1
|
Hosseini RS, Ebrahimi PS, Shokrani A. Diagnostic value of enhanced-contrast ultrasound for cesarean scar pregnancy: A systematic review. Eur J Obstet Gynecol Reprod Biol 2024; 293:119-124. [PMID: 38145593 DOI: 10.1016/j.ejogrb.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Cesarean scar pregnancy, an uncommon ectopic pregnancy in which the embryo is implanted in the cesarean scar, poses significant risks without prompt diagnosis and treatment. Its prevalence has risen alongside increased cesarean section rates. Despite various treatment approaches, consensus remains elusive. Ultrasonography, particularly contrast-enhanced ultrasonography, shows promise in cesarean scar pregnancy diagnosis. MAIN BODY This systematic review, following PRISMA guidelines, explores contrast-enhanced ultrasound's diagnostic potential in cesarean scar pregnancy. We searched PubMed, Scopus, Web of Science, and Google Scholar up to August 2023. Selection involved two stages: title/abstract screening and full-text assessment. The included studies investigated contrast-enhanced ultrasound's diagnostic value in cesarean scar pregnancy, provided adequate data, and were peer-reviewed in English. Quality assessment followed the QUADAS-2 criteria. We extracted the diagnostic accuracy metrics: sensitivity, specificity, and accuracy. Out of 193 records, five studies met the inclusion criteria (2016-2020, China). Contrast-enhanced ultrasound displayed sensitivities of 77%-100% and specificities of 95%-100%. Two studies reported accuracy of 96.9%-97.8%. Compared with conventional ultrasound, contrast-enhanced ultrasound exhibited superior sensitivity, specificity, and accuracy. It also outperformed transvaginal ultrasound. CONCLUSION Enhanced-contrast ultrasound holds promise for diagnosing and managing cesarean scar pregnancy by visualizing scar vascularization in real-time, thereby reducing severe complication risks. This review highlights contrast-enhanced ultrasound as a transformative diagnostic tool for cesarean scar pregnancy management, despite existing evidence limitations.
Collapse
Affiliation(s)
- Reza Shah Hosseini
- Istanbul Medipol University, Faculty of Medicine, Medical Student, Istanbul, Turkey.
| | | | - Aniseh Shokrani
- Istanbul Medipol University, Faculty of Medicine, Medical Student, Istanbul, Turkey
| |
Collapse
|
2
|
Williamson C, Nana M, Poon L, Kupcinskas L, Painter R, Taliani G, Heneghan M, Marschall HU, Beuers U. EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy. J Hepatol 2023; 79:768-828. [PMID: 37394016 DOI: 10.1016/j.jhep.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 07/04/2023]
Abstract
Liver diseases in pregnancy comprise both gestational liver disorders and acute and chronic hepatic disorders occurring coincidentally in pregnancy. Whether related to pregnancy or pre-existing, liver diseases in pregnancy are associated with a significant risk of maternal and fetal morbidity and mortality. Thus, the European Association for the Study of Liver Disease invited a panel of experts to develop clinical practice guidelines aimed at providing recommendations, based on the best available evidence, for the management of liver disease in pregnancy for hepatologists, gastroenterologists, obstetric physicians, general physicians, obstetricians, specialists in training and other healthcare professionals who provide care for this patient population.
Collapse
|
3
|
Sundaram KM, Morgan MA, Depetris J, Arif-Tiwari H. Imaging of benign gallbladder and biliary pathologies in pregnancy. Abdom Radiol (NY) 2023; 48:1921-1932. [PMID: 36790454 DOI: 10.1007/s00261-023-03832-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Abstract
The rising incidence combined with pregnancy-related physiological changes make gallbladder and biliary pathology high on the differential for pregnant patients presenting with right upper abdominal pain. Imaging plays a crucial role in determining surgical versus non-surgical management in pregnant patients with biliary or gallbladder pathology. Ultrasound (first-line) and magnetic resonance with magnetic resonance cholangiopancreatography (second-line) are the imaging techniques of choice in pregnant patients with suspected biliary pathology due to their lack of ionizing radiation. MRI/MRCP offers an excellent non-invasive imaging option, providing detailed anatomical detail without known harmful fetal side effects. This article reviews physiological changes in pregnancy that lead to gallstone and biliary pathology, key imaging findings on US and MRI/MRCP, and management pathways.
Collapse
Affiliation(s)
- Karthik M Sundaram
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA.
| | - Matthew A Morgan
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA
| | - Jena Depetris
- Department of Radiology, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, USA
| | - Hina Arif-Tiwari
- Department of Radiology, University of Arizona-Tuscon, 1501 N. Campbell Avenue, Tuscon, AZ, USA
| |
Collapse
|
4
|
Zhang L, Sun K, Shi L, Qiu J, Wang X, Wang S. Ultrasound Image-Based Deep Features and Radiomics for the Discrimination of Small Fat-Poor Angiomyolipoma and Small Renal Cell Carcinoma. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:560-568. [PMID: 36376157 DOI: 10.1016/j.ultrasmedbio.2022.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/20/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
We evaluated the performance of ultrasound image-based deep features and radiomics for differentiating small fat-poor angiomyolipoma (sfp-AML) from small renal cell carcinoma (SRCC). This retrospective study included 194 patients with pathologically proven small renal masses (diameter ≤4 cm; 67 in the sfp-AML group and 127 in the SRCC group). We obtained 206 and 364 images from the sfp-AML and SRCC groups with experienced radiologist identification, respectively. We extracted 4024 deep features from the autoencoder neural network and 1497 radiomics features from the Pyradiomics toolbox; the latter included first-order, shape, high-order, Laplacian of Gaussian and Wavelet features. All subjects were allocated to the training and testing sets with a ratio of 3:1 using stratified sampling. The least absolute shrinkage and selection operator (LASSO) regression model was applied to select the most diagnostic features. Support vector machine (SVM) was adopted as the discriminative classifier. An optimal feature subset including 45 deep and 7 radiomics features was screened by the LASSO model. The SVM classifier achieved good performance in discriminating between sfp-AMLs and SRCCs, with areas under the curve (AUCs) of 0.96 and 0.85 in the training and testing sets, respectively. The classifier built using deep and radiomics features can accurately differentiate sfp-AMLs from SRCCs on ultrasound imaging.
Collapse
Affiliation(s)
- Li Zhang
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Kui Sun
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Liting Shi
- Department of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Jianfeng Qiu
- Medical Science and Technology Innovation Center, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Shumin Wang
- Department of Ultrasound, Peking University Third Hospital, Beijing, China.
| |
Collapse
|
5
|
Olinger K, Maheshwari E, Shenoy-Bhangle AS, Adejolu M, McGettigan M, Mathew H, Lee KS, Nicola R. Mimics of cancer in pregnancy. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 48:1752-1773. [PMID: 36577923 DOI: 10.1007/s00261-022-03783-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/30/2022]
Abstract
Pregnancy is a remarkable time of pronounced growth and development of the fetus. Benign pathologies outside of the uterus, including those containing hormonally responsive tissue which undergo physiologic changes and other incidentally identified lesions, may mimic malignancy on clinical evaluation and imaging. A detailed history and physical exam, ultrasound and non-contrast magnetic resonance imaging features and comparison with prior imaging if available may help to narrow the list of potential differential diagnoses. Follow-up imaging in the postpartum period is often vital to confirm benignity and, in some cases, sampling to confirm the diagnosis is necessary. This review will cover the clinical, pathological and multimodality imaging features of numerous potential mimickers of cancer in the setting of pregnancy organized by organ systems. The goal is to better equip abdominal radiologists to accurately identify benign disease and help guide further imaging or follow-up recommendations to avoid unnecessarily aggressive intervention and improve patient care.
Collapse
Affiliation(s)
- Kristen Olinger
- Division of Abdominal Radiology, Department of Radiology, University of North Carolina at Chapel Hill, 2021 Old Clinic Building, Chapel Hill, NC, 27599, USA.
| | - Ekta Maheshwari
- Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15143, USA
| | - Anuradha S Shenoy-Bhangle
- Division of Abdominal Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02214, USA
| | - Margaret Adejolu
- Department of Radiology, The Royal Marsden Hospital, London, England, UK
| | | | | | - Karen S Lee
- Division of Abdominal Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Refky Nicola
- Division of Abdominal Imaging, Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| |
Collapse
|
6
|
Perelli F, Turrini I, Giorgi MG, Renda I, Vidiri A, Straface G, Scatena E, D’Indinosante M, Marchi L, Giusti M, Oliva A, Grassi S, De Luca C, Catania F, Vizzielli G, Restaino S, Gullo G, Eleftheriou G, Mattei A, Signore F, Lanzone A, Scambia G, Cavaliere AF. Contrast Agents during Pregnancy: Pros and Cons When Really Needed. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416699. [PMID: 36554582 PMCID: PMC9779218 DOI: 10.3390/ijerph192416699] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/06/2022] [Accepted: 12/10/2022] [Indexed: 05/13/2023]
Abstract
Many clinical conditions require radiological diagnostic exams based on the emission of different kinds of energy and the use of contrast agents, such as computerized tomography (CT), positron emission tomography (PET), magnetic resonance (MR), ultrasound (US), and X-ray imaging. Pregnant patients who should be submitted for diagnostic examinations with contrast agents represent a group of patients with whom it is necessary to consider both maternal and fetal effects. Radiological examinations use different types of contrast media, the most used and studied are represented by iodinate contrast agents, gadolinium, fluorodeoxyglucose, gastrographin, bariumsulfate, and nanobubbles used in contrast-enhanced ultrasound (CEUS). The present paper reports the available data about each contrast agent and its effect related to the mother and fetus. This review aims to clarify the clinical practices to follow in cases where a radiodiagnostic examination with a contrast medium is indicated to be performed on a pregnant patient.
Collapse
Affiliation(s)
- Federica Perelli
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santa Maria Annunziata Hospital, 50012 Florence, Italy
| | - Irene Turrini
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
- Correspondence:
| | - Maria Gabriella Giorgi
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
| | - Irene Renda
- Division of Obstetrics and Gynecology, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, 50134 Florence, Italy
| | - Annalisa Vidiri
- School of Medicine, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Gianluca Straface
- Obstetrics and Gynecology Unit, Policlinico Abano Terme, 35031 Abano Terme, Italy
| | - Elisa Scatena
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
| | - Marco D’Indinosante
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
| | - Laura Marchi
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santo Stefano Hospital, 59100 Prato, Italy
| | - Marco Giusti
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santa Maria Annunziata Hospital, 50012 Florence, Italy
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Simone Grassi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Carmen De Luca
- Teratology Information Service, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Catania
- Department of Obstetrics and Gynecology, Ospedale “Santa Maria Alla Gruccia”, 52025 Montevarchi, Italy
| | - Giuseppe Vizzielli
- Department of Medicinal Area (DAME) Clinic of Obstetrics and Gynecology, Santa Maria della Misericordia Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Stefano Restaino
- Department of Medicinal Area (DAME) Clinic of Obstetrics and Gynecology, Santa Maria della Misericordia Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Giuseppe Gullo
- IVF Public Center, Azienda Ospedaliera Ospedali Riuniti (AOOR) Villa Sofia Cervello, University of Palermo, 90146 Palermo, Italy
| | - Georgios Eleftheriou
- Poison Control Center and Teratology Information Service, Hospital Papa Giovanni XIII, 24127 Bergamo, Italy
| | - Alberto Mattei
- Azienda USL Toscana Centro, Gynecology and Obstetric Department, Santa Maria Annunziata Hospital, 50012 Florence, Italy
| | - Fabrizio Signore
- Obstetrics and Gynecology Unit, Santo Eugenio Hospital, 00144 Rome, Italy
- School of Medicine, Unicamillus University Rome, 00131 Rome, Italy
| | - Antonio Lanzone
- School of Medicine, Catholic University of the Sacred Hearth, 00168 Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giovanni Scambia
- School of Medicine, Catholic University of the Sacred Hearth, 00168 Rome, Italy
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Anna Franca Cavaliere
- School of Medicine, Catholic University of the Sacred Hearth, 00168 Rome, Italy
- Division of Gynecology and Obstetrics Fatebenefratelli Isola Tiberina, 00186 Rome, Italy
| |
Collapse
|
7
|
Contemporary Clinical Definitions, Differential Diagnosis, and Novel Predictive Tools for Renal Cell Carcinoma. Biomedicines 2022; 10:biomedicines10112926. [PMID: 36428491 PMCID: PMC9687297 DOI: 10.3390/biomedicines10112926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Despite significant progress regarding clinical detection/imaging evaluation modalities and genetic/molecular characterization of pathogenesis, advanced renal cell carcinoma (RCC) remains an incurable disease and overall RCC mortality has been steadily rising for decades. Concomitantly, clinical definitions have been greatly nuanced and refined. RCCs are currently viewed as a heterogeneous series of cancers, with the same anatomical origin, but fundamentally different metabolisms and clinical behaviors. Thus, RCC pathological diagnosis/subtyping guidelines have become increasingly intricate and cumbersome, routinely requiring ancillary studies, mainly immunohistochemistry. Meanwhile, RCC-associated-antigen targeted systemic therapy has been greatly diversified and emerging, novel clinical applications for RCC immunotherapy have already reported significant survival benefits, at least in the adjuvant setting. Even so, systemically disseminated RCCs still associate very poor clinical outcomes, with currently available therapeutic modalities only being able to prolong survival. In lack of a definitive cure for advanced RCCs, integration of the amounting scientific knowledge regarding RCC pathogenesis into RCC clinical management has been paramount for improving patient outcomes. The current review aims to offer an integrative perspective regarding contemporary RCC clinical definitions, proper RCC clinical work-up at initial diagnosis (semiology and multimodal imaging), RCC pathological evaluation, differential diagnosis/subtyping protocols, and novel clinical tools for RCC screening, risk stratification and therapeutic response prediction.
Collapse
|
8
|
Jha P, Pōder L, Glanc P, Patel-Lippmann K, McGettigan M, Moshiri M, Nougaret S, Revzin MV, Javitt MC. Imaging Cancer in Pregnancy. Radiographics 2022; 42:1494-1513. [PMID: 35839139 DOI: 10.1148/rg.220005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Pregnancy-associated cancer (PAC) is defined as cancer that is detected during pregnancy and up to 1 year postpartum. Although rare (~1:1000 pregnancies), PAC is increasing owing to postponed childbearing and advanced maternal age at conception. Cancer-related symptoms masked by physiologic gestational changes may delay diagnosis. Imaging, clinical management, and treatment require a carefully choreographed multidisciplinary team approach. The risk-benefit of every imaging modality, the strategies to balance the safety of mother and fetus, and the support of the patient and family at every step are crucial. US and MRI are preferred imaging modalities that lack ionizing radiation. Radiation dose concerns should be addressed, noting that most imaging examinations (including mammography, radiography, CT, and technetium 99m-labeled sulfur colloid sentinel lymph node staging) are performed at radiation levels below thresholds at which deterministic side effects are seen. Dose estimates should be provided after each examination. The use of iodinated intravenous contrast material is safe during pregnancy, but gadolinium-based contrast material should be avoided. Accurate diagnosis and staging combined with gestational age affect decisions about surgery and chemotherapy. Whole-body MRI with diffusion-weighted sequences is ideal to screen for primary and metastatic sites, determine disease stage, identify biopsy targets, and guide further cancer site-specific imaging. The authors provide an update of the imaging triage, safety considerations, cancer-specific imaging, and treatment options for cancer in pregnancy. An invited commentary by Silverstein and Van Loon is available online. Online supplemental material is available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Priyanka Jha
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
| | - Liina Pōder
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
| | - Phyllis Glanc
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
| | - Krupa Patel-Lippmann
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
| | - Melissa McGettigan
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
| | - Mariam Moshiri
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
| | - Stephanie Nougaret
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
| | - Margarita V Revzin
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
| | - Marcia C Javitt
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143 (P.J., L.P.); Department of Radiology, Obstetrics and Gynecology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.G.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L., M. Moshiri); Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida College of Medicine, Tampa, Fla (M. McGettigan); Department of Radiology, Institut Régional du Cancer de Montpellier, University of Montpellier, Montpellier, France (S.N.); Montpellier Cancer Research Institute, University of Montpellier, Montpellier, France (S.N.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, George Washington University Medical Center, Washington, DC (M.C.J.); and Department of Medical Imaging, Rambam Health Care Campus, Haifa, Israel (M.C.J.)
| |
Collapse
|
9
|
Diagnosis and Analysis of Transabdominal and Intracavitary Ultrasound in Gynecological Acute Abdomen. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2021:9508838. [PMID: 35003327 PMCID: PMC8731280 DOI: 10.1155/2021/9508838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/08/2021] [Accepted: 11/22/2021] [Indexed: 01/30/2023]
Abstract
In order to explore the effective diagnosis method of gynecological acute abdomen, this paper takes hospital gynecological acute abdomen patients as samples and selects gynecological acute abdomen patients admitted to the hospital to be included in this study. They are divided into transabdominal ultrasound group, intracavitary ultrasound group, and combined group. Moreover, this paper uses mathematical statistics to carry out sample statistics. The statistical data mainly include ectopic pregnancy, torsion of ovarian tumor pedicle, acute suppurative salpingitis, torsion of fallopian tube, hemorrhagic salpingitis, acute pelvic inflammatory disease, rupture of corpus luteum cyst, and diagnosis accuracy rate. In addition, this paper compares the diagnostic accuracy of the abdominal ultrasound group, the intracavitary ultrasound group, and the combined group. The experimental research shows that the combined ultrasound diagnosis method can effectively improve the accuracy of the diagnosis of gynecological acute abdomen.
Collapse
|
10
|
Abstract
Contrast-enhanced ultrasound (CEUS) is a safe adjunct tool for liver imaging and can be an alternative to computed tomography or MR imaging. CEUS has a proven track record in guiding management for patients with chronic liver disease who need further evaluation of focal liver lesions. CEUS is a dynamic examination with high temporal and spatial resolution. CEUS uses a pure blood pool contrast agent that allows for a unique evaluation of the perfusion kinetics of a region of interest.
Collapse
Affiliation(s)
- Stephanie Spann
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, E6-230-BF, Dallas, TX 75390-9316, USA
| | - David T Fetzer
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, E6-230-BF, Dallas, TX 75390-9316, USA.
| |
Collapse
|
11
|
Bourgioti C, Konidari M, Gourtsoyianni S, Moulopoulos LA. Imaging during pregnancy: What the radiologist needs to know. Diagn Interv Imaging 2021; 102:593-603. [PMID: 34059484 DOI: 10.1016/j.diii.2021.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 12/14/2022]
Abstract
During the last decades, there has been a growing demand for medical imaging in gravid women. Imaging of the pregnant woman is challenging as it involves both the mother and the fetus and, consequently, several medical, ethical, or legal considerations are likely to be raised. Theoretically, all currently available imaging modalities may be used for the evaluation of the pregnant woman; however, in practice, confusion regarding the safety of the fetus often results in unnecessary avoidance of useful diagnostic tests, especially those involving ionizing radiation. This review article is focused on the current safety guidelines and considerations regarding the use of different imaging modalities in the pregnant population; also presented is an imaging work-up for the most common medical conditions of pregnant women, with emphasis on fetal and maternal safety.
Collapse
Affiliation(s)
- Charis Bourgioti
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76, Vassilisis Sofias Avenue, Athens 11528, Greece.
| | - Marianna Konidari
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76, Vassilisis Sofias Avenue, Athens 11528, Greece
| | - Sofia Gourtsoyianni
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76, Vassilisis Sofias Avenue, Athens 11528, Greece
| | - Lia Angela Moulopoulos
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76, Vassilisis Sofias Avenue, Athens 11528, Greece
| |
Collapse
|
12
|
Wen C, Huang L, Jiang H. Diagnosis of Interventional Transvaginal Maternal Diseases Based on Color Doppler Ultrasound. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5517785. [PMID: 33868617 PMCID: PMC8032514 DOI: 10.1155/2021/5517785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 11/18/2022]
Abstract
In recent years, with the development of color Doppler ultrasound technology in obstetrics, this noninvasive, direct, convenient, and sensitive inspection method has become one of the best methods to observe the fetal circulation in the uterus. This paper discusses the clinical value of using transvaginal color Doppler ultrasound in the differential diagnosis of ovarian corpus luteum disease and ectopic pregnancy disease. This paper selects 100 cases of ectopic pregnancy and 100 cases of pregnant corpus luteum as the experimental research objects. Clinical analysis of transvaginal color Doppler ultrasonography was performed on all patients. In the process of measuring the patient's ectopic pregnancy, the size of the patient's adnexal mass is mainly measured, and the blood flow spectrum is measured. The clinical choice of transvaginal color Doppler ultrasound method to distinguish ectopic pregnancy disease and corpus luteum pregnancy disease can play a significant value. It can be effectively diagnosed according to the type of disease, then effective methods can be studied for clinical treatment, the quality of life of patients with the two diseases can be significantly improved, and the clinical application value of color Doppler ultrasound can be improved.
Collapse
Affiliation(s)
- Canliang Wen
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong 510623, China
| | - Lan Huang
- Department of Ultrasound, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong 510623, China
| | - Hongye Jiang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| |
Collapse
|
13
|
Schnitzer ML, Sabel L, Schwarze V, Marschner C, Froelich MF, Nuhn P, Falck Y, Nuhn MM, Afat S, Staehler M, Rückel J, Clevert DA, Rübenthaler J, Geyer T. Structured Reporting in the Characterization of Renal Cysts by Contrast-Enhanced Ultrasound (CEUS) Using the Bosniak Classification System-Improvement of Report Quality and Interdisciplinary Communication. Diagnostics (Basel) 2021; 11:diagnostics11020313. [PMID: 33671991 PMCID: PMC7919270 DOI: 10.3390/diagnostics11020313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/29/2021] [Accepted: 02/11/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND This study aims to evaluate the potential benefits of structured reporting (SR) compared to conventional free-text reporting (FTR) in contrast-enhanced ultrasound (CEUS) of cystic renal lesions, based on the Bosniak classification. METHODS Fifty patients with cystic renal lesions who underwent CEUS were included in this single-center study. FTR created in clinical routine were compared to SR retrospectively generated by using a structured reporting template. Two experienced urologists evaluated the reports regarding integrity, effort for information extraction, linguistic quality, and overall quality. RESULTS The required information could easily be extracted by the reviewers in 100% of SR vs. 82% of FTR (p < 0.001). The reviewers trusted the information given by SR significantly more with a mean of 5.99 vs. 5.52 for FTR (p < 0.001). SR significantly improved the linguistic quality (6.0 for SR vs. 5.68 for FTR (p < 0.001)) and the overall report quality (5.98 for SR vs. 5.58 for FTR (p < 0.001)). CONCLUSIONS SR significantly increases the quality of radiologic reports in CEUS examinations of cystic renal lesions compared to conventional FTR and represents a promising approach to facilitate interdisciplinary communication in the future.
Collapse
Affiliation(s)
- Moritz L. Schnitzer
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.L.S.); (L.S.); (V.S.); (C.M.); (Y.F.); (M.-M.N.); (J.R.); (D.-A.C.); (J.R.)
| | - Laura Sabel
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.L.S.); (L.S.); (V.S.); (C.M.); (Y.F.); (M.-M.N.); (J.R.); (D.-A.C.); (J.R.)
| | - Vincent Schwarze
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.L.S.); (L.S.); (V.S.); (C.M.); (Y.F.); (M.-M.N.); (J.R.); (D.-A.C.); (J.R.)
| | - Constantin Marschner
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.L.S.); (L.S.); (V.S.); (C.M.); (Y.F.); (M.-M.N.); (J.R.); (D.-A.C.); (J.R.)
| | - Matthias F. Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany;
| | - Philipp Nuhn
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany;
| | - Yannick Falck
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.L.S.); (L.S.); (V.S.); (C.M.); (Y.F.); (M.-M.N.); (J.R.); (D.-A.C.); (J.R.)
| | - Maria-Magdalena Nuhn
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.L.S.); (L.S.); (V.S.); (C.M.); (Y.F.); (M.-M.N.); (J.R.); (D.-A.C.); (J.R.)
| | - Saif Afat
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany;
| | - Michael Staehler
- Department of Urology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany;
| | - Johannes Rückel
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.L.S.); (L.S.); (V.S.); (C.M.); (Y.F.); (M.-M.N.); (J.R.); (D.-A.C.); (J.R.)
| | - Dirk-André Clevert
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.L.S.); (L.S.); (V.S.); (C.M.); (Y.F.); (M.-M.N.); (J.R.); (D.-A.C.); (J.R.)
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.L.S.); (L.S.); (V.S.); (C.M.); (Y.F.); (M.-M.N.); (J.R.); (D.-A.C.); (J.R.)
| | - Thomas Geyer
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (M.L.S.); (L.S.); (V.S.); (C.M.); (Y.F.); (M.-M.N.); (J.R.); (D.-A.C.); (J.R.)
- Correspondence: ; Tel.: +49-89440073620
| |
Collapse
|
14
|
Diagnostic Value of CEUS Prompting Liver Biopsy: Histopathological Correlation of Hepatic Lesions with Ambiguous Imaging Characteristics. Diagnostics (Basel) 2020; 11:diagnostics11010035. [PMID: 33375514 PMCID: PMC7824701 DOI: 10.3390/diagnostics11010035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 02/08/2023] Open
Abstract
Background: Contrast-enhanced ultrasound (CEUS) allows for dynamic analysis of vascularization patterns of unclear hepatic lesions. Our study aimed to evaluate the diagnostic performance of CEUS for further characterizing suspicious liver lesions by comparing findings from CEUS examinations with corresponding histopathology. Methods: Between 2005 and 2016, 160 patients with unclear liver lesions underwent CEUS followed by liver biopsy. All examinations were performed by an experienced consultant radiologist (EFSUMB Level 3) and included native B-mode ultrasound, Color Doppler, and CEUS. A second-generation blood pool contrast agent was applied for CEUS. Results: CEUS was successfully performed in all patients without occurrence of any adverse side effects. CEUS showed a sensitivity of 94.5%, a specificity of 70.6%, a true positive rate of 87.3%, and a true negative rate of 85.7% compared to histopathological results as the reference standard. Conclusions: CEUS represents a safe imaging modality with a high diagnostic accuracy in assessing both—benign and malignant—liver lesions compared to corresponding histopathological results.
Collapse
|
15
|
Contrast-Enhanced Ultrasound for Assessing Abdominal Conditions in Pregnancy. ACTA ACUST UNITED AC 2020; 56:medicina56120675. [PMID: 33302381 PMCID: PMC7762549 DOI: 10.3390/medicina56120675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
Background and objectives: Native ultrasound is the most common imaging modality in obstetrics. The use of contrast-enhanced ultrasound (CEUS) during pregnancy has not been officially approved by leading societies for obstetrics and ultrasound. The present study aims to monitor the safety and diagnostic performance of CEUS for assessing abdominal issues in five pregnant women. Materials and Methods: Five pregnant patients who underwent a total of 11 CEUS examinations between June 2020 and October 2020 were included (mean age: 34 years; mean time of pregnancy: 21 weeks). All CEUS scans were interpreted by one experienced consultant radiologist (EFSUMB Level 3). Results: Upon contrast application, no maternal nor fetal adverse effects were observed. Moreover, no fetal contrast enhancement was observed in any patient. CEUS helped to diagnose renal angiomyolipoma, pyelonephritis, necrotic uterine fibroid, gallbladder polyp, and superior mesenteric vein thrombosis. Conclusions: In our study, off-label use of CEUS showed an excellent safety profile allowing the avoidance of ionizing radiation exposure as well as contrast agents in case of CT or use of gadolinium-based contrast agents in case of MRI. CEUS is a promising diagnostic instrument for facilitating clinical decision-making and improving the management of pregnant women.
Collapse
|
16
|
Marschner CA, Rübenthaler J, Froelich MF, Schwarze V, Clevert DA. Benefits of contrast-enhanced ultrasonography for interventional procedures. Ultrasonography 2020; 40:207-216. [PMID: 33530676 PMCID: PMC7994736 DOI: 10.14366/usg.20083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/19/2020] [Indexed: 12/14/2022] Open
Abstract
For evaluating unclear tumorous lesions, contrast-enhanced ultrasonography (CEUS) is an important imaging modality in addition to contrast-enhanced computed tomography and magnetic resonance imaging, and may provide valuable insights into the microvascularization of tumors in dynamic examinations. In interventional procedures, CEUS can make a valuable contribution in pre-, peri-, and post-interventional settings, reduce radiation exposure and, under certain circumstances, decrease the number of interventions needed for patients.
Collapse
Affiliation(s)
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - Matthias Frank Froelich
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Mannheim, Germany
| | - Vincent Schwarze
- Department of Radiology, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - Dirk-André Clevert
- Department of Radiology, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| |
Collapse
|
17
|
Geyer T, Schwarze V, Marschner C, Schnitzer ML, Froelich MF, Rübenthaler J, Clevert DA. Diagnostic Performance of Contrast-Enhanced Ultrasound (CEUS) in the Evaluation of Solid Renal Masses. ACTA ACUST UNITED AC 2020; 56:medicina56110624. [PMID: 33227984 PMCID: PMC7699268 DOI: 10.3390/medicina56110624] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/20/2022]
Abstract
Background: The present study aims to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for discriminating between benign and malignant solid renal masses. Methods: 18 patients with histopathologically confirmed benign solid renal masses (11 oncocytomas, seven angiomyolipomas) as well as 96 patients with confirmed renal cell carcinoma (RCC) who underwent CEUS followed by radical or partial nephrectomy were included in this single-center study. CEUS examinations were performed by an experienced radiologist (EFSUMB Level 3) and included the application of a second-generation contrast agent. Results: Renal angiomyolipomas, oncocytomas, and renal cell carcinomas showed varying sonomorphological characteristics in CEUS. Angiomyolipomas showed heterogeneous echogenicity (57% hypo-, 43% hyperechoic), while all lesions showed rapid contrast-enhancement with two lesions also showing venous wash-out (29%). Notably, 9/11 oncocytomas could be detected in conventional ultrasound (64% hypo-, 9% hyper-, 9% isoechoic) and 2/11 only demarcated upon intravenous application of contrast agent (18%). All oncocytomas showed hyperenhancement in CEUS, venous wash-out was registered in 7/11 lesions (64%). Conclusions: In line with the current state of knowledge, no specific sonomorphological characteristics allowing for accurate distinction between benign and malignant solid renal masses in CEUS could be detected in our study.
Collapse
Affiliation(s)
- Thomas Geyer
- Department of Radiology, Ludwig-Maximilians-University Munich, 81377 Munich, Germany; (V.S.); (C.M.); (M.L.S.); (J.R.); (D.-A.C.)
- Correspondence: ; Tel.: +49-89-4400-73620
| | - Vincent Schwarze
- Department of Radiology, Ludwig-Maximilians-University Munich, 81377 Munich, Germany; (V.S.); (C.M.); (M.L.S.); (J.R.); (D.-A.C.)
| | - Constantin Marschner
- Department of Radiology, Ludwig-Maximilians-University Munich, 81377 Munich, Germany; (V.S.); (C.M.); (M.L.S.); (J.R.); (D.-A.C.)
| | - Moritz L. Schnitzer
- Department of Radiology, Ludwig-Maximilians-University Munich, 81377 Munich, Germany; (V.S.); (C.M.); (M.L.S.); (J.R.); (D.-A.C.)
| | - Matthias F. Froelich
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, 68167 Mannheim, Germany;
| | - Johannes Rübenthaler
- Department of Radiology, Ludwig-Maximilians-University Munich, 81377 Munich, Germany; (V.S.); (C.M.); (M.L.S.); (J.R.); (D.-A.C.)
| | - Dirk-André Clevert
- Department of Radiology, Ludwig-Maximilians-University Munich, 81377 Munich, Germany; (V.S.); (C.M.); (M.L.S.); (J.R.); (D.-A.C.)
| |
Collapse
|
18
|
Schwarze V, Rübenthaler J, Marschner C, Fabritius MP, Rueckel J, Fink N, Puhr-Westerheide D, Gresser E, Froelich MF, Schnitzer ML, Große Hokamp N, Afat S, Staehler M, Geyer T, Clevert DA. Advanced Fusion Imaging and Contrast-Enhanced Imaging (CT/MRI-CEUS) in Oncology. Cancers (Basel) 2020; 12:cancers12102821. [PMID: 33007933 PMCID: PMC7600560 DOI: 10.3390/cancers12102821] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Fusion imaging depicts an innovative technique by which previously performed computed tomography/magnetic resonance imaging can be integrated and reconstructed with advanced contrast-enhanced ultrasound using modern ultrasound devices in a real-time manner. Fusion imaging allows for complementing strengths and reducing restrictions of the combined imaging modalities. The visualization of parenchymal and tumoral microperfusion by contrast-enhanced ultrasound can be dynamically fused and assessed with images from previous cross-sectional studies and may help to decipher underlying entities of indeterminate lesions or validate suspicious morphology. The findings from our study demonstrate the benefits of fusion imaging for evaluating focal hepatic and renal lesions. The excellent safety profile, accessibility, repeatability and cost-effectiveness are advantages of fusion imaging which make it a powerful diagnostic tool for the modern radiologist. Abstract Fusion imaging depicts an innovative technique that facilitates combining assets and reducing restrictions of advanced ultrasound and cross-sectional imaging. The purpose of the present retrospective study was to evaluate the role of fusion imaging for assessing hepatic and renal lesions. Between 02/2011–08/2020, 92 patients in total were included in the study, of which 32 patients had hepatic lesions, 60 patients had renal lesions. Fusion imaging was technically successful in all patients. No adverse side effects upon intravenous (i.v.) application of SonoVue® (Bracco, Milan, Italy) were registered. Fusion imaging could clarify all 11 (100%) initially as indeterminate described hepatic lesions by computed tomography/magnetic resonance imaging (CT/MRI). Moreover, 5/14 (36%) initially suspicious hepatic lesions could be validated by fusion imaging, whereas in 8/14 (57%), malignant morphology was disproved. Moreover, fusion imaging allowed for the clarification of 29/30 (97%) renal lesions initially characterized as suspicious by CT/MRI, of which 19/30 (63%) underwent renal surgery, histopathology revealed malignancy in 16/19 (84%), and benignity in 3/19 (16%). Indeterminate findings could be elucidated by fusion imaging in 20/20 (100%) renal lesions. Its accessibility and repeatability, even during pregnancy and in childhood, its cost-effectiveness, and its excellent safety profile, make fusion imaging a promising instrument for the thorough evaluation of hepatic and renal lesions in the future.
Collapse
Affiliation(s)
- Vincent Schwarze
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
- Correspondence: ; Tel.: +49-89-4400-73620
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Constantin Marschner
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Matthias Philipp Fabritius
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Johannes Rueckel
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Nicola Fink
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Daniel Puhr-Westerheide
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Eva Gresser
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Matthias Frank Froelich
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany;
| | - Moritz Ludwig Schnitzer
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University Cologne, Kerpener Str. 62, 50937 Cologne, Germany;
| | - Saif Afat
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany;
| | - Michael Staehler
- Department of Urology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany;
| | - Thomas Geyer
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Dirk-André Clevert
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| |
Collapse
|