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Schwarze V, Rübenthaler J, Marschner C, Fabritius MP, Rueckel J, Fink N, Puhr-Westerheide D, Gresser E, Froelich MF, Schnitzer ML, Große Hokamp N, Afat S, Staehler M, Geyer T, Clevert DA. Advanced Fusion Imaging and Contrast-Enhanced Imaging (CT/MRI-CEUS) in Oncology. Cancers (Basel) 2020; 12:cancers12102821. [PMID: 33007933 PMCID: PMC7600560 DOI: 10.3390/cancers12102821] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Fusion imaging depicts an innovative technique by which previously performed computed tomography/magnetic resonance imaging can be integrated and reconstructed with advanced contrast-enhanced ultrasound using modern ultrasound devices in a real-time manner. Fusion imaging allows for complementing strengths and reducing restrictions of the combined imaging modalities. The visualization of parenchymal and tumoral microperfusion by contrast-enhanced ultrasound can be dynamically fused and assessed with images from previous cross-sectional studies and may help to decipher underlying entities of indeterminate lesions or validate suspicious morphology. The findings from our study demonstrate the benefits of fusion imaging for evaluating focal hepatic and renal lesions. The excellent safety profile, accessibility, repeatability and cost-effectiveness are advantages of fusion imaging which make it a powerful diagnostic tool for the modern radiologist. Abstract Fusion imaging depicts an innovative technique that facilitates combining assets and reducing restrictions of advanced ultrasound and cross-sectional imaging. The purpose of the present retrospective study was to evaluate the role of fusion imaging for assessing hepatic and renal lesions. Between 02/2011–08/2020, 92 patients in total were included in the study, of which 32 patients had hepatic lesions, 60 patients had renal lesions. Fusion imaging was technically successful in all patients. No adverse side effects upon intravenous (i.v.) application of SonoVue® (Bracco, Milan, Italy) were registered. Fusion imaging could clarify all 11 (100%) initially as indeterminate described hepatic lesions by computed tomography/magnetic resonance imaging (CT/MRI). Moreover, 5/14 (36%) initially suspicious hepatic lesions could be validated by fusion imaging, whereas in 8/14 (57%), malignant morphology was disproved. Moreover, fusion imaging allowed for the clarification of 29/30 (97%) renal lesions initially characterized as suspicious by CT/MRI, of which 19/30 (63%) underwent renal surgery, histopathology revealed malignancy in 16/19 (84%), and benignity in 3/19 (16%). Indeterminate findings could be elucidated by fusion imaging in 20/20 (100%) renal lesions. Its accessibility and repeatability, even during pregnancy and in childhood, its cost-effectiveness, and its excellent safety profile, make fusion imaging a promising instrument for the thorough evaluation of hepatic and renal lesions in the future.
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Affiliation(s)
- Vincent Schwarze
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
- Correspondence: ; Tel.: +49-89-4400-73620
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Constantin Marschner
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Matthias Philipp Fabritius
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Johannes Rueckel
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Nicola Fink
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Daniel Puhr-Westerheide
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Eva Gresser
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Matthias Frank Froelich
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany;
| | - Moritz Ludwig Schnitzer
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University Cologne, Kerpener Str. 62, 50937 Cologne, Germany;
| | - Saif Afat
- Department for Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany;
| | - Michael Staehler
- Department of Urology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany;
| | - Thomas Geyer
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
| | - Dirk-André Clevert
- Department of Radiology, University Hospital LMU, Marchioninistrasse 15, 81377 Munich, Germany; (J.R.); (C.M.); (M.P.F.); (J.R.); (N.F.); (D.P.-W.); (E.G.); (M.L.S.); (T.G.); (D.-A.C.)
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Negrão de Figueiredo G, Mueller-Peltzer K, Schwarze V, Zhang L, Rübenthaler J, Clevert DA. Performance of contrast-enhanced ultrasound (CEUS) compared to MRI in the diagnostic of gallbladder diseases. Clin Hemorheol Microcirc 2020; 73:85-93. [PMID: 31561332 DOI: 10.3233/ch-199202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Conventional ultrasound and MRI are very important techniques for the detection of gallbladder alterations. In the past years, studies showed that the additional use of contrast media to the conventional ultrasound allows the early depiction of pathological microvessels and their flow elucidating suspect findings stipulating the prompt therapy approach. OBJECTIVE The study aims to evaluate the performance of CEUS in gallbladder diseases and compare it to MR imaging using histopathological findings as a gold standard. MATERIAL AND METHODS The retrospective mono-center study analysed 18 patients with gallbladder alterations between 2009 and 2017. All patients underwent CEUS and MRI examinations and all results were confirmed in the pathology. CEUS images were performed and interpreted by a single experienced physician. RESULTS CEUS imaging results compared to MR imaging of the gallbladder demonstrated a sensitivity of 100%, specificity of 93%, a positive predictive value of 67% and a negative predictive value of 100%. CONCLUSION CEUS enables the depiction and characterization of important vascularization's patterns facilitating the early differentiation between malignant and benign findings. In this study, CEUS displayed a better diagnostic accuracy than MRI proving to be a valuable additional tool to the established imaging modalities.
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Affiliation(s)
- G Negrão de Figueiredo
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
| | - K Mueller-Peltzer
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
| | - V Schwarze
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
| | - L Zhang
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
| | - J Rübenthaler
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
| | - D A Clevert
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
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Keschenau PR, Alkassam H, Kotelis D, Jacobs MJ, Kalder J. Intraoperative contrast-enhanced ultrasound examination for endoleak detection after complex and infrarenal endovascular aortic repair. J Vasc Surg 2019; 71:1200-1206. [PMID: 31492615 DOI: 10.1016/j.jvs.2019.07.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this pilot study was to evaluate intraoperative contrast-enhanced ultrasound (iCEUS) examination for endoleak (EL) detection after complex endovascular aortic repairs (EVAR) in comparison with the standard angiographic completion control. METHODS Twenty-one patients (16 male; median age, 73 years [range, 54-81 years]) who underwent single-stage EVARs at our center between October 2016 and October 2018 were included prospectively. The procedures comprised fenestrated and/or branched EVAR (n = 14; 66%), infrarenal EVAR (n = 5; 24%), infrarenal EVAR with bilateral iliac side branch implantation (n = 1; 5%), and infrarenal EVAR with occluder implantation into the internal iliac artery (n = 1; 5%). The used endografts included 14 custom made devices (Cook, Australia Pty Ltd, Brisbane, Australia, n = 6; Vascutek Terumo, Glasgow, Scotland, n = 8) and seven standard infrarenal endografts (Medtronic Inc, Santa Rosa, Calif, n = 5; Vascutek Terumo, Glasgow, Scotland, n = 1; Cook, n = 1). All patients underwent an angiographic completion control for EL detection followed by iCEUS examination. The iCEUS examination was performed by the same examiner who was blinded to the angiography result. In addition to the comparison of the angiographic results to iCEUS examination, iCEUS examination was also compared with the computed tomography angiography (CTA) before discharge (median time to CTA, 5 days [range, 1-7 days]). RESULTS Angiography detected eight type II EL, defining the EL origin in four cases. In addition to detecting all of those eight EL, iCEUS examination revealed eight more type II EL not seen on angiography (P = .002) and allowed a definition of the EL origin in all cases. CTA before discharge showed a persistence of only 5 of the 16 type II EL detected by iCEUS examination (31%, P = .002). CONCLUSIONS An iCEUS examination can be used as another adjunct to decrease exposure to contrast agent and radiation during EVAR, including complex procedures. A replacement of the completion angiography by iCEUS examination is conceivable for infrarenal EVAR, but also for endovascular type IV or type V repairs. Future studies with larger patient numbers will help to further validate iCEUS examination during complex EVAR.
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Affiliation(s)
- Paula R Keschenau
- European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Hussam Alkassam
- European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Drosos Kotelis
- European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Michael J Jacobs
- European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany; European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, AZM Maastricht, Maastricht, The Netherlands.
| | - Johannes Kalder
- European Vascular Center Aachen-Maastricht, Department of Vascular and Endovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
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Abstract
CLINICAL/METHODICAL ISSUE Cystic renal lesions are commonly seen during routine ultrasound examinations of the abdomen. STANDARD RADIOLOGICAL METHODS Some cystic renal lesions cannot be sufficiently characterized using native ultrasound. In these cases additional imaging might be necessary. METHODICAL INNOVATIONS Contrast-enhanced ultrasound (CEUS) is a reliable imaging modality to characterize cystic renal lesions. Contrast enhancement of septations and the cystic wall are visualized in high resolution. This information helps to categorize the cystic renal lesions applying the CEUS Bosniak classification. This classification helps to estimate the probability of a malignant etiology of cystic renal lesions. PERFORMANCE Using CEUS, cystic renal lesions can be characterized with a high sensitivity and specificity. ACHIEVEMENTS The advantages of CEUS include that there is no effect on the function of the kidneys or the thyroid gland and no radiation exposure. In some cases, additional cross-sectional imaging is necessary to optimize diagnostic accuracy. PRACTICAL RECOMMENDATIONS CEUS is a helpful imaging modality to characterize cystic renal lesions, to avoid unnecessary follow-ups and to detect malignant cystic renal lesions.
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Negrão de Figueiredo G, Müller-Peltzer K, Schwarze V, Rübenthaler J, Clevert DA. Ultrasound and contrast enhanced ultrasound imaging in the diagnosis of acute aortic pathologies. VASA 2018; 48:17-22. [PMID: 30403367 DOI: 10.1024/0301-1526/a000758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Conventional ultrasound is worldwide the first-line imaging modality for the prompt diagnosis in the daily practice because it is a cost-effective and easy to perform technique. The additional application of contrast media has been used to enhance the intravascular contrast and to improve the imaging diagnostic accuracy in the detection, classification and follow-up of vascular pathologies. Contrast-enhanced ultrasound has the advantage of being a safe, fast and dynamic non-invasive imaging tool with excellent results in the diagnosis of acute aortic pathologies, especially the detection of endoleaks after endovascular aneurysm repair. This review describes the diagnostic and therapeutic roles of ultrasound and contrast-enhanced ultrasound imaging in the most common vascular pathologies such as aortic dissections, aneurysms and endoleaks. Keywords: Endoleak, contrast media, ultrasonography, aorta.
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Affiliation(s)
- Giovanna Negrão de Figueiredo
- 1 Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
| | - Katharina Müller-Peltzer
- 1 Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
| | - Vincent Schwarze
- 1 Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
| | - Johannes Rübenthaler
- 1 Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
| | - Dirk-André Clevert
- 1 Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich - Grosshadern Campus, Munich, Germany
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