Second-generation Contrast Agent Research Articles

Comparison of contrast-enhanced voiding urosonography using second-generation contrast agents and voiding cystourethrogram

Voiding cystourethrogram (VCUG) has been considered the gold standard for detecting and evaluating vesicoureteral reflux (VUR) among children. However, ionizing radiation exposure is a concern for this diagnostic modality. Contrast-enhanced voiding urosonography (ceVUS) is an alternative technique for the detection of vesicoureteral reflux (VUR) using ultrasound and intravesical administration of an ultrasound (US) contrast agent. ceVUS is a radiation-free, effective, and safe method for identifying and grading VUR. We performed a study specifically for our hospital. The purpose of this study was to evaluate the diagnostic accuracy of contrast-enhanced voiding urosonography (ceVUS) in the detection of vesicoureteral reflux and its grading in children, compared to voiding cystourethrogram (VCUG). If we consider VCUG as the gold standard, the sensitivity of ceVUS in our study was 83%, specificity was 100% and accuracy was 94%. Our positive cases had Grade II to V reflux on ceVUS and Grade I to V reflux on VCUG. In our small sample of 18 patients, the detection of vesicoureteral reflux by ceVUS was comparable to that of VCUG. ceVUS can be used as a radiation-free alternative to VCUG for the detection of VUR in children. A benefit of ceVUS is the ability to do cyclical assessment without the fear of increasing radiation dose, as you would with VCUG.

A review of contrast-enhanced harmonic endoscopic ultrasonography for pancreatic solid tumors.

Endoscopic ultrasonography (EUS) is superior to other imaging modalities in the detection of pancreatic masses, although differentiating the types of pancreatic masses detected on EUS remains challenging. However, the value of contrast-enhanced harmonic EUS (CH-EUS) using ultrasound contrast agents for this differentiation has been reported. CH-EUS plays a pivotal role in analysis of small lesions that can only be detected with EUS. Recently, CH-EUS was used for staging and/or determining the resectability of pancreatic cancer in several clinical trials. In addition, it is used to estimate the response of pancreatic cancer to chemotherapy and to determine the prognosis in cases of pancreatic cancer and pancreatic neuroendocrine neoplasms. It is also postulated that CH-EUS improves the diagnostic performance of endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) through complementary diagnoses using CH-EUS and EUS-FNAB, or CH-EUS-guided EUS-FNAB. Thus, CH-EUS has been employed for various qualitative diagnoses, including differentiation of pancreatic masses. Second-generation contrast agents such as Sonazoid are used clinically for ultrasound diagnostic imaging of liver and breast disease. The positioning of CH-EUS with Sonazoid as a test for the diagnosis of solid pancreatic tumors is an issue for further studies.

Nonlinear ultrasound in liquid containing multiple coated microbubbles: effect of buckling and rupture of viscoelastic shell on ultrasound propagation

With promising applications in medical diagnosis and therapy, the behavior of shell-encapsula-ted ultrasound contrast agents (UCAs) has attracted considerable attention. Currently, second-generation contrast agents stabilized by a phospholipid membrane are widely used and studies have focused on the dynamics of single phospholipid shell-encapsulated microbubbles. To improve the safety and the efficiency of the methods using the propagation or targeted ultrasound, a better understanding of the propagation of ultrasound in liquids containing multiple encapsulated microbubbles is required. By incorporating the Marmottant–Gompertz model into the multiple scale analysis of two-phase model, this study derived a Korteweg–de Vries–Burgers equation as a weakly nonlinear wave equation for one-dimensional ultrasound in bubbly liquids. It was found that the wave propagation characteristics changed with the initial surface tension, highlighting two notable features of the phospholipid shell: buckling and rupture. These results may provide insights into the suitable state of microbubbles, and better control of ultrasound for medical applications, particularly those that require high precision.

Noninvasive Evaluation of Clinically Significant Portal Hypertension in Patients with Liver Cirrhosis: The Role of Contrast-Enhanced Ultrasound Perfusion Imaging and Elastography.

Hepatic venous pressure gradient (HVPG) is the gold standard for assessing the degree of portal hypertension (PH), but it is not suitable for routine clinical use. The recently developed ultrasonography techniques, dynamic contrast-enhanced ultrasound (D-CEUS) and liver stiffness (LS), have expanded the possibilities for noninvasive evaluation. To investigate the usefulness of D-CEUS and elastographic parameters in assessing the presence and degree of PH. This is a prospective monocentric study. Patients with liver cirrhosis referred for HVPG measurements underwent hepatic Doppler ultrasound, LS measurement, and D-CEUS with a second-generation contrast agent. Pearson's correlation and a receiver operating characteristic (ROC) curve analysis were performed to assess the role of noninvasive findings in predicting clinically significant PH (CSPH) and severe PH (SPH). 46 consecutive patients (31 men; mean age±SD: 57±11 years) were enrolled. A significant positive correlation was noted between LS and HVPG (r = 0.809, p<0.0001) with an area under the ROC curve of 0.923. A cut-off value of 24.2 kPa best predicted CSPH with a positive predictive value of 85%. Among the D-CEUS features, the area under the ROC curves of liver parenchyma peak intensity (PI-LP) was greater than the other indices both for CSPH and SPH (1.000 and 0.981, respectively). A PI-LP under 23.3 arbitrary units indicated the presence of CSPH with a sensitivity and a specificity of 100%. A multimodal ultrasound approach based on D-CEUS and LS might become a reliable predictor of CSPH and SPH and a useful alternative to HVPG.

Efficacy of Contrast-Enhanced Endoscopic Ultrasonography for the Diagnosis of Pancreatic Tumors

Endoscopic ultrasound can be useful for obtaining detailed diagnostic images for pancreatic disease. Contrast-enhanced harmonic endoscopic ultrasound has allowed to demonstrate not only microvasculature but also real perfusion imaging using second-generation contrast agents. Furthermore, endoscopic ultrasound fine-needle aspiration cytology and histology have become more ubiquitous; however, the risk of dissemination caused by paracentesis has yet to be resolved, and the application of less invasive contrast-enhanced endoscopic ultrasound for the differential diagnosis of pancreatic tumors has been anticipated. Contrast-enhanced harmonic endoscopic ultrasound can contribute to the differential diagnosis of pancreatic tumors.

Contrast-enhanced ultrasound in pediatric blunt abdominal trauma: a systematic review.

Intra-abdominal injury is a major cause of morbidity in children. Computed tomography (CT) is the reference standard for the evaluation of hemodynamically stable abdominal trauma. CT has an increased risk of long-term radiation induced malignancies and a possible risk associated with the use of iodinated contrast media. Contrast-enhanced ultrasound (CEUS) might represent an alternative to CT in stable children with blunt abdominal trauma (BAT). Nonetheless, CEUS in pediatrics remains limited by the lack of strong evidence. The purpose of this study was to offer a systematic review on the use of CEUS in pediatric abdominal trauma. Electronic search of PubMed, EMBASE and Cochrane databases of studies investigating CEUS for abdominal trauma in children. The risk of bias was assessed using the ROBINS-I tool. This systematic review included 7 studies. CEUS was performed with different ultrasound equipment, always with a curvilinear transducer. Six out of seven studies used a second-generation contrast agent. No immediate adverse reactions were reported. The dose of contrast agent and the scanning technique varied between studies. All CEUS exams were performed by radiologists, in the radiology department or at the bedside. No standard training was reported to become competent in CEUS. The range of sensitivity and specificity of CEUS were 85.7 to 100% and 89 to 100%, respectively. CEUS appears to be safe and accurate to identify abdominal solid organ injuries in children with BAT. Further research is necessary to assess the feasibility of CEUS by non-radiologists, the necessary training, and the benefit-cost ratio of CEUS as a tool to potentially reduce CT scans.

Диабетическая кардиомиопатия: классификация, инструментальные методы диагностики

В обзоре приведена международная классификация, подробно проанализированы современные инструментальные методы диагностики диабетической кардиомиопатии. В частности, проведен анализ особенностей проведения и диагностических критериев эхокардиографии, традиционной допплер-эхокардиографии, тканевой допплерографии, эхокардиографии с контрастированием контрастными агентами второго поколения, акустической допплер-эхокардиографии, трехмерной эхокардиографии, спекл-трекинг-эхокардиографии, магнитно-резонансной томографии, кардиоваскулярной магнитно-резонансной томографии, магнитно-резонансного томографически-градиентного эхо, фазово-контрастной магнитно-резонансной томографии, магнитно-резонансной томографии с радиоактивным фармпрепаратом (меткой), мультиспиральной компьютерной томографии, однофотонной эмиссионной компьютерной томографии, G-однофотонной эмиссионной компьютерной томографии и позитронно-эмиссионной томографии. Диабетическая кардиомиопатия возникает довольно часто и длительное время имеет бессимптомный характер, что требует динамического наблюдения и прицельного обследования с целью ее ранней диагностики. На сегодняшний день существует целый ряд информативных инструментальных методов обследования, которые существенно расширяют диагностические возможности и в конкретной ситуации дают возможность получить адекватную картину состояния сердечно-сосудистой системы. Патогенетически диабетическая кардиомиопатия — это обменная миокардиодистрофия, связанная с нарушением энергообеспечения клеток, синтеза белков, электролитного обмена, обмена микроэлементов, окислительно-восстановительных процессов, кислородно-транспортной функции крови. Значительная роль в ее формировании принадлежит микроангиопатии и дисгормональным расстройствам. У больных преобладают дистрофические изменения в миокарде, к которым присоединяются микрососудистые поражения с развитием клинических проявлений некоронарогенной (неатеросклеротической) ишемической болезни сердца, возникновением инфаркта миокарда, не связанного с ишемической болезнью сердца атеросклеротического происхождения.

Contrast-Enhanced Ultrasound Imaging of Prostate Gland in Neutered Dogs.

Simple SummaryDiagnosis of prostatic neoplasia in dogs remains critical since none of the diagnostic methods routinely performed seem to have sufficient sensitivity or specificity. In recent years, contrast-enhanced ultrasound of the prostate gland has been successfully performed in intact dogs. However, data regarding the performance of the technique in castrated dogs have not been provided, despite the incidence of prostate neoplasia potentially being higher after castration. The purpose of the present study was to evaluate the application of contrast-enhanced ultrasound in castrated dogs and to describe the vascular pattern of the canine prostate. Prior to contrast-enhanced ultrasound evaluation, B-mode ultrasound was performed to assess prostate size and parenchymal features. In all cases, perfusion kinetics of the contrast agent within the prostate was analyzed, with the aim of detecting any areas with increased microvessel density. None of the dogs had any ultrasonographically detected pathology. Contrast ultrasound allowed an improved and enhanced ability to evaluate the prostate compared with B-mode ultrasound. This technique is not yet to become a first-choice diagnostic tool; however, since the results of this study are favorable, it seems likely that contrast ultrasound will have an important role in the future for the detection of prostate pathologies in neutered dogs.Prostatic neoplasia (PN) occurs in 5–7% of dogs with prostatic disease, with castrated dogs having the same or higher prevalence when compared to intact dogs. Considering the promising results achieved by performing contrast-enhanced ultrasound (CEUS) in intact dogs to detect PN, the present study aimed to acquire data on the prostatic perfusion pattern in neutered dogs. CEUS was performed in 64 neutered dogs, using a 5–7.5 MHz linear transducer with coded harmonic capability, dedicated analytical software, and a second-generation contrast agent, SonoVue. After B-mode evaluation was performed to assess mean prostate volume, the CEUS examination was undertaken. The flow of contrast agent was visible 10 s after injection. The subcapsular vessels were highlighted and produced rapid peripheral rim enhancement. Subsequently, the contrast agent reached the prostatic urethra via the parenchymal arterioles and gradually reached the entire prostate. Perfusion peak intensity (PPI) and time to peak (TTP) values were respectively 45.3% and 34.1 s. The measured parameters were compared with those obtained in previous studies on intact dogs with normal and with pathological patterns. In this study, CEUS showed features that may be promising for its use as a diagnostic tool for early detection of PN in neutered dogs.

Breast Ultrasound Microvascular Imaging and Radiogenomics.

Microvascular ultrasound (US) techniques are advanced Doppler techniques that provide high sensitivity and spatial resolution for detailed visualization of low-flow vessels. Microvascular US imaging can be applied to breast lesion evaluation with or without US contrast agents. Microvascular US imaging without a contrast agent uses a sophisticated wall filtering system to selectively obtain low-flow Doppler signals from overlapped artifacts. Microvascular US imaging with second-generation contrast agents amplifies flow signals and makes them last longer, which facilitates hemodynamic evaluation of breast lesions. In this review article, we will introduce various microvascular US techniques, explain their clinical applications in breast cancer diagnosis and radiologic-histopathologic correlation, and provide a summary of a recent radiogenomic study using microvascular US.

Diagnostic Performance of Contrast-Enhanced Ultrasound (CEUS) in the Evaluation of Solid Renal Masses.

Background: The present study aims to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for discriminating between benign and malignant solid renal masses. Methods: 18 patients with histopathologically confirmed benign solid renal masses (11 oncocytomas, seven angiomyolipomas) as well as 96 patients with confirmed renal cell carcinoma (RCC) who underwent CEUS followed by radical or partial nephrectomy were included in this single-center study. CEUS examinations were performed by an experienced radiologist (EFSUMB Level 3) and included the application of a second-generation contrast agent. Results: Renal angiomyolipomas, oncocytomas, and renal cell carcinomas showed varying sonomorphological characteristics in CEUS. Angiomyolipomas showed heterogeneous echogenicity (57% hypo-, 43% hyperechoic), while all lesions showed rapid contrast-enhancement with two lesions also showing venous wash-out (29%). Notably, 9/11 oncocytomas could be detected in conventional ultrasound (64% hypo-, 9% hyper-, 9% isoechoic) and 2/11 only demarcated upon intravenous application of contrast agent (18%). All oncocytomas showed hyperenhancement in CEUS, venous wash-out was registered in 7/11 lesions (64%). Conclusions: In line with the current state of knowledge, no specific sonomorphological characteristics allowing for accurate distinction between benign and malignant solid renal masses in CEUS could be detected in our study.

Value of contrast-enhanced ultrasound (CEUS) in Focal Liver Lesions (FLL) with inconclusive findings on cross-sectional imaging.

Contrast-enhanced ultrasound (CEUS) has been used as an additional imaging technique in order to evaluate focal liver lesions. CEUS is easy and fast to perform, overcomes the limitations of B-mode US. To evaluate the diagnostic potential of contrast-enhanced ultrasound (CEUS) in focal liver lesions (FLL) with unclear findings on computed tomography (CT) or magnetic resonance imaging (MRI). In this single-center retrospective study, 146 patients with at least one FLL underwent additional CEUS of the liver to clarify inconclusive cross-sectional imaging findings. Ultrasonography was performed using B-mode imaging and CEUS after injection of sulphur hexafluoride microbubbles (second-generation contrast agent) within two months after ceMRI or ceCT and interpreted by an experienced radiologist (EFSUMB level 3). Histopathological reports, long-term follow-up or clinical course served as reference standard. Thirty-eight of the 146 patients had malignant and 108 benign FLL. Overall, CEUS had 92% sensitivity (95% -CI, 79-97) and 98% specificity (95% -CI, 93-99) with an AUC of 0.95 in correctly characterizing the lesion as malignant or benign. Sensitivity increased to 98% (95% -CI, 96-100) for benign lesions and decreased to 92% (95% -CI, 78-98) for malignant lesions. CEUS showed the highest diagnostical accuracy in lesion <1 cm with an AUC of 1.000, while the lowest accuracy was achieved in lesions >2 cm with an AUC of 0.924 due to a decreasing specificity of 86% (95% -CI, 87-100). CEUS correctly distinguished malignant from benign FLL in cases with inconclusive cross-sectional imaging findings and achieved high levels of diagnostic accuracy. CEUS has added diagnostic value especially in small lesions ≤1 cm while specificity remains limited in larger lesions.

Contrast-Enhanced Ultrasound in the Short-Term Evaluation of Hepatocellular Carcinoma after Locoregional Treatment

Background: Contrast-enhanced ultrasound (CEUS) with second-generation contrast agents performed 1 month after hepatocellular carcinoma (HCC) treatment is almost as sensitive as contrast-enhanced computed tomography (CECT) in depicting the residual tumor. However, the efficacy of CEUS performed early after the procedure is still debated. Aim: We evaluated the diagnostic accuracy (DA) of CEUS for the assessment of tumor response shortly after locoregional therapy in patients with unresectable HCC. Methods: Ninety-four patients with 104 HCC lesions who were scheduled to receive percutaneous ethanol injection, radiofrequency ablation, transcatheter arterial chemoembolization, or combined treatment were enrolled in this study. With CECT at 1-month as the reference standard, the DA of CEUS performed 48-h after the procedure was evaluated. Patients were followed-up to look for tumor or disease progression. Results: Based on CECT findings, 43/104 lesions were diagnosed as having residual viability after 1 month. CEUS performed 48 h after treatment detected residual tumor in 34/43 nodules with treatment failure at CECT with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 79.1, 96.7, 94.4, 86.8, and 89%, respectively. There was a high degree of concordance between CEUS and CECT (kappa coefficient = 0.78). A hyperemic halo was detectable in 35 lesions without a statistically significant difference between concordant and discordant cases. In patients with uninodular disease responders according to 48 h CEUS had a significantly longer mean overall survival and time to progression compared to nonresponders. Conclusion: CEUS performed 48 h after treatment can be considered a reliable modality for the evaluation of the real extent of necrosis and has prognostic value in the assessment of HCC.

Sonography of splenic tumors: The almost forgotten organ in abdominal US examination

Although examination of the spleen is routinely included in the general abdominal gray-scale ultrasound (US) study, it was considered of limited use in the past and was performed almost only to distinguish between cystic and solid lesions. In the last two decades due to accumulated experience and the introduction of second-generation contrast agents, this technique has been re-evaluated as contrast-enhanced US (CEUS) allows detection and characterization of most focal lesions of the spleen with a high sensitivity and a good specificity. US can provide a correct diagnosis in simple cysts, whereas CEUS is useful when cystic lymphangioma is suspected. US presents a low specificity and relatively low sensitivity in splenic infarctions, while CEUS can achieve a high specificity (up to 100 %). There is a wide spectrum of benign and malignant neoplasms of the spleen. Lymphomas and vascular tumors comprise the most common splenic neoplasms. Splenic hemangiomas and angiosarcomas are the most common mesenchymal tumors in which US and CEUS may show characteristic imaging findings and permit precise diagnosis. US-guided fine needle aspiration and/or biopsy of focal splenic lesions are being increasingly performed to obtain tissue for histopathological characterization. Accurate diagnosis of focal splenic lesions allows institution of optimal patient management. In the study of splenic lesions, the most important problem is to differentiate between angioma, hamartoma, lymphoma, and metastasis. CEUS presents a high specificity in the differentiation of benign and malignant splenic lesions, as hypoenhancement in the parenchymal phase is suggestive of malignancy in 87 % of cases. US, as compared to CT and MRI, has certain advantages, including its ubiquitous availability, lack of ionizing radiation, and low cost, and with additional application of CEUS, can be widely indicated in the study of focal splenic lesions.

Contrast-enhanced ultrasound (CEUS) in pediatric blunt abdominal trauma.

Baseline ultrasound is the first-choice technique in traumatic hemodynamically stable children, and is essential in the early assessment of unstable patients to detect hemoperitoneum or other potentially fatal conditions. Despite the technological advancements in new ultrasound equipment and the experience of the operators, it is not always possible to rule out the presence of parenchymal traumatic lesions by means of baseline ultrasound nor to suspect them, especially in the absence of hemoperitoneum. For this reason, in the last decades, basic ultrasound has been associated with contrast-enhanced ultrasound (CEUS) to evaluate the stable little patient in cases such as low-energy blunt abdominal trauma. Because it relies on second-generation contrast agents, the CEUS technique allows for better detection of parenchymal injuries. CEUS has been demonstrated to be almost as sensitive as contrast-enhanced CT in the detection of traumatic injuries in patients affected by low-energy isolated abdominal trauma, with levels of sensitivity and specificity up to 95%. A very important point in favor of CEUS is its capacity to help distinguish the healthy patient, who can be discharged, from the one needing prolonged monitoring, operative management or hospitalization. Finally, we also have the ability to follow-up on low-grade traumatic lesions using CEUS, always keeping in mind patients' clinical conditions and their hemodynamics.

Application of contrast-enhanced ultrasound for evaluation of thyroid nodules.

Contrast-enhanced ultrasound (CEUS) is widely used to evaluate tumor microcirculation, which is useful in the differential diagnosis between benignity and malignancy. In the last 10 years, the applicability of CEUS to thyroid nodules has greatly improved due to technological refinements and the development of second-generation contrast agents. In this review, we summarize the applications of CEUS for thyroid nodules, focusing on the imaging findings of malignant and benign nodules in the existing literature and the use of those findings to predict malignancies, with an additional brief description of the utilization of CEUS for other thyroid-related diseases.

Contrast-enhanced US for characterization of focal liver lesions: a comprehensive meta-analysis.

This meta-analysis was performed to evaluate the accuracy of contrast-enhanced ultrasound (CEUS) in differentiating malignant from benign focal liver lesions (FLLs). Cochrane Library, PubMed and Web of Science databases were systematically searched and checked for studies using CEUS in characterization of FLLs. Data necessary to construct 2×2 contingency tables were extracted from included studies. The QUADAS tool was utilized to assess the methodologic quality of the studies. Meta-analysis included data pooling, subgroup analyses, meta-regression and investigation of publication bias was comprehensively performed. Fifty-seven studies were included in this meta-analysis and the overall diagnostic accuracy in characterization of FLLs was as follows: pooled sensitivity, 0.92 (95%CI: 0.91-0.93); pooled specificity, 0.87 (95%CI: 0.86-0.88); diagnostic odds ratio, 104.20 (95%CI: 70.42-154.16). Subgroup analysis indicated higher diagnostic accuracy of the second-generation contrast agents (CAs) than the first-generation CA (Levovist; DOR: 118.27 vs. 62.78). Furthermore, Sonazoid demonstrated the highest diagnostic accuracy among three major CAs (SonoVue, Levovist and Sonazoid; DOR: 118.82 vs. 62.78 vs. 227.39). No potential publication bias was observed of the included studies. CEUS is an accurate tool to stratify the risk of malignancy in FLLs. The second-generation CAs, especially Sonazoid may greatly improve diagnostic performance. • CEUS shows excellent diagnostic accuracy in differentiating malignant from benign FLLs. • The second-generation CAs have higher diagnostic accuracy than first-generation CAs. • Sonazoid demonstrates the highest diagnostic accuracy among three major CAs.

Up-to-date Doppler techniques for breast tumor vascularity: superb microvascular imaging and contrast-enhanced ultrasound

Ultrasonographic Doppler techniques have improved greatly over the years, allowing more sophisticated evaluation of breast tumor vascularity. Superb microvascular imaging (SMI) and contrast-enhanced ultrasound (CEUS) with second-generation contrast agents are two representative up-to-date techniques. SMI is a sensitive Doppler technique that adopts an intelligent filter system to separate low-flow signals from artifacts. With the development of second-generation contrast agents, CEUS has also emerged as a useful Doppler technique for evaluating tumor microcirculation. Both techniques can improve the diagnostic performance of gray-scale ultrasonography by providing vascular information useful not only for the morphologic assessment of microvessels, but also for the quantitative analysis of perfusion. In this review, we explain the imaging principles and previous research underlying these two vascular techniques, and describe our clinical experiences.

Role of Contrast-enhanced Ultrasound in the Evaluation of Inflammatory Arthritis

Objective:Contrast-enhanced ultrasound (CEUS) is a well-established imaging modality which has been put into clinical use in recent years with the development of second-generation contrast agent and imaging devices, and its applications in the assessment of inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, have provoked abundant discussion and researches among radiologists and rheumatologists. To summarize the achievements of clinical studies on CEUS in the application of arthritis, and to keep up with the latest progresses of the imaging technique, we reviewed the literature in recent years, hoping to establish the role of CEUS in joint diseases.Data Sources:PubMed and EMBASE.Study Selection:We searched the database with the conditions “contrast-enhanced ultrasound AND arthritis” with the time limitation of recent 10 years. Clinical studies applying CEUS in inflammatory arthritis and review articles about development of CEUS in joint diseases in English were selected.Results:As it is proved by most studies in recent years, by delineating microvasculature within the inflamed joints, CEUS can indicate early arthritis with high sensitivity and specificity. Moreover, the imaging of CEUS has been proved to be consistent with histopathological changes of inflammatory arthritis. Quantitative analysis of CEUS permits further evaluation of disease activity. CEUS also plays a significant role in the therapeutic monitoring of the disease, which has been backed up by a number of studies.Conclusions:CEUS may be a new choice for the rheumatologists to evaluate inflammatory arthritis, because of its low price, ability to provide dynamic pictures, and high sensitivity to angiogenesis. It can also be applied in disease classification and therapeutic monitoring. More studies about CEUS need to be done to set up the diagnostic standards.

Sonazoid-Enhanced Ultrasonography Guidance Improves the Quality of Pathological Diagnosis in the Biopsy of Focal Hepatic Lesions

Contrast-enhanced ultrasonography (US) using second-generation contrast agent Sonazoid has improved the detection and characterization of focal hepatic lesions. We evaluated the utility of Sonazoid-enhanced ultrasonography (SEUS) in guiding percutaneous biopsy of focal hepatic lesions by comparing accuracy of histopathological diagnosis between B-mode US and SEUS guidance. This retrospective study included 140 focal hepatic lesions in 127 patients (mean age; 63.6 years) referred for US-guided percutaneous biopsy between April 2012 and September 2016. The diagnostic accuracy of the biopsy was defined as the percentage of the total number of lesions clearly diagnosed at the initial biopsy. A case was considered a technical failure when pathological results failed to specifically indicate final diagnosis owing to insufficient material or when pathological results changed from benign to malignant by re-biopsy. Among 140 focal hepatic lesions, 57 lesions underwent biopsy with B-mode US guidance while 83 received SEUS guidance. Patient characteristics (sex, age, lesion location and diameter, and reasons for biopsy) did not differ significantly between groups. Diagnostic accuracy was significantly higher under SEUS guidance than B-mode US guidance (91.6% vs. 75.4%, respectively; p < 0.05). When biopsies were performed to diagnose or rule out malignancy in indeterminate focal hepatic lesions, diagnostic accuracy was also significantly higher under SEUS guidance than B-mode US guidance (100% vs. 70.8%, respectively; p < 0.05). SEUS guidance resulted in a significantly higher rate of successful single-puncture attempts during biopsy procedures than B-mode US guidance (53.0% vs. 35.1%, respectively; p < 0.05). SEUS guidance improves the accuracy of hepatic tumor biopsy pathological diagnosis compared to B-mode US guidance. SEUS guidance is recommended for more accurate localization of suitable hepatic lesion biopsy areas since it increases conspicuity and differentiates viable area from denaturalization or necrosis.

339 Comparison of voiding cystourethrography and urosonography with second-generation contrast agents in simultaneous prospective study

BackgroundThe invasiveness and exposure to radiation in voiding cystourethrography led to the introduction of alternative methods of diagnosis of vesicoureteral reflux, including contrast enhanced voiding urosonography. While there is a limited number of studies comparing these methods using new generation ultrasound contrast agents, none of them compared both methods simultaneously. This study is aimed at assessing agreement between contrast enhanced voiding urosonography with second-generation ultrasound contrast agents and voiding cystourethrography.MethodsFrom April 2013 to May 2014, 83 children (37 female and 46 male), mean age 3.5 years, age range from 1 month to 17.5 years, underwent prospective simultaneous assessment by contrast enhanced voiding urosonography and voiding cystourethrography, with a total of 166 uretero-renal units evaluated.ResultsThe sensitivity of voiding cystourethrography and contrast enhanced voiding urosonography were comparable, amounting to 88%, however, neither reached 100% for the entire studied population. The negative predictive value of voiding urosonography and voiding cystourethrography was 97%, and there was no difference between both methods.ConclusionVoiding cystourethrography and contrast enhanced voiding urosonography are comparable methods in diagnosis of vesicoureteral reflux, and can be performed alternatively. However, some limitations of contrast enhanced voiding urosonography must be remembered.