Oral Contrast-enhanced Ultrasonography Research Articles

Clinical value of oral contrast-enhanced ultrasonography in diagnosis of gastric tumors.

The incidence of gastric cancer remains high, and it is the sixth most common cancer and the fourth leading cause of cancer deaths worldwide. Oral contrast-enhanced ultrasonography is a simple, non-invasive, and painless method for the diagnosis of gastric tumors. To explore the diagnostic value of oral contrast-enhanced ultrasonography for the detection of gastric tumors. The screening results based on oral contrast-enhanced ultrasonography and electronic gastroscopy were compared with those of the postoperative pathological examination. Among 42 patients with gastric tumors enrolled in the study, the diagnostic accordance rate was 95.2% for oral contrast-enhanced ultrasonography (n = 40) and 90.5% for electronic gastroscopy (n = 38) compared with postoperative pathological examination. The Kappa value of consistency test with pathological findings was 0.812 for oral contrast-enhanced ultrasonography and 0.718 for electronic gastroscopy, and there was no significant difference between them (P = 0.397). For the TNM staging of gastric tumors, the accuracy rate of oral contrast-enhanced ultrasonography was 81.9% for the overall T staging and 50%, 77.8%, 100%, and 100% for T1, T2, T3, and T4 staging, respectively. The sensitivity and specificity were both 100% for stages T3 and T4. The diagnostic accuracy rate of oral contrast-enhanced ultrasonography was 93.8%, 80%, 100%, and 100% for stages N0, N1-N3, M0, and M1, respectively. The accordance rate of qualitative diagnosis by oral contrast-enhanced ultrasonography is comparable to that of gastroscopy, and it could be used as the preferred method for the early screening of gastric tumors.

Risk stratification of gastric cancer screening in community population based on oral contrast-enhanced ultrasonography examination: A 3-year follow-up analysis report.

This study aimed to retrospectively investigate the use of oral contrast-enhanced ultrasonography (O-CEUS) in assessing the thickness of the gastric wall for gastric cancer (GC) screening and to establish screening strategies for GC with different risk stratifications based on the gastric wall thickness. From January 2015 to March 2020, people who underwent O-CEUS at the Physical Examination Center of our hospital with at least three years of follow-up were included in this study. The thickness of the gastric wall measured by O-CEUS was divided into three groups using 6 mm and 9 mm as cutoff values. The occurrence of GC in each group was observed. The imaging and clinical information of these populations were recorded and analyzed. Kaplan-Meier survival analysis and Cox's proportional hazards regression were performed to calculate the risk of GC occurrence. A total of 4,047 people were finally included in this study. During the follow-up period, GC occurred in 7 individuals (incidence rate 0.17%). Among them, according to the thickness of the gastric wall, one case occurred in Group A (< 6 mm), two cases occurred in Group B (6-9 mm), and four cases occurred in Group C (>9mm). Based on Kaplan-Meier survival analysis, the curves of the three groups were significantly different (P < 0.01). The risk of GC occurrence in Group C and Group B were higher than that in Group A (4.76E+2-fold and 1.50E+2-fold). O-CEUS is a convenient, economical, safe, and noninvasive screening method for GC. Measuring the thickness of the gastric wall is helpful to predict the risk of GC occurrence according to our stratification screening system.

Initial screening of gastric cancer using oral contrast-enhanced trans-abdominal ultrasonography in rural asymptomatic individuals

Background & aimsInitial screening for high-risk population of gastric cancer (GC) is needed in rural areas of large-population countries. This study aims to explore the feasibility of applying noninvasive ultrasonography as an initial screening strategy to improve the early diagnosis and prevention of GC. MethodsOral contrast-enhanced trans-abdominal ultrasonography (OCTU) was initially applied to screen around 15,000 residents from 24 different rural villages of Changxing Island in Shanghai, China, facilitating the identification of high-risk population for further endoscopy examination. Results176 subjects (1.18 %) were initially identified with gastric diseases using OCTU while 14,787 ones (98.93 %) were normal with negative results. 145 out of 176 individuals (82.39 %) took further endoscopy examination, and 16 were diagnosed with GC with biopsy examination, with 9 of them at the early stage. We followed up with the Center for Disease Control and Prevention, and identified another 6 GC cases occurred within one year among OCTU-negative population, serving as an adjustment factor for sensitivity analysis. As a result, with a total of 22 GC cases included in this cohort, the positive predictive rate, the negative predictive value, sensitivity, and specificity were 9.09％, 99.96 %, 75.5 %, and 98.93 %, respectively. ConclusionsOCTU is feasible, non-invasive, low-cost, and widely acceptable in rural area, thus we proposed that OCTU is practicable to serve as a supplementary screening method to improve the early detection of GC in rural area of China and other developing countries with large population.

The value of oral contrast-enhanced ultrasonography in the diagnosis of gastric tumors in the elderly.

The value of oral contrast-enhanced ultrasonography in the diagnosis of gastric tumors in the elderly.

Automatic Detection of Gastric Wall Structure Based on Oral Contrast-Enhanced Ultrasound and Its Application on Tumor Screening.

Gastric cancer is the second most lethal type of malignant tumor in the world. Early diagnosis of gastric cancer can reduce the transformation to advanced cancer and improve the early treatment rate. As a cheap, real-time, non-invasive examination method, oral contrast-enhanced ultrasonography (OCUS) is a more acceptable way to diagnose gastric cancer than interventional diagnostic methods such as gastroscopy. In this paper, we proposed a new method for the diagnosis of gastric diseases by automatically analyzing the hierarchical structure of gastric wall in gastric ultrasound images, which is helpful to quantify the diagnosis information of gastric diseases and is a useful attempt for early screening of gastric cancer. We designed a gastric wall detection network based on U-net. On this basis, anisotropic diffusion technology was used to extract the layered structure of the gastric wall. A simple and useful gastric cancer screening model was obtained by calculating and counting the thickness of the five-layer structure of the gastric wall. The experimental results showed that our model can accurately identify the gastric wall, and it was found that the layered parameters of abnormal gastric wall is significantly different from that of normal gastric wall. For the screening of gastric disease, a statistical model based on gastric wall stratification can give a screening accuracy of 95% with AUC of 0.92.

Difference in Perfusion Parameters Between Gastric Cancer and Gastric Stromal Tumors: Evaluation With Oral Contrast Plus Contrast-Enhanced Ultrasonography.

Objective: To explore the difference of perfusion parameters between gastric cancer (GC) and gastric stromal tumors (GSTs) by using oral contrast plus contrast-enhanced ultrasonography (OC+CEUS).Methods: We retrospectively reviewed 149 patients with histologically confirmed gastric lesions (80 patients with GC and 69 patients with GST). OC+CEUS was performed in all patients in the GC group and the GST group before surgery. The cine loops of OC+CEUS of all cases were analyzed. The perfusion parameters including arrival time (AT), time to peak (TTP), basal intensity (BI), and peak intensity (PI) were obtained via a program designed for autotracking contrast quantification (ACQ). The between-group differences in these parameters were compared.Results: According to time-intensity curve (TIC) analysis, high-risk GST had higher PI than low-risk GST (P < 0.05). GC had faster AT and higher PI than normal gastric wall (P < 0.05); GST had higher PI than normal gastric wall (P < 0.05). Furthermore, the GC group had faster AT and higher PI than the GST group (P < 0.05). In contrast, the difference in BI and peak time (TTP) between the groups was not significant (P > 0.05).Conclusion: AT and PI differ significantly between the GC group and the GST group. As a new method, OC+CEUS has value for the differential diagnosis of GC and GST.

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.

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.

Oral Contrast-Enhanced Gastric Ultrasonography in the Assessment of Gastric Lesions: A Large-Scale Multicenter Study.

To determine the diagnostic efficiency of oral contrast-enhanced gastric ultrasonography in the evaluation of gastric lesions, based on large-scale multicenter study. The study enrolled 383,945 patients with suspect gastric lesions who underwent complete oral contrast-enhanced gastric ultrasonography and endoscopic evaluation. Two operators, unaware of the results of other diagnostic procedures, performed each examination independently. The accuracies of conventional ultrasonography, oral contrast-enhanced gastric ultrasonography, and upper gastrointestinal endoscopy were determined. After oral contrast, the anatomy of the stomach and morphologic features of gastric lesions were clearly visualized. The sensitivities, specificities, positive predictive values, negative predictive values and accuracies of oral contrast-enhanced ultrasonography in detecting the sites, sizes, numbers, and the extent of gastric lesions,were similar to those of upper gastrointestinal endoscopy (P > .05) and far greater than those of conventional ultrasonography (P < .01). Moreover, oral contrast-enhanced ultrasonography was far better than upper gastrointestinal endoscopy (P < .01) and was better than conventional ultrasonography (P < .05) in detecting the submucosal abnormalities (<5mm) and the adjacent structures abnormalities identified in surgical pathology. However, oral contrast-enhanced ultrasonography was a bit poorer than upper gastrointestinal endoscopy (P < .05) and far better than conventional ultrasonography (P < .01) in detecting the minor mucosal abnormalities (<5mm). Oral contrast-enhanced gastric ultrasonography is superior to conventional gastric ultrasonography in defining the anatomic location and extension of gastric lesions. Its diagnostic performance is not worse than upper gastrointestinal endoscopy and it can be used as a useful supplement to upper gastrointestinal endoscopy.

Prediction of T stage in gastric carcinoma by enhanced CT and oral contrast-enhanced ultrasonography.

BackgroundThe aim of this study is to explore the values of enhanced CT and oral contrast-enhanced ultrasonography on preoperative T stage in gastric carcinoma.MethodsForty patients with gastric carcinoma, including 27 males and 13 females, were confirmed by endoscopy, operation, and pathology. The median age of these patients was 49 years old (25 to 73 years). There were 19 cases of well-differentiated adenocarcinoma, 13 cases of poorly differentiated adenocarcinoma, 5 cases of signet ring cell carcinoma, and 4 cases of mucinous adenocarcinoma by pathology. All these patients were examined by both enhanced CT and ultrasound examination simultaneously 1 week before surgery. T staging in all these gastric carcinomas was carried out by enhanced CT or oral contrast-enhanced ultrasonography, respectively, or by both of them. The statistical difference between T stage by imaging and pathological T stage was analyzed.ResultsIn this study, there were 5 cases with T1 stage, 9 cases with T2 stage, 20 cases with T3 stage, and 6 cases with T4 stage by pathology; 5 cases with T1 stage, 7 cases with T2 stage, 22 cases with T3 stage, and 6 cases with T4 stage by enhanced CT imaging with an accuracy of 75.00%; 6 cases with T1 stage, 7 cases with T2 stage, 22 cases with T3 stage, and 5 cases with T4 stage by ultrasonography examination, with an accuracy of 77.50%; and 4 cases with T1 stage, 10 cases with T2 stage, 19 cases with T3 stage, and 7 cases with T4 stage by both enhanced CT imaging and ultrasonography examination, with an accuracy of 85.00%. The accuracy of T staging in gastric carcinoma by both enhanced CT and ultrasound was higher than that either by enhanced CT or by ultrasound, respectively (P < 0.05). The anastomosis degree of the gastric carcinoma between enhanced CT and ultrasonography was κ = 0.404.ConclusionsCombination diagnosis of enhanced CT and oral contrast-enhanced ultrasonography is helpful to improve the accuracy of T staging of gastric carcinoma before operations.

Double contrast-enhanced two-dimensional and three-dimensional ultrasonography for evaluation of gastric lesions

To investigate the value of two-dimensional (2D) and three-dimensional (3D) double contrast-enhanced ultrasonography (DCUS) imaging for evaluation of gastric lesions. 2D and 3D DCUS imaging with both oral and intravenous administrations of contrast agents was used to assess gastroscopiclly-confirmed gastric lesions in 46 patients with benign and malignant diseases. Initially, liquid-based ultrasound contrast agent (Xinzhang®) was given orally at dose of 500-600 mL for conventional ultrasound examination of the gastric lesions, and then a microbubble-based contrast agent (SonoVue) was injected intravenously at dose of 1.2-2.4 mL in bolus fashion to assess the perfusion pattern of the lesions using contrast imaging modes. The parameters derived from time-intensity curves including the arrival time (AT), time to peak (TTP), peak intensity (PI) and enhanced intensity (EI) were measured on the 2D DCUS imaging. 3D DCUS of the lesions was acquired to demonstrate the value of this imaging mode. There were 22 cases with benign lesions including chronic gastritis (n = 5), gastric ulcer (n = 9), gastric polyps (n = 3), gastric stromal tumors (n = 5), and 24 cases with malignant lesions including gastric cancer (n = 20), gastric cardia carcinoma (n = 3) and post-operative recurrent gastric cancer (n = 1) in the study. The oral contrast-enhanced ultrasonography (CEUS) imaging of the stomach clearly demonstrated the anatomy of the stomach and morphologic features of gastric lesions. With optimal scanning window and imaging display under oral CEUS, intravenous CEUS clearly showed the perfusion of gastric lesions with various characteristic manifestations. Both 2D and 3D DCUS images clearly demonstrated normal gastric wall as a three-layer structure, from the inside out, hyperechoic mucosa, hypoechoic muscularis and hyperechoic serosa, respectively. There were statistical significant differences of AT (8.68 ± 2.06 vs 10.43 ± 2.75, P = 0.017), PI (34.64 ± 6.63 vs 29.58 ± 8.22, P = 0.023) and EI (29.72 ± 6.69 vs 22.66 ± 7.01, P = 0.001) between malignant lesions and normal gastric wall. However, no differences of AT, PI and EI between benign lesions and normal gastric wall tissue were found. 3D DCUS could intuitively display morphological features and vascularities of the lesions with multiplanar and volume views. 3D DCUS imaging provided comprehensive information complementary to 2D imaging. The crater or wellhead appearances and feeding vessels as well as distorted nourishing vasculature of gastric carcinoma were better seen with 3D imaging than 2D imaging. DCUS imaging can simultaneously display the anatomic and perfusion features of gastric lesions. 3D DCUS can provide additional information to 2D DCUS for evaluation of gastric lesions.

Value of diagnosing superior mesenteric artery syndrome using oral contrast-enhanced ultrasonography in children

Objective To explore oral contrast-enhanced ultrasonography findings in superior mesenteric artery syndrome (SMAS).Methods Twenty-nine patients with SMAS were examined using oral contrast-enhanced ultrasonography,which was confirmed by contrast-enhanced spiral computerized tomography.Results Abdominal ultrasonography with oral contrast-enhanced ultrasonography revealed a significant reduction of the SMA angle and diminished SMA-aorta distance in 29 subjects.Duodenum was showed the indentation and funnel shaped or dumbbell shaped findings which was caused by pressure of the SMA in patients with recumbent position.The proximal part of duodenum expanded distinctively with contrast media movement fro.Ultrasonography and CT examinations had a good agreement in diagnosing pathological aortomesenteric angle and distance.Conclusions Oral contrast-enhanced ultrasonography presents characteristic findings in patients with SMAS,which is useful in epidemiological screening of suspicious cases of SMAS in children. Key words: Ultrasonography; Superior mesenteric artery syndrome; Children

Comparison of preoperative T staging by oral contrast enhanced ultrasonography and double contrast enhanced ultrasonography in advanced gastric carcinoma

To compare the accuracy of preoperative T staging of gastric cancer by oral and intravenous contrast-enhanced gastric ultrasonography. One hundred and forty three patients who had been diagnosed as gastric cancer by endoscopic biopsy and confirmed by pathology after operation were examined by oral and intravenous contrast-enhanced gastric ultrasonography, and they were divided into satisfied group and non-satisfied group according to the 2-D image quality of lesion. The results were compared with postoperative pathologic findings. All the patients with gastric cancer presented regional gastric wall thickening. Among them, 117 cases were clearly presented with good image quality. The remaining 26 cases were presented with vague profile, the ulcerative surface of lesion was filled with hyperechogenicity combined with rear shadow. The accuracy of oral contrast-enhanced ultrasonography in determining the T stage of gastric cancer was 74.1%. The accuracy in satisfied group and non-satisfied group was 78.6% and 53.8%, respectively. The enhancement pattern of 143 cases was showed as hyperenhancement during the arterial phase and hypoenhancement during the portal phase in DCUS. The accuracy of double contrast-enhanced ultrasongraphy in determining the T stage of gastric cancer was 86.7%, but the accuracy in satisfied group and non-satisfied group was 88.9% and 76.9%, respectively. There was a significant difference between the two methods (χ(2) = 9.031, P < 0.01). DCUS is more accurate than oral contrast-enhanced ultrasonography as a useful diagnostic method for preoperative T staging of gastric cancer.

Diagnostic value of double contrast-enhanced ultrasonography in preoperative staging of gastric cancer

To evaluate the clinical value of double contrast-enhanced ultrasonography using oral and intravenous contrast agents in preoperative staging of gastric cancer. Sixty-two patients with biopsy-proven gastric cancer were enrolled into this study, and were examined by double contrast-enhanced gastric ultrasonography preoperatively. The results were compared with postoperative pathologic findings. The accuracy of oral contrast-enhanced gastric ultrasonography and double contrast-enhanced ultrasonography in determining the T stage of gastric cancer was 72.9% (T1: 66.7%, T2: 60.0%, T3: 76.9%, T4: 71.4%) and 88.1% (T1: 66.7%, T2: 80.0%, T3: 89.7%, T4: 100%), respectively, with a statistically significant difference between the two methods (P = 0.036). The sensitivity, specificity, accuracy and Youden index of oral contrast-enhanced gastric ultrasonography and double contrast-enhanced ultrasonography in assessment of lymph node metastasis were 74.5%, 66.7%, 72.9%, and 0.41 versus 89.4%, 75.0%, 86.4%, 0.76, respectively. No significant difference in the accuracy of assessment for lymph node metastasis was observed (P > 0.05). Double contrast-enhanced ultrasonography is useful for preoperative staging of gastric cancer, especially for T staging.