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Ranjan S, Bosch S, Lukkari H, Schirmer J, Aaltonen N, Nieminen HJ, Lehto VP, Urtti A, Lajunen T, Rilla K. Development of Focused Ultrasound-Assisted Nanoplexes for RNA Delivery. NANOMATERIALS (BASEL, SWITZERLAND) 2024; 14:1089. [PMID: 38998694 PMCID: PMC11243722 DOI: 10.3390/nano14131089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/20/2024] [Accepted: 06/23/2024] [Indexed: 07/14/2024]
Abstract
RNA-based therapeutics, including siRNA, have obtained recognition in recent years due to their potential to treat various chronic and rare diseases. However, there are still limitations to lipid-based drug delivery systems in the clinical use of RNA therapeutics due to the need for optimization in the design and the preparation process. In this study, we propose adaptive focused ultrasound (AFU) as a drug loading technique to protect RNA from degradation by encapsulating small RNA in nanoliposomes, which we term nanoplexes. The AFU method is non-invasive and isothermal, as nanoplexes are produced without direct contact with any external materials while maintaining precise temperature control according to the desired settings. The controllability of sample treatments can be effectively modulated, allowing for a wide range of ultrasound intensities to be applied. Importantly, the absence of co-solvents in the process eliminates the need for additional substances, thereby minimizing the potential for cross-contaminations. Since AFU is a non-invasive method, the entire process can be conducted under sterile conditions. A minimal volume (300 μL) is required for this process, and the treatment is speedy (10 min in this study). Our in vitro experiments with silencer CD44 siRNA, which performs as a model therapeutic drug in different mammalian cell lines, showed encouraging results (knockdown > 80%). To quantify gene silencing efficacy, we employed quantitative polymerase chain reaction (qPCR). Additionally, cryo-electron microscopy (cryo-EM) and atomic force microscopy (AFM) techniques were employed to capture images of nanoplexes. These images revealed the presence of individual nanoparticles measuring approximately 100-200 nm in contrast with the random distribution of clustered complexes observed in ultrasound-untreated samples of liposome nanoparticles and siRNA. AFU holds great potential as a standardized liposome processing and loading method because its process is fast, sterile, and does not require additional solvents.
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Affiliation(s)
- Sanjeev Ranjan
- Institute of Biomedicine, University of Eastern Finland, 70210 Kuopio, Finland
- Medical Ultrasonics Laboratory (MEDUSA), Department of Neuroscience and Biomedical Engineering, Aalto University, 02150 Espoo, Finland
| | - Stef Bosch
- Institute of Biomedicine, University of Eastern Finland, 70210 Kuopio, Finland
| | - Hannamari Lukkari
- Institute of Biomedicine, University of Eastern Finland, 70210 Kuopio, Finland
- FinVector Oy, 70210 Kuopio, Finland
| | - Johanna Schirmer
- Nanoscience Center, Department of Chemistry, University of Jyväskylä, 40014 Jyväskylä, Finland
| | - Niina Aaltonen
- Institute of Biomedicine, University of Eastern Finland, 70210 Kuopio, Finland
| | - Heikki J Nieminen
- Medical Ultrasonics Laboratory (MEDUSA), Department of Neuroscience and Biomedical Engineering, Aalto University, 02150 Espoo, Finland
| | - Vesa-Pekka Lehto
- Department of Technical Physics, University of Eastern Finland, 70210 Kuopio, Finland
| | - Arto Urtti
- School of Pharmacy, University of Eastern Finland, 70210 Kuopio, Finland
- Drug Research Program, Faculty of Pharmacy, University of Helsinki, 00100 Helsinki, Finland
| | - Tatu Lajunen
- School of Pharmacy, University of Eastern Finland, 70210 Kuopio, Finland
- Drug Research Program, Faculty of Pharmacy, University of Helsinki, 00100 Helsinki, Finland
| | - Kirsi Rilla
- Institute of Biomedicine, University of Eastern Finland, 70210 Kuopio, Finland
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Del Campo Fonseca A, Ahmed D. Ultrasound robotics for precision therapy. Adv Drug Deliv Rev 2024; 205:115164. [PMID: 38145721 DOI: 10.1016/j.addr.2023.115164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/07/2023] [Accepted: 12/22/2023] [Indexed: 12/27/2023]
Abstract
In recent years, the application of microrobots in precision therapy has gained significant attention. The small size and maneuverability of these micromachines enable them to potentially access regions that are difficult to reach using traditional methods; thus, reducing off-target toxicities and maximizing treatment effectiveness. Specifically, acoustic actuation has emerged as a promising method to exert control. By harnessing the power of acoustic energy, these small machines potentially navigate the body, assemble at the desired sites, and deliver therapies with enhanced precision and effectiveness. Amidst the enthusiasm surrounding these miniature agents, their translation to clinical environments has proven difficult. The primary objectives of this review are threefold: firstly, to offer an overview of the fundamental acoustic principles employed in the field of microrobots; secondly, to assess their current applications in medical therapies, encompassing tissue targeting, drug delivery or even cell infiltration; and lastly, to delve into the continuous efforts aimed at integrating acoustic microrobots into in vivo applications.
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Affiliation(s)
- Alexia Del Campo Fonseca
- Department of Mechanical and Process Engineering, Acoustic Robotics Systems Lab, ETH Zurich, Säumerstrasse 4, 8803 Rüschlikon, Switzerland.
| | - Daniel Ahmed
- Department of Mechanical and Process Engineering, Acoustic Robotics Systems Lab, ETH Zurich, Säumerstrasse 4, 8803 Rüschlikon, Switzerland.
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Wahyulaksana G, Wei L, Schoormans J, Voorneveld J, van der Steen AFW, de Jong N, Vos HJ. Independent Component Analysis Filter for Small Vessel Contrast Imaging During Fast Tissue Motion. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:2282-2292. [PMID: 35594222 DOI: 10.1109/tuffc.2022.3176742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Suppressing tissue clutter is an essential step in blood flow estimation and visualization, even when using ultrasound contrast agents. Blind source separation (BSS)-based clutter filter for high-framerate ultrasound imaging has been reported to perform better in tissue clutter suppression than the conventional frequency-based wall filter and nonlinear contrast pulsing schemes. The most notable BSS technique, singular value decomposition (SVD) has shown compelling results in cases of slow tissue motion. However, its performance degrades when the tissue motion is faster than the blood flow speed, conditions that are likely to occur when imaging the small vessels, such as in the myocardium. Independent component analysis (ICA) is another BSS technique that has been implemented as a clutter filter in the spatiotemporal domain. Instead, we propose to implement ICA in the spatial domain where motion should have less impact. In this work, we propose a clutter filter with the combination of SVD and ICA to improve the contrast-to-background ratio (CBR) in cases where tissue velocity is significantly faster than the flow speed. In an in vitro study, the range of fast tissue motion velocity was 5-25 mm/s and the range of flow speed was 1-12 mm/s. Our results show that the combination of ICA and SVD yields 7-10 dB higher CBR than SVD alone, especially in the tissue high-velocity range. The improvement is crucial for cardiac imaging where relatively fast myocardial motions are expected.
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Makhlouf NA, Moustafa EF, Hassany SM. Diagnostic accuracy of hepatic vein arrival time performed with contrast-enhanced ultrasonography for HCV liver cirrhosis. Arab J Gastroenterol 2022; 23:195-200. [PMID: 35688684 DOI: 10.1016/j.ajg.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/14/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND STUDY AIMS Contrast-enhanced ultrasonography (CEUS) has increased considerably the use of ultrasound for hemodynamical analyses and quantification. Bolus injection of microbubble agents is used to evaluate transit times. This study aimed to determine the diagnostic accuracy of arrival time (seconds) to the hepatic artery (HAAT), hepatic vein (HVAT), and portal vein (PVAT), based on CEUS used for the diagnosis of cirrhosis, and to correlate these arrival times with the liver stiffness and disease severity. PATIENTS AND METHODS This study evaluated 29 HCV cirrhotic and 19 chronic hepatitis C patients. History, clinical examination, laboratory investigations, abdominal ultrasonography, point shear-wave elastography (pSWE), and CEUS were conducted. RESULTS The mean liver stiffness increased significantly in cirrhotic versus chronic HCV (22.7 versus 5.1; p-value < 0.001). The mean HAAT (p-value = 0.001), PVAT (p-value = 0.002), and HVAT values (p-value: 0.001) were significantly prolonged in cirrhotic compared with chronic HCV. The HVAT cut-off point of cirrhotic patients was 18 s with a sensitivity, specificity, and accuracy of 96.6%, 63.2%, and 83.3%, respectively (area under curve: 0.801). Significant positive correlation was found between liver stiffness (kPa) and HVAT (s) (r = 0.585; p-value = 0.005). No significant correlation was detected between HVAT (s) and the severity of liver disease, as assessed by the Child or MELD scores in cirrhotic patients. CONCLUSION Measuring HVAT by CEUS yielded high-accuracy and correlation outcomes for cirrhosis detection. It could be a valuable noninvasive method for the diagnosis of cirrhosis.
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Affiliation(s)
- Nahed A Makhlouf
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assuit University, Assiut 71515, Egypt.
| | - Ehab F Moustafa
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assuit University, Assiut 71515, Egypt
| | - Sahar M Hassany
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assuit University, Assiut 71515, Egypt
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Liu Y, Lai X, Zhu Y, Guo F, Su L, Arkin G, He T, Xu J, Ran H. Contrast-enhanced ultrasound imaging using long-circulating cationic magnetic microbubbles in vitro and in vivo validations. Int J Pharm 2021; 616:121299. [PMID: 34929311 DOI: 10.1016/j.ijpharm.2021.121299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/26/2021] [Accepted: 11/11/2021] [Indexed: 02/07/2023]
Abstract
Traditional encapsulated microbubbles are recently used as delivery carriers for drugs and genes, but they have low efficiency. If the local microbubble concentration could be increased, this might be able to improve the therapeutic efficacy of diseases. In this study, we developed novel cationic magnetic microbubbles (MBM), which could simultaneously realize targeted aggregation under a magnetic field as well as ultrasonographic real-time visualization. Their physicochemical properties, biocompatibility, ultrasonography, magnetic response characteristics, and biodistribution were systematically evaluated. Here, the MBM were 2.55±0.14µm in size with a positive zeta potential, and had a good biocompatibility. They were able to enhance ultrasonographic contrast both in vitro and in vivo. MBM could be attracted by an external magnet for directional movement and aggregation in vitro. We confirmed that MBM also had a great magnetic response in vivo, by means of fluorescence imaging and contrast-enhanced ultrasound imaging. Following intravenous injection into tumor-bearing mice, MBM showed excellent stability in the internal circulation, and could accumulate in the tumor vasculature through magnetic targeting. With the excellent combination of magnetic response and acoustic properties, cationic magnetic microbubbles (MBM) have promising potential for use as a new kind of drug/gene carrier for theranostics in the future.
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Affiliation(s)
- Yingying Liu
- Shenzhen Medical Ultrasound Engineering Center, Department of Ultrasonography, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China
| | - Xiaoshu Lai
- Shenzhen Medical Ultrasound Engineering Center, Department of Ultrasonography, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China
| | - Yao Zhu
- Shenzhen Medical Ultrasound Engineering Center, Department of Ultrasonography, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China
| | - Fengjuan Guo
- Shenzhen Medical Ultrasound Engineering Center, Department of Ultrasonography, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China
| | - Lili Su
- Shenzhen Medical Ultrasound Engineering Center, Department of Ultrasonography, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China
| | - Gulzira Arkin
- Shenzhen Medical Ultrasound Engineering Center, Department of Ultrasonography, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China
| | - Tianzhen He
- Shenzhen Medical Ultrasound Engineering Center, Department of Ultrasonography, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China
| | - Jinfeng Xu
- Shenzhen Medical Ultrasound Engineering Center, Department of Ultrasonography, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen 518020, Guangdong, China.
| | - Haitao Ran
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China.
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Jokisch F, Buchner A, Schulz GB, Grimm T, Weinhold P, Pfitzinger PL, Chaloupka M, Stief CG, Schlenker B, Clevert DA. Prospective evaluation of 4-D contrast-enhanced-ultrasound (CEUS) imaging in bladder tumors. Clin Hemorheol Microcirc 2019; 74:1-12. [PMID: 31743990 DOI: 10.3233/ch-199231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The evaluation of the potential clinical benefit of four-dimensional ultrasound (4D-US) in the assessment of bladder cancer (BC). MATERIAL AND METHODS 20 patients with indication for cystoscopy for suspicion of bladder cancer were prospectively included in this study. All patients underwent two-dimensional ultrasound (2D-US), contrast enhanced ultrasound (CEUS) and real-time four-dimensional ultrasound (4D-US). All acquisitions were compared to each other in regard to image quality. This assessment was done using a 6 point scale (1 = best). All patients underwent subsequently cystoscopy with resection of the tumor (TURB), due a histopathological analysis was possible. RESULTS All examinations were performed successfully and no patient had to be excluded from the study. Patients acceptance of 4D-US was consistently good. No adverse events occurred. Image quality of real time 4D-US (score: 1.27±0.46) was significantly superior (p < 0.001) to both, conventional 2D-US (score: 2.33±0.62) and also to 2D-CEUS (score: 2.00±0.53). In terms of tumor detection no superiority was evident for 4D-US compared to 2D-US or in utilization of CEUS (sensitivity = 0.89; specificity = 1.00; positive predictive value = 1.00; negative predictive value = 0.50; AUC = 0.944; (95% CI: 07.43-0.998)). CONCLUSION The assessment of bladder cancer using real time 4D-US is feasible and improves the image quality and therefore also the precise anatomical consistency of intravesical tumor masses.
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Affiliation(s)
- F Jokisch
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - A Buchner
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - G B Schulz
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - T Grimm
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - P Weinhold
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - P L Pfitzinger
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - M Chaloupka
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - C G Stief
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - B Schlenker
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - D-A Clevert
- Department of Clinical Radiology, Interdisciplinary Ultrasound-Center, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany
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Rübenthaler J, Mueller-Peltzer K, Negrão de Figueiredo G, Gresser E, Clevert DA. [CEUS-diagnostic workup of cystic renal lesions]. Radiologe 2019; 58:545-552. [PMID: 29728745 DOI: 10.1007/s00117-018-0394-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
CLINICAL/METHODICAL ISSUE Cystic renal lesions are common incidental findings in radiological imaging and they should be adequately examined to be able to characterize them as benign or malignant. STANDARD RADIOLOGICAL METHODS It is not always possible to sufficiently characterize cystic renal lesion solely using native B‑mode sonography and color-Doppler sonography. METHODICAL INNOVATIONS Using contrast-enhanced ultrasound (CEUS), it is possible to dynamically evaluate the perfusion of cystic renal lesions and to characterize the potential malignancy of these lesions using the Bosniak classification in order to give recommendations regarding further work-up. CEUS can also be used in patients with contraindications for other radiological imaging modalities as it uses a contrast agent with almost no side effects. PERFORMANCE Using CEUS, cystic renal lesions can be reliably characterized with a diagnostic accuracy greater than 90%. ACHIEVEMENTS CEUS is a useful method in diagnosing and characterizing unclear cystic renal lesions and should always be considered as a viable diagnostic tool. PRACTICAL RECOMMENDATIONS CEUS should always be performed in initially unclear cases and is a useful additional tool for the diagnosis and characterization of unclear cystic renal lesions.
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Affiliation(s)
- J Rübenthaler
- Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschall-Zentrum, Universitätsklinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - K Mueller-Peltzer
- Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschall-Zentrum, Universitätsklinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - G Negrão de Figueiredo
- Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschall-Zentrum, Universitätsklinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - E Gresser
- Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschall-Zentrum, Universitätsklinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - D A Clevert
- Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschall-Zentrum, Universitätsklinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
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Rübenthaler J, Wilson S, Clevert DA. Multislice computed tomography/contrast-enhanced ultrasound image fusion as a tool for evaluating unclear renal cysts. Ultrasonography 2018; 38:181-187. [PMID: 30531649 PMCID: PMC6443590 DOI: 10.14366/usg.18024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/03/2018] [Indexed: 12/13/2022] Open
Abstract
Ultrasonography is a generally accepted imaging technique for diagnosing and monitoring cystic renal lesions. The widely used Bosniak classification (I-IV) categorizes renal cystic lesions into five distinctive groups according to ultrasonography and computed tomography (CT) image criteria. For solid renal lesions, determination of vascularity is discriminatory for malignancy in most instances. In indeterminate cases, contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging/CT-ultrasound image fusion are able to detect and characterize difficult pathologies, with superior performance to either technique alone. In contrast to multislice CT (MS-CT), ultrasound image fusion is a real-time imaging technique that can be used in combination with other cross-sectional imaging modalities. This technical note describes state-of-the-art image fusion of CEUS and MS-CT to detect and characterize unclear renal pathologies.
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Affiliation(s)
- Johannes Rübenthaler
- Department of Clinical Radiology, Interdisciplinary Ultrasound Center, Ludwig-MaximiliansUniversity of Munich-Grosshadern Campus, Munich, Germany
| | - Stephanie Wilson
- Department of Radiology, University of Calgary, Foothills Medical Centre, Calgary, Canada
| | - Dirk-Andre Clevert
- Department of Clinical Radiology, Interdisciplinary Ultrasound Center, Ludwig-MaximiliansUniversity of Munich-Grosshadern Campus, Munich, Germany
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Kummer T, Oh L, Phelan MB, Huang RD, Nomura JT, Adhikari S. Emergency and critical care applications for contrast-enhanced ultrasound. Am J Emerg Med 2018; 36:1287-1294. [PMID: 29716799 DOI: 10.1016/j.ajem.2018.04.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/19/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Contrast-enhanced ultrasound (CEUS) using intravascular microbubbles has potential to revolutionize point-of-care ultrasonography by expanding the use of ultrasonography into clinical scenarios previously reserved for computed tomography (CT), magnetic resonance imaging, or angiography. METHODS We performed a literature search and report clinical experience to provide an introduction to CEUS and describe its current applications for point-of-care indications. RESULTS The uses of CEUS include several applications highly relevant for emergency medicine, such as solid-organ injuries, actively bleeding hematomas, or abdominal aortic aneurysms. Compared with CT as the preeminent advanced imaging modality in the emergency department, CEUS is low cost, radiation sparing, repeatable, and readily available. It does not require sedation, preprocedural laboratory assessment, or transportation to the radiology suite. CONCLUSIONS CEUS is a promising imaging technique for point-of-care applications in pediatric and adult patients and can be applied for patients with allergy to CT contrast medium or with impaired renal function. More high-quality CEUS research focusing on accuracy, patient safety, health care costs, and throughput times is needed to validate its use in emergency and critical care settings.
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Affiliation(s)
- Tobias Kummer
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Laura Oh
- Department of Emergency Medicine, Emory University, Atlanta, GA, United States
| | - Mary Beth Phelan
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Robert D Huang
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Jason T Nomura
- Department of Emergency Medicine, Christiana Care Health System, Newark, DE, United States
| | - Srikar Adhikari
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, United States
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Transient Segmental Enhancement of Pyogenic Liver Abscess: A Comparison Between Contrast-Enhanced Ultrasound and Computed Tomography. J Comput Assist Tomogr 2018; 42:133-138. [PMID: 28806319 DOI: 10.1097/rct.0000000000000659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aimed to investigate the correlation between the transient segmental enhancement (TSE) of liver abscesses on contrast-enhanced ultrasound (CEUS) imaging and contrast-enhanced computed tomography (CT) scans. METHODS In total, 42 abscesses in 38 patients were evaluated with real-time CEUS and contrast-enhanced CT imaging. The CT imaging and CEUS examinations were performed within one to 2 days of each other in all cases. The initial reports of the observations of TSE on CEUS scans were correlated later with the findings of TSE on contrast-enhanced CT images. Contrast-enhanced CT was used as the reference standard to evaluate the presence of TSE. Relationships between the 2 groups were analyzed using the χ test. P < 0.05 was considered to be statistically significant. RESULTS In 16 patients, 16 typical TSE signs were shown by CEUS. Meanwhile, enhanced CT imaging showed 18 typical signs of TSE in 17 patients. We identified 38 patients with hepatic abscesses proven by needle aspiration (10 patients) or image-guided biopsy (28 patients). Ten patients had hepatobiliary cholelithiasis, 5 had diabetes mellitus type 2, and 2 had gastric cancer, whereas no evidence of underlying hepatobiliary or gastrointestinal diseases was found in the other 21 patients. Considering that enhanced CT is the reference standard for the diagnosis of hepatic abscesses, the sensitivity of CEUS in showing TSE was 89%, and the specificity was 100%. The χ test indicated that CEUS and enhanced CT were significantly correlated for detection of hepatic perfusion disorders (P < 0.05). CONCLUSIONS The appearance of TSE in liver abscess was reliably detected by CEUS, which correlated well with the enhanced CT images (P < 0.05).
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Rübenthaler J, Paprottka KJ, Marcon J, Reiser M, Clevert DA. MRI and contrast enhanced ultrasound (CEUS) image fusion of renal lesions. Clin Hemorheol Microcirc 2017; 64:457-466. [PMID: 27886003 DOI: 10.3233/ch-168116] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Ultrasound is a common and established imaging method for the initial characterization of renal lesions. The widespread used Bosniak classification (I-IV) classifies renal lesions in five individual groups using contrast-enhanced computer tomography (CE-CT), magnetic resonance imaging (MRI) and/or contrast-enhanced ultrasound (CEUS) imaging criteria. For complex pathologies, CEUS/MRI image fusion is a novel imaging technique for the differentiation of benign and malignant renal lesions. Compared to CE-CT and MRI alone, ultrasound image fusion offers the additional possibility of being a real-time imaging technique that can be used together with other cross-sectional imaging techniques.This article describes the newest possibilities of image fusion with CEUS and MRI in detection and characterization of unclear renal lesions.
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Affiliation(s)
- J Rübenthaler
- Department of Clinical Radiology, Interdisciplinary Ultrasound Center, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - K J Paprottka
- Department of Clinical Radiology, Interdisciplinary Ultrasound Center, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - J Marcon
- Department of Urology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - M Reiser
- Department of Clinical Radiology, Interdisciplinary Ultrasound Center, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
| | - D A Clevert
- Department of Clinical Radiology, Interdisciplinary Ultrasound Center, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Marchioninistr., Munich, Germany
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Imai K, Kotani T, Tsuda H, Nakano T, Hirakawa A, Kikkawa F. A Novel Approach to Detecting Postpartum Hemorrhage Using Contrast-Enhanced Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:615-620. [PMID: 28024660 DOI: 10.1016/j.ultrasmedbio.2016.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/10/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
The aim of this study was to estimate the efficacy of contrast-enhanced ultrasound (CEUS) in detecting postpartum hemorrhage (PPH) after cesarean section. This is the first study of CEUS in obstetric hemorrhage. A total of 37 patients, operated at Nagoya University Hospital, underwent CEUS. We evaluated the findings of CEUS, which were qualitatively defined as positive when pooling or leakage of contrast agent was observed in the uterine cavity, by measuring the amount of bleeding during the first 4 h after cesarean section. The time-intensity curve patterns of leaked contrast agents were also analyzed for quantitative prediction of the amount of blood loss. Significant differences between the excessive hemorrhage (N = 7) and non-excessive hemorrhage groups (N = 30) were noted in the occurrence of positive CEUS (p = 0.011). Additionally, mean postpartum blood loss markedly increased in patients with a positive CEUS (p = 0.002). From a quantitative perspective, the time until leakage of contrast agents was detected correlated with the amount of bleeding, but the other characteristics of the time-intensity curve pattern did not provide valuable information. In conclusion, CEUS, which enables bedside assessment and rapid diagnosis, is a promising strategy for the detection of PPH.
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Affiliation(s)
- Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Tsuda
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Nakano
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiro Hirakawa
- Biostatistics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Abstract
CLINICAL/METHODICAL ISSUE For diagnostic and interventional procedures ultrasound (US) image fusion can be used as a complementary imaging technique. METHODICAL INNOVATIONS Image fusion has the advantage of real time imaging and can be combined with other cross-sectional imaging techniques. PERFORMANCE With the introduction of US contrast agents sonography and image fusion have gained more importance in the detection and characterization of liver lesions. ACHIEVEMENTS Fusion of US images with computed tomography (CT) or magnetic resonance imaging (MRI) facilitates the diagnostics and postinterventional therapy control. PRACTICAL RECOMMENDATIONS In addition to the primary application of image fusion in the diagnosis and treatment of liver lesions, there are more useful indications for contrast-enhanced US (CEUS) in routine clinical diagnostic procedures, such as intraoperative US (IOUS), vascular imaging and diagnostics of other organs, such as the kidneys and prostate gland.
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Affiliation(s)
- E M Jung
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg (UKR), Regensburg, Deutschland
| | - D-A Clevert
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
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Paprottka PM, Zengel P, Cyran CC, Paprottka KJ, Ingrisch M, Nikolaou K, Reiser MF, Clevert DA. Evaluation of multimodality imaging using image fusion with MRI and CEUS in an experimental animal model. Clin Hemorheol Microcirc 2016; 61:143-50. [PMID: 26519228 DOI: 10.3233/ch-151986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To evaluate the diagnostic benefits of multimodality imaging using image fusion with magnetic-resonance-imaging (MRI) and contrast-enhanced-ultrasound (CEUS) in an experimental small-animal-squamous-cell-carcinoma-model for the assessment of tissue hemodynamics and morphology. MATERIAL AND METHODS Human hypopharynx-carcinoma-cells were injected subcutaneously into the left flank of 15 female athymic nude rats. After 10 daysof subcutaneous tumor growth, CEUS and MRI measurements were performed using a high-end-ultrasound-system and 3-T-MRI. After successful point-to-point or plan registration, the registered MR-images were simultaneously shown with the respective ultrasound sectional plane. Data evaluation was performed using the digitally stored video sequence data sets by two experienced radiologists using a subjective 5-point scale. RESULTS CEUS and MRI are well-known techniques for the assessment of tissue hemodynamics (score: mean 3.8 ± 0.4 SD and score 3.8 ± 0.4 SD). Real-time image fusion of MRI and CEUS yielded a significant (p < 0.001) improvement in score (score 4.8 ± 0.4 SD). Reliable detection of small necrotic areas was possible in all animals with necrotic tumors. No significant intraobserver and interobserver variability was detected (kappa coefficient = +1). CONCLUSION Image fusion of MRI and CEUS gives a significant improvement for reliable differentiation between different tumor tissue areas and simplifies investigations by showing the morphology as well as surrounding macro-/microvascularization.
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Affiliation(s)
- P M Paprottka
- Institute for Clinical Radiology, Ludwig Maximilian University Hospital, Munich, Germany
| | - P Zengel
- Institute for Ear, Nose and Throat Medicine, Munich, Germany
| | - C C Cyran
- Institute for Clinical Radiology, Ludwig Maximilian University Hospital, Munich, Germany
| | - K J Paprottka
- Institute for Clinical Radiology, Ludwig Maximilian University Hospital, Munich, Germany
| | - M Ingrisch
- Institute for Clinical Radiology, Ludwig Maximilian University Hospital, Munich, Germany
| | - K Nikolaou
- Institute for Clinical Radiology, Ludwig Maximilian University Hospital, Munich, Germany
| | - M F Reiser
- Institute for Clinical Radiology, Ludwig Maximilian University Hospital, Munich, Germany
| | - D A Clevert
- Institute for Clinical Radiology, Ludwig Maximilian University Hospital, Munich, Germany
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15
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Miele V, Piccolo CL, Trinci M, Galluzzo M, Ianniello S, Brunese L. Diagnostic imaging of blunt abdominal trauma in pediatric patients. Radiol Med 2016; 121:409-30. [PMID: 27075018 DOI: 10.1007/s11547-016-0637-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/01/2016] [Indexed: 01/27/2023]
Abstract
Trauma is a leading cause of morbidity and mortality in childhood, and blunt trauma accounts for 80-90 % of abdominal injuries. The mechanism of trauma is quite similar to that of the adults, but there are important physiologic differences between children and adults in this field, such as the smaller blood vessels and the high vasoconstrictive response, leading to the spreading of a non-operative management. The early imaging of children undergoing a low-energy trauma can be performed by CEUS, a valuable diagnostic tool to demonstrate solid organ injuries with almost the same sensitivity of CT scans; nevertheless, as for as urinary tract injuries, MDCT remains still the technique of choice, because of its high sensitivity and accuracy, helping to discriminate between an intra-peritoneal form a retroperitoneal urinary leakage, requiring two different managements. The liver is the most common organ injured in blunt abdominal trauma followed by the spleen. Renal, pancreatic, and bowel injuries are quite rare. In this review we present various imaging findings of blunt abdominal trauma in children.
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Affiliation(s)
- Vittorio Miele
- Department of Emergency Radiology, Azienda Ospedaliera S. Camillo-Forlanini, Circonvallazione Gianicolense, 87, 00152, Rome, Italy.
| | - Claudia Lucia Piccolo
- Department of Medicine and Health Sciences, Università del Molise, Campobasso, Italy
| | - Margherita Trinci
- Department of Emergency Radiology, Azienda Ospedaliera S. Camillo-Forlanini, Circonvallazione Gianicolense, 87, 00152, Rome, Italy
| | - Michele Galluzzo
- Department of Emergency Radiology, Azienda Ospedaliera S. Camillo-Forlanini, Circonvallazione Gianicolense, 87, 00152, Rome, Italy
| | - Stefania Ianniello
- Department of Emergency Radiology, Azienda Ospedaliera S. Camillo-Forlanini, Circonvallazione Gianicolense, 87, 00152, Rome, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences, Università del Molise, Campobasso, Italy
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16
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Miele V, Piccolo CL, Galluzzo M, Ianniello S, Sessa B, Trinci M. Contrast-enhanced ultrasound (CEUS) in blunt abdominal trauma. Br J Radiol 2016; 89:20150823. [PMID: 26607647 DOI: 10.1259/bjr.20150823] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Baseline ultrasound is essential in the early assessment of patients with a huge haemoperitoneum undergoing an immediate abdominal surgery; nevertheless, even with a highly experienced operator, it is not sufficient to exclude parenchymal injuries. More recently, a new ultrasound technique using second generation contrast agents, named contrast-enhanced ultrasound (CEUS) has been developed. This technique allows all the vascular phase to be performed in real time, increasing ultrasound capability to detect parenchymal injuries, enhancing some qualitative findings, such as lesion extension, margins and its relationship with capsule and vessels. CEUS has been demonstrated to be almost as sensitive as contrast-enhanced CT in the detection of traumatic injuries in patients with low-energy isolated abdominal trauma, with levels of sensitivity and specificity up to 95%. Several studies demonstrated its ability to detect lesions occurring in the liver, spleen, pancreas and kidneys and also to recognize active bleeding as hyperechoic bands appearing as round or oval spots of variable size. Its role seems to be really relevant in paediatric patients, thus avoiding a routine exposure to ionizing radiation. Nevertheless, CEUS is strongly operator dependent, and it has some limitations, such as the cost of contrast media, lack of panoramicity, the difficulty to explore some deep regions and the poor ability to detect injuries to the urinary tract. On the other hand, it is timesaving, and it has several advantages, such as its portability, the safety of contrast agent, the lack to ionizing radiation exposure and therefore its repeatability, which allows follow-up of those traumas managed conservatively, especially in cases of fertile females and paediatric patients.
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Affiliation(s)
- Vittorio Miele
- Department of Emergency Radiology, S. Camillo Hospital, Rome, Italy
| | | | - Michele Galluzzo
- Department of Emergency Radiology, S. Camillo Hospital, Rome, Italy
| | | | - Barbara Sessa
- Department of Emergency Radiology, S. Camillo Hospital, Rome, Italy
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Wang B, Ye Z, Chen Y, Zhao Q, Huang M, Chen F, Li Y, Jiang T. Hepatic angiomyolipomas: ultrasonic characteristics of 25 patients from a single center. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:393-400. [PMID: 25542497 DOI: 10.1016/j.ultrasmedbio.2014.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/29/2014] [Accepted: 09/02/2014] [Indexed: 06/04/2023]
Abstract
Twenty-five pathologically proven hepatic angiomyolipomas (AMLs) were included in the study. Ultrasonic features of hepatic AMLs were reviewed. Three types of echogenicity were observed on ultrasound examination: (i) strong hyper-echogenicity, (ii) moderate hyper-echogenicity and (iii) hypo-echogenicity. Vascular signals within tumors could be detected in 22 (88.00%) tumors as multiple punctiform, filiform or dendriform signals by color Doppler flow imaging. Based on the enhancement patterns in the arterial, portal and late phases, the features of hepatic AMLs on contrast-enhanced ultrasound were divided into four subtypes: (i) "fast in slow out" (68.00%, n = 17); (ii) "fast in same out" (16%, n = 4); (iii) "fast in fast out" (12.00%, n = 3); and (iv) "fast in uneven out" (4.00%, n = 1). Contrast-enhanced ultrasound diagnosed 22 (88.00%) tumors as benign tumors and 13 (52.00%) as hepatic AMLs. Four cases were misdiagnosed as hepatic hemangioma, five cases as focal nodular hyperplasia (total = 36.00%). The rate of correct diagnosis of hepatic AMLs increased significantly from 24.00% for ultrasound alone to 52.00% for contrast-enhanced ultrasound. Therefore, information obtained from ultrasound, color Doppler flow imaging and contrast-enhanced ultrasound should be combined to improve diagnosis.
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Affiliation(s)
- Baohua Wang
- Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Zhengdu Ye
- Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yan Chen
- Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Qiyu Zhao
- Department of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Min Huang
- Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Fen Chen
- Department of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yanyuan Li
- Department of Pathology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Tian'an Jiang
- Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
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18
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Pinto F, Miele V, Scaglione M, Pinto A. The use of contrast-enhanced ultrasound in blunt abdominal trauma: advantages and limitations. Acta Radiol 2014; 55:776-84. [PMID: 24060814 DOI: 10.1177/0284185113505517] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Computed tomography (CT) is the imaging method of choice in the assessment of multiple trauma patients. However, in patients who suffered from low-energy abdominal trauma, the use of CT is controversial, since the probability of injury is low and therefore most of the studies are normal. Thus, conventional US imaging has increasingly been employed as the initial imaging modality in the work-up of minor traumatic emergency condition. More recently, the introduction of a new contrast-enhanced ultrasound (CEUS) technique, using second-generation ultrasound contrast agents, has led to a notable increase in the diagnostic accuracy of US in many organs. Therefore, in trauma patients, following assessment with conventional US imaging, a CEUS exam can be performed, to provide a more reliable assessment of solid organ injuries. CEUS has the potential to detect active bleeding from a variety of traumatic origins. Similar to CT, active extravasation is considered when there is evidence of contrast agent collection with echogenicity similar to that of an adjacent vessel. On the other hand, at least some drawbacks have to be addressed, including operator competence and reduced panoramic view. Moreover, CEUS, like conventional US imaging, cannot depict some lesions, such as diaphragmatic ruptures, bowel, and mesenteric traumatic injuries. This technique represents a non-invasive and repeatable method that can be performed at patient's bedside and is therefore extremely helpful for the follow-up of solid organs traumas managed conservatively, especially in pediatric patients and women of fertile age. Moreover, it may reduce the number of CT scans and expedite patient discharge.
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Affiliation(s)
- Fabio Pinto
- Department of Diagnostic Radiological Imaging, Marcianise Hospital, Marcianise (CE), Italy
| | - Vittorio Miele
- Department of Emergency Radiology, “San Camillo” Hospital, Rome, Italy
| | - Mariano Scaglione
- Department of Diagnostic Imaging, “Pineta Grande” Medical Center, Castelvolturno (CE), Italy
| | - Antonio Pinto
- Department of Diagnostic Radiological Imaging, “A. Cardarelli” Hospital, Naples, Italy
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19
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The role of CEUS in the assessment of haemodynamically stable patients with blunt abdominal trauma. Radiol Med 2014; 120:3-11. [PMID: 25142944 DOI: 10.1007/s11547-014-0455-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022]
Abstract
Computed tomography (CT) still represents the preferred imaging method in the assessment of patients presenting with multiple trauma. Nevertheless, in patients with low-energy abdominal trauma, the use of CT is debated because of the possible unnecessary radiation exposure. Accordingly, conventional ultrasound (US) imaging has been increasingly employed as the initial imaging modality in the workup of minor traumatic emergency conditions. Focused assessment with sonography for trauma is widely used to detect free intra-abdominal fluid, but its role is controversial, because the absence of free fluid does not exclude the presence of injuries to abdominal organ. Injection of an ultrasound contrast agent (UCA) may give the radiologist relevant additional information to that obtained with conventional US. Thus, in trauma patients, following early assessment with conventional US imaging, a contrast-enhanced US (CEUS) can provide a more reliable evaluation of solid organ injuries and related vascular complications, including active bleeding, pseudoaneurysms, and artero-venous fistulas. CEUS cannot replace abdominal CT, but it represents a noninvasive and repeatable imaging tool capable of providing a reliable assessment of trauma severity and expedite the patient's treatment.
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20
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Clevert DA, Sterzik A, Braunagel M, Notohamiprodjo M, Graser A. [Modern imaging of kidney tumors]. Urologe A 2013; 52:515-26. [PMID: 23571801 DOI: 10.1007/s00120-012-3098-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
If a renal mass is suspected on clinical examination or ultrasound the finding has to be confirmed by cross-sectional imaging. Methods that are used include multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI). Also contrast-enhanced ultrasound has been successfully implemented in renal imaging and now plays a major role in the differentiation of benign from malignant renal masses. In expert hands it can be used to show very faint vascularization and subtle enhancement. The MDCT technique benefits from the recently introduced dual energy technology that allows superior characterization of renal masses in a single-phase examination, thereby greatly reducing radiation exposure. For young patients and persons allergic to iodine MRI should be used and it provides excellent soft tissue contrast and visualizes contrast enhancement kinetics in multiphase examinations.This article aims at giving a comprehensive overview of these different imaging modalities, their clinical indications and contraindications, as well as a description of imaging findings of various renal masses.
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Affiliation(s)
- D-A Clevert
- Institut für Klinische Radiologie, Klinikum der Universität München, Marchioninistraße 15, 81377 München, Deutschland
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21
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Qu P, Yu X, Liang P, Cheng Z, Han Z, Liu F, Yu J. Contrast-enhanced ultrasound in the characterization of hepatocellular carcinomas treated by ablation: comparison with contrast-enhanced magnetic resonance imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:1571-1579. [PMID: 23830098 DOI: 10.1016/j.ultrasmedbio.2013.03.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 01/26/2013] [Accepted: 03/27/2013] [Indexed: 06/02/2023]
Abstract
The purpose of this study was to evaluate the clinical utility of low-mechanical-index contrast-enhanced ultrasound (CEUS) in assessing the response to percutaneous microwave ablation in patients with hepatocellular carcinoma by comparing the results with those of contrast-enhanced magnetic resonance imaging (CEMRI). Between August 2005 and July 2011, 182 patients with 231 lesions treated by microwave ablation were included in the study. One month after microwave ablation, CEUS and CEMRI were performed to evaluate therapeutic responses. The difference in diagnostic accuracy between the two methods was analyzed to evaluate the value of contrast-enhanced ultrasound after microwave ablation. The final diagnosis was based on computed tomography and MRI typical findings of therapeutic response of hepatocellular carcinoma, proven serum tumor marker levels and additional follow-up. The sensitivity of CEUS and CEMRI in evaluating the therapeutic effect of hepatocellular carcinoma was 86.5% and 84.6%; the specificity, 98.3% and 98.9%; and the accuracy, 95.7% and 95.7%.There was no significant statistical disparity between CEUS and CEMRI (p > 0.05).The sensitivity, specificity and accuracy were 98.1, 97.2 and 97.8% when CEUS was used in combination with CEMRI to evaluate the therapeutic response of hepatocellular carcinoma to microwave ablation. CEUS examination was proven to be a tolerable and easy modality for assessment of the therapeutic effect of microwave ablation and can provide results comparable to those obtained with CEMRI. Combining the results of these two examinations may reduce false-positive and false-negative diagnoses.
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Affiliation(s)
- Peng Qu
- Department of Intentional Ultrasound, Chinese Liberation Army General Hospital, Beijing, China
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22
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Millen A, Canavati R, Harrison G, McWilliams RG, Wallace S, Vallabhaneni SR, Fisher RK. Defining a role for contrast-enhanced ultrasound in endovascular aneurysm repair surveillance. J Vasc Surg 2013; 58:18-23. [DOI: 10.1016/j.jvs.2012.12.057] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/10/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
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Vascularisation pattern of chronic pancreatitis compared with pancreatic carcinoma: results from contrast-enhanced endoscopic ultrasound. Int J Inflam 2012; 2012:420787. [PMID: 22844642 PMCID: PMC3400364 DOI: 10.1155/2012/420787] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 04/14/2012] [Accepted: 05/22/2012] [Indexed: 12/14/2022] Open
Abstract
Discriminating between focal chronic pancreatitis and pancreatic cancer is always a challenge in clinical medicine. Contrast-enhanced endoscopic ultrasound using Doppler techniques can uniquely reveal different vascularisation patterns in pancreatic tissue alterated by chronic inflammatory processes and even allows a discrimination from pancreatic cancer. This paper will describe the basics of contrast-enhanced high mechanical index endoscopic ultrasound (CEHMI EUS) and contrast enhanced low mechanical index endoscopic ultrasound (CELMI EUS) and explain the pathophysiological differences of the vascularisation of chronic pancreatitis and pancreatic carcinoma. Furthermore it will discuss how to use these techniques in daily clinical practice.
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24
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Clevert DA, Helck A, Paprottka PM, Schwarz F, Reiser MF. [Latest developments in ultrasound of the liver]. Radiologe 2012; 51:661-70. [PMID: 21847777 DOI: 10.1007/s00117-010-2124-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abdominal ultrasound (US) is often the first-line imaging modality used to assess focal liver lesions. Due to various new gray-scaled US techniques, such as tissue harmonic imaging (THI), spatial compounding technique and speckle reduction technique, as well as contrast-enhanced techniques, abdominal ultrasound nowadays has great potential regarding detection and characterization of focal liver lesions. Furthermore, image fusion with computed tomography (CT), magnetic resonance imaging (MRI) and 3D ultrasound will most likely help to improve clinical management before and after interventional procedures. This article illustrates the principles and clinical impact of recently developed techniques in the field of ultrasound.
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Affiliation(s)
- D-A Clevert
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Grosshadern, München, Deutschland.
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Clevert DA, Helck A, D’Anastasi M, Trumm C, Meimarakis G, Weidenhagen R, Kopp R, Jauch K, Reiser M. Ultraschallgesteuerte EVAR-Interventionen und Follow-up-Diagnostik mit der kontrastmittelgestützten Sonographie und der Bildfusion. GEFASSCHIRURGIE 2011. [DOI: 10.1007/s00772-011-0892-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Zhou X, Luo Y, Peng YL, Cai W, Lu Q, Lin L, Sha XX, Li YZ, Zhu M. Hepatic Perfusion Disorder Associated with Focal Liver Lesions: Contrast-enhanced US Patterns—Correlation Study with Contrast-enhanced CT. Radiology 2011; 260:274-281. [PMID: 21467250 DOI: 10.1148/radiol.11101454] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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27
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Valentino M, Bertolotto M, Derchi L, Bertaccini A, Pavlica P, Martorana G, Barozzi L. Role of contrast enhanced ultrasound in acute scrotal diseases. Eur Radiol 2011; 21:1831-40. [PMID: 21633826 DOI: 10.1007/s00330-010-2039-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 10/21/2010] [Accepted: 10/28/2010] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the efficacy of contrast-enhanced ultrasound (CEUS) in patients with acute scrotal pain not defined at ultrasound (US) with colour Doppler . METHODS CEUS was carried out in 50 patients with acute scrotal pain or scrotal trauma showing testicular lesion of undefined nature at US. The accuracy of US and CEUS findings versus definitive diagnosis (surgery or follow-up) was calculated. RESULTS Twenty-three patients had a final diagnosis of testicular tumour, three abscess, eight focal infarction, seven trauma, three testicular torsion, one haematoma. Five patients were negative. Thirty-five patients were operated (23 testicular tumours, six trauma, three testicular torsion, one abscess, one focal infarction, and one haematoma) and 15 underwent medical treatment or were discharged. US provided a definitive diagnosis in 34/50 as compared to the 48/50 patients diagnosed at CEUS. Sensitivity and specificity were 76% and 45% for US and 96% and 100% for CEUS respectively. CONCLUSIONS CEUS was more accurate in the final diagnosis compared to US, potentially reducing the need for further imaging. In particular CEUS can be proposed in emergency in cases where US diagnosis remains inconclusive, namely in infarction, and trauma, when testicular torsion cannot be ruled out, and in identifying testicular mass.
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Affiliation(s)
- Massimo Valentino
- Department of Diagnostic Imaging-Emergency Radiology Unit, University Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy.
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28
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De Giorgi V, Gori A, Grazzini M, Rossari S, Marino G, D'Elia G, Crocetti E, Roselli G, Innocenti P, Dini M, Lotti T. Contrast-enhanced ultrasound: a filter role in AJCC stage I/II melanoma patients. Oncology 2011; 79:370-5. [PMID: 21430406 DOI: 10.1159/000323494] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 11/26/2010] [Indexed: 12/14/2022]
Abstract
One of the most significant advances in melanoma staging is sentinel lymph node biopsy (SLNB). It is a surgical technique to detect occult nonpalpable micrometastases in regional lymph nodes. Recently, contrast-enhanced ultrasound (CEUS) was introduced as a noninvasive procedure, in spite of SLNB, for the detection of SLNs in patients with cutaneous melanoma. The main purpose of this study was to evaluate the diagnostic accuracy of CEUS in the diagnostic workup of patients with melanoma in comparison with the final histology of SLNs detected through preoperative lymphoscintigraphy. Fifteen patients with cutaneous melanoma underwent prompt excisional biopsy with narrow margins in order to avoid impairment of the melanoma lymphatic basin and were referred for SLNB according to routine indications between January and February 2009. In our study CEUS showed, albeit based on a small patient sample, a negative predictive value of 100%, that means that all negative results were confirmed by negative SLN histopathological examination; all ultrasonographically negative lymph nodes corresponded to nonmetastatic sentinel nodes.
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Schoeppler GM, Buchner A, Zaak D, Khoder W, Staehler M, Stief CG, Reiser MF, Clevert DA. Detection of urinary leakage after radical retropubic prostatectomy by contrast enhanced ultrasound - do we still need conventional retrograde cystography? BJU Int 2011; 106:1632-7. [PMID: 20590540 DOI: 10.1111/j.1464-410x.2010.09497.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION To prospectively evaluate the accuracy of transvesical contrast-enhanced ultrasound (CEUS) as an alternative method for the detection of anastomotic leakage after radical retropubic prostatectomy (RRP) in comparison with the current standard method of conventional retrograde cystography (CG). PATIENTS AND METHODS Forty-three patients underwent RRP for histologically proven localized prostate cancer. The vesico-urethral anastomosis was evaluated 8 days after RRP by CG and CEUS. Any peri-anastomotic leakage was assessed and determined in CG and CEUS as follows: no extravasation (EV), small leakage (≤0.5 cm), moderate leakage (>0.5 cm to ≤2 cm), large leakage (>2 cm diameter of EV seen). RESULTS In total, 21 (49%) patients showed a watertight anastomosis. Ten (23%), two (4.7%) and ten (23%) patients showed a small, intermediate and large EV, respectively. In 31 cases (72%) there was 100% agreement of CG and CEUS for detection of no, moderate and large EV, respectively. In nine cases a small and in two cases a moderate EV was categorized as watertight anastomosis by CEUS. Only in one case did CG detect a small EV where a large EV was detected in CEUS. The agreement between both methods was 95% for detecting absence or large leakages. CONCLUSION CEUS is a promising imaging modality that seems to be equivalent to CG for detecting the presence of a large anastomotic leakage that is clinically relevant for postoperative persistence of the indwelling catheter. CEUS could be a cheap and time-saving alternative to the CG without exposure of the patient to radiation.
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Affiliation(s)
- Gita M Schoeppler
- Department of Urology, University Hospitals - Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany.
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Lassau N, Chami L, Koscielny S, Chebil M, Massard C, Benatsou B, Bidault S, Cioffi A, Blay JY, Le Cesne A. Quantitative functional imaging by dynamic contrast enhanced ultrasonography (DCE-US) in GIST patients treated with masatinib. Invest New Drugs 2010; 30:765-71. [PMID: 21136137 DOI: 10.1007/s10637-010-9592-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 11/12/2010] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To determine the quantitative parameters of DCE-US for predicting early functional response of patients with metastatic gastrointestinal stromal tumors (GIST). MATERIALS AND METHODS Phase II multicentre clinical trial in patients with metastatic GIST treated with masatinib mesylate (7.5 mg/kg daily by oral route) Patients followed using three different imaging techniques: 1) DCE-US before treatment and on days 1, 7, 15 and after 1, 2, 4, 6 months and every 3 months. 2) CT assessments, using RECIST criteria, before treatment, after 2, 4, 6 months and then every 3 months. 3) FDG PET before treatment and after 1 month. RESULTS Twenty patients included and followed-up for up to 36 months, with 269 DCE-US examinations performed. No significant changes in the 7 selected DCE-US variables on day 1 and 7 vs baseline. On day 15, significant reductions in all the variables related to blood volume recorded: area under the curve (AUC) (p = 0. 004), area under the wash-in (AUWI) (p = 0.002), area under the wash-out (AUWO) (p = 0.002) and Peak Intensity (p = 0.005). Also slope of wash-in changed significantly (p = 0.003). An important reduction in Standard Uptake Values (SUV) recorded in 7/11 patients (PFS >18 months). Decrease in DCE-US AUC, AUWI and AUWO values on day 7 were predictive of PET-CT results. CONCLUSIONS AUC AUWI, AUWO are the DCE-US parameters related to blood volume that at D 15 can predict the response of GISTs to treatment with masatinib. Additional studies are ongoing.
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Affiliation(s)
- Nathalie Lassau
- Department of Medical Imaging, Ultrasonography Unit, Institut Gustave Roussy, University Paris-Sud, Villejuif, France.
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Moschouris H, Stamatiou K, Lampropoulou E, Kalikis D, Matsaidonis D. Imaging of the acute scrotum: is there a place for contrast-enhanced ultrasonography? Int Braz J Urol 2010; 35:692-702; discussion 702-5. [PMID: 20028575 DOI: 10.1590/s1677-55382009000600008] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2009] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To present and evaluate the findings of contrast-enhanced ultrasonography (CEUS) in typical cases of acute painful scrotum. MATERIALS AND METHODS Nineteen patients aged from 19 to 61 years old were included in the study. All patients underwent grey-scale and color Doppler ultrasonography (US) of the scrotum, followed by imaging after i.v. administration of 2.4 mL of a second generation ultrasound contrast agent (microbubbles of sulphur hexafluoride). ? dedicated, contrast-sensitive technique was used (Contrast Tissue Imaging - CnTI). The diagnosis was confirmed surgically in 6 cases while in the remaining 8 cases it was based on the combination of clinical, imaging and laboratory findings. RESULTS The final diagnosis was testicular torsion (n = 4), epididymitis (n = 2, one of the cases complicated by abscess), testicular abscess (n = 1), scrotal abscess (n = 1), testicular trauma of varying severity (n = 6). Five out of 19 cases were true negatives: neither clinical examination nor laboratory tests revealed any pathology. CEUS showed complete lack of enhancement in all cases of torsion, permitting a rapid and definitive diagnosis. In the cases of infection complicated by abscesses, CEUS delineated the lesions much better than the combination of B-mode/Color Doppler US. The severely traumatized testicles showed minimal, inhomogeneous or patchy enhancement, while cases of minor trauma showed no significant enhancement defects. Hematomas were presented as non-enhancing lesions. CONCLUSION Generally, there was no advantage over Doppler US as has been previously shown. However, CEUS can be used supplementary to traditional Doppler US in the investigation of blunt testicular trauma especially when there is uncertainty in diagnosis after appropriate clinical and radiographic evaluations occurs. Further studies are required to clearly define the indications of this method.
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Affiliation(s)
- H Moschouris
- Department of Radiology, General Hospital of Pireas Tzaneio, Pireas, Greece
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Meijerink MR, van Waesberghe JHTM, van Schaik C, Boven E, van der Veldt AAM, van den Tol P, Meijer S, van Kuijk C. Perfusion CT and US of colorectal cancer liver metastases: a correlative study of two dynamic imaging modalities. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:1626-1636. [PMID: 20800954 DOI: 10.1016/j.ultrasmedbio.2010.06.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 06/09/2010] [Accepted: 06/17/2010] [Indexed: 05/29/2023]
Abstract
The purpose of this study was to evaluate the correlation between dynamic-contrast-enhanced computed tomography (DCE-CT) and first-pass dynamic-contrast-enhanced ultrasound (DCE-US) of normal appearing liver parenchyma and of colorectal cancer liver metastases. Thirty patients with hepatic metastases from colorectal cancer underwent DCE-CT and DCE-US. To obtain DCE-US reproducibility measurements, double contrast-passages (2 × 2.4 mL SonoVue intravenous) were acquired. From several DCE-US-derived perfusion indices, the slope-value scored best with a reproducibility concordance correlation coefficient ranging from 0.75-0.93 and overall highest correlation to DCE-CT-derived variables (r = 0.52 to 0.73). The DCE-US-based tumor-to-liver perfusion gradient also showed a low test-retest variability and moderately correlated to DCE-CT (concordance correlation coefficient 0.87-0.92; r = 0.57 to 0.59). To conclude, DCE-US-based slope-value and tumor-to-liver perfusion gradient correlate best with DCE-CT perfusion values. However, both techniques cannot be used interchangeably. DCE-US should be restricted for studies in which a considerable change in perfusion is expected and for patients with a relatively high tumor blood flow at baseline.
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Affiliation(s)
- Martijn R Meijerink
- Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
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Kopp R, Zürn W, Weidenhagen R, Meimarakis G, Clevert DA. First experience using intraoperative contrast-enhanced ultrasound during endovascular aneurysm repair for infrarenal aortic aneurysms. J Vasc Surg 2010; 51:1103-10. [PMID: 20420978 DOI: 10.1016/j.jvs.2009.12.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 12/13/2009] [Accepted: 12/16/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Endovascular aortic repair (EVAR) has become an additional treatment option for patients with infrarenal aortic aneurysms and suitable aortic morphology. However, endoleaks are commonly encountered and represent a relevant risk for secondary treatment failure. In addition, impaired renal function or allergic reactions to intravascular iodine application might represent exclusion criteria for conventional infrarenal endovascular aortic repair using intraoperative angiography with iodine contrast media. Real-time contrast-enhanced ultrasound (CEUS) with a low mechanical index (MI) is a promising method recently introduced for follow up after endovascular infrarenal aortic repair. METHODS In this study, intraoperative CEUS using SonoVue as ultrasound contrast agent was evaluated in 17 patients for localization of the proximal infrarenal landing zone, the distal iliac fixation area, and identification of endoleaks in patients suitable for endovascular aortic repair with an infrarenal aortic neck > or =10 mm and non-aneurysmal common iliac arteries. For comparison, 20 patients were treated by conventional EVAR using intraoperative fluoroscopy and iodine contrast media. RESULTS Intraoperative application of contrast-enhanced ultrasound (iCEUS) for identification of the infrarenal landing zone and proximal stent graft release was achieved in 14 out of 17 patients (82.4%), as verified by intraoperative angiography or postinterventional imaging. Intraoperative CEUS-assisted visualization of the distal fixation area proximal to the level of the iliac bifurcation was achieved in 89.3% (25 out of 28 iliac arteries examined) in comparison to intraoperative angiography or postinterventional CEUS, computed tomography (CT), or magnetic resonance (MR) angiography. Three selected patients having contraindications for iodine-based contrast media were treated by iCEUS-assisted EVAR without the use of any iodine contrast during fluoroscopy. Time for exposure to intraoperative radiation, volume of contrast medium used, and the number of intraoperative angiographies and postinterventional CT or MR angiographies were significantly reduced in the iCEUS-assisted EVAR group in comparison to conventional endovascular aortic treatment (P < .002 or less for all parameters). Intraoperative application of CEUS detected more endoleaks than conventional EVAR (8/17 vs 4/20; P = .08) treated by proximal stent graft extension in one symptomatic patient with a type Ia endoleak. CONCLUSIONS Intraoperative CEUS-assisted EVAR in patients with infrarenal aortic aneurysms represents a new option for intraoperative visualization of aortoiliac segments required as proximal or distal fixation zones and identification of endoleaks, especially in those patients with contraindications for usage of iodine-containing contrast agents, in association with a reduction of iodine contrast media used and radiation exposure during fluoroscopy.
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Affiliation(s)
- Reinhard Kopp
- Department of Abdominal and Vascular Surgery, Klinikum Harlaching, Staedtisches Klinikum Munich, Munich, Germany.
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Clevert DA, Horng A, Kopp R, Schick K, Meimarakis G, Sommer WH, Reiser M. [Imaging of endoleaks after endovascular aneurysm repair (EVAR) with contrast-enhanced ultrasound (CEUS)]. Radiologe 2010; 49:1033-9. [PMID: 19855950 DOI: 10.1007/s00117-009-1876-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Endoleaks following endovascular aneurysm repair (EVAR) are common and present a diagnostic challenge in the follow-up after EVAR. Contrast-enhanced ultrasound (CEUS) is a promising new method for the diagnosis and follow-up of endoleaks. CEUS with SonoVue allows a rapid and non-invasive diagnosis in the follow-up after EVAR. The sensitivity and specificity of conventional ultrasound compared to the multislice CT angiography is estimated to be 33-63% and 63-93%, respectively. These values can be increased through the use of CEUS in up to 98-100% (sensitivity) and 82-93% (specificity). This article describes the etiology, classification and importance of different types of endoleaks. The value of CEUS in this clinical scenario will be discussed.
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Affiliation(s)
- D-A Clevert
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland.
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Active gastrointestinal bleeding: evaluation with contrast-enhanced ultrasonography. ACTA ACUST UNITED AC 2009; 35:637-42. [DOI: 10.1007/s00261-009-9588-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wang Z, Xu HX, Xie XY, Xie XH, Kuang M, Xu ZF, Liu GJ, Chen LD, Lin MX, Lu MD. Imaging features of hepatic angiomyolipomas on real-time contrast-enhanced ultrasound. Br J Radiol 2009; 83:411-8. [PMID: 19723766 DOI: 10.1259/bjr/81174247] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to evaluate the imaging features of hepatic angiomyolipoma (AML) on contrast-enhanced ultrasound (CEUS). The imaging features of 12 pathologically proven hepatic AML lesions in 10 patients who had undergone baseline ultrasound (BUS) and CEUS examinations were evaluated retrospectively. The enhancement extent, pattern and dynamic change, along with the enhancement process, on CEUS were analysed. The diagnostic results of BUS and CEUS before pathological examination were also recorded. The results showed that 75% (9/12) of the AML lesions exhibited mixed echogenicity on BUS and most showed remarkable hyperechogenicity in combination with a hypoechoic or anechoic portion. Arterial flow signals were detected in 75% (9/12) of the lesions on colour Doppler imaging. On CEUS, 66.7% (n = 8) of the 12 lesions exhibited hyperenhancement in the arterial phase, slight hyperenhancement (n = 2) or isoenhancement (n = 6) in the portal phase, and slight hyperenhancement (n = 1) or isoenhancement (n = 7) in the late phase. Three (25%) lesions exhibited hyperenhancement in the arterial phase and hypoenhancement in both portal and late phases. One (8.3%) lesion exhibited hypoenhancement throughout the CEUS process. Before pathological examination with BUS, only 3 (25%) lesions were correctly diagnosed as hepatic AML. Conversely, on CEUS, correct diagnoses were made for 66.8% (8/12) of hepatic AMLs. Therefore, arterial hyperenhancement and subsequent sustained enhancement on CEUS were found in the majority of hepatic AMLs. The combination of BUS and CEUS leads to the correct diagnosis in the majority of hepatic AMLs, and is higher than the success rate achieved by BUS alone.
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Affiliation(s)
- Z Wang
- Department of Medical Ultrasonics, The First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, China
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Manetta R, Pistoia ML, Bultrini C, Stavroulis E, Di Cesare E, Masciocchi C. Ultrasound enhanced with sulphur-hexafluoride-filled microbubbles agent (SonoVue) in the follow-up of mild liver and spleen trauma. Radiol Med 2009; 114:771-9. [PMID: 19484583 DOI: 10.1007/s11547-009-0406-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 12/09/2008] [Indexed: 01/04/2023]
Abstract
PURPOSE This study assessed the role of contrast-enhanced ultrasound (CEUS) in the follow-up of patients with a diagnosis of traumatic liver or spleen lesions. MATERIALS AND METHODS Between April 2006 and February 2008, 18 patients (13 males and five females, age range 8-42 years) with blunt abdominal trauma were evaluated with computed tomography (CT) and CEUS at the emergency department of our institution. Seven were diagnosed as surgical emergencies and were excluded from the study. The remaining 11 were treated conservatively and were monitored with CEUS at variable time intervals, depending on their clinical needs. RESULTS CEUS confirmed lesion sites identified on presentation and allowed us to follow all phases of the repair process until complete resolution. CONCLUSIONS The conservative management of abdominal lesions in both adults and children is increasingly widespread but requires accurate follow-up over time. As a noninvasive, versatile, easy to perform and repeatable technique with a low rate of adverse reactions, CEUS is ideally suited for this purpose and allowed us to reduce the number of CT scans, especially in the follow-up of young patients.
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Affiliation(s)
- R Manetta
- Dipartimento di Diagnostica per Immagini., Università degli Studi di L'Aquila, Via Vetoio, L'Aquila, Italy
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Tang J, Li W, Lv F, Zhang H, Zhang L, Wang Y, Li J, Yang L. Comparison of gray-scale contrast-enhanced ultrasonography with contrast-enhanced computed tomography in different grading of blunt hepatic and splenic trauma: an animal experiment. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:566-575. [PMID: 19097681 DOI: 10.1016/j.ultrasmedbio.2008.09.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2007] [Revised: 06/14/2008] [Accepted: 09/29/2008] [Indexed: 05/27/2023]
Abstract
To compare the diagnostic value of contrast-enhanced ultrasonography (CEUS) with contrast-enhanced computed tomography (CECT) for the detection of different grading of solid organ injuries in blunt abdominal trauma in animals. A self-made miniature tools were used as models to simulate a blunt hepatic or splenic trauma in 16 and 14 anesthetized dogs, respectively. Baseline ultrasound, CEUS and CECT were used to detect traumatic injuries of livers and spleens. The degree of injuries was determined by CEUS according to the American Association for the Surgery of Trauma (AAST) scale and the results compared with injury scale based on CECT evaluation. CEUS showed 22 hepatic injury sites in 16 animals and 17 splenic injury sites in other 14 animals. According to AAST scale, 2 grade I, 4 grade II, 3 grade III, 5 grade IV and 2 grade V hepatic lesions were present in 16 animals; 2 grade I, 4 grade II, 6 grade III and 2 grade IV splenic lesions in 14 animals. On CECT scan, 21 hepatic and 17 splenic injuries were demonstrated. According to Becker CT scaling for hepatic injury, 1 grade I, 2 grade II, 4 grade III, 5 grade IV and 2 grade V hepatic injuries were present. On the basis of Buntain spleen scaling, 2 grade I, 5 grade II, 5 grade III, 2 grade IV splenic injuries were showed. After Spearman rank correlation analysis, the agreement of CEUS with CECT on the degree of hepatic and splenic injury is 93.3% and 92.9%, respectively. CT is currently considered as the reference method for grading blunt abdominal trauma, according to experiment results, CEUS grading showed high levels of concordance with CECT. CEUS can accurately determine the degree of injury and will play an important role in clinical application.
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Affiliation(s)
- Jie Tang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, China.
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Chen L, Zhan WW, Shen ZJ, Rui WB, Lv C, Chen M, Zhou JQ, Zhou P, Zhou M, Zhu Y. Blood perfusion of the contralateral testis evaluated with contrast-enhanced ultrasound in rabbits with unilateral testicular torsion. Asian J Androl 2009; 11:253-60. [PMID: 19151740 DOI: 10.1038/aja.2008.13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The changes of blood perfusion of contralateral testis after unilateral testicular torsion remain controversial. In this study, 28 New Zealand white male rabbits were randomly divided into five groups. Group A (n = 8), the control group, underwent a sham operation on the unilateral testis without inducing testicular torsion. In groups B, C, and D (n = 5 each), unilateral testicular torsion was induced, and, after 3, 6 or 24 h, respectively, detorsion was performed. In group E (n = 5), permanent unilateral testicular torsion was applied. Contrast-enhanced ultrasound was used to observe the blood perfusion of the contralateral testis at the following stages: pre-torsion (preopration), immediately post-torsion (postopration), pre-detorsion, immediately post-detorsion, and late-stage post-detorsion (6-12 h post-detorsion in groups B-D) or at a similar time point (15-21 h post-torsion in group E). Time-intensity curves were generated, and the following parameters were derived and analyzed: arrival time, time to peak intensity, peak intensity, and half-time of the descending peak intensity. The analysis revealed that blood perfusion of the contralateral testis increased immediately after testicular torsion on the opposite side (P < 0.05), which increased with prolonged testicular torsion of the other testis. This research demonstrated that contrast-enhanced ultrasound was valuable in evaluating blood perfusion of the contralateral testis after unilateral testicular torsion.
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Affiliation(s)
- Lin Chen
- Department of Ultrasound, Ruijin Hospital, Medical School of Shanghai Jiao Tong University, Shanghai 200025, China
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Clevert DA, Stickel M, Flach P, Strautz T, Horng A, Jauch KW, Reiser M. Contrast-enhanced ultrasound in detection and follow-up of an infrarenal abdominal aortic aneurysm with aorto-caval fistula and endovascular treatment. Cardiovasc Intervent Radiol 2007; 30:480-4. [PMID: 17205366 DOI: 10.1007/s00270-006-0143-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
An aorto-caval fistula is a rare complication of a symptomatic or ruptured infrarenal aortic aneurysm having a frequency of 3-6%. Patients typically present with clinical signs of diffuse abdominal pain associated with increasing venous congestion and tachycardia, rapid cardiopulmonary decompensation with acute dyspnea, and an audible machinerylike bruit. Perioperative mortality is high, ranging from 20% to 60%. We report a case of an endovascular aortic repair in a patient with a symptomatic infrarenal aortic aneurysm and an aorto-caval fistula. Contrast-enhanced ultrasound seems to be a promising new diagnostic option for the diagnosis and preoperative treatment planning for patients with abdominal aortic aneurysms with rupture into the inferior vena cava. It is in addition to computed tomography angiography. It might allow a more rapid and noninvasive diagnosis, especially for patients in intensive care because of its bedside availability. Because the examination is dynamic, additional information about blood flow between the aorta and inferior cava vein can be evaluated.
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Affiliation(s)
- D-A Clevert
- Department of Clinical Radiology, University of Munich-Grosshadern Campus, Munich, Germany.
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Heijmink SWTPJ, Barentsz JO. Contrast-enhanced versus systematic transrectal ultrasound-guided prostate cancer detection: an overview of techniques and a systematic review. Eur J Radiol 2007; 63:310-6. [PMID: 17719734 DOI: 10.1016/j.ejrad.2007.06.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 06/19/2007] [Accepted: 06/27/2007] [Indexed: 11/29/2022]
Abstract
An overview is given of the current conventional and contrast-specific transrectal ultrasound (TRUS) techniques for prostate imaging that may be used for guiding biopsy. Subsequently, a systematic literature search resulted in inclusion of four studies that directly compared systematic and contrast-enhanced-targeted TRUS-guided biopsy of the prostate. All four studies revealed that contrast-enhanced-targeted TRUS-guided biopsy significantly improved the positive biopsy core rate. In the largest study, the mean Gleason score of the contrast-enhanced-targeted TRUS-guided biopsies was significantly higher than that of the systematic biopsies. Future randomized clinical trials, preferably in a non-academic multi-institutional set-up, will have to be performed to confirm the value of contrast-enhanced-targeted TRUS-guided biopsy in regular clinical practice.
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Affiliation(s)
- Stijn W T P J Heijmink
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein zuid 10, NL 6500 HB Nijmegen, The Netherlands.
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Ehrhardt AR, Reuter S, Buck AK, Haenle MM, Mason RA, Gabelmann A, Kern P, Kratzer W. Assessment of disease activity in alveolar echinococcosis: a comparison of contrast enhanced ultrasound, three-phase helical CT and [(18)F] fluorodeoxyglucose positron emission tomography. ACTA ACUST UNITED AC 2007; 32:730-6. [PMID: 17285403 DOI: 10.1007/s00261-006-9173-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Objective of the present study was to assess activity or vascularization of focal liver lesions in alveolar echinococcosis (AE) using [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) in comparison with contrast enhanced ultrasound (CEUS) and three-phase helical computed tomography (CT). METHODS In this prospective study, 17 patients with confirmed AE of the liver were included (6 males, 11 females; average age: 59 +/- 16 years; average duration of disease: 10.5 years) and were then examined using FDG-PET, precontrast ultrasound (US), CEUS, and three-phase helical CT. We assessed metabolic activity (FDG-PET) and vascularization (CEUS and CT) of Echinococcus multilocularis specific hepatic lesions. RESULTS FDG-PET identified increased metabolic activity in the corresponding lesions in seven patients (41.2%). A vascularization pattern of echinococcal lesions was visualized in 9 patients (52.9%) by CEUS and in 4 patients (23.5%) by CT. All positive FDG-PET findings were also positive at CEUS. CONCLUSIONS There was association between findings of metabolic activity in AE at FDG-PET and vascularized lesions of the liver returned by CEUS. This suggests that CEUS may represent a cost-effective tool in the decision making to perform FDG-PET examination.
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Affiliation(s)
- Alexander R Ehrhardt
- Department of Internal Medicine I, University Hospital Ulm, Robert-Koch-Str. 8, 89081, Ulm, Germany.
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Maruyama H, Ebara M. Recent applications of ultrasound: diagnosis and treatment of hepatocellular carcinoma. Int J Clin Oncol 2007; 11:258-67. [PMID: 16937299 DOI: 10.1007/s10147-006-0585-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Indexed: 12/23/2022]
Abstract
Ultrasound (US) has the advantages of real-time observation, simple technique, and a noninvasive procedure compared to other imaging modalities. The recent development of digital technologies has enabled the observation of sonograms with improved signal-to-noise ratio, penetration, and spatial and contrast resolutions. Furthermore, microbubble contrast agents have increased the diagnostic ability of US examination, and the use of three-dimensional sonograms is now not unusual. These advances have furthered the usefulness of US for liver tumors in clinical practice. This article reviews the recent applications of US in the diagnosis and treatment of hepatocellular carcinoma.
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Affiliation(s)
- Hitoshi Maruyama
- Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan.
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Catalano O, Sandomenico F, Vallone P, D'Errico AG, Siani A. Contrast-enhanced sonography of the spleen. Semin Ultrasound CT MR 2007; 27:426-33. [PMID: 17048457 DOI: 10.1053/j.sult.2006.06.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sonography is frequently the first imaging modality employed to evaluate the spleen. Nevertheless, splenic abnormalities frequently determine subtle changes in echogenicity and may be overlooked. Additionally, splenic disorders have a nonspecific appearance, mostly appearing as hypoechoic defects. Difficulties in differential diagnosis are not uncommon, with splenic infarctions resembling, for example, focal lesions. Color Doppler is usually of limited additional value. Instead, the spleen is optimally suited for contrast-enhanced sonography, being superficial, small, and homogeneous, and showing intense and persistent contrast enhancement. Scarcely evident abnormalities become evident after contrast medium injection. Additional information can be obtained in many clinical scenarios, including blunt trauma, left flank pain, lymphoma, and incidental detection of splenic abnormalities.
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Affiliation(s)
- Orlando Catalano
- Department of Radiology, National Cancer Institute, Fondazione G. Pascale, Naples, Italy.
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Clevert DA, Stickel M, Johnson T, Glaser C, Clevert DA, Steitz HO, Kopp R, Jauch KW, Reiser M. Imaging of aortic abnormalities with contrast-enhanced ultrasound. A pictorial comparison with CT. Eur Radiol 2007; 17:2991-3000. [PMID: 17219146 DOI: 10.1007/s00330-006-0542-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 10/25/2006] [Accepted: 11/17/2006] [Indexed: 10/23/2022]
Abstract
Aortic abnormalities are commonly encountered and may represent a diagnostic challenge in patients with acute or chronic clinical symptoms. Contrast-enhanced ultrasound (CEUS) with low mechanical index (low MI) is a new promising method in the diagnosis and follow-up of pathological aortic lesions. CEUS with SonoVue allows a more rapid and noninvasive diagnosis, especially in critical patients because of its bedside availability. This review compares CEUS findings with those documented on computed tomography angiography (CTA), allowing the reader to appreciate the usefulness of CEUS in this clinical situation.
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Affiliation(s)
- D-A Clevert
- Department of Clinical Radiology, University of Munich-Grosshadern, Munich, Germany.
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Lassau N, Lamuraglia M, Chami L, Leclère J, Bonvalot S, Terrier P, Roche A, Le Cesne A. Gastrointestinal stromal tumors treated with imatinib: monitoring response with contrast-enhanced sonography. AJR Am J Roentgenol 2006; 187:1267-73. [PMID: 17056915 DOI: 10.2214/ajr.05.1192] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate contrast-enhanced Doppler sonography with perfusion software as a predictor of early tumor response to imatinib (Glivec) in c-kit-positive gastrointestinal stromal tumors (GISTs). SUBJECTS AND METHODS Thirty patients (59 tumors) with metastases or a recurrence from a GIST were prospectively included in a single-center imaging trial. Contrast-enhanced Doppler sonography was performed with an Aplio scanner the day before (day-1) starting oral treatment (400 mg) and at days 1, 7, 14, 60, 90, and 6 months, 9 months, and 1 year. The percentage of contrast uptake (Levovist or Sonovue) before treatment and at the different stages of follow-up was evaluated by two radiologists. Digitized quantification was performed using Photoshop software. To define the benchmark standard, all patients were rated as responders or nonresponders at 2 and 6 months by a board consisting of oncologists and radiologists who had all clinical and imaging data at their disposal. Changes in the percentage of contrast uptake at each sonographic examination were compared statistically. RESULTS A total of 185 examinations were performed. Forty-four lesions in 24 patients were completely evaluated at 2 months, and 29 lesions in 15 patients were completely evaluated at 6 months. Initial contrast uptake at day 1 was predictive of the future response. A strong correlation was found between the decline in tumor contrast uptake at days 7 and 14 and tumor response (p < 10(-4)). CONCLUSION Contrast-enhanced Doppler sonography is a noninvasive imaging technique that allows the early prediction of tumor response in c-kit-positive GIST treated with Glivec.
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Affiliation(s)
- Nathalie Lassau
- Department of Medical Imaging, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France.
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Lamuraglia M, Escudier B, Chami L, Schwartz B, Leclère J, Roche A, Lassau N. To predict progression-free survival and overall survival in metastatic renal cancer treated with sorafenib: pilot study using dynamic contrast-enhanced Doppler ultrasound. Eur J Cancer 2006; 42:2472-9. [PMID: 16965911 DOI: 10.1016/j.ejca.2006.04.023] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 04/18/2006] [Accepted: 04/20/2006] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The objective of this study was to evaluate dynamic contrast-enhanced Doppler ultrasound (DCE-US) with perfusion software (Vascular Recognition Imaging) and contrast agent injection as a predictor of tumour response, progression-free survival (PFS) and overall survival (OS). PATIENTS AND METHODS Thirty patients with a metastatic renal cell carcinoma (RCC) already enrolled in a double-blind randomised study were evaluated. Examinations were performed at baseline, and after 3 and 6 weeks on sorafenib or a placebo in patients with tumour targets that were accessible to DCE-US. RESULTS A total of 85 examinations were performed, 30 at baseline, 28 at 3 weeks and 27 at 6 weeks. The combination of a decrease in contrast uptake exceeding 10% and stability or a decrease in tumour volume allowed us to discriminate seven good responders and 20 poor responders at 3 weeks. There was a statistically significant difference in PFS (p=10(-4)) and OS (p=10(-4)) between good and poor responders. CONCLUSION DCE-US is a new noninvasive imaging technique which might be an effective tool for evaluating antiangiogenic drugs in renal cancer.
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Affiliation(s)
- Michele Lamuraglia
- Department of Medical Imaging, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France
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Catalano O, Cusati B, Nunziata A, Siani A. Active abdominal bleeding: contrast-enhanced sonography. ACTA ACUST UNITED AC 2006; 31:9-16. [PMID: 16317492 DOI: 10.1007/s00261-005-0369-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Active contrast medium extravasation is a recognized and important angiographic and computed tomographic (CT) sign of bleeding. It is an indicator of active, ongoing, and potentially life-threatening hemorrhage and, hence, of the need for an immediate surgical or interventional treatment. Sonography (US) is frequently used as the first imaging option for screening patients with traumatic and nontraumatic abdominal emergencies. Owing to the current possibilities of low-mechanical index, real-time, contrast-specific systems, it is now possible to detect a contrast leakage by using US. This finding opens new possibilities in the assessment and management of several abdominal emergencies, including trauma (initial workup and monitoring), spontaneous hematomas, and rupture of aneurysms or masses. This article describes the technique, findings, possibilities, and limitations of contrast-enhanced US in the evaluation of active abdominal bleeding.
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Affiliation(s)
- O Catalano
- Department of Radiology, Istituto Pascale, via Semmola, Naples, 80131, Italy.
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Kamino D, Hata J, Haruma K, Manabe N, Tanaka S, Chayama K. Real-time visualization and quantitation of canine gastric mucosal blood flow by contrast-enhanced ultrasonography. Scand J Gastroenterol 2006; 41:856-61. [PMID: 16785201 DOI: 10.1080/00365520500464975] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Contrast-enhanced ultrasonography has become a method of choice for evaluating gastric blood flow, but intermittent scanning techniques can sometimes distort the results. Low-mechanical index imaging using Definity as the injected contrast material has been advocated for real-time evaluation of microperfusion in other organs. We investigated the reliability of low-mechanical index imaging using Definity in the evaluation of gastric mucosal blood flow. MATERIAL AND METHODS Under general anesthesia, 10 beagle dogs weighing 9-10 kg underwent real-time harmonic imaging under low acoustic power (mechanical index = 0.2) after intravenous contrast injection using Definity (60 mg/kg). Laser Doppler flow measurement was also performed to evaluate gastric mucosal blood flow. After administration of a diclofenac sodium suppository, low-mechanical index imaging and laser Doppler flowmetry were repeated. RESULTS Real-time visualization of gastric mucosal blood flow was successful in all dogs undergoing low-mechanical index imaging with Definity. Quantitative assessment of gastric mucosal blood flow was successful in eight dogs. After diclofenac sodium administration, gastric mucosal blood flow measured by both laser Doppler flowmetry and contrast ultrasonography decreased in seven of eight dogs; in the other dog, gastric mucosal blood flow increased slightly. A strong positive correlation was evident between blood flow measured by laser Doppler flowmetry and low-mechanical index imaging (r=0.777, p<0.005). CONCLUSIONS Low-mechanical index imaging with Definity is a non-invasive way to evaluate gastric mucosal blood flow in real-time, high-resolutional images, which may have additional important gastrointestinal tract applications.
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Affiliation(s)
- Daisuke Kamino
- Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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