Contrast-enhanced ultrasound for blunt hepatic trauma: an animal experiment

Effectiveness of contrast-enhanced ultrasound and serum liver enzyme measurement in detection and classification of blunt liver trauma

Objective

This study was performed to identify the correlation between contrast-enhanced ultrasound (CEUS) and contrast-enhanced multidetector computed tomography (CE-MDCT) as well as the correlation between serum liver enzyme concentrations and CE-MDCT in classification of the severity of blunt hepatic trauma using CE-MDCT as a reference standard.

Materials and methods

A blunt liver trauma model was created using 20 rabbits, and CE-MDCT, CEUS, and serum liver enzyme assays were performed. A radiologist and an ultrasound physician independently evaluated the degree of liver trauma. The diagnostic performance of CEUS and serum liver enzyme measurements was compared with that of CE-MDCT using Spearman’s correlation analysis and Pearson’s correlation analysis, respectively.

Results

Spearman’s rank correlation coefficient between the CEUS-based classification and CE-MDCT was 0.888. The aspartate aminotransferase and lactate dehydrogenase concentrations and the aspartate aminotransferase/alanine aminotransferase ratio were positively correlated with the grade of liver injury; Pearson’s correlation coefficients were 0.664, 0.704, and 0.503, respectively. The gamma-glutamyltransferase concentration had a significantly negative correlation with the grade of liver injury (r = −0.467).

Conclusions

CEUS and serum liver enzyme measurement exhibited high consistency with CE-MDCT for both detection and grading of intraparenchymal lesions in blunt liver trauma. These techniques may permit more accurate diagnosis of liver trauma.

Real-time 3-dimensional contrast-enhanced ultrasound in detecting hemorrhage of blunt renal trauma

OBJECTIVES

The objective of this study is to evaluate the diagnostic value of real-time 3-dimensional contrast-enhanced ultrasound in the hemorrhage of blunt renal trauma.

METHODS

Eighteen healthy New Zealand white rabbits were randomly divided into 3 groups. Blunt renal trauma was performed on each group by using minitype striker. Ultrasonography, color Doppler flow imaging, and contrast-enhanced 2-dimensional and real-time 3-dimensional ultrasound were applied before and after the strike. The time to shock and blood pressure were subjected to statistical analysis. Then, a comparative study of ultrasound and pathology was carried out.

RESULTS

All the struck kidneys were traumatic. In the ultrasonography, free fluid was found under the renal capsule. In the color Doppler flow imaging, active hemorrhage was not identified. In 2-dimensional contrast-enhanced ultrasound, active hemorrhage of the damaged kidney was characterized. Real-time 3-dimensional contrast-enhanced ultrasound showed a real-time and stereoscopic ongoing bleeding of the injured kidney. The wider the hemorrhage area in 4-dimensional contrast-enhanced ultrasound was, the faster the blood pressure decreased.

CONCLUSIONS

Real-time 3-dimensional contrast-enhanced ultrasound is a promising noninvasive tool for stereoscopically and vividly detecting ongoing hemorrhage of blunt renal trauma in real time.

A novel hemostatic sealant composed of gelatin, transglutaminase and thrombin effectively controls liver trauma-induced bleeding in dogs

AIM

novel hemostatic sealant based on the in situ gel formation of gelatin catalyzed by thrombin and crosslinked by transglutaminase was designed. The aim of this study was to investigate the efficacy of the hemostatic sealant in control of bleeding caused by liver trauma in dogs.

METHODS

Hepatic trauma that mimicked the grade III-IV rupture of liver was made in 20 dogs. The traumatic lesion was topically administered the hemostatic sealant (treatment group, n=10), or a thrombin solution (control group, n=10). The time to achieve hemostasis and the blood loss were measured. Contrast-enhanced ultrasound (CEUS) examination was performed in each animal on d 3, d 7, and d 10 d postoperatively to study the healing of the lesions.

RESULTS

The mean time to achieve hemostasis in the treatment group was significantly shorter than that in the control group (1.20±0.33 vs 6.70±0.64 min, P<0.05). The mean blood loss in the treatment group was significantly less than that in the control group (47.22±8.61 vs 79.29±11.97 mL, P<0.05). In CEUS examination, the traumatic lesions in the treatment group became significantly smaller on d 3, and disappeared on d 7, whereas the lesions in the control group still existed on d 10. Ascites were never found during 10 d follow-up in the treatment group but were observed on d 3 and d 7 in the control group.

CONCLUSION

Compared with thrombin, the novel hemostatic sealant shows much better efficacy in hemostasis and may promote wound healing in dog liver trauma.

The acute effects of exercise on the microvascular volume of Achilles tendons in healthy young subjects

BACKGROUND

Real-time harmonic contrast-enhanced ultrasound (CEU) is used in several diseases to visualize the microvascularization in various tissues, due to its high sensitivity.

AIM

The aim of the present study was to investigate whether CEU could be used to detect an increase in the microvascular volume (MV) in healthy tendon tissue in response to exercise comprising a 1-h run.

METHODS

After a bolus injection of the ultrasound contrast SonoVue(®), CEU measurements of (MV) in the Achilles tendon were taken prior to exercise, immediately after a 1-h run, and 24 h after exercise in nine healthy young subjects (seven men and two women) mean age 31 ± 4 years. In addition, the effect of 15 min of arm cycling exercise on the flow within the Achilles tendon was tested in four athletes (mean age 33 ± 6 years) using the CEU method before and after exercise.

RESULTS

The present data show a significant increase in the (MV) of the Achilles tendon for all subjects following the run compared with before exercise. No significant change in (MV) was seen in the Achilles tendon after 15-min arm cycling exercise (P = 0·96). This indicates that the increase in microvascular blood volume within the Achilles tendon in response to running is a local response.

CONCLUSION

The present data reveal that real-time harmonic CEU can be used to determine the MV of healthy Achilles tendons both at rest and after 1 h of running exercise.

Liver trauma diagnosis with contrast-enhanced ultrasound: interobserver variability between radiologist and emergency physician in an animal study

OBJECTIVE

The purpose of our study was to evaluate interobserver variability between the radiologist and emergency physician in detecting blunt liver trauma by conventional and contrast-enhanced ultrasound (US) (CEUS).

METHODS

We created 20 sites of blunt liver trauma in rabbits and performed conventional US and CEUS on the animals. A radiologist and an emergency physician independently evaluated the degree of liver trauma. Using contrast-enhanced computed tomography as a reference standard, the diagnostic performance of US and CEUS was calculated. Interobserver variability between radiologist and emergency physician was compared before and after contrast enhancement of US.

RESULTS

Overall sensitivity and specificity for detecting liver trauma on conventional US, regardless of the degree of trauma, were 61.1% and 100% for the radiologist and 50% and 100% for the emergency physician. On CEUS, the sensitivity and specificity were 94.4% and 100% for both the radiologist and emergency physician. The interobserver agreement between emergency physician and radiologist increased from 0.867 to 0.955 after contrast enhancement on US.

CONCLUSIONS

Contrast-enhanced US may permit a more accurate diagnosis for liver trauma than conventional US by both the radiologist and emergency physician. Contrast-enhanced US may also reduce interobserver variability for this diagnosis.