Contrast-enhanced Ultrasound Quantitative Analysis Research Articles

Quantitative analysis of contrast-enhanced ultrasonography: differentiating focal nodular hyperplasia from hepatocellular carcinoma

To explore the potential of quantitative analysis of contrast-enhanced ultrasonography (CEUS) in differentiating focal nodular hyperplasia (FNH) from hepatocellular carcinoma (HCC). 34 cases of FNH and 66 cases of HCC (all lesions <5 cm) were studied using CEUS to evaluate enhancement patterns and using analytic software Sonoliver® (Image-Arena™ v.4.0, TomTec Imaging Systems, Munich, Germany) to obtain quantitative features of CEUS in the region of interest. The quantitative features of maximum of intensity (IMAX), rise slope (RS), rise time (RT) and time to peak (TTP) were compared between the two groups and applied to further characterise both FNH and HCC with hypoenhancing patterns in the late phase on CEUS. The sensitivity and specificity of CEUS for diagnosis of FNH were 67.6% and 93.9%, respectively. For quantitative analysis, IMAX and RS in FNHs were significantly higher than those in HCCs (p<0.05), while RT and TTP in FNHs were significantly shorter (p<0.05). Both the 11 FNHs and 62 HCCs with hypo-enhancing patterns in the late phase were further characterised with their quantitative features, and the sensitivity and specificity of IMAX for diagnosis of FNH were 90.9% and 43.5%, RS 81.8% and 80.6%, RT 90.9% and 71.0%, and TTP 90.9% and 71.0%, respectively. The quantitative features of CEUS in FNH and HCC were significantly different, and they could further differentiate FNH from HCC following conventional CEUS. Our findings suggest that quantitative analysis of CEUS can improve the accuracy of differentiating FNH from HCC.

Quantitative analysis of contrast-enhanced ultrasound in the evaluation of YC-1 effect

Objective To explore the value of contrast-enhanced ultrasound quantitative analysis in the evaluation of YC-1 effect on transplanted tumor of human gastric carcinoma in nude mice.Methods The transplanted tumor model of human gastric carcinoma in nude mice was established by injecting SGC7901/displatin (DDP) cells into the subcutaneous space of 24 nude mice.The mice were randomized into four groups as control group ( DMSO given),DDP group ( DDP given),YC-1 group (YC-1 given) and YC-1 + DDP group ( both YC-1 and DDP given).Contrast-enhanced ultrasound was performed one week after withdrawl and the dynamic image was analyzed quantitatively using SonoLiver software.For each tumor,two ROIs as ROItotal (including the total tumor) and ROIsmall (including the highest enhanced part of the tumor)were drawn and parameters including time-to-peak (TTP),rise time (RT),mean transit time (mTT),maximun intensity ( Imax),R10,R20 and R30 ( descending velocity-the rate of intensity at TTP + 10/20/30 s to Imax) and ascending velocity (Vasc) were recorded for the statistical analysis.Results No parameter had significant difference between control group and DDP group or between YC-1 group and YC-1 + DDP group in both ROIsamll and ROItotal (P ＞ 0.05 ).The mice were regrouped into YC-1-treated-group and non-YC-1-treated-group.For ROItotal,no parameter had significant difference between the two groups (P ＞ 0.05 ).For ROIsmall,microbubbles in YC-1-treated-group reached the peak earlier (TTP:5.47 ±0.93 vs 8.05 ±2.00; RT:4.99 ±0.96 vs 7.67 ± 1.78,P＜0.05) and regressed faster (mTT:37.49 ± 19.51 vs 98.94 ±60.97; R10:0.39 ±0.15 vs 0.55 ±0.08; R20:0.30 ±0.10 vs 0.43 ±0.10; R30:0.25 ±0.08 vs0.33±0.08) than in non-YC-1-treated-group (P＜0.05).Conclusion Contrast-enhanced ultrasound quantitative analysis could reflect the change of tumor blood supply after antiangiogenesis treatment.ROIsmall was more suitable and sensitive than ROItotal to evaluate antiangiogenesis effect. Key words: Ultrasonography ; Contrast media; Neovascularization

Quantitative evaluation of contrast-enhanced ultrasound after intravenous administration of a microbubble contrast agent for differentiation of benign and malignant thyroid nodules: assessment of diagnostic accuracy

To investigate the diagnostic accuracy, through quantitative analysis, of contrast-enhanced ultrasound (CEUS), using a microbubble contrast agent, in the differentiation of thyroid nodules. This prospective study enrolled 46 patients with solitary, scintigraphically non-functional thyroid nodules. These patients were scheduled for surgery and underwent preoperative CEUS with pulse-inversion harmonic imaging after intravenous microbubble contrast medium administration. Using histology as a standard of reference, time-intensity curves of benign and malignant nodules were compared by means of peak enhancement and wash-out enhancement relative to the baseline intensity using a mixed model ANOVA. ROC analysis was performed to assess the diagnostic accuracy in the differentiation of benign and malignant nodules on CEUS. The complete CEUS data of 42 patients (31/42 [73.8%] benign and 11/42 [26.2%] malignant nodules) revealed a significant difference (P < 0.001) in enhancement between benign and malignant nodules. Furthermore, based on ROC analysis, CEUS demonstrated sensitivity of 76.9%, specificity of 84.8% and accuracy of 82.6%. Quantitative analysis of CEUS using a microbubble contrast agent allows the differentiation of benign and malignant thyroid nodules and may potentially serve, in addition to grey-scale and Doppler ultrasound, as an adjunctive tool in the assessment of patients with thyroid nodules. • Contrast-enhanced ultrasound (CEUS) helps differentiate between benign and malignant thyroid nodules. • Quantitative CEUS analysis yields sensitivity of 76.9% and specificity of 84.8%. • CEUS may be a potentially useful adjunct in assessing thyroid nodules.

Gray-scale Contrast-enhanced Ultrasonography for Quantitative Evaluation of the Blood Perfusion of the Sciatic Nerves with Crush Injury

Blood perfusion of peripheral nerves plays an important role in regeneration after nerve injury. Functional recovery after a peripheral nerve injury depends not only on the survival of the affected neurons but also on the recovered blood perfusion. Previous studies have shown that it is possible to quantitatively assess blood perfusion of tissue using contrast-enhanced ultrasound (CEUS). The aim of this study was to evaluate the usefulness of CEUS for the quantitative evaluation of blood perfusion of the sciatic nerves with crush injury. Crush injuries were created in the left sciatic nerve of 30 New Zealand white rabbits. CEUS of the bilateral sciatic nerves was performed in six experimental rabbits at 3 days, 1 week, 2 weeks, 4 weeks, and 8 weeks after injury. Pulse-inversion harmonic imaging was used for real-time CEUS. The other six rabbits were used as a control group. Serial laser Doppler measurements of blood flow and quantitative histologic evaluation were performed parallel to CEUS on all animals. Quantitative analysis of CEUS showed that the perfusion index of the crushed sciatic nerves was increased at 3 days after injury, with a peak at 1 week after injury (P = .000). The area under the curve for the crushed sites was increased at 3 days after injury, with a peak at 2 weeks after injury (P = .000). The mean transit time and maximum intensity of the crushed site of the left sciatic nerves were not significantly changed during the 2 months after injury (P = .335 and P = .157 respectively). The perfusion indices measured by CEUS correlated well with those measured by laser Doppler (r = 0.791, P = .000). Marked Wallerian degeneration was found at the crushed site of sciatic nerves at 3 days after injury. The percentage of degenerated myelinated axons was increased during the first 2 weeks after injury and then decreased during the following period. Regenerated axons with small diameter and thin myelin sheaths were found at 2 weeks after injury and during the following period. CEUS may provide a new imaging method to quantitatively analyze blood perfusion of injured peripheral nerves.

Contrast-enhanced ultrasound in the characterisation of breast masses: utility of quantitative analysis in comparison with MRI

To evaluate the reliability of contrast-enhanced ultrasound quantitative analysis (CE-US) in characterizing breast lesions, in comparison with MRI. Thirty-nine patients with breast lesions BI-RADS 3-5 at US or mammography underwent CE-US and MRI. All lesions underwent histological and quantitative enhancement evaluation with both imaging methods. B-mode US, colour/power Doppler US and CE-US were used; an amplitude and phase modulation technique (CPS) read the signals produced by microbubbles and dedicated software produced the following parameters on time/intensity (T/I) curves: peak %, time to peak (TTP), mean transit time (MTT), regional blood volume (RBV) and regional blood flow (RBF). Student's t test was used to calculate the diagnostic accuracy of CE-US parameters compared with histological results. MRI (1.5 T) was performed before and after bolus gadolinium enhancement. Time/intensity curves were generated for all nodules and Fischer's multimodal score was used to classify them. Pathology showed 43 nodules (11 benign; 32 malignant). Peak and RBF were the most significant parameters in differential diagnosis, with p values of 0.02 and 0.004, respectively. Positive predictive value (PPV) of CE-US evaluation was 91%, negative predictive value (NPV) was 73% with a high concordance index (k = 0.59) with MRI. CE-US quantitative analysis offers an objective and reproducible assessment of lesion vascularisation, with good correlation with the results of MRI.

Assessment of antiangiogenic therapy in a nude murine hepatocellular carcinoma model with real-time gray-scale contrast-enhanced ultrasonography

Objective To assess intratumoral microvascular perfusion changes by real-time gray-scale contrast-enhanced ultrasonography(CEUS) in a nude murine hepatocellular carcinoma model treated with angiogenesis inhibitor,and to investigate the applicative value of quantitative analysis of CEUS. Methods Human hepatocellular carcinoma xenograft model was established in thirty nude mice subcutaneously. Fifteen nude mice were treated with an inhibitor of vascular endothelial growth factor receptors (pazopanib) by oral administration and fifteen nude mice were set as control. Volume measurement and CEUS were performed 3 days before treatment, 7 days, 14 days and 21 days after treatment, respectively. Regions of interest within tumors were analyzed off-line to perform time-intensity curves and determine CEUS parameters. The relation between CEUS parameters and necrosis index of pathology were investigated. Results The relative tumor proliferation rate in the treatment group was 41% on 21 days after treatment. Increased signal intensity (ISI),area under the curve (AUC) and blood flow coefficient (BF) were lower in the treatment tumors than those in the control tumors,in addition slope of decrease to half of peak (a2) and slope of rise time (a3) was higher (P<0.05). CEUS parameters correlated with the volume growth rate in treatment tumors,respectively (P<0.05). A3 and ISI were negative correlated with necrosis index (r=-0.54, P=0.008; r=-0.46, P=0.027). Conclusions Real-time gray-scale CEUS reflects changes of microvascular perfusion in tumors objectively, which is potential in monitoring tumor vascular response to antiangiogenic therapy. Key words: Ultrasonography; Microbubbles; Liver neoplasms, experimental; Neovascularization, pathologic

O117 Contrast-enhanced ultrasound quantitative analysis of neovascularization within carotid atherosclerotic soft plaques in patients with cerebral infarction

O117 Contrast-enhanced ultrasound quantitative analysis of neovascularization within carotid atherosclerotic soft plaques in patients with cerebral infarction