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Tanaka S, Fukuda J, Nakao M, Ioka T, Ashida R, Takakura R, Okagaki S, Katayama K, Ohkawa K, Ikezawa K, Nagata S. Effectiveness of Contrast-Enhanced Ultrasonography for the Characterization of Small and Early Stage Pancreatic Adenocarcinoma. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2245-2253. [PMID: 32527594 DOI: 10.1016/j.ultrasmedbio.2020.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
The purpose of this retrospective study is to evaluate the effectiveness of contrast-enhanced ultrasonography for the characterization of small and early stage pancreatic adenocarcinoma. Contrast-enhanced ultrasonography and contrast-enhanced computed tomography (CT) were performed in 200 cases, with pancreatic hypoechoic regions detected with ultrasonography. Assuming that hypo-enhancement was indicative of pancreatic adenocarcinoma, the sensitivity of each imaging modality was calculated. The sensitivities of contrast-enhanced ultrasonography and contrast-enhanced CT to characterize adenocarcinoma were 97.0% and 77.0% (p < 0.0001) for all 100 adenocarcinoma cases, 100% and 76.7% (p = 0.0016) for 43 small (≤20 mm) cancers, 100% and 58.3% (p = 0.0253) for 12 smaller (≤10 mm) cancers and 100% and 72.2% (p = 0.0016) for 36 stage IA cancers, respectively. The sensitivity of contrast-enhanced ultrasonography was sufficiently high and significantly superior to that of contrast-enhanced CT. Contrast-enhanced ultrasonography is a sensitive tool for selecting highly possible pancreatic adenocarcinoma lesions without overlooking early stage tiny adenocarcinomas among a large number of hypoechoic lesions detected with ultrasonography.
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Affiliation(s)
- Sachiko Tanaka
- Department of Gastrointestinal Cancer Screening and Surveillance, Osaka International Cancer Institute, Osaka, Japan.
| | - Junko Fukuda
- Department of Gastrointestinal Cancer Screening and Surveillance, Osaka International Cancer Institute, Osaka, Japan
| | - Miho Nakao
- Department of Gastrointestinal Cancer Screening and Surveillance, Osaka International Cancer Institute, Osaka, Japan
| | - Tatsuya Ioka
- Department of Gastrointestinal Cancer Screening and Surveillance, Osaka International Cancer Institute, Osaka, Japan
| | - Reiko Ashida
- Department of Gastrointestinal Cancer Screening and Surveillance, Osaka International Cancer Institute, Osaka, Japan
| | - Rena Takakura
- Health Administration Center, Sumitomo Hospital, Osaka, Japan
| | - Suetsumi Okagaki
- Department of Gastrointestinal Cancer Screening and Surveillance, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuhiro Katayama
- Department of Gastrointestinal Cancer Screening and Surveillance, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuyoshi Ohkawa
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kenji Ikezawa
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shigenori Nagata
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
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Wu S, Liu G, Cui X, Liang X, Chen K. Importance of Distending Stomach With Fluid for Ultrasound Detection of Focal Lesion in the Elongated Left Lobe of the Liver. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2553-2558. [PMID: 28656719 DOI: 10.1002/jum.14303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/17/2017] [Accepted: 03/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate distending the stomach with water for ultrasound detection of focal lesions in the elongated left lobe of the liver. METHODS A total of 13,277 patients undergoing liver ultrasound were evaluated for the presence of an elongated left lobe of the liver and a focal lesion. Patients with an elongated left lobe of the liver had their stomach distended with oral water for further evaluation of a focal lesion. A portion of the patients had computed tomography (CT) examinations, which were compared with the ultrasound studies. RESULTS A total of 643 patients were found with elongated left lobe of the liver by ultrasound; of them, 451 underwent CT, 259 out of the 451 patients meeting the inclusion criteria underwent second ultrasound and final analysis, and 16 of these 259 patients had focal lesion in the elongated left lobe of the liver on CT study. The sonographic visualization of the liver and spleen at the same scan view before and after distending the stomach were 7% (7 of 100) and 100% (100 of 100), respectively (P < .001). The sonographic detection of the lesions before and after distending the stomach were zero and 87.5%, respectively (P < .001). CONCLUSIONS Distending the stomach with water can greatly increase ultrasound detection of focal lesions in the elongated left lobe of the liver.
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Affiliation(s)
- Size Wu
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical College, Haikou, China
| | - Guangqing Liu
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical College, Haikou, China
| | - Xiaojing Cui
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical College, Haikou, China
| | - Xian Liang
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical College, Haikou, China
| | - Kailiang Chen
- Department of Ultrasound, the First Affiliated Hospital of Hainan Medical College, Haikou, China
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Marsico M, Gabbani T, Casseri T, Biagini MR. Factors Predictive of Improved Abdominal Ultrasound Visualization after Oral Administration of Simethicone. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2532-2537. [PMID: 27481017 DOI: 10.1016/j.ultrasmedbio.2016.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 06/02/2016] [Accepted: 06/06/2016] [Indexed: 06/06/2023]
Abstract
Ultrasonography is a non-invasive, accurate and low-cost technique used to study the upper abdomen, but it has reduced reliability in the study of the pancreas and retroperitoneum. Simethicone is a well-known emulsifying agent that has been used to improve ultrasonographic visualization. The aim of this study was to identify anthropometric parameters that are able to predict a good response to simethicone in improving ultrasonographic visualization of abdominal structures. One hundred twenty-seven patients were recruited. After basal examination, their anthropometric parameters were collected. Patients with an incomplete upper abdominal examination because of gastrointestinal gas have greater body mass index, waist circumference and abdominal wall thickness. In our study, the best anthropometric parameter for identifying patients with poor visualization at abdominal ultrasound examination is waist circumference. Using a cutoff of 84 cm, we can identify patients with poor visibility at abdominal ultrasound examination (group B) with a sensitivity of 90%.
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Affiliation(s)
- Maria Marsico
- Division of Gastroenterology, AOU Modena University Hospital, Modena, Italy
| | - Tommaso Gabbani
- Oncology Department, Division of Gastroenterology, AOU Careggi University Hospital, Florence, Italy.
| | - Tommaso Casseri
- Division of Radiology, AOU Senese, Siena University Hospital, Siena, Italy
| | - Maria Rosa Biagini
- Oncology Department, Division of Gastroenterology, AOU Careggi University Hospital, Florence, Italy
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Comparison of 2 oral ultrasonography contrast agents: simethicone-coated cellulose and simethicone-water rotation in improving pancreatic visualization. Ultrasound Q 2014; 30:135-8. [PMID: 24850028 DOI: 10.1097/ruq.0000000000000052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to prospectively compare the efficacy of 2 oral ultrasonography (US) contrast agents (simethicone-water rotation [SWR] and simethicone-coated cellulose [SCC]) in improving visualization of the pancreas. METHODS Two sessions (SWR and SCC) of transabdominal US studies were performed on 38 healthy volunteers. In each session, US images were obtained in precontrast supine and upright positions and postcontrast supine and upright positions. The visualization of the pancreas was graded on a scale of 1 to 5 (1 = nonvisualization, 5 = excellent visualization), grading the head, body, and tail separately. RESULTS In the supine position, SWR significantly improved the visualization of the pancreatic head, body, and tail, whereas there were no significant differences between SCC and precontrast images. Simethicone-water rotation showed significantly better visualization than SCC. The average scores of the head, body, and tail of the pancreas that graded 4 or more were 15.8% of precontrast, 21.1% of SCC, and 50% of SWR. In the upright position, both SWR and SCC significantly improved the visualization of the pancreas, except for the pancreatic body on SCC. There were no significant differences between SWR and SCC. The average scores that graded 4 or more were 26.3% of precontrast, 57.9% of SCC, and 65.8% of SWR. CONCLUSION Simethicone-water rotation was more effective than SCC in improving the visualization of the pancreas.
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Approach to improving sonographic visualization of elongated left lobe of the liver and its implications. J Med Ultrason (2001) 2013; 40:425-8. [PMID: 27277456 DOI: 10.1007/s10396-013-0447-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 03/26/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine whether visualization of the elongated left lobe of the liver can be improved by distending the stomach with water and the implications of this technique. METHODS Forty-three out of 87 patients with elongated left lobe of the liver found at abdominal CT were included in this study after obtaining informed consent. Their livers were examined using ultrasound before and after drinking water. The left lobe of the liver was scanned from the subxiphoid and left subcostal approaches, with the sound beam directed to the spleen and the left lobe of the liver neighboring or behind the stomach; the elongated left lobe of the liver overlying the spleen was detected by scanning from the 9th-11th intercostal approach of the left flank. RESULTS The overall visualization of the elongated left lobe of the liver before and after filling the stomach with water was 4.7 % (2/43) and 100.0 % (43/43), respectively (P < 0.001); and the overall visualization of the spleen before and after filling the stomach with water was 4.7 % (2/43) and 100.0 % (43/43), respectively (P < 0.001). CONCLUSION Distending the stomach with sufficient water can substantially improve visualization of elongated left lobe of the liver at ultrasound, potentially improving detection of tumors in the liver and preventing misdiagnosis.
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Maconi G, Bolzacchini E, Radice E, Marzocchi M, Badini M. Alpha-galactosidase versus active charcoal for improving sonographic visualization of abdominal organs in patients with excessive intestinal gas. J Ultrasound 2012; 15:232-8. [PMID: 23730387 DOI: 10.1016/j.jus.2012.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
UNLABELLED Intestinal gas is a frequent cause of poor visualization during gastrointestinal ultrasound (US). The enzyme alpha-galactosidase may reduce intestinal gas production, thereby improving abdominal US visualization. We compared the efficacies of alpha-galactosidase and active charcoal in improving US visualization in patients with previous unsatisfactory abdominal US scans caused by excessive intestinal gas. MATERIALS AND METHODS 45 patients with poor visualization of at least one target organ: pancreas, hepatic lobes (score 0-2) or common bile duct (CBD) (score 0-1) were enrolled in a prospective randomized, crossover, observer-blinded study. The patients received alpha-galactosidase (Sinaire Forte, Promefarm, Milan, Italy) 600 GalU t.i.d. for 2 days before abdominal US plus 900 GalU the morning of exam or active charcoal 448 mg t.i.d., for 2 days before the exam plus 672 mg the morning of the exam. Visualization was graded as follows: 0 = none (complete gas interference); 1 = severe interference, 2 = moderate interference, 3 = mild interference; 4 = complete (no gas interference). RESULTS 42 patients completed the study. Both alpha-galactosidase and active charcoal improved the visualization of target organs. Visualization of the right hepatic lobe, CBD and pancreatic tail was significantly improved (vs. baseline) only by alpha-galactosidase (p < 0.01). Scores ≥3 for all parts of the pancreas and both hepatic lobes were achieved in only 12.5% of the patients after both treatments. Both products were well tolerated. CONCLUSION Alpha-galactosidase and active charcoal can improve US visualization of abdominal organs in patients whose scans are frequently unsatisfactory due to excessive intestinal gas. Visualization of the pancreatic tail and right hepatic lobe was significantly improved only by alpha-galactosidase. However, both treatments allowed adequate visualization of all target organs during the same examination only in a few patients.
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Affiliation(s)
- G Maconi
- Chair of Gastroenterology, Department of Clinical Sciences, L. Sacco University Hospital, Milan, Italy
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Pinto PNV, Chojniak R, Cohen MP, Yu LS, Queiroz-Andrade M, Bitencourt AGV. Comparison of three types of preparations for abdominal sonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:203-208. [PMID: 21337584 DOI: 10.1002/jcu.20790] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 11/24/2010] [Indexed: 05/30/2023]
Abstract
PURPOSE The purpose of this randomized, prospective study was to evaluate the effect of three preparation types on the abdominal sonographic examination quality and on patient acceptance. METHODS Examinations were performed on 611 patients in the imaging department of a referral oncology center. Patients were divided into three groups: preparation with fasting, water, laxatives, and antiflatulents (Group I), preparation with fasting, water, and antiflatulents alone (Group II), or preparation with fasting and water alone (Group III). The examination quality was evaluated both objectively through grades and subjectively through impressions. Statistical significance was set at the p ≤ 0.05 level. RESULTS No difference in examination quality was seen among patients with or without medication. Improved visualization of the retroperitoneum in the mid abdomen was observed among Group I patients. Patients in Groups II and III displayed fewer side effects. Other variables, such as obesity and increased abdominal wall thickness, also impacted the image quality. CONCLUSIONS Visualization of the abdominal organs was satisfactory even in patients who had only fasted and received water. The use of laxative and antiflatulent preparations is not required before routine abdominal ultrasound examinations.
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Affiliation(s)
- Paula N V Pinto
- Department of Diagnostic Imaging, Hospital A C Camargo, Rua Prof. Antônio Prudente, 211, 01509-010, São Paulo SP, Brazil
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R. Babić R, Bašić B, Govedarović K, Đinđić B, Stanković Babić G, Marković Perić S. EXCRETORY UROGRAPHY IN PATIENTS PREPARED BY SIMETHICON (ESPUMISAN®). ACTA MEDICA MEDIANAE 2011. [DOI: 10.5633/amm.2011.0107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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R. Babić R, Bašić B, Govedarović K, Đinđić B, Stanković Babić G, Marković Perić S. INTRAVENSKA UROGRAFIJA POSLE PRIPREME BOLESNIKA SIMETHICON-OM (ESPUMISAN® ). ACTA MEDICA MEDIANAE 2011. [DOI: 10.5633/amm.2011.0107s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Tongprasert S, Sobhonslidsuk A, Rattanasiri S. Improving quality of colonoscopy by adding simethicone to sodium phosphate bowel preparation. World J Gastroenterol 2009; 15:3032-7. [PMID: 19554657 PMCID: PMC2702112 DOI: 10.3748/wjg.15.3032] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effectiveness of simethicone in enhancing visibility and efficacy during colonoscopy.
METHODS: A prospective, double-blind, randomized, placebo-controlled study was conducted. One hundred and twenty-four patients were allocated to receive 2 doses of sodium phosphate plus 240 mg of tablet simethicone or placebo as bowel preparation. Visibility was blindly assessed for the amount of air bubbles and adequacy of colon preparation. Total colonoscopic time, side effects of the medication, endoscopist and patient satisfaction were also compared.
RESULTS: Sodium phosphate plus simethicone, compared to sodium phosphate plus placebo, improved visibility by diminishing air bubbles (100.00% vs 42.37%, P < 0.0001) but simethicone failed to demonstrate improvement in adequacy of colon preparation (90.16% vs 81.36%, P = 0.17). Endoscopist and patient satisfaction were increased significantly in the simethicone group. However, there was no difference in the total duration of colonoscopy and side effects of the medication.
CONCLUSION: The addition of simethicone is of benefit for colonoscopic bowel preparation by diminishing air bubbles, which results in enhanced visibility. Endoscopist and patient satisfaction is also increased.
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