Contrast-enhanced Ultrasound Parameters Research Articles

Contrast-enhanced ultrasound (CEUS) - A new tool for evaluating blood supply in primary peripheral lung cancer.

To explore the feasibility of contrast-enhanced ultrasound (CEUS) as a new tool for characterizing vascularization of primary peripheral lung cancer. 315 consecutive patients with definite primary peripheral lung cancers underwent CEUS examination from November 2016 to March 2022. CEUS parameters including time to enhancement (TE), time to peak (TP), time to wash-out (TW), distribution of vessels (DV), extent of enhancement (EE) and homogeneity of enhancement (HE) were obtained. The lesions were grouped on the basis of TE which reflects tumor vascularization: early enhancement (pulmonary arterial vascularization) (n = 91) and delayed enhancement group (bronchial arterial vascularization) (n = 224). Overall, lung tumors commonly (71.1%) manifested a delayed enhancement which indicating blood supply originated from bronchial arteries, while an early enhancement was present in less than a third of the cases. Tumors with bronchial vascularization tended to show a delayed, reduced and heterogeneous enhancement. Correspondingly, it is characterized by a shorter TE, marked EE and a relatively infrequent occurrence of necrosis in tumors with pulmonary vascularization. Providing micro-perfusion information, CEUS is a potentially imaging tool for evaluating blood supply in primary peripheral lung cancer.

Contrast-Enhanced Ultrasound in Distinguishing between Malignant and Benign Peripheral Pulmonary Consolidations: The Debated Utility of the Contrast Enhancement Arrival Time

Background. Limited studies and observations conducted on a too small number of patients prevent determining the actual clinical utility of pulmonary contrast-enhanced ultrasound (CEUS). The aim of the present study was to examine the efficacy of contrast enhancement (CE) arrival time (AT) and other dynamic CEUS findings for differentiating between malignant and benign peripheral lung lesions. Methods. 317 inpatients and outpatients (215 men, 102 women; mean age: 52 years) with peripheral pulmonary lesions were included in the study and underwent pulmonary CEUS. Patients were examined in a sitting position after receiving an intravenous injection of 4.8 mL of sulfur hexafluoride microbubbles stabilized by a phospholipid shell as ultrasound contrast agent (SonoVue-Bracco; Milan, Italy). Each lesion was observed for at least 5 min in real-time and the following temporal characteristics of enhancement were detected: the arrival time (AT) of microbubbles in the target lesion; the enhancement pattern; the wash-out time (WOT) of microbubbles. Results were then compared in light of the definitive diagnosis of community acquired pneumonia (CAP) or malignancies, which was not known at the time of CEUS examination. All malignant cases were diagnosed by histological results, while pneumonia was diagnosed on the basis of clinical and radiological follow-up, laboratory findings and, in some cases, histology. Results. CE AT has not been shown to differ between benign and malignant peripheral pulmonary lesions. The overall diagnostic accuracy and sensibility of a CE AT cut-off value < 10 s in discriminating benign lesions were low (diagnostic accuracy: 47.6%; sensibility: 5.3%). Poor results were also obtained in the sub-analysis of small (mean diameter < 3 cm) and large (mean diameter > 3 cm) lesions. No differences were recorded in the type of CE pattern showed between benign and malignant peripheral pulmonary lesions. In benign lesions we observed a higher frequency of delayed CE wash-out time (WOT) > 300 s. Anyhow, a CE WOT cut-off value > 300 s showed low diagnostic accuracy (53.6%) and sensibility (16.5%) in discriminating between pneumonias and malignancies. Similar results were also obtained in the sub-analysis by lesion size. Squamous cell carcinomas showed a more delayed CE AT compared to other histopathology subtypes. However, such a difference was statistically significant with undifferentiated lung carcinomas. Conclusions. Due to an overlap of CEUS timings and patterns, dynamic CEUS parameters cannot effectively differentiate between benign and malignant peripheral pulmonary lesions. Chest CT remains the gold standard for lesion characterization and the eventual identification of other pneumonic non-subpleural localizations. Furthermore, in the case of malignancy, a chest CT is always needed for staging purposes.

Detection of Subchondral Bone Microcirculatory Perfusion in Adults with Early Osteonecrosis of the Femoral Head Using Contrast-Enhanced Ultrasound: A Prospective Study.

The aim of this study was to quantitatively assess subchondral bone microcirculation perfusion in adults with early osteonecrosis of the femoral head (ONFH) using contrast-enhanced ultrasound (CEUS) and to evaluate its correlation with the Association Research Circulation Osseous (ARCO) stage. We investigated 97 adult patients with definite ONFH by imaging a total of 155 hips, performing CEUS, storing images of CEUS processes at different ARCO stages and generating CEUS time-intensity curves (TICs) to obtain perfusion parameters. Differences in CEUS parameters at different ARCO stages were analyzed, and correlations were explored. A logistic regression model was constructed by incorporating the meaningful CEUS indicators. The CEUS parameters time to peak (TTP), peak intensity (PI), enhanced intensity (EI), ascending slope (AS), descending slope (DS) and area under the receiver operating characteristic curve (AUC) were significantly different in ARCO stage Ⅰ compared with stage ⅢA, and the same results were obtained in stage Ⅱ compared with stage ⅢA. However, there were no significant differences between stages Ⅰ and Ⅱ. The MTT (mean transit time) assay was not significantly different between the different stages. The receiver operating characteristic curve analysis of TTP, PI, EI, AS, DS and AUC in stages Ⅰ and ⅢA had a certain diagnostic efficacy, similar to the results in stages Ⅱ and ⅢA. The diagnostic performance of DS was less accurate in stages Ⅰ and ⅢA, while the diagnostic performance of TTP was less accurate in stages Ⅱ and ⅢA. ARCO stage was independently and negatively correlated with TTP and DS and independently and positively correlated with PI, EI, AS and AUC. The MTT assay was not correlated with ARCO stage. Logistic regression models containing statistically significant TTP, EI and AUC values were constructed, and all three values were closely related to the ARCO stage. In patients with different ARCO stages of ONFH, CEUS can effectively assess subchondral bone perfusion of the femoral head and is expected to become an effective imaging method for the diagnosis of early ONFH.

Evaluation of the Therapeutic Effect of Contrast-Enhanced Ultrasound on Different Types of Knee Osteoarthritis in the Elderly

Objective: To evaluate the curative effect of the Traditional Chinese Medicine (TCM) external therapy on knee osteoarthritis patients with different TCM constitutions using musculoskeletal ultrasonography and contrast-enhanced ultrasonography, and to explore the application value of contrast-enhanced ultrasonography in knee joint diseases. Methods: A total of 57 patients diagnosed with knee osteoarthritis in Shaanxi University of Traditional Chinese Medicine from December 2019 to May 2021 were collected, and they were divided into qi stagnation and blood stasis type group (23 cases) and cold-dampness obstruction type group (34 cases) according to the traditional Chinese medicine method. All patients were given acupuncture combined with TCM fumigation and washing. All patients underwent musculoskeletal ultrasonography and contrast-enhanced ultrasonography before and after treatment, observed and recorded relevant data, and compared the treatment effects between the two groups. Results: 85.96% (49/57) of knee osteoarthritis (KOA) patients had suprapatellar bursa effusion, 42.1% (24/57) had iliotibial band bursae effusion, some of which had poor sound transmission, and thickened synovium was seen in most effusions, 33.33% (19/57) had osteophyte formation. Compared with before treatment, the depth of suprapatellar sac effusion in the Qi stagnation and blood stasis type group decreased after treatment (P < 0.05). The protrusion height decreased (P < 0.05), and the infrapatellar and prefermoral fat pad thickness increased (P < 0.05). The contrast-enhanced ultrasonography of the thickened synovial membrane of the knee joint in KOA patients showed different degrees of uniform enhancement, showing slow in and slow out. Compared with the surrounding soft tissue, the arterial phase showed equal enhancement. The enhanced synovium had a clear boundary and a clear boundary with the effusion. In the venous phase, the intensity gradually decreased until clearing. Compared with before treatment, there was no significant difference in contrast-enhanced ultrasound parameters in the qi stagnation and blood stasis type group after treatment (P < 0.05). Conclusion: Musculoskeletal contrast-enhanced ultrasonography was used to quantitatively evaluate the efficacy of TCM external therapy on KOA for different TCM constitutions. Dynamic observation of synovial lesions of knee osteoarthritis provides a valuable imaging method for evaluating the efficacy of traditional Chinese medicine.

Диагностическая эффективность контраст-усиленного ультразвукового исследования у пациентов с хроническими вирусными гепатитами

Aim: to determine the diagnostic efficiency of contrast-enhanced ultrasound of the liver in patients with chronic viral hepatitis B and C. Study Design: open randomized study. Materials and methods. 240 people were examined on the basis of the Smolensk Clinical Hospital No. 1 from 2019 to 2021: patients with chronic viral hepatitis who have been examined by contrast-enhanced ultrasound; patients with chronic viral hepatitis who have not been examined by contrast-enhanced ultrasound to determine the diagnostic effectiveness of the method in assessing the complicated course development, patients without chronic viral hepatitis who have been examined by contrast-enhanced ultrasound to determine the standardized CEUS parameters. Liver biopsy and shear wave elastography were used as reference methods. Results. It was found that the greatest changes in contrast-enhanced ultrasound parameters were observed in patients with F4 fibrosis stage according to the METAVIR score. It was also found that the assessment of qualitative parameters according to the proposed standardized program has the highest diagnostic potential, and among the quantitative parameters — the difference of quantitative parameters in the proximal and distal zones (time of arrival, time to peak, peak intensity, half-time washout). Conclusion. The use of a contrast agent increases the value of the ultrasound method in the diagnostic algorithm for patients with chronic viral hepatitis. Keywords: contrast-enhanced ultrasound, chronic viral hepatitis, contrast agent, arterial phase, portal venous phase, late venous phase, qualitative parameters, quantitative parameters.

Contrast-Enhanced Ultrasonography for the Evaluation of Crohn's Disease in Pediatric Patients.

Contrast-enhanced ultrasonography (CEUS) of the bowel wall has been suggested as an alternative imaging modality for the follow-up of children with Crohn's disease. To demonstrate the feasibility and clinical usefulness of CEUS in the estimation of Crohn's disease activity in children with endoscopy as the reference standard. In this prospective study, 30 pediatric patients with Crohn's disease (24 males and 6 females; median age 14 years) underwent CEUS from December 2020 to August 2021. The simple endoscopic score for Crohn's disease, pediatric Crohn's disease activity index, serologic inflammatory markers, fecal calprotectin and CEUS perfusion parameters were assessed and compared between the inactive and active group based on endoscopic findings. CEUS was performed successfully in all 30 patients. Two patients showed mild adverse side effects such as temporary dysosmia. The active Crohn's disease group showed higher erythrocyte sedimentation rate (mm/hr) (13.0 vs. 2.0, P = 0.003), C-reactive protein (mg/dL) (4.7 vs. 0.55, P = 0.018) and fecal calprotectin (mcg/g) (1,503 vs. 237.5, P = 0.005). Among the quantitative parameters for CEUS, the mean gradient to the peak value was higher in the active group (1.18 vs. 0.93, P = 0.034). The sensitivity and specificity of the mean gradient to the peak value for predicting active Crohn's disease was 55.6% and 83.3%, respectively, with a cut-off of 1.09 (P = 0.015). CEUS can be a safe and specific diagnostic modality for Crohn's disease activity in children. Among quantitative CEUS parameters, the mean gradient to the peak value could be used to differentiate active and inactive Crohn's disease.

Update of Contrast-enhanced Ultrasound in Musculoskeletal Medicine: Clinical Perspectives - A Review.

Contrast-enhanced ultrasound (CEUS) uses an intravascular contrast agent to enhance blood flow signals and assess microcirculation in different parts of the human body. Over the past decade, CEUS has become more widely applied in musculoskeletal (MSK) medicine, and the current review aims to systematically summarize current research on the application of CEUS in the MSK field, focusing on 67 articles published between January 2001 and June 2021 in online databases including PubMed, Scopus, and Embase. CEUS has been widely used for the clinical assessment of muscle microcirculation, tendinopathy, fracture nonunions, sports-related injuries, arthritis, peripheral nerves, and tumors, and can serve as an objective and quantitative evaluation tool for prognosis and outcome prediction. Optimal CEUS parameters and diagnostic cut off values for each disease category remain to be confirmed.

Assessment of Parotid Gland Tumors by Means of Quantitative Multiparametric Ultrasound (mpUS)

The preoperative diagnostical differentiation of parotid gland tumor (PGT) is not always simple due to several different entities. B-mode-ultrasound (US) remains the imaging modality of choice, while histopathology serves as the gold standard for finalizing the diagnosis. We aimed to evaluate the use of multiparametric US (mpUS) in the assessment of PGT. We included 97 PGTs from 96 patients. A standardized mpUS protocol using B-mode-US, shear-wave elastography (SWE), and standardized contrast-enhanced ultrasound (CEUS) was performed prior to surgical intervention. SWE was assessed by real-time measurement conducting a minimum of five measurements, while quantitative CEUS parameters were assessed with a post-processing perfusion software. SWE allowed differentiation between benign PGT (Warthin's Tumor (WT) paired with lymph nodes (LN) and pleomorphic adenoma (PA)), and WT and LN were softer compared to PA. WT showed lower velocities than squamous cell carcinoma (SCC): the most common malignant PGT. CEUS parameters showed significant group differences between WT and PA, WT and malignant lesions, WT and SCC, WT paired with LN versus PA, and WT paired with LN versus SCC. MpUS seems to be beneficial in the assessment of PGT characterization, with benign PGT appearing to be softer in SWE than tumors with malignant tendencies. The quantitative CEUS parameter shows higher perfusion in WT than in PA, and malignant PGTs are less vascularized than WTs.

Evaluating renal microcirculation in patients with acute kidney injury by contrast-enhanced ultrasonography: a protocol for an observational cohort study.

Acute kidney injury (AKI) in critically ill patients has poor renal outcome with high mortality. Changes in intra-renal microcirculation and tissue oxygenation are currently considered essential pathophysiological mechanisms to the development and progression of AKI. This study aims to investigate the characteristics of contrast-enhanced ultrasonography (CEUS) derived parameters in biopsy-proven AKI patients, and examine the predictive value of these markers for renal outcome. This prospective observational study will enroll AKI patients who are diagnosed and staging following KDIGO (Kidney Disease: Improving Global Outcomes) criteria. All patients undergo a kidney biopsy and pathological tubulointerstitial nephropathy is confirmed. The CEUS examination will be performed at 0, 4 and 12weeks after biopsy to monitor renal microcirculation. The percentage decrease of serum creatinine, 4-week and 12-week eGFR (estimated glomerular filtration rate) will also be reviewed as renal prognosis. The relationship of CEUS parameters with clinical and pathological markers will be analyzed. We perform a lassologit procedure to select potential affecting variables, including clinical, laboratory indexes and CEUS markers, to be included in the logistic regression model, and examine their predictive performance to AKI outcomes. If we are able to show that CEUS derived parameters contribute to diagnosis and prognosis of AKI, the quality of life of patients will be improved while healthcare costs will be reduced. This study is retrospectively registered on the Chinese Medical Research Registration information System( https://61.49.19.26/login ) on December 31, 2021: MR-11-22-003,503. This study has been approved by the Ethics and Scientific Research Department of Peking University First Hospital.

Contrast Enhanced Ultrasonography of Kidney in Chronic Intermittent Hypoxia Rat Model.

The objective of our study was to assess the ability of contrast-enhanced ultrasound (CEUS) in evaluating renal microperfusion in an animal model. Twenty Sprague-Dawley rats were subdivided into two groups: the normal and chronic intermittent hypoxia (CIH) groups. In the CIH model, 10 Sprague-Dawley rats were exposed to CIH for 8 weeks to mimic obstructive sleep apnea (OSA). The CEUS parameters of the renal cortex and medulla were obtained and compared between groups. The pathological changes of the kidney tissues were examined by histological staining such as hematoxylin and eosin (H&E) and Masson's trichrome. CIH caused morphological damage to kidneys. In the cortex, the peak intensity (PI) (P=.009) was significantly lower and time to peak (Ttop) (P=.019) was significantly prolonged in the CIH group compared with the controls. The area under ascending curve (WiAUC) in the medulla and cortex were both significantly lower in the CIH group than those in the control group (P both <.05). CEUS parameters (including PI and WiAUC of the cortex and WiAUC of the medulla) were negatively correlated with serum creatinine (P all <.05). In the medulla, the area under descending curve (WoAUC) was positively correlated with serum creatinine (P=.027), PI was negatively correlated with uric acid (P=.034). CEUS parameters (including Ttop, PI, WoAUC, and WiAUC) reflect renal microvascular changes in CIH. CEUS could be a safe and accurate imaging method to assess renal microvascular damage in CIH rats.

Quantitative analysis of contrast-enhanced ultrasound combined with ultrasound in the unifocal papillary thyroid micro-carcinoma.

To evaluate diagnostic value of ultrasound (US) combined with contrast-enhanced ultrasound (CEUS) in the invasiveness of unifocal papillary thyroid micro-carcinoma (UPTMC) without capsule-invasion. This retrospective study included data from patients with UPTMC who received US and CEUS examinations in the Ultrasound Department of the Central Hospital of Changsha, China between June 2019 and September 2021. Univariate and multivariate logistic regression analysis were used to evaluate the risk of US and CEUS parameters for UPTMC. Diagnostic performance was estimated by ROC analysis. A total of 136 cases were enrolled, including invasive UPTMC (n=47) and non-invasive UPTMC (n=89), which were divided into test set (n=109) and validation set (n=27). The occurrence of microcalcification and the ratios (R) of each time-intensity curve (TIC) of CEUS parameter were significantly higher in patients with invasive UTPMC than non-invasive UPTMC (all P<0.05). Additionally, nodular diameter was significantly longer in the invasive group (P<0.05). Multivariate analysis showed that microcalcification (OR=2.917, 95% CI: 1.002-8.491, P=0.050), R-TTP > 1 (OR=3.376, 95%CI: 1.267-8.994, P=0.015), R-DS > 1 (OR=6.558, 95% CI: 2.358-18.243, P<0.010) were independently associated with invasive UPTMC. The sensitivities of US, CEUS and their combined application were 82.1%, 46.2% and 79.5%, respectively, and their specificities were 37.1%, 88.6% and 61.4%, respectively. The combination of the two methods had the best diagnostic efficiency (AUC=0.775)compared to US (AUC=0.596) and CEUS (AUC=0.750). The combination of US and CEUS might have good diagnostic value for UPTMC with capsule non-invasion.

Correlation between serum cystatin C level and renal microvascular perfusion assessed by contrast-enhanced ultrasound in patients with diabetic kidney disease

Objectives To investigate the relationship between serum cystatin C (CysC) levels and renal microvascular perfusion in patients with diabetic kidney disease (DKD). Methods A total of 57 patients with high CysC levels and 45 patients with normal CysC levels were enrolled. Data on clinical characteristics and laboratory examination results were also collected. Contrast-enhanced ultrasound (CEUS) of the kidneys was successively performed. The time-intensity curve (TIC) and related quantitative parameters of the kidneys were obtained by CEUS and the correlations between CysC and CEUS parameters were analyzed. Results Compared to the normal CysC group, the high CysC group had significantly lower wash-in area under the curve (WiAUC), wash-out area under the curve (WoAUC), and wash-in and wash-out area under the curve (WiWoAUC). In the normal CysC group, patients with Stage III chronic kidney disease (CKD) had higher AUCs than those with Stage I–II CKD (p < 0.05). In the high CysC group, patients with Stage IV–V CKD had lower wash-in AUC compared to patients with Stage I–II CKD (p = 0.023). The renal cortex microvascular perfusion parameters AUCs were positively correlated with the estimated glomerular filtration rate (GFR) (r = 0.280, 0.222, and 0.243), and CysC was inversely correlated with AUCs (r= −0.299, −0.251, and −0.273). Conclusions CEUS parameters reflected changes in renal microvascular perfusion in patients with DKD, while AUCs might be useful indicators of declining GFR in DKD patients with increased CysC.

B-Mode and Contrast-Enhanced Ultrasonography Aspects of Benign and Malignant Superficial Neoplasms in Dogs: A Preliminary Study.

Simple SummaryIn dogs, superficial neoplasms are common, and it is crucial to determine their malignancy, as this will have an impact on treatment and prognosis. So far, the diagnostic value of ultrasound modalities, such as B-mode and contrast enhanced ultrasound, for superficial neoplasms in dogs is still unclear, despite promising studies in humans. B-mode ultrasound enables assessment of the size, shape and arrangement of the neoplastic tissue, whereas contrast enhanced ultrasound enables the assessment of blood flow intensity and pattern. The aim of this study was to identify B-mode and contrast enhanced ultrasound characteristics that may be used to distinguish benign and malignant superficial neoplasms in dogs. Ultrasonographic characteristics, for which a significant difference was observed between benign and malignant neoplasms, were border definition, echogenicity, echotexture, blood flow pattern at wash-in and blood flow intensity during wash-out at the center of the neoplasm. Despite these significant differences, there was a considerable overlap in ultrasonographic characteristics between benign and malignant neoplasms. In conclusion, B-mode and contrast enhanced ultrasound might contribute to malignancy prediction; however, based on individual ultrasonographic characteristics, they seem unable to replace cytology or histopathology.Contrast-enhanced ultrasonography (CEUS) is considered a promising technique for differentiation of benign and malignant tumors in humans. However, few studies have assessed superficial neoplasms in dogs by means of CEUS. The aim of this study was to identify ultrasonographic criteria evaluated by B-mode ultrasound (US) and CEUS that may be used to distinguish benign and malignant superficial neoplasms in dogs. A total of 63 superficial neoplasms from 59 dogs were evaluated using B-mode US and CEUS prior to histopathologic examination. Qualitative and quantitative parameters were compared between benign and malignant neoplasms by Fischer’s exact test or fixed effects model. With B-mode US, a significant difference was found for border definition, echogenicity and echotexture. With CEUS, a significant difference was found for the enhancement pattern at wash-in and the wash-out area under the curve at the center of the neoplasm. Malignant neoplasms had on average a lower regional blood volume during the wash-out phase compared to benign neoplasms. Despite these significant differences, there was a considerable overlap in B-mode and CEUS parameters between benign and malignant neoplasms. In conclusion, B-mode US and CEUS might contribute to malignancy prediction; however, based on individual ultrasonographic parameters, they seem unable to replace cytology or histopathology.

Evaluation of atezolizumab plus bevacizumab combination therapy for hepatocellular carcinoma using contrast-enhanced ultrasonography

PurposePrevious reports suggest that contrast-enhanced ultrasonography (CEUS) is useful for predicting the efficacy of sorafenib and lenvatinib treatment. However, there are no reports on the utility of CEUS for predicting the efficacy of atezolizumab plus bevacizumab combination therapy (Atezo + Bev). This study aimed to identify CEUS parameters for predicting the efficacy of Atezo + Bev.MethodsA total of 30 patients with hepatocellular carcinoma (HCC) treated with Atezo + Bev who underwent CEUS before and 5 weeks after treatment initiation were included.ResultsPost area under the curve (post AUC) was identified as a predictive factor for early progressive disease (PD). The optimal cut-off value of post AUC for predicting progression-free survival (PFS) was 61.3.ConclusionThe results of this study suggest that CEUS at 5 weeks after initiation of Atezo + Bev may predict PFS in HCC patients. Changes to the treatment plan may need to be considered in patients with post AUC > 61.3.

Contrast-Enhanced Ultrasound Parameters and D-Dimer: New Prognostic Parameters for Diffuse Large B-Cell Lymphoma.

ObjectiveTo investigate the predictive role of contrast-enhanced ultrasonography (CEUS) plus D-dimer levels in the prognosis of patients with diffuse large B-cell lymphoma (DLBCL).MethodsCEUS was applied to assess lymph nodes in 186 patients with confirmed DLBCL. The clinical data and laboratory indicators were collected from these patients, and a retrospective analysis was conducted on the relationship between the quantitative parameters of CEUS (TTP, PI, AUC, WOT), D-dimer levels, and clinical features of the DLBCL patients. The Cox regression model was used for univariate and multivariate analyses for the risk factors associated with the prognosis.ResultsThere was an increase of D-dimer levels in advanced DLBCL patients, who were combined with a significant reduction in TTP and WOT and a significant increase in PI and AUC. D-dimer levels and quantitative parameters of CEUS were strongly correlated with the Ann Arbor, B symptoms, International Prognostic Index (IPI), LDH and CRP levels. The results of the Cox regression model indicated that D-dimer levels, TTP and PI, the quantitative parameters of CEUS, were important prognostic factors for DLBCL.ConclusionCEUS results and D-dimer levels can be used as independent prognostic factors for DLBCL.

Correlation between quantitative parameters of CEUS and Ki-67 labeling index in soft-tissue sarcoma.

Apart from the immunohistochemical Ki-67 labeling index (LI), clinicians need a non-invasive and convenient way to predict the prognosis of patients with soft-tissue sarcoma (STS). To investigate the correlation between quantitative parameters of contrast-enhanced ultrasound (CEUS) and Ki-67 LI in STS. A total of 25 patients diagnosed with STS who underwent CEUS examination using SonoVue®, between January 2019 to November 2020, were included in the study. They were then divided into a high-proliferation group and low-proliferation group according to 30% Ki-67 positive tumor cells. The quantitative parameters in the semi-automatic time intensity curve analysis software, including arrival time, time to peak, peak intensity, rise time (RT), rise slope, 50% wash-out time, and 50% wash-out intensity, were extracted from the time intensity curve of CEUS by two independent observers. Statistical evaluation of the correlation and difference between CEUS quantitative parameters and Ki-67 LI between the two groups was performed. According to the area under the curve (AUC) analysis, optimal cutoff points of parameters with significant difference were determined. CEUS RT of the high-proliferation group in STS was significantly higher than that of the low-proliferation group (ρ = 0.509, P = 0.01). The most reasonable cutoff to distinguish between low- and high-proliferation groups was 10.84 s. The sensitivity, specificity, and the AUC were 86.7%, 80%, and 0.80, respectively. CEUS RT was correlated with Ki-67 LI of STS, which can be used as a minimally invasive auxiliary tool to predict the prognosis of STS in clinical practice.

The Predictive Value of Contrast-Enhanced Ultrasound Combined with Serum miR-124 Level in Acute Cerebral Infarction and Their Correlation with the Contrast Enhancement of Carotid Atherosclerotic Plaque.

ObjectiveTo investigate the predictive value of contrast-enhanced ultrasound (CEUS) combined with serum miR-124 level in acute cerebral infarction (ACI) and their association with the contrast enhancement of carotid atherosclerotic plaque.MethodsTotally 60 patients diagnosed with ACI and 60 controls were included in the study. All the subjects had carotid atherosclerotic plaques, and all of them were examined by CEUS and were tested for serum miR-124 levels.ResultsTime to peak (TTP) and mean transit time (MTT) in the ACI group were significantly shorter than those in the control group (P < 0.05), but the peak intensity ratio (PIR), the area under the curve (AUC), and relative expression levels of serum miR-124 were notably greater in the ACI group (P < 0.05). There were statistically significant differences in TTP, MTT, PIR, AUC, and serum miR-124 expression in patients with different cerebral infarct areas in the ACI group (P < 0.05). Besides, the sensitivity and specificity of serum miR-124 levels for the prediction of ACI were 71.67% and 90.00%, respectively, with a cut-off value of 1.52, and the sensitivity was 86.67% and specificity was 93.33% of CEUS combined with serum miR-124 in the prediction of ACI. The ACI group showed a higher proportion of grades 2 and 3 (P < 0.001). Pearson correlation analysis showed that the intraplaque contrast enhancement was negatively related to TTP and MTT but had a positive correlation with PIR, AUC, and serum miR-124 levels.ConclusionGrades 2 and 3 intraplaque contrast enhancement and serum miR-124 level of 1.52 had high sensitivity and specificity to predict ACI. Moreover, the CEUS parameters combined with serum miR-124 level could improve the performance in predicting ACI and had auxiliary value in evaluating the stability of carotid atherosclerotic plaques.

Contrast-enhanced ultrasound for the evaluation of symptomatic and asymptomatic carotid plaques: A systematic review and meta-analysis.

Contrast-enhanced ultrasound (CEUS) is a promising imaging modality for the assessment of plaque vulnerability. We aimed to systematically review and meta-analyze the ability of CEUS parameters to differentiate between symptomatic and asymptomatic carotid plaques and to assess its reproducibility. PubMed, EMBASE, and Cochrane Library databaseswere searched for studies that potentiallyevaluated carotid plaques using CEUS. From the initial 2870 searches, 11 relevant publications comprising a total of 821 carotid plaques were reviewed. Data on CEUS parameters including quantitative and semi-quantitative parameters were extracted and analyzed. The overall analysis showed significantly higher CEUS parameters in symptomatic carotid plaques compared to asymptomatic carotid plaques (standardised mean difference (SMD) .95, 95% confidence interval (CI) .56-1.27, p<.01). Intra and inter-observer reproducibility of quantitative CEUS parameters were excellent (intra-observer, r=.95, 95% CI .87-1; inter-observer, r=.93, 95% CI .80-.1). Semi-quantitative CEUS parameters showed good intra-observer reliability and moderate inter-observer reliability (intra-observer, r=.77, 95% CI .64-.89; inter-observer, r=.75, 95% CI .61-.89). Heterogeneity among studies compared CEUS parameters in symptomatic and asymptomatic plaques and studies assessed inter-observer reproducibility, and significant biases in studies assessing CEUS reproducibility were present. CEUS is a useful vascular imaging method to differentiate between symptomatic and asymptomatic carotid plaques with moderate to excellent reproducibility. Quantitative CEUS analysis appeared to be more sensitive and reliable in assessing carotid plaques than semi-quantitative parameters. Further longitudinal prospective trials evaluating carotid plaque in asymptomatic population using CEUS to determine plaque characteristics that can become symptomatic are required.

Contrast-enhanced ultrasonography for assessing histopathology in pediatric immunoglobulin A nephropathy and Henoch–Schönlein purpura nephritis

BackgroundGlomerular disease, including immunoglobulin A nephropathy (IgAN) and Henoch–Schönlein purpura nephritis, is one of the most common kidney diseases in children. The diagnosis of these diseases depends on pathological biopsy, although this procedure is seriously limited by its invasive and high-risk nature.ObjectiveTo investigate the potential of contrast-enhanced ultrasonography (CEUS) for evaluating the histopathological severity of IgAN and Henoch–Schönlein purpura nephritis (HSPN).Materials and methodsWe investigated a total of 13 children with IgAN and 12 children with HSPN confirmed by renal histopathology. We reevaluated the pathological lesions of the children according to the Oxford classification and the Lee grading system and then all the children underwent CEUS. Using SonoLiver software, we constructed time–intensity curves of CEUS for regions of interest in the renal cortex. We analyzed CEUS quantitative parameters for IgAN and HSPN and used Spearman correlation analysis to examine the correlation between CEUS parameters and clinicopathological indexes in the study cohort.ResultsThe CEUS parameters rise time (RT) and time to peak (TTP) were significantly higher in children with Lee grade IV than in those with Lee grades II or III. Spearman correlation analysis revealed a positive correlation between rise time and time to peak with Lee grade in the overall cohort of children, and a positive correlation between rise time and time to peak and severity of crescents in the Oxford classification scoring system.ConclusionContrast-enhanced US may be used as a noninvasive imaging technique to evaluate the severity of renal pathology and formation of crescents in children with IgAN and HSPN.

Fall time may be a reliable discriminator between neoplastic and non-neoplastic urinary bladder lesions in dogs undergoing contrast-enhanced ultrasound: a pilot study.

Contrast-enhanced ultrasound (CEUS) can provide quantitative information on enhancement patterns and perfusion of lesions, based on time-intensity curves (TICs). No published studies have compared CEUS parameters in neoplastic and non-neoplastic urinary bladder lesions in dogs. The aim of the current prospective, pilot study was to quantitatively characterize the CEUS pattern of neoplastic and non-neoplastic urinary bladder lesions in dogs, assessing the influence of contrast arrival time (CAT) on the final appearance of the curves. Fourteen dogs with cyto-histopathological diagnoses were included (seven malignant and seven inflammatory lesions). B-mode ultrasound was performed followed by CEUS examination after an intravenous bolus injection of 0.04 mL/kg of contrast medium, and TICs were elaborated by dedicated software. Receiver operating characteristic curves (ROC) for each TIC parameter were obtained. Neoplastic lesions had subjectively shorter rise time (RT), time to peak (TTP) and fall time (FT) than inflammatory lesions. Based on ROC curve analyses, fall time ≥ 10.49 s was the most reliable parameter for diagnosing non-neoplastic disease in this small sample of dogs (area under the curve [AUC] 0.75, sensitivity 83.33%, specificity 66.67%). No difference was found between ROCs calculated for each parameter of TICs by adding or removing CAT. Results of the current study provide background for future, larger scale studies evaluating use of a CEUS FT threshold of 10.49 s as a possible discriminator for urinary bladder neoplastic lesions in dogs.