Contrast-enhanced Ultrasonography In Diagnosis Research Articles

Diagnostic value of contrast enhanced ultrasound for splenic artery complications following acute pancreatitis

To assess the value of contrast-enhanced ultrasound (CEUS) in diagnosing splenic artery complications (SACs) after acute pancreatitis (AP). One hundred and eighteen patients with AP were enrolled in the study. All patients were examined by CEUS and contrast-enhanced computed tomography (CECT). CECT was accepted as a gold standard for the diagnosis of SACs in AP. The diagnostic accuracy of splenic CEUS and pancreatic CEUS was compared with that of CECT. Splenic infarction was the diagnostic criterion for splenic artery embolism and local dysperfusion of the splenic parenchyma was the diagnostic criterion for splenic arterial stenosis. The incidence of splenic sub-capsular hemorrhage, splenic artery aneurysms, and splenic rupture was all lower than that of SACs. Nine patients were diagnosed as having SACs after AP by CECT among the 118 patients. The patients with SACs were diagnosed with severe acute pancreatitis (SAP). Among them, 6 lesions were diagnosed as splenic artery embolism, 5 as splenic artery aneurysms, and 1 as splenic arterial stenosis. No lesion was diagnosed by pancreatic CEUS and 5 lesions were diagnosed by splenic CEUS. By splenic CEUS, 4 cases were diagnosed as splenic artery embolism and 1 as splenic arterial stenosis. The accuracy of splenic CEUS in diagnosis of SACs in SAP was 41.7% (5/12), which was higher than that of pancreatic CEUS (0%). Splenic CEUS is a supplementary method for pancreatic CEUS in AP patients, which can decrease missed diagnosis of SACs.

Real-Time Grey Scale Contrast-Enhanced Ultrasonography in Diagnosis of Gallbladder Cancer

Real-Time Grey Scale Contrast-Enhanced Ultrasonography in Diagnosis of Gallbladder Cancer

346 Use of contrast-enhanced ultrasonography in diagnosis of renal masses and concordance with computed tomography

346 Use of contrast-enhanced ultrasonography in diagnosis of renal masses and concordance with computed tomography

Contrast-enhanced ultrasound diagnosis of splenic artery steal syndrome after orthotopic liver transplantation

The aim of this study was to investigate the use of contrast-enhanced ultrasound (CEUS) for the detection of splenic artery steal syndrome (SASS) after orthotopic liver transplantation (OLT). Two hundred forty-seven patients underwent OLT. Blood tests and color Doppler flow imaging (CDFI) were performed at various time points after the operation. CEUS and celiac angiography were used for patients suspected of having SASS. If the diagnosis of SASS was confirmed, splenic artery embolization was performed to enhance hepatic artery flow. CEUS and angiography were performed for the assessment of postinterventional clinical outcomes. Three of the 247 patients died postoperatively, and 8 patients were suspected of having SASS because of elevated liver enzyme levels and slim or undetectable hepatic artery blood signals by CDFI at various points after the operation. In these 8 patients, CEUS showed a delayed and weak contrast-enhanced blood signal in the hepatic artery associated with a rapid and intense enhancement of the portal vein blood. No narrowing of the hyperintense signal was observed in the hepatic artery by CEUS. The 8 diagnoses of SASS were proven by celiac angiography, which showed delayed perfusion of the hepatic artery and rapid filling of the splenic artery. Immediately after the interventional procedure, CEUS demonstrated a significantly enlarged hyperintense blood signal in the hepatic artery. In conclusion, approximately 3.27% of SASS cases occur after OLT. SASS can be identified as a sluggish and weak hyperintense blood signal in the hepatic artery without the narrowing and interruption of the hypointense signal in CEUS imaging. CEUS is an effective imaging modality for the detection of SASS after OLT.

Assessment of Contrast-Enhanced Ultrasonography in Diagnosis and Preoperative Localization of Insulinoma

Ultrasound Quarterly: June 2012 - Volume 28 - Issue 2 - p 127 doi: 10.1097/01.RUQ.0000415524.13763.12

Value of three-dimensional contrast-enhanced ultrasonography in diagnosis of small adnexal masses: a preliminary study

Objective To evaluate the value of three-dimensional contrast-enhanced ultrasonography (3D-CEUS) in diagnosis of small adnexal masses.Methods Forty-three patients with 47 adnexal masses were examined by both two-dimensional contrast-enhanced ultrasound (2D-CEUS) and 3D-CEUS.Sonographic features of adnexal masses with 3D-CEUS were analyzed and compared with 2D-CEUS.All patients with adnexal masses were proved by operational pathology and long-term follow-up results.Results Enhancement from the periphery to the parenchyma, septa or papillae was shown by 2D-CEUS among 40 benign adnexal masses, and multicenter enhancement from parenchyma to the periphery among 7 malignant ones.There were significant differences in blood vessels of envelope and septa, and the enhancement of parenchyma between benign and malignant adnexal masses by 3D-CEUS (P ＜0.05).Straight and sparse blood vessels were seen inside benign solid masses.Enhancement was observed in the wall of cystic masses,but not in intracapsular structures.Dense and distorted vascularity was found inside malignant adnexal masses forming a ball in the parenchyma, which was significantly enhanced.Thick vasa vasorum was also visible in 6 out of 7 malignant ones.Conclusions 3D-CEUS has an advantage in displaying complex spatial vascular structures,and might be a new tool to study real vascular structures in small adnexal masses. Key words: Ultrasonography; Microbubbles; Adnexal diseases

Clinical application of contrast-enhanced ultrasound in diagnosis of liver and spleen trauma

Objective To discuss clinical application value of contrast-enhanced ultrasound(CEUS) technology in the diagnosis of liver and spleen trauma. Methods Retrospective analysis 25 cases of liver and spleen trauma patients, the conventional ultrasonic CEUS complete material, analysis of the liver and spleen damage CEUS performance,and with surgery and computed tomography(CT) strengthen comparative analysis of the sensitivity of the conventional ultrasonic, CEUS, specific degree and the classification accuracy. Results Among the surgery or CT confirmed 23 cases for liver and spleen rupture,the pure 8 cases liver, injury 13 cases of pure spleen rupture ,liver and spleen composite injury in 2 cases. And surgery or CT comparison, the sensitivity of the CEUS and specific degrees were 90.5％ and 66.7％ ,significantly higher than conventional ultrasound 59. 1％ and 33.3％ (P ＜0.05) ;CEUS classification was 91.3％ (21/23), significantly higher than the rules of ultrasound was 65.2％ ( 15/23 ), both differences were statistically significant( P ＜ 0.05). Conclusion CEUS diagnosis liver and spleen, due to the sensitivity of the damage degree high, and the classification accuracy was higher, the diagnosis to accurately evaluate the extent of the damage to the liver and spleen in liver and spleen, the loss of the diagnosis and treatment of clinical guidelines choice had important value of clinical application. Key words: Contrast-enhanced ultrasound; Liver; Spleen ; Trauma

The Role of Contrast-Enhanced Ultrasonography in Diagnosis and Therapeutical Follow-Up of Liver Abscesses: Comparative Case Reports

The Role of Contrast-Enhanced Ultrasonography in Diagnosis and Therapeutical Follow-Up of Liver Abscesses: Comparative Case Reports

Contrast-enhanced ultrasonography in diagnosis of inflammatory pseudotumor of liver

To evaluate the application of contrast-enhanced ultrasonography (CEUS) in diagnosis of inflammatory pseudotumor of liver (IPL). The contrast-enhanced untrasonography was performed in 32 cases of IPL and the results were retrospectively analyzed. Among total 32 cases, 21 had absent contrast enhancement (type I); 6 had rimlike or stringlike enhancement during arterial phase and presented hypoechoic lesions during the late phase (type II); 2 had diffuse and homogeneous enhancement during early arterial phase,persisting hyperechoic during the late phase (type III); 3 had enhancement during arterial phases and washed out more quickly than liver parenchymal (type IV). The perfusion pattern of IPL with CEUS varies, the predominant type is no contrast enhancement; type IV may be confused with atypical hepatic carcinoma, in that case the needle biopsy is necessary.

Time-relative-intensity curve of contrast-enhanced ultrasonography for discrimination of malignant and benign liver tumors

Objective To study the diagnostic value of relative parameters and time-relative-intensity curve(TRIC) in malignant and benign liver tumors with contrast-enhanced ultrasound(CEUS). Methods Fifty-nine focal liver lesions were examined with CEUS and drawed time-intensity curve(TIC) with QLAB software. The relative parameters of malignant and benign liver tumors were calculated and analysed. The relative intensity equaled the echo intensity of lesion substracted the encho intensity of liver. TRIC were drawed with time as abscissa and relative intensity as the ordinate. The types of TIRC were analysed comparatively in different groups (benign and malignant). Results There were significant differences in relative peak time, relative peak intensity, relative enhancement time and relative decline slope between malignant and benign lesions( P ＜0. 05). TRIC appeared quick-ascending and quick-descending types in the malignant lesions,the decline curve of TRIC droped down to 0 dB at (28.24 ± 8. 14)s and down to lowest - 8 dB continually, meanwhile fluctuated slightly. While TRIC appeared slow-ascending and slow-descending types in the benign lesions, the decline curve of TRIC droped down to the lowest 4 dB continually, meanwhile fluctuated slightly. Conclusions The relative parameters and TRIC are new quantitative indicators of CEUS for diagnosis of malignant and benign liver tumors. Key words: Ultrasonography; Microbubbles; Liver neoplasms

Assessment of contrast-enhanced ultrasonography in diagnosis and preoperative localization of insulinoma

This study was to evaluate the value of contrast-enhanced ultrasonography (CEUS) in the diagnosis and preoperative localization of insulinoma and explore the enhancement patterns of the tumors. Unenhanced and contrast-enhanced ultrasonographic examinations of 31 patients who underwent resection of insulinomas were retrospectively reviewed. The diagnosis sensitivity and localization specificity of CEUS for insulinomas were determined. Results of unenhanced ultrasonography and CEUS were compared by Chi-square test. Unenhanced ultrasonography could display 9 of 37 (24.3%) surgically verified insulinomas in 31 patients, while the diagnosis sensitivity and localization specificity of preoperative CEUS was 33 (89.2%) and 32 (86.5%) of the 37 tumors, respectively. In contrast to the unenhanced ultrasonography, the improvement of CEUS in the diagnosis and preoperative localization of insulinomas was significant (p<0.0001). The enhancement pattern of insulinoma on CEUS was fast wash-in and slow wash-out. All the tumors were homogeneous hypervascularity in the earlier arterial phase, while the tumors still displayed hyperenhancing pattern in the late phase. Our study demonstrates the great potential of CEUS in the diagnosis and preoperative localization of insulinomas. Since CEUS is a convenient, inexpensive, effective and non-invasive modality, the study supports the use of CEUS as a primary tool in the evaluation of patients with insulinomas.

Unclear Focal Liver Lesions in Contrast-Enhanced Ultrasonography – Lessons to be Learned from the DEGUM Multicenter Study for the Characterization of Liver Tumors

To discuss the difficulties of contrast-enhanced ultrasound (CEUS) in a large multi-center trial. CEUS was performed on 1349 liver lesions with an unclear diagnosis after native ultrasound using a standardized protocol (phase inversion; low MI < 0.4; Sonovue Bolus 1.2 - 4.8 ml). The early arterial, arterial, portal venous and late phase > 2 min. were documented. The diagnosis based on CEUS results was compared to the final diagnosis (histology: n = 1006; MRI: n = 269; CT: n = 269 - multiple examinations possible). Of the 1349 enclosed liver lesions, 20 could not be definitively diagnosed even using all diagnostic steps including histology (the others were proven to be benign n = 573 or malignant n = 756). Of the 1349 unclear liver lesions, 1257 could be differentiated with an accuracy of 90.3% using CEUS. The sensitivity, specificity, and positive and negative predictive value for malignant liver lesions was 95.8%, 83.1%, 88.2% and 93.7% respectively. 92 liver lesions (6.8%) could not be definitively diagnosed using CEUS. Most of them were benign (n = 67) on final diagnosis. The CEUS diagnosis was wrong for 39 lesions. However, only 8 lesions classified as benign by CEUS turned out to be malignant. In 3 cases HCC proven by histology was incorrectly diagnosed by CEUS as adenoma and 2 lesions incorrectly diagnosed by CEUS as FNH turned out to be an HCC and a metastasis. Two lesions diagnosed by CEUS as hemangiomas turned out to be an HCC and a metastasis. One lesion classified as benign by CEUS was ultimately diagnosed as a lymphoma. Even in this multi-center trial, CEUS proved to be an excellent method for clarifying liver lesions remaining unclear after native ultrasound. The CEUS diagnosis of benign was only incorrect in a few cases.

Clinical Application of Contrast-Enhanced Ultrasonography in Diagnosis of Superficial Lymphadenopathy

The purpose of this study was to evaluate the value of contrast-enhanced ultrasonography (CEUS) in differential diagnosis of superficial lymphadenopathy. Ninety-four superficial enlarged lymph nodes in 94 patients were studied by conventional ultrasonography (gray scale and color Doppler) and CEUS. Contrast-enhanced sonograms were analyzed using contrast-specific quantification software. All of the results were compared with pathologic diagnoses. Of the 94 lymph nodes examined, 44 were benign and 50 were malignant (33 metastases and 17 lymphomas). The sensitivity, specificity, and accuracy of conventional ultrasonography in differential diagnosis between benign and malignant nodes were 51%, 47%, and 55%, respectively. Contrast-enhanced ultrasonography showed intense homogeneous enhancement in 39 of 44 benign lymph nodes, inhomogeneous enhancement in 32 of 33 metastases, and intense homogeneous enhancement and absence of perfusion in 9 of 17 and 6 of 17 lymphomas, respectively. The sensitivity specificity, and accuracy of CEUS were 84%, 79%, and 80%. After time-intensity curve gamma variates were calculated, the area under the curve of the benign lymph nodes was greater than those of the metastatic lymph nodes and lymphomas (P < .01). These results indicate that the use of CEUS and contrast-specific software has a higher degree of diagnostic accuracy than conventional ultrasonography for evaluations of superficial lymphadenopathy. The contrast enhancement patterns and time-intensity curves provide valuable diagnostic information for differential diagnosis of benign and malignant lymph nodes.

Evaluation of contrast-enhanced ultrasonography in diagnosis of focal splenic solid lesions

Objective To investigate the value of contrast-enhanced ultrasonography(CEUS) for differential diagnosis of focal splenic solid lesions.Methods Thirty-two patients with 32 focal splenic lesions were examined with CEUS.The enhancement phases and perfusion were observed.Each group has 16 patients.Results The contrast media extincted more quickly in malignant lesions than in benign ones.The peak time and initial decreasing time of the malignant lesions were (19.7±4.5)s and (29.7±10.9)s.The opposite time of the benign lesions were (24.2±4.4)s and (50.9±22.8)s.The initial decreasing time of the malignant lesions was earlier than that of the benign ones.The enhancement pattern was similar between the two groups.More lesions can be detected after CEUS.The number of the lesions was 111 before CEUS and 142 after CEUS.Conclusions CEUS is useful in the differential diagnosis of splenic lesions. Key words: Ultrasonography; Microbubbles; Splenic diseases

Contrast Enhanced Ultrasound Sonography in Intestinal Acute Graft Versus Host Disease: Advantages of Non-Invasive Anatomic and Physiologic Measurements.

Abstract 4493▪ IntroductionAcute GVHD involving the gastrointestinal tract is now the major cause of non-relapse mortality following allogenic transplant. Diagnosis remains problematic for some patients with pathology in the mid-gut; there is significant sampling error with mucosal biopsy; we lack objective measures of physiologic improvement or worsening in the gut; and duration of immune suppressive therapy remains imprecise. To address these issues, we have serially evaluated intestinal pathology in patients with acute GVHD using a reproducible ultrasound technique as a proof of principle study. Specifically, we examined the hypothesis that contrast-enhanced ultrasound (CEUS) could detect an enhancement of microcirculation during active intestinal acute GVHD as a diagnostic tool and that CEUS could be used to serially assess physiologic changes after treatment. MethodsFour patients (pts) with hematologic malignancy (1 each with ALL, AML, mantle cell lymphoma, and myeloma) received a matched unrelated donor allogenic transplant after a myeloablative (N=2), reduced intensity (N=1), or non-myeloablative (N=1) conditioning. GVHD prophylaxis consisted of cyclosporine with either short course methotrexate (N=3) or mycophenolate mofetil (N=1). All patients developed biopsy-proven intestinal GVHD that was steroid refractory in 2 patients. At GVHD onset, patients were scanned with transabdominal ultrasonography and subsequently by CEUS using a linear phased-array 7.5-MHz transducer. A second generation echo-contrast agent (SonoVue®, Bracco), which consists of microbubbles stabilized by phospholipids and filled with sulphur hexafluoride, was injected i.v. as a bolus (2.4 mL) followed by 5 mL saline flush. Microbubbles have a mean diameter of 2.5 μm and remain within the vascular space allowing real-time imaging of microcirculation. ResultsIn all patients, routine ultrasonography revealed mucosal edema involving the terminal ileum in 3 patients (wall thickness 5.1, 5.8 and 7.9 mm) and the colon in 4 patients (ascending colon 5.8, 6, 8.4 and 18 mm; transverse colon 6 and 12.6 mm; descending colon 11 mm). CEUS at GVHD onset showed an arterial phase (AP) complete enhancement of the entire wall section from the mucosal to the serosal layer (terminal ileum) in 2 patients. There was absence of enhancement only in the outer border of the muscularis propria in 1 patient (pt); there was absence of enhancement both in the outer and in the inner border of the colon wall and enhancement only of the intermediate layer in 1 pt. All patients showed late parenchymal phase (PP) wash out. These enhancement patterns have previously been described in active Crohn's disease (Serra C. et al; 2007). CEUS follow-up findings on serial examinations: 1) allowed us to monitor residual disease in one pt after Infliximab, showing persistent AP enhancement of microcirculation suggesting residual GVHD activity which required further treatment with eventually complete remission; 2) CEUS showed normalization and/or decreased microcirculation enhancement in pts responding to treatment (N=2); 3) CEUS showed AP microcirculation enhancement when GVHD flared (N=2); 4) CEUS showed persistence of AP enhancement of microcirculation after Rituxan (4 doses 375mg/m2/weekly) despite a decrease in ileum wall thickness and in agreement with only a slight improvement of symptoms in one pt when GVHD flared, 5) CEUS showed no improvement of intestinal microcirculation wall enhancement in steroid refractory aGVHD patients who eventually died (N=2). In one of them there was persistence of AP phase enhancement despite improvement of symptoms suggesting still active disease. ConclusionsContrast enhanced US showed intestinal microcirculation wall enhancement and delayed washout at the onset of GVHD symptoms in areas of the intestine inaccessible to endoscopic evaluation. CEUS findings on serial examinations correlated with incomplete responses and flares of GVHD symptoms (microcirculation enhancement) and responses to therapy (decreased microcirculation activity). CEUS may be useful for both diagnosis and prognosis, as it provides both anatomic and physiologic information about intestinal GVHD. These findings prompted us to design a prospective study to evaluate clinical usefulness of CEUS in diagnosis and follow-up of intestinal acute GVHD. Disclosures:No relevant conflicts of interest to declare.

Comparative diagnostic value of computed tomography and contrast-enhanced ultrasonography in diagnosis of focal liver lesions

OBJECTIVE. The aim of the study was to evaluate focal liver lesions by computed tomography and contrast-enhanced ultrasonography and to compare their diagnostic values. MATERIALS AND METHODS. There were 67 patients, examined and treated in the Departments of Gastroenterology, Surgery, and Oncology, Hospital of Kaunas University of Medicine, during 2007 (study group). All the patients underwent contrast-enhanced ultrasonography and bolus computed tomography. Control group included 73 patients with focal hepatic lesions who were examined and treated in the Hospital of Kaunas University of Medicine during 2006. Focal hepatic lesions were detected and characterized by conventional ultrasonography and bolus computed tomography. The diagnosis was confirmed by biopsy or during surgery in both groups, and hemangiomas were confirmed by magnetic resonance imaging. Patients' age varied from 20 to 80 years (there were 46 [68.7%] women and 21 [31.3%] men with a mean age of 55.85+/-13.417 years). The age of patients in the study group varied from 18 to 91 years (mean age, 60.81+/-16.059 years; out of 73 patients, 46 [63%] were women and 27 [37%] men). RESULTS. The following was determined in the study group: hemangioma (n=18, 26.9%), focal nodular hyperplasia (n=4, 6%), adenoma (n=2, 3%), echinococcosis (n=2, 3%), hepatocellular carcinoma (n=11, 16.4%), cholangiocellular carcinoma (n=1, 1.5%), solitary metastasis (n=13, 19.4%), hepatic cyst (n=3, 4.5%), etc. The sensitivity and specificity of contrast-enhanced ultrasonography as compared with computed tomography in detecting and characterizing focal liver lesions was 44.2% and 46.7%, respectively; positive prognostic value was 74.2% and negative prognostic value was 19.4%. The sensitivity and specificity of conventional ultrasonography as compared with contrast-enhanced ultrasonography in detecting and characterizing focal liver lesions was 34.5% and 100%, respectively; positive prognostic value was 100% and negative prognostic value was 25%. CONCLUSIONS. Ultrasound contrast agents (SonoVue, Bracco(R), Milan, Italy) definitely improve detection and characterization of focal liver lesions. Ultrasonography correlates with computed tomography and magnetic resonance imaging, particularly during arterial phase. The sensitivity of contrast-enhanced ultrasonography as compared with computed tomography in detecting and characterizing focal liver lesions was 74.2% and positive prognostic value was 44.2%; sensitivity of conventional ultrasonography as compared with contrast-enhanced ultrasonography in detecting and characterizing focal liver lesions was 34.5% and positive prognostic value was 100%.

Diagnostic efficacy of SonoVue®, a second generation contrast agent, in the assessment of extracranial carotid or peripheral arteries using colour and spectral Doppler ultrasound: a multicentre study

The purpose of this study was to demonstrate the improvement in diagnostic quality and diagnostic accuracy of SonoVue microbubble contrast-enhanced ultrasound (CE-US) versus unenhanced ultrasound imaging during the investigation of extracranial carotid or peripheral arteries. 82 patients with suspected extracranial carotid or peripheral arterial disease received four SonoVue doses (0.3 ml, 0.6 ml, 1.2 ml and 2.4 ml) with Doppler ultrasound performed before and following each dose. Diagnostic quality of the CE-US examinations was evaluated off-site for duration of clinically useful contrast enhancement, artefact effects and percentage of examinations converted from non-diagnostic to diagnostic. Accuracy, sensitivity and specificity were assessed as agreement of CE-US diagnosis evaluated by an independent panel of experts with reference standard modality. The median duration of clinically useful signal enhancement significantly increased with increasing SonoVue doses (p< or =0.002). At the dose of 2.4 ml of SonoVue, diagnostic quality evaluated as number of inconclusive examinations significantly improved, falling from 40.7% at baseline down to 5.1%. Furthermore, SonoVue significantly (p<0.01) increased the accuracy, sensitivity and specificity of assessment of disease compared with baseline ultrasound. SonoVue increases the diagnostic quality of Doppler images and improves the accuracy of both spectral and colour Doppler examinations of extracranial carotid or peripheral arterial disease.