), lower preoperative time to peak (TTP), and washout time (WOT). Compared with adjacent normal tissues, the protein and mRNA expressions of HGF were reduced in HCC tissues, but the protein and mRNA expressions of c-Met and MVD were increased. The protein expressions of HGF and c-Met exhibited evident correlations with TNM stage, tumor size, vascular invasion, liver cirrhosis, and hepatitis B virus and hepatitis C virus infection of HCC patients. The tumor size and number, vascular invasion, the protein expressions of HGF and c-Met, and MVD were associated with the TTP, PI, WOT, and AUC of CEUS in HCC patients. The protein expressions of HGF and c-Met, MVD and preoperative PI revealed negative associations with the prognosis of HCC patients. In conclusion, quantitative parameters of CEUS and HGF/c-Met signaling pathway-related proteins may be helpful for early diagnosis and prognosis prediction of HCC patients.

P273 Prediction of treatment response in Crohn's disease patients using contrast enhanced ultrasound: a pilot study

Background: Increased vascularity of the bowel wall is an early pathologic change that occurs in patients with active Crohn's disease (CD) and is used in imaging methods with intravenous contrast. We investigated whether a baseline contrast-enhanced ultrasound (CEUS) can differentiate responders from non-responders treated medically over a period of 6 to 12 months. Methods: Unselected adult CD patients from a tertiary care IBD center were recruited. Baseline demographic and clinical data was gathered and CEUS was performed at baseline in patients using a second-generation US microbubble contrast agent (Definity®) using 0.2 ml as bolus followed by drip infusion at a fixed rate. Following placement of an ROI (region of interest) over the bowel wall, perfusion analysis software modeled time-intensity curves (TIC) and relative kinetic perfusion parameters were measured. In each patient, clinical activity, treatment and therapeutic outcome were assessed at 3, 6 and 12 months after the CEUS. Treatment changes after baseline, systemic steroid dependency, ongoing clinical activity, new disease complications and need for surgery during the observation period were considered treatment failures. CEUS parameters were compared in patients with active (aCD) versus inactive CD (aCD) at baseline and in patients with favorable versus poor outcome at 3, 6 and 12 months post CEUS. Results: Twenty-one patients (9 men, median age 32 years, median disease duration 13 years; 15 aCD and 12 with previous surgery) were recruited. Baseline kinetic CEUS parameters peak systolic velocity (PSV-wash in rate) & wash in/wash out area under curve (WiWoAUC) in bolus and drip infusion differed significantly in aCD (n=15) versus iCD patients (n=6), while there was no difference in bowel wall US features including peristalsis, vascularity, layers loss, submucosa echogenicity nor in CRP levels between the two groups (Table 2). At baseline, 8 patients were started on a new treatment or were escalated and 5 of them were non-responders at 6 months. There was a trend towards higher median values in baseline CEUS kinetic parameters (PSV and WiWoAUC) in responders versus non-responders (Table 2). Conclusions: CEUS is a potentially useful, non-invasive tool to identify patients with active CD and who are more likely to respond to therapy.

Contrast-Enhanced Ultrasound with VEGFR2-Targeted Microbubbles for Monitoring Regorafenib Therapy Effects in Experimental Colorectal Adenocarcinomas in Rats with DCE-MRI and Immunohistochemical Validation.

ObjectivesTo investigate contrast-enhanced ultrasound (CEUS) with VEGFR2-targeted microbubbles for monitoring therapy effects of regorafenib on experimental colon carcinomas in rats with correlation to dynamic contrast-enhanced MRI (DCE-MRI) and immunohistochemistry.Materials and MethodsHuman colorectal adenocarcinoma xenografts (HT-29) were implanted subcutaneously in n = 21 (n = 11 therapy group; n = 10 control group) female athymic nude rats (Hsd: RH-Foxn1rnu). Animals were imaged at baseline and after a one-week daily treatment with regorafenib or a placebo (10 mg/kg bodyweight), using CEUS with VEGFR2-targeted microbubbles and DCE-MRI. In CEUS tumor perfusion was assessed during an early vascular phase (wash-in area under the curve = WiAUC) and VEGFR2-specific binding during a late molecular phase (signal intensity after 8 (SI8min) and 10 minutes (SI10min)), using a conventional 15L8 linear transducer (transmit frequency 7 MHz, dynamic range 80 dB, depth 25 mm). In DCE-MRI functional parameters plasma flow (PF) and plasma volume (PV) were quantified. For validation purposes, CEUS parameters were correlated with DCE-MRI parameters and immunohistochemical VEGFR2, CD31, Ki-67 and TUNEL stainings.ResultsCEUS perfusion parameter WiAUC decreased significantly (116,989 ± 77,048 a.u. to 30,076 ± 27,095a.u.; p = 0.005) under therapy with no significant changes (133,932 ± 65,960 a.u. to 84,316 ± 74,144 a.u.; p = 0.093) in the control group. In the therapy group, the amount of bound microbubbles in the late phase was significantly lower in the therapy than in the control group on day 7 (SI8min: 283 ± 191 vs. 802 ± 460 a.u.; p = 0.006); SI10min: 226 ± 149 vs. 645 ± 461 a.u.; p = 0.009). PF and PV decreased significantly (PF: 147 ± 58 mL/100 mL/min to 71 ± 15 mL/100 mL/min; p = 0.003; PV: 13 ± 3% to 9 ± 4%; p = 0.040) in the therapy group. Immunohistochemistry revealed significantly fewer VEGFR2 (7.2 ± 1.8 vs. 17.8 ± 4.6; p < 0.001), CD31 (8.1 ± 3.0 vs. 20.8 ± 5.7; p < 0.001) and Ki-67 (318.7 ± 94.0 vs. 468.0 ± 133.8; p = 0.004) and significantly more TUNEL (672.7 ± 194.0 vs. 357.6 ± 192.0; p = 0.003) positive cells in the therapy group. CEUS parameters showed significant (p < 0.05) correlations to DCE-MRI parameters and immunohistochemistry.ConclusionsCEUS with VEGFR2-targeted microbubbles allowed for monitoring regorafenib functional and molecular therapy effects on experimental colorectal adenocarcinomas with a significant decline of CEUS and DCE-MRI perfusion parameters as well as a significant reduction of specifically bound microbubbles under therapy, consistent with a reduced expression of VEGFR2.

Comparison of Conventional Ultrasound, Doppler, Elastography and Contrast Enhanced Ultrasonography Parameters with Histopathology Findings in the Differential Diagnosis of Benign and Malignant Thyroid Nodules

Background: Though neck ultrasound is the first line of choice for the screening of thyroid nodules, very few studies have compared the diagnostic performances of both conventional and advanced ultrasound parameters. In this study, we aim to compare various conventional and advanced ultrasound imaging parameters and confirm it with histopathology findings to differentiate between benign and malignant thyroid nodules. Methods: One hundred and thirty nine patients with 173 thyroid nodules underwent conventional ultrasonography (cUSG) which included gray-scale parameters, colour Doppler (CD) and power Doppler (PD) followed by elastography and contrast enhanced ultrasonography (CEUSG). Post-USG imaging all patients underwent fine needle aspiration cytology followed by surgery if indicated and histopathological results were obtained. Stata 11.2 statistical software was used for the statistical analysis. Results: Of 173 nodules, 65 were benign and 108 were malignant. cUSG had a sensitivity, specificity, PPV, NPV and accuracy of 94.4%, 90.4%, 94.4%, 90.4%, and 91.9%, respectively with AUC:0.97. On ROC analysis, the cut-off value for differentiating malignant from benign thyroid nodules on Ueno elasticity scoring was >3; AUC: 0.86 versus >2.2 using elasticity ratio method, AUC: 0.90. CEUSG and elastography had sensitivity, specificity, PPV, NPV and accuracy of 93.8%, 95.3%, 97.2%, 89.8%, and 94.2%, respectively with AUC:0.98. On combining and ranking, both conventional and advanced cUSG parameters, the significant indicators for malignancy were heterogeneous contrast enhancement, followed by Type-IV/V PD flow patterns, absence of ring enhancement and elasticity ratio >2.2 patterns with the largest AUC:0.994. Conclusions: Conjoint analysis of specific features of thyroid nodules on cUSG, elastography and CEUSG will enhance the diagnostic value in the screening of thyroid nodules.

Perivascular Perfusion on Contrast-Enhanced Ultrasound (CEUS) Is Associated with Inflammation in Patients with Acute Deep Vein Thrombosis.

Background Inflammatory processes of the venous wall in acute deep vein thrombosis (DVT) play a role in thrombus formation and resolution. However, direct evaluation of the perivascular inflammation is currently not feasible. Objective To assess perivascular perfusion in acute proximal DVT using contrast-enhanced ultrasound (CEUS) reflecting perivenous inflammation and its association with systemic inflammatory markers in a single-centre, prospective observational study. Patients/Methods Twenty patients with proximal DVT underwent CEUS imaging in the thrombosed and contralateral popliteal vein at baseline and after 2 weeks and 3 months. Perfusion was quantified by measuring peak enhancement (PE) and wash-in rate (WiR) in a perivenous region after bolus injection of the contrast agent. High-sensitive C-reactive protein (hsCRP) and interleukin-6 (IL-6) were determined at the time of each CEUS imaging. Results PE and WiR were significantly higher in the thrombosed compared with the unaffected leg at baseline (1,007 vs. 34 au and 103 vs. 4 au/s) and 2-week follow-up (903 vs. 35 au and 70 vs. 4 au/s). Compared with baseline, PE and WiR in the thrombosed leg significantly decreased to 217 au and 18 au/s at 3-month follow-up.At baseline, hsCRP and IL-6 were elevated at 20.1 mg/mL and 8.2 pg/mL and decreased significantly to 2.8 mg/mL and 2.6 pg/mL at 2-week follow-up, remaining low after 3 months. There was a weak association between the level of inflammatory markers and the CEUS parameters at baseline on the thrombosed leg. Conclusion Elevated perivascular perfusion assessed by CEUS imaging is associated with the inflammatory response in acute DVT.

Evaluation of gastric blood supply in diabetic patients with gastroparesis by contrast-enhanced ultrasound.

Improvement in regional blood flow has been shown to ameliorate diabetic gastroparesis. We compared the gastric blood supply in patients with diabetes with gastroparesis with that in healthy subjects, by using contrast-enhanced ultrasound (CEUS). 30 healthy subjects and 40 patients with diabetic gastroparesis were enrolled. The CEUS parameters of greater curvatures of the antrum (GCOA) and lesser curvatures of the antrum (LCOA), including peak intensity (PI) and the area under the curve (AUC), were compared between the two groups. Intraclass correlation coefficient (ICC) for PI in healthy subjects measured on CEUS were 0.831-0.857 and 0.803-0.823, respectively. Intra-ICC and inter-ICC values for AUC were 0.805-0.823 and 0.813-0.815, respectively. In both groups, no significant difference was observed in PI and AUC values of GCOA and LCOA (p > 0.05). The PI and AUC of GCOA and LCOA in the diabetes group were less than those in the normal group (p < 0.05). CEUS can assess stomach wall vascularity with a high reproducibility. Microcirculation in the antrum of patients with diabetic gastroparesis is poorer than that of normal group, which is consistent with the mechanisms of diabetic neuropathy. CEUS can be used for evaluation of microvascular perfusion in patients with stomach wall disease. Advances in knowledge: This was the first study to use CEUS for assessment of blood supply of the gastric wall and to compare microvascular perfusion between healthy individuals and patients with diabetes with gastroparesis.

Can quantitative contrast-enhanced ultrasonography predict cervical tumor response to neoadjuvant chemotherapy?

ObjectiveTo evaluate the feasibility of quantitative contrast-enhanced ultrasonography (CEUS) for predicting and assessing cervical tumor response to neoadjuvant chemotherapy (NACT). MethodsThirty-eight cases with stage IB2 or IIA cervical cancer were studied using CEUS before and after one cycle of NACT. The quantitative CEUS parameters maximum intensity (IMAX), rise time (RT), time to peak (TTP), and mean transit time (MTT) were compared between cervical tumors and myometrium (reference zone) using Sonoliver software. Absolute and relative changes in quantitative CEUS parameters were also compared among complete response, partial response, and non-responsive groups. Correlations between pre-treatment IMAX and changes in quantitative parameters were assessed after one cycle of NACT. ResultsThere were significant changes in cervical tumor IMAX (P<0.001), RT (P<0.05), and TTP (P<0.05) after one cycle of NACT. According to the Response Evaluation Criteria In Solid Tumors guidelines, the enrollments were divided into complete response, partial response, stable disease and progressive disease groups. There were no significant differences in quantitative CEUS parameters among complete response, partial response, and non-responsive groups (P>0.05). In the stable disease group (n=17), cervical tumor IMAX, RT, and TTP decreased significantly after NACT (P<0.001). The absolute and percentage changes in IMAX were positively correlated with pre-treatment IMAX in all 38 patients (r=0.576, P<0.001 and r=0.429, P<0.001). ConclusionQuantitative CEUS analysis can reveal changes in tumor perfusion following NACT. Tumor perfusion values changes likely precede size changes during the NACT course, and pre-treatment IMAX may be a valuable predictor of cervical tumor perfusion response to NACT with a great decrease in IMAX correlated with better perfusion response.

Contrast-enhanced ultrasound: A promising method for renal microvascular perfusion evaluation.

This article reviews the application of contrast-enhanced ultrasound (CEUS) in gauging renal microvascular perfusion in diverse renal diseases. The unique nature of the contrast agents used in CEUS provides real-time and quantitative imaging of the vasculature. In addition to the traditional use of CEUS for evaluation of kidney masses, it also emerges as a safe and effective imaging approach to assess microvascular perfusion in diffuse renal lesions, non-invasively. Although the precise CEUS parameters that may best predict disease still warrant systematic evaluation, animal models and limited clinical trials in humans raise hopes that CEUS could outcompete competing modalities as a first-line tool for assessing renal perfusion non-invasively, even in ailments such as acute kidney injury and chronic kidney disease.

Dynamic contrast-enhanced ultrasound and elastography assess deltoid muscle integrity after reverse shoulder arthroplasty

The outcome after reverse shoulder arthroplasty (RSA) depends on the condition of the deltoid muscle, which we assessed with new ultrasound modalities and electromyography (EMG). Contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) were applied to assess perfusion and elasticity of the deltoid muscle compared with the clinical and functional outcome. The study recruited 64 patients (mean age, 72.9 years) treated with RSA between 2004 and 2013. The deltoid muscle was examined with EMG and ultrasound imaging. Functional scores such as Constant score and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score were assessed. Among other CEUS parameters, the wash-in perfusion index, time to peak, and rise time were compared between the operated-on and contralateral shoulders as well as between patients with above-average and below-average outcome. The stiffness of the deltoid muscle was analyzed with ARFI. After RSA, deltoid perfusion (wash-in perfusion index, Δ = -12% ± 22%, P = .0001) and shoulder function (Constant score, Δ = -14 ± 24, P < .0001) were both inferior compared with the contralateral side. This perfusion deficit was associated with a limited range of motion (time to peak and anteversion: r = -0.290, P = .022). Deltoid perfusion was higher in patients with above-average outcome (rise time, Δ = 33% ± 13%, P = .038). The operated-on deltoid muscles showed higher stiffness than the contralateral muscles (ARFI, Δ = 0.2 ± 0.9 m/s, P = .0545). EMG excluded functionally relevant axillary nerve injuries in the study population. CEUS revealed reduced mean perfusion of the deltoid muscle after RSA. Reduced perfusion was associated with limited range of motion and below-average outcome. Functional shoulder impairment after RSA might be predicted by noninvasive CEUS as a surrogate parameter for the integrity of the deltoid muscle.

Clinical value of contrast-enhanced ultrasound in evaluating portal hypertension in patients with decompensated liver cirrhosis

To investigate the correlation between contrast-enhanced ultrasound parameters and hepatic venous pressure gradient (HVPG), and to develop a new noninvasive method for the evaluation of portal hypertension in patients with decompensated liver cirrhosis. One-hundred patients with decompensated liver cirrhosis were examined by contrast-enhanced ultrasound, and the dynamic images were collected for offline analysis. The contrast arrival time was obtained in the hepatic artery (HA), portal vein (PV), and hepatic vein (HV), and HA-HV transit time (HA-HVTT) and PV-HV transit time (PV-HVTT) were calculated. At the same time, HVPG was measured within 24 hours after contrast-enhanced ultrasound, Pearson correlation analysis was performed between each parameter and HVPG, and the receiver operating characteristic (ROC) curve was also used for analysis. HV arrival time (HVAT), HA-HVTT, and PV-HVTT were negatively correlated with HVPG (r = -0.385, -0.409, and -0.572, respectively). The area under the ROC curve (AUROC) was 0.903 for PV-HVTT < 2.5 s in judging HVPG≥ l0 mmHg in patients with decompensated liver cirrhosis, and the sensitivity and specificity were 74.4% and 89.5%, respectively. The AUROC was 0.861 for PV-HVTT < 1.5 s in judging HVPG≥l6 mmHg in these patients, and the sensitivity and specificity were 80.4% and 81.5%, respectively. HVAT and intrahepatic transit time demonstrate negative linear correlations with HVPG in patients with decompensated liver cirrhosis, and among all parameters, PV-HVTT shows the strongest correlation with HVPG and can be used to determine and predict the severity of portal hypertension.

Diagnostic Value of Contrast-Enhanced Ultrasound Evaluation of Malignant and Benign Solitary Thyroid Nodules

Abstract The aim of the study was to investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) in differentiating benign and malignant thyroid nodules. Thirty-five patients with morphologically proved thyroid nodules (17 malignant; 18 benign), underwent CEUS examination. Five enhancement patterns were evaluated: vascularisation, homogeneity, presence of peripheral rim type enhancement, wash-out rate of the contrast medium, and enhancement using microvascular imaging application. Time-intensity curves (TIC) were analysed in post-processing and defined as three types: slow versus rapid and stable versus rapid biphasic wash-out. Diagnostic value of the listed CEUS parameters was calculated. The results showed medium strength correlation between morphology (benign versus malignant nodule) and type of TIC curve r s = 0.38 (p = 0.021), as well as between mode of contrast enhancement r s = 0.39 (p = 0.022) and wash-out pattern r s =0.39 (p = 0.024). The overall pooled sensitivity of selected diagnostic parameters was 82%, specificity 57%, and accuracy 70%. Malignant nodules were characterised by iso- or hypovascular contrast enhancement and slow wash-out, while benign nodules showed hypervascular enhancement with rapid wash-out TIC curve and rim-like pattern. The CEUS patterns significantly differed between malignant and benign thyroid nodules with high diagnostic accuracy. Thus, CEUS has important clinical value as an additional tool to ultrasound and fine needle biopsy.

Quantitative Contrast-Enhanced Ultrasound Parameters in Crohn Disease: Their Role in Disease Activity Determination With Ultrasound.

The primary objective of our study was to examine the association between contrast-enhanced ultrasound (CEUS) parameters and established gray-scale ultrasound with color Doppler imaging (CDI) for the determination of disease activity in patients with Crohn disease. Our secondary objective was to develop quantitative time-signal intensity curve thresholds for disease activity. One hundred twenty-seven patients with Crohn disease underwent ultrasound with CDI and CEUS. Reviewers graded wall thickness, inflammatory fat, and mural blood flow as showing remission or inflammation (mild, moderate, or severe). If both gray-scale ultrasound and CDI predicted equal levels of disease activity, the studies were considered concordant. If ultrasound images suggested active disease not supported by CDI findings, the ultrasound results for disease activity were indeterminate. Time-signal intensity curves from CEUS were acquired with calculation of peak enhancement (PE), and AUCs. Interobserver variation and associations between PE and ultrasound parameters were examined. Multiclass ROC analysis was used to develop CEUS thresholds for activity. Ninety-six (76%) studies were concordant, 19 of which showed severe disease, and 31 (24%) studies were indeterminate. Kappa analyses revealed good interobserver agreement on grades for CDI (κ = 0.76) and ultrasound (κ = 0.80) assessments. PE values on CEUS and wall thickness showed good association with the Spearman rank correlation coefficient for the entire population (ρ = 0.62, p < 0.01) and for the concordant group (ρ = 0.70, p < 0.01). Multiclass ROC analyses of the concordant group using wall thickness alone as the reference standard showed cutoff points of 18.2 dB for differentiating mild versus moderate activity (sensitivity, 89.0% and specificity, 87.0%) and 23.0 dB for differentiating moderate versus severe (sensitivity, 90% and specificity, 86.8%). Almost identical cutoff points were observed when using ultrasound global assessment as the reference standard: using 18.2 dB to differentiate mild versus moderate activity yielded sensitivity of 89.2% and specificity of 90.9% and using 22.9 dB to differentiate moderate versus severe activity yielded sensitivity of 89.5% and specificity of 83.1%. Quantitative CEUS parameters integrated into inflammatory assessments with ultrasound reduce indeterminate results and improve disease activity level determinations.

The Value of the Model and Quantitative Parameters of Contrast-Enhanced Ultrasound in Judging the Severity of SHPT.

Using the model and quantitative parameters of contrast-enhanced ultrasound (CEUS) to assess the severity of secondary hyperparathyroidism (SHPT) was proposed. 42 SHPT patients who underwent CEUS examination were divided into three groups, light, moderate, and heavy as per parathyroid hormone (PTH). The process of CEUS was divided into two phases, wash-in phase and wash-out phase. The three groups were analyzed with their enhancing model in the two phases. The quantitative parameters of CEUS such as Arrival Time (AT), Time to Peak (TTP), Mean Transit Time (MTT), and Maximum Intensity (IMAX) were measured by time-intensity curve (TIC) and compared among the three groups. The enhancing model of light SHPT, moderate SHPT, and heavy SHPT showed statistical significance in wash-in phase and wash-out phase (P < 0.05). No difference was observed in AT and TTP among the three groups (P > 0.05) while MTT and IMAX showed statistical significance (P < 0.05). The CEUS of light SHPT was characterized by “slow-in, fast-out, and lower-enhancement” with short enhancement time; the CEUS of moderate SHPT was characterized by “fast-in, fast-out, and higher-enhancement” with slightly long enhancement time; the CEUS of heavy SHPT was characterized by “fast-in, slow-out, and higher-enhancement” with long enhancement time. Therefore, the model and quantitative parameters of CEUS can be benefit for the assessment of the severity of SHPT.

Intraoperative Contrast Enhanced Ultrasound Evaluates the Grade of Glioma.

Objective. The aim of our study was to investigate the value of intraoperative contrast enhanced ultrasound (CEUS) for evaluating the grade of glioma and the correlation between microvessel density (MVD) and vascular endothelial growth factor (VEGF). Methods. We performed intraoperative conventional ultrasound (CUS) and CEUS on 88 patients with gliomas. All of the patients have undergone surgery and obtained the results of pathology. All patients have undergone intraoperative CUS and CEUS to compare the characteristics of different grade gliomas and the results of CUS and CEUS were compared with pathological results. Results. The time to start (TTS) and time to peak (TTP) of low grade glioma (LGG) were similar to those of edema and normal brain surrounding glioma. The enhanced extent of LGG was higher than that of the normal brain and edema. The TTS and TTP of high grade glioma were earlier than those of the edema and normal brain surrounding glioma. The enhancement of HGG was higher than that of LGG. The absolute peak intensity (API) was correlated with MVD and VEGF. Conclusion. Intraoperative CEUS could help in determining boundary of peritumoral brain edema of glioma. Intraoperative CEUS parameters in cerebral gliomas could indirectly reflect the information of MVD and VEGF.

Dynamic Quantitative Contrast-enhanced Ultrasound for Assessment of Cilostazol Induced Pro-angiogenic Therapeutic Effects on Skeletal Muscle Microcirculation in Peripheral Arterial Disease

Purpose: To assess the effect of cilostazol on muscular microperfusion in patients with peripheral artery occlusive disease (PAOD) using dynamic quantitative contrast-enhanced ultrasound (CEUS). Materials and Methods: 20 patients with PAOD, Rutherford classification grade I, category III were evaluated performing CEUS with the arterial occlusion paradigm, ankle-brachial-index (ABI) and treadmill walking distance test before and after oral treatment with cilostazol for three months. Microperfusion of the calf skeletal muscle was assessed using quantitative CEUS parameters which were extracted from time signal-intensity curves (TIC). Results: 10 patients had to be taken off medication secondary to side effects. Maximum CEUS signal enhancement prior to therapy was 104 ± 69 ~mL compared to 114±68 ~mL post treatment (P=0.26). tmax was 34 ± 20 s before and 36 ± 23 s post treatment (P=0.51). Maximum slope of the TIC (m2) prior to therapy was 6.06 ± 5.55 ~mL/s and revealed to be 5.12 ± 3.30 ~mL/s post treatment (P=0.62). Area under the curve after the occlusion (AUCpost) was 3975.38 ± 2856.52 ~mL/s prior to cilostazol therapy compared to 4210.98 ± 2816.33 ~mL/s after therapy (P=0.39). The values for ABI and treadmill walking distance test did not differ significantly differ, either. Conclusion: In patients with PAOD, medical therapy with cilostazol seems not to be associated with significant improvement of muscular microperfusion as assessed by dynamic quantitative CEUS. This study demonstrates the feasibility of the CEUS technique to evaluate response to pro-angiogenic drug treatment and confirmation of results in a larger population is warranted.

Splanchnic Hemodynamics and Intestinal Vascularity in Crohn's Disease: An In Vivo Evaluation Using Doppler and Contrast-Enhanced Ultrasound and Biochemical Parameters

Crohn's disease (CD) is characterized by inflammation and angiogenesis of affected bowel. We evaluated the correlation among vascularity of intestinal wall in CD, splanchnic hemodynamics, clinical activity and biochemical parameters of inflammation and angiogenesis. Sixteen patients with ileal CD and 10 healthy controls were investigated by means of Doppler ultrasound of the superior mesenteric artery and color Doppler and contrast-enhanced ultrasound of the ileal wall. In parallel, serum levels of vascular endothelial growth factor, tumor necrosis factor-α (TNF-α) and nitric oxide, before and 30 min after a standard meal, were evaluated. In CD patients, there was a significant post-prandial reduction in the resistance index and pulsatility index of the superior mesenteric artery, associated with increased levels of nitric oxide and decreased amounts of TNF-α. A correlation was observed between vascular endothelial growth factor and contrast-enhanced ultrasound parameters of intestinal wall vascularity (r = 0.63–0.71, p < 0.05) and between these parameters and superior mesenteric artery blood flow after fasting (resistance and pulsatility indexes: r = −0.64 and −0.72, p < 0.05). Our results revealed a post-prandial increase in nitric oxide and decrease in TNF-α in CD patients in vivo. They also confirm the role of vascular endothelial growth factor in angiogenesis and in pathologic vascular remodeling of CD and its effect on splanchnic blood flow.

Qualitative, quantitative and combination score systems in differential diagnosis of breast lesions by contrast-enhanced ultrasound

ObjectiveTo assess the feasibility of score systems in differential diagnosis of breast lesions by contrast-enhanced ultrasound (CEUS). MethodsCEUS was performed in 121 patients with 127 breast lesions by Philips iU22 with Sonovue as contrast agent. Pearson Chi-square χ2 test, binary logistic regression analysis and Student’s t-test are used to identify significant CEUS parameters in differential diagnosis. Based on these significant CEUS parameters, qualitative, quantitative and combination score systems were built by scoring 1 for benign characteristic and scoring 2 for malignant characteristic. Receiver operating characteristic (ROC) curve was applied to evaluate the diagnostic efficacy of different analytical methods. ResultsPathological results showed 41 benign and 86 malignant lesions. Qualitative analysis and logistic regression analysis showed that there are significant differences in enhancement degree, enhancement order, internal homogeneity, enhancement margin, surrounding vessels and enlargement of diameters (P<0.05) between benign and malignant lesions. Quantitative analysis indicated that malignant lesions tended to show higher peak intensity (PI), larger area under the curve (AUC) and shorter time to peak (TTP) than benign ones (P<0.05). Qualitative score systems showed higher diagnostic efficacy than single quantitative CEUS parameters. The corresponding area under the ROC curve for qualitative, quantitative and combination score systems were 0.897, 0.716 and 0.903 respectively. Z test showed that area under the ROC curve of quantitative score system was statistically smaller than that of other score systems. ConclusionsQuantitative score system helps little in improving the diagnostic efficacy of CEUS. While qualitative score system improves the performance of CEUS greatly in discrimination of benign and malignant breast lesions. The application of qualitative could develop the diagnostic performance of CEUS which is clinically promising.

Value of contrast-enhanced ultrasound and enhancement MRI in differetial diagnosis of the orbital neoplasms

Objective To evaluate the ability of contrast-enhanced ultrasonography (CEUS) compared to enhanced MRI scan in differential diagnosis of benign and malign tumor of orbit. Methods CEUS and enhanced MRI was performed in 74 patients with tumor of orbit.These patients were divided into two groups: benign and malignant tumor depended on histological diagnosis. The results were analysed with SonoLiver software. The coincidence rate of diagnosis and enhancement intensity among CEUS, MRI and CEUS+ MRI were compared and the quantitative parameters of CEUS were analysed. Results (1)The diagnostic accordance rate of benign group by three methods were 90.0%, 80.0% and 96.0% respectively, there was statistical difference for diagnostic coincidence rate between the MRI and CEUS+ MRI(P 0.05). (2) The enhancement intensity of CEUS was different between benign and malignant groups (P 0.05). (3) The parameters of tumor imaging obtained time intensity curve(TIC): rise time (RT), half elution time and time to peaking (TTP) were significantly different between benign and malignant groups(P 0.05). Conclusions CEUS had higher diagnostic accuracy than MRI in benign orbital tumor. The contrast enhancement intensity and time-intensity curves provide valuable diagnostic information for differential diagnosis of benign and malignant orbital tumor. Key words: Ultrasonography; Microbubbles; Orbital neoplasms; Magnetic resonance imaging

Value of contrast-enhanced ultrasound on assessment of limb muscle crush injury: an animal experiment

Objective To explore the diagnostic value of quantitative contrast-enhanced ultrasonography(CEUS) for crush injury in the hind limb muscle of rabbits. Methods A totle of 120 New Zealand white rabbits were randomized to receive compression on the left hind limb for either 2 h(n=56) or 4 h(n=56) to induce muscle crush injury, another 8 animals were not injured and served as normal controls. CEUS parameters such as peak intensity(PI), area under curve(AUC), ascending slop(AS) and descending slop(DS) were measured at 0.5 h, 2 h, 6 h, 24 h, 3 d, 7 d, 14 d after decompression. Results Compared with the uninjured muscle, reperfusion of the injured muscles showed early and high enhancement in CEUS. The time-intensity curve showed a trend of rapid lift and gradual drop. The PI and AUC values differed significantly among the three groups and were positively correlated with serum and tissue biomarkers. Rabbits of the 4 h compression group showed significantly higher PI and AUC values compared with the 2 h compression group at each time points. Conclusions CEUS can effectively detect muscle crush injury and monitor dynamic changes of the injured muscle in rabbits.PI and AUC are promising diagnostic parameters for this disease. CEUS might play an important role in the pre-hospital and bedside settings for the diagnosis of muscle crush injury. Key words: Ultrasonography; Microbubbles; Muscle; Crush injury