Double Contrast-enhanced Ultrasonography Research Articles

Comparing endoscopic ultrasonography and double contrast-enhanced ultrasonography in the preoperative diagnosis of gastric stromal tumor

BackgroundThis study was designed to perform a comparative analysis between endoscopic ultrasonography (EUS) and double contrast-enhanced ultrasonography (DCEUS) for the preoperative diagnosis of gastric stromal tumors (GSTs).MethodsA retrospective study was conducted involving 139 patients with histologically confirmed GSTs. All patients preoperatively underwent DCEUS and EUS. The pathology reports were treated as the baseline and were retrospectively compared with the findings of EUS and DCEUS.ResultsOf the 139 lesions, 120 and 113 were correctly identified by DCEUS and EUS, respectively, with an accuracy of 86.3% and 81.3%. The results revealed an insignificant difference between these two methods (p = 0.189).ConclusionsDCEUS can display not only the locations, sizes, shapes, borders, internal echoes, but also show the blood perfusion patterns of GSTs. It is a highly accurate, noninvasive, and convenient method to be used at the pre-treatment stage.

Evaluation of the efficacy of gastric lymphoma treated with non-surgical therapy using oral and double contrast-enhanced gastric ultrasonography.

To investigate the feasibility of assessing the ecacy of non-surgical treatment for gastric lymphoma using oral contrast-enhanced ultrasound (OCEUS) and double contrast-enhanced ultrasound (DCEUS). A total of 27 patients with gastric lymphoma treated nonoperatively were included in this retrospective study. The ecacy was evaluated using OCEUS and CT, respectively, and the results were tested for kappa concordance. Sixteen of the 27 patients underwent multiple DCEUS examinations before and after treatment. Micro-perfusion of the lesion in DCEUS is represented by the Echo Intensity Ratio (EIR), (echo intensity of the lymphoma lesion/echo intensity of the normal gastric wall), and one-way ANOVA was used to compare the differences between groups in EIR values before and after treatment. OCEUS and CT were highly consistent in assessing the efficacy of gastric lymphoma, with a Kappa value of 0.758. During a median follow-up of 8.8 months, there was no statistical difference between the complete remission rate obtained by OCEUS and that obtained by endoscopic and CT (25.93% vs. 44.44%, p=0.154; 25.93% vs. 33.33%, p=0.766). There was also no statistical difference in the time to achieve complete remission using OCEUS assessment and endoscopy and CT (4.71±1.03 months vs. 6.01±2.14 months, p=0.088; 4.47±1.84 months vs. 6.01±2.14 months p=0.143). The difference in EIR between the groups before treat-ment and after different numbers of treatments was statistically signifficant (p<0.05), and post hoc analysis revealed this dif-ference as early as after the second treatment (p<0.05). Transabdominal OCEUS and CT are comparable in the assessment of gastric lymphoma treatment ecacy. DCEUS is a noninvasive, cost-effective, and widely available method for gastric lymphoma therapeutic effect evaluation. Therefore, transabdominal OCEUS and DCEUS have the potential to be used for the early assessment of the ecacy of the non-surgical treatment of gastric lymphoma.

Comparison of double contrast-enhanced ultrasonography and contrast-enhanced computed tomography in preoperative TNM stages of gastric cancer

Background: China accounts for about 40% of new cases of Gastric Cancer (GC) in the world every year. Preoperative TNM stages

Double contrast-enhanced ultrasound for the preoperative gross classification of gastric cancer: a comparison with multidetector computed tomography

PurposeTo compare the diagnostic performance of double contrast-enhanced ultrasound (DCEUS) and multi-detector row computed tomography (MDCT) in the gross classification of gastric cancer (GC) preoperatively.Methods54 patients with histology proved GC were included in this retrospective study. The sensitivity and specificity of DCEUS and MDCT for the gross classification of GC was calculated and compared. The area under the curve (AUC) from a receiver operating characteristic curve analysis was used to evaluate the difference of the diagnostic performance between these two methods.ResultsThere were no significant differences between DCEUS and MDCT in terms of AUC for early gastric cancer (EGC), Borrmann I, II, III and Borrmann (III + IV) (P = 0.248, 0.317, 0.717, 0.464 and 0.594, respectively). The accuracy of DCEUS in diagnosing EGC, Borrmann I, II and Borrmann (III + IV) was higher than that of MDCT (96% vs 92%; 96% vs 94%; 87% vs 80%; 83% vs 73%), while in determining Borrmann III and IV, that of DCEUS was lower than that of MDCT (72% vs 74%; 89% vs 96%).ConclusionConsidering the revolution in clinical decision, prognosis evaluation, safety and non-invasion aspects, DCEUS can be used as the main alternative method for Borrmann classification of GC preoperatively.

Clinical Research of Combined Application of DCEUS and Dynamic Contrast-Enhanced MSCT in Preoperative cT Staging of Gastric Cancer.

Purpose To investigate the clinical value of double contrast-enhanced ultrasound (DCEUS) combined with dynamic contrast-enhanced multislice CT (MSCT) in preoperative T staging of gastric cancer (GC). Methods 206 patients with GC confirmed by preoperative gastroscopy from February 2019 to February 2021 were collected, all patients were examined by DCEUS and dynamic contrast-enhanced MSCT before operation, and the invasion depth (T staging) of GC was evaluated. The diagnosis results of DCEUS, dynamic contrast-enhanced MSCT, and combined diagnosis of DCEUS and MSCT methods (D&M method) were compared with the pathological staging results (gold standard). Results The correct diagnosis rate of MSCT was 27.27% in T1 staging, 55.56% in T2 staging, 42.11% in T3 staging, 59.29% in T4 staging, and 55.34% in summation. The correct diagnosis rate of DCEUS was 90.91% in T1 staging, 88.89% in T2 staging, 78.95% in T3 staging, 82.86% in T4 staging, and 83.98% in summation. The correct diagnosis rate of the D&M method was 100.00% in T1 staging, 94.44% in T2 staging, 89.47% in T3 staging, 93.57% in T4 staging, and 93.69% in summation. The D&M method had higher correct diagnosis rate than MSCT or DCEUS alone, the correct diagnosis rate of the D&M method in T1, T2, T3, and T4 staging was significantly higher than that of MSCT (P < 0.05). The correct diagnosis rate of the D&M method in T1, T3, and T4 was significantly higher than that of DCEUS (P < 0.05). The Youden index of preoperative T1, T2, T3, and T4 staging of GC by the D&M method was 99.49%, 94.44%, 84.13%, and 90.54%, respectively, and the Kappa values of these were 0.954, 0.966, 0.707, and 0.881, respectively. Conclusions Dynamic contrast-enhanced MSCT combined with DCEUS in the diagnosis of preoperative cT staging of GC has more validity, reliability, and revenue than the using of MSCT or DCEUS alone, which is an image evaluation method worthy of clinical promotion.

Double Contrast-Enhanced Ultrasonography in Preoperative T Staging of Gastric Cancer: A Comparison With Endoscopic Ultrasonography.

Objective: To compare the precision of double contrast-enhanced ultrasonography (DCEUS) to endoscopic ultrasonography (EUS) in preoperative T staging of gastric cancers.Methods: This retrospective study consisted of 158 pathologically confirmed gastric cancer patients. All patients underwent DCEUS (intravenous contrast-enhanced ultrasonography combined with oral contrast-enhanced ultrasonography) and endoscopic ultrasonography (EUS) preoperatively. The histopathological findings of resected specimens were compared with the results of DCEUS and EUS retrospectively.Results: The accuracy of DCEUS and EUS in evaluating the T staging of gastric cancer were 82.3% (T1 62.5%,T2 84.4%,T3 87.9%,T4 91.3%) and 76.6% (T1 84.4%,T2 82.2%,T3 72.4%,T4 65.2%), respectively. There were no significant differences between the methods for the overall T staging accuracy (χ2 = 1.569, P = 0.210). But EUS was superior to DCEUS for T1 stage (χ2 = 3.925, P = 0.048) and DCEUS was superior to EUS for T3 stage (χ2 = 4.393, P = 0.036) and T4 stage (χ2 = 4.600, P = 0.032).Conclusion: DCEUS is a convenient and noninvasive method with high precision, which can be used as the primary imaging technique for advanced gastric cancer T staging. In early gastric cancer, we should prefer EUS. Two methods are complementary for assessing tumor invasion depth of gastric cancer.

Value of double contrast-enhanced ultrasound QontraXt three-dimensional pseudocolor quantitative analysis to therapeutic effect evaluation of preoperative neoadjuvant chemotherapy in advanced gastric cancer patients

Objective: To investigate the value of tumor perfusion parameter measured by using double contrast-enhanced ultrasound (DCEUS) QontraXt three-dimensional pseudocolor quantitative analysis to the therapeutic effect evaluation of preoperative neoadjuvant chemotherapy (NAC) in advanced gastric cancer (AGC) patients. Methods: Eighty-nine AGC patients underwent 3 cycles of preoperative NAC (XELOX) followed by complete resection of lesion. The DCEUS QontraXt three-dimensional pseudocolor was performed one or two weeks before the NAC and operation were applied, respectively. The peak enhancement (PE), time to peak (TP), sharpness of the bolus (β) and area under the enhancement curve (AUC) of primary gastric tumor were measured by QontraXt three-dimensional pseudocolor quantitative analysis. These DCEUS parameters between respond and non-respond groups before and after NAC therapy were compared. The prediction accuracy of DCEUS to the therapeutic effect evaluation of preoperative NAC was determined by the receive operating characteristic (ROC) curves. Results: Among 89 AGC patients, 52 patients responded to NAC therapy, while 37 patients resisted to NAC therapy. Twelve cases in respond group and 26 cases in non-respond group were mucinous carcinoma. Forty cases in respond group and 11 cases in non-respond group were non-mucinous carcinoma (P<0.05). In responder group, the PE and TP before NAC were (53.7±9.3)% and (14 521±2 667) ms, and (32.2±5.5)% and (17 235±1 898) ms after NAC. The ratio of changes of PE (ΔPE) and TP (ΔTP) were 0.43±0.17 and 0.36±0.14, respectively. In non-respond group, the PE and TP before NAC were (54.4±7.2)% and (13 869±3 247) ms, and (45.3±6.1)% and (15 127±1 423) ms after NAC therapy. The ratio of ΔPE and ΔTP were 0.24±0.20 and 0.22±0.12. The PE and TP after NAC, the ratio of ΔPE and ΔTP were significant different among these two groups (all of P<0.05). The ROC curves showed that the ratio of ΔPE in assessing the respond of gastric cancer patients to NAC was superior compared to other parameters (AUC=0.784, P=0.004). The optimal cut-off value of the ratio of ΔPE was 24% and its sensitivity and specificity to the therapeutic effect evaluation of NAC in gastric cancer were 82.7% and 64.9%. Conclusion: DCEUS QontraXt three-dimensional pseudocolor quantitative analysis might be a novel, noninvasive and reliable method to evaluate the therapeutic effect of preoperative NAC in AGC patients.

Double contrast-enhanced ultrasound improves the detection and localization of occult lesions in the pancreatic tail: a initial experience report.

The aim of this study is to review our initial experience of Double contrast-enhanced ultrasonography (DCEUS) in the preoperative detection of pancreatic tail occult tumors. Thirty-five patients were recruited to undergo DCEUS of the pancreas suspected by occult lesions of pancreatic with MRI or clinical evidence. The radiologists assessed the images (conventional US, DCEUS, and MRI) for enhancement phases, tumor presence, location, enhancement characteristics, and tumor conspicuity. The differences in the onset times of the phases between DCEUS and MRI were noted. Tumor conspicuity was graded on a four-point scale for conspicuity comparison among three imaging modalities. Pancreatic tail tumors were missed on conventional transabdominal US in 11 of 35 patients. DCEUS revealed 12 lesions of 35 patients. Pancreatic tail tumors were identified on MRI in 10 of 35 patients. The sensitivity and specificity of DCEUS for depicting occult lesions of ≤ 2.2cm were 92% and 95%, respectively. In contrast, the sensitivity and specificity of conventional US were 67% and 66%, respectively. The sensitivity and specificity of MRI were 91% and 88%, respectively. The conspicuity ratings of the three phases did not significantly differ between the DCEUS and MRI groups (P > 0.05). The DCEUS phases started much earlier than the corresponding MRI phases. DCEUS is a promising technique in the detection of occult pancreatic tail tumors and is possibly superior to dynamic enhanced MRI in the case of some peripheral lesions.

Value of double contrast-enhanced ultrasonography in determining pathological features of advanced gastric cancer

Value of double contrast-enhanced ultrasonography in determining pathological features of advanced gastric cancer

Comparing single oral contrast-enhanced ultrasonography and double contrast-enhanced ultrasonography in the preoperative Borrmann classification of advanced gastric cancer.

ObjectivesTo evaluate the accuracy of double contrast-enhanced ultrasonography (DCEUS) in preoperative Borrmann classification of advanced gastric cancer (AGC).Materials and MethodsA total of 162 patients histologically confirmed AGC were enrolled into this study. Single oral contrast-enhanced ultrasonography (SOCEUS) were performed in 80 patients and DCEUS (intravenous microbubbles combined with oral contrast-enhanced ultrasound) were performed in 82 patients preoperatively. The findings of the histopathologic examination of resected specimens after surgery were considered as gold standard. The accuracy of SOCEUS was compared with the accuracy of DCEUS in determining Borrmann classification. Interobserver agreement between two sonographyers of SOCEUS and DCEUS had also been assessed.ResultsThe accuracy of SOCEUS and DCEUS in Borrmann classification of advanced gastric cancer were 78.75% and 91.46% respectively. There was a significant difference between two methods (χ2 = 5.186, P < 0.05). The interobserver agreement of two methods was both excellent for assessing the Borrmann classification with a Kappa value of 0.777 by SOCEUS and 0.844 by DCEUS.ConclusionsDCEUS is a valuable method for Borrmann classification with its high accuracy preoperatively. It should be used widely.

Improvement to ultrasonographical differential diagnosis of gastric lesions: The value of contrast enhanced sonography with gastric distention.

ObjectiveThe purpose of this retrospective study is to evaluate the diagnostic value of contrast enhanced sonography plus gastric distention sonography, the Double Contrast-enhanced Ultrasound (DCUS) in gastric lesions.Methods107 cases with pathology confirmed gastric lesions were retrospectively reviewed, DCUS and oral contrast agent ultrasound (US) were performed in all cases prior to operation. Perfusion parameters including arrival time (AT), peak intensity (PI), time to peak (TTP), and area under the curve (AUC) of the lesion and surrounding normal tissue were analyzed. A reader blinded to pathology results were asked to rate and compare each case with surgical or resection biopsy pathology results.ResultsFrom the 107 gastric lesions, 75 were malignant gastric lesions (33 gastric cancers,42 gastrointestinal stromal tumors (GISTs)) and 32 were benign gastric lesions (11 inflammatory masses and 21 polypoid adenomas). Compared with US, DCUS achieved higher value in sensitivity (90.6% vs. 70.6%), specificity (75% vs. 62.5%), positive predictive value (89.5% vs. 81.5%), negative predictive value (77.4% vs. 47.6%), and overall accuracy (85.9% vs. 68.2%). When US was tested against DCUS, the increase in correct diagnoses value was significant (P = .01). Furthermore, gastric cancer had faster AT, higher PI and AUC than normal tissue (P<0.05); GIST and Inflammatory mass had higher PI than normal tissue (P<0.05); gastric cancer and GIST had faster AT than polypoid adenoma (P<0.05), Inflammatory mass showed higher PI than other 3 lesions and gastric cancer had higher PI than polypoid adenoma and GIST (P<0.05); gastric cancer and inflammatory mass had larger AUC than polypoid adenoma and GIST (P<0.05). Conclusion DCUS improved diagnostic performance compared with US. The combination of different CEUS enhancement characteristics with quantitative perfusion parameters may provide a promising tool to help differentiate gastric cancer and GIST from benign lesions.

Double contrast-enhanced ultrasonography in the detection of periampullary cancer: Comparison with B-mode ultrasonography and MR imaging

PurposeTo investigate the value of double contrast-enhanced ultrasonography (DCEUS) in the detection of periampullary cancer. Materials and methodsNinety-nine patients with surgery or biopsy-proven periampullary cancer who underwent both DCEUS and magnetic resonance imaging (MRI) examinations before operation were enrolled in our study. DCEUS in which intravenous microbubbles were used in combination with oral contrast agent and MRI were performed preoperatively to make a detection diagnosis of periampullary cancer. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of DCEUS, B-mode ultrasonography (BUS) and MRI were calculated and compared. Receiver operating characteristic (ROC) curves were used to evaluate the accuracy of BUS, DCEUS and MRI in the detection. Stratified analyses were performed for different pathological types and different sizes of periampullary lesions. The inter- and intra-observer reliability of DCEUS for cancer detection was also investigated. ResultThere were no significant differences in sensitivity, specificity, PPV, NPV or accuracy between DCEUS and MRI (all P>0.05). ROC analysis showed that the accuracy of DCEUS or MRI was higher than that of BUS (P<0.001), while no significant differences were noted in the accuracy between DCEUS and MR. In the 76 cases of periampullary cancer, DCEUS appeared to be superior to BUS for ampullary carcinoma, duodenum carcinoma and for lesions with an average diameter of less than 3cm. DCEUS appeared equal to BUS in other groups. No significant differences were noted between DCEUS and MRI in the stratified analysis. A considerably well agreement between DCEUS and MRI was obtained using Kappa analysis (k=0.649, P<0.001). The intra- and inter-observer reproducibility were both good for detection of periampullary cancer by DCEUS, with a Kappa values of 0.783 (P<0.01) and 0.732 (P<0.01), respectively. ConclusionDCEUS provides an available and useful imaging modality in the detection of periampullary cancer. This technique can aid in displaying the invisible periampullary region in BUS and may also become an effective supplemental method to MRI.

Preoperative Gross Classification of Gastric Adenocarcinoma: Comparison of Double Contrast-Enhanced Ultrasound and Multi-Detector Row CT

The aim of this study was to compare the accuracy of multi-detector computed tomography (MDCT) with double contrast-enhanced ultrasound (DCEUS), in which intravenous microbubbles are used alongside oral contrast-enhanced ultrasound, in determining the gross classification of patients with gastric carcinoma (GC). Altogether, 239 patients with GC proved by histology after endoscopic biopsy were included in this study. DCEUS and MDCT were performed pre-operatively. The diagnostic accuracies of DCEUS and MDCT in determining the gross classification were calculated and compared. The overall accuracy of DCEUS in determining the gross appearance of GC was higher than that of MDCT (84.9% vs. 79.9%, p < 0.001). There was no significant difference in accuracy between DCEUS and MDCT for Borrmann I and IV classifications of advanced gastric cancer (χ2, p = 0.323 for Borrmann type I, p = 0.141 for Borrmann type IV). The accuracy of DCEUS for early GC and Borrmann II and III classifications of GC was higher than that of MDCT (χ2, p = 0.000 for all). DCEUS may be regarded as a valuable complementary tool to MDCT in determining the gross appearance of gastric adenocarcinoma pre-operatively.

Evaluation of prediction of pathologic grade of regression to preoperative neoadjuvant chemotherapy in patients with resectable advanced gastric cancer using double contrast-enhanced ultrasound

Objective To discuss the value of double contrast-enhanced ultrasound(DCEUS) as a method to predict the pathologic grade of regression to preoperative neoadjuvant chemotherapy(NAC) in advanced gastric cancer(AGC) patients, the contrast parameters of gastric carcinoma were measured and its correlation with pathologic response degree was analyzed. Methods Fifty seven patients with endoscopic biopsy-proven AGC were considered for a complete resection of the lesion and had a DCEUS prior to and following XELOX pre-operative NAC therapy for 3 cycles. The arrival time (AT), time-to-peak (TTP), baseline intensity (BI) and peak intensity (PI) of the primary gastric tumor were measured.The enhanced intensity (EI) was defined as PI minus BI. The percentage of change of DCEUS parameters before and after NAC therapy and its correlation with phathologic grades of regression was calculated. Patients were divided into responder and nonreponder group according to different pathologic response grade. The differences of DCEUS parameters between two groups were compared. The diagnostic accuracy of DCEUS in prediction of benefit from preoperative NAC was represented by means of receive operating characteristic (ROC) curves. Results After NAC, the PI and EI values of local gastric cancer were significantly lower than before NAC. There were significant differences in PI and EI after NAC between the responder and nonresponder groups. Among the DCEUS parameters showed significant correlation with pathologic grade of regression, the correlation factor was highest in percentage of EI reduction of primary gastric tumor(ρ=-0.501, P=0.007). When the optimal cutoff value of EI reduction rate of gastric tumor determined was 27%, a sensitivity of 81.8% and specificity of 66.7% were achieved. Conclusions DCEUS might be a novel, noninvasive, liable and potential method to select the benefit responder from the preoperative NAC in AGC patient. Key words: Contrast-enhanced ultrasound; Microbubbles; Stomach neoplasms; Neoadjuvant chemotherapy

Comparison of preoperative Borrmann classification in advanced gastric carcinoma with double contrast-enhanced ultrasound and multi-detector row CT: correlation with surgical and histologic results

Objective To compare the accuracy of double contrast-enhanced ultrasound (DCEUS) and multi-detector row CT (MDCT) in determining the Borrmann classification in advanced gastric carcinoma (AGC) preoperatively. Methods Two hundred and nine patients with AGC proved by endoscopic biopsy were included. DCEUS (intravenous microbubbles combined with oral contrast-enhanced ultrasound) and MDCT were performed preoperatively. The diagnostic accuracy of DCEUS and MDCT in determining Borrmann classification was calculated and compared. Additionally, intra- and inter- observer reliability of DCEUS and MDCT were assessed using Kappa analysis and a well reliability was set as Kappa value large than 0.75. Results The overall accuracy of DCEUS in determining the Borrmann classification of AGC was 87.9%, the accuracy of DCEUS in determining Borrmann Ⅰ, Ⅱ, Ⅲ and Ⅳ was 90.3%, 86.5%, 87.1% and 88.2%, respectively. The overall accuracy of MDCT in determining the Borrmann classification of AGC was 80.9%, the accuracy of MDCT in determining Borrmann Ⅰ, Ⅱ, Ⅲ and Ⅳ was 87.1%, 78.4%, 78.6% and 85.3%, respectively.There was no significant difference in accuracy between DCEUS and MDCT for Borrmann Ⅰ and Ⅳ classification of AGC (chi-square test, P=0.349 for Borramnn Ⅰ type, P=0.094 for Borrmann Ⅳ type). The accuracy of DCEUS for Borrmann Ⅱ and Ⅲ classification of AGC was higher than the accuracy of MDCT (chi-square test, P=0.000 for Borrmann Ⅱ type, P=0.000 for Borrmann Ⅲ type). The intra- and inter-observe reproducibility were both almost perfect for assessing the Borrmann classification of AGC with a Kappa value of 0.891(P=0.000) for intra-observer and 0.860(P=0.000) for inter-observer by DCEUS. The intra- and inter-observe reproducibility were both almost perfect for assessing the Borrmann classification of AGC with a Kappa value of 0.884 (P=0.000) for intra-observer and 0.852 (P=0.000) for inter-observer by MDCT. Conclusions DCEUS could be considered as a new, reliable and noninvasive method for preoperative the Borrmann classification in AGC. Key words: Ultrasonography; Microbubbles; Tomography, X-ray computed; Stomach neoplasms; Borrmann classification

Diagnostic value of double contrast-enhanced ultrasonography in preoperative staging of rectal carcinoma

Objective To evaluate the preoperative T staging value of rectal carcinoma by using double contrast-enhanced ultrasonography (DCUS).Methods 71 patients with rectal carcinoma were examined by ultrasound after infusing contrast agent and bolus injection of SonoVue preoperatively.The border,shape and perfusion patterns of the tumor were observed.After surgery,the T staging made by DCUS and perfused contrast-enhanced ultrasonography (PCUS) was compared with final pathologic results respectively.Results The accuracy of PCUS and DCUS in determining the T stage of rectal carcinoma were 71.8％(T1 72.7％％,T250.0％,T374.4％,T476.9％) and 85.9％(T190.9％,T275.0％,T387.1％,T484.6％) respectively.The difference between these two methods was statistically significant (P ＜0.05).Conclusions DCUS is a new valuable method for T staging of rectal carcinoma with its high accuracy preoperatively. Key words: Ultrasonography; Microbubbles ; Rectal neoplasms; Neoplasm staging

Evaluation of 40 patients with periampullary carcinoma using double contrast-enhanced ultrasonography (DCUS)

Objective To analyze the double contrast-enhanced ultrasonography (DCUS) features of periamupullary carcinoma for enhancing the ultrasound diagnostic value of the disease.Methods The DCUS and clinical data of 40 patients with periampullary carcinoma confirmed by histopathology were reviewed.Results (1) The displaying rate of the lesions and the judgment of lesion location was statistically higher on DCUS than that of ordinary ultrasound (P ＜ 0.05).(2) DCUS features of periampullary carcinoma:the size of most lesions was less than 30 mm except for 1 case in which no lesion was found; In 100％ (39/39) of the lesions,the morphology did not change with duodenum movement ; In 64.1％ (25/39) of lesions hyperenhancement or isoenhancement was displayed in the arterial phase,with low enhancement in the venous phase; In 87.2％ (34/39) of lesions homogeneous enhancement was displayed; In 95％ (38/40) the bile ducts were moderately or severely dilated.The lesion locations and whether the lesions projected into the duodenal cavity or not were statistically different between the three different types of periampullary carcinoma (P ＜ 0.05).The lesions projected into the duodenal cavity of duodenum were more commonly seen in papillary carcinoma and ampullary carcinoma than distal common bile duct carcinoma.The lesion size,whether the lesion morphology changed or not with duodenum movement,enhancement level,enhancement homogeneity,the degree of bile duct dilatation,whether there was pancreatic duct dilatation or not were not statistically different between the three different types of periampullay carcinoma (P ＞ 0.05).Conclusions DCUS is an effective way to show periampullay carcinoma,and is helpful to diagnose periampullary carcinoma and distinguish the three different types of periampullary carcinoma. Key words: Ultrasonography ; Microbubbles ; Contrast ; Periamupullay carcinoma; Diagnosis

Double contrast-enhanced ultrasonography in preoperative Borrmann classification of advanced gastric carcinoma: comparison with histopathology

The purpose of this study was to investigate the accuracy of double contrast-enhanced ultrasonography (DCEUS) for assessing the Borrmann classification of advanced gastric carcinoma (AGC) preoperatively. Three hundred twenty nine patients with proved AGC were enrolled. DCEUS (intravenous microbubbles combined with combined with oral contrast-enhanced ultrasound) was performed preoperatively. The diagnostic accuracy of DCEUS in determining Borrmann classification was compared with postoperative pathological findings. The reliability of DCEUS was analyzed. The accuracy of DCEUS in determining the Borrmann classification of AGC was 91.49%. The intra- and inter-observer reproducibility was both almost perfect for assessing the Borrmann classification of AGC by DCEUS. DCEUS could be considered as an accurate, non-invasive, and reliable diagnostic method for preoperative Borrmann classification of advanced gastric carcinoma.

Preoperative T Staging of Advanced Gastric Cancer using Double Contrast-Enhanced Ultrasound

To determine the accuracy of double contrast-enhanced ultrasound (DCEUS), in which intravenous microbubbles are used together with an oral contrast agent, in the preoperative T staging of advanced gastric cancer. This prospective, ethics committee-approved study recruited 350 patients who gave informed consent. All had gastric cancer proved by endoscopic biopsy and underwent preoperative ultrasound staging using the TNM classification (UICC 2002). The results of DCEUS were compared with postoperative pathologic findings. The staging accuracy of oral contrast-enhanced ultrasound (OCEUS) and DCEUS were compared to each other. Sensitivity and specificity for assessing serosal involvement by DCEUS were evaluated, and the concordance of this method was analyzed using Kappa statistics. The accuracies of OCEUS and DCEUS in determining the T stage of advanced gastric cancer were 75.1 % (70.4 % for T2, 79.5 % for T3, 68.1 % for T4) and 87.4 % (83.3 % for T2, 89.7 % for T3, 87.2 % for T4), respectively, and the difference between the two methods was statistically significant (χ2 = 17.364, p< 0.001). The performance of DCEUS for staging lesions in the cardia (69.81 %), fundus (85.71 %) and body (85.56 %) had lower accuracy than that of other parts (93.94 % for antrum; 92.11 % for pylorus). Sensitivity and specificity for assessing serosal involvement by DCEUS were 98.76 % and 83.33 % respectively. The reliability was almost perfect with Kappa values of 0.89 (p< 0.001) for intra-observer and 0.82 (p< 0.001) for inter-observer agreement. DCEUS could be considered as an accurate, non-invasive, and reliable diagnostic method for preoperative staging of advanced gastric cancer.

Comparison of Double Contrast-Enhanced Ultrasound and MDCT for Assessing Vascular Involvement of Pancreatic Adenocarcinoma: Preliminary Results Correlated with Surgical Findings

To investigate the accuracy of double contrast-enhanced ultrasound (DCEUS) for assessing vascular involvement by pancreatic adenocarcinoma. 38 patients with pancreatic adenocarcinoma proven by postoperative pathology or biopsy were enrolled in this study. DCEUS (intravenous microbubbles combined with an oral contrast agent) and 16-row multi-detector CT (MDCT) were performed preoperatively to assess vascular invasion by pancreatic adenocarcinoma. The diagnostic accuracy of DCEUS and MDCT for assessing vascular involvement was calculated and compared. ROC curves were used to evaluate the diagnostic confidences of the two methods. The inter- and intra-observer reliability of DCEUS for assessing vascular invasion was investigated in the present study. Almost perfect agreement between DCEUS and MDCT was obtained using Kappa analysis (k = 0.83, p = 0.000). Compared with surgical findings, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of peripancreatic vascular invasion were 66.67 %, 100 %, 100 %, 60 %, and 77.78 %, respectively, for DCEUS and 75 %, 100 %, 100 %, 66.67 %, and 83.33 %, respectively, for MDCT. There was no significant difference in accuracy between DCEUS and MDCT for evaluating peripancreatic vascular invasion (p = 0.108). The combination of DCEUS and MDCT increased the diagnostic confidence in assessing peripancreatic vascular invasion with an area under ROC curve from 0.83 for DCEUS (p = 0.025) and 0.88 for MDCT (p = 0.011) to 0.92 for both combined (p = 0.005). The intra- and inter-observer reproducibility were both almost perfect for assessing the peripancreatic vascular invasion by DCEUS with a Kappa value of 0.94 (p = 0.000) for intra-observer and 0.83 (p = 0.000) for inter-observer. DCEUS could be considered as a reliable and accurate method for evaluating the peripancreatic vascular invasion of pancreatic adenocarcinoma.