Quantitative Contrast-enhanced Ultrasound Parameters Research Articles

Diagnostic Role of Contrast-enhanced Ultrasound in the Discrimination of Malignant Portal Vein Thrombosis in Patients With Hepatocellular Carcinoma.

To investigate the accuracy of contrast-enhanced ultrasound (CEUS) in differentiating benign and malignant portal vein thrombosis (PVT) complicating hepatocellular carcinoma (HCC), compared to diffusion-weighted magnetic resonance imaging (DWI). Forty-nine patients with HCC who had PVT were enrolled. The quantitative and qualitative parameters of CEUS were analysed. We examined the diagnostic performance of CEUS compared with DWI. The relationships between CEUS parameters and biomarkers were also assessed. All qualitative CEUS parameters (e.g., arterial-phase enhancement, washout in the venous phase, vessel occlusion, and expansion) were significantly more common in malignant thrombosis than in benign thrombosis (p<0.05). Among the quantitative CEUS parameters, increased area under the time-intensity curve, prolonged time for full width at half maximum, and prolonged rise time were observed in malignant thrombosis, compared to benign thrombosis (p<0.05). CEUS and DWI performed similarly in discriminating between malignant and benign thrombi (p>0.05). Several CEUS parameters exhibited significant correlations with the tumour marker and stage (p<0.05). CEUS was useful for characterisation of PVT and showed a consistent high diagnostic accuracy, compared to DWI.

Contrast-enhanced Ultrasonography and Color Doppler Ultrasonography for Dynamic Assessment of Intracranial Changes in Early MCAO Rats Models

To assess the value of contrast-enhanced ultrasound (CEUS) and color Doppler ultrasound (DUS) on hemodynamic changes and cerebral perfusion quantitative analyses in Sprague-Dawley (SD) rats with focal permanent ischemic stroke. Sixteen SD rats with thin skulls were subjected to establish middle cerebral artery occlusion (MCAO) model. CEUS images were performed before modeling (T 0), immediately after modeling (5-15 min after modeling, T 1), 3 h after modeling (T 2), followed by the measurement of bilateral middle cerebral artery (MCA), anterior cerebral artery (ACA), posterior cerebral artery (PCA) using DUS. The peak systolic velocity (PSV), end-diastolic velocity (EDV) and mean velocity (MV) of these arteries were obtained. The brain time-intensity curve was taken as interest region of the whole right brain, and the quantitative parameters of CEUS were obtained, including peak intensity (PI), area under the curve ( AUC), wash in slope (WIS), time to peak (TTP), rise time (RT) and time from peak to one half (TPH). The modified neurological deficit score (mNSS) of the rats was performed 3 h after the modeling, and the data of the rats with a score of 9-11 were statistically analyzed. A total of 12 rats were successfully modeled and completed with mNSS score 9-11. No blood flow signals were observed on the right MCA and ACA in the 12 rats at T 1 and T 2. From T 0 to T 1, PI, AUC and WIS of the right hemisphere decreased sharply with TTP and RT significantly prolonged, and the differences were statistically significant. However, there was no significant difference in hemodynamic parameters at that period of time. From T 1 to T 2, there were no significant changes in CEUS quantitative parameters (except AUCand TPH), while PSV, EDV, MV of LMCA and bilateral PCA showed significant acceleration, and the differences were statistically significant. CEUS and DUS can reveal the intracranial hemodynamics and brain tissue perfusion trends of MCAO rats, which could be new methods in assessment of ischemic stroke model at multiple time points.

A pilot trial to evaluate the clinical usefulness of contrast-enhanced ultrasound in predicting renal outcomes in patients with acute kidney injury.

Contrast-enhanced ultrasound (CEUS) enables the assessment of real-time renal microcirculation. This study investigated CEUS-driven parameters as hemodynamic predictors for renal outcomes in patients with acute kidney injury (AKI). Forty-eight patients who were diagnosed with AKI were prospectively enrolled and underwent CEUS at the occurrence of AKI. Parameters measured were the wash-in slope (WIS), time to peak intensity, peak intensity (PI), area under the time-intensity curve (AUC), mean transit time (MTT), time for full width at half maximum, and rise time (RT). The predictive performance of the CEUS-driven parameters for Kidney Disease Improving Global Outcomes (KDIGO) AKI stage, initiation of renal replacement therapy (RRT), AKI recovery, and chronic kidney disease (CKD) progression was assessed. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of CEUS. Cortical RT (Odds ratio [OR] = 1.21) predicted the KDIGO stage 3 AKI. Cortical MTT (OR = 1.07) and RT (OR = 1.20) predicted the initiation of RRT. Cortical WIS (OR = 76.23) and medullary PI (OR = 1.25) predicted AKI recovery. Medullary PI (OR = 0.78) and AUC (OR = 1.00) predicted CKD progression. The areas under the ROC curves showed reasonable performance for predicting the initiation of RRT and AKI recovery. The sensitivity and specificity of the quantitative CEUS parameters were 60-83% and 62-77%, respectively, with an area under the curve of 0.69-0.75. CEUS may be a supplemental tool in diagnosing the severity of AKI and predicting renal prognosis in patients with AKI.

Correlation analysis between the pre-operative contrast-enhanced ultrasound parameters and biological characteristics of papillary thyroid carcinoma and associated risk factors for prognosis after radiofrequency ablation.

The present study aimed to assess the correlation between the contrast-enhanced ultrasound (CEUS) parameters and biological characteristics of papillary thyroid carcinoma (PTC), and identify risk factors of recurrence for the prognosis after radiofrequency ablation. A total of 72 patients with PTC were included. Disease recurrence and metastasis were evaluated based on the imaging performance and laboratory tests. Perfusion parameters were recorded and compared. After biopsy, the tumor tissues were subjected to hematoxylin and eosin staining, and the expression levels of P53 and Ki67 were detected using immunohistochemistry. The association between the CEUS parameters and the expression of P53 and Ki67 was analyzed. Risk factors for disease recurrence were analyzed using logistic regression. Compared with normal tissues, PTC tissue was characterized by a slow perfusion pattern with no obvious enhancement. The peak time and intensity were lower, while the initial increasing time and mean transit time (MTT) were longer in the PTC tissue. The expression levels of P53 and Ki67 in PTC tissues were associated with age, local infiltration, lymph node metastasis and the number of lesions, but not with gender, tumor size, histological type or degree of differentiation. The initial increasing time, peak time and MTT were negatively correlated, while the peak intensity was positively correlated with the expression of P53 and Ki67 in PTC tissues. Multivariate logistic regression analysis suggested that lymph node metastasis, age, local infiltration, peak intensity and MTT were risk factors for disease recurrence. In conclusion, quantitative CEUS parameters are closely linked to the biological characteristics of PTC and may serve as indicators for the prognosis of patients.

Values of the Quantitative Parameters of Contrast-enhanced Ultrasound in the Diagnosis of Thyroid Benign and Malignant Nodules

Objective To investigate the value of contrast-enhanced ultrasound(CEUS)quantitative parameters in the diagnosis of thyroid benign and malignant nodules. Methods The CEUS features of 85 histopathologically confirmed thyroid nodules were quantitatively analyzed using five parameters including rising time(RT),time to peak(TTP),area under the curve(AUC),maximum intensity(Imax),and mean transit time(mTT).The dynamic vascular pattern(DVP)curves were also drawn. Results The Imax(Z=-7.08,P=0.01)and AUC(Z=-2.03,P=0.04)of thyroid malignant nodules were significantly smaller than those of thyroid tissue,and the Imax(Z=-1.35,P=0.02)and AUC(Z=-0.21,P=0.02)of thyroid benign nodules were significantly larger than those of thyroid tissue.There were significant differences between thyroid benign and malignant nodules in Imax(Z=-4.16,P=0.00),AUC(Z=-3.01,P=0.01),and DVP curve types(P=0.00).RT(Z=-0.28,P=0.62),TTP(Z=-0.10,P=0.89),and mTT(Z=-0.79,P=0.05)were not significantly different between thyroid benign and malignant nodules. Conclusion The quantitative parameters of CEUS,especially Imax and AUC parameters,are valuable in the diagnosis of benign and malignant thyroid nodules.

Application of quantitative analysis of contrast-enhanced ultrasonography in the evaluation of acute radiation-induced liver damage.

The aim of the present study was to evaluate the microcirculation perfusion in patients with acute radiation-induced liver damage (RILD) and explore the feasibility of non-invasive evaluation of RILD using quantitative analysis of contrast-enhanced ultrasound (CEUS). Patients who successfully underwent three-dimensional conformal intensity-modulated radiotherapy for abdominal tumors were selected. CEUS was performed on the liver prior to and 2, 3 and 4 weeks after exposure, and the time-intensity curve (TIC) was obtained by quantitative analysis of CEUS. The time to peak (TTP), gradient (Grad) and area under the curve (AUC) were analyzed offline. The Grad of the CEUS TIC was decreased and TTP increased with the prolongation of the irradiation duration, with statistically significant differences between the values in the 2-, 3- and 4-week groups vs. those prior to exposure (P<0.05), as well as among the values of the 2-, 3- and 4-week groups (P<0.05). Following irradiation, the AUC decreased gradually in the 2- and 3-week groups and increased in the 4-week group, with statistically significant differences compared with the AUC prior to irradiation (P<0.05). The quantitative analysis parameters of CEUS may be important reference parameters for the early diagnosis of acute RILD.

Improved methods of the contrast-enhanced ultrasound in patient with chronic viral hepatitis

Rationale. The article presents the data obtained by an improved method of contrast-enhanced ultrasound (CEUS) in patients with chronic viral hepatitis.&#x0D; Methods. We compared the quantitative and qualitative CEUS parameters in 2 groups of patients: the 1st group was administered 2.5 ml of the contrast agent, and the 2nd group was administered 1.0 ml of the contrast agent.&#x0D; Results. The results showed that the quantitative parameters had no statistical differences in the arterial and portal phases.&#x0D; Conclusion. The parameters of the late venous phase were not clinically significant, since the study objective included the assessment of diffuse liver disease, not focal liver lesions.

Quantitative contrast-enhanced US helps differentiating neoplastic vs non-neoplastic gallbladder polyps.

To differentiate between large (≥ 1cm in diameter) gallbladder (GB) non-neoplastic and neoplastic polyps using quantitative analysis of contrast-enhanced ultrasound (CEUS) findings. From September 2017 to May 2018, 29 patients (10 males; median age, 63years) with GB polyps of ≥ 1cm in diameter who were undergoing cholecystectomy were consecutively enrolled. All patients underwent preoperative conventional US and CEUS examinations. Quantitative analysis of CEUS findings using time-intensity curves between the two groups was independently performed by two radiologists. The interobserver agreement for the quantitative analysis of the CEUS results was measured using the intraclass correlation coefficient. Receiver operating characteristic analysis was performed to evaluate the diagnostic performance of CEUS examination. After the cholecystectomy, the patients were classified into the non-neoplastic polyp group (n = 12) and the neoplastic polyp group (n = 17) according to the pathological results. The interobserver agreement for quantitative assessment between the two radiologists was near perfect to substantial. Quantitative assessment of the CEUS findings revealed that the rise time, mean transit time, time to peak, and fall time of non-neoplastic GB polyps were significantly shorter than those of neoplastic polyps (p < 0.001, p = 0.008, p = 0.013, and p = 0.002, respectively). The sensitivity and specificity of the quantitative CEUS parameters for the differentiation between the two groups were 76.5-100% and 75%, respectively, with an area under the curve of 0.765-0.887. Quantitative analysis of CEUS findings could be valuable in differentiating GB neoplastic polyps from non-neoplastic polyps. • Quantitative analysis of CEUS findings could be valuable in differentiating gallbladder neoplastic polyps from non-neoplastic polyps. • Quantitative analysis of CEUS findings in gallbladder polyps provides cut-off values for differentiation between neoplastic polyps and non-neoplastic polyps with near-perfect to substantial interobserver agreement.

Contrast-Enhanced Ultrasound Imaging of Breast Masses: Adjunct Tool to Decrease the Number of False-Positive Biopsy Results.

This pilot study evaluated use of contrast-enhanced ultrasound (CEUS) to reduce the number of benign breast masses recommended for biopsy. This prospective study included 131 consenting women, from October 2016 to June 2017, with American College of Radiology Breast Imaging Reporting and Data System category 4a, 4b, and 4c masses detected by mammography, conventional ultrasound (US), or both. Contrast-enhanced US examinations (using intravenous injection of perflutren lipid microspheres or sulfur hexafluoride lipid-type A microspheres) were performed before biopsy. Qualitative and quantitative CEUS parameters were compared with reference standard histopathologic results from biopsy of 131 masses. There were 109 benign, 6 high-risk, and 16 malignant masses, with a median size of 12 mm (range, 4 to 48 mm) on conventional US imaging. Of 131 masses, 93 (71%) enhanced on CEUS imaging, including 73 of 109 (67%) benign, 6 of 6 (100%) high-risk, and 14 of 16 (87.5%) malignant. Thirty-eight lesions did not enhance, including 36 of 109 (33%) benign and 2 of 16 (12.5%) malignant. Prediction models using recursive petitioning revealed that CEUS may reduce 31% (95% confidence interval, 23%, 40%) of benign biopsies for masses that are: nonenhancing with circumscribed margins or enhancing with an oval shape and homogeneous enhancement. Quantitative parameters indicated that benign masses had the longest time to peak (P = .078), highest time-to-peak ratio of mass to background (P = .036), lowest peak intensity (P = .021), and smallest difference in peak intensity between the mass and background (P = .079) compared to high-risk and malignant lesions. Contrast-enhanced US may be a valuable modality that can be used to predict benign pathologic results of breast masses, thereby reducing the number of biopsies.

Qualitative and quantitative analysis of wrist joint in rheumatoid arthritis by contrast-enhanced ultrasound and its clinical value

Objective To evaluate the value of contrast-enhanced ultrasound (CEUS) in detection of synovial hyperplasia in wrist joint of patients with rheumatoid arthritis (RA) and to explore the correlation with disease activity. Methods Thirty-nine RA patients with their wrist involved were examined by CEUS. The imaging features of synovitis were observed and the analysis of time intensity curve (TIC) was performed by contrast dynamic software. Some quantitative parameters were obtained from these fitting curves including basic intensity (a0), increased intensity(a1), descending slope(a2), ascending slope(a3), time to peak (TTP), peak intensity (PI), actual peak intensity (PI-a0), arrival time (AT), and area under the curve (AUC). And the correlation between these parameters with clinical activity index was analyzed. Results 35.9% (14/39) synovitis showed a centripetal enhancement pattern supplied by ring-like or arc-shaped arterials peripherally while 64.1% (25/39) showed diffusely entire enhancement. All the lesions were heterogeneous enhanced, 87.2% (34/39) of which exhibited hyperenhancement. The detection rate of perfusion defects was 41.0% (16/39). The disease activity in the diffuse enhancement group was higher than that in the centripetal enhancement group (4.64±1.09 vs 3.69±0.67, P=0.005). CEUS quantitative parameters a3 and (PI-a0) were positively correlated with erythrocyte sedimentation rate (ESR) (r=0.465, P=0.006; r=0.325, P=0.043), however TTP had a negative relationship (r=-0.352, P=0.041). Conclusions Active synovitis usually represents as a diffuse enhancement pattern. A higher a3 and PI, and a shorter TTP indicate a higher disease activity. CEUS plays a great role in monitoring RA disease activity both from qualitative and quantitative aspect. Key words: Contrast-enhanced ultrasonography; Arthritis, rheumatoid; Synovitis; Musculoskeletal ultrasound

Parameters for Contrast-Enhanced Ultrasound (CEUS) of Enlarged Superficial Lymph Nodes for the Evaluation of Therapeutic Response in Lymphoma: A Preliminary Study.

BackgroundThe aims of this preliminary study were to evaluate contrast-enhanced ultrasound (CEUS) imaging and the therapeutic response of enlarged superficial lymph nodes in patients with lymphoma before and after chemotherapy and to determine the most useful CEUS response parameters.Material/MethodsForty-three patients with lymphoma, with 43 enlarged superficial lymph nodes, underwent CEUS and conventional ultrasound (US), before treatment and after the first three cycles of chemotherapy. Clinical responses included overall response (OR) and no response (NR). Imaging parameters by time-intensity curve (TIC) included basic intensity (B), wash-out slope and/or decent slope (K), wash-in slope or rise slope (C), time to peak (TTP), area under the gamma curve (Area), arrive time(ATM), peak intensity (PI), change of peak intensity (I) were compared. And receiver operating characteristic (ROC) curve analysis was operated.ResultsQuantitative parameters of CEUS before and after the first three cycles of chemotherapy showed a significant difference in the AreaΔ, PIΔ, and IΔ in the OR group compared with NR group (P<0.05). There was a significant difference in the Cpre, Areain, PIin, Iin, AreaΔ, PIΔ, and IΔ in the OR group compared with NR group (P<0.05). The effectiveness of the therapeutic response was predicted by the CEUS parameters of IΔ (P<0.05). And ΔArea has the highest diagnostic performance of ineffectiveness.ConclusionsThe findings of this study have shown that quantitative analysis by CEUS may be a useful, and objective, imaging method for the evaluation of the therapeutic response of enlarged superficial lymph nodes in lymphoma before and after chemotherapy.

Utility of quantitative contrast-enhanced ultrasound for the prediction of extracapsular extension in papillary thyroid carcinoma

The aim of this study was to find an accurate method for the detection of extracapsular extension (ECE) in papillary thyroid carcinoma (PTC). A total of 102 patients with 109 PTC nodules were retrospectively enrolled. Contrast-enhanced ultrasound (CEUS) characteristics were evaluated. The diagnostic efficacy of quantitative CEUS and tumor size was analyzed. The qualitative CEUS features did not differ significantly between the ECE and non-ECE groups (P > 0.05). All of the quantitative CEUS parameters with the exception of peak intensity and tumor size were found to differ significantly between the ECE and non-ECE groups (P < 0.05). Multivariate stepwise logistic regression analysis demonstrated that time from peak to one half (TPH), tumor size and wash-in slope (WIS) were the significantly different parameters between the ECE and non-ECE groups (P = 0.000, P = 0.005 and P = 0.030, respectively).The sensitivity and specificity in the diagnosis of ECE were: TPH, 75.4% (43/57) and 78.9% (41/52), respectively; WIS, 87.7% (50/57) and 42.3% (22/52), respectively; and tumor size, 71.9% (41/57) and 65.4% (34/52), respectively. Quantitative CEUS analysis and tumor size are essential for the prediction of ECE in PTC; in particular TPH has good diagnostic value in detecting ECE. Our study provides important insights into the prediction of ECE in PTC.

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.

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.

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.

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.

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.

Predictive value of quantitative contrast-enhanced ultrasound in hepatocellular carcinoma recurrence after ablation.

To investigate the relationship between contrast-enhanced ultrasound (CEUS), basic fibroblast growth factor (bFGF), endothelin-1 (ET-1), and hepatocellular carcinoma (HCC) recurrence after ablation. A total of 51 HCC patients (38 males and 13 females) who received radiofrequency ablation in our hospital from June 2012 to July 2014 were enrolled in this study. The patients were divided into two groups: recurrence group and non-recurrence group. Routine abdominal examination was first performed in the horizontal position. Then the patients underwent CEUS and immunohistochemical staining before receiving radiofrequency ablation. All patients were followed-up every three months for one year. The results of CEUS and serum tumor marker levels were evaluated and combined together to estimate HCC recurrence and metastasis. Patients were divided into two groups: recurrence group and non-recurrence group. Quantitative parameters of CEUS and tumor expression levels of bFGF and ET-1 were compared between the two groups, respectively. Binary logistic regression analysis was used to analyze the relationship between CEUS quantitative parameters, expression levels of ET-1 and bFGF, and HCC recurrence after ablation. Based on the quantitative parameters of CEUS before patients received radiofrequency ablation, the levels of tumor rise time (tRT), tumor time to peak (tTTP), tumor peak intensity (tPI) and tumor-parenchymal peak intensity (t-pPI) in the recurrence group were significantly lower than those in the non-recurrence group (16.6 ± 6.1 vs 23.2 ± 7.0, P = 0.000; 41.2 ± 10.2 vs 59.6 ± 14.2, P = 0.000; 23.8 ± 6.7 vs 31.4 ± 6.4, P = 0.000; 7.1 ± 3.4 vs 14.6 ± 7.4, P = 0.000; respectively). The expression levels of bFGF in the recurrence group were significantly higher than those in the non-recurrence group (P < 0.05). Levels of tTTP showed a significant inverse correlation with the level of bFGF in tumors (r = -0.312, P = 0.037). The Binary logistic regression analysis results revealed that the levels of tRT, tTTP, tPI and the level of bFGF were associated with HCC recurrence after radiofrequency ablation (P < 0.05). CEUS is a noninvasive and effective method for evaluating the angiogenesis of HCC, and predicting its recurrence and prognosis.

Quantitative analysis of contrast-enhanced ultrasonography of the bowel wall can predict disease activity in inflammatory bowel disease

PurposeTo evaluate the accuracy of quantitative analysis of bowel wall enhancement in inflammatory bowel disease (IBD) with contrast enhanced ultrasound (CEUS) by comparing the results with vascular density in a biopsy sample from the same area of the intestinal tract, and to determine the usefulness of this analysis for the prediction of disease activity. Materials and methodsThis prospective study was approved by our institute's ethics committee and all patients gave written informed consent. We enrolled 33 consecutive adult patients undergoing colonoscopy and biopsy for IBD. All patients underwent CEUS and the results were quantitatively analyzed. Vessel count per high-power field on biopsy specimens was compared with colonoscopy, baseline ultrasonography, and CEUS findings, and with analysis of peak intensity, time to peak, regional blood volume, mean transit time, and regional blood flow. Results in patients with high and low vascular density were compared using Fisher's test, t-test, Pearson's correlation test, and receiver operating characteristic curve (ROC) analysis. Cutoff values were determined using ROC analysis, and sensitivity and specificity were calculated. ResultsHigh vascular density (>265 vessels per field) on histological examination was significantly correlated with active disease on colonoscopy, baseline ultrasonography, and CEUS (p<.0001). Quantitative analysis showed a higher enhancement peak, a shorter time to peak enhancement, a higher regional blood flow and regional blood volume in patients with high vascular density than in those with low vascular density. Cutoff values to distinguish between active and inactive disease were identified for peak enhancement (>40.5%), and regional blood flow (>54.8ml/min). ConclusionQuantitative analysis of CEUS data correlates with disease activity as determined by vascular density. Quantitative parameters of CEUS can be used to predict active disease with high sensitivity and specificity.

Comparative study of rabbit VX2 tumor angiogenesis in fatty liver and normal liver and correlation with contrast-enhanced ultrasound quantitative parameters

Objective To comparative analysis the rabbit VX2 tumors angiogenesis in fatty liver and normal liver,and investigate the correlation of contrast-enhanced ultrasound (CEUS) parameters and their angiogenesis.Methods Rabbit models of fatty liver and normal liver with implanted VX2 tumors were established.Two groups of hepatic backgrounds and VX2 tumors were analyzed by QontraXt quantitative software of CEUS.The expression level of tumor microvascular density (MVD) and vascular endothelial growth factor (VEGF) were detected with immunohistochemical techniques and real-time fluorescence quantitative PCR (FQ-PCR).Results ①No significant difference was found in MVD,VEGF protein and gene expression between VX2 tumors in normal liver and fatty liver.The expression of VEGF gene in fatty liver parenchyma were lower than normal liver parenchyma (P ＜0.05).②There was positive correlation between MVD and peak intensity (r =0.494,P ＜0.05; r =0.591,P ＜0.01) both in fatty liver and normal liver VX2 tumors.The expression of VEGF protein were not correlated with TIC parameters (all P ＞ 0.05).③The MVD had positive correlation with expression of VEGF protein in fatty liver and normal liver VX2 tumors (r =0.508,P ＜0.05; r =0.570,P ＜0.01).Conclusions The expression of MVD and VEGF had no significant difference between fatty liver and normal liver VX2 tumors.The peak intensity of VX2 tumors CEUS had positive correlation with MVD both in fatty liver and normal liver,which can indirectly reflect MVD expression level and help to evaluate tumor angiogenesis. Key words: Ultrasonography; Microbubbles; Liver neoplasms, experimental; Fatty liver; Neovascularization, pathologic