Contrast-enhanced power Doppler sonography: improved detection of characteristic flow patterns in focal liver lesions

PURPOSE

The aim of this study was to evaluate whether intravenous injection of an ultrasound contrast agent aids in the visualization of focal liver lesions on power Doppler images.

METHODS

Fifty patients with focal liver lesions were studied by B-mode and power Doppler sonography before and after intravenous injection of the contrast agent Levovist (galactose-based microbubbles; 10 ml of a concentration of 300 mg/ml). Thirty-two patients had malignant liver lesions (19 metastases, 12 hepatocellular carcinomas, 1 cholangiocellular carcinoma), while 18 had benign lesions (12 hemangiomas, 2 focal nodular hyperplasias, 4 others).

RESULTS

After contrast medium injection, the number of lesions with no intralesional flow dropped from 18 to 9. Flow signal intensity was rated subjectively as marked on contrast-enhanced images in 17 patients; only 4 patients had marked flow on precontrast images. On precontrast studies, central flow in 10 lesions and peripheral flow in 29 lesions could be observed. After enhancement, the numbers increased to 18 and 34 lesions, respectively.

CONCLUSIONS

On power Doppler images, a greater number of intratumoral vessels are seen in focal liver lesions after contrast medium administration.

Do ultrasonic contrast agents artificially increase maximum Doppler shift? In vivo study of human common carotid arteries

The aim of this study was to establish whether an increase of maximum Doppler shift occurs in the human common carotid artery after the administration of Levovist, an ultrasonographic echo enhancer. Twenty common carotid arteries of 10 patients were examined. Spectral Doppler waveform examinations were performed before and after administration of Levovist using an Acuson 128 XP 10 and a 7.0 MHz transducer probe. Time averaged mean velocity, peak velocity, maximum Doppler shift, and spectral Doppler indices (pulsatility index, resistive index, systolic-diastolic ratio) were assessed. No significant changes in any of the measured parameters, including maximum Doppler shifts, peak velocity (P = 0.35, Wilcoxon rank sum test), pulsatility indices (P = 0.70), resistive indices (P = 0.98), or other spectral indices, were found. We conclude that an increase in Doppler shift does not inevitably occur after the administration of a signal enhancer when examining the human common carotid artery.

Telemedicine in rural areas. Experience with medical desktop-conferencing via satellite

Cooperation between physicians in hospitals in rural areas can be assisted by desktop-conferencing using a satellite link. For six weeks, medical desktop-conferencing was tested during daily clinical conferences between the Virchow-Klinikum, Berlin, and the Medical Academy, Wroclaw. The communications link was provided by the German Telekom satellite system MCS, which allowed temporary connections to be established on demand by manual dialling. Standard hardware and software were used for videoconferencing, as well as software for medical communication developed in the BERMED project. Digital data, such as computed tomography or magnetic resonance images, were transmitted by a digital data channel in parallel to the transmission of analogue video and audio signals. For conferences involving large groups of people, hardware modifications were required. These included the installation of a video projector, adaptation of the audio system with improved echo cancellation, and installation of extra microphones. Learning to use an unfamiliar communication medium proved to be uncomplicated for the participating physicians.

[Quality criteria of digital subtraction angiography of the trunk of the body]

The presently valid quality criteria of digital subtraction angiography in the body trunk area are described. The indications for intravenous and intraarterial examinations are explained; these are closely connected with the respective demands. The problem levels are analysed and update technical and methodical solutions are offered.

[Color duplex sonography of liver transplantation. The vascular status]

The present study deals with the value of CDS in liver transplantation. Between September 1988 and October 1991 CDS of hepatic vessels was carried out in 194 liver transplants. Flow direction and flow velocity in the portal vein could be demonstrated in 97%. Measurement of flow velocity indicates the extent of portal hypertension; this can be confirmed by determining flow direction in the splenic and superior mesenteric veins. In 47 of 179 patients venous collaterals were demonstrated and in 15 of 179 patients there was retrograde flow in the splenic vein. In 95% of patients CDS indicated flow direction in the hepatic artery and in 93% in the hepatic veins. Thrombosis of liver vessels (portal and hepatic veins) was demonstrated in 11 out of 13 patients by means of CDS.

Contrast-enhanced transcranial Doppler US with a new transpulmonary echo contrast agent based on saccharide microparticles

The purpose of this first patient study (phase II) was to evaluate the clinical usefulness of a new echo contrast agent at transcranial Doppler ultrasonography (US). Twenty patients were selected from a group of 242 patients undergoing conventional transcranial Doppler US who had low (n = 18) or absent (n = 2) Doppler signals from the middle cerebral artery (MCA). The extent and duration of Doppler signal increase was measured in 30 MCAs and in 14 basilar arteries following the intravenous injection of a transpulmonary galactose microparticle suspension (SH U 508 A) at three concentrations (200, 300, and 400 mg/mL). Doppler waveform analysis became possible in 93% (28 of 30) of the MCAs following injection. The maximal increase in average Doppler signal intensity (11 dB at 200 mg/mL, 15 dB at 300 mg/mL, and 17 dB at 400 mg/mL) and the increase in average duration of the signal enhancement (163 seconds at 200 mg/mL, 219 seconds at 300 mg/mL, and 240 seconds at 400 mg/mL) depended on contrast agent concentration. Doppler waveform analysis became possible in 79% (11 of 14) of the basilar arteries. The intravenous injection of this new echo contrast agent markedly increases Doppler signal intensity in patients with nondiagnostic results at conventional Doppler US.

[A 3-dimensional reconstructive procedure in lumbar computed tomography]

In this study, 50 patients were examined by a Siemens' "Somatom Plus"; continuous 2 mm sections between the third lumbar and first sacral vertebra were obtained. The accuracy of the 3-D reconstruction software programme was checked by measuring a polyethylene phantom of a second lumbar vertebra. Reconstruction was carried out with a threshold definition of 150 Hu. In each case, four standard projections and medio-sagittal, medio-lateral and coronary sections were reconstructed, photographed and compared with axial CT sections and conventional radiographs. All these imaging procedures were suitable for the diagnosis of osteochondrosis and chondrosis. Spondylosis was diagnosed more frequently on 3-D CT. Spondylarthrosis, with narrowing of the intervertebral foramina and root canals is shown particularly well by 3-D CT, since the entire extent of these structures can be seen. 3-D surface reconstruction of the lumbar spine is useful in the diagnosis of lumbar spondylarthrosis with narrowing of the root canals and of the spinal canal. This method of axial Ct is superior to conventional radiography of the lumbar spine in the usual two planes.

[The Berlin Radiology Communication Project. The initial clinical experiences]

As part of a radiological communication project (RADKOM), two PACS systems of the radiological clinic in the Rudolf Virchow University Clinic in Charlottenburg and Wedding were connected via the BERKOM network of the German post office. Within the radiology departments, all CT and MRT systems were joined through a local network. The first results have shown that the PACS stations are of value for providing uniformity of diagnosis and for radiological conferences. It is evident, however, that the speed of transfer and the architecture within the PACS system would be of crucial importance for their practicability for radiological conferences.

[A comparison of the quantified determination of the echogeneity of the liver by ultrasound and the density of the liver by CT]

A defined region of the right lobe of the liver was measured by grey scale analysis based on similar presets according to a manual input of a Region of Interest (ROI). During 20 days, the livers of healthy subjects were tested by this method in order to test the reproducibility of the results. By prospective studies, the livers of 30 patients were examined by ultrasound and CT regarding the determination of the extent of their fatty liver disease. The value of the density of liver was determined in Hounsfield units (HU). Both methods lead to parameters that characterise the fatty content of the liver. Statistic analysis shows acceptable correlation of both methods. By means of grey scale analysis in ultrasound measurements it is possible to estimate the extent of the fatty content of liver.