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Filippone A, Kirchin MA, Monteith J, Storto ML, Spinazzi A. Safety of Lumason® (SonoVue®) in special populations and critically ill patients. Front Cardiovasc Med 2023; 10:1225654. [PMID: 37600063 PMCID: PMC10433219 DOI: 10.3389/fcvm.2023.1225654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Evidence for the safe use of Lumason® (SonoVue®), an ultrasound enhancing agent (UEA), in special patient populations is critical to enable healthcare professionals to make informed decisions concerning its use in such patients. Herein, we provide insight on the safety and tolerability of Lumason® in special patient populations. Findings are presented from clinical pharmacology studies conducted in patients with compromised cardiopulmonary conditions, from a retrospective study performed in critically ill patients, and from post-marketing surveillance data from over 20 years of market use of Lumason® (SonoVue®). No detrimental effects of Lumason® on cardiac electrophysiology were observed in patients with coronary artery disease (CAD), and no significant effects on pulmonary hemodynamics were noted in patients with pulmonary hypertension or congestive heart failure. Similarly, no effects on several assessments of pulmonary function (e.g., FVC) were observed in patients with chronic obstructive pulmonary disease (COPD), and no clinically meaningful changes in O2 saturation or other safety parameters were observed after administration of Lumason® to patients with diffuse interstitial pulmonary fibrosis (DIPF). The retrospective study of critically ill patients revealed no significant difference for in-hospital mortality between patients administered Lumason® for echocardiography versus those who had undergone echocardiography without contrast agent. Post-marketing surveillance revealed very low reporting rates (RR) for non-serious and serious adverse events and that serious hypersensitivity reactions were rare. These findings confirm that Lumason® is a safe and well tolerated UEA for use in special populations and critically ill patients.
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Affiliation(s)
- A. Filippone
- Global Medical & Regulatory Affairs, Bracco Imaging SpA, Milan, Italy
| | - M. A. Kirchin
- Global Medical & Regulatory Affairs, Bracco Imaging SpA, Milan, Italy
| | - J. Monteith
- Global Medical & Regulatory Affairs, Bracco Diagnostics Inc., Monroe, NJ, United States
| | - M. L. Storto
- Global Medical & Regulatory Affairs, Bracco Diagnostics Inc., Monroe, NJ, United States
| | - A. Spinazzi
- Global Medical & Regulatory Affairs, Bracco Diagnostics Inc., Monroe, NJ, United States
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2
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Liang S, Liu M, Liu Z, Zhong X, Qin Y, Liang T, Wang X, Tang Z, Li Q, Huang H. Global longitudinal strain assessment in contrast-enhanced echocardiography in breast cancer patients: a feasibility study. Cardiovasc Ultrasound 2023; 21:7. [PMID: 37081550 PMCID: PMC10116775 DOI: 10.1186/s12947-023-00304-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 04/02/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Left ventricular global longitudinal strain (GLS) obtained from two-dimensional speckle-tracking echocardiography (2D-STE) can reflect cancer therapy-related cardiac dysfunction in breast cancer (BC) patients, however, the accuracy and reproducibility of 2D-STE are restricted due to poor image quality. METHODS Between January 2019 and October 2021, 160 consecutive BC patients aged ≥ 18 years were recruited. The 160 BC patients (mean age: 48.41 ± 9.93 years, 100% women) underwent both 2D-STE and Contrast-enhanced echocardiography (CEcho), 125 of whom were included in the measurement of GLS. The intraclass correlation coefficient (ICC) was used to determine the intra- and inter-observer reproducibility of 2D-STE and CEcho-STE. Correlation (r) was calculated using Pearson correlation. Statistical significance was set at P < 0.05. RESULTS Among 160 BC patients, more segments were recognized by CEcho-STE than by 2D-STE (2,771, 99.53% vs. 2,440, 84.72%). The left ventricular ejection fraction (LVEF) obtained by 2D was lower than CEcho (61.75 ± 6.59% vs. 64.14 ± 5.97%, P < 0.0001). The GLS obtained by 2D-STE was lower than CEcho-STE (-21.74 ± 2.77% vs. -26.79 ± 4.30%, P = 0.001). The ICC of the intraobserver and interobserver agreements in the CEcho-STE group was lower than that in the 2D-STE group. GLS measurements were in good agreement between the 2D-STE and CEcho-STE groups (r = 0.773). CONCLUSIONS CEcho can overcome some imaging limitations and recognize more segments than 2D, which may provide an LVEF and GLS closer to the true value. Based on AutoStrain, CEcho-STE may serve as a complementary method for those with poor image quality.
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Affiliation(s)
- Shichu Liang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Mei Liu
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Zhiyue Liu
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Xiaorong Zhong
- Department of Head and Neck Oncology Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yupei Qin
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Ting Liang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Xi Wang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Zhuoqin Tang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Qian Li
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - He Huang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China.
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Kaneko M, Lenon MSL, Storino Ramacciotti L, Medina LG, Sayegh AS, La Riva A, Perez LC, Ghoreifi A, Lizana M, Jadvar DS, Lebastchi AH, Cacciamani GE, Abreu AL. Multiparametric ultrasound of prostate: role in prostate cancer diagnosis. Ther Adv Urol 2022; 14:17562872221145625. [PMID: 36601020 PMCID: PMC9806443 DOI: 10.1177/17562872221145625] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 11/25/2022] [Indexed: 12/28/2022] Open
Abstract
Recent advances in ultrasonography (US) technology established modalities, such as Doppler-US, HistoScanning, contrast-enhanced ultrasonography (CEUS), elastography, and micro-ultrasound. The early results of these US modalities have been promising, although there are limitations including the need for specialized equipment, inconsistent results, lack of standardizations, and external validation. In this review, we identified studies evaluating multiparametric ultrasonography (mpUS), the combination of multiple US modalities, for prostate cancer (PCa) diagnosis. In the past 5 years, a growing number of studies have shown that use of mpUS resulted in high PCa and clinically significant prostate cancer (CSPCa) detection performance using radical prostatectomy histology as the reference standard. Recent studies have demonstrated the role mpUS in improving detection of CSPCa and guidance for prostate biopsy and therapy. Furthermore, some aspects including lower costs, real-time imaging, applicability for some patients who have contraindication for magnetic resonance imaging (MRI) and availability in the office setting are clear advantages of mpUS. Interobserver agreement of mpUS was overall low; however, this limitation can be improved using standardized and objective evaluation systems such as the machine learning model. Whether mpUS outperforms MRI is unclear. Multicenter randomized controlled trials directly comparing mpUS and multiparametric MRI are warranted.
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Affiliation(s)
- Masatomo Kaneko
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Maria Sarah L. Lenon
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lorenzo Storino Ramacciotti
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Luis G. Medina
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Aref S. Sayegh
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anibal La Riva
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Laura C. Perez
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alireza Ghoreifi
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Maria Lizana
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Donya S. Jadvar
- Dornsife School of Letters and Science, University of Southern California, Los Angeles, CA, USA
| | - Amir H. Lebastchi
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E. Cacciamani
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andre Luis Abreu
- Center for Image-Guided Surgery, Focal Therapy, and Artificial Intelligence for Prostate Cancer, USC Institute of Urology and Catherine & Joseph Aresty
- Department of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA 90089, USADepartment of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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4
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Salih M, Ali SM, Jena N, Ananthasubramaniam K. Review of ultrasound contrast agents in current clinical practice with special focus on DEFINITY ® in cardiac imaging. Future Cardiol 2020; 17:197-214. [PMID: 32897099 DOI: 10.2217/fca-2020-0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Echocardiography is the most widely used noninvasive modality to evaluate the structure and function of the cardiac muscle in daily practice. However, up to 15-20% of echocardiograms are considered suboptimal. To enable accurate assessment of cardiac function and wall motion abnormality, the use of ultrasound microbubble contrast has shown substantial benefits in cases of salvaging nondiagnostic studies and enhancing the diagnostic accuracy in daily practice. DEFINITY® is a perflutren based, lipid shelled microbubble contrast agent, which is US FDA approved for left ventricular opacification. The basis of ultrasound microbubbles, its development, and the clinical role of DEFINITY (characteristics, indications and case examples, side effect profile and existing evidence) is the subject of discussion in this review.
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Affiliation(s)
- Mohammed Salih
- Department of Medicine, St Joseph Mercy Oakland Hospital, Pontiac, MI 48341, USA
| | - Syed Musadiq Ali
- Department Of Cardiology, Beth Israel Deaconess Hospital, Boston, MA 02215, USA
| | - Nihar Jena
- Department of Medicine, St Joseph Mercy Oakland Hospital, Pontiac, MI 48341, USA
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Wang X, Li Y, Ren W, Yu X, Tan X. Clinical diagnostic value of contrast-enhanced ultrasonography in the diagnosis of cardiac masses: A pilot study. Echocardiography 2020; 37:231-238. [PMID: 32003068 DOI: 10.1111/echo.14597] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To assess the qualitative and quantitative characteristics of suspected cardiac masses by contrast-enhanced ultrasonography (CEUS) and to evaluate its usefulness. METHODS Twenty-eight adult patients with suspected cardiac masses were selected for this study. All of them were examined by conventional transthoracic echocardiography (TTE) and CEUS. The location, attachment point, basement, morphology, size, boundary, internal echo, shape change, range of motion, length, area, effect on hemodynamics, and peak enhancement of the masses (A1), and adjacent normal myocardium (A2) were measured. Then, the A1 to A2 ratio was calculated and the above parameters were analyzed. RESULTS The benign lesions showed regular morphology and clear-boundary uniform enhancement of the contrast agent. Malignant lesions showed an irregular shape, unclear boundary with surrounding tissue, and uneven enhancement of the contrast agent. The normal myocardial perfusion intensity was the same; there was no enhancement inside a simple thrombus, and the A1 of the benign lesion was lower than that of the normal myocardium (mean value [dB] ± SD, 0.63 ± 0.42); the A2 of the malignant lesion was higher than that of the normal myocardium (mean value [dB] ± SD, 1.49 ± 0.09). The difference in the ratio of A1 to A2 between groups was statistically significant (P < .05). CONCLUSIONS Contrast-enhanced ultrasonography can assess the basic biological characteristics and properties of cardiac masses and has a high diagnostic accuracy for differentiation of a thrombus from a tumor or a benign tumor from a malignant tumor.
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Affiliation(s)
- Xin Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaona Yu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xueying Tan
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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6
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Orde S, Slama M, Pathan F, Huang S, Mclean A. Feasibility of myocardial perfusion assessment with contrast echocardiography: can it improve recognition of significant coronary artery disease in the ICU? Crit Care 2019; 23:257. [PMID: 31315648 PMCID: PMC6635996 DOI: 10.1186/s13054-019-2519-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnosis of significant coronary artery disease (CAD) and acute coronary artery occlusion in ICU can be difficult, and an inappropriate intervention is potentially harmful. Myocardial contrast perfusion echo (MCPE) examines ultrasound contrast intensity replenishment curves in individual myocardial segments measuring peak contrast intensity and slope of return as an index of myocardial blood flow (units = intensity of ultrasound per second [dB/s]). MCPE could possibly serve as a triage tool to invasive angiography by estimating blood flow in the myocardium. We sought to assess feasibility in the critically ill and if MCPE could add incremental value to the clinical acumen in predicting significant CAD. METHODS This is a single-centre, prospective, observational study. Inclusion criteria were as follows: adult ICU patients with troponin I > 50 ng/L and cardiology referral being made for consideration of inpatient angiography. Exclusion criteria were as follows: poor echo windows (2 patients), known ischaemic heart disease, and contrast contraindications. Seven cardiologists and 6 intensivists blinded to outcome assessed medical history, ECG, troponin, and 2D echo images to estimate likelihood of significant CAD needing intervention (clinical acumen). Clinical acumen, quantitative MCPE, and subjective (visual) MCPE were assessed to predict significant CAD. RESULTS Forty patients underwent MCPE analysis, 6 (15%) had significant CAD, and median 11 of 16 segments (IQR 8-13) could be imaged (68.8% [IQR 50-81]). No adverse events occurred. A significant difference was found in overall MCPE blood flow estimation between those diagnosed with significant CAD and those without (3.3 vs 2.4 dB/s, p = 0.050). A MCPE value of 2.8 dB/s had 67% sensitivity and 88% specificity in detecting significant CAD. Clinical acumen showed no association in prediction of CAD (OR 0.6, p = 0.09); however, if quantitative or visual MCPE analysis was included, a significant association occurred (OR 17.1, p = 0.01; OR 23.0, p = 0.01 respectively). CONCLUSIONS MCPE is feasible in the critically ill and shows better association with predicting significant CAD vs clinical acumen alone. MCPE adds incremental value to initial assessment of the presence of significant CAD which may help guide those who require urgent angiography.
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Affiliation(s)
- Sam Orde
- Intensive Care Unit, Nepean Hospital, Sydney, 2750, Australia. .,Intensive Care Unit, Nepean Hospital, Kingswood, Sydney, NSW, 2749, Australia.
| | - Michel Slama
- Medical ICU, Amiens University Hospital, Amiens, France
| | - Faraz Pathan
- Cardiology Department, Nepean Hospital, Sydney, 2750, Australia
| | - Stephen Huang
- Intensive Care Unit, Nepean Hospital, Sydney, 2750, Australia
| | - Anthony Mclean
- Intensive Care Unit, Nepean Hospital, Sydney, 2750, Australia
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7
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Abstract
PURPOSE OF REVIEW Non-invasive molecular imaging is currently used as a research technique to better understand disease pathophysiology. There are also many potential clinical applications where molecular imaging may provide unique information that allows either earlier or more definitive diagnosis, or can guide precision medicine-based decisions on therapy. Contrast-enhanced ultrasound (CEU) with targeted microbubble contrast agents is one such technique that has been developed that has the unique properties of providing rapid information and revealing information only on events that occur within the vascular space. RECENT FINDINGS CEU molecular probes have been developed for a wide variety of disease states including atherosclerosis, vascular inflammation, thrombosis, tumor neovascularization, and ischemic injury. While the technique has not yet been adapted to clinical use, it has been used to reveal pathological processes, to identify new therapeutic targets, and to test the efficacy of novel treatments. This review will explore the physical basis for CEU molecular imaging, its strengths and limitations compared to other molecular imaging modalities, and the pre-clinical translational research experience.
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Affiliation(s)
- Eran Brown
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.,Knight Cardiovascular Institute, UHN-62, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, UHN-62, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA. .,Oregon National Primate Research Center (J.R.L.), Oregon Health & Science University, Portland, OR, USA.
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Ashrafi AN, Nassiri N, Gill IS, Gulati M, Park D, de Castro Abreu AL. Contrast-Enhanced Transrectal Ultrasound in Focal Therapy for Prostate Cancer. Curr Urol Rep 2018; 19:87. [PMID: 30155585 PMCID: PMC9084632 DOI: 10.1007/s11934-018-0836-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Contrast-enhanced transrectal ultrasound (CeTRUS) is an emerging imaging technique in prostate cancer (PCa) diagnosis and treatment. We review the utility and implications of CeTRUS in PCa focal therapy (FT). RECENT FINDINGS CeTRUS utilizes intravenous injection of ultrasound-enhancing agents followed by high-resolution ultrasound to evaluate tissue microvasculature and differentiate between benign tissue and PCa, with the latter demonstrating increased enhancement. The potential utility of CeTRUS in FT for PCa extends to pre-, intra- and post-operative settings. CeTRUS may detect PCa, facilitate targeted biopsy and aid surgical planning prior to FT. During FT, the treated area can be visualized as a well-demarcated non-enhancing zone and continuous real-time assessment allows immediate re-treatment if necessary. Following FT, the changes on CeTRUS are immediate and consistent, thus facilitating repeat imaging for comparison during follow-up. Areas suspicious for recurrence may be detected and target-biopsied. Enhancement can be quantified using time-intensity curves allowing objective assessment and comparison. Based on encouraging early outcomes, CeTRUS may become an alternative imaging modality in prostate cancer FT. Further study with larger cohorts and longer follow-up are needed.
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Affiliation(s)
- Akbar N Ashrafi
- USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Nima Nassiri
- USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Inderbir S Gill
- USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Mittul Gulati
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Daniel Park
- USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Andre L de Castro Abreu
- USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA.
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Porter TR, Mulvagh SL, Abdelmoneim SS, Becher H, Belcik JT, Bierig M, Choy J, Gaibazzi N, Gillam LD, Janardhanan R, Kutty S, Leong-Poi H, Lindner JR, Main ML, Mathias W, Park MM, Senior R, Villanueva F. Clinical Applications of Ultrasonic Enhancing Agents in Echocardiography: 2018 American Society of Echocardiography Guidelines Update. J Am Soc Echocardiogr 2018; 31:241-274. [DOI: 10.1016/j.echo.2017.11.013] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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10
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Chang EH. An Introduction to Contrast-Enhanced Ultrasound for Nephrologists. Nephron Clin Pract 2017; 138:176-185. [PMID: 29131073 DOI: 10.1159/000484635] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/27/2017] [Indexed: 12/15/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is an emerging technology with no known nephrotoxicity. CEUS has been utilized in cardiac and abdominal imaging for decades in Asia and Europe and has recently received greater attention in the United States with its approval for characterization of indeterminate liver lesions. Emerging data suggest that CEUS has potential as a diagnostic imaging tool among individuals who have contraindications to CT and MRI. Few nephrologists are aware of CEUS and even fewer are aware of its potential applications among individuals with kidney disease. This review introduces CEUS to the nephrology community and provides a basic overview of CEUS technology. Knowledge of the applications, advantages, and disadvantages of CEUS provides the framework for nephrologists to make informed decisions regarding this emerging imaging test in appropriate circumstances. This review focuses on the use of CEUS for the characterization of indeterminate kidney lesions and summarizes the most recent data, some of which specifically includes patients with chronic kidney disease (CKD). The results demonstrate that CEUS has high sensitivity and moderate specificity for detecting malignancy in indeterminate kidney lesions among individuals with and without CKD. In conclusion, CEUS is an emerging imaging technique that may have clinically useful applications for detecting malignant kidney lesions, specifically in patients with CKD. However, most of the current data come from small, single-center studies, and larger, multicenter studies are needed.
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Abstract
In October 2007, the Food and Drug Administration mandated significant revisions to product labeling for the commercially available echocardiographic contrast agents (ECA) Definity and Optison after spontaneous healthcare provider reports of 4 patient deaths and ≈190 severe cardiopulmonary reactions occurring in close temporal relationship to ECA administration. Since then, multiple large ECA safety studies have been published and have included outpatients, hospitalized patients (including the critically ill), patients undergoing stress echocardiography, and patients with pulmonary hypertension. In addition, the Food and Drug Administration has convened 2 Advisory Committee meetings and the product labels for Optison and Definity have been substantially revised with a softening of safety restrictions. In this review, we will address the safety of ECA use in patients with serious cardiopulmonary conditions, patients with intracardiac shunts, and special patient populations including pulmonary hypertension, pediatrics, and pregnancy. In addition, we will discuss the confounding role of pseudocomplication in attribution of adverse events during diagnostic testing, the current status of the ECA Black Box Warning, and recommended safety precautions during ECA administration.
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Affiliation(s)
| | - Michael L. Main
- From Saint Luke’s Mid America Heart Institute, Kansas City, MO
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12
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Lee H, Song S, Oh YK, Kang W, Kim E. Is gender still a predisposing factor in contrast-media associated adverse drug reactions? A systematic review and meta-analysis of randomized trials and observational studies. Eur J Radiol 2017; 89:81-89. [PMID: 28267554 DOI: 10.1016/j.ejrad.2017.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 01/09/2017] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the role of gender as a risk factor for developing contrast media-associated adverse drug reactions (CM-ADRs) by comparing the incidence of CM-ADR between male and female patients according to study design, ADR type, and computed tomography (CT) examination. MATERIAL AND METHODS We systematically searched three electronic databases for eligible studies. In the studies included (n=18), we assessed effect estimates of the relative incidence of CM-ADR, analysed by experimental design, ADR type and CT examination. This was calculated by using a random effects model if clinical conditions showed heterogeneity; otherwise, a fixed effects model was used. RESULTS We identified 10,776 patients administered CM. According to the designs, studies were classified into randomised controlled trials (RCTs) and observational studies. Results were as follows: risk ratio (RR)=1.07 (95% confidence interval (CI): 0.79-1.46, P=0.66) for RCTs, and RR=0.77 (95% CI: 0.58-1.04, P=0.09) for observational studies. The results of analysis according to ADR type and for undergoing CT demonstrated that the incidence of CM-ADR did not differ between males and females. CONCLUSIONS We found no significant difference in the incidence of CM-ADRs between male and female patients according to study design, ADR type, or CT examination. Future studies to determine why gender has shown different roles as a risk factor between CM-ADRs and non-CM ADRs are needed.
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Affiliation(s)
- Heeyoung Lee
- Evidence-Based Research Laboratory, Division of Health, Social and Clinical Pharmacotherapy, College of Pharmacy, Chung-Ang University, Seoul, South Korea.
| | - Seungyeon Song
- Evidence-Based Research Laboratory, Division of Health, Social and Clinical Pharmacotherapy, College of Pharmacy, Chung-Ang University, Seoul, South Korea.
| | - Yun-Kyoung Oh
- Evidence-Based Research Laboratory, Division of Health, Social and Clinical Pharmacotherapy, College of Pharmacy, Chung-Ang University, Seoul, South Korea; Department of Pharmacy, Konkuk University Medical Center, Seoul, South Korea.
| | - WonKu Kang
- College of Pharmacy, Chung-Ang University, Seoul, South Korea.
| | - Eunyoung Kim
- Evidence-Based Research Laboratory, Division of Health, Social and Clinical Pharmacotherapy, College of Pharmacy, Chung-Ang University, Seoul, South Korea; College of Pharmacy, Chung-Ang University, Seoul, South Korea.
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13
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Karogiannis N, Senior R. Contrast echocardiography for detection of myocardial perfusion abnormalities. Herz 2017; 42:287-294. [DOI: 10.1007/s00059-017-4536-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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14
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Malone CD, Mattrey RF, Fetzer DT. Contrast-Enhanced Ultrasound (CEUS) for the Diagnosis and Management of Hepatocellular Carcinoma: Current Status and Future Trends. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s11901-016-0324-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Opacic T, Paefgen V, Lammers T, Kiessling F. Status and trends in the development of clinical diagnostic agents. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2016; 9. [DOI: 10.1002/wnan.1441] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/02/2016] [Accepted: 09/15/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Tatjana Opacic
- Department of Experimental Molecular Imaging; RWTH Aachen University; Aachen Germany
| | - Vera Paefgen
- Department of Experimental Molecular Imaging; RWTH Aachen University; Aachen Germany
| | - Twan Lammers
- Department of Experimental Molecular Imaging; RWTH Aachen University; Aachen Germany
- Department of Pharmaceutics; Utrecht University; Utrecht The Netherlands
- Department of Targeted Therapeutics; University of Twente; Enschede The Netherlands
| | - Fabian Kiessling
- Department of Experimental Molecular Imaging; RWTH Aachen University; Aachen Germany
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Hauben M, Hung EY, Hanretta KC, Bangalore S, Snow V. Safety of Perflutren Ultrasound Contrast Agents: A Disproportionality Analysis of the US FAERS Database. Drug Saf 2016; 38:1127-39. [PMID: 26242615 DOI: 10.1007/s40264-015-0332-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Perflutren microbubble/microsphere ultrasound contrast agents have a black-box warning based on case reports of serious cardiopulmonary events. There have been several subsequent observational safety studies. Large spontaneous reporting databases may help detect/refine signals of rare adverse events that elude other data sources/study designs. OBJECTIVE The objective of this study was to supplement existing knowledge of the reported safety of perflutren using statistical analysis of spontaneous reports. METHODS We analyzed information from the US Food and Drug Administration Adverse Event Reporting System using a disproportionality analysis. Analysis of overall reporting for perflutren was supplemented by subset (age, indication) analysis. A signal of disproportionate reporting (SDR) was defined as EB05 >2. RESULTS Overall, 18/380 Preferred Terms and 1/83 Standardized Medical Queries had SDRs. Most were small (EB05 = 2-4). Back pain and flank pain were the largest SDRs followed by events compatible with signs/symptoms of hypersensitivity. The general pattern of SDRs in the subset analysis was consistent with the overall analysis. Almost all events with SDRs were literally or conceptually labeled. Except for chest pain (higher in the age <65 years subgroup) and back pain (higher in the age ≥65 years subgroup), there were no statistically significant differences between age subsets. Except for the Preferred Terms Pruritus and Urticaria and the narrow Standardized Medical Queries Ventricular tachyarrhythmia, Angioedema, Oropharyngeal allergic conditions, and Hypersensitivity (higher in the stress test subgroup), there were no statistically significant reporting differences between indication subsets. There were no SDRs associated with the major cardiovascular events of death, myocardial infarction/ischemia, angina, arrhythmias, or convulsions in any analysis. CONCLUSIONS Our combined signal detection/evaluation analysis did not identify SDRs of novel adverse events or major cardiovascular events associated with perflutren ultrasound contrast agents. The negative results for major cardiovascular events extend previous signal evaluation exercises supporting the relative cardiovascular safety of these agents.
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Affiliation(s)
- Manfred Hauben
- New York University Medical Center, New York, NY, USA.,Pfizer, Incorporated, 219 East 42nd Street, New York, NY, 10017, USA
| | - Eric Y Hung
- Pfizer, Incorporated, 219 East 42nd Street, New York, NY, 10017, USA.
| | | | | | - Vincenza Snow
- Pfizer, Incorporated, 219 East 42nd Street, New York, NY, 10017, USA
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Appis AW, Tracy MJ, Feinstein SB. Update on the safety and efficacy of commercial ultrasound contrast agents in cardiac applications. Echo Res Pract 2015; 2:R55-62. [PMID: 26693339 PMCID: PMC4676450 DOI: 10.1530/erp-15-0018] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/22/2015] [Indexed: 12/27/2022] Open
Abstract
Ultrasound contrast agents (UCAs) are currently used throughout the world in both clinical and research settings. The concept of contrast-enhanced ultrasound imaging originated in the late 1960s, and the first commercially available agents were initially developed in the 1980s. Today's microbubbles are designed for greater utility and are used for both approved and off-label indications. In October 2007, the US Food and Drug Administration (FDA) imposed additional product label warnings that included serious cardiopulmonary reactions, several new disease-state contraindications, and a mandated 30 min post-procedure monitoring period for the agents Optison and Definity. These additional warnings were prompted by reports of cardiopulmonary reactions that were temporally related but were not clearly attributable to these UCAs. Subsequent published reports over the following months established not only the safety but also the improved efficacy of clinical ultrasound applications with UCAs. The FDA consequently updated the product labeling in June 2008 and reduced contraindications, although it continued to monitor select patients. In addition, a post-marketing program was proposed to the sponsors for a series of safety studies to further assess the risk of UCAs. Then in October 2011, the FDA leadership further downgraded the warnings after hearing the results of the post-marketing data, which revealed continued safety and improved efficacy. The present review focuses on the use of UCAs in today's clinical practice, including the approved indications, a variety of off-label uses, and the most recent data, which affirms the safety and efficacy of UCAs.
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Affiliation(s)
- Andrew W Appis
- Division of Cardiology, Rush University Medical Center , 1653 West Congress Parkway, Chicago, Illinois, 60612 , USA
| | - Melissa J Tracy
- Division of Cardiology, Rush University Medical Center , 1653 West Congress Parkway, Chicago, Illinois, 60612 , USA
| | - Steven B Feinstein
- Division of Cardiology, Rush University Medical Center , 1653 West Congress Parkway, Chicago, Illinois, 60612 , USA
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Abstract
Microbubbles are an excellent intravascular tracer, and both the rate of myocardial opacification (analogous to coronary microvascular perfusion) and contrast intensity (analogous to myocardial blood volume) provide unique insights into myocardial perfusion. A strong evidence base has been accumulated to show comparability with nuclear perfusion imaging and incremental diagnostic and prognostic value relative to wall motion analysis. This technique also provides the possibility to measure myocardial perfusion at the bedside. Despite all of these advantages, the technique is complicated, technically challenging, and has failed to scale legislative and financial hurdles. The development of targeted imaging and therapeutic interventions will hopefully rekindle interest in this interesting modality.
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Affiliation(s)
- Faraz Pathan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Thomas H Marwick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
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Platts DG, Kelly NF, Wijesekera VA, Sengupta A, Burns K, Burstow DJ, Butler T, Radford DJ, Nicolae M. The Feasibility and Clinical Utility of Microsphere Contrast-enhanced Transthoracic Echocardiography in Adult Congenital Heart Disease. CONGENIT HEART DIS 2015; 10:428-36. [DOI: 10.1111/chd.12254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2015] [Indexed: 12/22/2022]
Affiliation(s)
- David G. Platts
- Department of Echocardiography; The Prince Charles Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Natalie F.A. Kelly
- Department of Echocardiography; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Vishva A. Wijesekera
- Adult Congenital Heart Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Abhishek Sengupta
- Cardiology Department; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Kylie Burns
- Adult Congenital Heart Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Darryl J. Burstow
- Department of Echocardiography; The Prince Charles Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Thomas Butler
- Department of Echocardiography; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Dorothy J. Radford
- Department of Echocardiography; The Prince Charles Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
- Adult Congenital Heart Service; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Mugur Nicolae
- Department of Echocardiography; The Prince Charles Hospital; Brisbane Queensland Australia
- Adult Congenital Heart Service; The Prince Charles Hospital; Brisbane Queensland Australia
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Ripley DP, Kannoly S, Gosling OE, Hossain E, Chawner RR, Moore J, Shore AC, Bellenger NG. Safety and feasibility of dobutamine stress cardiac magnetic resonance for cardiovascular assessment prior to renal transplantation. J Cardiovasc Med (Hagerstown) 2014; 15:288-94. [PMID: 24699013 DOI: 10.2459/jcm.0000000000000029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS Current guidelines recommend cardiovascular risk assessment prior to renal transplantation. There is currently no evidence for the role of cardiovascular magnetic resonance (CMR) in this population, despite an established evidence base in the non-chronic kidney disease (CKD) population. Our aim is to determine the feasibility and safety of dobutamine stress CMR (DSCMR) imaging in the risk stratification of CKD patients awaiting renal transplantation. METHODS CKD patients who were deemed at high risk for coronary artery disease (CAD) and awaiting renal transplantation underwent DSCMR. RESULTS Forty-one patients whose median age was 56 years (range 28–73 years) underwent DSCMR. Nineteen were undergoing haemodialysis, 10 peritoneal dialysis and 12 pre-dialysis. The aetiology of the renal failure was diabetes mellitus in 29%, glomerulonephritis in 24%, hypertension in 22% and autosomal dominant polycystic kidney disease in 10%. Thirty-eight patients (93%) achieved the end point, either positive for ischaemia or negative, achieving at least 85% of age-predicted heart rate. Two of them did not achieve target heart rate and one was discontinued because of severe headache. Of the 38 patients who achieved the end point, 35 (92%) were negative for inducible wall motion abnormalities and four (10%) were positive. There were no serious adverse effects. CONCLUSION DSCMR is a well tolerated and viable investigation for the cardiovascular risk stratification of high-risk CKD patients prior to renal transplantation. DSCMR already has an established evidence base in the non-CKD population with superiority over other noninvasive techniques. Larger studies with outcome data are now required to define its true utility in the CKD population.
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Glassy MS, Groves EM. Analysis of the quantitative improvements in resting echocardiographic image sharpness through the use of contrast enhanced echocardiography. Int J Cardiovasc Imaging 2014; 30:867-73. [PMID: 24647916 DOI: 10.1007/s10554-014-0401-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/12/2014] [Indexed: 10/25/2022]
Abstract
Contrast enhanced echocardiography (CEE) is a technique for the improvement of suboptimal echocardiographic studies. While commonly performed at selected institutions, its value has only been shown qualitatively, and to this point no study has been directed at establishing a quantitative improvement in image quality compared with non-contrast enhanced echocardiography (non-CEE). The purpose of this study was to quantitatively measure the effect of contrast on the quality of images obtained during non-CEE versus CEE. Thirty consecutive patients underwent CEE. In all subjects a non-CEE was obtained prior to administering any contrast, allowing for a direct comparison and an internal control group. Sharpness of the septal, apical and lateral myocardial walls in the apical 4-chamber view was calculated with and without contrast. Three signal intensity levels were obtained for each wall then averaged to compare the images with and without contrast for a statistically significant difference in sharpness. Quantitative analysis showed a significant difference in sharpness between CEE and non-CEE in the left ventricular septal myocardial wall, p < 0.01. A more drastic significant increase in image sharpness was observed between non-CEE and CEE in the apical and lateral left ventricular myocardial walls, both p < 0.000001. CEE significantly increases the sharpness at all left ventricular myocardial walls thus allowing higher quality images with presumably more accurate diagnosis of regional wall motion abnormalities, left ventricular endocardial border detection, left ventricular dimensions, ejection fraction and apical pathology.
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Affiliation(s)
- Matthew S Glassy
- Department of Internal Medicine, University of California, Irvine, 2141 Engineering Hall, Irvine, CA, 92697, USA
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