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Correas JM, Anglicheau D, Joly D, Gennisson JL, Tanter M, Hélénon O. Ultrasound-based imaging methods of the kidney-recent developments. Kidney Int 2016; 90:1199-1210. [PMID: 27665116 DOI: 10.1016/j.kint.2016.06.042] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/05/2016] [Accepted: 06/14/2016] [Indexed: 12/11/2022]
Abstract
In recent years, several novel ultrasound (US)-based techniques have emerged for kidney diagnostic imaging, including tissue stiffness assessment with elastography, Ultrasensitive Doppler techniques, and contrast-enhanced ultrasonography to assess renal microvascularization. Renal elastography has become available with the development of noninvasive quantitative techniques, following the rapidly growing field of liver fibrosis diagnosis. With the increased incidence of chronic kidney disease, noninvasive diagnosis of renal fibrosis can be of critical value. However, it is difficult to simply extend the application of US elastography from one organ to the other due to anatomic and technical issues. Today, renal elastography appears to be a promising application that, however, still requires optimization and validation. New ultrasensitive Doppler techniques improve the detection of slow blood flow and can be used alone or after administration of US contrast agents. These microbubble-based agents are extremely well tolerated and can be administered even in cases of impaired renal function. Despite the lack of approval, they improve the characterization of atypical renal masses, complex cystic renal masses, and peripheral vascular disorders. Dynamic contrast-enhanced US is based on quantification of the signal intensity from region of interest and mathematical fits of the time-intensity curves. Perfusion-related parameters can be extracted for the monitoring of vascular changes in the renal parenchyma and in tumors in order to evaluate drug response. This estimation of renal perfusion depends on many parameters that should be kept constant for follow-up studies, and, when possible, an internal reference should be used to normalize the measurements.
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Affiliation(s)
- Jean-Michel Correas
- Paris-Descartes Sorbonne University, Paris, France; Department of Adult Radiology, Necker University Hospital, Paris, France; Langevin Institute, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France.
| | - Dany Anglicheau
- Paris-Descartes Sorbonne University, Paris, France; Department of Adult Nephrology and Transplantation, Necker University Hospital, Paris, France; Necker - Sick Children Institute, INSERM U1151, Paris, France
| | - Dominique Joly
- Paris-Descartes Sorbonne University, Paris, France; Department of Adult Nephrology and Transplantation, Necker University Hospital, Paris, France
| | - Jean-Luc Gennisson
- Langevin Institute, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France
| | - Mickael Tanter
- Langevin Institute, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France
| | - Olivier Hélénon
- Paris-Descartes Sorbonne University, Paris, France; Department of Adult Radiology, Necker University Hospital, Paris, France
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Skakić A, Stojanov D, Bašić D, Dinić L, Potić M, Tasić A. DIAGNOSTIC IMAGING OF SMALL RENAL MASSES. ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Quantitative assessment of solid renal masses by contrast-enhanced ultrasound with time-intensity curves: how we do it. ACTA ACUST UNITED AC 2016; 40:2461-71. [PMID: 26036794 DOI: 10.1007/s00261-015-0468-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To discuss the evaluation of the enhancement curve over time of the major renal cell carcinoma (RCC) subtypes, oncocytoma, and lipid-poor angiomyolipoma, to aid in the preoperative differentiation of these entities. Differentiation of these lesions is important, given the different prognoses of the subtypes, as well as the desire to avoid resecting benign lesions. METHODS We discuss findings from CT, MR, and US, but with a special emphasis on contrast-enhanced ultrasound (CEUS). CEUS technique is described, as well as time-intensity curve analysis. RESULTS Examples of each of the major RCC subtypes (clear cell, papillary, and chromophobe) are shown, as well as examples of oncocytoma and lipid-poor angiomyolipoma. For each lesion, the time-intensity curve of enhancement on CEUS is reviewed, and correlated with the enhancement curve over time reported for multiphase CT and MR. CONCLUSIONS Preoperative differentiation of the most common solid renal masses is important, and the time-intensity curves of these lesions show some distinguishing features that can aid in this differentiation. The use of CEUS is increasing, and as a modality it is especially well suited to the evaluation of the time-intensity curve.
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Histotype differentiation of hypo-echoic renal tumors on CEUS: usefulness of enhancement homogeneity and intensity. ACTA ACUST UNITED AC 2016; 40:1675-83. [PMID: 25549784 DOI: 10.1007/s00261-014-0340-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE The purpose of this study is to evaluate qualitative and quantitative analysis of contrast-enhanced ultrasound (CEUS) in differential diagnoses of hypo-echoic renal tumor histotypes. METHODS Our study cohort comprised 103 clear cell renal cell carcinomas (ccRCCs), 24 papillary renal cell carcinomas (pRCCs), 28 chromophobe renal cell carcinomas (cRCCs), and 34 angiomyolipomas (AMLs), hypo-echoic on ultrasound, and imaged between January 2011 and December 2013. Enhancement homogeneity and tumor-to-cortex intensity ratio (TOC ratio) were retrospectively analyzed. RESULTS Overall, heterogeneous enhancement was more common in ccRCCs than AMLs, pRCCs, and cRCCs. TOC ratio showed the trend ccRCC > AML > pRCC = cRCC. Similar trends were seen in tumors <4 cm. Using heterogeneous enhancement or TOC ratio >107.5% to differentiate ccRCC from other histotypes, the sensitivity, specificity, positive and negative predictive values were 93.1%, 74.5%, 84.8%, and 87.5%, respectively. Tumors >4 cm exhibited considerable overlap in enhancement homogeneity among different histotypes. TOC ratios were similar between homo- and heterogeneously enhancing tumors for ccRCCs and for pRCCs and cRCCs, but higher in homogeneously enhancing than heterogeneously enhancing AMLs. In homo- and heterogeneously enhancing tumors, TOC ratios followed the trends ccRCCs > AMLs > pRCCs = cRCCs and ccRCCs > AMLs = pRCCs = cRCCs, respectively. With TOC ratio >105.81% and >72.37% to differentiate homo- and heterogeneously enhancing ccRCCs from other histotypes in tumors >4 cm with same enhancement homogeneity, the sensitivity, specificity, positive and negative predictive values were 70.0%, 85.7%, 70.0%, 85.7%, and 91.7%, 94.4%, 95.7%, 89.5%, respectively. CONCLUSION CEUS homogeneity and TOC ratio are helpful in differential diagnosis of hypo-echoic renal tumor histotypes. Diameter and enhancement homogeneity should be considered when deciding the diagnostic TOC ratio cutoff.
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Lu Q, Li CX, Huang BJ, Xue LY, Wang WP. Triphasic and epithelioid minimal fat renal angiomyolipoma and clear cell renal cell carcinoma: qualitative and quantitative CEUS characteristics and distinguishing features. ACTA ACUST UNITED AC 2015; 40:333-42. [PMID: 25139641 DOI: 10.1007/s00261-014-0221-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To determine the contrast-enhanced ultrasonography (CEUS) characteristics of minimal fat renal angiomyolipoma (AML) (triphasic and epithelioid) and compare them to each other and to clear cell renal cell carcinoma (ccRCC) to explore their differential diagnostic clue. METHODS Qualitative and quantitative CEUS analyses were retrospectively conducted for epithelioid renal AMLs (EAMLs) (n = 15), triphasic minimal fat AMLs (TAMLs) (n = 25), and ccRCCs (n = 113). Enhancement patterns and features with CEUS were qualitatively evaluated. As for the quantitative parameters, rise times (RT), time to peak (TTP), and tumor-to-cortex enhancement ratio (TOC ratio) were compared among these renal tumor histotypes. RESULTS No significant differences were detected on conventional ultrasound in the three histotypes of renal tumor. On qualitative CEUS analysis, centripetal enhancement in cortical phase (73.3% in EAMLs, 84.0% in TAMLs vs. 18.6% in ccRCCs, p < 0.001 for both), homogeneous peak enhancement (100.0% in both EAMLs and TAMLs vs. 43.4% in ccRCCs, p < 0.001 for both), and iso-enhancement in parenchyma phase (53.3% in AMLs, 52.0% in TAMLs vs. 26.5% in ccRCCs, p = 0.034 and 0.013, respectively) were valuable traits for differentiating EAMLs and TAMLs from ccRCCs. Furthermore, with quantitative analysis, RT and TTP were much shorter in ccRCCs than those in EAMLs and TAMLs. However, all these qualitative and quantitative characteristics made no significant difference between EAMLs and TAMLs. In the differential diagnosis of EAMLs from TAMLs, pseudocapsule sign was valuable (40.0% in EAMLs vs. 0.0% in TAMLs, p < 0.001), and TOC ratio was much higher in EAMLs (166.01 ± 64.47%) than that in TAMLs (93.74 ± 46.56%)(p < 0.001), though they did make overlaps with ccRCCs. With either heterogeneous peak enhancement or the presence of pseudocapsule or TOC ratio >97.34% as the criteria to differentiate ccRCCs and EAMLs from TAMLs, the sensitivity and specificity were 80.0% and 87.5%, respectively. CONCLUSIONS Qualitative and quantitative CEUS analyses are helpful in the differential diagnosis of ccRCCs, EAMLs, and TAMLs.
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Affiliation(s)
- Qing Lu
- Department of Ultrasound, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China,
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Lu Q, Wen JX, Huang BJ, Xue LY, Wang WP. Virtual Touch quantification using acoustic radiation force impulse (ARFI) technology for the evaluation of focal solid renal lesions: preliminary findings. Clin Radiol 2015; 70:1376-81. [PMID: 26375726 DOI: 10.1016/j.crad.2015.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/10/2015] [Accepted: 08/05/2015] [Indexed: 12/13/2022]
Abstract
AIM To evaluate potential value of Virtual Touch quantification (VTQ) of acoustic radiation force impulse (ARFI) imaging for characterising focal solid renal lesions. MATERIALS AND METHODS Two independent operators performed 10 and five measurements of each lesion and adjacent renal cortex, respectively. Mean shear wave velocity (SWV) and shear wave velocity ratio (SWR) of histotypes were compared. RESULTS One hundred and ninety-seven renal lesions were evaluated, including 155 renal cell carcinomas (RCCs; 129 clear-cell RCCs [ccRCCs], 14 papillary RCCs [pRCCs], and 12 chromophobe RCCs [cRCCs]) and 42 angiomyolipomas (AMLs). The interoperator reproducibility of SWV of renal tumours and renal cortex were good (ICC=0.852, and 0.903, respectively). SWV of the renal cortex at a depth of <4 cm was significant higher than that at a depth of >4 cm. Regardless of the subtypes of RCC, SWV and SWR of RCCs differed significantly from those of AMLs (2.28±0.85 versus 1.98±0.85; 1.09±0.56 versus 0.78±0.34; p=0.045 and p<0.001, respectively). At cut-off points of SWV >1.87 m/s or SWR >0.84 to differentiate RCCs from AMLs, the sensitivity and specificity were 47.5%, 33.2% or 47.5%, 30.2%, respectively. When the subtypes of RCCs were taken into account, SWV and SWR of ccRCCs were significantly higher than those of pRCCs, cRCCs, and AMLs, while there was no significant difference among the latter. With SWV >1.98 m/s or SWR >0.80 as the cut-off point to differentiate ccRCCs from other renal tumours, the sensitivity and specificity were 69.8%, 65% or 76.8%, 73.4%, respectively. CONCLUSION The ARFI technique offers additional information regarding renal tumour elasticity with good reproducibility. SWV and SWR are potential biomarkers in this setting, helping to differentiate ccRCC from other renal tumour histotypes.
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Affiliation(s)
- Q Lu
- Shanghai Institute of Imaging, Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - J-X Wen
- Shanghai Institute of Imaging, Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - B-J Huang
- Shanghai Institute of Imaging, Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China.
| | - L-Y Xue
- Shanghai Institute of Imaging, Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - W-P Wang
- Shanghai Institute of Imaging, Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
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Differentiation of Renal Tumor Histotypes: Usefulness of Quantitative Analysis of Contrast-Enhanced Ultrasound. AJR Am J Roentgenol 2015; 205:W335-42. [PMID: 26295670 DOI: 10.2214/ajr.14.14204] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Xue LY, Lu Q, Huang BJ, Ma JJ, Yan LX, Wen JX, Wang WP. Contrast-enhanced ultrasonography for evaluation of cystic renal mass: in comparison to contrast-enhanced CT and conventional ultrasound. ACTA ACUST UNITED AC 2015; 39:1274-83. [PMID: 24929667 DOI: 10.1007/s00261-014-0171-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess the value of contrast-enhanced ultrasonography (CEUS) in evaluating cystic renal lesions compared with conventional ultrasound (US) and contrast-enhanced computed tomography (CECT). METHODS One hundred and three patients with complex cystic renal masses underwent preoperative US and CEUS, among which 70 conducted CECT at our institution. The images were analyzed with the number of septa, septa and wall thickness and the presence of solid component, and final diagnosis was made. RESULTS In malignancies, CEUS demonstrated more septa, thicker wall or septa, and more solid components than US and CECT. CEUS permitted categorization of 51.7% (30/58) and 28.6% (10/35) of malignant tumors in higher grade than by US and CECT, respectively. In benign lesions, CEUS detected more septa than CECT and correctly diagnosed benign cysts which appeared as solid lesions in US. CEUS permitted downgrading of 71.1% (32/45) and 17.1% (6/35) of benign lesions compared to US and CECT. The diagnostic performance of CEUS was better than US for benign cystic lesions. The phenomenon that solid-like component by US did not enhance by CEUS was a strong predictor of benign disease, with a positive predictive value (PPV) of 100%. Enhancement of solid, soft tissue by CEUS was highly predictive of malignancy, with a PPV of 100%. CONCLUSIONS CEUS was superior to US and CECT in visualizing the number of septa septa and wall thickness, and the presence of solid component of cystic renal lesions. CEUS may play a similar role to CECT in the diagnosis of renal cystic lesions, and better than US.
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Affiliation(s)
- Li-Yun Xue
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Bldg 1#, 180 Fenglin Rd., Xuhui District, Shanghai, 200032, China
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Abstract
Ultrasound is an imaging technology that has evolved swiftly and has come a long way since its beginnings. It is a commonly used initial diagnostic imaging modality as it is rapid, effective, portable, relatively inexpensive, and causes no harm to human health. In the last few decades, there have been significant technological improvements in the equipment as well as the development of contrast agents that allowed ultrasound to be even more widely adopted for urologic imaging. Ultrasound is an excellent guidance tool for an array of urologic interventional procedures and also has therapeutic application in the form of high-intensity focused ultrasound (HIFU) for tumor ablation. This article focuses on the recent advances in ultrasound technology and its emerging clinical applications in urology.
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Affiliation(s)
- Anupam Lal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Priyanka Naranje
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Santhosh Kumar Pavunesan
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Xue LY, Lu Q, Huang BJ, Li Z, Li CX, Wen JX, Wang WP. Papillary renal cell carcinoma and clear cell renal cell carcinoma: Differentiation of distinct histological types with contrast - enhanced ultrasonography. Eur J Radiol 2015; 84:1849-56. [PMID: 26149528 DOI: 10.1016/j.ejrad.2015.06.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/10/2015] [Accepted: 06/16/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Papillary renal cell carcinoma (pRCC) and clear cell renal cell carcinoma (ccRCC) have different biological behaviours and imaging features. The role of contrast-enhanced ultrasound (CEUS) in differentiating these two carcinoma subtypes has not been comprehensively studied. MATERIALS AND METHODS Forty-eight patients with 49 pRCC lesions and 153 patients with 156 ccRCC lesions underwent preoperative conventional ultrasound (US) and CEUS. Among them, 91 patients (25 pRCCs and 66 ccRCCs) also underwent preoperative contrast-enhanced computed tomography (CECT) in our hospital. The characteristics of CEUS and CECT images for each patient imaged were analysed by each of two blinded observers. RESULTS Images for five (5/25, 20%) pRCC patients demonstrated equivocal or no enhancement using CECT, while all lesions were enhanced using CEUS. From CEUS, images of pRCCs, when compared with ccRCC images, demonstrated significantly higher frequencies of slow wash-in (59.2% vs. 5.8%), fast wash-out (87.7% vs. 46.1%), and hypo-enhancement (57.1% vs. 7.1%) patterns, p<0.001, as well as the presence of pseudocapsule (42.9% vs. 23.1%), p=0.007. For lesions with large diameters (> 3 cm), a higher percentage of pRCC images demonstrated homogeneous enhancement compared with ccRCC images. Using the combination of slow wash-in, fast wash-out, and hypoenhancement patterns at peak as criteria to differentiate pRCC from ccRCC, positive and negative predictive value, and sensitivity and specificity were found to be 86.7%, 86.9%, 53.1%, and 97.4%, respectively. CONCLUSIONS CEUS imaging features of slow-in, fast-out, and hypo-enhancement patterns may be useful for differentiating pRCC and ccRCC. In addition, CEUS may be helpful for diagnosing hypovascular renal lesions that demonstrate equivocal or no enhancement by CECT and, thus, for improving diagnostic confidence.
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Affiliation(s)
- Li-Yun Xue
- Department of Ultrasound Zhongshan Hospital, Fudan University, Shanghai institute of medical imaging, Bldg. 1#, 180 Fenglin Rd., Xuhui District, Shanghai 200032, China
| | - Qing Lu
- Department of Ultrasound Zhongshan Hospital, Fudan University, Shanghai institute of medical imaging, Bldg. 1#, 180 Fenglin Rd., Xuhui District, Shanghai 200032, China
| | - Bei-Jian Huang
- Department of Ultrasound Zhongshan Hospital, Fudan University, Shanghai institute of medical imaging, Bldg. 1#, 180 Fenglin Rd., Xuhui District, Shanghai 200032, China.
| | - Zheng Li
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Cui-Xian Li
- Department of Ultrasound Zhongshan Hospital, Fudan University, Shanghai institute of medical imaging, Bldg. 1#, 180 Fenglin Rd., Xuhui District, Shanghai 200032, China
| | - Jie-Xian Wen
- Department of Ultrasound Zhongshan Hospital, Fudan University, Shanghai institute of medical imaging, Bldg. 1#, 180 Fenglin Rd., Xuhui District, Shanghai 200032, China
| | - Wen-Ping Wang
- Department of Ultrasound Zhongshan Hospital, Fudan University, Shanghai institute of medical imaging, Bldg. 1#, 180 Fenglin Rd., Xuhui District, Shanghai 200032, China
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Growing indications for CEUS: The kidney, testis, lymph nodes, thyroid, prostate, and small bowel. Eur J Radiol 2015; 84:1675-84. [PMID: 26014102 DOI: 10.1016/j.ejrad.2015.05.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/05/2015] [Indexed: 12/11/2022]
Abstract
Contrast enhanced ultrasonography (CEUS) is increasingly used for non-hepatic applications as well, so that nearly all organs have been investigated. Among them, there is a growing clinical use for a variety of pathologies of the kidney, testis, and small bowel. The possibility to differentiate benign from malignant nodes in cancer patients has been investigated. A new application is in the detection of sentinel nodes after intradermal microbubble injection. The need to distinguish thyroid nodules eligible for fine needle aspiration cytology has led to the use of CEUS in thyroid examinations as well. The potential of CEUS for prostate cancer detection has been extensively investigated, with encouraging initial results. Early promise, however, has not been fulfilled. New perspective regards evaluation of the extent of prostate tissue devascularization following ablative treatments.
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Onur MR, Poyraz AK, Bozgeyik Z, Onur AR, Orhan I. Utility of semiquantitative strain elastography for differentiation between benign and malignant solid renal masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:639-647. [PMID: 25792579 DOI: 10.7863/ultra.34.4.639] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The aim of this study was to determine the role of semiquantitative strain elastography for differentiation of benign and malignant solid renal masses. METHODS Seventy-one patients with solid renal masses were prospectively examined with ultrasound elastography after grayscale sonography. Strain elastography was used to compare the stiffness of the renal masses and renal parenchyma. The ratio of strain in a renal mass and nearby renal parenchyma was defined as the strain index value. Mean strain index values for benign masses (n = 29; 24 angiomyolipomas and 5 oncocytomas) and malignant masses (n = 42; 34 renal cell carcinomas, 4 transitional cell carcinomas, 3 metastases, and 1 lymphoma) and mean strain index values for angiomyolipomas and renal cell carcinomas were compared. RESULTS There were no significant differences in the mean age of the patients, mean diameter of the masses, and mean probe-mass distance between benign and malignant groups. The mean strain index value ± SD for malignant masses (4.05 ± 2.17) was significantly higher than the value for benign masses (1.43 ± 0.94; P < .05). The mean strain index value for renal cell carcinomas (4.30 ± 2.27) was significantly higher than the value for angiomyolipomas (1.28 ± 1.01; P < .0001). CONCLUSIONS Strain elastography may be a useful imaging technique for differentiation between benign and malignant solid renal masses.
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Affiliation(s)
- Mehmet Ruhi Onur
- Department of Radiology, Faculty of Medicine, University of Firat, Elazig, Turkey.
| | - Ahmet Kursad Poyraz
- Department of Radiology, Faculty of Medicine, University of Firat, Elazig, Turkey
| | - Zulkif Bozgeyik
- Department of Radiology, Faculty of Medicine, University of Firat, Elazig, Turkey
| | - Ahmet Rahmi Onur
- Department of Radiology, Faculty of Medicine, University of Firat, Elazig, Turkey
| | - Irfan Orhan
- Department of Radiology, Faculty of Medicine, University of Firat, Elazig, Turkey
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Lu Q, Huang BJ, Wang WP, Li CX, Xue LY. Qualitative and quantitative analysis with contrast-enhanced ultrasonography: diagnosis value in hypoechoic renal angiomyolipoma. Korean J Radiol 2015; 16:334-41. [PMID: 25741195 PMCID: PMC4347269 DOI: 10.3348/kjr.2015.16.2.334] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/15/2014] [Indexed: 12/19/2022] Open
Abstract
Objective To evaluate the value of enhancement features and quantitative parameters of contrast-enhanced ultrasonography (CEUS) in differentiating solid hypoechoic renal angiomyolipomas (AMLs) from clear cell renal cell carcinomas (ccRCCs). Materials and Methods We analyzed the enhancement features and quantitative parameters of CEUS in 174 hypoechoic renal masses (32 AMLs and 142 ccRCCs) included in the study. Results Centripetal enhancement pattern was more common in AMLs than in ccRCCs on CEUS (71.9% vs. 23.2%, p < 0.001). At peak enhancement, all AMLs showed homogeneous enhancement (100% in AML, 27.5% in ccRCCs; p < 0.001). Quantitative analysis showed no significant difference between rise time and time to peak. Tumor-to-cortex (TOC) enhancement ratio in AMLs was significantly lower than that in ccRCCs (p < 0.001). The criteria of centripetal enhancement and homogeneous peak enhancement together with TOC ratio < 91.0% used to differentiate hypoechoic AMLs from ccRCCs resulted in a sensitivity and specificity of 68.9% and 95.8%, respectively. Conclusion Both qualitative and quantitative analysis with CEUS are valuable in the differential diagnosis of hypoechoic renal AMLs from ccRCCs.
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Affiliation(s)
- Qing Lu
- Shanghai Imaging Institute of Medicine, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Bei-jian Huang
- Shanghai Imaging Institute of Medicine, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wen-ping Wang
- Shanghai Imaging Institute of Medicine, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Cui-xian Li
- Shanghai Imaging Institute of Medicine, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Li-yun Xue
- Shanghai Imaging Institute of Medicine, Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Xu G, Wu J, Yao MH, Yao XD, Peng B, Wei Q, Xu HX, Wu R. Parameters of prostate cancer at contrast-enhanced ultrasound: correlation with prostate cancer risk. Int J Clin Exp Med 2015; 8:2562-2569. [PMID: 25932202 PMCID: PMC4402849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 01/29/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE to investigate the correlation between the parameters of prostate cancer (PCa) at contrast-enhanced ultrasound (CEUS) with PCa risk. METHODS 84 patients (68 ± 8 years; range, 33-79 years) who had undergone CEUS were included. All the images were offline analyzed. Parameters (maximum intensity (IMAX), rise time (RT), time to peak (TTP) and mean transit time (mTT)) were recorded and compared with PSA level, Gleason score, clinical stages and PCa risk. RESULTS Age was correlated significantly with PCa risk. RT and mTT of outer gland were associated with PCa risk. No significant correlation was found between PSA and CEUS enhancement parameters. Furthermore, with the exception of IMAX of inner gland and IMAX of outer gland, there were no significant differences of enhancement parameters in Gleason score groups and clinical stages groups. CONCLUSION The enhancement parameters of PCa at CEUS may be used to predict PCa risk. And it is helpful for the choice of therapeutic options.
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Affiliation(s)
- Guang Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
| | - Jian Wu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
| | - Ming-Hua Yao
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
| | - Xu-Dong Yao
- Department of Urology, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
| | - Bo Peng
- Department of Urology, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
| | - Qing Wei
- Department of Pathology, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures, Shanghai Institute of Ceramics, Chinese Academy of SciencesShanghai 200050, China
| | - Rong Wu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of MedicineShanghai 200072, China
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Yan L, Huang B, Xue L, Lu Q, Wen J, Wang W. Contrast-enhanced ultrasound characterization of renal mucinous tubular and spindle cell carcinoma: report of two cases. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:55-58. [PMID: 24706525 DOI: 10.1002/jcu.22159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 03/17/2014] [Indexed: 06/03/2023]
Abstract
Mucinous tubular and spindle cell carcinoma of the kidney is a relatively rare pathologic entity that has recently been described in the World Health Organization 2004 renal cell carcinoma classification. We report two cases of mucinous tubular and spindle cell carcinoma in which contrast-enhanced ultrasound was used.
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Affiliation(s)
- Lixia Yan
- Department of Ultrasound, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University
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67
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Prospective evaluation of CT indeterminate renal masses using US and contrast-enhanced ultrasound. ACTA ACUST UNITED AC 2014; 40:542-51. [DOI: 10.1007/s00261-014-0237-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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68
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Cai Y, Du L, Li F, Gu J, Bai M. Quantification of enhancement of renal parenchymal masses with contrast-enhanced ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1387-1393. [PMID: 24768490 DOI: 10.1016/j.ultrasmedbio.2014.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 01/29/2014] [Accepted: 02/03/2014] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to investigate the value of quantitative assessment of enhancement in diagnosing renal cell carcinoma (RCC) with contrast-enhanced ultrasound (CEUS). A total of 73 solid renal parenchymal masses underwent both conventional ultrasound and CEUS. We compared the difference in maximum diameters on conventional ultrasound and CEUS between the benign and malignant groups. Enhancement features derived from a time-intensity curve were also analyzed. The diameters of renal cancer were found to be larger on CEUS than on conventional ultrasound (p < 0.05). When cutoff values of 4.74 s for washout time and 8.52% for enhancement intensity at 60 s for diagnosing RCCs were applied, the sensitivity, specificity and area under the receiver operating characteristic curve were 67.3%, 95.2%, 86.5% and 65.4%, 81.0%, 68.4%, respectively. The sensitivity and specificity for these two enhancement characteristics combined as a criterion for differentiating RCCs from benign lesions were 44.0% and 99.1%, respectively. Early washout in the area of maximal intensity in the interior of the lesion and prolonged washout in the whole area of the lesion are specific CEUS manifestations suggestive of RCC.
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Affiliation(s)
- Yingyu Cai
- Department of Ultrasound, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
| | - Fan Li
- Department of Ultrasound, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiying Gu
- Department of Ultrasound, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Min Bai
- Department of Ultrasound, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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69
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Shi J, Yin X, Xu R, Wang Y, Jin L, Gao W. Clinical application of contrast enhanced ultrasound to diagnose benign prostatic hyperplasia. Diagn Pathol 2014; 9:133. [PMID: 24986664 PMCID: PMC4108000 DOI: 10.1186/1746-1596-9-133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/05/2014] [Indexed: 11/23/2022] Open
Abstract
Abstract Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4852383312229155
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Affiliation(s)
- Jingfang Shi
- Department of Ultrasound, Jiading Center Hospital, Shanghai 201800, China.
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70
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Abstract
The role of percutaneous renal mass biopsy has expanded considerably in the past 10 years. The incidence of incidentally detected small (< 4 cm) solid renal masses is on the rise, and despite a commensurate increase in nephron-sparing treatment, the mortality rate from renal cell carcinoma remains the same. Earlier detection and treatment have not had dramatic effects on population outcome, implying that not all small renal masses will grow to be life-limiting. Indeed, many small solid renal masses are benign, and among those that are malignant, not all share the same malignant behavior. Percutaneous biopsy provides a minimally invasive method for discriminating benign from malignant renal masses, and portends the potential for stratifying malignant risk. With recent improvements in image-guided equipment and technique, percutaneous renal mass biopsy can be performed safely and effectively, with a low complication rate (< 5%) and a high diagnostic yield (> 90%).
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Affiliation(s)
- Elaine M Caoili
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Matthew S Davenport
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
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71
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Patard JJ, Baumert H, Bensalah K, Bernhard JC, Bigot P, Escudier B, Grenier N, Hétet JF, Long JA, Méjean A, Paparel P, Richard S, Rioux-Leclercq N, Coloby P, Soulié M. Recommandations en onco-urologie 2013 du CCAFU: Cancer du rein. Prog Urol 2013; 23 Suppl 2:S177-204. [DOI: 10.1016/s1166-7087(13)70055-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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72
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Houtzager S, Wijkstra H, de la Rosette JJMCH, Laguna MP. Evaluation of renal masses with contrast-enhanced ultrasound. Curr Urol Rep 2013; 14:116-23. [PMID: 23344685 DOI: 10.1007/s11934-013-0309-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The clinical need for characterising small renal masses (SRMs) is increasing due to their rising incidental detection. This increase is especially seen in younger and older generations and concerns mainly SRMs. Diagnostics is mainly made by contrast-enhanced CT or MRI. However, these imaging methods fail to accurately distinguishing benign from malignant SRMs. Other disadvantages of CT or MRI are high costs, the use of ionizing radiation, nephrotoxicity induced by iodine contrast agents or nephrogenic systemic fibrosis (NSF) induced by gadolinium contrast agents. Contrast-enhanced ultrasound (CEUS) is based on ultrasonography and microbubbles to real-time visualize the renal blood flow without the use of nephrotoxic agents or ionizing radiation. This comprehensive review evaluates the capabilities of CEUS in the diagnostics of benign (angiomyolipomas, cysts, oncocytomas, pseudotumors) and malignant masses (renal cell carcinomas), and focuses on possible future treatment.
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Affiliation(s)
- S Houtzager
- Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
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73
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Conventional frequency ultrasonic biomarkers of cancer treatment response in vivo. Transl Oncol 2013; 6:234-43. [PMID: 23761215 DOI: 10.1593/tlo.12385] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/11/2013] [Accepted: 02/14/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Conventional frequency quantitative ultrasound in conjunction with textural analysis techniques was investigated to monitor noninvasively the effects of cancer therapies in an in vivo preclinical model. METHODS Conventional low-frequency (∼7 MHz) and high-frequency (∼20 MHz) ultrasound was used with spectral analysis, coupled with textural analysis on spectral parametric maps, obtained from xenograft tumor-bearing animals (n = 20) treated with chemotherapy to extract noninvasive biomarkers of treatment response. RESULTS Results indicated statistically significant differences in quantitative ultrasound-based biomarkers in both low- and high-frequency ranges between untreated and treated tumors 12 to 24 hours after treatment. Results of regression analysis indicated a high level of correlation between quantitative ultrasound-based biomarkers and tumor cell death estimates from histologic analysis. Applying textural characterization to the spectral parametric maps resulted in an even stronger correlation (r (2) = 0.97). CONCLUSION The results obtained in this research demonstrate that quantitative ultrasound at a clinically relevant frequency can monitor tissue changes in vivo in response to cancer treatment administration. Using higher order textural information extracted from quantitative ultrasound spectral parametric maps provides more information at a high sensitivity related to tumor cell death.
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74
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Rosenbaum C, Wach S, Kunath F, Wullich B, Scholbach T, Engehausen DG. Dynamic Tissue Perfusion Measurement: A New Tool for Characterizing Renal Perfusion in Renal Cell Carcinoma Patients. Urol Int 2013; 90:87-94. [DOI: 10.1159/000341262] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 06/21/2012] [Indexed: 11/19/2022]
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Xue LY, Lu Q, Huang BJ, Li CL, Yan CJ, Wen JX, Wang WP. Evaluation of renal urothelial carcinoma by contrast-enhanced ultrasonography. Eur J Radiol 2012; 82:e151-7. [PMID: 23228279 DOI: 10.1016/j.ejrad.2012.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 09/10/2012] [Accepted: 11/01/2012] [Indexed: 01/16/2023]
Abstract
PURPOSE To observe ultrasonographic features of urothelial carcinoma in renal pelvis and evaluate contrast-enhanced ultrasound (CEUS) in diagnosis. MATERIALS AND METHODS Fifty-two patients with urothelial carcinoma underwent preoperative conventional US, colour Doppler flow imaging (CDFI) and CEUS. RESULTS Of 52 total lesions, 41 (78.8%) could be clearly identified by US, and 49 (94.2%) were enhanced by CEUS. Among US-imaged lesions, 39 (95.1%) were solid tumours, and two (4.9%) were mixed solid-cystic; 25 (61.0%) were isoechoic, 11 (26.8%) hypoechoic, and five (12.2%) hyperechoic. Analysis of tumour blood flow by CDFI characterised 17 avascular lesions (41.5% of total), 16 hypovascular (39.0%), and 8 hypervascular (19.5%). The resistance index ranged from 0.65 to 0.88 (mean of 0.71). Enhancement was seen in 49 lesions after injection of SonoVue. A slow enhancement pattern was observed in 36 lesions (73.5%) relative to renal cortex, and 13/49 (26.5%) showed simultaneous enhancement. At peak enhancement, 38 lesions (77.6%) were hypo-enhanced, six (12.2%) iso-enhanced, and five (10.2%) hyper-enhanced. There were 12 lesions with intertumoural necrosis or haemorrhage (24.5%) that were heterogeneously enhanced, and 37 (75.5%) were homogeneously enhanced. A fast washout pattern was observed in 46 lesions (93.9%), synchronous washout in two (4.08%), and slow washout in one (2.04%). CONCLUSIONS Slow-in, fast-out, and hypo-enhancement properties are associated with renal urothelial carcinoma and may thus have diagnostic value. We found that CEUS is able to identify tumours that are ambiguous by conventional US, and it thus significantly improves the confidence of diagnosis.
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Affiliation(s)
- Li-Yun Xue
- Shanghai Institute of Medical Imaging, Department of Ultrasound, Zhongshan Hospital, Fudan University, Building 1#, 180 Fenglin Road, Xuhui District, Shanghai 200032, China.
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Al-Mahrouki AA, Karshafian R, Giles A, Czarnota GJ. Bioeffects of ultrasound-stimulated microbubbles on endothelial cells: gene expression changes associated with radiation enhancement in vitro. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1958-1969. [PMID: 22980406 DOI: 10.1016/j.ultrasmedbio.2012.07.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 06/06/2012] [Accepted: 07/16/2012] [Indexed: 06/01/2023]
Abstract
Ultrasound can be used to target endothelial cells in cancer therapy where the destruction of vasculature leads to tumor cell death. Here, we demonstrate ultrasound bioeffects in which the levels of genes in endothelial cells can be significantly altered by ultrasound-stimulated microbubble exposure. These were compared with established effects of radiation on endothelial cells at a gene level. Human-endothelial cells were exposed to ultrasound and microbubbles, radiation or combinations of ultrasound, microbubbles and radiation. Gene expression analyses revealed an up-regulation of genes known to be involved in apoptosis and ceramide-induced apoptotic pathways, including SMPD2, UGT8, COX6B1, Caspase 9 and MAP2K1 with ultrasound-stimulated microbubble exposure but not SMPD1. This was supported by immunohistochemistry and morphologic changes examined with cell microscopy, which showed changes in SMPD1 gene product in cells with microbubble exposure. This supports the hypothesis that ultrasound-stimulated microbubbles can induce significant bioeffect-related changes in gene expression and can affect ceramide signaling pathways in endothelial cells, leading to apoptosis.
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Affiliation(s)
- Azza A Al-Mahrouki
- Radiation Oncology and Imaging Research, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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