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Elbanna KY, Krishna S, Finelli A, Atri M. Contrast-Enhanced Ultrasound of the Indeterminate Renal Mass, From the AJR "How We Do It" Special Series. AJR Am J Roentgenol 2024. [PMID: 38415576 DOI: 10.2214/ajr.24.30817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Contrast-enhanced ultrasound (CEUS) is distinguished from CT and MRI by the use of microbubble ultrasound contrast agents (UCAs) with intravascular blood pool distribution. When performing CEUS, low-intensity ultrasound allows real-time tissue subtraction imaging, whereas high-intensity ultrasound leads to microbubble destruction, enabling visualization of the contrast inflow pattern. CEUS has exceptional contrast resolution that enables the detection of even minimal blood flow, achieving very high NPV for ruling out vascular perfusion and providing high frame rates in the evaluation of tissue perfusion dynamics. UCAs undergo hepatic metabolism and pulmonary clearance, ensuring safety in patients with renal impairment. CEUS excels in distinguishing solid from cystic renal masses, with higher sensitivity than CT or MRI for detection of lesion enhancement. CEUS can aid the further characterization of both solid and cystic lesions and may have particular applications in the surveillance of cystic masses and surveillance after renal cell carcinoma ablation. This review describes the use of CEUS to help characterize indeterminate renal masses, based on the authors' institutional experience. The article highlights key differences between CEUS and CT or MRI, and provides practical insights for performing and interpreting CEUS of renal masses.
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Affiliation(s)
- Khaled Y Elbanna
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Canada
| | - Satheesh Krishna
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and of Surgical Oncology, Princess Margaret Hospital and the University Health Network, University of Toronto, Canada
| | - Mostafa Atri
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Canada
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Zhang Z, Shao K, Zhou C, Zhou P, Zhou Q, An H, Ji R. Using 1/2 Descending Time in CEUS to Identify Renal Allograft Rejection. Acad Radiol 2024:S1076-6332(24)00048-5. [PMID: 38418346 DOI: 10.1016/j.acra.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 03/01/2024]
Abstract
RATIONALE AND OBJECTIVES This study investigates the potential of quantitative Contrast-Enhanced Ultrasound (CEUS) parameters to distinguish between graft dysfunction due to rejection and non-rejection in kidney transplant recipients. METHODS In this retrospective study, 50 kidney transplant patients who presented elevated serum creatinine or proteinuria were analyzed. They were categorized as rejection or non-rejection based on biopsy outcomes. These classifications were applied in both derivation (n = 33) and validation cohorts (n = 17). Prior to the biopsy, all patients underwent a CEUS. Quantitative parameters derived from the CEUS were further analyzed for their consistency and reliability. Additionally, the relationship between the Banff scores, a standard for diagnosing transplant rejections, and these CEUS parameters was explored. RESULTS Significant differences between rejection and non-rejection groups were observed in the CEUS parameters of derivation cohorts. Specifically, Peak Intensity (PI), 1/2 Descending Time (DT/2), Area Under Curve (AUC), and Mean Transit Time (MTT) stood out. Sensitivity and specificity for these parameters were 76.5% and 87.5% for PI, 76.5% and 81.2% for DT/2, 76.5% and 87.5% for AUC, and 68.8% and 94.1% for MTT, respectively. DT/2 and MTT showed superior interobserver agreement compared to PI and AUC. When extrapolating the cutoff values from the derivation cohort to the validation group, DT/2 and AUC exhibited optimal diagnostic precision with positive and negative predictive values being 91.7% vs. 100% and 100% vs. 85.7%, respectively. Additionally, DT/2 effectively differentiated between mild and moderate to severe microvascular inflammation, pivotal in diagnosing antibody-mediated renal transplant rejection. CONCLUSION DT/2 from CEUS parameters presents as a reliable tool to differentiate rejection from non-rejection causes in renal transplant dysfunction. Yet, large-scale, multi-center studies are essential for further validation.
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Affiliation(s)
- Zhe Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Shao
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peijun Zhou
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Quan Zhou
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huimin An
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ri Ji
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Ren Q, Yuan M, Wang G. Role of ultrasonography in the evaluation of disease severity and treatment efficacy in adenomyosis. Arch Gynecol Obstet 2024; 309:363-371. [PMID: 37115275 DOI: 10.1007/s00404-023-07034-4] [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: 01/05/2023] [Accepted: 04/01/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Adenomyosis is a benign disorder characterized by the presence of ectopic endometrial glands and stroma within the myometrium. The main clinical manifestations of adenomyosis are dysmenorrhea, menorrhagia, and infertility, which affect patients' quality of life. Recently, with advancements in imaging techniques, magnetic resonance imaging, and ultrasonography have become the main diagnostic tools for adenomyosis. In addition to the diagnosis and differential diagnosis of adenomyosis, ultrasonography can also be used to evaluate the severity of adenomyosis. The emergence of new techniques, such as elastography and contrast-enhanced ultrasonography (CEUS), has significantly improved the accuracy of ultrasound-based diagnosis of adenomyosis. These two imaging tools can also be used for the differential diagnosis of adenomyosis and the evaluation of treatment efficacy after medication or ablation procedure. OBJECTIVE we review the efficacy of ultrasonography as a diagnostic tool for adenomyosis. We also aim to introduce the potential of ultrasound imaging in the evaluation of the severity of this disease, as well as the application of elastography and contrast-enhanced ultrasonography (CEUS) in its diagnosis. RESULTS AND CONCLUSION Our findings reveal the potential value of ultrasonography combined with elastography and/or CEUS as medication guidance and efficacy evaluation tools in the long-term management of adenomyosis.
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Affiliation(s)
- Qianhui Ren
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Jinan, 250000, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ming Yuan
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Jinan, 250000, Shandong, China
- Gynecology Laboratory, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Guoyun Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Jinan, 250000, Shandong, China.
- Gynecology Laboratory, Shandong Provincial Hospital, Jinan, Shandong, China.
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Olinger K, Liu X, Khoshpouri P, Khoshpouri P, Scoutt LM, Khurana A, Chaubal RN, Moshiri M. Added Value of Contrast-enhanced US for Evaluation of Female Pelvic Disease. Radiographics 2024; 44:e230092. [PMID: 38175802 DOI: 10.1148/rg.230092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Since the first application of contrast-enhanced US (CEUS) in the late 1960s, the use of US contrast agents has grown tremendously, and this examination has proved to be a valuable adjunct to diagnostic US for detection and characterization of disease. Also, CEUS has emerged as an excellent option for evaluation of indeterminate lesions that require additional imaging, given its excellent safety profile, including that in patients with end-stage renal disease or allergies to contrast material who are unable to undergo contrast-enhanced CT or MRI. US traditionally has been considered the imaging modality of choice for evaluation of the female pelvis, followed by MRI and rarely fluoroscopy, CT, PET, or angiography. CEUS has the potential to add significant value in imaging gynecologic disease, and indications for its use in the female pelvis are expected to continue evolving. It can aid in evaluation of nonvascular structures, such as assessment of tubal patency, uterine cavity morphology, and pelvic fistulas. CEUS can help characterize poorly vascularized gynecologic tumors or tissues with slow flow by using qualitative and quantitative parameters and aid in image-guided interventions or biopsies by facilitating visualization of lesions that are difficult to see with other imaging modalities. The authors provide an overview of current applications of US contrast agents in the female pelvis and discuss associated factors such as technique, interpretation, and image optimization. They also discuss the limitations of CEUS and describe its utility in the evaluation of female pelvic disease by using an organ system case-based approach. © RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Kristen Olinger
- From the Department of Radiology, University of North Carolina at Chapel Hill, 2021 Old Clinic Bldg, Chapel Hill, NC 27599 (K.O.); Department of Radiology, University of Toronto, Toronto, Ontario, Canada (X.L.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (Parisa Khoshpouri); Department of Radiology, University of Washington, Seattle, WA (Pegah Khoshpouri); Department of Radiology, Yale University, New Haven, CT (L.M.S.); Department of Radiology, University of Kentucky, Lexington, KY (A.K.); Department of Radiology, Jaslok Hospital, Mumbai, India (R.N.C.); and Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (M.M.)
| | - Xiaoyang Liu
- From the Department of Radiology, University of North Carolina at Chapel Hill, 2021 Old Clinic Bldg, Chapel Hill, NC 27599 (K.O.); Department of Radiology, University of Toronto, Toronto, Ontario, Canada (X.L.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (Parisa Khoshpouri); Department of Radiology, University of Washington, Seattle, WA (Pegah Khoshpouri); Department of Radiology, Yale University, New Haven, CT (L.M.S.); Department of Radiology, University of Kentucky, Lexington, KY (A.K.); Department of Radiology, Jaslok Hospital, Mumbai, India (R.N.C.); and Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (M.M.)
| | - Parisa Khoshpouri
- From the Department of Radiology, University of North Carolina at Chapel Hill, 2021 Old Clinic Bldg, Chapel Hill, NC 27599 (K.O.); Department of Radiology, University of Toronto, Toronto, Ontario, Canada (X.L.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (Parisa Khoshpouri); Department of Radiology, University of Washington, Seattle, WA (Pegah Khoshpouri); Department of Radiology, Yale University, New Haven, CT (L.M.S.); Department of Radiology, University of Kentucky, Lexington, KY (A.K.); Department of Radiology, Jaslok Hospital, Mumbai, India (R.N.C.); and Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (M.M.)
| | - Pegah Khoshpouri
- From the Department of Radiology, University of North Carolina at Chapel Hill, 2021 Old Clinic Bldg, Chapel Hill, NC 27599 (K.O.); Department of Radiology, University of Toronto, Toronto, Ontario, Canada (X.L.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (Parisa Khoshpouri); Department of Radiology, University of Washington, Seattle, WA (Pegah Khoshpouri); Department of Radiology, Yale University, New Haven, CT (L.M.S.); Department of Radiology, University of Kentucky, Lexington, KY (A.K.); Department of Radiology, Jaslok Hospital, Mumbai, India (R.N.C.); and Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (M.M.)
| | - Leslie M Scoutt
- From the Department of Radiology, University of North Carolina at Chapel Hill, 2021 Old Clinic Bldg, Chapel Hill, NC 27599 (K.O.); Department of Radiology, University of Toronto, Toronto, Ontario, Canada (X.L.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (Parisa Khoshpouri); Department of Radiology, University of Washington, Seattle, WA (Pegah Khoshpouri); Department of Radiology, Yale University, New Haven, CT (L.M.S.); Department of Radiology, University of Kentucky, Lexington, KY (A.K.); Department of Radiology, Jaslok Hospital, Mumbai, India (R.N.C.); and Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (M.M.)
| | - Aman Khurana
- From the Department of Radiology, University of North Carolina at Chapel Hill, 2021 Old Clinic Bldg, Chapel Hill, NC 27599 (K.O.); Department of Radiology, University of Toronto, Toronto, Ontario, Canada (X.L.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (Parisa Khoshpouri); Department of Radiology, University of Washington, Seattle, WA (Pegah Khoshpouri); Department of Radiology, Yale University, New Haven, CT (L.M.S.); Department of Radiology, University of Kentucky, Lexington, KY (A.K.); Department of Radiology, Jaslok Hospital, Mumbai, India (R.N.C.); and Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (M.M.)
| | - Rajas N Chaubal
- From the Department of Radiology, University of North Carolina at Chapel Hill, 2021 Old Clinic Bldg, Chapel Hill, NC 27599 (K.O.); Department of Radiology, University of Toronto, Toronto, Ontario, Canada (X.L.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (Parisa Khoshpouri); Department of Radiology, University of Washington, Seattle, WA (Pegah Khoshpouri); Department of Radiology, Yale University, New Haven, CT (L.M.S.); Department of Radiology, University of Kentucky, Lexington, KY (A.K.); Department of Radiology, Jaslok Hospital, Mumbai, India (R.N.C.); and Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (M.M.)
| | - Mariam Moshiri
- From the Department of Radiology, University of North Carolina at Chapel Hill, 2021 Old Clinic Bldg, Chapel Hill, NC 27599 (K.O.); Department of Radiology, University of Toronto, Toronto, Ontario, Canada (X.L.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (Parisa Khoshpouri); Department of Radiology, University of Washington, Seattle, WA (Pegah Khoshpouri); Department of Radiology, Yale University, New Haven, CT (L.M.S.); Department of Radiology, University of Kentucky, Lexington, KY (A.K.); Department of Radiology, Jaslok Hospital, Mumbai, India (R.N.C.); and Department of Radiology, Vanderbilt University Medical Center, Nashville, TN (M.M.)
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Russell G, Strnad BS, Ludwig DR, Middleton WD, Itani M, Khot R, Mellnick V, Malone C. Contrast-Enhanced Ultrasound for Image-Guided Procedures. Tech Vasc Interv Radiol 2023; 26:100913. [PMID: 38071027 DOI: 10.1016/j.tvir.2023.100913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) uses intravenously injected gas microbubbles as a pure blood pool contrast agent to demonstrate blood flow and tissue perfusion at a much higher sensitivity than color Doppler and power Doppler ultrasound. CEUS has gained traction in abdominal diagnostic imaging for improved lesion detection and characterization and a complementary problem-solving tool to CT and MRI. In addition to its diagnostic applications, CEUS has also proven useful for pre-procedure planning, procedure guidance, and post-procedure evaluation. This review provides a practical overview and guides to the application of CEUS in percutaneous, ultrasound-guided, needle-driven procedures, focusing on 2 common procedures, which illustrate the many benefits of CEUS- core needle biopsy (CNB) and percutaneous hepatic lesion ablation.
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Affiliation(s)
- Gentry Russell
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital/Washington University School of Medicine, St Louis, MO
| | - Benjamin S Strnad
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital/Washington University School of Medicine, St Louis, MO
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital/Washington University School of Medicine, St Louis, MO
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital/Washington University School of Medicine, St Louis, MO
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital/Washington University School of Medicine, St Louis, MO
| | - Rachita Khot
- Department of Radiology, University of Virginia Medical Center/University of Virginia School of Medicine, Charlottesville, VA
| | - Vincent Mellnick
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital/Washington University School of Medicine, St Louis, MO
| | - Christopher Malone
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital/Washington University School of Medicine, St Louis, MO.
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Liu X, Tan SBM, Awiwi MO, Jang HJ, Chernyak V, Fowler KJ, Shaaban AM, Sirlin CB, Furlan A, Marks RM, Elsayes KM. Imaging Findings in Cirrhotic Liver: Pearls and Pitfalls for Diagnosis of Focal Benign and Malignant Lesions. Radiographics 2023; 43:e230043. [PMID: 37651277 DOI: 10.1148/rg.230043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Cirrhosis is the end stage of chronic liver disease and causes architectural distortion and perfusional anomalies. It is a major risk factor for developing hepatocellular carcinoma (HCC). Common disease entities in noncirrhotic livers, such as hemangiomas, can be rare in cirrhotic livers, and benign entities such as confluent hepatic fibrosis and focal nodular hyperplasia-like lesions may mimic the appearance of malignancies,. HCC usually has typical imaging characteristics, such as the major features established by the Liver Imaging Reporting and Data System. However, HCC can also have a spectrum of atypical or uncommon appearances, such as cystic HCC, hypovascular HCC, or macroscopic fat-containing HCC. HCCs with certain genetic mutations such as CTNNB-1-mutated HCC can harbor unique imaging features not seen in other types of HCC. In addition, malignancies that are less common than HCC, such as cholangiocarcinoma and metastases, which can be difficult to differentiate, can still occur in cirrhotic livers. Atypical imaging features of benign and malignant lesions can be challenging to accurately diagnose. Therefore, familiarity with these features and an understanding of the prevalence of disease entities in cirrhotic livers are key in the daily practice of radiologists for evaluation of cirrhotic livers. The authors illustrate the typical and atypical features of benign and malignant lesions in cirrhosis and discuss the technical pitfalls and unique advantages associated with various imaging modalities in assessing cirrhotic livers, including noncontrast and contrast-enhanced US, CT, and MRI. Work of the U.S. Government published under an exclusive license with the RSNA. Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Xiaoyang Liu
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Stephanie B M Tan
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Muhammad O Awiwi
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Hyun-Jung Jang
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Victoria Chernyak
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Kathryn J Fowler
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Akram M Shaaban
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Claude B Sirlin
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Alessandro Furlan
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Robert M Marks
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Khaled M Elsayes
- From the Department of Medical Imaging, University of Toronto, University Health Network, 263 McCaul St, 4th Fl, Toronto, ON, Canada M5T 1W7, and Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Toronto, Ontario, Canada (X.L., S.B.M.T., H.J.J.); Department of Radiology, The University of Texas Health Science Center at Houston, Houston, Tex (M.O.A.); Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (V.C.); Department of Radiology, University of California San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology. University of Utah Health, Salt Lake City, Utah (A.M.S.); Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.F.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); and Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
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Gupta S, Manchanda S, Dadhwal V. Ovarian torsion: incremental role of contrast-enhanced ultrasound. BMJ Case Rep 2022; 15:e251285. [PMID: 36517077 PMCID: PMC9756187 DOI: 10.1136/bcr-2022-251285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We highlight the role of contrast-enhanced ultrasound (CEUS) as a supplementary modality to ultrasound (USG) examination in ovarian torsion in this case report. The reported patient had clinical history suspicious of ovarian torsion; however, USG and Doppler flow study findings were equivocal. CEUS was performed to solve the diagnostic dilemma and to know the status of ovarian parenchymal viability which revealed non-enhancement of the ovarian cyst wall and pedicle throughout the USG examination thus establishing the diagnosis of non-viable or infarcted ovarian parenchyma. The per operative and histopathology findings were consistent with our CEUS findings. CEUS is an emerging promising modality which provides information regarding parenchymal perfusion, resulting in a reliable diagnosis of ovarian torsion along with information on ovarian parenchymal viability. This ability makes CEUS equivalent to contrast-enhanced CT or MRI.
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Affiliation(s)
- Shivani Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Vatsla Dadhwal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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8
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Gupta P, Rana P, Marodia Y, Samanta J, Sharma V, Sinha SK, Singh H, Gupta V, Yadav TD, Sreenivasan R, Vaiphei K, Rajwanshi A, Kochhar R, Sandhu M. Contrast-enhanced ultrasound of solid pancreatic head lesions: a prospective study. Eur Radiol 2022; 32:6668-6677. [PMID: 35587829 DOI: 10.1007/s00330-022-08854-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/26/2022] [Accepted: 04/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the role of contrast-enhanced ultrasound (CEUS) in the differential diagnosis of solid pancreatic head lesions (SPHL). METHODS This prospective study comprised consecutive patients with SPHL who underwent CEUS evaluation of the pancreas. Findings recorded at CEUS were enhancement patterns (degree, completeness, centripetal enhancement, and percentage enhancement) and presence of central vessels. In addition, time to peak (TTP) and washout time (WT) were recorded. The final diagnosis was based on histopathology or cytology. Multivariate analysis was performed to identify parameters that were significantly associated with pancreatic ductal adenocarcinoma (PDAC). RESULTS Ninety-eight patients (median age 53.8 years, 59 males) were evaluated. The final diagnosis was PDAC (n = 64, 65.3%), inflammatory mass (n = 16, 16.3%), neuroendocrine tumor (NET, n = 14, 14.3%), and other tumors (n = 4, 4.1%). Hypoenhancement, incomplete enhancement, and centripetal enhancement were significantly more common in PDAC than non-PDAC lesions (p = 0.001, p = 0.031, and p = 0.002, respectively). Central vessels were present in a significantly greater number of non-PDAC lesions (p = 0.0001). Hypoenhancement with < 30% enhancement at CEUS had sensitivity and specificity of 80.6% and 67.7%, respectively, for PDAC. There was no significant difference in the TTP and WT between PDAC and non - PDAC lesions. However, the WT was significantly shorter in PDAC compared to NET (p = 0.011). In multivariate analysis, lack of central vessels was significantly associated with a PDAC diagnosis. CONCLUSION CEUS is a useful tool for the evaluation of SPHL. CEUS can be incorporated into the diagnostic algorithm to differentiate PDAC from non-PDAC lesions. KEY POINTS • Hypoenhancement and incomplete enhancement at CEUS were significantly more common in PDAC than in non-PDAC. • Central vessels at CEUS were significantly associated with PDAC. • There was no difference in TTP and WT between PDAC and non-PDAC lesions.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India.
| | - Pratyaksha Rana
- Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India
| | - Yashi Marodia
- Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India
| | | | - Vishal Sharma
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Saroj K Sinha
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Harjeet Singh
- Department of Surgical Gastroenterology, PGIMER, Chandigarh, India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, PGIMER, Chandigarh, India
| | | | | | - Kim Vaiphei
- Department of Histopathology, PGIMER, Chandigarh, India
| | | | - Rakesh Kochhar
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Manavjit Sandhu
- Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India
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9
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Granata A, Rahbari E, Pesce F, Gesualdo L, Zeiler M. Contrast-enhanced ultrasound in peritoneal dialysis: when and how to perform it. J Nephrol 2022; 35:1329-1337. [PMID: 35275378 DOI: 10.1007/s40620-022-01287-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 02/16/2022] [Indexed: 12/01/2022]
Abstract
In the field of peritoneal dialysis contrast enhanced ultrasound (CEUS) is a new add-on examination to B-mode ultrasound, but until recently it has never been systematically studied. Based on the experience of the Project Group "Integrated Imaging and Interventional Nephrology" of the Italian Society of Nephrology, CEUS is helpful for evaluating catheter malfunction, peritoneal-pleural communication, leakage, and herniation, and in particular it facilitates dynamic functional imaging of the catheter and its complications. The use of CEUS in peritoneal dialysis is simple, repeatable, safe, radiation-free, and appears to be less time-consuming and more cost-effective than other radiological imaging techniques such as peritoneography, computed tomography, magnetic resonance or peritoneal scintigraphy.
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Affiliation(s)
- Antonio Granata
- Nephrology and Dialysis Unit, "Cannizzaro" Hospital, Via Messina 829, 95126, Catania, Italy
| | - Elnaz Rahbari
- Nephrology and Dialysis Unit, "Cannizzaro" Hospital, Via Messina 829, 95126, Catania, Italy
| | - Francesco Pesce
- Nephrology, Dialysis and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Piazza G. Cesare 11, 70124, Bari, Italy
| | - Matthias Zeiler
- Nephrology and Dialysis Unit, "C. e G. Mazzoni" Hospital, Via degli Iris 1, 63100, Ascoli Piceno, Italy.
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10
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Atri M, Jang HJ, Kim TK, Khalili K. Contrast-enhanced US of the Liver and Kidney: A Problem-solving Modality. Radiology 2022; 303:11-25. [PMID: 35191740 DOI: 10.1148/radiol.211347] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Contrast-enhanced US (CEUS) has an important role as a supplement to CT or MRI in clinical practice. The main established utilizations are in the liver and the kidney. The primary advantages of CEUS compared with contrast-enhanced CT or MRI relate to its superior contrast resolution, real-time continuous scanning, pure intravascular nature, portability, and safety-especially in patients with renal impairment or CT or MRI contrast agent allergy. This article focuses on the use of CEUS in the liver and kidney.
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Affiliation(s)
- Mostafa Atri
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Hyun-Jung Jang
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Tae Kyoung Kim
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Korosh Khalili
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
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11
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Boddapati SB, Lal A, Gupta P, Kalra N, Yadav TD, Gupta V, Dass A, Srinivasan R, Singhal M. Contrast enhanced ultrasound versus multiphasic contrast enhanced computed tomography in evaluation of gallbladder lesions. Abdom Radiol (NY) 2022; 47:566-575. [PMID: 34874479 DOI: 10.1007/s00261-021-03364-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 12/15/2022]
Abstract
AIM To compare the diagnostic performance of contrast enhanced ultrasound (CEUS) and multiphasic contrast enhanced computed tomography (CECT) in differentiating benign and malignant gallbladder (GB) lesions. METHODS This prospective ethical review board approved study comprised consecutive patients with GB lesions who underwent CEUS and multiphasic CECT at a tertiary care referral center. The enhancement patterns at CEUS and CT were compared. The quantitative CEUS parameters including arrival time (AT), AT in liver, time to peak enhancement, and washout time (WT) were assessed. The diagnostic performance of CEUS and CT features was calculated using receiver operating characteristic analysis. A subgroup analysis was performed for patients with GB wall thickening. Multivariate analysis was performed to identify features significantly associated with malignancy. RESULTS Over the study period, 30 patients (mean age, 52.8 ± 12.2 years, 17 females) with GB lesions were evaluated. Benign and malignant diseases were present in 13 and 17 patients, respectively. There was excellent agreement between CEUS and CT findings. Among the quantitative CEUS features, only WT was significantly associated with malignancy in the overall group (p < 0.001) and wall thickening subgroup (p = 0.007). WT within 53.5 s and 51.5 s had sensitivity of 88.2% and 81.8% and specificity of 84.5% and 100% in diagnosing malignant lesions in the overall group (AUC 0.900) and the wall thickening subgroup (area under curve, AUC 0.927), respectively. At multivariate analysis, features that were significantly associated with malignant lesions in the overall group were disruption of GB wall (CEUS), intralesional non-enhancing areas (CEUS), liver involvement (CEUS or CT), and arterial phase hyperenhancement (CT) in the overall group and disruption of GB wall (CEUS), WT (CEUS), and liver involvement (CEUS or CT) in the wall thickening subgroup. CONCLUSION CEUS is a useful adjunct to CT in evaluation of GB lesions. Its utilization in patients with GB wall thickening may improve detection of malignancy.
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Affiliation(s)
- Suresh Babu Boddapati
- Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Anupam Lal
- Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Pankaj Gupta
- Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Naveen Kalra
- Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Thakur Deen Yadav
- Departments of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Vikas Gupta
- Departments of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ashim Dass
- Departments of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Radhika Srinivasan
- Departments of Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Manphool Singhal
- Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Sridharan A, Hwang M, Kutty S, McCarville MB, Paltiel HJ, Piskunowicz M, Shellikeri S, Silvestro E, Taylor GA, Didier RA. Translational research in pediatric contrast-enhanced ultrasound. Pediatr Radiol 2021; 51:2425-2436. [PMID: 33991196 DOI: 10.1007/s00247-021-05095-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/21/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
The role of contrast-enhanced ultrasound (CEUS) imaging is being widely explored by various groups for its use in the pediatric population. Clinical implementation of new diagnostic or therapeutic techniques requires extensive and meticulous preclinical testing and evaluation. The impact of CEUS will be determined in part by the extent to which studies are oriented specifically toward a pediatric population. Rather than simply applying principles and techniques used in the adult population, these studies are expected to advance and augment preexisting knowledge with pediatric-specific information. To further develop this imaging modality for use in children, pediatric-focused preclinical research is essential. In this paper we describe the development and implementation of the pediatric-specific preclinical animal and phantom models that are being used to evaluate CEUS with the goal of clinical translation to children.
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Affiliation(s)
- Anush Sridharan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Shelby Kutty
- Taussig Heart Center, Johns Hopkins University, Baltimore, MD, USA
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Harriet J Paltiel
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Sphoorti Shellikeri
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Elizabeth Silvestro
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - George A Taylor
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Harvard Medical School, Boston, MA, USA
| | - Ryne A Didier
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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13
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Contrast-enhanced ultrasound of transplant organs - liver and kidney - in children. Pediatr Radiol 2021; 51:2284-2302. [PMID: 33978794 PMCID: PMC8865443 DOI: 10.1007/s00247-020-04867-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/13/2020] [Accepted: 09/30/2020] [Indexed: 10/21/2022]
Abstract
Ultrasound (US) is the first-line imaging tool for evaluating liver and kidney transplants during and after the surgical procedures. In most patients after organ transplantation, gray-scale US coupled with color/power and spectral Doppler techniques is used to evaluate the transplant organs, assess the patency of vascular structures, and identify potential complications. In technically difficult or inconclusive cases, however, contrast-enhanced ultrasound (CEUS) can provide prompt and accurate diagnostic information that is essential for management decisions. CEUS is indicated to evaluate for vascular complications including vascular stenosis or thrombosis, active bleeding, pseudoaneurysms and arteriovenous fistulas. Parenchymal indications for CEUS include evaluation for perfusion defects and focal inflammatory and non-inflammatory lesions. When transplant rejection is suspected, CEUS can assist with prompt intervention by excluding potential underlying causes for organ dysfunction. Intracavitary CEUS applications can evaluate the biliary tract of a liver transplant (e.g., for biliary strictures, bile leak or intraductal stones) or the urinary tract of a renal transplant (e.g., for urinary obstruction, urine leak or vesicoureteral reflux) as well as the position and patency of hepatic, biliary and renal drains and catheters. The aim of this review is to present current experience regarding the use of CEUS to evaluate liver and renal transplants, focusing on the examination technique and interpretation of the main imaging findings, predominantly those related to vascular complications.
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14
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Characterization of Indeterminate Liver Lesions on CT and MRI With Contrast-Enhanced Ultrasound: What Is the Evidence? AJR Am J Roentgenol 2020; 214:1295-1304. [DOI: 10.2214/ajr.19.21498] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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15
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Erlichman DB, Weiss A, Koenigsberg M, Stein MW. Contrast enhanced ultrasound: A review of radiology applications. Clin Imaging 2019; 60:209-215. [PMID: 31927496 DOI: 10.1016/j.clinimag.2019.12.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/08/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022]
Abstract
Ultrasound contrast agents have been used for decades in Europe and Asia for cardiac and abdominal imaging and are now being more commonly utilized in the United States for radiology applications. Our article reviews the basics of contrast-enhanced ultrasound including how the contrast agent works, advantages and disadvantages, as well as pearls and pitfalls to help the radiologist efficiently integrate this technology into day-to-day clinical practice. We also discuss the diagnosis of focal hepatic lesions as well as off-label applications such as evaluation of renal masses.
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Affiliation(s)
- David B Erlichman
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, United States of America.
| | - Amanda Weiss
- Northwell Health System, Zucker School of Medicine at Hofstra/Northwell, United States of America
| | - Mordecai Koenigsberg
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, United States of America
| | - Marjorie W Stein
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, United States of America
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16
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Berstad AE, Brabrand K, Horneland R, Syversveen T, Haugaa H, Jenssen TG, Foss A. Microbubble contrast-enhanced ultrasound in the vascular evaluation after pancreas transplantation: a single-center experience. Acta Radiol 2019; 60:1224-1231. [PMID: 30754980 DOI: 10.1177/0284185119828190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Audun E Berstad
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Knut Brabrand
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Rune Horneland
- Surgical Department, Section of Transplant Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Håkon Haugaa
- Dept. of Anesthesiology, Oslo University Hospital, Oslo, Norway
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Trond G Jenssen
- Section of Nephrology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Metabolic and Renal Research Group, The Arctic University of Norway, Tromsø, Norway
- Medical Faculty, University of Oslo, Oslo, Norway
| | - Aksel Foss
- Surgical Department, Section of Transplant Surgery, Oslo University Hospital, Oslo, Norway
- Medical Faculty, University of Oslo, Oslo, Norway
- Uppsala University Hospital, Uppsala, Sweden
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17
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Affiliation(s)
- Emilio Quaia
- From the Department of Radiology, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
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18
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Sofuni A, Tsuchiya T, Itoi T. Ultrasound diagnosis of pancreatic solid tumors. J Med Ultrason (2001) 2019; 47:359-376. [PMID: 31420821 DOI: 10.1007/s10396-019-00968-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/16/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Advances and widespread use of various diagnostic imaging modalities have dramatically improved our ability to visualize and diagnose pancreatic diseases. In particular, ultrasonography in pancreatic diseases plays an important role from screening to diagnosis as a simple and safe examination method. METHODS The basic scanning method of transabdominal pancreatic ultrasonography, characterization, and differential diagnosis by ultrasonography including contrast-enhanced ultrasonography (CEUS) for solid pancreatic tumors are reviewed with reference to various papers. RESULTS In recent years, the ability to visualize and diagnose pancreatic mass lesions has been dramatically improved with advances in ultrasound equipment. In particular, CEUS using an ultrasound contrast agent has made it possible to evaluate hemodynamics in organs or lesions as well as in the flow signal of arterial blood vessels, and it has played an important role not only in diagnosis of the presence of a lesion but also in the qualitative diagnosis. The enhancement behavior and pattern with CEUS of pancreatic solid tumors is shown in text and Fig. 9. Moreover, the flow chart for diagnosing pancreatic solid tumors with CEUS classifying the enhancement behavior and pattern for pancreatic solid tumors on CEUS is shown (Fig. 10). In meta-analyses, the pooled sensitivity in the differential diagnosis of pancreatic adenocarcinomas and other pancreatic focal masses with CEUS was 86-90%, and the pooled specificity was 75-88%. CONCLUSION CEUS is a minimally invasive and useful diagnostic method that can be used to make a simple and quick qualitative diagnosis of pancreatic diseases. CEUS provides a lot of information important for diagnosis, and has led to changes in the conventional diagnostic systems in pancreatic diseases.
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Affiliation(s)
- Atsushi Sofuni
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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