Second-generation Contrast Agent Research Articles

Contrast Enhanced Sonography of Focal Splenic Lesions with a Second-Generation Contrast Agent

Contrast enhanced sonography (CES) of second generation contrast media have shown a spleen-specific uptake of the microbubble contrast agent. The aim of this study was to investigate the ability of a second generation contrast agent to enhance splenic lesions. From October 2003 to September 2004, 46 consecutive patients with focal (peri-) splenic lesions on B-mode sonography were studied by CES using a transpulmonary second-generation contrast agent (SonoVue). Data were retrospectively evaluated. Diagnosis of the patients were infarction (n = 9), lymphoma (n = 7), metastasis (n = 6), injury (n = 4), haemangioma/splenoma (n = 6), accessory spleen (n = 3), cyst (n = 2), and unknown cause (n = 9). Diagnosed of splenic lesions was confirmed by histology (n = 5), contrast enhanced computed tomography (n = 25), MRI (n = 4), scintigraphy (n = 1), and follow up (n = 38). Extent of enhancement (EE) was evaluated during the arterial phase (5-30 s) and the parenchymal phase (3-5 minutes): EE of focal splenic lesions was determined using the surrounding splenic tissue as an in vivo reference, and classified as anechoic vs. hypoechoic vs. isoechoic vs. hyperechoic vs. mixed. The contribution of CES to the final diagnosis was classified as low, helpful or highly necessary. In all but one patient enhancement of normal splenic tissue occurred. During the arterial and parenchymal phase, lesions were found to have anechoic 10/10, hypoechoic 12/24, isoechoic 12/7, hyperechoic 7/0 and mixed enhancement 5/5, respectively. Value of CES for final diagnosis was low n = 24 (52%) (7 lymphomas, 6 metastases, 2 cysts, 9 unknown), helpful n = 9 (20%) (4 infarctions, 2 ruptures, 3 accessory spleens) and highly necessary n = 13 (28%) (5 infarctions, 2 ruptures, 6 haemangiomas/splenomas). Contrast-enhanced sonography is of diagnostic value in subgroups of patients with (peri-)splenic lesions (48%): including splenic infarction, splenic rupture, splenic haemangioma/splenoma, and accessory spleen.

The Use of Contrasted Transvaginal Sonography in the Diagnosis of Gynecologic Diseases

The purpose of this study was to evaluate the efficacy of a new contrast-dedicated ultrasound technology, contrast-tuned imaging (CnTI), implemented on an endovaginal probe and using the second-generation contrast agent SonoVue (Bracco International BV, Amsterdam, the Netherlands), compared with the standard ultrasound examination in different gynecologic diseases. Eighty-nine patients were enrolled in the study in 4 different clinical centers. The study included 40 patients with uncertain pelvic adnexal masses, 10 patients with pelvic masses indicative of recurrences of gynecologic tumors, 26 patients with uterine pathologic features, and 13 patients with cervical lesions. Application of CnTI technology after the SonoVue injection gave a picture of the intralesional microvascularization dramatically different from that obtained during color Doppler examination. Of the 40 pelvic masses, 15 (37.5%) were considered benign and 25 (62.5%) were considered malignant at B-mode and color Doppler examinations. Contrast-enhanced sonography showed no intralesional contrast perfusion in 11 (73%) of 15 cases, and all these were benign at final diagnosis. Of the 4 (27%) cases that had perfusion, 2 were malignant. Conversely, of the 25 cases with positive findings at color Doppler examination and therefore expected to show the appearance of contrast tissue-filling morphologic characteristics, 13 (52%) were malignant at final diagnosis. For evaluation of uterine pathologic features, the CnTI-SonoVue technology did not appear to be superior to the B-mode and color Doppler examinations; however, for the evaluation of cervical cancer, CnTI-SonoVue technology revealed a better definition of the margins of the neoplastic lesions in 4 (40%) of 10 cases. In the evaluation of uncertain pelvic masses, the CnTI technology led to an improvement in the ability of the practitioner to differentiate benign from malignant adnexal lesions.

Effect of Angiosonography to Monitor Response During Imatinib Treatment in Patients with Metastatic Gastrointestinal Stromal Tumors

Gastrointestinal stromal tumor (GIST) metastases are typically intra-abdominal and hypervascular. We assessed the effect of angiosonography with a second-generation contrast agent to monitor response during imatinib treatment in patients with metastatic KIT+ GIST. Ten consecutive patients with known advanced KIT+ GIST were investigated with angiosonography and computerized tomography (CT). We also monitored the serum levels of the major angiogenic growth factor, vascular endothelial growth factor. Angiosonography showed a reduction in tumor vascularization of liver metastases during imatinib treatment in all cases. We observed a reduction in tumor vascularization before a reduction in tumor size. The tumor perfusion appeared reduced in the central part of the liver metastases. With a median follow-up of 18 months (range 3-33), a reduction in tumor vascularization was initially observed in all patients, but progressive disease was documented in four patients following imatinib treatment. CT documented tumor response according to standardized criteria in six patients, stable disease in four, and progressive disease according to angiosonography. The reduction of tumor perfusion at angiosonography correlated with the pseudocystic appearance at CT. The "nodule(s) within a mass" pattern of recurrence occurred in two patients with no difference observed between angiosonography and CT. Early decreasing serum vascular endothelial growth factor levels were observed in the two cases with higher pretreatment levels. Imatinib could induce antiangiogenic and/or antivascular effects in GIST, and this effect could be easily monitored with angiosonography. Angiosonography might be a useful complement for monitoring the therapeutic effect of imatinib in these patients.

Contrast‐enhanced gray‐scale harmonic ultrasound in the efficacy assessment of ablation treatments for hepatocellular carcinoma

The aim of this study was to compare contrast-enhanced gray-scale harmonic ultrasound with multiphasic spiral computed tomography in the assessment of treatment efficacy of non-surgically treated HCC. We studied 56 HCCs treated by percutaneous ethanol injection (31 cases), radiofrequency ablation (three cases), trans-arterial chemoembolization (12 cases), and combined treatment (10 cases). The efficacy of therapies was blindly assessed by multiphasic computed tomography and gray-scale harmonic ultrasound with a second-generation contrast agent (sulfur hexafluoride). On computed tomography 30 tumors (53.6%) showed complete necrosis, while 26 lesions (45.4%) were still viable. On contrast-enhanced ultrasound examination 33/56 nodules (58.9%) had no contrast enhancement in the arterial phase, while 23/56 lesions (41.1%) were still vascularized. All the nodules assessed as completely necrotic on computed tomography did not show arterial enhancement on contrast-enhanced ultrasound and diagnostic agreement was found in 53/56 cases (94.6%) (P<0.001). Contrast-enhanced ultrasound demonstrated relative sensitivity and specificity of 87.0% and 98.4%. Contrast-enhanced harmonic ultrasound is promising in the efficacy evaluation of ablation treatments for HCC. Nodules vascularized in the arterial phase on contrast harmonic ultrasound should be considered still viable and addressed to additional treatment without further evaluation.

258 Real time characterization of focal liver lesions using contrast-enhanced ultrasound after the injection of sonovue, a second-generation contrast agent

258 Real time characterization of focal liver lesions using contrast-enhanced ultrasound after the injection of sonovue, a second-generation contrast agent

Contrast-Enhanced Sonography with SonoVue: Enhancement Patterns of Benign Focal Liver Lesions and Correlation with Dynamic Gadobenate Dimeglumine–Enhanced MRI

Contrast-enhanced real-time low-mechanical-index sonography is a new diagnostic technique for the assessment of macro- and microcirculation. The purpose of our article is to describe contrast-enhancement patterns of different benign focal liver lesions using the second-generation contrast agent SonoVue and to compare these findings with those of gadobenate dimeglumine-enhanced MRI. SonoVue-enhanced real-time low-mechanical-index sonography provides specific contrast-enhancement patterns of different benign focal liver lesions, allowing accurate characterization. Findings on SonoVue-enhanced sonography correlate well with those obtained on gadobenate dimeglumine-enhanced MRI.

Kontrastverst�rkte Sonographie der Leber

The detection rate of liver lesions using ultrasonography is 53-77%, rendering this method inferior to CT and MRI. Despite well-known limitations, development of stable second-generation contrast agents in conjunction with new techniques of contrast display has led to increased diagnostic accuracy. Characterization of focal liver lesions with ultrasound contrast agents follows known features of iodine- and gadolinium-containing contrast agents, but compared to CT and MRI sensitive visualization of intratumoral vessels takes place in real time. In addition to very high diagnostic accuracy in differentiating benign from malignant lesions, detectability of tumors of nonhepatocellular origin is increased significantly and direct assessment of treatment success with minimally invasive tumor ablative interventions in the liver is possible. The active principle of ultrasound contrast agents, examination technique as well as distinguishing features and appearance of various, frequently observed focal liver lesions are illustrated by cases from our department.

Contrast-Enhanced Sonographic Appearance of Hepatocellular Carcinoma in Patients with Cirrhosis: Comparison with Contrast-Enhanced Helical CT Appearance

We sought to investigate the efficacy of contrast-enhanced sonography using a second-generation contrast agent for the evaluation of hepatocellular carcinoma in patients with cirrhosis by comparing the results to those obtained with contrast-enhanced helical CT. Between October 2002 and March 2003, 74 patients with cirrhosis (60 men and 14 women; age range, 47-80 years; mean age, 67 years) who had a single nodule of hepatocellular carcinoma were selected to be studied from a cohort of 437 patients with cirrhosis. The size range of the 74 nodules was 9-65 mm (mean, 28.2 mm). Twenty-eight (38%) were 20 mm smaller (range, 9-20 mm; mean, 16.6 mm), and 46 (62%) were larger than 20 mm (range, 21-65 mm; mean, 35.2 mm). Contrast-enhanced sonography was performed at a low mechanical index after IV administration of the contrast agent SonoVue. CT scans were obtained in all patients. The enhancement pattern related to tumor hypervascularity was analyzed. The chi-square test was used for statistical analysis. For the 28 hepatocellular carcinomas 20 mm or smaller, contrast-enhanced sonography showed 15 (53.6%) as hypervascular and 10 (35.7%) as avascular; three (10.7%) carcinomas were missed. On CT, 12 (42.9%) of the 28 hepatocellular carcinomas appeared hypervascular, 13 (46.4%) appeared hypovascular, and three (10.7%) were missed. For the 46 hepatocellular carcinomas larger than 20 mm, contrast-enhanced sonography showed 42 (91.3%) as hypervascular and four (8.7%) as avascular. On CT, 35 (76.1%) hepatocellular carcinomas appeared hypervascular, eight (17.4%) appeared hypovascular, and three (6.5%) were missed. Differences between CT appearance of hepatocellular carcinomas and contrast-enhanced sonographic appearance of the carcinomas were not statistically significant. Concordance between contrast-enhanced sonographic and CT appearances was observed in 61 (82.4%) of 74 cases. Contrast-enhanced sonography is similar to CT for detecting hepatocellular carcinoma hypervascularity. It could be complementary to conventional unenhanced sonography for evaluation of liver nodules.

Abdominal aortic aneurysm: contrast-enhanced US for missed endoleaks after endoluminal repair.

To evaluate contrast material-enhanced ultrasonography (US) for depiction of endoleaks after endovascular abdominal aortic aneurysm repair (or endovascular aneurysm repair [EVAR]) in patients with aneurysm enlargement and no evidence of endoleak. From November 1998 to February 2003, 112 patients underwent EVAR. At follow-up, duplex US and biphasic multi-detector row computed tomographic (CT) angiography were performed. In 10 patients (group A), evident aneurysm enlargement was observed, with no evidence of complications, at both CT angiography and duplex US. Group A patients, 10 men (mean age, 69.6 years +/- 10 [standard deviation]), underwent US after intravenous bolus injection of a second-generation contrast agent, with continuous low-mechanical index (0.01-0.04) real-time tissue harmonic imaging. Group B patients, 10 men (mean age, 71.3 years +/- 8.2) with aneurysm shrinkage and no evidence of complications, and group C patients, 10 men (mean age, 73.2 years +/- 6) with CT angiographic evidence of endoleak, underwent contrast-enhanced US. Digital subtraction angiography (DSA) was performed in groups A and C. Endoleak detection and characterization were assessed with imaging modalities used in groups A-C; at contrast-enhanced US, time of detection of endoleak, persistence of sac enhancement, and morphology of enhancement were evaluated. In group A, contrast-enhanced US depicted one type I, six type II, one type III, and two undefined endoleaks that were not detected at CT angiography. All leakages were characterized by slow and delayed echo enhancement detected at longer than 150 seconds after contrast agent administration. DSA results confirmed findings in all patients; percutaneous treatment was performed. In group B, contrast-enhanced US did not show echo enhancement; in group C, results with this modality confirmed findings at CT angiography and DSA. Contrast-enhanced US depicts endoleaks after EVAR, particularly when depiction fails with other imaging modalities.

Ultrasonographic contrast-enhanced study of sicca syndrome

Objective: To assess the ability of US contrast-enhanced time–intensity curves to depict the changes connected with sicca syndrome, a fairly common condition that is often associated with autoimmune disorders such as Sjogren's syndrome or other diseases. Diagnostic criteria are complex and controversial and although no single test can be considered the gold standard, salivary gland scintigraphy and biopsy are reliable diagnostic methods. Materials and methods: Sixty consecutive patients with sicca syndrome, 40 of whom had primary ( n = 23) or secondary ( n = 17) Sjogren's syndrome and 20 had non-Sjogren's sicca syndrome, selected according to European Community Study Group diagnostic criteria for Sjogren's syndrome and subjected to contrast-enhanced US imaging of the parotids using a second-generation contrast agent with analysis of time–intensity curves at rest and during salivary stimulation, Tc99m salivary gland scintigraphy and labial gland biopsy. Results: In the 40 Sjogren's patients, US enhancement values were significantly lower ( P < 0.0001 and P < 0.00003, respectively) than in the 20 non-Sjogren's patients both at rest and during stimulation. In the 23 subjects with the primary syndrome, values during stimulation were significantly lower than in the 17 subjects with the secondary syndrome ( P < 0.0006), whereas at rest differences were not significant. Contrast-enhanced US imaging allowed to discriminate Sjogren's from non-Sjogren's sicca patients with 87.5% sensitivity, 85% specificity and 86.7% accuracy and the primary from the secondary syndrome with 78.2% sensitivity, 70.5% specificity and 75% accuracy. Interestingly, in eight patients with the primary syndrome, i.e. those with the more severe gland involvement, enhancement values were lower during stimulation than at rest. Conclusion: Preliminary results indicate that contrast-enhanced US imaging can provide useful information on sicca characterisation and severity.

Effect of angio-echography with a second-generation contrast agent to assess tumor response to imatinib treatment in patients with advanced gastrointestinal stromal tumor (GIST): Comparison with computerized tomography (CT)

4216 Background: GIST metastases are typically intra-abdominal and hypervascular. BR1 (Sonovue, Bracco, Milan, Italy) is a new blood pool second-generation contrast agent, which consists of stabilized microbubbles of a totally innocuous sulphur hexafluoride gas. We report preliminary results with angio-echography with BR1 (AE) to assess tumor response (TR) to imatinib treatment (IT) in patients (pts) with advanced GIST. Methods: Twelve consecutive pts with known advanced cKIT+ GIST were investigated prospectively. CT and AE were performed before IT and then at 1, 2, 4, 6, and then every 3 months during IT. A strict prospective evaluation with AE was performed in 2 pts at 1, 2, 4, 6, 8 weeks during IT. Results: At a median follow-up of 12 months (range 4–18), in the 11 evaluable pts CT documented TR in 5 (46%) pts and stable disease (SD) in 4 (36%) RECIST criteria), while AE showed early TR in all these 9 (82%) cases. The median time to TR by RECIST criteria at CT was 4 months (range 1–9), while TR was observed at the first AE, and after 2 weeks in the 2 cases receiving strict AE evaluation. During IT, in 1 case CT showed increase of liver metastases, but AE demonstrated TR with intra-tumoral edema. Compared with CT, AE better depicted liver subcentimetric metastases. No differences between CT and AE were seen in the evaluation of extra-hepatic metastases. Conclusions: In large studies, CT (RECIST criteria) showed TR (54%) or SD (34%) associated with IT, which correlated closely with a finding of ≥50% decrease in FDG uptake on PET scan in 89% of pts. In our study, AE improved the display of tumor vascularity as well as the accuracy in differentiating between SD and TR. The effective TR to IT in GISTs might be superior to that showed by CT only, according to RECIST criteria. The close relation between clinical outcome and the findings on AE indicates that such scanning might be an useful complement to standard anatomical imaging for monitoring the therapeutic effect of imatinib in pts with GIST. Large prospective studies are warranted. No significant financial relationships to disclose.

Effect of angio-echography with a second-generation contrast agent to assess tumor response to imatinib treatment in patients with advanced gastrointestinal stromal tumor (GIST): Comparison with computerized tomography (CT)

4216 Background: GIST metastases are typically intra-abdominal and hypervascular. BR1 (Sonovue, Bracco, Milan, Italy) is a new blood pool second-generation contrast agent, which consists of stabili...

Contrast-Enhanced Second-Harmonic Sonography in the Detection of Pseudocapsule in Renal Cell Carcinoma

Our purpose was to assess the capacity of contrast-enhanced second-harmonic sonography to detect a pseudocapsule in renal masses compared with conventional gray-scale sonography. SUBJECTS AND METHODS. Thirty-two patients with 40 renal masses suspicious for renal cancer (mean diameter, 3.1 cm) were prospectively studied with contrast-enhanced second-harmonic sonography during IV administration of a second-generation sonographic contrast agent. The sonographic criteria for the presence of a pseudocapsule were a peritumoral hypoanechoic halo on conventional gray-scale imaging and a rim of perilesional enhancement, increasing in the tardive phase of the examination, on contrast-enhanced second-harmonic imaging. Multiphasic helical CT or dynamic MRI or both were performed in all patients. Final diagnoses of the 40 renal masses were as follows: hemorrhagic cysts, five; angiomyolipomas, four; lymphomas, four; metastasis from lung cancer, one; and renal cell carcinomas (RCCs), 26. Histologic diagnosis of RCC was surgically obtained in all patients. Nephron-sparing surgery was performed in 12 of 26 RCCs, and radical nephrectomy was performed in the remaining 14. At pathologic examination, pseudocapsule was found in 14 (53.8%) of 26 RCCs. On conventional sonography, the presence of a pseudocapsule was detected in 3 of 14 RCCs (sensitivity, 21%). Sonographic contrast-enhanced harmonic imaging revealed the presence of pseudocapsule in 12 of 14 RCCs (sensitivity, 85.7%). In the remaining 12 RCCs with either absent or extensive neoplastic infiltration of pseudocapsule seen at pathologic evaluation, pseudocapsule was not visible on either conventional or contrast-enhanced second-harmonic sonography. The pseudocapsule was not visible in any of the 14 noncancerous renal masses on either conventional or contrast-enhanced sonography. Sonographic contrast-specific imaging with a second-generation contrast agent is effective in improving the sonographic visualization of tumoral pseudocapsule. This finding could be useful both in the sonographic diagnosis and in the choice of conservative surgery for renal cell carcinoma. The potential role of second-harmonic contrast-enhanced sonography in the management of renal cell carcinoma should be investigated in larger series and compared with the findings of state-of-the-art MRI and CT.

Evaluation of Lymph Node Perfusion Using Continuous Mode Harmonic Ultrasonography With a Second‐Generation Contrast Agent

To evaluate the contribution of continuous mode contrast-enhanced harmonic ultrasonography (CE-HUS) with a second-generation contrast agent to the characterization of superficial lymphadenopathies with respect to conventional ultrasonographic techniques (B-mode and power Doppler). Fifty-six lymph nodes from 45 patients were studied both by conventional techniques and by CE-HUS. The dimensions, intranodal architecture, margins, and location of vessels were evaluated. Subsequently, all the lymph nodes were examined by CE-HUS, and enhancement of echogenicity was evaluated. The diagnoses obtained by means of fine-needle aspiration cytologic examination, surgical biopsy, or both were compared with those obtained by ultrasonography. Of the lymph nodes examined, 30 were benign and 26 were malignant (18 metastases and 8 non-Hodgkin lymphomas). The study using CE-HUS showed intense homogeneous enhancement in 28 of 30 reactive lymph nodes; perfusion defects in 17, of which 15 were neoplastic and 2 were inflammatory; intense but inhomogeneous speckled enhancement in the early arterial phase in 5 cases of lymphoma; and, last, scarce or absent intranodal enhancement in 4 metastases. The specificity, sensitivity, and accuracy of conventional techniques in differentiation between benign and malignant lymph nodes were 76%, 80%, and 78% versus 93%, 92%, and 92.8% for CE-HUS. The increase in correct diagnoses was significant (P = .05) when conventional ultrasonography was tested against CE-HUS. Superficial lymph nodes can be characterized as being neoplastic or benign with a high degree of diagnostic accuracy on the basis of the perfusion characteristics evaluated by CE-HUS. This technique has been shown to afford a higher degree of accuracy than currently obtainable by any other ultrasonographic technique.

Harmonic US imaging of vesicoureteric reflux in children: usefulness of a second generation US contrast agent.

Contrast-enhanced voiding urosonography (VUS) is largely accepted both for the diagnosis and follow-up of vesicoureteric reflux (VUR) in children. To evaluate the usefulness of contrast-enhanced second-harmonic VUS in the diagnosis and grading of VUR, using a second-generation contrast agent. Eighty consecutive children were prospectively studied with contrast-enhanced second-harmonic VUS. All children received a second-generation contrast medium, constituted by phospholipid-stabilized microbubbles of sulphur-hexafluoride (SonoVue, Bracco, Milan, Italy). US monitoring of the bladder, of the retrovesical space and of the kidneys was performed using, alternatively, both tissue-harmonic and contrast-harmonic modes. In those young boys where VUR was depicted at VUS, examination was completed with transperineal, sagittal urethral exploration during micturition. VUR was graded in five steps and diagnoses were compared with voiding cystourethrography (VCUG). VUR was diagnosed in 52 reno-ureteral units with VUS. In 49 of these reno-ureteral units, VCUG confirmed the presence of VUR. In comparison to VUS, sensitivity and negative predictive value of VCUG were inferior. The grade of VUR detected at VUS was higher than that detected at VCUG in three units. In no case was the grade of VUR detected at VCUG higher than the one detected at VUS. The differences between VUS and VCUG in grading VUR were statistically significant (p=0.02). Imaging of the normal posterior urethra was skilfully demonstrated with US in 15 young boys with VUR. No statistically significant differences were found between tissue-harmonic and contrast-harmonic mode (p=0.102). Contrast-enhanced second-harmonic VUS is a sensitive and easy technique for the evaluation of VUR. A second-generation US contrast medium such as SonoVue, if available, should be the first choice as the dose required for one examination is much lower and consequently significant reduction of contrast agent cost is possible.

Échographie de contraste des tumeurs hépatiques

Second-generation ultrasound contrast agents are gas microbubbles that are injected into a peripheral vein and enhance the backscattered ultrasound from the blood vessel lumen. The non-linear signal produced by the bubbles can be differentiated from the tissue signal. No severe adverse events have been reported, and these agents can be used in patients who are at high risk due to heart failure, renal failure, or pulmonary hypertension. In patients with liver disease, contrast-enhanced ultrasonography provides an evaluation of the microvessels within focal nodular lesions and a characterization of benign and malignant lesions similar in terms of semiology and reliability to that obtained with computed tomography. Second-generation contrast agents substantially improve the results of ultrasonography for detecting and quantifying liver metastases. Adaptations to the ultrasound equipment must be made to allow use of these agents.

Focal liver lesions: evaluation with contrast-enhanced ultrasonography.

The development of contrast agents for ultrasound has significantly extended its clinical applications, particularly in the detection and characterization of focal liver lesions. Real-time evaluation of the vascular phase currently can be achieved by combining new microbubble-specific methods with second-generation contrast agents. The enhancement pattern in the vascular phase combined with the behavior in the liver-specific late phase allows characterization of the most frequent focal liver lesions, with an accuracy similar to those of dynamic computed tomography and magnetic resonance imaging.

Characterization of focal liver lesions with contrast-enhanced ultrasound.

The development of second-generation contrast agents and newer specific contrast imaging methods has improved the accuracy of US in the characterization of FLLs using a combination of vascular and parenchymal approaches. CEUS provides crucial diagnostic information about the pattern enhancement of the most frequent FLLs, and can be usefully employed as a first-line technique when a FLL is detected using US.

Ultrasound/color Doppler with low mechanical index technique (CE-US/CD low MI) and ultrasound contrast media in follow-up of patients with aortic endoprosthesis

Objective: The aim of this study was to evaluate the diagnostic efficacy of ultrasound color Doppler with second-generation contrast agent in follow-up of aortic endo-prosthesis performing both modules with harmonic low MI technique (CE-US/CD low MI).Methods: 18 patients with aortic endoprosthesis underwent a baseline color Doppler and a CE-US/CD low MI examination in early follow-up after procedure; Sono Vue® was used as contrast agent; the examinations were performed at the bedside of patients. Multislice CT was performed in each patient before being discharged from hospital; the late follow-up was carried out in the first following months through the above-mentioned US techniques. If any suspicion of endoleak raised from CE-US/CD low MI and CT examinations (early follow-up), digital subtracted angiography (DSA) confirmed the diagnosis and allowed the treatment in the same session.Results: Baseline color Doppler detected a lower number of endoleaks in comparison with CE-US/CD low MI and was invalidated by false positives (due to movement artefacts or to low PRF). CE-US/CD low MI showed a high diagnostic agreement with CT in endoleak detection: the information concerning the flow direction provided by CE-US/CD low MI (chromatic code) enabled to identify the endoleak type.Conclusions: CE-US/CD low MI examination is to be considered a promising non-invasive diagnostic tool in early and late follow-up of aortic endo-prosthesis. Objective: The aim of this study was to evaluate the diagnostic efficacy of ultrasound color Doppler with second-generation contrast agent in follow-up of aortic endo-prosthesis performing both modules with harmonic low MI technique (CE-US/CD low MI). Methods: 18 patients with aortic endoprosthesis underwent a baseline color Doppler and a CE-US/CD low MI examination in early follow-up after procedure; Sono Vue® was used as contrast agent; the examinations were performed at the bedside of patients. Multislice CT was performed in each patient before being discharged from hospital; the late follow-up was carried out in the first following months through the above-mentioned US techniques. If any suspicion of endoleak raised from CE-US/CD low MI and CT examinations (early follow-up), digital subtracted angiography (DSA) confirmed the diagnosis and allowed the treatment in the same session. Results: Baseline color Doppler detected a lower number of endoleaks in comparison with CE-US/CD low MI and was invalidated by false positives (due to movement artefacts or to low PRF). CE-US/CD low MI showed a high diagnostic agreement with CT in endoleak detection: the information concerning the flow direction provided by CE-US/CD low MI (chromatic code) enabled to identify the endoleak type. Conclusions: CE-US/CD low MI examination is to be considered a promising non-invasive diagnostic tool in early and late follow-up of aortic endo-prosthesis.

Improved characterization of reactive and malignant superficial lymph nodes (LN) using harmonic ultrasound with a second-generation contrast agent

Improved characterization of reactive and malignant superficial lymph nodes (LN) using harmonic ultrasound with a second-generation contrast agent