Value Of Contrast-enhanced Ultrasonography Research Articles

Hemodynamics of hepatic focal nodular hyperplasia with contrast-enhanced ultrasonography

Objective To investigate enhancement appearance of hepatic focal nodular hyperplasia(FNH) at real-time gray-scale contrast enhanced ultrasonography(CEUS),and evaluate the value of CEUS in the diagnosis of FNH. Methods Thirty-four patients (36 lesions) with histologically proved FNH were examined by ultrasonography. Appearance on conventional ultrasonography and the enhancement pattern on CEUS were investigated. Results Thirty-six lesions were mostly hypoechoic.39% (14/36) of lesions had peripheral hypoechogenic circle. Color Doppler flow imaging showed a asteroid-like or spoke-and-wheel pattern in 65% (20/ 31) of lesions.Three enhancement patterns were observed in the early arterial phase: whole-enhancement pattern (28%, 10/36), gushing-spring enhancement pattern (44%, 16/36), and spoke-and-wheel enhancement pattern (28%,10/36).The frequency of central scar on CEUS was 17% (6/36), and detection rate of central scar by CEUS compared with pathology was 40% (6/15).Regarding one of the features (gushing-spring enhancement, spoke-and-wheel enhancement and scar) as standard of FNH, the coincidence of CEUS in this group was 78% (28/ 36) ,which was significantly higher than that of conventional ultrasonography 28% (10/36).Conclusions CEUS can be as a important method for diagnosing FNH. Key words: Ultrasonography; Microbubbles; Focal nodular hyperplasia

Contrast enhanced ultrasound of splenic lymphoma involvement

Objective The aim of this study was to compare the value of contrast-enhanced ultrasonography (CEUS) with standard B-mode ultrasound (US) for diagnosis of splenic lymphoma involvement. Methods From 04/2005 to 10/2008 n = 250 lymphoma patients were investigated by standard B-mode US. A homogeneous splenic echotexture was found in 199 patients (79%). To clarify the benefit of CEUS in this group a pilot series was performed with 16 of the 199 lymphoma patients. All patients with an abnormal splenic echotexture on standard B-Mode US ( n = 51) including focal hypoechoic splenic lesions ( n = 41) and an inhomogeneous splenic texture ( n = 10) were studied by CEUS. CEUS data were retrospectively evaluated. The diagnoses included indolent lymphoma ( n = 27), aggressive lymphoma ( n = 14), and Hodgkin's disease ( n = 10). Number and size of lesions were determined by B-mode US and CEUS. The visualisation of splenic lymphoma involvement by CEUS in comparison to B-mode US was classified as worse, equal, or better. Results All patients with a homogeneous spleen on B-mode US ( n = 16) had no visible focal lesions on CEUS. Study patients with focal lesions ( n = 41) had a hypoechoic ( n = 22) or isoechoic ( n = 19) enhancement during the arterial phase, and a hypoechoic enhancement during the parenchymal phase ( n = 41). The visualisation of focal splenic lymphoma was equal ( n = 32), better ( n = 6), or worse ( n = 3). In all study patients with an inhomogeneous spleen on B-mode US ( n = 10) no focal lesions were found by CEUS and the value of CEUS therefore was classified as worse. Conclusion CEUS has no clear advantage for diagnosis of splenic lymphoma involvement.

Kontrastmittelverstärkter Ultraschall im Follow-up nach endovaskulärer Stentversorgung eines infrarenalen Bauchaortenaneurysmas

Endoleaks following endovascular aneurysm repair (EVAR) are common and present a diagnostic challenge in the follow-up after EVAR. Contrast-enhanced ultrasound (CEUS) is a promising new method for the diagnosis and follow-up of endoleaks. CEUS with SonoVue allows a rapid and non-invasive diagnosis in the follow-up after EVAR. The sensitivity and specificity of conventional ultrasound compared to the multislice CT angiography is estimated to be 33-63% and 63-93%, respectively. These values can be increased through the use of CEUS in up to 98-100% (sensitivity) and 82-93% (specificity). This article describes the etiology, classification and importance of different types of endoleaks. The value of CEUS in this clinical scenario will be discussed.

1398: Small Solid Pseudopapillary Tumor of the Pancreas: Sonographic Features in Regular Check-Up Healthy Population and the Value of Contrast-Enhanced Ultrasound

1398: Small Solid Pseudopapillary Tumor of the Pancreas: Sonographic Features in Regular Check-Up Healthy Population and the Value of Contrast-Enhanced Ultrasound

The perfomance of small renal cell carcinoma with contrast-enhanced ultrasonography

Objective To compare features between color Doppler flow imaging(CDFI) and contrast-enhanced ultrasonography(CEUS) in the diagnosis of small renal cell carcinoma(SRCC) and investigate the diagnostic value of CEUS. Methods The images of CDFI and CEUS examination were retrospectively analyzed in forty-five SRCC (≤3 cm in diameter) which were confirmed sequentially by operation and pathology. Inner echoes,boundary,dark-ring and color flow of tumors were observed by CDFI. The degree of tumor vascularity was subjectively graded from 0 to Ⅳ. Enhancement patterns and phases on uhrasonography were reviewed, including enhancement start time, peak time, wash-out time and enhancement appearances of SRCC. Results The images were observed as homogeneous or relatively homogeneous (19) and heterogeneous or relatively heterogeneous(26), clear boundaries(37, including 10 with dark-ring) and ill-defined margins(8). The tumor vascularity was showed as grade 0(5) ,grade Ⅰ (6),grade Ⅱ (14),grade Ⅲ (14),grade Ⅳ(6) on CDFI. All lesions were showed mean enhancement start time (13.84±3.80) seconds,peak time (19.49±4.73) seconds,wash-out time (26.91±5.86) seconds respectively on CEUS. All cases were observed as simultaneous wash-in(39) and gradually wash-in(6),hyperechoic(14) and isoechoic(22) and hypoechoic(9) in peak time, simultaneous wash-out (19) and rapidly wahs-out (19) and gradually wahs-out(7). After contrast medium injection, tumors were detected partly non-enhaneement or cellular enhancement (25) and pseudocapsule (20). Conclusions CEUS is effective in improving the sonographic visualization of tumoral vascularity ,internal structure and pseudocapsule. It plays an important role in the diagnosis of SRCC. Key words: Ultrasonography, Doppler, color; Microbubbles; Kidney neoplasms

The role of contrast-enhanced ultrasound in detection of liver metastases from colorectal cancer: A prospective monocentric study

e15105 Background: Up to 15–25% of patients with colorectal cancer (CRC) will develop metacronous liver metastases during the follow up. The management and prognosis of these patients depend heavily on the early detection of metastases. The most effective surveillance strategy has not yet being extablished. The introduction of second generation ultrasound contrast agents have improved the ability of contrast-enhanced ultrasound (CEUS) in detecting and characterizing liver lesions, showing that its accuracy is comparable to that of spiral CT and MRI with a liver contrast agent, with a cost and a time saving. We tested the sensitivity and specificity of CEUS in detecting liver metastases compared with the standard imaging modalities used in the follow up of CRC. Methods: We conducted a prospective study considering all patients with a diagnosis of CRC in high risk stage II, stage III or with a previous metastasectomy of the liver. In order to detect possible metastases, the patients were followed with a follow-up schedule including a six-monthly ultrasonography alternated to an annual CT, and a six-monthly CEUS with SonoVue contrast agent for the first 3 years. Results: From January 1st to December 2008 we executed 60 CEUS, identifying thirteen suspected liver lesions. 10/13 were confirmed metastases by CT, MRI or TC/PET. 2/13 resulted benign lesions. 1/13 resulted negative at the CT but positive with a MRI. Another additional case was missed by CEUS but detected by CT. CEUS improve specificity and sensitivity compared with baseline ultrasonography. We had an histological confirmation in all cases except one. The study is still recruiting patients. Conclusions: The clinical value of CEUS as a reliable alternative to CT or MRI in characterizing focal liver lesions has been expressed in various documents and guidelines. Our preliminary results confirm the similar diagnostic performance and confidence of CEUS compared to these imaging modalities in the follow up of CRC. Further clinical studies are still needed to strenghten the existing data. No significant financial relationships to disclose.

Clinical value of contrast-enhanced ultrasound in the interventional therapy response of hepatocellular carcinoma

Objective To investigate the clinical value of contrast-enhanced ultrasonography(CEUS) in evaluating treatment response of hepatocellular carcinoma after interventional therapy. Methods One hundred and three patients with 136 lesions of hepatocellular carcinoma confirmed by pathology were examined by common color ultrasound (US), contrast-enhanced CT, CEUS and DSA pre- and post-interventional treatment respectively. Results The sensitivity,specificity and accuracy of CEUS for focus judgment after interventional therapy were 95.8%, 95.6% and 98. 5% respectively. The sensitivity, specificity and accuracy of US in detecting tumor deactivation and residue were 92.3% ,77.4% and 83.1% respectively. CEUS were highly consistent with the results of enhanced CT/DSA (Kappa = 0.93) and significantly higher than those of US (Kappa = 0.66). Conclusions CEUS is useful to monitor the efficacy and guide treatment after interventional therapy. Key words: Ultrasonography; Microbubbles; Liver neoplasms; Treatment outcome

Application of contrast-enhanced ultrasonography in the diagnosis of hepatic artery complications after liver transplantation

Objective To evaluate the value of contrast-enhanced ultrasonography(CEUS)in the diagnosis of hepatic artery complications after liver transplantation.Methods Thirty-seven patients suspected of hepatic artery complications were examined by CEUS.Contrast agent was SonoVue and low mechanical index harmonic CEUS was performed.Results CEUS helped significantly improve flow visualization in hepatic artery(100%).After contrast agent injection,mean contrast material arrival time was(16.1±5.5)s in hepatic artery and(19.3±4.6)s in portal vein.The diagnostic accuracy of hepatic artery thrombosis(HAT)was improved from 86%(30/35)to 100%(35/35)with CEUS.In the HAT group,contrast material arrival time in portal vein was(13.6±4.6)s,shorter to that in group without HAT(P＜0.05).Hepatic artery pseudo-aneurysm was also showed in 2 patients with CEUS after liver transplantation.Conclusions CEUS is a useful technique in improving hepatic artery visualization,which contribute to diagnose hepatic artery complications after liver transplantation. Key words: Ultrasonography; Microbuhbles; Liver transplantation; Hepatic artery; Postoperative complications

Value of Contrast-Enhanced Ultrasound using Cadence Contrast Pulse Sequencing (CPS) technology for Prostate Cancer Detection: preliminary results

We evaluated contrast-enhanced ultrasound (US) using cadence contrast pulse sequencing (CPS) technology in comparison with systematic biopsy for detection of prostate cancer (PCa).

Diagnostic and Prognostic Value of Contrast-Enhanced Ultrasound in Acute Stroke

In the last decade transcranial color-coded sonography (TCCS) was established as a routine in neurovascular departments for the evaluation of brain-supplying vessels in cerebrovascular diseases. TCCS has demonstrated feasibility and validity for the evaluation of the basal cerebral arteries, especially for the middle cerebral artery (MCA). In some patients an insufficient bone window may limit the diagnostic power. The application of microbubble agents can overcome this limitation in most patients. Beside the demonstration of vessel pathology such as stenosis and occlusion, TCCS also provides prognostic information. In the case of proximal MCA occlusion shown by TCCS within 6 hours of stroke, nearly 90 % of the patients suffered an unfavorable outcome. Furthermore TCCS is suitable for monitoring thrombolysis in acute stroke to detect whether there is recanalization of the affected vessel. The possibility for bedside examination, the non-invasiveness and the cost-effectiveness are features which make TCCS an optimal tool for the evaluation of cerebral vessels in acute ischemic stroke.

Value of contrast-enhanced ultrasound in diagnosis of focal liver lesions

Objective By observing the pattern of the focal liver lesions (FLL) in different phases by real time contrast-enhanced ultrasound (CEUS), compared to enhanced CT, investigate the value of CEUS in diagnosing focal liver lesions.

3530: Value of contrast-enhanced ultrasonography with low MI in the diagnosis of small hepatic malignancy

3530: Value of contrast-enhanced ultrasonography with low MI in the diagnosis of small hepatic malignancy

1714: Diagnostic Evaluation of Small Renal Masses: Value of Contrast-Enhanced Ultrasound in Comparison to Multidetector Helical Computed Tomography

1714: Diagnostic Evaluation of Small Renal Masses: Value of Contrast-Enhanced Ultrasound in Comparison to Multidetector Helical Computed Tomography

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.