Value Of Double Contrast-enhanced Ultrasonography Research Articles

Value of double contrast-enhanced ultrasonography in determining pathological features of advanced gastric cancer

Value of double contrast-enhanced ultrasonography in determining pathological features of advanced gastric cancer

Double contrast-enhanced ultrasonography in the detection of periampullary cancer: Comparison with B-mode ultrasonography and MR imaging

PurposeTo investigate the value of double contrast-enhanced ultrasonography (DCEUS) in the detection of periampullary cancer. Materials and methodsNinety-nine patients with surgery or biopsy-proven periampullary cancer who underwent both DCEUS and magnetic resonance imaging (MRI) examinations before operation were enrolled in our study. DCEUS in which intravenous microbubbles were used in combination with oral contrast agent and MRI were performed preoperatively to make a detection diagnosis of periampullary cancer. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of DCEUS, B-mode ultrasonography (BUS) and MRI were calculated and compared. Receiver operating characteristic (ROC) curves were used to evaluate the accuracy of BUS, DCEUS and MRI in the detection. Stratified analyses were performed for different pathological types and different sizes of periampullary lesions. The inter- and intra-observer reliability of DCEUS for cancer detection was also investigated. ResultThere were no significant differences in sensitivity, specificity, PPV, NPV or accuracy between DCEUS and MRI (all P>0.05). ROC analysis showed that the accuracy of DCEUS or MRI was higher than that of BUS (P<0.001), while no significant differences were noted in the accuracy between DCEUS and MR. In the 76 cases of periampullary cancer, DCEUS appeared to be superior to BUS for ampullary carcinoma, duodenum carcinoma and for lesions with an average diameter of less than 3cm. DCEUS appeared equal to BUS in other groups. No significant differences were noted between DCEUS and MRI in the stratified analysis. A considerably well agreement between DCEUS and MRI was obtained using Kappa analysis (k=0.649, P<0.001). The intra- and inter-observer reproducibility were both good for detection of periampullary cancer by DCEUS, with a Kappa values of 0.783 (P<0.01) and 0.732 (P<0.01), respectively. ConclusionDCEUS provides an available and useful imaging modality in the detection of periampullary cancer. This technique can aid in displaying the invisible periampullary region in BUS and may also become an effective supplemental method to MRI.

Diagnostic value of double contrast-enhanced ultrasonography in preoperative staging of rectal carcinoma

Objective To evaluate the preoperative T staging value of rectal carcinoma by using double contrast-enhanced ultrasonography (DCUS).Methods 71 patients with rectal carcinoma were examined by ultrasound after infusing contrast agent and bolus injection of SonoVue preoperatively.The border,shape and perfusion patterns of the tumor were observed.After surgery,the T staging made by DCUS and perfused contrast-enhanced ultrasonography (PCUS) was compared with final pathologic results respectively.Results The accuracy of PCUS and DCUS in determining the T stage of rectal carcinoma were 71.8％(T1 72.7％％,T250.0％,T374.4％,T476.9％) and 85.9％(T190.9％,T275.0％,T387.1％,T484.6％) respectively.The difference between these two methods was statistically significant (P ＜0.05).Conclusions DCUS is a new valuable method for T staging of rectal carcinoma with its high accuracy preoperatively. Key words: Ultrasonography; Microbubbles ; Rectal neoplasms; Neoplasm staging

Features of time–intensity curve parameters of colorectal adenocarcinomas evaluated by double-contrast enhanced ultrasonography: Initial observation

This study is to investigate the value of double contrast-enhanced ultrasonography (DCEU) in assessing microcirculation of colorectal adenocarcinomas and to describe the perfusion features of the tumours. DCEUS was performed in 42 patients with adenocarcinoma. The time-intensity curve parameters (arrival time (AT), time-to-peak (TTP), peak intensity (PI) and area under the curve (AUC)) within the tumours were extracted. The parameters were compared among the tumours with different CEUS features and stages. The mean values of AT, TTP, PI and AUC of the colorectal adenocarcinomas were 13.68±13.36s, 32.61±19.56s, 19.82±16.54dB and 271.10±159.19dBs, respectively. In the adenocarcinomas with necrosis, the mean values of AUC was significantly lower than that of the adenocarcinomas without (231.10±219.27dBs, 278.10±123.20dBs, p=0.004). In the adenocarcinomas with necrosis, the AUC and PI of the non-necrotic part were significantly higher than that of the necrotic part (p=0.007, 0.0025, respectively). AUC increased progressively in the subgroups of T2, T3 and T4 and the difference of AUC between T2 and T4 subgroup was significant (p=0.008). Double contrast-enhanced ultrasonography is a valuable technique for quantifying tumour vascularity of colorectal adenocarcinomas. AUC was significantly different in the subgroups of different T stage. AUC and PI could reflect the different perfusion status of tumours with or without necrosis.

Double contrast-enhanced ultrasonography evaluation of preoperative Lauren classification of advanced gastric carcinoma

IntroductionThe clinical value of double contrast-enhanced ultrasonography (DCUS) in determining the Lauren classification of advanced gastric carcinoma needed investigation.Material and methodsFifty-eight patients with gastric cancer proved by endoscopic biopsy underwent preoperative DCUS examination in which an oral contrast agent was combined with an intravenous agent, and the findings were compared with the postoperative pathological findings using haematoxylin-eosin and Alcian Blue-Periodic Acid Schiff (AB-PAS) staining.ResultsOf 58 patients, 34 (59%) were the intestinal type and 24 (41%) the diffuse type on pathological examination of resected specimens. Among intestinal type patients, 30 (88%) showed homogeneous vascular enhancement and 4 (12%) heterogeneous enhancement with the “sandwich” pattern in 2 patients (50%) and “barrier” pattern in 2 patients (50%). In the diffuse type, 22 of 24 patients (92%) enhanced heterogeneously, with stippled and peripheral enhancement in 9 (41%), the “sandwich” pattern in 8 (36%) and “barrier” pattern in 5 (23%). Two of 24 patients (8%) with the diffuse type enhanced homogeneously. The proportion of heterogeneous enhancement was significantly different between the 2 subtypes of tumour (p = 0.0001). The sensitivity and specificity of heterogeneous enhancement in diagnosing the diffuse type of advanced gastric cancer were 92% and 88%, respectively. Youden’s index was 0.8.ConclusionsDouble contrast-enhanced ultrasonography is a new and useful method to determine Lauren classification in patients with gastric carcinoma.

Evaluation of the chemotherapy effect in advanced gastric carcinoma using double contrast-enhanced ultrasonography

Objective To explore the clinical value of double contrast-enhanced ultrasonography (DCUS) on evaluation of the chemotherapy effect in advanced gastric carcinoma. Methods A total of 21 patients with unresectable and received chemotherapy of advanced gastric carcinoma were examined using ultrasound after taking oral contrast agent and bolus injection of Sono Vue, and findings of DCUS of each patient before and after chemotherapy were compared. Results The thickness of lesions was slightly thinner than that after chemotherapy,but there was no significant difference ( P ＞0. 05). In addition, there was no significant difference in the basal intensity (BI), peak intensity (PI), arrive time (AT) and time to peak (TTP) of gastric carcinoma tissues after chemotherapy (P ＞0.05). While the enhanced intensity (EI) value of gastric carcinoma tissues after chemotherapy was significantly less than that before chemotherapy (P ＜0.05). Conclusions The EI value in gastric carcinoma tissues may be considered as a sensitive and effective index in assessing the therapeutic effect of the chemotherapy in patients with advanced gastric carcinoma. Key words: Ultrasonography; Microbubbles; Stomach neoplasms

Application of double contrast-enhanced ultrasonography to access the lymph nodes metastasis of gastric carcinoma

Objective To investigate the clinical value of double contrast-enhanced ultrasonography (DCUS) in diagnosing lymph nodes metastasis of gastric carcinoma.Methods One hundred and sixteen patients with gastric cancer diagnosed by gastroscope and confirmed by pathology after operation were examined by DCUS preoperatively.The enhanced characteristic of gastric carcinoma tissues was assessed by autotracking contrast quantification(ACQ) software.The baseline intensity(BI), peak intensity(PI), arrival time(AT) and time to peak(TTP) of gastric cancer was measured automatically,and the enhanced intensity (EI) and wash-in time(WIT) of gastric cancer was calculated manually (EI=PI-BI; WIT=TTP-AT).All of the subjects were divided into two groups according to their lymph nodes status postoperatively:group N1,sixty-nine patients with lymph nodes metastasis; and group N0, forty-seven patients without lymph nodes metastasis.The DCUS quantitative analysis and pathological results of these two groups were compared each other.The Kappa's test was used for inter-rater reliability.Results BI of group N1 in the gastric carcinoma tissues was lower than that of group N0 significantly [(1.41 ± 1.56)dB vs (3.92 ± 2.82)dB, t = - 4.81, P = 0.000].EI of group N1 in the gastric carcinoma tissues was higher than that of group N0 significantly [(20.67±3.71)dB vs (14.12±3.75)dB, t=7.31, P=0.000].Moreover, there was a significant difference of WIT in the gastric carcinoma tissues between these two groups[(9.12±2.99)s vs (10.88±3.05)s, t =-2.43, P=0.018].The WIT in patients with lymph nodes metastasis was shorter than that without it. A cut-off value ＞17.05 dB of EI in gastric cancer tissues for assessing the lymph nodes metastasis had a sensitivity of 80.50% and specificity of 76.70% respectively obtained by the area under the ROC curve. The Kappa value of this method was 0.88.Conclusions EI of gastric cancer tissues can be considered as a new potential index to evaluate the lymph nodes metastasis of gastric cancer. Key words: Ultrasonography; Microbubbles; Stomach neoplasms; Lymphatic metastasis

Diagnostic value of double contrast-enhanced ultrasonography in preoperative staging of gastric cancer

To evaluate the clinical value of double contrast-enhanced ultrasonography using oral and intravenous contrast agents in preoperative staging of gastric cancer. Sixty-two patients with biopsy-proven gastric cancer were enrolled into this study, and were examined by double contrast-enhanced gastric ultrasonography preoperatively. The results were compared with postoperative pathologic findings. The accuracy of oral contrast-enhanced gastric ultrasonography and double contrast-enhanced ultrasonography in determining the T stage of gastric cancer was 72.9% (T1: 66.7%, T2: 60.0%, T3: 76.9%, T4: 71.4%) and 88.1% (T1: 66.7%, T2: 80.0%, T3: 89.7%, T4: 100%), respectively, with a statistically significant difference between the two methods (P = 0.036). The sensitivity, specificity, accuracy and Youden index of oral contrast-enhanced gastric ultrasonography and double contrast-enhanced ultrasonography in assessment of lymph node metastasis were 74.5%, 66.7%, 72.9%, and 0.41 versus 89.4%, 75.0%, 86.4%, 0.76, respectively. No significant difference in the accuracy of assessment for lymph node metastasis was observed (P > 0.05). Double contrast-enhanced ultrasonography is useful for preoperative staging of gastric cancer, especially for T staging.

Pilot study of double contrast ultrasonography for pathological typing of advanced gastric cancer

Objective To explore the value of double contrast-enhanced ultrasonography(DCUS) in the evaluation of pathological typing of advanced gastric cancer. Methods Sixty one patients who had been diagnosed as gastric cancer by gastroscope and confirmed by pathology after operation were examined using DCUS. According to pathological typing, all cases were divided into mucoid gastric cancer (26 cases) and non-mucoid gastric cancer (35 cases). A comparison with final pathologic results was made after surgery. The correlation of initial enhanced features of the lesions was compared with pathological typing of gastric cancer. Results Among 26 cases of mucoid gastric cancer,21 cases of initial enhanced region were mainly focused on serosa surface or mucosa surface, which were disconnected as line-typed, and followed by lamellar signs (at least 3 seconds duration). As for 35 cases of non-mucoid gastric cancer,30 cases were presented as diffused distribution at initial enhanced region,and were enhanced thoroughly after 3 seconds. The sensitivity and specificity of initial enhanced features in diagnosing mucoid gastric cancer was 80.8% and 88.6% respectively,and the Youden's index was 0.69. In thirty five cases of non-mucoid gastric cancer, the peak intensity(PI) and enhanced intensity(EI) in poorly differentiated and undifferentiated group was higher than that in well and moderatel differentiated group significantly(P 0.05). The PI and EI in mucoid gastric cancer was lower than that in poorly differentiated and undifferentiated group of non-mucoid gastric cancer (P<0.05). Conclusions DCUS could initial estimate the pathological typing of advanced gastric caner before operation. Key words: Ultrasonography; Microbubbles; Stomach neoplasms