Three-dimensional Contrast-enhanced Ultrasonography Research Articles

Combination of GI-RADS and 3D-CEUS for differential diagnosis of ovarian masses.

The purpose of this study is to evaluate the efficacy of the combination of gynecologic imaging reporting and data system (GI-RADS) ultrasonographic stratification and three-dimensional contrast-enhanced ultrasonography (3D-CEUS) in order to distinguish malignant from benign ovarian masses. In this study, 102 patients with ovarian masses were examined by both two-dimensional ultrasound(2D-US) and 3D-CEUS. Sonographic features of ovarian masses obtained from 3D-CEUS were analyzed and compared with 2D-US. All patients with ovarian masses were confirmed by operational pathology or long-term follow-up results. (1)The Chi-square test and multiple Logistic regression analysis confirmed that there were only eight independent predictors of malignant masses, including thick septa (≥3mm), thick papillary projections(≥7mm), solid areas, presence of ascites, central vascularization, contrast enhancement, distribution of contrast agent, and vascular characteristics of the solid part and their odds ratios which were 5.52, 5.39, 4.94, 4.34, 5.92, 7.44, 6.09, and 7.67, respectively (P<0.05). (2)These eight signs were used to combine the GI-RADS with 3D-CEUS scoring system in which the corresponding value of the area under the curve (AUC) was 0.969, which was superior to using GI-RADS lonely (Z-value=1.64, P<0.025). Using 4 points as the cut-off, the scoring system showed the performance was clearly better than using GI-RADS alone (P<0.05). (3) The Kappa value was 0.872 for two different clinicians with equal experience. The combination of GI-RADS and 3D-CEUS scoring system would be a more effective method to distinguish malignant from benign ovarian masses.

Comparison of 2-dimensional and 3-dimensional contrast-enhanced ultrasound for quantitative analysis in liver neoplasms

Objective To evaluate the correlation and consistency of dynamic three-dimensional contrast-enhanced ultrasonography (3D-CEUS) and two-dimensional contrast-enhanced ultrasonography (2D-CEUS) in the time-intensity curve (TIC) parameters of quantitative analysis in liver neoplasms. Methods Thirty patients were examined with 2D-CEUS and dynamic 3D-CEUS.The dynamic raw data were analyzed by quantitative analysis software. The regions of interest were manually selected around the entire lesion; TIC curves were generated and fitted respectively. Quality of fit (QOF) was used to evaluate the degree of fit between the fitted curve and the initial curve. The corresponding 2D-CEUS and 3D-CEUS quantitative parameters of the same lesion were compared, including peak intensity (PI), slope (S), area under curve (AUC), time to peak (TTP) and mean transit time (MTT). The correlation of the intensity-related quantitative parameters and the consistency of the time-related quantitative parameters were analyzed between the two kinds of CEUS. Results The consistency of time related quantitative parameters, including MTT and TTP, were 0.97 and 0.96, and the correlation were 0.94 and 0.93. The correlation coefficients of S, PI and AUC were 0.92, 0.72 and 0.65, respectively. Conclusions The quantitative results of 3D-CEUS are stable and reliable, and have fair concordance with 2D-CEUS. Dynamic 3D-CEUS can be used for clinical evaluation of the blood perfusion of liver neoplasms. Key words: Contrast-enhanced ultrasonography; Liver neoplasms; Quantitative analysis

Preliminary application of quantitative analysis of focal liver lesions with dynamic 3D contrast-enhanced ultrasonography

Objective To assess the ability of three-dimensional contrast-enhanced ultrasonography (3D-CEUS) and quantitative analysis in differential diagnosis of focal liver lesions (FLL). Methods The quantitative analysis technique was used to deal with the dynamic 3D-CEUS raw data of FLL, which were confirmed by clinical or pathological diagnosis. The corresponding time-intensity curve and parameters were obtained. The parameters were compared to confirm whether there existed any difference in the parameters between benign and malignant FLL. Results Seventy-three FLL were enrolled including 59 malignant and 14 benign lesions. The differences of the parameters between benign and malignant groups were statistically significant, including area under the curve (A)(169.58±95.46 vs 71.26±64.13), area under the curve of wash-in (AWI)(22.84±18.37 vs 9.96±10.01), and area under the curve of wash-out (AWO)(146.73±82.03 vs 61.29±55.06)(all P 0.05). Conclusions The quantitative analysis can be used to identify benign and malignant FLLs on 3D-CEUS. Key words: Ultrasonography, three-dimensional; Quantitative analysis; Focal liver lesions

Comparative analysis of the clinical value of two-dimensional and three-dimensional contrast-enhanced ultrasonography in the diagnosis of uterine submucosal myoma

Objective To compare the clinical value of uterine submucosal myoma classification by two-dimensional and three-dimensional contrast-enhanced ultrasonography and surgical pathologic results. Methods The imaging data of ultrasonographic hysterography including 2D and 3D of 124 patients with uterine submucosal myoma were retrospectively analyzed, and the results were compared with the surgical pathologic results.The diagnostic accuracy of uterine submucosal myoma classification and the operation success rate of uterine submucosal myoma for Ⅰ grade by ultrasonographic hysterography including 2D and 3D were compared. Results The patients were diagnosed pathologically with 0, Ⅰ and Ⅱ grade of uterine submucosal myoma in 26 cases, 52 cases, 68 cases, respectively.The patients were diagnosed by 2D ultrasonic sonohysterography with 0 grade, Ⅰ grade and Ⅱgrade of uterine submucosal myoma in 26 cases, 62 cases, 58 cases, respectively.The patients were diagnosed by 3D ultrasonic sonohysterography with 0, Ⅰ and Ⅱ grade of uterine submucous myoma in 26 cases, 52 cases, 68 cases, respectively.For pathological results as the gold standard , the diagnostic sensitivity, specificity and accuracy of uterine submucosal myoma for 0 grade by 2D and 3D ultrasonic sonohysterography were all 100.00%.The diagnostic sensitivity, specificity and accuracy of uterine submucosal myoma for Ⅰ and Ⅱ grade by 2D ultrasonic sonohysterography were 92.32%, 79.46%, 85.00%, respectively.The diagnostic sensitivity, specificity and accuracy of uterine submucosal myoma for Ⅰ and Ⅱ grade by 3D ultrasonic sonohysterography were 96.24%, 88.24%, 91.76%, respectively.There were significant differences in the diagnostic sensitivity, specificity and accuracy of submucosal myoma of uterus forⅠandⅡ grade by 2D and 3D ultrasonic sonohysterography(χ2=3.21, 2.78, 2.17, 2.33, all P<0.05). The patients diagnosed as uterine submucous myoma for 0 grade all underwent the hysteroscopic surgery for successful resection, while the patients with uterine submucous myoma for Ⅱ grade underwent laparoscopic surgery or open surgery.The operation success rates of uterine submucous myoma for Ⅰgrade by hysteroscopic surgery diagnosed by 2D and 3D ultrasonic sonohysterography were 75.81%, 98.07%, respectively.The operation success rate of uterine submucous myoma for Ⅰ grade by hysteroscopic surgery diagnosed by 3D ultrasonic sonohysterography was significantly higher than that diagnosed by 2D ultrasonic sonohysterography(χ2=7.15, P<0.05). Conclusion The accuracy of uterine submucosal myoma classification by 3D ultrasonographic hysterography is better than 2D ultrasonographic hysterography. Key words: Endosonography; Leiomyoma; Uterus; Diagnosis

Assessment of clear cell carcinoma of kidney by real-time three-dimensional contrast-enhanced ultrasonography

Objective To investigate the application value of real-time three-dimensional contrastenhanced ultrasonography (RT-3D-CEUS) for assessing the clear cell carcinoma of kidney.Methods Thirty five patients with renal clear cell carcinoma confirmed by pathology were enrolled in this study.The ultrasonography (US),two-dimensional contrast-enhanced ultrasonography (2D-CEUS) and RT-3D-CEUS were performed preoperatively.Pathological diagnosis was obtained after surgery.The identifiability,three dimensional features and vascular spatial relationship of renal lesions were evaluated by using a 3 point scoring method (1 =best).The results were compared among these three imaging models.Additionally,the intra-and inter-observer reliability of RT-3D-CEUS was further investigated in this study.Results Seventeen cases (48.57％),29 cases (82.86％) and 32 cases (91.43％) had a good identifiability of the renal lesion by US,2D-CEUS and RT-3D-CEUS respectively.There was a significant difference among these three models (x2 =19.352,P =0.001).No significant difference could be found between 2D-CEUS and RT-3D-CEUS (x2 =1.348,P =0.510),and the identifiability of US was inferior to 2D-CEUS and RT-3D-CEUS significantly (P ＜0.0125).For assessing the three dimensional features and vascular spatial relationship of renal lesions,7 cases (20.00 ％),12 cases (34.29 ％) and 30 cases (85.71 ％) had been evaluated as 1 score by US,2D-CEUS and RT-3D-CEUS respectively with a significant difference among these three models (x2 =34.146,P =0.000).RT-3D-CEUS was superior to the other two methods (P ＜0.0125).There was good intra-and inter-observer reliability of RT-3D-CEUS.Conclusions RT-3D-CEUS could display the three dimensional features and vascular spatial relationship of renal clear cell carcinoma which is superior to US and 2D-CEUS,and RT-3D-CEUS could be used as a novel method for assessing renal lesions. Key words: Ultrasonography, three-dimensional; Microbubbles ; Carcinoma, renal cell

Three-Dimensional Contrast-Enhanced Ultrasonography of Intraductal Papillary Mucinous Neoplasms of the Pancreas

The objective of this study was to prospectively compare the diagnostic accuracy of 3-dimensional contrast-enhanced ultrasonography (3D-CEUS) with that of magnetic resonance imaging (MRI) in the study of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Thirty consecutive patients with IPMN were studied. Three patients (10.0%) did not undergo diagnostic 3D-CEUS because of technical problems. Three dimensional CEUS identified 12 (44.4%) main-duct IPMNs versus no cases by MRI (P < 0.001). Intraductal papillary mucinous neoplasm localization showed poor agreement between 3D-CEUS and MRI (κ = 0.058), whereas good agreement was found in detecting the pancreatic calcifications (κ = 1.000). Significant differences between 3D-CEUS and MRI were found regarding the number of lesions detected (1.4 ± 0.8 vs 3.8 ± 3.6; P < 0.001), the detection of mucinous plugs (3.7% vs 50.0%; P < 0.001), chronic pancreatitis (7.4% vs 26.7%; P = 0.031), pancreatic atrophy (0% vs 50.0%; P < 0.001), thick septa (22.2% vs 53.3%; P = 0.004), and mural nodules (25.9% vs 3.3%; P = 0.016). Three dimensional CEUS showed similar results as compared with MRI in evaluating IPMNs smaller than 1 cm of diameter or greater than 2 cm. Even if MRI remains the criterion standard technique for the diagnosis of IPMNs, 3D-CEUS can be safely used to follow patients with IPMNs of less than 1 cm.

Comparison of enhancement features of hepatic tumors between dynamic three-dimensional and two-dimensional contrast-enhanced ultrasonography

Objective To investigate the enhancement features of hepatic tumors between dynamic three-dimensional contrast-enhanced ultrasonography (3D-CEUS) and two-dimensional contrast-enhanced ultrasonography (2D-CEUS).Methods Totally,65 patients with 67 focal liver lesions were examined with 2D-CEUS and dynamic 3D-CEUS.Enhancement patterns,sharpness or three-dimensional effect in different phases,definition of blood vessel in arterial phase and spatial relationships of tumor and vascularity of different hepatic tumors on the two imaging modes were compared statistically,the value of two modes in differential diagnosis of hepatic tumors was also evaluated.Results Dynamic 3D-CEUS was similar to 2DCEUS with respect to enhancement patterns,sharpness or three-dimensional effect of tumor in arterial and portal phases( P ＞0.05).And there was no significant difference between the value of dynamic 3D-CEUS and 2D-CEUS in differential diagnosis of hepatic tumors:the sensitivity,specificity,positive predictive value and negative predictive value were 98.0％,81.3 ％,94.3 ％ and 92.9％ for 3D-CEUS,and were 96.1％,81.3％,94.2％ and 86.7％ for 2D-CEUS,respectively.However,3D-CEUS was superior to 2D-CEUS in the display of definition of blood vessel in arterial phase,and spatial relationships of hepatic tumor and vascularity( P ＜0.05).Conclusions Dynamic 3D-CEUS is a useful technique in the differential diagnosis of hepatic tumors as well as 2D-CEUS,and dynamic 3D-CEUS displays the spatial relationship of hepatic tumors and vascularity more visually and effectively,which provides additional information in the diagnosis and therapy of hepatic tumors. Key words: Ultrasonography,three dimensional; Microbubbles; Liver neoplasms

Value of three-dimensional contrast-enhanced ultrasonography in diagnosis of small adnexal masses: a preliminary study

Objective To evaluate the value of three-dimensional contrast-enhanced ultrasonography (3D-CEUS) in diagnosis of small adnexal masses.Methods Forty-three patients with 47 adnexal masses were examined by both two-dimensional contrast-enhanced ultrasound (2D-CEUS) and 3D-CEUS.Sonographic features of adnexal masses with 3D-CEUS were analyzed and compared with 2D-CEUS.All patients with adnexal masses were proved by operational pathology and long-term follow-up results.Results Enhancement from the periphery to the parenchyma, septa or papillae was shown by 2D-CEUS among 40 benign adnexal masses, and multicenter enhancement from parenchyma to the periphery among 7 malignant ones.There were significant differences in blood vessels of envelope and septa, and the enhancement of parenchyma between benign and malignant adnexal masses by 3D-CEUS (P ＜0.05).Straight and sparse blood vessels were seen inside benign solid masses.Enhancement was observed in the wall of cystic masses,but not in intracapsular structures.Dense and distorted vascularity was found inside malignant adnexal masses forming a ball in the parenchyma, which was significantly enhanced.Thick vasa vasorum was also visible in 6 out of 7 malignant ones.Conclusions 3D-CEUS has an advantage in displaying complex spatial vascular structures,and might be a new tool to study real vascular structures in small adnexal masses. Key words: Ultrasonography; Microbubbles; Adnexal diseases

Application of two-and three-dimensional contrast-enhanced ultrasonography in evaluating hepatic arteries in the liver transplantation

Objective To assess the difference between two-dimensional contrast-enhanced ultrasonography ( 2D-CEUS ) and three-dimensional contrast-enhanced ultrasonography ( 3D-CEUS ) in evaluating hepatic arteries in the liver transplantation. Methods Both 2D-CEUS and 3D-CEUS were used to examine 26 liver transplantation donors and recipients. Fifteen patients who were confirmed by CTA or DSA or MRA were analyzed. The image' s quality and diagnostic levels of 2D-CEUS and 3D-CEUS were compared, and the diagnostic information about anatomic features of hepatic arteries provided by the two methods was evaluated. Results 1) The image' s quality of 2D-CEUS and 3D-CEUS were 3. 62 ± 0. 41, 2. 52 ± 0. 93, respectively. The difference between them was statistically significant ( P <0. 05). 2)When evaluating anatomic features ,2D-CEUS and 3D-CEUS had no significant difference in common hepatic artery (CHA) and proper hepatic artery (PHA). But 3D-CEUS was prior to 2D-CEUS in left hepatic artery (LHA) ,right hepatic artery(RHA) and segmental hepatic artery(SHA) ( P <0. 05). 3)Five hepatic artery complications were discovered by CTA or DSA or MRA in 15 patients. In 4 patients (80%) ,both 2D-CEUS and 3D-CEUS made the affirmative diagnoses in accordance with the results. However, 2D-CEUS made a false positive diagnosis and 3D-CEUS corrected it. Conclusions The 3D-CEUS could provide more diagnostic information,could confirm or correct some diagnosis of 2D-CEUS,but,its image's quality is not as good as 2D-CEUS. Therefore,combining the 3D-CEUS with 2D-CEUS has practical clinical value in liver transplantation. Key words: Ultrasonography; Microbubbles; Liver transplantation; Hepatic artery

Application of three-dimensional contrast-enhanced ultrasonography in evaluating origin of segment IV feeding artery in living liver donors

Objective To assess the value of three-dimensional contrast-enhanced ultrasound (3D-CEUS) in evaluation origin of segment Ⅳ feeding artery in living liver donors. Methods 3D-CEUS were used to examine 20 living liver donors. The origin of segment Ⅳ feeding artery were evaluated by two radiologists who blinded to other imaging information. The findings obtained on operation and (or) CTA were used as the reference standard. Results Segment Ⅳ feeding artery originating from left artery, both left and right artery, proper hepatic artery were demonstrated on 3D-CEUS in 13, 1 and 2 patients,respectively. 3D-CEUS accurately depicted the origin of segment Ⅳ feeding artery in 16(80%) patiens.Conclusions 3D-CEUS could be a useful method to demonstrate the origin of segment Ⅳ feeding artery in preoperative evaluation for LDLT. Key words: Ultrasonography,three-dimensional; Microbubbles; Liver transplantation; Hepatic artery

Application of two- and three-dimensional contrast-enhanced ultrasonography in evaluating hepatic arteries in the liver transplantation

Application of two- and three-dimensional contrast-enhanced ultrasonography in evaluating hepatic arteries in the liver transplantation