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Bertolotto M, Siracusano S, Cicero C, Iannelli M, Silvestri T, Celia A, Guarise A, Stacul F. Cryotherapy of Renal Lesions: Enhancement on Contrast-Enhanced Sonography on Postoperative Day 1 Does Not Imply Viable Tissue Persistence. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:301-310. [PMID: 27914172 DOI: 10.7863/ultra.16.02061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/23/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To investigate whether persistent enhancement detected on contrast-enhanced sonography at postoperative day 1 (early contrast-enhanced sonography) after cryoablation of renal tumors implies the presence of residual viable tumor tissue, defined as residual enhancing tissue on reference imaging (computed tomography or magnetic resonance imaging) performed 6 months after the procedure. METHODS Seventy-four patients with percutaneous cryoablation of renal tumors had early contrast-enhanced sonography from November 2011 to August 2015. Two independent readers evaluated early contrast-enhanced sonographic findings and contrast-enhanced sonographic investigations performed 1 month after cryoablation of lesions that displayed enhancement on early contrast-enhanced sonography. They scored intralesional enhancement in 4 groups: no enhancement, few intralesional vessels, focal enhancing areas, and diffuse enhancement. Inter-reader agreement in evaluating lesion vascularity on early contrast-enhanced sonography was assessed with weighted κ statistics. Computed tomography or magnetic resonance imaging performed 6 months after the treatment was the reference procedure for assessing the absence or presence of residual disease. RESULTS Inter-reader agreement in assessing intratumoral vascularization on early contrast-enhanced sonography was very good (κ = 0.90). Enhancement was absent for both readers in 33 of 74 cases; only a few intralesional vessels were visible in 21; whereas diffuse or focal enhancement was present in 13. In the remaining 7 patients, there were differences. Four lesions with focal enhancement on early contrast-enhanced sonography and 1 that was considered avascular had residual tumors on reference imaging. Ablation was successful in the remaining 69 of 74 patients (93%). CONCLUSIONS After cryoablation, intratumoral enhancement on early contrast-enhanced sonography does not imply tumor cell viability.
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Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Salvatore Siracusano
- Department of Urology, University of Verona, Policlinico G. B. Rossi, Verona, Italy
| | - Calogero Cicero
- Department of Radiology, Ospedale San Bassiano, Bassano del Grappa, Italy
| | - Mariano Iannelli
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Tommaso Silvestri
- Department of Urology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Antonio Celia
- Department of Urology, Ospedale San Bassiano, Bassano del Grappa, Italy
| | - Alessandro Guarise
- Department of Radiology, Ospedale San Bassiano, Bassano del Grappa, Italy
| | - Fulvio Stacul
- S. C. Radiologia Ospedale Maggiore, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Trieste, Italy
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Gulati M, King KG, Gill IS, Pham V, Grant E, Duddalwar VA. Contrast-enhanced ultrasound (CEUS) of cystic and solid renal lesions: a review. ACTA ACUST UNITED AC 2016; 40:1982-96. [PMID: 25588715 DOI: 10.1007/s00261-015-0348-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Incidentally detected renal lesions have traditionally undergone imaging characterization by contrast-enhanced computer tomography (CECT) or magnetic resonance imaging. Contrast-enhanced ultrasound (CEUS) of renal lesions is a relatively novel, but increasingly utilized, diagnostic modality. CEUS has advantages over CECT and MRI including unmatched temporal resolution due to continuous real-time imaging, lack of nephrotoxicity, and potential cost savings. CEUS has been most thoroughly evaluated in workup of complex cystic renal lesions, where it has been proposed as a replacement for CECT. Using CEUS to differentiate benign from malignant solid renal lesions has also been studied, but has proven difficult due to overlapping imaging features. Monitoring minimally invasive treatments of renal masses is an emerging application of CEUS. An additional promising area is quantitative analysis of renal masses using CEUS. This review discusses the scientific literature on renal CEUS, with an emphasis on imaging features differentiating various cystic and solid renal lesions.
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Affiliation(s)
- Mittul Gulati
- Department of Radiology, Keck USC School of Medicine, 1500 San Pablo Street, 2nd Floor Imaging, Los Angeles, CA, 90033, USA,
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Sanz E, Hevia V, Arias F, Fabuel JJ, Álvarez S, Rodríguez-Patrón R, Gómez V, Díez-Nicolás V, González-Gordaliza C, Burgos FJ. Contrast-enhanced ultrasound (CEUS): an excellent tool in the follow-up of small renal masses treated with cryoablation. Curr Urol Rep 2015; 16:469. [PMID: 25404183 DOI: 10.1007/s11934-014-0469-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Strict imaging follow-up is mandatory after cryoablation of small renal masses (SRMs). Although it uses ionizing radiation and nephrotoxic iodinated contrast, computed tomography (CT) is still the gold standard test. Contrast-enhanced ultrasound (CEUS) is a novel technique that informs in real time about renal perfusion avoiding radiation and nephrotoxicity. The objective of this study is to compare outcomes between CEUS and CT in the follow-up of SRMs treated with cryoablation, as well as to assess degree of agreement between them. This is a prospective observational study (May 2012 to December 2013) comparing CEUS and CT in 16 patients with SRMs cryoablated. The on-going protocol of the study includes a CT and CEUS 3 months after treatment and then every 6 months during 5 years. Local relapse was defined as the presence of contrast enhancement in the mass. All the CEUS were performed by a single experienced observer (E.S.). Degree of agreement was measured with kappa index. CEUS detected contrast enhancement in three patients (3/16, 18.8%) and CT in two patients (2/16, 12.5%). Degree of agreement between CEUS and CT, according to Landis-Koch classification, was 0.76 (CI 0.33-1.19; p = 0.0165), which is excellent and higher than expected by random. Sensitivity of the test is 93.75% (15/16). Median time of follow-up after cryoablation is 22 months (15.5-36.5). CEUS has an excellent agreement with CT and a high sensitivity in the follow-up of SRMs treated with cryosurgery, demonstrating its usefulness. Due to these encouraging results, it could become a reference test in the near future for monitoring SRMs after ablative treatment.
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Affiliation(s)
- Enrique Sanz
- Urology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain
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Eisenbrey JR, Shaw CM, Lyshchik A, Machado P, Lallas CD, Trabulsi EJ, Merton DA, Fox TB, Liu JB, Brown DB, Forsberg F. Contrast-Enhanced Subharmonic and Harmonic Ultrasound of Renal Masses Undergoing Percutaneous Cryoablation. Acad Radiol 2015; 22:820-6. [PMID: 25882093 DOI: 10.1016/j.acra.2015.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 03/06/2015] [Accepted: 03/07/2015] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES The objective of this study was to evaluate and compare contrast-enhanced subharmonic and harmonic ultrasound as tools for characterizing solid renal masses and monitoring their response to cryoablation therapy. MATERIALS AND METHODS Sixteen patients undergoing percutaneous ablation of a renal mass provided informed consent to undergo ultrasound examinations the morning before and approximately 4 months after cryoablation. Ultrasound contrast parameters during pretreatment imaging were compared to biopsy results obtained during ablation (n = 13). Posttreatment changes were evaluated by a radiologist and compared to contrast-enhanced magnetic resonance imaging (MRI)/computed tomography (CT) follow-up. RESULTS All masses initially showed heterogeneous enhancement with both subharmonic and harmonic ultrasound. Early contrast washout in the mass relative to the cortex was observed in 6 of 9 malignant and 0 of 4 benign lesions in subharmonic mode and 8 of 9 malignant and 1 of 4 benign lesions in harmonic imaging. In cases where the lesion was adequately visualized at follow-up (n = 12), subharmonic and harmonic ultrasound showed accuracies of 83% and 75%, respectively, in predicting treatment outcome. Although harmonic imaging showed less overall error, no significant differences (P > .29) in ablation cavity volumes were observed between MRI/CT and either contrast-imaging mode. CONCLUSIONS Subharmonic and harmonic contrast-enhanced ultrasound may be a safe and accurate imaging alternative for characterizing renal masses and evaluating their response to cryoablation therapy. Although subharmonic imaging was more accurate in detecting effective cryoablation, harmonic imaging was superior in quantifying ablation cavity volumes.
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Affiliation(s)
- John R Eisenbrey
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th St, Philadelphia, PA 19107.
| | - Colette M Shaw
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th St, Philadelphia, PA 19107
| | - Andrej Lyshchik
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th St, Philadelphia, PA 19107
| | - Priscilla Machado
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th St, Philadelphia, PA 19107
| | - Costas D Lallas
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Edouard J Trabulsi
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daniel A Merton
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th St, Philadelphia, PA 19107
| | - Traci B Fox
- Department of Radiologic Sciences, Jefferson College of Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ji-Bin Liu
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th St, Philadelphia, PA 19107
| | - Daniel B Brown
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th St, Philadelphia, PA 19107
| | - Flemming Forsberg
- Department of Radiology, Sidney Kimmel Medical College at Thomas Jefferson University, 132 South 10th St, Philadelphia, PA 19107
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Houtzager S, Wijkstra H, de la Rosette JJMCH, Laguna MP. Evaluation of renal masses with contrast-enhanced ultrasound. Curr Urol Rep 2013; 14:116-23. [PMID: 23344685 DOI: 10.1007/s11934-013-0309-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The clinical need for characterising small renal masses (SRMs) is increasing due to their rising incidental detection. This increase is especially seen in younger and older generations and concerns mainly SRMs. Diagnostics is mainly made by contrast-enhanced CT or MRI. However, these imaging methods fail to accurately distinguishing benign from malignant SRMs. Other disadvantages of CT or MRI are high costs, the use of ionizing radiation, nephrotoxicity induced by iodine contrast agents or nephrogenic systemic fibrosis (NSF) induced by gadolinium contrast agents. Contrast-enhanced ultrasound (CEUS) is based on ultrasonography and microbubbles to real-time visualize the renal blood flow without the use of nephrotoxic agents or ionizing radiation. This comprehensive review evaluates the capabilities of CEUS in the diagnostics of benign (angiomyolipomas, cysts, oncocytomas, pseudotumors) and malignant masses (renal cell carcinomas), and focuses on possible future treatment.
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Affiliation(s)
- S Houtzager
- Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
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Barwari K, Wijkstra H, van Delden OM, de la Rosette JJ, Laguna MP. Contrast-enhanced ultrasound for the evaluation of the cryolesion after laparoscopic renal cryoablation: an initial report. J Endourol 2013; 27:402-7. [PMID: 23092215 DOI: 10.1089/end.2012.0400] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Stringent radiological follow-up is essential after renal tumor ablation. Drawbacks of postablation follow-up by contrast-enhanced computed tomography (CECT) are the associated ionizing radiation and nephrotoxic contrast agent. Contrast-enhanced ultrasound (CEUS) has shown potential to demonstrate microvasculature without using either ionizing radiation or toxic contrast agent. We assessed the concordance of enhancement patterns of CEUS and CECT/MRI in cryolesion assessment after laparoscopic renal cryoablation (LCA). METHODS From 01/2006 to 01/2009, a CEUS was performed before and after LCA (3 and 12 months) in addition to regular CECT/MRI. Using an enhancement score (0=no enhancement, 1=rim enhancement, 2=diffuse enhancement, 3=localized enhancement, 4=no enhancement defect), the cryolesion was assessed by both modalities, and concordance of enhancement score was assessed. RESULTS In total, 45 tumors were included (29 biopsy proven renal cell carcinoma (RCC), mean size 2.66 cm). One cryoablation failed, resulting in a nonenhancing cryolesion apart from the persisting renal tumor. There were no postablation recurrences during the study period. Pre-LCA: Both modalities were available in 26 cases. In 20 out of 26, there was concordance of enhancement score (77%, all cases score 3 or 4). Three months: Both modalities were available in 32 cases. Enhancement score corresponded in 23 out of 32 cases (72%). Seven cases showed enhancement on CECT/MRI ("1" in six cases, "4" in one case) with enhancement score "0"on CEUS. Two cases showed enhancement on CEUS without enhancement on CECT/MRI (specificity 92%, negative predictive value [NPV] 77%). Except one case, all enhancement resolved on subsequent imaging. Twelve months: Both modalities were available in 21 tumors. Enhancement score corresponded in 19 out of 21 cases (91%). Two cases showed enhancement on CEUS without enhancement on CECT/MRI (specificity 90%, NPV 100%). CONCLUSION This pilot study shows that CEUS is a safe imaging technique with high concordance of enhancement score between CEUS and CECT/MRI. While cross-sectional imaging seems sensible to demonstrate successful ablation at first follow-up, CEUS might be used to diminish the burden of contrast-enhanced cross-sectional imaging in the long-term follow-up.
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Affiliation(s)
- Kurdo Barwari
- Department of Urology, AMC University Hospital, University of Amsterdam, Amsterdam, The Netherlands.
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Watson KD, Hu X, Lai CY, Lindfors HA, Hu-Lowe DD, Tuthill TA, Shalinsky DR, Ferrara KW. Novel ultrasound and DCE-MRI analyses after antiangiogenic treatment with a selective VEGF receptor inhibitor. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:909-21. [PMID: 21531499 PMCID: PMC3198831 DOI: 10.1016/j.ultrasmedbio.2011.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 02/22/2011] [Accepted: 03/01/2011] [Indexed: 05/15/2023]
Abstract
We report a comparison between tumor perfusion estimates acquired using contrast-enhanced MRI and motion-corrected contrast-enhanced ultrasound before and after treatment with AG-028262, a potent vascular endothelial growth factor receptor tyrosine kinase inhibitor. Antiangiogenic activity was determined by assessing weekly ultrasound and MRI images of rats with bilateral hind flank mammary adenocarcinomas before and after treatment with AG-028262. Images were acquired with a spoiled gradient, 1.5 T magnetic resonance sequence and a destruction-replenishment ultrasound protocol. For ultrasound, a time to 80% contrast replenishment was calculated for each tumor voxel; for MR imaging, a measure of local flow rate was estimated from a linear fit of minimum to maximum intensities. AG-028262 significantly decreased tumor growth and increased the time required to replenish tumor voxels with an ultrasound contrast agent from 2.66 to 4.54 s and to fill with an MR contrast agent from 29.5 to 50.8 s. Measures of flow rate derived from MRI and ultrasound demonstrated a positive linear correlation of r2 = 0.86.
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Affiliation(s)
- Katherine D Watson
- Department of Biomedical Engineering, University of California, Davis, CA 95327, USA
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Aoki S, Hattori R, Yamamoto T, Funahashi Y, Matsukawa Y, Gotoh M, Yamada Y, Honda N. Contrast-enhanced ultrasound using a time-intensity curve for the diagnosis of renal cell carcinoma. BJU Int 2010; 108:349-54. [PMID: 21044245 DOI: 10.1111/j.1464-410x.2010.09799.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE • To evaluate the usefulness of contrast-enhanced ultrasound (CEUS) for the diagnosis of renal cell carcinoma by employing a time-intensity curve (TIC). PATIENTS AND METHODS • From May 2008 to October 2009, CEUS was performed prior to surgery in 30 patients with renal masses. • In all, 10 of the 30 patients had cystic renal masses. The final diagnoses of all patients were pathologically confirmed. Contrast enhancement as a function of time was measured in two (tumour or solid component of cystic lesions and normal parenchyma) regions of interest (ROI) and TICs were obtained. • The time to the contrast enhancement peak (TTP), intensity change from the baseline to peak (ΔI) and ΔI/TTP of the tumour and the normal parenchyma were measured from the TIC. RESULTS • Pathological diagnoses were renal cell carcinoma in 30 patients. • The TTP of the cancer was shorter than that of the normal parenchyma in all cases (6.0 ± 2.0 vs 10.4 ± 3.0 s; P < 0.0001). • The ΔI did not differ between the cancer and normal parenchyma [21.3 ± 5.9 vs 20.9 ± 7.0 decibels (db); P= 0.68]; the ΔI/TTP of the cancer was significantly higher than that of the normal parenchyma (3.9 ± 1.4 vs 2.2 ± 0.94 db/s; P < 0.0001). • TIC patterns of solid cancer and cystic cancer were very similar. CONCLUSIONS • An objective and quantitative diagnosis of renal cell carcinoma by CEUS using a second-generation ultrasound contrast agent can be made by employing a TIC. • The TIC patterns of solid and cystic cancers were very similar, despite their morphological and vascular differences. • CEUS using TIC is a promising tool in the diagnosis of cystic renal cancer.
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Affiliation(s)
- Shigeyuki Aoki
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Lagerveld BW, van Horssen P, Pes MPL, van den Wijngaard JPHM, Streekstra GJ, de la Rosette JJMCH, Wijkstra H, Spaan JAE. Immediate effect of kidney cryoablation on renal arterial structure in a porcine model studied by imaging cryomicrotome. J Urol 2010; 183:1221-6. [PMID: 20096877 DOI: 10.1016/j.juro.2009.11.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE Injury to blood microvessels has a crucial role in effective cryoablation for renal masses. We visualized vascular injury induced by a clinically applied cryoablation instrument and established a microvascular diameter threshold for vascular damage. MATERIALS AND METHODS In 5 anesthetized pigs 1 kidney each was exposed and 3, 17 gauge cryoneedles were inserted in 1 pole. Tissue was exposed to freezing for 2 x 10 minutes with a 10-minute thaw between freezes. After nephrectomy the arteries were injected with fluorescence dyed casting material and the kidney was frozen to -20C and cut in 40 to 60 micron slices in the imaging cryomicrotome, where fluorescent images of the cutting plane of the bulk were obtained. This resulted in a 3-dimensional image of the arterial tree that was segmented, resulting in unbranched vessel segments. Histograms were constructed with the total segment length per diameter bin plotted as function of diameter. RESULTS The ablated zone was sharply demarcated on fluorescent and normal light images. Mean +/- SD diameter at the peak of the histogram from control areas was 152.4 +/- 5.3 micron. Compared to control areas the peak diameter of ablated areas was shifted to a larger diameter by an average of 25.4 +/- 2.6 micron. CONCLUSIONS Immediate renal cryoablation injury destroys arteries smaller than 180 micron. Branching structures of larger arteries remain anatomically intact and connected to vascular structures in surrounding tissue.
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Affiliation(s)
- Brunolf W Lagerveld
- Department of Urology, St Lucas Andreas Hospital, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Pollard RE, Dayton PA, Watson KD, Hu X, Guracar IM, Ferrara KW. Motion corrected cadence CPS ultrasound for quantifying response to vasoactive drugs in a rat kidney model. Urology 2009; 74:675-81. [PMID: 19589583 DOI: 10.1016/j.urology.2009.01.086] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 01/12/2009] [Accepted: 01/27/2009] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To establish the ability of contrast-enhanced motion corrected cadence pulse sequencing (CPS) to detect changes in renal blood flow induced by vasoactive substances in rats. METHODS Ultrasound contrast media was administered as a constant rate infusion into a phantom at a known rate and CPS data acquired. Rats were anesthetized and predrug CPS estimates of replenishment rate were made for the right kidney. Real-time motion correction was applied, and parametric images were generated from the CPS data. Group 1 rats (n = 7) were administered a vasodilator and group 2 rats (n = 3) were administered a vasoconstrictor. The CPS imaging of the kidney was repeated after ample time for drug effects to occur. RESULTS Contrast CPS accurately estimated flow velocity in the phantom model. In addition, CPS defined statistically significant differences between pre- and postdrug blood flow in the renal medulla (vasodilator, P < .01; vasoconstrictor, P < .0001) and cortex (vasoconstrictor, P < .0001). CONCLUSIONS We conclude that motion-corrected CPS ultrasound provides real-time quantification of renal blood flow alterations and may prove useful for the assessment of blood flow in transplanted kidneys.
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Affiliation(s)
- Rachel E Pollard
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California 95616, USA.
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Gravas S, Mamoulakis C, Rioja J, Tzortzis V, de Reijke T, Wijkstra H, de la Rosette J. Advances in Ultrasound Technology in Oncologic Urology. Urol Clin North Am 2009; 36:133-45, vii. [DOI: 10.1016/j.ucl.2009.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Aigner F, Pallwein L, Mitterberger M, Pinggera GM, Mikuz G, Horninger W, Frauscher F. Contrast-enhanced ultrasonography using cadence-contrast pulse sequencing technology for targeted biopsy of the prostate. BJU Int 2009; 103:458-63. [DOI: 10.1111/j.1464-410x.2008.08038.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kimura M, Baba S, Polascik TJ. Minimally invasive surgery using ablative modalities for the localized renal mass. Int J Urol 2009; 17:215-27. [PMID: 20070411 DOI: 10.1111/j.1442-2042.2009.02445.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Due to a number of evolving devices and modalities to treat the small, localized renal mass, the physician and patient have the opportunity to choose an appropriate therapy from several treatment options. Minimally invasive surgery to ablate a localized renal tumor is an alternative strategy to nephron-sparing surgery for the small renal mass. Even though partial nephrectomy has been established as an optimal technique for nephron-sparing surgery, patients who have comorbidities and renal insufficiency would potentially benefit from less invasive treatment. With respect to those concerns, several articles are discussed here regarding thermal ablative therapy for the small renal mass along with oncological outcomes and complications among these modalities compared to conventional procedures. In this review, a comprehensive PubMed search was conducted. For the purposes of reviewing the current status of thermal ablative modalities for the small renal mass, only articles written in English published from 1992 to 2009 were considered. Cryoablation and radiofrequency ablation are the most utilized and potentially promising therapies that are evolving as nephron-sparing minimally invasive surgery for patients with a localized renal tumor. High-intensity focused ultrasound, a relatively new modality to treat the renal mass, needs further study. All modalities require long-term follow up with unified reporting methods in terms of patient selection, pre- and post-treatment evaluation, treatment description, and analysis of outcome.
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Affiliation(s)
- Masaki Kimura
- Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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