1
|
Schauer MI, Jung EM, Platz Batista da Silva N, Akers M, Loch E, Markowiak T, Piler T, Larisch C, Neu R, Stroszczynski C, Hofmann HS, Ried M. Intraoperative Contrast-Enhanced Ultrasonography (Io-CEUS) in Minimally Invasive Thoracic Surgery for Characterization of Pulmonary Tumours: A Clinical Feasibility Study. Cancers (Basel) 2023; 15:3854. [PMID: 37568670 PMCID: PMC10417103 DOI: 10.3390/cancers15153854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/19/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The intraoperative detection of solitary pulmonary nodules (SPNs) continues to be a major challenge, especially in minimally invasive video-assisted thoracic surgery (VATS). The location, size, and intraoperative frozen section result of SPNs are decisive regarding the extent of lung resection. This feasibility study investigates the technical applicability of intraoperative contrast-enhanced ultrasonography (Io-CEUS) in minimally invasive thoracic surgery. METHODS In this prospective, monocentric clinical feasibility study, n = 30 patients who underwent Io-CEUS during elective minimally invasive lung resection for SPNs between October 2021 and February 2023. The primary endpoint was the technical feasibility of Io-CEUS during VATS. Secondary endpoints were defined as the detection and characterization of SPNs. RESULTS In all patients (female, n = 13; mean age, 63 ± 8.6 years) Io-CEUS could be performed without problems during VATS. All SPNs were detected by Io-CEUS (100%). SPNs had a mean size of 2.2 cm (0.5-4.5 cm) and a mean distance to the lung surface of 2.0 cm (0-6.4 cm). B-mode, colour-coded Doppler sonography, and contrast-enhanced ultrasound were used to characterize all tumours intraoperatively. Significant differences were found, especially in vascularization as well as in contrast agent behaviour, depending on the tumour entity. After successful lung resection, a pathologic examination confirmed the presence of lung carcinomas (n = 17), lung metastases (n = 10), and benign lung tumours (n = 3). CONCLUSIONS The technical feasibility of Io-CEUS was confirmed in VATS before resection regarding the detection of suspicious SPNs. In particular, the use of Doppler sonography and contrast agent kinetics revealed intraoperative specific aspects depending on the tumour entity. Further studies on Io-CEUS and the application of an endoscopic probe for VATS will follow.
Collapse
Affiliation(s)
- Martin Ignaz Schauer
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Ernst-Michael Jung
- Institute for Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (N.P.B.d.S.); (M.A.); (C.S.)
| | - Natascha Platz Batista da Silva
- Institute for Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (N.P.B.d.S.); (M.A.); (C.S.)
| | - Michael Akers
- Institute for Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (N.P.B.d.S.); (M.A.); (C.S.)
| | - Elena Loch
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Till Markowiak
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Tomas Piler
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Christopher Larisch
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Reiner Neu
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Christian Stroszczynski
- Institute for Radiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (N.P.B.d.S.); (M.A.); (C.S.)
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (T.P.); (C.L.); (H.-S.H.); (M.R.)
| |
Collapse
|
2
|
Osmanodja B, Muench F, Holderied A, Budde K, Fischer T, Lerchbaumer MH. Assessment of Renal Transplant Perfusion by Contrast-Enhanced Ultrasound after Switch from Calcineurin Inhibitor to Belatacept: A Pilot Study. J Clin Med 2022; 11:jcm11154354. [PMID: 35955971 PMCID: PMC9368965 DOI: 10.3390/jcm11154354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 02/01/2023] Open
Abstract
Calcineurin inhibitors (CNIs) have improved short-term kidney allograft survival but are nephrotoxic and vasoconstrictive. Vasoconstriction is potentially reversible after switching from CNIs to belatacept. The kidney allograft shows optimal requirements for dynamic perfusion imaging using contrast-enhanced ultrasound (CEUS). We performed standardized CEUS in patients after switching from CNIs to belatacept for clinical indication to study the suitability of CEUS, in order to assess the effects of CNI cessation on kidney allograft perfusion. Eleven kidney transplant patients were enrolled from February 2020 until November 2020. Demographic, clinical, and laboratory parameters, as well as perfusion imaging, were assessed at baseline and 6 months after switching immunosuppression. Quantification of perfusion imaging on CEUS was performed using a post-processing software tool on uncompressed DICOM cine loops. After CNI cessation, estimated glomerular filtration rate increased by 4.8 mL/min/1.73 m2 (16%). Despite good quality of fit and comparable regions of interest in baseline and follow-up CEUS examinations, quantification of perfusion imaging showed a slightly improved cortical perfusion without reaching statistical significance after CNI cessation. This is the first study that systematically investigates the suitability of CEUS to detect changes of microvascular perfusion in kidney transplant recipients in vivo. No significant differences could be detected in perfusion measurements before and after CNI cessation.
Collapse
Affiliation(s)
- Bilgin Osmanodja
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (F.M.); (A.H.); (K.B.)
- Correspondence: ; Tel.: +49-30-450-614-368
| | - Frédéric Muench
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (F.M.); (A.H.); (K.B.)
| | - Alexander Holderied
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (F.M.); (A.H.); (K.B.)
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (F.M.); (A.H.); (K.B.)
| | - Thomas Fischer
- Department of Radiology, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (T.F.); (M.H.L.)
| | - Markus Herbert Lerchbaumer
- Department of Radiology, Charité–Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; (T.F.); (M.H.L.)
| |
Collapse
|
3
|
Platz Batista da Silva N, Engeßer M, Hackl C, Brunner S, Hornung M, Schlitt HJ, Evert K, Stroszczynski C, Jung EM. Intraoperative Characterization of Pancreatic Tumors Using Contrast-Enhanced Ultrasound and Shear Wave Elastography for Optimization of Surgical Strategies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1613-1625. [PMID: 33124700 DOI: 10.1002/jum.15545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/31/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate intraoperative contrast-enhanced ultrasound (IoCEUS) and intraoperative shear wave elastography (IoSWE) for characterization of focal pancreatic lesions (FPLs) in correlation with postoperative histologic results. Thereby, the impact of intraoperative ultrasound (US) on pancreas surgery was evaluated. METHODS Intraoperative CEUS and SWE data from 54 patients, who underwent pancreas surgery between 2017 and 2019, were analyzed retrospectively. Ultrasound examinations were performed with multifrequency linear/T-shaped transducers (3-9 MHz) on a high-end US device (LOGIQ E9; GE Healthcare, Chicago, IL). To analyze FPL stiffness by SWE, regions of interest were placed to measure the shear wave speed (meters per second) and stiffness (kilopascals). After intravenous bolus injections of 2.4 to 10 mL of sulfur hexafluoride microbubbles, a dynamic analysis of FPL microvascularization from arterial to late phases was performed using IoCEUS considering hypoenhancement/irregular vascularization of macrocystic/small solid FPL malignancy criteria. Ultrasound findings were correlated with postoperative histologic results. The impact of intraoperative US on surgery was documented in each case. RESULTS Of 54 FPLs, IoCEUS could correctly characterize 39 of 39 malignant and 6 of 15 benign FPLs; IoSWE 29 of 39 as malignant and 7 of 15 as benign. Intraoperative CEUS's sensitivity was 100%; specificity, 40%; accuracy, 83.3%; positive predictive value, 81.3%; and negative predictive value, 100% (P < .05). Applying cutoff values of 3 m/s and 28.7 kPa, SWE's sensitivity was 74.4%; specificity, 46.7%; accuracy, 66.7%; positive predictive value; 78.4%; and negative predictive value, 41.2% for cancer detection (P < .05). The combined use of both techniques showed an accuracy rate of 76%, sensitivity of 74.4%, and specificity of 33.3%. In 29.6%, US results had an immediate impact on surgery. CONCLUSIONS Intraoperative SWE and CEUS are highly valuable techniques for intraoperative characterization of FPLs. Although IoCEUS proved to be superior to IoSWE, the combined use can be helpful in particular cases.
Collapse
Affiliation(s)
| | - Maria Engeßer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Christina Hackl
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Brunner
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Matthias Hornung
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Hans J Schlitt
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Katja Evert
- Department of Pathology, University Hospital Regensburg, Regensburg, Germany
| | | | - Ernst Michael Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
4
|
Therapeutic response monitoring after targeted therapy in an orthotopic rat model of hepatocellular carcinoma using contrast-enhanced ultrasound: Focusing on inter-scanner, and inter-operator reproducibility. PLoS One 2020; 15:e0244304. [PMID: 33362203 PMCID: PMC7757904 DOI: 10.1371/journal.pone.0244304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/03/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To assess therapeutic response monitoring after targeted therapy in an orthotopic rat model of hepatocellular carcinoma (HCC) using CEUS with focusing on inter-scanner and inter-operator reproducibility. Materials and methods For reproducibility, CEUS was performed using two different US scanners by two operators in sixteen rat models of HCC. Using perfusion analysis software (VueBox ®), eleven parameters were collected, and intra-class correlation coefficient (ICC) was used to analyze reproducibility. Then seventeen rat models of HCC were divided into treatment group (n = 8, 30 mg/kg/day sorafenib for five days) and control group (n = 9). CEUS was performed at baseline and 14 days after first treatment, and changes of perfusion parameters were analyzed. Results In treatment group, CEUS perfusion parameters showed a significant change. The peak enhancement (PE, 2.50 x103±1.68 x103 vs 5.55x102±4.65x102, p = 0.010) and wash-in and wash out AUC (WiWoAUC, 1.07x105±6.48 x104 vs 2.65x104±2.25x104, p = 0.009) had significantly decreased two weeks after treatment. On the contrary, control group did not show a significant change, including PE (1.15 x103±7.53x102 vs 9.43x102± 7.81 x102, p = 0.632) and WiWoAUC (5.09 x104±3.25x104 vs 5.92 x104±3.20x104, p = 0.646). For reproducibility, the various degrees of inter-scanner reproducibility were from poor to good (ICC: <0.01–0.63). However, inter-operator reproducibility of important perfusion parameters, including WiAUC, WoAUC, and WiWoAUC, ranged from fair to excellent (ICC: 0.59–0.93) in a different scanner. Conclusion Our results suggest that CEUS is useful for assessment of the treatment response after targeted therapy and with fair to excellent inter-operator reproducibility.
Collapse
|
5
|
Dong Y, Xu B, Cao Q, Zhang Q, Qiu Y, Yang D, Yu L, Wang WP. Incidentally detected focal fundal gallbladder wall thickening: Differentiation contrast enhanced ultrasound features with high-resolution linear transducers. Clin Hemorheol Microcirc 2020; 74:315-325. [PMID: 31524151 DOI: 10.3233/ch-190697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM To investigate the value of contrast enhanced ultrasound with high resolution linear transducers (HF-CEUS) for differential diagnosis of focal fundal gallbladder (GB) wall thickening. METHODS A total of 32 patients with incidentally detected focal fundal GB wall thickening were included. After conventional B mode ultrasound (BMUS) examinations, HF-CEUS were performed with a 7.5-12 MHz 9L4 linear transducer (S2000 HELX OXANA unit, Siemens). Two radiologists independently reviewed the HF-CEUS enhancement patterns to determine the differential features between malignancy and benignity with a five-point confidence scale. The diagnostic accuracy of BMUS and HF-CEUS for GB wall thickening was compared. The final gold standard was surgery with histological examination. RESULTS Final diagnoses included GB adenocarcinoma (n = 16), adenomyomatosis (n = 12), Xanthogranulomatous (n = 2) and cholecystitis (n = 2). HF-CEUS features associated with GB adenocarcinoma including arterial phase inhomogeneous hyperenhancement, venous phase hypoenhancement and disruption of GB wall layer structure (P < 0.05). Two small (5 mm) liver metastasis were confirmed by HF-CEUS during the late phase liver sweep as hypoenhanced lesions. Nonenhanced Rokitansky-Aschoff sinuses were clearly observed in 83.3% focal adenomyomatosis. Overall sensitivity, specificity and accuracy for differentiation between malignant and benign focal fundal GB wall thickening of HF-CEUS and BMUS were 84.3% vs 53.1%, 90.6% vs 59.3% and 87.5% vs 56.2% (P < 0.005). CONCLUSIONS CEUS performed with high frequency linear transducers could be a useful alternative in the differential diagnosis of focal fundal GB wall thickening on conventional ultrasound.
Collapse
Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Benhua Xu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiong Cao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Zhang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yijie Qiu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daohui Yang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lingyun Yu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
6
|
Dong Y, Liu L, Cao Q, Zhang Q, Qiu Y, Yang D, Yu L, Wang WP. Differential diagnosis of focal gallbladder lesions: The added value of contrast enhanced ultrasound with liner transducers. Clin Hemorheol Microcirc 2020; 74:167-178. [PMID: 31306115 DOI: 10.3233/ch-190639] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM To evaluate the benefits of contrast-enhanced ultrasound (CEUS) with high frequency transducers in characterization of focal gallbladder lesions (FGL). MATERIAL AND METHODS From January 2017 to April 2019, 59 FGL detected by B mode ultrasound (BMUS) were examined, first with the low frequency convex transducer (1-5 MHz) and afterwards with high frequency transducer (7.5-12 MHz). High frequency dynamic CEUS were applied after bolus injection of 4.8 ml Sulphur hexafluoride microbubbles (SonoVue®, Milan). The BMUS and CEUS imaging features were recorded and compared. All lesions were confirmed by surgical resection and histopathologic results. RESULTS The final diagnoses of 59 FGL included gallbladder adenocarcinoma (n = 15), gallbladder polyps (n = 11), gallbladder adenomas (n = 18), focal adenomyomatosis (n = 9), and gallbladder Ascariasis debris (n = 6). The mean diameter of FGL was 24.5±11.4 mm, and mean depth to the abdominal wall was 21.2±7.3 mm. While applying CEUS with high frequency transducer, specific diagnostic features, including arterial phase irregular intralesional vascularity (10/15, 66.7%), late phase hypoenhancement (12/15, 80%), destruction of gallbladder wall (8/15, 53.3%), infiltration to the adjacent liver (6/15, 40.0%) were significantly higher in malignant FGL. The overall sensitivity, specificity and diagnostic accuracy for the correct characterization of malignant FGL were significantly improved by CEUS with high frequency transducer (sensitivity 93.3%, specificity 88.5%, accuracy 100%). CONCLUSION With its superior contrast resolution, CEUS performed with high frequency transducers is helpful to achieve better visualization of gallbladder fundus and make differential diagnosis of gallbladder lesions, which might greatly improve diagnostic confidence between malignant and benign FGL.
Collapse
Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lingxiao Liu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiong Cao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Zhang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yijie Qiu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daohui Yang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lingyun Yu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
7
|
[Role of the radiologist in surgery of colorectal liver metastases : What should be removed and what must remain]. Radiologe 2019; 59:791-798. [PMID: 31410495 DOI: 10.1007/s00117-019-0577-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The radical resection of colorectal liver metastases is the only curative option for affected patients. If properly performed, surgery provides the chance of long-term tumor-free survival. OBJECTIVE Summary of the critical interaction points between radiology and surgery in the planning and performance of (complex) liver resections. RESULTS There are many interaction points between radiology and surgery in the treatment of patients with colorectal liver metastases. Radiology supports surgery by providing detailed information of the localization of metastases, information on liver inflow and outflow as well as basic information on liver quality and function. Perioperatively, it provides interventional treatment options for postoperative complications as well as ablation of non-resectable metastases. CONCLUSION Complex liver resections can only be performed properly and successfully after thorough planning by an interdisciplinary board of surgeons, radiologists and associated disciplines.
Collapse
|
8
|
Putz FJ, Verloh N, Erlmeier A, Schelker RC, Schreyer AG, Hautmann MG, Stroszczynski C, Banas B, Jung EM. Influence of limited examination conditions on contrast-enhanced sonography for characterising liver lesions. Clin Hemorheol Microcirc 2019; 71:267-276. [DOI: 10.3233/ch-189417] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Franz J. Putz
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Niklas Verloh
- Department of Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - Anna Erlmeier
- Department of Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - Roland C. Schelker
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Andreas G. Schreyer
- Department of Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | | | - Christian Stroszczynski
- Department of Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Banas
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Ernst M. Jung
- Department of Radiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
9
|
Qin S, Chen Y, Liu XY, Cheng WJ, Yu JL, Zhang WJ, Jiang QL, Wang YM, Wen YL, Liu GJ. Clinical Application of Contrast-Enhanced Ultrasound Using High-Frequency Linear Probe in the Detection of Small Colorectal Liver Metastases. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2765-2773. [PMID: 29037844 DOI: 10.1016/j.ultrasmedbio.2017.08.932] [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: 02/28/2017] [Revised: 07/28/2017] [Accepted: 08/10/2017] [Indexed: 06/07/2023]
Abstract
To compare the performance of contrast-enhanced ultrasound (CEUS) using high-frequency linear and convex probes in the detection of small colorectal liver metastases (CRLMs). A total of 85 patients with 143 small CRLMs were evaluated. High-frequency ultrasound (US) and CEUS detected significantly more superficial lesions within 60 mm below the skin than a convex probe (p <0.05). The detection rate decreased in the chemotherapy group, especially when using a convex probe for US (p <0.05). By combining convex and linear probes, detection rates of US and CEUS were significantly higher than that of a convex or a linear probe alone (p <0.05). High-frequency US and CEUS helped to improve detection of small CRLMs and reduce the influence of chemotherapy. For patients with a high risk of CRLMs and those after chemotherapy, we recommend first scanning the liver by using a convex probe and subsequently screening the surface area of the liver and suspicious small lesions by using a linear probe.
Collapse
Affiliation(s)
- Si Qin
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yao Chen
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xiao-Yin Liu
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wen-Jie Cheng
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jun-Li Yu
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wen-Jing Zhang
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Qing-Ling Jiang
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yi-Min Wang
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yan-Ling Wen
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Guang-Jian Liu
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
| |
Collapse
|
10
|
da Silva NPB, Beyer L, Hottenrott M, Hackl C, Schlitt H, Stroszczynski C, Wiggermann P, Jung E. Efficiency of contrast enhanced ultrasound for immediate assessment of ablation status after intraoperative radiofrequency ablation of hepatic malignancies. Clin Hemorheol Microcirc 2017; 66:357-368. [DOI: 10.3233/ch-179112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - L.P. Beyer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - M.C. Hottenrott
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - C. Hackl
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - H.J. Schlitt
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - C. Stroszczynski
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - P. Wiggermann
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - E.M. Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
11
|
Zhao CK, Xu HX, Guo LH, Sun LP, Yu M. A primary hepatic angiosarcoma mimicking intrahepatic cholangiocarcinoma on conventional ultrasound and contrast-enhanced ultrasound: A case report and review of literatures. Clin Hemorheol Microcirc 2017; 66:7-14. [PMID: 27814287 DOI: 10.3233/ch-16212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Mei Yu
- Department of Medical Ultrasound, Shanghai Dahua Hospital, Shanghai, China
| |
Collapse
|
12
|
Platz Batista da Silva N, Schauer M, Hornung M, Lang S, Beyer LP, Wiesinger I, Stroszczynski C, Jung EM. Intrasurgical dignity assessment of hepatic tumors using semi-quantitative strain elastography and contrast-enhanced ultrasound for optimisation of liver tumor surgery. Clin Hemorheol Microcirc 2017; 64:735-745. [PMID: 27767982 DOI: 10.3233/ch-168029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the efficacy of strain elastography (SE) using semi-quantitative measurement methods compared to constrast enhanced ultrasound during liver tumor surgery (Io-CEUS) for dignity assessment of focal liver lesions(FLL). MATERIAL AND METHODS Prospective data acquisition and retrospective analysis of US data of 100 patients (116 lesions) who underwent liver tumor surgery between 10/2010 and 03/2016. Retrospective reading of SE color patterns was performed establishing groups depending on dominant color (>50% blue = stiff, inhomogenous, >50% yellow/red/green = soft tissue). Semi-quantitative analysis was performed by Q-analysis based on a scale from 0 (soft) to 6 (stiff). 2 ROIs were placed centrally, 5 ROIs in the lesion's surrounding tissue. Io-CEUS was performed by bolus injection of 5-10 ml sulphurhexaflourid microbubbles evaluating wash-in- and -out- kinetics in arterial, portal venous and late phase. Histopathology after surgical resection served as goldstandard. RESULTS 100 patients (m: 65, f: 35, mean age 60.5 years) with 116 liver lesions were included. Lesion's size ranged from 0.5 to 8.4 cm (mean 2.42 cm SD±1.44 cm). Postoperative histology showed 105 malignant and 11 benign lesions. Semi-quantitative analysis showed central indurations of >2.5 in 76/105 cases suggesting malignancy. 7 benign lesions displayed no central indurations correctly characterized benign by SE. ROC-analysis and Youden index showed a sensitivity of 72.4% and specificity of 63.6% assuming a cut-off of 2.5. Io-CEUS correctly characterized 103/105 as malignant. Sensitivity was 98%, specificity 72.7%. CONCLUSION Strain elastography is a valuable tool for non-invasive characterization of FLLs. Semi-quantitative intratumoral stiffness values of >2.5 suggested malignancy. However, sensitivity of Io-CEUS in detecting malignant lesions was higher compared to SE. In conclusion SE should be considered for routine use during intraoperative US in addition to Io-CEUS for optimization of curative liver surgery.
Collapse
Affiliation(s)
| | - M Schauer
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M Hornung
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S Lang
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - L P Beyer
- Departement of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - I Wiesinger
- Departement of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - C Stroszczynski
- Departement of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - E M Jung
- Departement of Radiology, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
13
|
Abstract
CLINICAL/METHODICAL ISSUE For diagnostic and interventional procedures ultrasound (US) image fusion can be used as a complementary imaging technique. METHODICAL INNOVATIONS Image fusion has the advantage of real time imaging and can be combined with other cross-sectional imaging techniques. PERFORMANCE With the introduction of US contrast agents sonography and image fusion have gained more importance in the detection and characterization of liver lesions. ACHIEVEMENTS Fusion of US images with computed tomography (CT) or magnetic resonance imaging (MRI) facilitates the diagnostics and postinterventional therapy control. PRACTICAL RECOMMENDATIONS In addition to the primary application of image fusion in the diagnosis and treatment of liver lesions, there are more useful indications for contrast-enhanced US (CEUS) in routine clinical diagnostic procedures, such as intraoperative US (IOUS), vascular imaging and diagnostics of other organs, such as the kidneys and prostate gland.
Collapse
Affiliation(s)
- E M Jung
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg (UKR), Regensburg, Deutschland
| | - D-A Clevert
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
| |
Collapse
|
14
|
Wu Q, Wang Y, Li Y, Hu B, He ZY. Diagnostic value of contrast-enhanced ultrasound in solid thyroid nodules with and without enhancement. Endocrine 2016; 53:480-8. [PMID: 26732040 DOI: 10.1007/s12020-015-0850-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/17/2015] [Indexed: 01/20/2023]
Abstract
We aimed to investigate different enhancement patterns of solid thyroid nodules on contrast-enhanced ultrasound (CEUS) and then to evaluate the corresponding diagnostic performance in the differentiation of benign and malignant nodules with and without enhancement. 229 solid thyroid nodules in 196 patients who had undergone both conventional ultrasound and CEUS examinations were classified into enhancement and non-enhancement groups. Besides, different enhancement patterns in the enhancement group were characterised with five indicators including arrival time, mode of entrance, echo intensity, homogeneity, and washout time. Then aforementioned indicators were compared between benign and malignant nodules of different sizes (<10 mm and >10 mm), and diagnostic performance of significant enhancement indicators was calculated. As for the enhancement group, there were statistically significant differences of <10 mm subgroup among three CEUS indicators including arrival time, mode of entrance, and washout time between malignant and benign thyroid nodules (p < 0.05), while all CEUS indicators showed statistically significant differences in the total group and ≥10 mm subgroup (p < 0.05). All the five CEUS indicators displayed better diagnostic performance with specificity (92.86, 92.14, 95.71, 90.71, and 90.71 %, respectively) and diagnostic accuracy (80.79, 79.48, 74.67, 75.11, and 81.66 %, respectively), while the sensitivity and negative predictive value of non-enhancement were 95.51 and 95.83 %, respectively, with an accuracy of 77.29 %. CEUS is a very promising diagnostic technique that could improve the diagnostic accuracy of identifying benign thyroid lesions to spare a large number of patients an unnecessary invasive procedure.
Collapse
Affiliation(s)
- Qiong Wu
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Yan Wang
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
| | - Yi Li
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Zhi-Yan He
- Department of Radiology, Shanghai Jiao Tong University Affiliated First People's Hospital, Shanghai, China
| |
Collapse
|
15
|
Pschierer K, Grothues D, Rennert J, da Silva NPB, Schreyer AG, Melter M, Stroszczysnski C, Jung EM. Evaluation of the diagnostic accuracy of CEUS in children with benign and malignant liver lesions and portal vein anomalies. Clin Hemorheol Microcirc 2016; 61:333-45. [PMID: 26444615 DOI: 10.3233/ch-152003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Comparison of the diagnostic findings of MRI, CT and CEUS in children with benign and malignant and portal venous anomalies of the liver. MATERIALS/METHODS Retrospective analysis of the diagnostic findings of CEUS, MRI and CT scans in 56 children (age 0-17 years) with a total of 60 benign and malignant liver lesions and anomalies of the portal vein/perfusion. All patients underwent CEUS using sulphur hexafluoride microbubbles and a multi-frequency probe (1-5 MHz, 6-9 MHz). Cine-loops were stored up to 3 minutes. MRI was performed in 38 lesions. CT was performed in 8 lesions. RESULTS Out of the 56 patients 49 liver lesions (48 benign, 1 malignant), 9 anomalies of the portal vein/perfusion and 2 of the biliary system were detected. 16/49 lesions were analyzed histopathologically. Using CEUS, the characterization of the lesions was possible in 45 out of 49 cases. In 32 cases, CEUS provided the exact diagnosis. Only two benign lesions were falsely categorized as malignant.Findings of MRI and CEUS were concordant in 84% of cases (n = 32/38). CEUS considered 1 benign lesion to be malignant. 2 lesions were not detectable and in 3 lesions no definite diagnosis was established using MRI.Findings of CT and CEUS were concordant in 5 of 8 cases. In 21 lesions CEUS as the only imaging modality was found to be sufficient for diagnostics. CONCLUSION Despite the restricted indications for using CEUS in children, it offers a high diagnostic detection rate (93%) for characterization of liver lesions and portal vein anomalies.
Collapse
Affiliation(s)
- K Pschierer
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany
| | - D Grothues
- Department of Paediatrics and Juvenile Medicine (KUNO), University Hospital Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany
| | - J Rennert
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany
| | - N Platz Batista da Silva
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany
| | - A G Schreyer
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany
| | - M Melter
- Department of Paediatrics and Juvenile Medicine (KUNO), University Hospital Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany
| | - C Stroszczysnski
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany
| | - E M Jung
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany
| |
Collapse
|
16
|
Ren WP, Yu MH, Xu P. Contrast-enhanced ultrasonography vs contrast-enhanced computed tomography for assessing blood supply of liver metastases. Shijie Huaren Xiaohua Zazhi 2015; 23:1328-1332. [DOI: 10.11569/wcjd.v23.i8.1328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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 compare the value of contrast-enhanced ultrasonography (CEUS) vs contrast-enhanced computed tomography (CECT) in assessing the blood supply of liver metastases (LM).
METHODS: Fifty-five patients with LM (70 nodules) who underwent both CEUS and CECT were included. The degree of enhancement in arterial phase, the appearance of vasa vasorum and the classification of the blood supply around the nodule were compared between CEUS and CECT.
RESULTS: The degree of enhancement in arterial phase was more significant for CEUS than for CECT (1: 59% vs 5%; 0: 41% vs 62%; -1: 0% vs 33%) (P < 0.05). The appearance of vasa vasorum around the nodule was significantly more frequent for CEUS than for CECT (54% vs 34%, χ2 = 5.674, P = 0.017). The rate of abundant blood supply was 70% for CEUS, significantly higher than that for CECT (30%; χ2 = 19.330, P = 0.000).
CONCLUSION: CEUS is better than CECT in evaluation of blood supply of LM.
Collapse
|
17
|
Jiang J, Shang X, Wang H, Xu YB, Gao Y, Zhou Q. Diagnostic value of contrast-enhanced ultrasound in thyroid nodules with calcification. Kaohsiung J Med Sci 2015; 31:138-44. [PMID: 25744236 DOI: 10.1016/j.kjms.2014.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 09/24/2014] [Accepted: 07/04/2014] [Indexed: 10/24/2022] Open
Abstract
The aim of this study was to investigate the diagnostic values of conventional ultrasound and contrast-enhanced ultrasound (CEUS) in benign and malignant thyroid nodules with calcification. Conventional ultrasound and CEUS were performed in 122 patients with thyroid nodules with calcification. The thyroid nodules were characterized as benign or malignant by pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accordance rate of the two imaging methods were determined. The area under the receiver operating characteristics curve (AUC) was used to assess the diagnostic values of the two imaging methods. In 122 cases of thyroid nodules with calcification, 73 benign nodules and 49 malignant nodules were verified by pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accordance rate of conventional ultrasound were 50%, 77%, 59%, 69%, and 66%, respectively, and those of CEUS were 90%, 92%, 88%, 93%, and 91%, respectively. There were significant differences between the two imaging methods. AUCs of conventional ultrasound and CEUS were 0.628 ± 0.052 and 0.908 ± 0.031, suggesting low and high diagnostic values, respectively. CEUS has high diagnostic values, being significantly greater than those of conventional ultrasound, in differential diagnosis of benign and malignant thyroid nodules with calcification.
Collapse
Affiliation(s)
- Jue Jiang
- Department of Medical Ultrasound, The 2nd Affiliated Hospital, Xi'an JiaoTong University School of Medicine, Xi'an, Shanxi Province, China
| | - Xu Shang
- Department of Medical Ultrasound, The 2nd Affiliated Hospital, Xi'an JiaoTong University School of Medicine, Xi'an, Shanxi Province, China
| | - Hua Wang
- Department of Medical Ultrasound, The 2nd Affiliated Hospital, Xi'an JiaoTong University School of Medicine, Xi'an, Shanxi Province, China
| | - Yong-Bo Xu
- Department of Medical Ultrasound, The 2nd Affiliated Hospital, Xi'an JiaoTong University School of Medicine, Xi'an, Shanxi Province, China
| | - Ya Gao
- Department of Medical Ultrasound, The 2nd Affiliated Hospital, Xi'an JiaoTong University School of Medicine, Xi'an, Shanxi Province, China.
| | - Qi Zhou
- Department of Medical Ultrasound, The 2nd Affiliated Hospital, Xi'an JiaoTong University School of Medicine, Xi'an, Shanxi Province, China.
| |
Collapse
|
18
|
Chiorean L, Bartos A, Pelau D, Iancu D, Ciuleanu T, Buiga R, Oancea I, Mangrau A, Iancu C, Badea R. Neuroendocrine tumor of gallbladder with liver and retroperitoneal metastases and a good response to the chemotherapeutical treatment. J Med Ultrason (2001) 2014; 42:271-6. [PMID: 26576584 DOI: 10.1007/s10396-014-0585-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 10/06/2014] [Indexed: 12/25/2022]
Abstract
Neuroendocrine carcinoma of the gallbladder is an uncommon disease. We present the case of a 45-year-old woman with a mass located in the gallbladder, whose diagnosis was based on contrast-enhanced ultrasound and magnetic resonance imaging. The tumor involved the liver and retroperitoneum, and was histopathologically confirmed by liver biopsy as a neuroendocrine tumor grade 3. The patient received chemotherapy with good response, followed by surgery with cholecystectomy and partial hepatectomy.
Collapse
Affiliation(s)
- Liliana Chiorean
- Department of Ultrasonography, "Octavian Fodor" Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Adrian Bartos
- Department of Surgery, "Octavian Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Doris Pelau
- Department of Oncology, "Prof. Dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
| | - Dana Iancu
- Department of Oncology, "Prof. Dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
| | - Tudor Ciuleanu
- Department of Oncology, "Prof. Dr. Ion Chiricuta" Institute of Oncology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Rares Buiga
- Department of Pathology, "Prof. Dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
| | | | | | - Cornel Iancu
- Department of Surgery, "Octavian Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Badea
- Department of Ultrasonography, "Octavian Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
19
|
Abstract
CLINICAL/METHODICAL ISSUE Optimization of ultrasound guided interventional procedures of the liver and kidneys using new imaging methods. STANDARD RADIOLOGICAL METHODS Punctures, biopsies, drainage, intraoperative ultrasound, fusion, embolization in correlation with ultrasound and other imaging methods. METHODICAL INNOVATIONS Real-time-sonography, contrast-enhanced ultrasound (CEUS) and fusion for planning, monitoring and postinterventional control. PERFORMANCE The use of CEUS enables better detection, characterization and execution of interventional procedures. Fusion facilitates detection. ACHIEVEMENTS The CEUS procedure is superior for detection and characterization of smaller lesions in comparison to the B scan. Fusion enables the performance of difficult interventional procedures. PRACTICAL RECOMMENDATIONS The B scan is the standard imaging method but CEUS and fusion could be helpful for smaller lesions.
Collapse
Affiliation(s)
- D-A Clevert
- Institut für Klinische Radiologie, Klinikum der Ludwigs-Maximilian-Universität München, Campus Großhadern, München, Deutschland
| | | |
Collapse
|
20
|
Frilling A, Modlin IM, Kidd M, Russell C, Breitenstein S, Salem R, Kwekkeboom D, Lau WY, Klersy C, Vilgrain V, Davidson B, Siegler M, Caplin M, Solcia E, Schilsky R. Recommendations for management of patients with neuroendocrine liver metastases. Lancet Oncol 2014; 15:e8-21. [PMID: 24384494 DOI: 10.1016/s1470-2045(13)70362-0] [Citation(s) in RCA: 329] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Many management strategies exist for neuroendocrine liver metastases. These strategies range from surgery to ablation with various interventional radiology procedures, and include both regional and systemic therapy with diverse biological, cytotoxic, or targeted agents. A paucity of biological, molecular, and genomic information and an absence of data from rigorous trials limit the validity of many publications detailing management. This Review represents the views from an international conference, for which 15 expert working groups prepared evidence-based assessments addressing specific questions, and from which an independent jury derived final recommendations. The aim of the conference was to review the existing approaches to neuroendocrine liver metastases, assess the evidence on which management decisions were based, develop internationally acceptable recommendations for clinical practice (when evidence was available), and make recommendations for clinical and research endeavours. This report represents the final clinical statements and proposals for future research.
Collapse
Affiliation(s)
| | | | - Mark Kidd
- Yale University, New Haven, Connecticut, USA
| | | | | | - Riad Salem
- Northwestern University Chicago, Chicago, USA
| | | | - Wan-yee Lau
- Chinese University of Hong Kong, Hong Kong, China
| | | | | | | | | | - Martyn Caplin
- University College London, London, UK; Royal Free Hospital, London, UK
| | - Enrico Solcia
- IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | | | | |
Collapse
|
21
|
Zheng SG, Xu HX, Liu LN. Management of hepatocellular carcinoma: The role of contrast-enhanced ultrasound. World J Radiol 2014; 6:7-14. [PMID: 24578787 PMCID: PMC3936208 DOI: 10.4329/wjr.v6.i1.7] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 09/09/2013] [Accepted: 11/16/2013] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the sixth most common neoplasm and the third cause of cancer death worldwide. Contrast enhanced ultrasound (CEUS) has been applied for more than ten years and plays increasingly important roles in the management of HCC. On the basis of the Guideline and Good Clinical Practice Recommendations for CEUS in the liver-update 2012 and related literature about the management of HCC, we summarize the main roles and applications of CEUS in the management of HCC, including HCC surveillance, diagnosis, CEUS-guided treatment, treatment response evaluation and follow-up. The diagnostic algorithm for HCC is also suggested. Meanwhile, the comparisons between CEUS and contrast enhanced computed tomography/magnetic resonance imaging (CECT/CEMRI) in these areas are made. Although CEUS is subject to the same limitation as ordinary US and is inferior to CECT/CEMRI in some aspects, CEUS has proved to be of great value in the management of HCC with inherent advantages, such as sufficient high safety profile making it suitable for patients with renal failure or allergic to iodine, absence of radiation, easy reproducibility and high temporal resolution. The tremendous application of CEUS to the diagnosis and treatment of HCC provides more opportunities for patients with HCC diagnosed at different stages.
Collapse
|
22
|
Wang Q, Shi G, Wang L, Liu X, Wu R. Early prediction of response of sorafenib on hepatocellular carcinoma by CT perfusion imaging: an animal study. Br J Radiol 2014; 87:20130695. [PMID: 24452058 DOI: 10.1259/bjr.20130695] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study evaluated the feasibility of CT perfusion parameters for the early efficacy prediction of sorafenib in the treatment of hepatocellular carcinoma (HCC) in rats. METHODS CT hepatic perfusion measurements were performed in the livers of 40 rats implanted with rat HCC. The rats in the experimental group (n = 28) were treated by oral gavage with sorafenib (20 mg per day), whereas the rats in the control group (n = 12) were treated by normal saline. Rats were classified into the responder group if the maximum diameter of their tumour had decreased 21 days after treatment, whereas the other rats were classified into the non-responder group. Data were analysed using the Pearson correlation analysis or analysis of variance. RESULTS CT perfusion was used to depict haemodynamic changes before and after treatment. The arterial liver perfusion was significantly decreased in the responder group on Day 11 after treatment with sorafenib (from 71.5 to 53.4 ml min(-1) 100 ml(-1)), whereas no significant changes were observed in the non-responder group (p = 0.87). The maximum diameter of the tumour was also significantly decreased in the responder group on Day 21 after treatment (p = 0.042), whereas the maximum tumour diameter was significantly increased in the control group (p = 0.001). CONCLUSION AND ADVANCES IN KNOWLEDGE: CT perfusion could be used to quantitatively analyse the haemodynamic changes in the treatment of HCC with sorafenib, which indicates that this approach may be developed for the early prediction of treatment efficacy for sorafenib.
Collapse
Affiliation(s)
- Q Wang
- Department of Radiology, The Fourth Clinical Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | | | | | | | | |
Collapse
|
23
|
Intrahepatic cholangiocarcinoma: relationship between tumor imaging enhancement by measuring attenuation and clinicopathologic characteristics. ACTA ACUST UNITED AC 2013; 38:785-92. [PMID: 23232581 DOI: 10.1007/s00261-012-9974-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Arterial enhancement of intrahepatic cholangiocarcinoma (ICC) has been noted. To precisely identify the characteristics of tumor enhancement patterns, we examined the relationship between CT attenuation in the tumor and clinicopathological parameters or prognosis. METHODS Subjects were 42 ICC patients who had undergone hepatectomy. microvessel density (MVD) determined by CD34 staining was compared with imaging. Attenuation was calculated in images from multidetector CT of tumor and non-tumorous regions. Enhancement patterns were divided into two groups: arterial enhancement with higher attenuation (>16 HU; Hyper group, n = 12); and arterial enhancement with lower attenuation (Hypo group, n = 30). RESULTS Univariate analysis identified high tumor marker level, increased size, less-differentiation, incomplete resection, increased bleeding, and lower MVD as significantly associated with poor survival (p < 0.05). Increased attenuation throughout the whole ICC correlated significantly with radiological findings and MVD. Concomitant hepatitis, well-differentiation, and smaller tumor were more significantly frequent in the Hyper group than in the Hypo group (p < 0.05). Postoperative early recurrence was significantly less frequent in the Hyper group, and overall survival was significantly better in the Hyper group (p < 0.05). CONCLUSIONS Increased CT attenuation correlated with ICC tumor vascularity. Increased tumor enhancement in the arterial phase was associated with chronic hepatitis, lower malignancy, and better survival.
Collapse
|
24
|
Alzaraa A, Gravante G, Chung WY, Al-Leswas D, Morgan B, Dennison A, Lloyd D. Contrast-enhanced ultrasound in the preoperative, intraoperative and postoperative assessment of liver lesions. Hepatol Res 2013; 43:809-19. [PMID: 23745715 DOI: 10.1111/hepr.12044] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 12/04/2012] [Accepted: 12/10/2012] [Indexed: 12/12/2022]
Abstract
The use of contrast agents (CA) with liver ultrasound (US) has gained recently an established role for the diagnosis of various hepatic diseases due to their safety, high versatility and low costs (contrast-enhanced ultrasound: CEUS). The purpose of this review is to provide a state-of-the-art summary of the available evidence for their use in the characterization of focal liver lesions. A published work search was conducted for all preclinical and clinical studies involving CA on hepatic US imaging. CEUS increases the sensitivity for lesion detection and the specificity to differentiate between benign and malignant diseases due to the enhanced visualization of the tumor microcirculation. Results achieved seem at least equivalent to those of spiral computed tomography or magnetic resonance imaging. The association of CA with intraoperative ultrasound has changed the surgical approach in 25% of patients and guarantees complete ablations by a single session in most of them. CEUS provides detailed information about tumor vasculature, improves the preoperative characterization and therefore the therapeutic strategy, and can evaluate the intraoperative completeness of the ablation.
Collapse
Affiliation(s)
- Ahmed Alzaraa
- Department of General Surgery, William Harvey Hospital, Ashford
| | | | | | | | | | | | | |
Collapse
|
25
|
Sancaktutar AA, Bozkurt Y, Tüfek A, Söylemez H, Önder H, Atar M, Penbegül N, Bodakçı MN, Hatipoğlu NK, Oktar T. Radiation-free percutaneous nephrostomy performed on neonates, infants, and preschool-age children. J Pediatr Urol 2013; 9:464-71. [PMID: 22763106 DOI: 10.1016/j.jpurol.2012.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 06/08/2012] [Indexed: 10/28/2022]
Abstract
AIM The aim of this study was to evaluate the effectiveness and safety of high-frequency linear probe ultrasonographic (US) guidance percutaneous nephrostomy (PN) in terms of diagnostic and therapeutic approach in preschool-age children with urological problems. MATERIALS AND METHODS PN was performed on 40 kidneys in 33 patients (13 girls, 20 boys) aged 3 days - 7 years (mean 4.1 years). All procedures were performed with US guidance utilizing a Shimadzu SDU 2200 Xplus 5-10 mHz probe. Complete blood count, urinalysis, bladder urine culture, blood urea, and creatinine values were obtained before PN placement on the same day. Urine cultures were obtained by nephrostomy tube and compared to bladder urine culture. RESULTS PN procedures were technically successful in 39 kidney units (97.5%). Two major complications were macroscopic hematuria requiring blood transfusions (1 case) and sepsis (1 case). Minor complications were displacement of the catheter (4), urinary tract infection (4), urine extravasation (1), early dislocation of the catheter (1). In three cases, the catheter was replaced. Analysis of bladder urine showed that 13 patients (39.4%) had positive cultures, but analysis of PN urine showed that 25 patients (78.1%) had positive cultures. CONCLUSIONS PN is an easy, safe and efficient diagnostic and therapeutic procedure with few complications even in preschool-age children. The antibiotic regimen should be revised in order to avoid sepsis and urinary tract infection.
Collapse
|
26
|
Buadu A, Meyer MA. Small liver nodule detection with a high-frequency transducer in patients with chronic liver disease: report of 3 cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:355-359. [PMID: 23341394 DOI: 10.7863/jum.2013.32.2.355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We report 3 cases in which small liver lesions were revealed on sonography with the supplemental use of a high-frequency transducer. In all 3 cases, the patients had cirrhosis or chronic liver disease. The lesions were not seen on computed tomography or magnetic resonance imaging. Sonography plays a pivotal role in surveillance for hepatocellular carcinoma and, with modern transducer technology, may be the first imaging modality to show an early small tumor. A more thorough search for focal liver lesions with adjunctive use of high-frequency transducers may prolong the examination time but can improve surveillance for hepatocellular carcinoma.
Collapse
Affiliation(s)
- Annemarie Buadu
- Department of Radiology, University of Arizona Health Science Center, Tucson, AZ 85724, USA.
| | | |
Collapse
|
27
|
Jung EM, Uller W, Stroszczynski C, Clevert DA. [Contrast-enhanced sonography. Therapy control of radiofrequency ablation and transarterial chemoembolization of hepatocellular carcinoma]. Radiologe 2012; 51:462-8. [PMID: 21557022 DOI: 10.1007/s00117-010-2101-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Due to the imaging of dynamic perfusion, hepatocellular carcinoma can be detected with a sensitivity of >90% using contrast-enhanced sonography. The characterization of liver tumors with contrast-enhanced sonography is comparable to the diagnostic accuracy of contrast-enhanced computed tomography. The dynamic detection of microvascularization with contrast-enhanced sonography allows the differentiation between vascularized tumors and non-vascularized necrotic lesions before, during and after transarterial chemoembolization or percutaneous radiofrequency ablation. Image fusion with volume navigation can be useful in the followup control.
Collapse
Affiliation(s)
- E M Jung
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg,Franz-Josef-Strauss-Allee 11, 93053 Regensburg.
| | | | | | | |
Collapse
|
28
|
Right Portal Vein Ligation Combined With In Situ Splitting Induces Rapid Left Lateral Liver Lobe Hypertrophy Enabling 2-Staged Extended Right Hepatic Resection in Small-for-Size Settings. Ann Surg 2012; 255:405-14. [DOI: 10.1097/sla.0b013e31824856f5] [Citation(s) in RCA: 930] [Impact Index Per Article: 77.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|