1
|
Parvizi D, Haas F, Peintinger F, Hubmer M, Rappl T, Koch H, Schintler M, Spendel S, Kamolz LP, Wurzer P, Tuca A, Fuchsjaeger M, Weinke R. First Experience Using Contrast-enhanced Ultrasound to Evaluate Vascularisation of Acellular Dermal Matrices after Implant-Based Breast Reconstruction. Breast J 2014; 20:461-7. [DOI: 10.1111/tbj.12301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Daryousch Parvizi
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Franz Haas
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Florentia Peintinger
- Department of Senology; Breast Center of University Hospital Salzburg; LKH Leoben; Leoben Austria
| | - Martin Hubmer
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Thomas Rappl
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Horst Koch
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Michael Schintler
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Stephan Spendel
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Paul Wurzer
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | - Alexandru Tuca
- Division of Plastic, Aesthetic and Reconstructive Surgery; Department of Surgery; Medical University of Graz; Graz Austria
| | | | - Roland Weinke
- Department of Radiology; Medical University of Graz; Graz Austria
| |
Collapse
|
2
|
Multifunctional polymersomes for cytosolic delivery of gemcitabine and doxorubicin to cancer cells. Biomaterials 2014; 35:6482-97. [PMID: 24797878 DOI: 10.1016/j.biomaterials.2014.04.026] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 04/08/2014] [Indexed: 11/20/2022]
Abstract
Although liposomes are widely used as carriers of drugs and imaging agents, they suffer from a lack of stability and the slow release of the encapsulated contents at the targeted site. Polymersomes (vesicles of amphiphilic polymers) are considerably more stable compared to liposomes; however, they also demonstrate a slow release for the encapsulated contents, limiting their efficacy as a drug-delivery tool. As a solution, we prepared and characterized echogenic polymersomes, which are programmed to release the encapsulated drugs rapidly when incubated with cytosolic concentrations of glutathione. These vesicles encapsulated air bubbles inside and efficiently reflected diagnostic-frequency ultrasound. Folate-targeted polymersomes showed an enhanced uptake by breast and pancreatic-cancer cells in a monolayer as well as in three-dimensional spheroid cultures. Polymersomes encapsulated with the anticancer drugs gemcitabine and doxorubicin showed significant cytotoxicity to these cells. With further improvements, these vesicles hold the promise to serve as multifunctional nanocarriers, offering a triggered release as well as diagnostic ultrasound imaging.
Collapse
|
3
|
Nahire R, Haldar MK, Paul S, Mergoum A, Ambre AH, Katti KS, Gange KN, Srivastava DK, Sarkar K, Mallik S. Polymer-coated echogenic lipid nanoparticles with dual release triggers. Biomacromolecules 2013; 14:841-53. [PMID: 23394107 DOI: 10.1021/bm301894z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Although lipid nanoparticles are promising drug delivery vehicles, passive release of encapsulated contents at the target site is often slow. Herein, we report contents release from targeted, polymer-coated, echogenic lipid nanoparticles in the cell cytoplasm by redox trigger and simultaneously enhanced by diagnostic frequency ultrasound. The lipid nanoparticles were polymerized on the external leaflet using a disulfide cross-linker. In the presence of cytosolic concentrations of glutathione, the lipid nanoparticles released 76% of encapsulated contents. Plasma concentrations of glutathione failed to release the encapsulated contents. Application of 3 MHz ultrasound for 2 min simultaneously with the reducing agent enhanced the release to 96%. Folic acid conjugated, doxorubicin-loaded nanoparticles showed enhanced uptake and higher cytotoxicity in cancer cells overexpressing the folate receptor (compared to the control). With further developments, these lipid nanoparticles have the potential to be used as multimodal nanocarriers for simultaneous targeted drug delivery and ultrasound imaging.
Collapse
Affiliation(s)
- Rahul Nahire
- Departments of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58108, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Kumar A, Srivastava V, Singh S, Shukla RC. Color Doppler ultrasonography for treatment response prediction and evaluation in breast cancer. Future Oncol 2010; 6:1265-78. [DOI: 10.2217/fon.10.93] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Primary systemic therapy is a well-established modality of treatment in locally advanced breast cancer. Assessment of tumor response to chemotherapy not only helps in assessing the efficacy of the regimen used but also predicts the overall outcome of the patient. The tumor vascularity is a surrogate marker of tumor burden and this can be readily assessed by color Doppler ultrasound using various indices (resistivity index, pulsatility index and maximum flow velocity). The pre- and post-chemotherapy indices can be compared with in order assess the response to chemotherapy. Among various imaging modalities, MRI and PET have the highest sensitivity in detecting the tumor response, but they are not cost effective. Color Doppler ultrasound is a promising alternative for tumor response assessment owing to its availability, reproducibility and cost–effectiveness.
Collapse
Affiliation(s)
| | - Vivek Srivastava
- Department of General Surgery & Radio Diagnosis & Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Seema Singh
- Department of General Surgery & Radio Diagnosis & Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Ram Chandra Shukla
- Department of General Surgery & Radio Diagnosis & Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| |
Collapse
|
5
|
New potential and applications of contrast-enhanced ultrasound of the breast: Own investigations and review of the literature. Eur J Radiol 2008; 69:14-23. [PMID: 18977102 DOI: 10.1016/j.ejrad.2008.07.037] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 07/28/2008] [Indexed: 12/14/2022]
Abstract
Imaging of angiogenesis is a challenge for modern imaging. Velocimetry in malignant breast lesions and density of malignant vessels are very low. In breast imaging, first results of contrast-enhanced ultrasound (CEUS) were disappointing. Microbubbles are fragile when examined with high frequency US, commonly used in breast imaging. Second-generation contrast agents increase intensively the signal level of breast lesions and new sequences like CPS (Coherence Pulse Sequencing) might be accurate to detect malignant vessels in breast lesions for characterization, to assess the extent of infiltrative breast carcinoma or to evaluate the tumor response after chemotherapy. Another interesting clinical application is the differentiation between post-operative changes and recurrences. In this review, we detail the main results obtained with contrast ultrasonography in a characterization study. In malignant lesions, enhancement was fast, starting with less than 20s. Compared to MR, enhancement appeared faster. Malignant vessels were predominant in the external ring of the nodule, conversely vessels were seen in the center of the lesion in benign nodules. Malignant vessels were also seen outside the lesion. This knowledge could lead the surgeon to perform a larger lumpectomy in these cases, to obtain sane margins and to reduce recurrences.
Collapse
|
6
|
Zdemir A, Kiliç K, Ozdemir H, Yücel C, Andaç S, Colak M. Contrast-enhanced power Doppler sonography in breast lesions: effect on differential diagnosis after mammography and gray scale sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:183-197. [PMID: 14992355 DOI: 10.7863/jum.2004.23.2.183] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate the efficacy of contrast-enhanced power Doppler sonography in the differential diagnosis of breast lesions after a mammography-gray scale sonography combination. METHODS Sixty-eight patients with 69 breast masses underwent power Doppler sonography before and after intravenous injection of a contrast agent. The lesions were diagnosed as "highly suggestive of malignancy" (category 5; n = 32), "suspicious" (category 4; n = 21), and "probably benign" (category 3; n = 16) by mammography and gray scale sonography, modeled on the American College of Radiology Breast Imaging Reporting and Data System classification. Power Doppler findings did not affect patient treatment. The authors subjectively evaluated the estimated area of vascularity, degree of enhancement following contrast agent administration, morphologic features, and distribution of vessels within the lesions. RESULTS The final diagnoses were malignant in 28 lesions and benign in 41. Significant enhancement after contrast agent injection was detected in both the malignant and benign groups. Only 2 criteria, estimated area of vascularity and degree of enhancement following contrast agent administration, proved to be significant diagnostic determinants for contrast-enhanced power Doppler sonography (P < .001; interobserver agreements, 74.4 and 77.8, respectively). Contrast-enhanced power Doppler sonography provided a higher specificity, positive predictive value, and negative predictive value than power Doppler sonography but a lower sensitivity and negative predictive value than mammography-gray scale sonography. Only in the category 4 lesions could the combination of mammography-gray scale sonography and contrast-enhanced power Doppler sonography accomplish a higher specificity (71%) and positive predictive value (70%) than mammography-gray scale sonography (39% and 53%, respectively). CONCLUSIONS Power Doppler and contrast-enhanced power Doppler sonography cannot be recommended as confirmatory tests in Breast Imaging Reporting and Data System category 3 and category 5 lesions. Although contrast-enhanced power Doppler sonography may help reduce unnecessary biopsies in Breast Imaging Reporting and Data System category 4 lesions, recommendation of its use has many drawbacks, such as imperfectly established criteria, lack of absolute certainty, and high cost.
Collapse
Affiliation(s)
- Ayşegül Zdemir
- Department of Radiology, University Hospital of Gazi, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
7
|
Kook SH, Kwag HJ. Value of contrast-enhanced power Doppler sonography using a microbubble echo-enhancing agent in evaluation of small breast lesions. JOURNAL OF CLINICAL ULTRASOUND : JCU 2003; 31:227-238. [PMID: 12767017 DOI: 10.1002/jcu.10172] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE The purpose of this study was to prospectively evaluate the usefulness of contrast-enhanced power Doppler sonography (PDUS) using a microbubble echo-enhancing agent in differentiating between malignant and benign small breast lesions. PATIENTS AND METHODS Between July 1, 2000, and September 30, 2001, we performed gray-scale sonographic examination of patients in whom diagnostic sonography or screening mammography had revealed solid breast lesions measuring less than 2 cm in the largest dimension. The patients were then examined on PDUS before and after injection of a microbubble contrast agent. The sonographic findings for all 3 techniques, as well as the morphologic features of the Doppler signals for each patient before and after injection of the contrast agent on PDUS, were independently assessed. Each lesion was classified as "benign" or "malignant" on the basis of specific criteria for sonographic interpretation. A hemodynamic study was performed in which time-transit profiles of the Doppler signals on contrast-enhanced PDUS were generated using a computer-assisted program, and the results for each patient were compared with the findings of a histopathologic examination of surgical specimens. RESULTS Thirty-six patients (35 women and 1 man) with a mean age of 43.5 years (range, 18-69 years) were evaluated. The tumors ranged from 4 to 19 mm in the largest dimension. Histopathologic examination revealed that 19 tumors were benign and 17 were malignant. For morphologic diagnosis of the malignant lesions, the sensitivity of gray-scale sonography was 100%, compared with 29% for PDUS without contrast enhancement. The specificity of gray-scale sonography was 47%, compared with 74% for PDUS without contrast enhancement. Contrast-enhanced PDUS had a sensitivity of 71% and a specificity of 58%. The diagnostic accuracy was 72% for gray-scale sonography, 53% for PDUS without contrast enhancement, and 64% for contrast-enhanced PDUS. The time-transit profiles of the hemodynamic study did not reveal a statistically significant difference in the accuracy rates of contrast-enhanced PDUS between benign and malignant breast lesions. CONCLUSIONS Compared with PDUS without contrast enhancement, contrast-enhanced PDUS provides better visualization of the morphology of vascular Doppler signals that is characteristic of malignancy and therefore has a higher sensitivity and diagnostic accuracy, albeit a lower specificity. In differentiating between benign and malignant small breast lesions, contrast-enhanced PDUS can be helpful when used with gray-scale sonography and PDUS without contrast enhancement.
Collapse
Affiliation(s)
- Shin-Ho Kook
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, 108 Pyeong-Dong, Jongro-Gu, Seoul 110-108, South Korea
| | | |
Collapse
|
8
|
Reinikainen H, Paakko E, Suramo I, Paivansalo M, Jauhiainen J, Rissanen T. Dynamics of contrast enhancement in MR imaging and power Doppler ultrasonography of solid breast lesions. Acta Radiol 2002. [DOI: 10.1034/j.1600-0455.2002.430509.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
9
|
Abstract
Ultrasound (US) has undergone dramatic changes since its inception three decades ago; the original cumbersome B-mode gantry system has evolved into a high resolution real-time imaging system. This review describes both recent advances in ultrasound and contrast media and likely future developments. Technological advances in electronics and computing have revolutionized ultrasound practice with ever expanding applications. Developments in transducer materials and array designs have resulted in greater bandwidths with improvements in spatial and contrast resolution. Developments in digital signal processing have produced innovations in beam forming, image display and archiving. Technological advances have resulted in novel imaging modes which exploit the non-linear behaviour of tissue and microbubble contrast agents. Microbubble contrast agents have dramatically extended the clinical and research applications of ultrasound. Not only can Doppler studies be enhanced but also novel non-linear modes allow vessels down to the level of the microcirculation to be imaged. Functional and quantitative studies allow interrogation of a wide spectrum of tissue beds. The advent of tissue-specific agents promises to improve the sensitivity and specificity of ultrasound in the detection and characterization of focal liver lesions to rival that of computed tomography (CT) and magnetic resonance imaging (MRI). Ultrasound has recently moved into therapeutic applications with high intensity focused ultrasound (HIFU) and microbubble assisted delivery of drugs and genes showing great promise.
Collapse
Affiliation(s)
- Christopher J Harvey
- Department of Imaging, Hammersmith Hospital, Imperial College School of Medicine, London, UK.
| | | | | | | | | |
Collapse
|
10
|
Adler RS. On the relationship between power mode and pressure amplitude decorrelation. ULTRASOUND IN MEDICINE & BIOLOGY 2001; 27:1291-1296. [PMID: 11597371 DOI: 10.1016/s0301-5629(01)00425-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Estimation of mean transit time, along with tissue blood volume, are important factors in determining soft tissue perfusion. Recently, power mode decorrelation techniques have been successfully used to estimate mean transit time of red blood cells or contrast material through a region-of-interest (ROI) both in laminar flow phantoms and in vivo. The previously described theory for power mode decorrelation derives from a phenomenological stochastic differential equation (Langevin equation) based on conservation of matter, relating the detected signal power to the measured rate of decorrelation. Given the experimental support for power mode decorrelation as a method to estimate mean transit time, it becomes important to determine the relationship between the phenomenological parameters that appear in the corresponding stochastic equation and system parameters, such as the transducer point response function. With this equation as a starting point, and using the fact that the pressure amplitude is a Gaussianly distributed random process, the following stochastic differential equation for the pressure amplitude p(t) is derived, a necessary first step in establishing the relationship between the measured decorrelation rate and system parameters (i.e., point response function): dp(t)/dt = -(v/2+2ik x v)p(t)+f(t), where v/2 represents the rate of decorrelation, 2k x v is the Doppler shift for an insonating wave vector k and particle velocity v.f(t) is a stationary, white noise Gaussian random process.
Collapse
Affiliation(s)
- R S Adler
- Division of Ultrasound and Body Imaging, Weill Medical College of Cornell University, Hospital for Special Surgery, Department of Radiology and Imaging, New York, NY 10021, USA.
| |
Collapse
|
11
|
Hashimoto H, Suzuki M, Oshida M, Nagashima T, Yagata H, Shishikura T, Imanaka N, Nakajima N. Quantitative ultrasound as a predictor of node metastases and prognosis in patients with breast cancer. Breast Cancer 2001; 7:241-6. [PMID: 11029805 DOI: 10.1007/bf02967467] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND A retrospective study was performed to determine whether preoperative quantitative ultrasound assessment could predict axillary lymph node metastases and prognosis in patients with breast cancer. We focused on the presence of a halo, which is one of the features of breast cancer on ultrasound and represents reflections from the invading margin around infiltrating malignancies. METHODS We evaluated ultrasonography from 187 infiltrating breast carcinoma patients with tumors 5 cm or less in greatest dimension (T1, T2). Using computer image analysis, the halo area (H) and the sum of the area of halo and internal echo (total tumor area (T)) were measured, and the ratio of halo to entire tumor (H/T, halo ratio) was calculated and compared with lymph node status and prognosis. RESULTS The mean of the halo ratio was 0.38+/-0.13. Using the value of 0.42 as a cut-off, the high halo ratio group had significantly worse prognoses for both overall and disease-free survival at 49 months in median follow-up (p <0.001 and p <0.0005, respectively). The specificity of a high halo ratio in the T1 classification for predicting axillary node metastasis was 83.1%, with a negative predictive value of 86.8%. In patients with tumors 1.0 cm or smaller, the negative predictive value was 100%. In a multivariate analysis, halo ratio was an independent predictor of disease-free survival of breast carcinoma patients (p =0.0232). CONCLUSIONS Preoperative quantitative ultrasound may be a useful non-invasive method for predicting the presence of axillary lymph node metastases and prognosis in patients with primary breast cancer.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Disease-Free Survival
- Female
- Humans
- Image Processing, Computer-Assisted/methods
- Image Processing, Computer-Assisted/standards
- Lymphatic Metastasis/diagnostic imaging
- Middle Aged
- Multivariate Analysis
- Neoplasm Staging
- Predictive Value of Tests
- Preoperative Care
- Prognosis
- Retrospective Studies
- Ultrasonography, Mammary/methods
- Ultrasonography, Mammary/standards
Collapse
Affiliation(s)
- H Hashimoto
- The First Department of Surgery, Chiba University School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Stuhrmann M, Aronius R, Schietzel M. Tumor vascularity of breast lesions: potentials and limits of contrast-enhanced Doppler sonography. AJR Am J Roentgenol 2000; 175:1585-9. [PMID: 11090380 DOI: 10.2214/ajr.175.6.1751585] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We investigated improving the evaluation of benignity in breast lesions using Doppler sonography with galactose palmitic acid-coated microbubbles. SUBJECTS AND METHODS In 77 patients with 84 breast tumors scheduled for surgical tumor removal, color-coded duplex sonography was performed before and after administration of Levovist. Of the 77 patients, 25 with 28 lesions had been treated for prior breast carcinoma. The parameters investigated were the following: degree of enhancement, number of tumor vessels, time to maximum enhancement, and the pattern of vascular morphology and course. RESULTS Findings in malignant tumors (n = 53) showed a greater number of vessels and a faster stronger enhancement after Levovist administration, whereas a definite partial overlap with results from benign tumors (n = 31) was found. The best distinction was produced by vascular morphology and course, with a sensitivity of 90% and a specificity of 81 %. In 23 of the 25 patients who previously underwent surgery, a clear distinction was possible between a postoperative scar (n = 11) and a tumor recurrence (n = 17). CONCLUSION Although administration of the contrast agent clearly improved evaluation of benign features on Doppler sonography, absolute certainty cannot be achieved. The feasibility of making an otherwise difficult distinction between a scar and tumor recurrence on sonography and mammography appears to be promising, but further studies are necessary.
Collapse
MESH Headings
- Breast Neoplasms/blood supply
- Breast Neoplasms/diagnostic imaging
- Carcinoma, Ductal, Breast/blood supply
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Lobular/blood supply
- Carcinoma, Lobular/diagnostic imaging
- Contrast Media
- Female
- Humans
- Middle Aged
- Neoplasm Recurrence, Local/blood supply
- Neoplasm Recurrence, Local/diagnostic imaging
- Polysaccharides
- Prospective Studies
- Sensitivity and Specificity
- Ultrasonography, Doppler, Color
- Ultrasonography, Mammary/methods
Collapse
Affiliation(s)
- M Stuhrmann
- All authors: Röntgenabteilung, Gemeinschaftskrankenhaus Herdecke, Universität Witten-Herdecke, Beckweg 4, 58313 Herdecke, Germany
| | | | | |
Collapse
|
13
|
Cosgrove DO, Eckersley RJ. Breast. ULTRASOUND IN MEDICINE & BIOLOGY 2000; 26 Suppl 1:S110-S115. [PMID: 10794892 DOI: 10.1016/s0301-5629(00)00181-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- D O Cosgrove
- Imperial College School of Medicine, Hammersmith Hospital, London, UK
| | | |
Collapse
|
14
|
Albrecht T, Blomley MJ, Cosgrove DO, Taylor-Robinson SD, Jayaram V, Eckersley R, Urbank A, Butler-Barnes J, Patel N. Non-invasive diagnosis of hepatic cirrhosis by transit-time analysis of an ultrasound contrast agent. Lancet 1999; 353:1579-83. [PMID: 10334257 DOI: 10.1016/s0140-6736(98)06373-9] [Citation(s) in RCA: 193] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hepatic cirrhosis is accompanied by several haemodynamic changes including arterialisation of the liver, intrahepatic shunts, pulmonary arteriovenous shunts, and a hyperdynamic circulatory state. We postulated that the hepatic first pass of a bolus of an ultrasound contrast agent injected into a peripheral vein is accelerated in patients with cirrhosis. We investigated this first pass in patients with diffuse liver disease and in normal controls to assess whether it provides useful differential diagnostic information. METHODS We enrolled 15 patients with biopsy-proven cirrhosis, 12 patients with biopsy-proven non-cirrhotic diffuse liver disease, and 11 normal controls. We carried out continuous spectral doppler ultrasonography of a hepatic vein from 20 s before to 3 min after a peripheral intravenous bolus injection of 2.5 g Levovist. The intensity of the doppler signal was measured and used to plot time-intensity curves. FINDINGS Patients with cirrhosis showed a much earlier onset of enhancement (arrival time; mean 18.3 s) and peak enhancement (mean 55.5 s) than controls (49.8 s and 97.5 s) or patients with non-cirrhotic diffuse liver disease (35.8 s and 79.7 s). All patients with cirrhosis had an arrival time of the bolus of less than 24 s, whereas the arrival time was 24 s or more in 22 of the 23 other participants. Peak enhancement was higher in patients with cirrhosis (mean 48.7 units) than in the other two groups (12.5 and 12.3 units, respectively). We found highly significant differences between the patients with cirrhosis and each of the other two groups for all variables (p<0.005), whereas we found no significant differences between non-cirrhotic patients and controls. INTERPRETATION Our preliminary study suggests that analysis of liver transit time of a bolus of ultrasound contrast agent provides useful information about haemodynamic changes in patients with cirrhosis. Measurement of the arrival time of the bolus allows discrimination of patients with cirrhosis from controls and from patients with non-cirrhotic diffuse liver disease, and has potential as a non-invasive test for cirrhosis.
Collapse
Affiliation(s)
- T Albrecht
- Department of Imaging, Hammersmith Hospital, Imperial College of Science, Technology, and Medicine, London, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
|