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Bardo DME, Gill AE, Iyer RS, Chan SS, Cooper ML, Dasgupta RA, Guimaraes CV, Hammer MR, Krowchuk DP, Levin TL, Liang MG, Meyers ML, Samet JD, Sammer MBK, Schooler GR, Squires JH, Sura AS, Trout AT, Pruthi S. ACR Appropriateness Criteria® Soft Tissue Vascular Anomalies: Vascular Malformations and Infantile Vascular Tumors (Non-CNS)-Child. J Am Coll Radiol 2024; 21:S310-S325. [PMID: 38823953 DOI: 10.1016/j.jacr.2024.02.030] [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: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Soft tissue vascular anomalies may be composed of arterial, venous, and/or lymphatic elements, and diagnosed prenatally or later in childhood or adulthood. They are divided into categories of vascular malformations and vascular tumors. Vascular malformations are further divided into low-flow and fast-flow lesions. A low-flow lesion is most common, with a prevalence of 70%. Vascular tumors may behave in a benign, locally aggressive, borderline, or malignant manner. Infantile hemangioma is a vascular tumor that presents in the neonatal period and then regresses. The presence or multiple skin lesions in an infant can signal underlying visceral vascular anomalies, and complex anomalies may be associated with overgrowth syndromes. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Dianna M E Bardo
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| | - Anne E Gill
- Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
| | - Ramesh S Iyer
- Panel Chair, Seattle Children's Hospital, Seattle, Washington
| | - Sherwin S Chan
- Panel Vice Chair, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Roshni A Dasgupta
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; American Pediatric Surgical Association
| | | | | | - Daniel P Krowchuk
- Wake Forest University School of Medicine, Winston Salem, North Carolina; American Academy of Pediatrics
| | - Terry L Levin
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Marilyn G Liang
- Boston Children's Hospital, Boston, Massachusetts; Society for Pediatric Dermatology
| | - Mariana L Meyers
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Jonathan D Samet
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Gary R Schooler
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Judy H Squires
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amit S Sura
- Children's Hospital Los Angeles, Los Angeles, California
| | - Andrew T Trout
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Commission on Nuclear Medicine and Molecular Imaging
| | - Sumit Pruthi
- Specialty Chair, Vanderbilt Children's Hospital, Nashville, Tennessee
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2
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Kaiser U, Dropco I, Reuthner K, Ertl M, Schlitt HJ, Herr W, Stroszczynski C, Jung EM. Wireless handheld focused ultrasound in student teaching during the COVID-19 pandemic: Initial results of a pilot study1. Clin Hemorheol Microcirc 2023; 85:297-305. [PMID: 36502312 DOI: 10.3233/ch-229104] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The study aim was to investigate the use of a novel device, the Vscan Air™, for rapidly and effectively performing ultrasound in student teaching during the COVID-19 pandemic. MATERIAL AND METHODS As part of the ultrasound practical course with integrated hands-on activity required by the regular medical curriculum, 100 medical students were instructed in the use of the Vscan Air™, including duplex mode. They then evaluated the quality of the ultrasound images obtained by the Vscan Air™ from previously selected organs. RESULTS 100 students were interviewed (female n = 68, male n = 32; age >18 years n = 100). The rated image quality never fell below a mean of 3 for the examined organs and portal vein flow (liver 4,58; spleen 3,99; kidneys 4,29; aorta 4,16; Douglas/rectovesical space 4,14; portal vein 4,43; pancreas 3,53; Focused Assessment with Sonography for Trauma 4,38). Scores below 3 were found sporadically in ultrasounds of the spleen (n = 4), kidneys (n = 3), Douglas/rectovesical space (n = 2), and pancreas (n = 15). The liver was rated the lowest for 59 ratings. The portal vein was evaluated in 68 cases. The hepatic artery and hepatic veins could be also visualized in all 68 examinations. The aorta was evaluated in 62 cases. CONCLUSION The Vscan Air™ technology offered adequate image quality and provided a new, fast and patient-oriented technique to support continuous ultrasound examinations and education of students, especially during a pandemic. Particularly noteworthy is the uncomplicated compliance with the required high level of hygiene.
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Affiliation(s)
- Ulrich Kaiser
- Medical Clinic and Polyclinic III, University Hospital Regensburg, Regensburg, Germany
| | - Ivor Dropco
- Clinic and Polyclinic for Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Kathrin Reuthner
- Medical Clinic and Polyclinic III, University Hospital Regensburg, Regensburg, Germany
| | - Michael Ertl
- Department of Medical Technology, University Hospital Regensburg, Regensburg, Germany
| | - Hans Jürgen Schlitt
- Clinic and Polyclinic for Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Medical Clinic and Polyclinic III, University Hospital Regensburg, Regensburg, Germany
| | - Christian Stroszczynski
- Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
| | - Ernst Michael Jung
- Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany
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3
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Contrast Enhanced Ultrasound for characterization of suspected soft tissue vascular anomalies. Eur J Radiol 2022; 153:110370. [DOI: 10.1016/j.ejrad.2022.110370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/26/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022]
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Schmidt VF, Masthoff M, Czihal M, Cucuruz B, Häberle B, Brill R, Wohlgemuth WA, Wildgruber M. Imaging of peripheral vascular malformations - current concepts and future perspectives. Mol Cell Pediatr 2021; 8:19. [PMID: 34874510 PMCID: PMC8651875 DOI: 10.1186/s40348-021-00132-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/25/2021] [Indexed: 12/17/2022] Open
Abstract
Vascular Malformations belong to the spectrum of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic vasculature. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) is of major importance to guide proper treatment. Imaging plays a crucial role to classify vascular malformations according to their dominant vessel type, anatomical extension, and flow pattern. Several imaging concepts including color-coded Duplex ultrasound/contrast-enhanced ultrasound (CDUS/CEUS), 4D computed tomography angiography (CTA), magnetic resonance imaging (MRI) including dynamic contrast-enhanced MR-angiography (DCE-MRA), and conventional arterial and venous angiography are established in the current clinical routine. Besides the very heterogenous phenotypes of vascular malformations, molecular and genetic profiling has recently offered an advanced understanding of the pathogenesis and progression of these lesions. As distinct molecular subtypes may be suitable for targeted therapies, capturing certain patterns by means of molecular imaging could enhance non-invasive diagnostics of vascular malformations. This review provides an overview of subtype-specific imaging and established imaging modalities, as well as future perspectives of novel functional and molecular imaging approaches. We highlight recent pioneering imaging studies including thermography, positron emission tomography (PET), and multispectral optoacoustic tomography (MSOT), which have successfully targeted specific biomarkers of vascular malformations.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Masthoff
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Michael Czihal
- Angiology Division, Department for Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Beatrix Cucuruz
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Beate Häberle
- Department for Pediatric Surgery, Dr. von Haunersches Kinderspital, University Hospital, LMU Munich, Munich, Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany. .,Clinic for Radiology, University Hospital Muenster, Muenster, Germany.
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Contrast-enhanced ultrasound in pediatric interventional radiology. Pediatr Radiol 2021; 51:2396-2407. [PMID: 33978796 DOI: 10.1007/s00247-020-04853-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/14/2020] [Accepted: 09/10/2020] [Indexed: 01/14/2023]
Abstract
There is growing interest in the use of contrast-enhanced ultrasound (CEUS) in diagnostic and interventional radiology. CEUS applications in interventional radiology are performed with intravascular or intracavitary administration of microbubble-based US contrast agents to allow for real-time evaluation of their distribution within the vascular bed or in body cavities, respectively, providing additional information beyond gray-scale US alone. The most common interventional-radiology-related CEUS applications in children have been extrapolated from those in adults, and they include the use of CEUS to guide lesion biopsy and to confirm drain placement in pleural effusions and intra-abdominal fluid collections. Other applications are emerging in interventional radiology for use in adults and children, including CEUS to optimize sclerotherapy of vascular malformations, to guide arthrography, and for lymphatic interventions. In this review article we present a wide range of interventional-radiology-related CEUS applications, emphasizing the current and potential uses in children. We highlight the technical parameters of the CEUS examination and discuss the main imaging findings.
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Malone CD, Fetzer DT, Monsky WL, Itani M, Mellnick VM, Velez PA, Middleton WD, Averkiou MA, Ramaswamy RS. Contrast-enhanced US for the Interventional Radiologist: Current and Emerging Applications. Radiographics 2021; 40:562-588. [PMID: 32125955 DOI: 10.1148/rg.2020190183] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
US is a powerful and nearly ubiquitous tool in the practice of interventional radiology. Use of contrast-enhanced US (CEUS) has gained traction in diagnostic imaging given the recent approval by the U.S. Food and Drug Administration (FDA) of microbubble contrast agents for use in the liver, such as sulfur hexafluoride lipid-type A microspheres. Adoption of CEUS by interventional radiologists can enhance not only procedure guidance but also preprocedure patient evaluation and assessment of treatment response across a wide spectrum of oncologic, vascular, and nonvascular procedures. In addition, the unique physical properties of microbubble contrast agents make them amenable as therapeutic vehicles in themselves, which can lay a foundation for future therapeutic innovations in the field in drug delivery, thrombolysis, and vascular flow augmentation. The purpose of this article is to provide an introduction to and overview of CEUS aimed at the interventional radiologist, highlighting its role before, during, and after frequently practiced oncologic and vascular interventions such as biopsy, ablation, transarterial chemoembolization, detection and control of hemorrhage, evaluation of transjugular intrahepatic portosystemic shunts (TIPS), detection of aortic endograft endoleak, thrombus detection and evaluation, evaluation of vascular malformations, lymphangiography, and percutaneous drain placement. Basic physical principles of CEUS, injection and scanning protocols, and logistics for practice implementation are also discussed. Early adoption of CEUS by the interventional radiology community will ensure rapid innovation of the field and development of future novel procedures. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Christopher D Malone
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - David T Fetzer
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Wayne L Monsky
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Philip A Velez
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - William D Middleton
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Michalakis A Averkiou
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Raja S Ramaswamy
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
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Harwin J, Sugi MD, Hetts SW, Conrad MB, Ohliger MA. The Role of Liver Imaging in Hereditary Hemorrhagic Telangiectasia. J Clin Med 2020; 9:jcm9113750. [PMID: 33233377 PMCID: PMC7700186 DOI: 10.3390/jcm9113750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 01/01/2023] Open
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disorder characterized by spontaneous epistaxis, telangiectasia, and visceral vascular malformations. Hepatic vascular malformations are common, though a minority are symptomatic. Symptoms are dependent on the severity and exact type of shunting caused by the hepatic malformation: Arteriosystemic shunting leads to manifestations of high output cardiac failure, and arterioportal shunting leads to portal hypertension. Radiologic imaging, including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), is an important tool for assessing liver involvement. Doppler ultrasonography is the first-line screening modality for HHT-related liver disease, and it has a standardized scale. Imaging can determine whether shunting is principally to the hepatic vein or the portal vein, which can be a key determinant of patients’ symptoms. Liver-related complications can be detected, including manifestations of portal hypertension, focal liver masses as well as ischemic cholangiopathy. Ultrasound and MRI also have the ability to quantify blood flow through the liver, which in the future may be used to determine prognosis and direct antiangiogenic therapy.
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Affiliation(s)
- Joelle Harwin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA; (J.H.); (M.D.S.); (S.W.H.); (M.B.C.)
| | - Mark D. Sugi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA; (J.H.); (M.D.S.); (S.W.H.); (M.B.C.)
- Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Steven W. Hetts
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA; (J.H.); (M.D.S.); (S.W.H.); (M.B.C.)
- Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Miles B. Conrad
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA; (J.H.); (M.D.S.); (S.W.H.); (M.B.C.)
- Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Michael A. Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA; (J.H.); (M.D.S.); (S.W.H.); (M.B.C.)
- Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
- Correspondence:
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Huf VI, Wohlgemuth WA, Uller W, Piehler AP, Goessmann H, Stroszczynski C, Jung EM. Contrast-enhanced ultrasound with perfusion analysis in patients with venous malformations before and after percutaneous treatment with ethanol-gel. Clin Hemorheol Microcirc 2020; 76:161-170. [PMID: 32925019 DOI: 10.3233/ch-209215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Percutaneous sclerotherapy is a well-established treatment option for venous malformations (VM). A recently established sclerosing agent is ethanol-gel. Aim of this study was to identify, if contrast-enhanced ultrasound (CEUS) with an integrated perfusion analysis allows for differentiation between untreated VM, healthy tissue, and with gelified ethanol treated malformation tissue. MATERIAL AND METHODS In this institutional review board approved prospective study symptomatic VM patients underwent CEUS at exactly the same position before and after sclerotherapy with ethanol-gel. Two experienced sonographers performed all examinations after the bolus injection of microbubbles using a multi-frequency probe with 6 -9 MHz of a high-end ultrasound machine. An integrated perfusion analysis was applied in the center of the VM and in healthy, surrounding tissue. For both regions peak enhancement (peak), time to peak (TTP), area under the curve (AUC), and mean transit time (MTT) were evaluated. Wilcoxon signed rank test was executed; p-values <0.05 were regarded statistically significant. RESULTS In 23 patients including children (mean age 25.3 years, 19 females) before treatment all identified parameters were significantly higher in the VM center compared to healthy tissue (peak: p < 0.01; TTP: p < 0.01; AUC: p < 0.01; MTT: p < 0.01). Comparing the VM center before and after treatment, TTP (p < 0.02) and MTT (p < 0.01) reduced significantly after sclerotherapy. In surrounding tissue only peak changed after treatment in comparison to pre-treatment results (p = 0.04). Comparing data in the VM center with surrounding tissue after sclerotherapy, results still differed significantly for peak (p < 0.01), TTP (p < 0.01), and AUC (p < 0.01), but assimilated for MTT (p = 0.07). CONCLUSION All with CEUS identified parameters seem to be excellent tools for differentiating between VM and healthy tissue. TTP and MTT could distinguish between with ethanol-gel sclerotized VM portions and untreated malformation parts and thereby might assist the monitoring of sclerotherapy with ethanol-gel.
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Affiliation(s)
- V I Huf
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - W A Wohlgemuth
- Interdisciplinary Center for Vascular Anomalies, University Clinic and Polyclinic of Radiology, University Hospital Halle, Halle (Saale), Germany
| | - W Uller
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - A P Piehler
- OnkoMedeor, MVZ Freising Laboratory, Freising, Germany
| | - H Goessmann
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - C Stroszczynski
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - E M Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
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Wiesinger I, Jung W, Zausig N, Wohlgemuth WA, Pregler B, Wiggermann P, Stroszczynski C, Jung EM. Evaluation of dynamic effects of therapy-induced changes in microcirculation after percutaneous treatment of vascular malformations using contrast-enhanced ultrasound (CEUS) and time intensity curve (TIC) analyses. Clin Hemorheol Microcirc 2018; 69:45-57. [PMID: 29630543 DOI: 10.3233/ch-189118] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this follow-up study was to demonstrate the effect of percutaneous interventional treatment on local microcirculation of peripheral vascular malformations using CEUS and TIC analysis. MATERIAL AND METHODS Retrospective analysis of 197 patients (136 female; 61 male; 3-86 years) with 135 venous (VM), 39 arterio-venous (AVM), 8 lymphatic and 15 veno-lymphatic peripheral vascular malformations before and after the first percutaneous treatment.CEUS was performed after i.v. injection of 1-2.4 ml of sulfur hexafluoride microbubbles (SonoVue®) using a 6-9 MHz linear probe. Digitally stored cine loops (starting in the early arterial phase for 60 sec) were read by independent readers in consensus. Regions of interest (ROI) were defined in the center and at the margins of the malformation, as well as in the healthy surrounding tissue. TIC analyses with Time to Peak (TTP) and Area under the Curve (AUC) were calculated using integrated perfusion software. RESULTS After the treatment there was a significant decrease for median AUC in VM in the center from 297.8 (14.5-2167.6) rU down to 243.3 (0.1-1678.8) rU (p = 0.043) and in the surrounding tissue down to 107.7 (20.2-660.2) rU (p = 0.018). For the other malformations AUC decreased in the center and the margins as well. TTP rose, however these changes did not reach the level of significance. CONCLUSION Analyzing the capillary microcirculation TICs offer a possibility of monitoring therapy-induced capillary changes of vascular malformations.
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Affiliation(s)
- I Wiesinger
- Institute of Radiology, University Medical Center Regensburg, Germany
| | - W Jung
- Institute of Radiology, University Medical Center Regensburg, Germany
| | - N Zausig
- Institute of Radiology, University Medical Center Regensburg, Germany
| | - W A Wohlgemuth
- Institute of Radiology, University Medical Center Regensburg, Germany
| | - B Pregler
- Institute of Radiology, University Medical Center Regensburg, Germany
| | - P Wiggermann
- Institute of Radiology, University Medical Center Regensburg, Germany
| | - C Stroszczynski
- Institute of Radiology, University Medical Center Regensburg, Germany
| | - E M Jung
- Institute of Radiology, University Medical Center Regensburg, Germany
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Teusch V, Piehler A, Uller W, Müller-Wille R, Prantl L, Stroszczynski C, Wohlgemuth W, Jung E. Value of different ultrasound elastography techniques in patients with venous malformations prior to and after sclerotherapy. Clin Hemorheol Microcirc 2017; 66:347-355. [DOI: 10.3233/ch-179106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- V.I. Teusch
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
- Department of Radiology, Klinikum Schwabing, Städtisches Klinikum München, Munich, Germany
| | - A.P. Piehler
- Bioscientia Institute for Medical Diagnostics GmbH, Karlsfeld, Germany
| | - W. Uller
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - R. Müller-Wille
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - L. Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - C. Stroszczynski
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - W.A. Wohlgemuth
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - E.M. Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
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