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Tavelli L, Kripfgans OD, Chan HL, Vera Rodriguez M, Sabri H, Mancini L, Wang HL, Giannobile WV, Barootchi S. Doppler ultrasonographic evaluation of tissue revascularization following connective tissue graft at implant sites. J Clin Periodontol 2023. [PMID: 37861110 DOI: 10.1111/jcpe.13889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023]
Abstract
AIM To assess the Doppler ultrasonographic tissue perfusion at dental implant sites augmented with connective tissue graft (CTG) using coronally advanced flap (CAF) or tunnel technique (TUN). MATERIALS AND METHODS Twenty-eight patients presenting with isolated healthy peri-implant soft-tissue dehiscence (PSTD) were included in this randomized clinical trial. PSTDs were treated with either CAF + CTG or TUN + CTG. Ultrasound scans were taken at baseline, 1 week, 1 month, 6 months and 12 months. Tissue perfusion at the mid-facial, mesial and distal aspects of the implant sites was assessed by colour Doppler velocity (CDV) and power Doppler imaging (PDI). Early vascularization of the graft and the flap at 1 week and at 1 month were evaluated via dynamic tissue perfusion measurements (DTPMs), including flow intensity (FI), mean perfusion relief intensity (pRI) and mean perfused area (pA). RESULTS Regression analysis did not reveal significant differences in terms of mid-facial CDV and PDI changes between CAF and TUN over 12 months (p > .05), while significant differences between the two groups were observed at the interproximal areas (p < .001 for both CDV and PDI changes). Higher early DTPMs were observed at the TUN-treated sites in terms of mean FI of the graft (p = .027) and mean FI (p = .024) and pRI of the flap (p = .031) compared with CAF-treated sites at 1 week. Assessment of the FI direction showed that CTG perfusion at 1 week and at 1 month mainly occurred from the flap towards the implant/bone. Early tissue perfusion outcomes were found to be associated with the 12-month mean PSTD coverage and mucosal thickness gain. CONCLUSIONS Doppler ultrasonography shows tissue perfusion changes occurring at implant sites augmented with CTG. The main differences in tissue perfusion between CAF and TUN were observed at the interproximal sites, with early perfusion associated with clinical and volumetric outcomes at 12 months.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, Massachusetts, USA
| | - Oliver D Kripfgans
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Maria Vera Rodriguez
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Postgraduate Periodontics, Division of Periodontics, Columbia University College of Dental Medicine, New York City, New York, USA
| | - Hamoun Sabri
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Leonardo Mancini
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, Massachusetts, USA
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - William V Giannobile
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Shayan Barootchi
- Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, Massachusetts, USA
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Piozzi GN, Reitano E, Panizzo V, Rubino B, Bona D, Tringali D, Micheletto G. Practical Suggestions for Prevention of Complications Arising from Oxidized Cellulose Retention: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:812-819. [PMID: 29991675 PMCID: PMC6066980 DOI: 10.12659/ajcr.910060] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/26/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bleeding is a major intraoperative complication during surgical procedures. When conventional methods such as ligature and diathermocoagulation are ineffective for bleeding management, hemostatic agents should be used. Oxidized cellulose is one of the major hemostatic agents used worldwide. Oxidized cellulose is often left in situ after hemostasis because of its high level of reabsorption that lasts up to 8 weeks. However, 38 cases of retaining-associated complications are reported in the literature. CASE REPORT A 51-year-old male patient presented in our emergency department with acute abdominal pain, nausea, and vomiting. The patient had been admitted in our department for laparoscopic cholecystectomy for acute cholecystitis 25 months previously. Abdominal ultrasound and CT scan showed the presence of a cystic circular mass, with homogeneous fluid content, close to the surgical clips of the previous surgery, resembling a "neogallbladder". Laparoscopic abdominal exploration and drainage were performed. Histological examination reported protein-based amorphous material with rare lymphocytes and macrophages. Culturing was negative for bacterial growth. The patient was discharged uneventfully on the 4 th postoperative day. The primary surgical report was evaluated with evidence of application of Gelita-Cel ® Standard for hemostatic purposes. Results of 12-month follow-up were normal. CONCLUSIONS Herein, we report the first case of a complication associated with the use of Gelita-Cel ® Standard. We reviewed the literature to better define the purpose and limits of oxidized cellulose use as a hemostatic agent. Despite the fundamental role of oxidized cellulose as a hemostatic agent, we provide some practical suggestions to prevent the reported severe complications and surgical overtreatments.
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Affiliation(s)
| | - Elisa Reitano
- Department of General Surgery, University of Milan, Milano, Italy
| | - Valerio Panizzo
- Department of General Surgery, Istituto Clinico Sant’Ambrogio, Milano, Italy
| | - Barbara Rubino
- Department of Pathology, IRCCS Policlinico San Donato Hospital, San Donato Milanese, Italy
| | - Davide Bona
- Department of General Surgery, Istituto Clinico Sant’Ambrogio, Milano, Italy
| | - Domenico Tringali
- Department of General Surgery, Istituto Clinico Sant’Ambrogio, Milano, Italy
| | - Giancarlo Micheletto
- Department of General Surgery, Istituto Clinico Sant’Ambrogio, Milano, Italy
- Department of Medical and Surgical Pathophysiology and Transplantation, Policlinico Hospital, Milano, Italy
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Ma X, Liu R, Zhu C, Zhang J, Ling W. Diagnostic Value of Contrast-Enhanced Sonography for Differentiation of Breast Lesions: A Meta-analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2095-2102. [PMID: 27503752 DOI: 10.7863/ultra.15.10005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/30/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The purpose of this study was to systematically review and evaluate the diagnostic accuracy of contrast-enhanced sonography in the differential diagnosis of benign and malignant breast lesions. METHODS The scientific literature databases PubMed and Embase were comprehensively searched for relevant studies before January 2015. Data were pooled to yield the summary sensitivity, specificity, and diagnostic odds ratio using meta-analysis software. RESULTS A total of 29 studies with 2296 lesions were included in the analysis. The pooled sensitivity and specificity were 0.88 (95% confidence interval [CI], 0.86-0.90; inconsistency index [I(2)] = 77.9%) and 0.80 (95% CI, 0.78-0.83; I(2) = 84.0%), respectively. The pooled diagnostic odds ratio was 30.35 (95% CI, 15.75-58.48; I(2)= 82.1%), and the area under the summary receiver operating characteristic curve was 0.9115 (SE, 0.0243). CONCLUSIONS The comprehensive results suggest that contrast-enhanced sonography could be a potentially effective method for differential diagnosis of benign and malignant breast lesions.
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Affiliation(s)
- Xuelei Ma
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China, Department of Oncology, West China Hospital, Sichuan University, Chengdu, China, Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Rongjun Liu
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chenjing Zhu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China, Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Jing Zhang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wenwu Ling
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
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Giuliani M, Fubelli R, Patrolecco F, Rella R, Borelli C, Buccheri C, Di Giovanni SE, Belli P, Romani M, Rinaldi P, Bufi E, Franceschini G, Bonomo L. Mammographic and Ultrasonographic Findings of Oxidized Regenerated Cellulose in Breast Cancer Surgery: A 5-Year Experience. Clin Breast Cancer 2015; 15:e249-56. [PMID: 25922282 DOI: 10.1016/j.clbc.2015.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/18/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this study was to describe the ultrasonographic (US) and mammographic (MX) findings in patients who underwent breast-conserving surgery followed by oxidized regenerated cellulose (ORC) implantation in the surgical cavity and their size variations in follow-up. MATERIALS AND METHODS We retrospectively reviewed 417 MX and 743 US images performed between January 2009 and January 2014 for 262 women who underwent breast-conserving surgery. All patients underwent US, only 203 women underwent MX examination. RESULTS In 170 of 262 patients, US examinations showed abnormal findings. Three main US patterns were identified: (1) complex masses: well-encapsulated ipoisoechoic lesions with circumscribed margins with internal hyperechoic nodules (56%); (2) hypoanechoic lesions without internal hyperechoic nodules (24%); and (3) completely anechoic collections (20%). Moreover, Doppler ultrasound examination was performed on all of the patients. In 95 of 203 patients, MX examinations showed abnormalities. Four main MX patterns were identified: (1) round or oval opacity with circumscribed margins (58%); (2) round or oval opacity with indistinct or ill-defined margins (17%); (3) irregular opacity with indistinct or spiculated margins (9%); and (4) architectural distortion or focal asymmetry (15%). Most of the lesions showed a decrease in size at US and MX follow-up examination and the decrease was statistically significant (P < .01). CONCLUSION When applied to the surgical residual cavity, ORC aids to control local hemorrhage and reduce the risk of postoperative infections, but can lead to alterations in surgical scar. Thus, knowledge of the radiological findings might allow avoidance of misdiagnosis of tumor recurrence or unnecessary diagnostic examinations.
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Affiliation(s)
- Michela Giuliani
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy.
| | - Rita Fubelli
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Federica Patrolecco
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Rossella Rella
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Cristina Borelli
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Chiara Buccheri
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Paolo Belli
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Maurizio Romani
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Pierluigi Rinaldi
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Enida Bufi
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Lorenzo Bonomo
- Department of Radiology, Catholic University of the Sacred Heart, Rome, Italy
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Zhang JX, Cai LS, Chen L, Dai JL, Song GH. CEUS helps to rerate small breast tumors of BI-RADS category 3 and category 4. BIOMED RESEARCH INTERNATIONAL 2014; 2014:572532. [PMID: 24967380 PMCID: PMC4055582 DOI: 10.1155/2014/572532] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 04/29/2014] [Accepted: 05/01/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE The primary aim of this study was to explore if classification, whether using the BI-RADS categories based on CEUS or conventional ultrasound, was conducive to the identification of benign and malignant category 3 or 4 small breast lesions. MATERIAL AND METHODS We evaluated 30 malignant and 77 benign small breast lesions using CEUS. The range of enhancement, type of enhancement strength, intensity of enhancement, and enhancement patterns were independent factors included to assess the BI-RADS categories. RESULTS Of the nonenhanced breast lesions, 97.8% (44/45) were malignant, while, of the hyperplasic nodules, 96.8% (30/31) showed no enhancement in our study. Category changes of the lesions were made according to the features determined using CEUS. The results showed that these features could improve diagnostic sensitivity (from 70.0 to 80.0, 80.0, 90.0, and 90.0%), reduce the negative likelihood ratio (from 0.33 to 0.22, 0.25, 0.11, and 0.12), and improve the NPV (from 88.8 to 92.2, 91.2, 96.2, and 95.5%). However, this was not conducive to improve diagnostic specificity or the PPV. CONCLUSION The vast majority of nonenhanced small breast lesions were malignant and most of the hyperplasic nodules showed no contrast enhancement. As a reference, CEUS was helpful in identifying BI-RADS category 3 or 4 small breast lesions.
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Affiliation(s)
- Jian-xing Zhang
- Departments of Ultrasound, Second Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Guangzhou 510120, China
| | - Li-shan Cai
- Departments of Ultrasound, First Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Guangzhou 510405, China
| | - Ling Chen
- Departments of Ultrasound, Second Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Guangzhou 510120, China
| | - Jiu-long Dai
- Departments of Ultrasound, Second Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Guangzhou 510120, China
| | - Guang-hui Song
- Departments of Ultrasound, Second Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Guangzhou 510120, China
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Abstract
In patients with known malignant disease, 51% of liver lesions less than 1.5 cm turn out to be benign. Whether the probability of malignancy is high or low, further investigations are often necessary to definitely exclude malignancy. Contrast-enhanced ultrasonography has a prominent role in lesion characterization with a diagnostic accuracy comparable with computed tomography and magnetic resonance imaging. Anti-angiogenic treatment is common in most oncological institutions and the response evaluation is a new challenge with a research focus on the change in tumour vasculature and perfusion. In planning biopsies, CEUS can identify necrotic and viable areas of tumours and improve the diagnostic accuracy.
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Affiliation(s)
- H H T Madsen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
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7
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Quaia E. Assessment of tissue perfusion by contrast-enhanced ultrasound. Eur Radiol 2010; 21:604-15. [PMID: 20927527 DOI: 10.1007/s00330-010-1965-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 08/13/2010] [Accepted: 08/17/2010] [Indexed: 12/11/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) with microbubble contrast agents is a new imaging technique for quantifying tissue perfusion. CEUS presents several advantages over other imaging techniques in assessing tissue perfusion, including the use of microbubbles as blood-pool agents, portability, availability and absence of exposure to radiation or nuclear tracers. Dedicated software packages are necessary to quantify the echo-signal intensity and allow the calculation of the degree of tissue contrast enhancement based on the accurate distinction between microbubble backscatter signals and native tissue background. The measurement of organ transit time after microbubble injection and the analysis of tissue reperfusion kinetics represent the two fundamental methods for the assessment of tissue perfusion by CEUS. Transit time measurement has been shown to be feasible and has started to become accepted as a clinical tool, especially in the liver. The loudness of audio signals from spectral Doppler analysis is used to generate time-intensity curves to follow the wash-in and wash-out of the microbubble bolus. Tissue perfusion may be quantified also by analysing the replenishment kinetics of the volume of microbubbles after their destruction in the imaged slice. This allows to obtain semiquantitative parameters related to local tissue perfusion, especially in the heart, brain, and kidneys.
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Affiliation(s)
- Emilio Quaia
- Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, Trieste, 34149, Italy.
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8
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Hitomi J, Kubota K, Ogawa Y, Hamada N, Murata Y, Nishioka A. Non-surgical therapy and radiologic assessment of stage I breast cancer treatment with novel enzyme-targeting radiosensitization: Kochi Oxydol-Radiation Therapy for Unresectable Carcinomas, type II (KORTUC II). Exp Ther Med 2010; 1:769-775. [PMID: 22993600 DOI: 10.3892/etm.2010.123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 07/09/2010] [Indexed: 01/22/2023] Open
Abstract
The new enzyme-targeting radiosensitization treatment, Kochi Oxydol-Radiation Therapy for Unresectable Carcinomas, type II (KORTUC II), markedly enhances the radiotherapeutic effect of treatment for various types of locally advanced malignant neoplasms. Patients who had declined surgical treatment and systemic chemotherapy, as well as a total of 14 stage I breast cancer patients, were enrolled. A maximum of 6 ml of KORTUC II was injected into tumor tissue twice a week under ultrasonographic guidance, immediately prior to each administration of radiation therapy. The median observation period was 21.6 months with a range of 4-48 months, and the therapy was well tolerated. Contrast-enhanced magnetic resonance imaging and [(18)F]-fluorodeoxyglucose positron emission computed tomography revealed that all primary breast tumors completely responded, and none of the subjects experienced local recurrence during the observation period. Ultrasonography depicted tumor-like findings in 2/14 cases after therapy. The intratumoral flow signal on color-Doppler sonography was positive in 4/14 cases before therapy, and the signal disappeared from all cases after therapy. The absence of a flow signal after therapy suggested that the tumor-like findings on ultrasonography were from scar tissue. Excellent local control based on accurate radiological evaluation implies that KORTUC II has the potential to replace surgery as a therapeutic option for stage I breast cancer. Precise evaluation by various radiological modalities helped to gage the success of this therapy.
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Affiliation(s)
- Jiro Hitomi
- Department of Radiology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
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Pan L, Han Y, Sun X, Liu J, Gang H. FDG-PET and other imaging modalities for the evaluation of breast cancer recurrence and metastases: a meta-analysis. J Cancer Res Clin Oncol 2010; 136:1007-22. [PMID: 20091186 PMCID: PMC2874488 DOI: 10.1007/s00432-009-0746-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 12/07/2009] [Indexed: 12/18/2022]
Abstract
Background and purpose Breast carcinoma is the most common cancer in female patients with a propensity for recurrence and metastases. The accuracy of ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), scintimammography (SMM) and positron emission tomography (PET) in diagnosing the recurrent and/or breast cancer has never been systematically assessed, and present systematic review was aimed at this issue. Methods MEDLINE and EMBASE were searched for articles dealt with detection of recurrent and/or metastatic breast cancer by US, CT, MRI, SMM or PET whether interpreted with or without the use of CT. Histopathologic analysis and/or close clinical and imaging follow-up for at least 6 months were used as golden reference. We extracted data to calculate sensitivity, specificity, summary receiver operating characteristic curves and area under the curve and to test for heterogeneity. Result In 42 included studies, US and MRI had highest pooled specificity (0.962 and 0.929, respectively); MRI and PET had highest pooled sensitivity (0.9500 and 0.9530, respectively). The AUC of US, CT, MRI, SMM and PET was 0.9251, 0.8596, 0.9718, 0.9386 and 0.9604, respectively. Results of pairwise comparison between each modality demonstrated that AUC of MRI and PET was higher than that of US or CT, p < 0.05. No statistical significance was found between MRI and PET. There was heterogeneity among studies and evidence of publication bias. Conclusion In conclusion, MRI seemed to be a more useful supplement to current surveillance techniques to assess patients with suspected recurrent and/or metastatic breast cancer. If MRI shows an indeterminate or benign lesion or MRI was not applicable, FDG-PET could be performed in addition.
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Affiliation(s)
- LingLing Pan
- Chinese Academy of Sciences, 730000 Lanzhou, China
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Cosgrove D, Lassau N. [Assessment of tumour angiogenesis using contrast-enhanced ultrasound]. ACTA ACUST UNITED AC 2009; 90:156-64. [PMID: 19212283 DOI: 10.1016/s0221-0363(09)70094-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Microbubbles are useful for imaging tumour angiogenesis and relatively crude forms of this approach are now routinely used for subjective diagnosis, especially in the liver. More sophisticated methods use quantitative approaches to measure the amount and the time course of bolus or reperfusion curves and have shown great promise in revealing effective tumour response to anti-angiogenic drugs in humans before tumour shrinkage occurs. These are beginning to be accepted into clinical practice. In the long term, targeted microbubbles for molecular imaging and eventually for directed anti-tumour therapy are expected to be tested.
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Affiliation(s)
- D Cosgrove
- Imaging Sciences Department, Imperial College, Hammersmith Hospital, London W120HS, UK.
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11
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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.
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Yang W, Dempsey PJ. Diagnostic Breast Ultrasound: Current Status and Future Directions. Radiol Clin North Am 2007; 45:845-61, vii. [PMID: 17888773 DOI: 10.1016/j.rcl.2007.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This summary of breast ultrasound reviews the current indications for its use, discusses the potential technical and human pitfalls in its performance, and briefly examines possible future applications that currently are works in progress. It also contains an in-depth discussion of the use and interpretation of color Doppler and power Doppler imaging, techniques that do not seem to be understood or used fully in daily practice.
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Affiliation(s)
- Wei Yang
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, The University of Texas, M.D. Anderson Cancer Center, P.O. Box 301439 - Unit 1350, Houston, TX 77230, USA.
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13
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Abramowicz JS. Ultrasonographic contrast media: has the time come in obstetrics and gynecology? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:517-531. [PMID: 15784770 DOI: 10.7863/jum.2005.24.4.517] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The aim of this work was to review the technical aspects and clinical applications of contrast media (microbubbles and nanomolecular agents) in obstetric and gynecologic ultrasonographic imaging. METHODS With the use of a computerized database (MEDLINE) and several Web-based search engines (Google Scholar and Copernic), relevant articles on ultrasonographic contrast media were reviewed. References cited in these articles and not obtained via the search engines were also reviewed. RESULTS Ultrasonographic contrast media constitute a new and expanding technology. They are frequently used, for example, in adult cardiology. Extensive research in laboratory setups, animals, and human subjects has shown their safety and huge potential as an adjunctive tool in clinical practice. They increase signals returning from insonated tissues and are particularly effective as intravascular agents, enhancing color and Doppler signals, for instance. Preliminary results in tumor imaging are encouraging. The ultrasonographic contrast media permit pharmacokinetic perfusion studies, which may be of enormous clinical importance in the study of early cancer development. Targeted imaging and therapies are becoming a reality. Microbubbles have already brought a new dimension to diagnostic ultrasonographic imaging. Many authors have described the clinical value of these agents in liver, prostate, and breast imaging, among others. Newer types of media, the nanomolecules, are now emerging as the latest in imaging enhancers as well as therapeutic agent carriers. CONCLUSIONS Although showing potential in imaging of the uterus and fallopian tubes as well as some obstetric applications, the contrast media, in particular the nanomolecules, seem to be most promising in ovarian cancer.
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Affiliation(s)
- Jacques S Abramowicz
- Department of Obstetrics and Gynecology, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612, USA.
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14
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Affiliation(s)
- D Cosgrove
- Imaging Sciences Department, Imperial College, Hammersmith Hospital, London, UK
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15
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Piñero A, Reus M, Illana J, Durán I, Martínez-Barba E, Canteras M, Parrilla P. Palpable breast lesions: utility of Doppler sonography for diagnosis of malignancy. Breast 2003; 12:258-63. [PMID: 14659310 DOI: 10.1016/s0960-9776(03)00103-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study was designed to find whether there are any differences between benign and malignant palpable breast lesions as they are seen on grey-scale and colour-Doppler and on power-Doppler sonography; to determine which variables for each technique are most helpful in distinguishing any such differences; and to see whether the use of an echo-enhancing agent gives better results in the differential diagnosis. Forty-five palpable breast lesions (16 benign and 29 malignant) were evaluated in a preoperative study using grey-scale sonography, colour-Doppler sonography and power-Doppler sonography before and after administration of an echo-enhancing agent (Levovist). We reached the following conclusions: (1) In the grey-scale ultrasound study of palpable breast lesions the presence of microcalcifications, acoustic shadowing and non-well-defined margins are related to malignancy. (2) Colour- and power-Doppler sonography may help in the differential diagnosis. (3) The use of an echo enhancer (Levovist) accentuates these differences and enables them to be noted in other variables, such as pulsatility index, nodule-to-vascularity ratio and number of poles.
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Affiliation(s)
- A Piñero
- Department of General Surgery, Virgen de la Arrixaca University Hospital, El Palmar, Murcia, Spain.
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Ordén MR, Jurvelin JS, Kirkinen PP. Kinetics of a US contrast agent in benign and malignant adnexal tumors. Radiology 2003; 226:405-10. [PMID: 12563133 DOI: 10.1148/radiol.2262011450] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the effects of a microbubble contrast agent on the power Doppler ultrasonographic (US) examination of adnexal tumors, with a special focus on the timing of the transit of the microbubble bolus. MATERIALS AND METHODS Seventy patients who were suspected of having ovarian tumors were examined preoperatively with contrast material-enhanced US. Images obtained during a 5-minute examination were stored digitally, and the behavior of the contrast agent was evaluated objectively with measurement of the time-dependent image intensity at the region of interest with a computer program. A time-intensity curve in each case was derived and analyzed. The Mann-Whitney U test was used to compare intensity changes and tumor parameters in benign and malignant adnexal tumors. RESULTS Both the baseline and maximum power Doppler intensities, as well as the absolute and relative (percent) rise in intensity, were significantly higher (P <.001) in malignant as compared with benign tumors. The arrival time was shorter (17.5 vs 22.5 seconds; P =.005) and the duration of contrast agent effect was longer (190.4 vs 103.6 seconds; P <.001) in malignant tumors than they were in benign tumors. The area under the time-intensity curve was significantly greater in malignant tumors compared with that in benign tumors (P <.001). CONCLUSION After microbubble contrast agent injection, malignant and benign adnexal lesions behave differently in degree, onset, and duration of Doppler US enhancement.
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Affiliation(s)
- Maija-Riitta Ordén
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland.
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