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Safai Zadeh E, Prosch H, Ba-Ssalamah A, Scharitzer M, Pochepnia S, Findeisen H, Alhyari A, Raab N, Huber KP, Görg C. Contrast-enhanced ultrasound of the liver: Vascular pathologies and interventions. ROFO-FORTSCHR RONTG 2024. [PMID: 38636540 DOI: 10.1055/a-2275-2972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Over the past two decades, contrast-enhanced ultrasound (CEUS) has been established as a method complementary to B-mode ultrasound and color Doppler sonography for diagnosing vascular liver pathologies and interventions.The objective of this review is to elucidate the application of CEUS in diagnosing vascular pathologies and interventional procedures.Considering the limitations of ultrasound, CEUS presents a similar alternative to other imaging modalities, such as computed tomography and magnetic resonance imaging, for evaluating vascular pathologies, guiding interventions, identifying complications, and assessing outcomes post intervention. Due to its widespread availability and the absence of radiation exposure, CEUS should be employed as a primary modality. · CEUS plays an important role in the detection of vascular liver pathologies.. · CEUS is helpful in characterizing vascular pathologies.. · CEUS is helpful in guiding interventions and identifying complications..
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Affiliation(s)
- Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Martina Scharitzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Svitlana Pochepnia
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Hajo Findeisen
- Department for Internal Medicine, Red Cross Hospital Bremen, Bremen, Germany
| | - Amjad Alhyari
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Nils Raab
- Department for Internal Medicine, West Mecklenburg Hospital Helene von Bülow, Ludwigslust, Germany
| | - Katharina Paulina Huber
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Görg
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
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Safai Zadeh E, Görg M, Görg C, Prosch H, Trenker C, Westhoff CC, Dietrich CF, Raab N, Alhyari A, Huber K, Pochepnia S, Weber M, Findeisen H. The value of contrast-enhanced ultrasound in percutaneous biopsy of retroperitoneal masses. Ultraschall Med 2024. [PMID: 38588693 DOI: 10.1055/a-2282-2353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
PURPOSE To evaluate the diagnostic yield of contrast-enhanced ultrasound (CEUS)-guided biopsy of retroperitoneal masses (RMs). MATERIALS AND METHODS Between 2006 and 2023, 87 patients presented at our US center for biopsy of an RM. In all biopsies, CEUS was performed prior to the intervention. The technical success rate of biopsy, the presence of diagnostic tissue in solid tumor biopsy samples, the accuracy of the biopsy and the occurrence of post-interventional complications were evaluated. RESULTS A US-guided biopsy could be conducted in 84/87 cases (96.6%). In 3/87 cases (3.4%), US-guided biopsy was impossible because the planned needle path was obstructed by vital structures. Of 84 lesions, 80 (95.2%) were solid lesions, and 4 (4.8%) were lesions containing fluid. In all solid tumors, 80/80 (100%), diagnostic vital tissue was successfully obtained. CEUS-guided biopsy showed a sensitivity of 93.2%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 72.2%, and a diagnostic accuracy of 94.2% for the differentiation between malignant and benign RMs. In one of the 84 cases (1.2%), there was a complication of postinterventional abdominal pain. CONCLUSION Percutaneous CEUS-guided biopsy is a safe procedure with a high diagnostic yield and a low complication rate.
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Affiliation(s)
- Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Wien, Austria
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Mathis Görg
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Wien, Austria
| | - Corinna Trenker
- Haematology, Oncology and Immunology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Christina Carolin Westhoff
- Institute of Pathology, University Hospital of Giessen and Marburg, Campus Marburg, Philipps-University of Marburg, Marburg, Germany
| | - Christoph F Dietrich
- Department General Internal Medicine, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Nils Raab
- General internal medicine and gastroenterology, Westmecklenburg Klinikum Helene von Bulow GmbH, Ludwigslust, Germany
| | - Amjad Alhyari
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Katharina Huber
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Svitlana Pochepnia
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Wien, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Wien, Austria
| | - Hajo Findeisen
- Department for Internal Medicine, Red Cross Hospital Bremen, Bremen, Germany
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Horn R, Görg C, Prosch H, Safai Zadeh E, Jenssen C, Dietrich CF. Sonography of the pleura. Ultraschall Med 2024; 45:118-146. [PMID: 38237634 DOI: 10.1055/a-2189-5050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
The CME review presented here is intended to explain the significance of pleural sonography to the interested reader and to provide information on its application. At the beginning of sonography in the 80 s of the 20th centuries, with the possible resolution of the devices at that time, the pleura could only be perceived as a white line. Due to the high impedance differences, the pleura can be delineated particularly well. With the increasing high-resolution devices of more than 10 MHz, even a normal pleura with a thickness of 0.2 mm can be assessed. This article explains the special features of the examination technique with knowledge of the pre-test probability and describes the indications for pleural sonography. Pleural sonography has a high value in emergency and intensive care medicine, preclinical, outpatient and inpatient, in the general practitioner as well as in the specialist practice of pneumologists. The special features in childhood (pediatrics) as well as in geriatrics are presented. The recognition of a pneumothorax even in difficult situations as well as the assessment of pleural effusion are explained. With the high-resolution technology, both the pleura itself and small subpleural consolidations can be assessed and used diagnostically. Both the direct and indirect sonographic signs and accompanying symptoms are described, and the concrete clinical significance of sonography is presented. The significance and criteria of conventional brightness-encoded B-scan, colour Doppler sonography (CDS) with or without spectral analysis of the Doppler signal (SDS) and contrast medium ultrasound (CEUS) are outlined. Elastography and ultrasound-guided interventions are also mentioned. A related further paper deals with the diseases of the lung parenchyma and another paper with the diseases of the thoracic wall, diaphragm and mediastinum.
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Affiliation(s)
- Rudolf Horn
- Emergency Department, Center da Sandà Val Müstair, Switzerland
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, Marburg
| | - Helmut Prosch
- Abteilung für Allgemeine Radiologie und Kinderradiologie, Medizinische Universität Wien, Austria
| | - Ehsan Safai Zadeh
- Abteilung für Allgemeine Radiologie und Kinderradiologie, Medizinische Universität Wien, Austria
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch-Oderland Strausberg/Wriezen and Brandenburg Institute for Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany
| | - Christoph F Dietrich
- Department of General Internal Medicine, Kliniken Hirslanden Beau-Site, Salem und Permanence, Bern, Switzerland
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Martin E, Görg C, Alhyari A, Zadeh ES, Findeisen H, Trenker C. Prevention of life-threatening bleeding complication from splenic venous ectasia by B-mode-, color Doppler- and contrast-enhanced ultrasound in a patient with ALL. J Ultrason 2024; 24:20240006. [PMID: 38419839 PMCID: PMC10897369 DOI: 10.15557/jou.2024.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/12/2023] [Indexed: 03/02/2024] Open
Abstract
Aim of the study Spontaneous splenic rupture is a serious complication of pathologically altered spleen tissue, associated with a high mortality rate. Case description We describe a spontaneous splenic rupture in a patient with acute lymphoblastic leukemia undergoing chemotherapy. Ultrasound revealed splenomegaly, and diffuse splenic acute lymphoblastic leukemia-infiltration was suspected. In addition, only color Doppler sonography and contrast-enhanced ultrasound diagnosed splenic vascular ectasias with a venous-flow-profile. During therapy, short-term sonographic follow-up examinations were able to reveal an increase in the size of venous ectasias and the associated increased risk of spontaneous splenic rupture. Based on these sonographic findings, immediate surgical splenectomy was performed in the spontaneous splenic rupture case and the patient survived. Conclusions Ultrasound is an important diagnostic method in patients with newly diagnosed malignant hematological diseases to detect disease-related splenic pathologies. Short-term follow-up examinations of splenic vascular pathologies can detect size progression and a potential risk of spontaneous splenic rupture with life-threatening bleeding.
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Affiliation(s)
- Evelyn Martin
- Department of Anesthesiology, University Hospital Marburg, Marburg, Germany
| | - Christian Görg
- Department of Gastroenterology, University Hospital Marburg, Marburg, Germany
| | - Amjad Alhyari
- Department of Gastroenterology, University Hospital Marburg, Marburg, Germany
| | - Ehsan Safai Zadeh
- Department of Gastroenterology, University Hospital Marburg, Marburg, Germany
| | - Hajo Findeisen
- Department of Internal Medicine, Red Cross Hospital, Bremen, Germany
| | - Corinna Trenker
- Department of Hematology/Oncology, University Hospital Marburg, Marburg, Germany
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Zadeh ES, Huber KP, Görg C, Möller K, Jenssen C, Lim A, Taut H, Dong Y, Cui XW, Dietrich CF. Comments on and illustrations of the WFUMB CEUS liver guidelines: Rare malignant neuroendocrine and predominant epithelioid liver lesions. Med Ultrason 2024. [PMID: 38244219 DOI: 10.11152/mu-4321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
The diagnosis or rare, non-hematologic malignant lesions of the liver may be a challenge owing to the rarity of the disease, and is usually made by histological confirmation. Ultrasound with color Doppler and contrast-enhanced, if required, taking into account the clinical background of the patient, may help to focus the differential diagnosis. In this review, we describe the pathological and ultrasound features of rare malignant neuroendocrine and predominantly epithelioid liver lesions including primary neuroendocrine tumor of the liver, Invasive mucinous cystic neoplasm of the liver, and also hepatoblastoma.
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Affiliation(s)
- Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Katharina Paulina Huber
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Germany
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg
| | - Kathleen Möller
- Medical Department I/Gastroenterology; SANA Hospital Lichtenberg, Berlin, Germany
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland, Brandenburg Institute of Clinical Medicine at Medical University Brandenburg, Germany
| | - Adrian Lim
- Imperial College London and Healthcare NHS Trust, London, UK
| | - Heike Taut
- Children's Hospital, Universitätsklinikum Dresden, Technische Universität Dresden, Germany
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xin Wu Cui
- 9Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Christoph F Dietrich
- 0Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland.
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Safai Zadeh E, Görg C, Prosch H, Kifjak D, Dietrich CF, Laursen CB, Findeisen H. Lung Ultrasound and Pleural Artifacts: A Pictorial Review. Diagnostics (Basel) 2024; 14:179. [PMID: 38248056 PMCID: PMC10814232 DOI: 10.3390/diagnostics14020179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
Lung ultrasound is a well-established diagnostic approach used in detecting pathological changes near the pleura of the lung. At the acoustic boundary of the lung surface, it is necessary to differentiate between the primary visualization of pleural parenchymal pathologies and the appearance of secondary artifacts when sound waves enter the lung or are reflected at the visceral pleura. The aims of this pictorial essay are to demonstrate the sonographic patterns of various pleural interface artifacts and to illustrate the limitations and pitfalls of the use of ultrasound findings in diagnosing any underlying pathology.
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Affiliation(s)
- Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, Clinic for Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35037 Marburg, Germany
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria
| | - Daria Kifjak
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria
- Department of Radiology, Mass Memorial Medical Center and University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Christoph Frank Dietrich
- Department of General Internal Medicine (DAIM), Hirslanden Clinics Bern, Beau Site, Salem and Permanence, 3018 Bern, Switzerland;
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, 5000 Odense, Denmark
- Odense Respiratory Research Unit, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Hajo Findeisen
- Department for Internal Medicine, Red Cross Hospital Bremen, 28199 Bremen, Germany
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Safai Zadeh E, Prosch H, Ba-Ssalamah A, Findeisen H, Alhyari A, Raab N, Görg C. Contrast-enhanced ultrasound of the liver: basics and interpretation of common focal lesions. ROFO-FORTSCHR RONTG 2024. [PMID: 38176437 DOI: 10.1055/a-2219-4726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Over the past 20 years, contrast-enhanced ultrasound (CEUS) has become established as a procedure that is complementary to B-mode ultrasound and color Doppler sonography.The aim of this review is to provide the fundamental knowledge required for examining the liver with CEUS. Additionally, the characteristic CEUS patterns of frequent focal liver lesions are described.Considering the limitations of ultrasound, CEUS offers an equivalent alternative to other imaging modalities, such as computed tomography and magnetic resonance imaging, for evaluating focal liver lesions. It should be utilized as a primary modality due to its lack of radiation exposure and rapid availability. KEY POINTS:: · CEUS plays an important role particularly in the detection and evaluation of incidentally detected liver lesions.. · Considering the limitations of ultrasound, CEUS offers an equivalent alternative to other imaging modalities, such as CT and MRI, for evaluating focal liver lesions.. CITATION FORMAT: · Safai Zadeh E, Prosch H, Ba-Ssalamah A et al. Contrast-enhanced ultrasound of the liver: basics and interpretation of common focal lesions. Fortschr Röntgenstr 2024; DOI: 10.1055/a-2219-4726.
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Affiliation(s)
- Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Wien, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Wien, Austria
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Wien, Austria
| | - Hajo Findeisen
- Department for Internal Medicine, Red Cross Hospital Bremen, Germany
| | - Amjad Alhyari
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Gießen and Marburg Campus Marburg, Germany
| | - Nils Raab
- Department for Internal Medicine, West Mecklenburg Hospital Helene von Bülow, Ludwigslust, Germany
| | - Christian Görg
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Gießen and Marburg Campus Marburg, Germany
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Möller K, Stock B, Ignee A, Zadeh ES, De Molo C, Serra C, Jenssen C, Lim A, Görg C, Dong Y, Klinger C, Tana C, Meloni MF, Sparchez Z, Francica G, Dirks K, Hollerweger A, Kinkel H, Weskott HP, Montagut NE, Srivastava D, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Rare focal liver lesions - non-infectious, non-neoplastic. Med Ultrason 2023; 25:435-444. [PMID: 37369029 DOI: 10.11152/mu-4192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
In this series of papers on comments and illustrations of the World Federation for Medicine and Biology (WFUMB) guidelines on contrast enhanced ultrasound (CEUS) the topics of non-infectious and non-neoplastic focal liver lesions (FLL) are discussed. Improved detection and characterization of common FLL are the main topics of these guidelines but detailed and illustrating information is missing. The focus in this paper is on non-infectious and non-neoplastic FLL and their appearance on B-mode, Doppler ultrasound and CEUS features. Knowledge of these data should help to raise awareness of these rarer findings, to think of these clinical pictures in the corresponding clinical situation, to interpret the ultrasound images correctly and thus to initiate the appropriate diagnostic and therapeutic steps in time.
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Affiliation(s)
- Kathleen Möller
- Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany.
| | - Bahar Stock
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
| | - André Ignee
- Medical Clinic, Department for Gastroenterology and Rheumatology, Klinikum Wuerzburg Mitte, Wuerzburg, Germany
| | - Ehsan Safai Zadeh
- 4Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Chiara De Molo
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg, Brandenburg Institute of Clinical Medicine at Medical University Brandenburg, Germany
| | - Adrian Lim
- Imperial College London and Healthcare NHS Trust, London, UK
| | - Christian Görg
- 4Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Christoph Klinger
- Department of Internal Medicine 1, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Claudio Tana
- Geriatrics Clinic, University Hospital of Chieti, Chieti, Italy
| | - Maria Franca Meloni
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA, Department of Interventional Ultrasound Casa di Cura Igea, Milano, Italy
| | - Zeno Sparchez
- Department of Internal Medicine-Gastroenterology, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Giampiero Francica
- Interventional Ultrasound Unit, Pinetagrande, Hospital Castelvolturno (CE), Italy
| | | | - Alois Hollerweger
- 5Department of Radiology and Nuclear Medicine, Barmherzige Brüder Hospital Salzburg, Austria
| | - Horst Kinkel
- 6Medical Care Center RUR, Gastroenterology, Düren, Germany
| | | | | | - David Srivastava
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence; Inselspital Bern, Hospital of the University of Bern, Switzerland
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland.
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Zander T, Zadeh ES, Möller K, Goerg C, Correas JM, Chaubal N, Dirks K, Hollerweger A, Jenssen C, Klinger C, Lim A, Dong Y, Cui XW, Montagut NE, Srivastava D, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Rare focal liver lesion - infectious parasitic, fungus. Med Ultrason 2023; 25:423-434. [PMID: 36996385 DOI: 10.11152/mu-4091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
In this series of papers on comments and illustrations of the World Federation for Medicine and Biology (WFUMB) guidelines on contrast enhanced ultrasound (CEUS) the topics of parasitic and fungus infections are discussed. Improved detection and characterization of common focal liver lesions (FLL) are the main topics of these guidelines but detailed and illustrating information is missing. The focus in this paper on infectious (parasitic and fungus) focal liver lesions is on their appearance on B-mode and Doppler ultrasound and CEUS features. Knowledge of these data should help to raise awareness of these rarer findings, to think of these clinical pictures in the corresponding clinical situation, to interpret the ultrasound images correctly and thus to initiate the appropriate diagnostic and therapeutic steps in time.
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Affiliation(s)
- Tobias Zander
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Germany
| | - Kathleen Möller
- Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany
| | - Christian Goerg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Germany
| | - Jean Michel Correas
- Service de Radiologie Adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Department of Radiology and Center For Imaging Science, Centre, Mumbai, India
| | | | - Alois Hollerweger
- Department of Radiology and Nuclear Medicine, Barmherzige Brüder Hospital Salzburg, Austria
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland GmbH, Strausberg/ Wriezen, Germany, Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg "Theodor Fontane", Neuruppin, Germany
| | - Christoph Klinger
- Department of Internal Medicine 1, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Adrian Lim
- Imperial College London and Healthcare NHS Trust, London, UK
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | | | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland.
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10
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Safai Zadeh E, Görg C, Huber KP, Dirks K, Jenssen C, Lim A, Möller K, Götzberger M, Dong Y, Cui XW, Fetzer DT, Klinger C, Clevert DA, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Rare malignant hematological liver lesions. Med Ultrason 2023. [PMID: 38150695 DOI: 10.11152/mu-4305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Diagnosing rare hematological malignancies in the liver is often challenging owing to their infrequency, and confirmation generally necessitates histological examination. Due to the rarity of these lesions, there are limited data concerning their appearance on ultrasound and, specifically, contrast-enhanced ultrasound. In this review, we describe the pathological and ultrasound features of several hematological malignant liver lesions, including lymphoma of the liver and chloroma. Furthermore, two specific forms of liver lymphoma are described: mucosa-associated lymphoid tissue (MALT) lymphoma andplasmacytoma of the liver.
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Affiliation(s)
- Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University, Marburg, Marburg
| | | | | | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland, Brandenburg Institute of Clinical Medicine at Medical University Brandenburg, Neuruppin
| | - Adrian Lim
- Imperial College London and Healthcare NHS Trust, London
| | - Kathleen Möller
- Medical Department I/Gastroenterology; SANA Hospital Lichtenberg, Berlin
| | - Manuela Götzberger
- Klinik für Gastroenterologie und Hepatologie Neuperlach und Harlaching, München Klinik Neuperlach
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - David T Fetzer
- Department of Radiology, UT Southwestern Medical Center, Dallas
| | - Christoph Klinger
- Department of Internal Medicine 1, Klinikum Ludwigsburg, Ludwigsburg
| | - Dirk Andre Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University of Munich-Grosshadern Campus
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland.
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11
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Abstract
The CME review is intended to explain and discuss the clinical value of lung ultrasound but also to enable a pragmatically oriented approach by analyzing the clinical aspect. This includes knowledge of the pre-test probability, the acuteness of the disease, the current clinical situation, detection and/or characterization, initial diagnosis or follow up assessment and the peculiarities of exclusion diagnosis. Diseases of the pleura and lungs are described using these criteria with their direct and indirect sonographic signs and the specific clinical significance of ultrasound findings. The importance and criteria of conventional B-mode, color Doppler ultrasound with or without spectral analysis of the Doppler signal and contrast-enhanced ultrasound are discussed as well.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Germany
| | - Rudolf Horn
- Center da sandà Val Müstair, CH-7537 Sta. Maria
| | - Helmut Prosch
- Abteilung für Allgemeine Radiologie und Kinderradiologie, Medizinische Universität Wien, Austria
| | - Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Germany
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch-Oderland, Strausberg/Wriezen, Germany
- Brandenburgisches Institut für Klinischen Ultraschall an der Medizinischen Hochschule Brandenburg, Neuruppin, Germany
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12
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Kroenig J, Safai Zadeh E, Westhoff CC, Klemmer A, Alhyari A, Görg C. Diagnosis of Thoracic Splenosis by Contrast-Enhanced Ultrasound (CEUS). Ultraschall Med 2023; 44:645-646. [PMID: 36063839 DOI: 10.1055/a-1926-7142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Johannes Kroenig
- Department of Medicine, Pulmonary and Critical Care Medicine, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound, Philipps-Universitat Marburg, Marburg, Germany
| | | | - Andreas Klemmer
- Department of Medicine, Pulmonary and Critical Care Medicine, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Amjad Alhyari
- Interdisciplinary Center of Ultrasound, Philipps-Universitat Marburg, Marburg, Germany
| | - Christian Görg
- Hematology, Oncology and Immunology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
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13
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Safai Zadeh E, Görg C, Post C, Alhyari A, Trenker C, Dietrich CF, Findeisen H. Evaluation and Classification of Incidentally Detected Splenic Lesions Based on B-Mode and Contrast-Enhanced Ultrasound. Ultraschall Med 2023; 44:637-644. [PMID: 36731494 DOI: 10.1055/a-2001-5516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE To evaluate B-mode ultrasound (B-US) and contrast-enhanced ultrasound (CEUS) patterns of focal splenic incidentalomas (FSIs), and to correlate ultrasound patterns with benignity and malignancy via histologic examination and/or the clinical course. MATERIALS AND METHODS Between 2004 and 2021, 139 consecutive patients with an FSI detected by B-US were investigated additionally with CEUS. On CEUS, the arterial enhancement (AE) of the FSI (hyperenhancement, isoenhancement, hypoenhancement, and absent enhancement) was analyzed. Subsequently, the malignancy rate according to different B-US echo patterns and CEUS perfusion patterns was determined. RESULTS The final diagnosis of FSI was malignant in 9/139 (6.5%) and benign in 130/139 (93.5%) cases. The hypoechoic and hyperechoic lesions on B-US with arterial hyperenhancement on CEUS and the echogenic cystic or complex lesions on B-US with predominantly absent enhancement on CEUS were benign in 54/54 (100%) cases. 6/37 (16.2%) hypoechoic lesions on B-US with arterial hypo-/isoenhancement on CEUS and 3/48 (6.3%) of hyperechoic lesions on B-US with an arterial hypo-/isoenhancement on CEUS were malignant. CONCLUSION Based on these results, FSIs reveal different malignancy rates depending on the B-US und CEUS patterns, and classification according to these B-US and CEUS patterns may be helpful in further evaluation of an FSI.
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Affiliation(s)
- Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics; Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Philipps-Universitat Marburg, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics; Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Philipps-Universitat Marburg, Marburg, Germany
| | - Clemens Post
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Amjad Alhyari
- Interdisciplinary Center of Ultrasound Diagnostics; Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Philipps-Universitat Marburg, Marburg, Germany
| | - Corinna Trenker
- Interdisciplinary Center of Ultrasound Diagnostics; Department of Hematology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Christoph F Dietrich
- Department General Internal Medicine, Hirslanden Beau Site, Salem and Permanence Clinics, Bern, Switzerland
| | - Hajo Findeisen
- Department for Internal Medicine, Red Cross Hospital Bremen, Bremen, Germany
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14
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Zadeh ES, Schreiber N, Görg C, Huber KP, Möller K, Berzigotti A, Thomsen T, Jenssen C, Jung EM, Lim A, Kitano M, Shimizu R, Dong Y, Cui XW, Srivastava D, Dietrich CF. Comments on and illustrations of the WFUMB CEUS liver guidelines: Rare malignant mesenchymal liver lesions. Med Ultrason 2023. [PMID: 38150699 DOI: 10.11152/mu-4302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
The diagnosis or rare mesenchymal malignant lesions of the liver may be a challenge owing to the rarity of the disease and is usually made by histological confirmation. An ultrasound examination with, if required, color Doppler sonography and contrast-enhanced ultrasound, taking into account the clinical background of the patient, may help to focus the differential diagnosis. In this review, we describe the pathological and ultrasound features of several rare mesenchymal malignant liver lesions which include undifferentiated sarcoma of the liver, leiomyosarcoma, angiosarcoma, fibrosarcoma, liposarcoma, and epithelioid hemangioendothelioma.
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Affiliation(s)
- Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna
| | - Nicole Schreiber
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, Marburg
| | | | - Kathleen Möller
- Medical Department I/Gastroenterology; SANA Hospital Lichtenberg, Berlin
| | - Analisa Berzigotti
- Departmen of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern
| | - Thomas Thomsen
- Department of Internal Medicine, Westkuestenkliniken, Brunsbuettel
| | - Christian Jenssen
- 8Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg. Brandenburg Institute of Clinical Medicine at Medical University Brandenburg
| | | | - Adrian Lim
- Imperial College London and Healthcare NHS Trust, London
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University
| | - Ryo Shimizu
- Second Department of Internal Medicine, Wakayama Medical University
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - David Srivastava
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern.
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15
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Wiest I, Safai Zadeh E, Görg C, Teufel A, Michels G, Dietrich CF. Value of contrast-enhanced ultrasound for vascular diseases of the liver - current indications and open questions. Z Gastroenterol 2023; 61:1504-1517. [PMID: 36522165 DOI: 10.1055/a-1973-5731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Contrast-enhanced ultrasonography (CEUS) is a widely available and well-tolerated technique that can expand the diagnosis of a variety of vascular liver diseases. This paper presents an overview of the current possibilities of the use of CEUS in vascular liver diseases. Particularly where Doppler sonography has technical limitations, CEUS provides additional opportunities to visualize vascular thrombosis and other obstructions restricting blood flow. When CT or MRI contrast agents cannot be used because of severe allergy or renal insufficiency, CEUS can be a valuable diagnostic alternative and has demonstrated comparable diagnostic performance in at least some vascular liver diseases, such as portal vein thrombosis. In addition, CEUS works without radiation and, therefore, might be particularly suitable for young patients and children. This may be useful, for example, in congenital disorders such as persistent umbilical vein or preduodenal portal vein. Vascular liver disease is rare and comprehensive data are still lacking, but the available literature provides promising insights into potential new ways to study vascular liver disease. Although most studies are based on small sample sizes or even case reports, the high diagnostic utility is undisputed.
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Affiliation(s)
- Isabella Wiest
- Department of Medicine II, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ehsan Safai Zadeh
- University Hospital Giessen and Marburg, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- University Hospital Giessen and Marburg, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, Philipps University Marburg, Marburg, Germany
| | - Andreas Teufel
- Department of Medicine II, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland, Eschweiler, Germany
| | - Christoph F Dietrich
- Allgemeine Innere Medizin (DAIM) Kliniken Beau Site, Salem und Permanence, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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16
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Möller K, Friedrich T, Safai Zadeh E, Görg C, Jenssen C, Hocke M, De Molo C, Serra C, Dong Y, Cui XW, Lim A, Dirks K, Srivastava D, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Cystic fibrosis associated liver disease. Med Ultrason 2023. [PMID: 37931013 DOI: 10.11152/mu-4297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
In this series of articles with comments and illustrations on the World Federation for Medicine and Biology (WFUMB) guidelines on contrast-enhanced ultrasound (CEUS) the topics of very rare focal liver lesions (FLL) are discussed. Improving the detection and characterization of the most common FLL are the main topics of these guidelines. The focus of this review is on the many manifestations of cystic fibrosis-related liver disease (CFLD). These include focal biliary fibrosis, liver cirrhosis, vascular manifestations with nodular regenerative hyperplasia and portal hypertension with or without cirrhosis. This article describes the diverse changes of liver involvement in cystic fibrosis and their appearance on ultrasound, duplex sonography, and contrast enhanced ultrasonography. This knowledge and the imaging should help to recognize liver manifestations in time and enable a correct interpretation of ultrasound images in CF in the corresponding clinical situation.
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Affiliation(s)
- Kathleen Möller
- Sana Hospital Lichtenberg, Medical Department I/Gastroenterology, Berlin.
| | - Thomas Friedrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern.
| | - Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna.
| | - Christian Görg
- Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, Marburg.
| | - Christian Jenssen
- Krankenhaus Märkisch-Oderland, Department of Internal Medicine, Strausberg, Germany; Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg, Neuruppin.
| | | | - Chiara De Molo
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna.
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna,.
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai.
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan.
| | - Adrian Lim
- Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
| | | | | | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern.
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17
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Findeisen H, Görg C, Winter H, Trenker C, Dietrich CF, Alhyari A, Eilsberger F, Safai Zadeh E. B-Mode Ultrasound and Contrast-Enhanced Ultrasound for the Detection of Splenic Involvement in Hodgkin Lymphoma: A Retrospective Analysis of 112 Patients. Ultraschall Med 2023. [PMID: 37863048 DOI: 10.1055/a-2173-2361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
PURPOSE To assess splenic involvement using B-mode ultrasound (US) and contrast-enhanced ultrasound (CEUS) compared with standard imaging with contrast-enhanced computerized tomography (CT) / 18-fluorodeoxyglucose positron-emission tomography (PET-CT) in patients with Hodgkin lymphoma. MATERIALS AND METHODS Imaging data from 112 patients from 12/2003 to 10/2022 with histologically confirmed Hodgkin lymphoma during staging or relapse were analyzed for splenic lymphoma involvement. In all patients, standard imaging (CT/PET-CT), along with B-mode US and CEUS examinations, was performed. Evidence of focal splenic lesions (FSLs) found by imaging procedures was suggestive of splenic involvement. Follow-up imaging was performed in each patient after treatment, and treatment response indicated definitive splenic involvement. RESULTS 40 patients (35.7%) were identified by imaging modalities as having splenic involvement, which was confirmed by response during follow-up. Standard CT/PET-CT imaging detected splenic involvement in 36/112 patients (32.1%). FSLs were detected with B-mode US in 38 patients (33.9%) and CEUS in 36 patients (32.1%). The sensitivity of standard imaging, B-mode US, and CEUS was 90%, 95%, and 90%, respectively. CONCLUSION B-mode US examination is a diagnostic method used in addition to standard imaging for the detection of splenic involvement in Hodgkin lymphoma. CEUS does not provide additional benefit compared to B-mode US and the standard reference procedure.
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Affiliation(s)
- Hajo Findeisen
- Department for Internal Medicine, Red Cross Hospital Bremen, Bremen, Germany
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics; Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Helen Winter
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Corinna Trenker
- Interdisciplinary Center of Ultrasound Diagnostics; Department of Hematology, Oncology and Immunology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Christoph F Dietrich
- Department General Internal Medicine, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Amjad Alhyari
- Interdisciplinary Center of Ultrasound Diagnostics; Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Friederike Eilsberger
- Department of Nuclear Medicine, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Wien, Austria
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18
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Alhyari A, Görg C, Tahat S, Trenker C, Dietrich CF, Westhoff CC, Safai Zadeh E, Findeisen H. Acoustic Radiation Force Impulse (ARFI) Elastography of Focal Splenic Lesions: Feasibility and Diagnostic Potential. Cancers (Basel) 2023; 15:4964. [PMID: 37894331 PMCID: PMC10605882 DOI: 10.3390/cancers15204964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/15/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE Nontraumatic focal splenic lesions (FSL) are rare, and the need for tissue diagnosis must be weighed against the very high risk of bleeding after a splenic biopsy. The aim of this study was to explore the feasibility and diagnostic potential of acoustic radiation force impulse (ARFI) elastography as a noninvasive method for different benign and malignant FSLs. No human studies on the elastographic characteristics of FSL exist. METHODS This was a retrospective analysis of 34 patients with FSLs, who underwent abdominal B-mode ultrasound (B-US), contrast-enhanced ultrasound (CEUS), and standardized ARFI examinations between October 2021 and December 2022 at our university hospital. The inclusion criteria were: (i) FSL size ≥ 1 cm; (ii) 10 valid ARFI measurements of the FSL, as well as of the normal splenic parenchyma (NSP) as an in vivo reference; and (iii) diagnostic confirmation of FSL etiology based on histological examination (8/34; 23.5%) or clinical evaluation, which included a clinical and sonographic follow-up (FU), CEUS morphology, and/or morphology on cross-sectional imaging (26/34; 76.5%). CEUS was performed on all patients and the FSLs were classified according to the current guidelines; cross-sectional imaging was available for 29/34 (85.3%). The mean FU duration was 25.8 ± 30.5 months. The mean ARFI velocity (MAV) of the FSL (MAVL), the NSP (MAVP), and the ratio of the MAVL to the MAVP (MAVL/P) were calculated and compared. RESULTS Of the 34 FSLs, 13 (38.2%) were malignant (mFSL) and 21 (61.8%) were benign (bFSL). The MAVL of all 34 FSLs (2.74 ± 0.71 m/s) was lower than the MAVP (3.20 ± 0.59 m/s), p = 0.009, with a mean MAVL/P ratio of 0.90 ± 0.34. No significant differences in the MAVL were observed between the mFSL (2.66 ± 0.67 m/s) and bFSL (2.79 ± 0.75 m/s). There were also no significant differences between the MAVP in patients with mFSL (3.24 ± 0.68 m/s) as compared to that in the patients with bFSL (3.18 ± 0.55 m/s). Likewise, the MAV L/P ratio did not differ between the mFSL (0.90 ± 0.41 m/s) and bFSL (0.90 ± 0.30 m/s) groups. CONCLUSION ARFI elastography is feasible in evaluating the stiffness of FSLs. The lesions' stiffness was lower than that of the NSP, regardless of the FSL etiology. However, differentiation between benign and malignant FSL with the help of this elastographic method does not appear possible. Larger prospective studies are needed to validate these findings.
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Affiliation(s)
- Amjad Alhyari
- Department of Gastroenterology, Endocrinology, Metabolism and Infectious Diseases, University Hospital Giessen and Marburg, Philipp University of Marburg, 35033 Marburg, Germany
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, 35033 Marburg, Germany
| | - Christian Görg
- Department of Gastroenterology, Endocrinology, Metabolism and Infectious Diseases, University Hospital Giessen and Marburg, Philipp University of Marburg, 35033 Marburg, Germany
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, 35033 Marburg, Germany
| | - Suhaib Tahat
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, 35033 Marburg, Germany
| | - Corinna Trenker
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, 35033 Marburg, Germany
- Department of Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University of Marburg, 35033 Marburg, Germany
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, 3013 Bern, Switzerland
| | - Christina C Westhoff
- Institute of Pathology, University Hospital Giessen and Marburg, Philipps University of Marburg, 35033 Marburg, Germany
| | - Ehsan Safai Zadeh
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, 35033 Marburg, Germany
- Department of Biomedical Imaging and Imaging-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Hajo Findeisen
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, 35033 Marburg, Germany
- Department of Internal Medicine, Red Cross Hospital Bremen, 28199 Bremen, Germany
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19
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Moller K, Hoffmann O, Zadeh ES, Gorg C, Jenssen C, Hocke M, De Molo C, Serra C, Dong Y, Cui XW, Lim A, Dirks K, Faiss S, Srivastava D, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Peliosis hepatis and porphyria. Med Ultrason 2023. [PMID: 37931015 DOI: 10.11152/mu-4287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
In this series of articles on comments and illustrations of the World Federation for Medicine and Biology (WFUMB) guidelines on contrast-enhanced ultrasound (CEUS), the topics on very rare focal liver lesions (FLL) are discussed. This article describes the diverse changes of focal liver lesions in peliosis hepatis and the typical changes in porphyria. Although the focus is on the appearance on ultrasound and CEUS, the clinical context is always considered. While peliosis may be a surprising finding on puncture, lesions in porphyria cutanea tarda may be typical visual diagnoses that obviate the need for biopsy. If only you knew. This article aims to sharpen the clinician's eye. It provides knowledge of the clinical presentation and US and CEUS imaging of peliosis hepatis and porphyria.
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Affiliation(s)
- Kathleen Moller
- Sana Hospital Lichtenberg, Medical Department I/Gastroenterology, Berlin, Germany
| | - Oliver Hoffmann
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christian Gorg
- Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch-Oderland, Department of Internal Medicine, Strausberg, Germany; Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg, Neuruppin, Germany
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Germany
| | - Chiara De Molo
- Interventional, Diagnostic and Therapeutic Ultrasound Unit,Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit,Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Adrian Lim
- 0Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | | | - Siegbert Faiss
- Sana Hospital Lichtenberg, Medical Department I/Gastroenterology, Berlin, Germany
| | - David Srivastava
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland Inselspital, University Hospital of Bern, Switzerland
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
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20
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Martin E, Görg C, Pehl A, Safai Zadeh E. B-Mode Ultrasound Patterns of Systemic Silicone Disease. Ultraschall Med 2023; 44:544-546. [PMID: 35705172 DOI: 10.1055/a-1816-6236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Evelyn Martin
- Anasthesie and Intensiv Care Unit, University Hospital of Giessen and Marburg Campus Marburg, Philipps- Universitat Marburg, Marburg, Germany
| | - Christian Görg
- University Hospital of Giessen and Marburg Campus Marburg, Philipps- Universitat Marburg, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology; Interdisciplinary Center of Ultrasound Diagnostics, Marburg, Germany
| | - Anika Pehl
- Institute of Pathology and Cytology, University Hospital of Giessen and Marburg Campus Marburg, Philipps- Universitat Marburg, Marburg, Germany
| | - Ehsan Safai Zadeh
- University Hospital of Giessen and Marburg Campus Marburg, Philipps- Universitat Marburg, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology; Interdisciplinary Center of Ultrasound Diagnostics, Marburg, Germany
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21
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Trenker C, Görg C, Dong Y, Cui XW, Zadeh ES, Alhyari A, Kripfgans O, Dietrich CF. Portal venous gas detection in different clinical situations. Med Ultrason 2023; 25:296-303. [PMID: 36780605 DOI: 10.11152/mu-4010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Portal Venous Gas (PVG) provides an important differential diagnosis in the diagnose of intrahepatic reflexogenic structures. This review article is intended to provide an overview of the current literature on the detection of PVG, its special forms and important differential diagnoses, it also shows possibilities for the diagnostic procedure in the case of sonographic detection of PVG.
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Affiliation(s)
- Corinna Trenker
- University Hospital Marburg and Philipps University Marburg, Department of Hematology, Oncology and Immunology, Germany
| | - Christian Görg
- University Hospital Marburg and Philipps University Marburg, Department of Gastroenterology, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, China
| | - Xin Wu Cui
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ehsan Safai Zadeh
- University Hospital Marburg and Philipps University Marburg, Department of Gastroenterology, Germany
| | - Amjad Alhyari
- University Hospital Marburg and Philipps University Marburg, Department of Gastroenterology, Germany
| | | | - Christoph F Dietrich
- Hirslanden Kliniken Bern, Department of Internal Medicine (DAIM), Bern, Switzerland.
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22
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Ignee A, Möller K, Thees-Laurenz R, Zadeh ES, Görg C, Correas JM, Chaubal N, Sansone V, Jenssen C, Dong Y, Götzberger M, Meloni MF, Cui XW, Klinger C, DeMolo C, Carla S, Lim A, Huang P, Espinosa Montagut N, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Rare focal liver lesions - infectious (bacterial). Med Ultrason 2023; 25:312-324. [PMID: 36996384 DOI: 10.11152/mu-4065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
In this series of papers on comments and illustrations of the World Federation for Medicine and Biology (WFUMB) guidelines on contrast enhanced ultrasound (CEUS) the topics of bacterial infections are discussed. Improved detection and characterization of common focal liver lesions (FLL) are the main topics of these guidelines but detailed and illustrating information is missing. The focus in this paper on infectious (bacterial) focal liver lesions is on their appearance on B-mode and Doppler ultrasound and CEUS features. Knowledge of these data should help to raise awareness of these rarer findings, to think of these clinical pictures in the corresponding clinical situation, to interpret the ultrasound images correctly and thus to initiate the appropriate diagnostic and therapeutic steps in time.
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Affiliation(s)
- André Ignee
- Medical Clinic - Department for Gastroenterology and Rheumatology, Klinikum Wuerzburg Mitte, Wuerzburg, Germany
| | - Kathleen Möller
- Medical Department I/Gastroenterology; SANA Hospital Lichtenberg, Berlin
| | - Ruth Thees-Laurenz
- Zentrum für Radiologie, Neuroradiologie, Sonographie und Nuklearmedizin. Krankenhaus der Barmherzigen Brüder Trier
| | - Ehsan Safai Zadeh
- 4Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, Marburg
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, Marburg, Germany
| | - Jean Michel Correas
- 5Service de Radiologie Adultes, Hôpital Necker, Université Paris Cité, Paris
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research 23 Department of Radiology and Center For Imaging Science, Centre, Mumbai
| | - Vito Sansone
- IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | - Christian Jenssen
- 8Medical Department, Krankenhaus Maerkisch-Oderland, Strausberg, Brandenburg Institute of Clinical Medicine at Medical University Brandenburg
| | - Yi Dong
- 9Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai
| | - Manuela Götzberger
- Klinik für Gastroenterologie und Hepatologie, München Klinik Neuperlach und Harlaching, Germany
| | - Maria Franca Meloni
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA, Department of Interventional Ultrasound Casa di Cura Igea, Milano
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Christoph Klinger
- Department of Internal Medicine 1, Klinikum Ludwigsburg, Ludwigsburg
| | - Chiara DeMolo
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna
| | - Serra Carla
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna
| | - Adrian Lim
- Imperial College London and Healthcare NHS Trust, London
| | - Pintong Huang
- Department of Ultrasound in Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | | | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern.
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23
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Möller K, Jenssen C, Correas JM, Safai Zadeh E, Bertolotto M, Ignee A, Dong Y, Cantisani V, Dietrich CF. CEUS Bosniak Classification-Time for Differentiation and Change in Renal Cyst Surveillance. Cancers (Basel) 2023; 15:4709. [PMID: 37835403 PMCID: PMC10571952 DOI: 10.3390/cancers15194709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
It is time for a change. CEUS is an established method that should be much more actively included in renal cyst monitoring strategies. This review compares the accuracies, strengths, and weaknesses of CEUS, CECT, and MRI in the classification of renal cysts. In order to avoid overstaging by CEUS, a further differentiation of classes IIF, III, and IV is required. A further development in the refinement of the CEUS-Bosniak classification aims to integrate CEUS more closely into the monitoring of renal cysts and to develop new and complex monitoring algorithms.
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Affiliation(s)
- Kathleen Möller
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, 10365 Berlin, Germany
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland, 15344 Strausberg, Germany
- Brandenburg Institute of Clinical Medicine, Medical University Brandenburg, 16816 Neuruppin, Germany
| | - Jean Michel Correas
- Biomedical Imaging Laboratory, UMR 7371-U114, University of Paris, 75006 Paris, France
| | - Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Michele Bertolotto
- Department of Radiology, Ospedale di Cattinara, University of Trieste, 34149 Trieste, Italy
| | - André Ignee
- Department of Medical Gastroenterology, Julius-Spital, 97070 Würzburg, Germany
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Vito Cantisani
- Department of Radiology, Oncology, and Anatomy Pathology, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin, Hirslanden Klinik Beau-Site, 3013 Bern, Switzerland
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24
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Dong Y, Guggisberg E, Wang WP, Zadeh ES, Christian G, Möller K, Berzigotti A, Chaubal N, Cui XW, De Molo C, Dirks K, Montagut NE, Gilja OH, Hollerweger A, Jenssen C, Jung EM, Klinger C, Lim A, Sansone V, Schuler A, Serra C, Sparchez Z, Srivastava D, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Rare benign focal liver lesion, part II. Med Ultrason 2023. [PMID: 37632825 DOI: 10.11152/mu-4261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
It is important to be familiar with the typical imaging features of the uncommon or even extremely rare focal liver lesions (FLL). Current guidelines of the World Federation for Ultrasound in Medicine and Biology (WFUMB) is aimed at assessing the usefulness of contrast enhanced ultrasound (CEUS) in the management of various FLL. In this review, we aim to summarize the ultrasound and CEUS characteristics with literature review of some extremely rare benign FLL, which might be helpful for improving diagnostic efficiency clinically.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Elisa Guggisberg
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Görg Christian
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg,
Germany
| | - Kathleen Möller
- Medical Department I/Gastroenterology; SANA Hospital Lichtenberg, Berlin, Germany
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nittin Chaubal
- Thane Ultrasound Centre: Jaslok Hospital and Research Centre, Mumbai, India
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chiara De Molo
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | | | | | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Alois Hollerweger
- Department of Radiology and Nuclear Medicine, Barmherzige Brüder Hospital Salzburg, Austria
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland Strausberg, Germany, and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany
| | | | | | - Adrian Lim
- 7Imperial College London and Healthcare NHS Trust, London, UK
| | - Vito Sansone
- Unit of Internal Medicine, Dpt of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Andreas Schuler
- Zentrum für Innere Medizin, Alb Fils Kliniken, Helfenstein Klinik, Geislingen, DOC-da! MVZ GmbH, Goeppingen Germany
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Zeno Sparchez
- Department of Internal Medicine-Gastroenterology, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - David Srivastava
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland.
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25
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Dong Y, Wang WP, Zadeh ES, Möller K, Görg C, Berzigotti A, Chaubal N, Cui XW, De Molo C, Dirks K, Montagut NE, Gilja OH, Hollerweger A, Jenssen C, Jung EM, Klinger C, Lim A, Sansone V, Schuler A, Serra C, Sparchez Z, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Rare benign focal liver lesion, part I. Med Ultrason 2023. [PMID: 37632826 DOI: 10.11152/mu-4260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
Improved detection and characterization of common focal liver lesions (FLL) are the main topics of the World Federation for Ultrasound in Medicine and Biology (WFUMB) guidelines on the use of contrast-enhanced ultrasound (CEUS). On stateof-the-art CEUS imaging, to create a library of rare FLL, especially concerning their atypical imaging characteristics, might be helpful for improving clinical diagnostic efficiency. In this review, we aim to summarize the ultrasound and CEUS features of rare benign FLL. Currently there are limited reports and images published.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Kathleen Möller
- Medical Department I/Gastroenterology; SANA Hospital Lichtenberg, Berlin, Germany
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nittin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chiara De Molo
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | | | | | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Alois Hollerweger
- Department of Radiology and Nuclear Medicine, Barmherzige Brüder Hospital Salzburg, Austria
| | - Christian Jenssen
- Medical Department, Krankenhaus MaerkischOderland, Strausberg, Germany, and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, Neuruppin, Germany
| | | | | | - Adrian Lim
- Imperial College London and Healthcare NHS Trust, London, UK
| | - Vito Sansone
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Andreas Schuler
- Zentrum für Innere Medizin, Alb Fils Kliniken, Helfenstein Klinik, Germany
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Zeno Sparchez
- Department of Internal Medicine-Gastroenterology, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland.
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26
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Moller K, Zadeh ES, Görg C, Jenssen C, Hocke M, De Molo C, Serra C, Dong Y, Cui XW, Lim A, Thees-Laurenz R, Faiss S, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: Rare vascular pathology, part II. Med Ultrason 2023; 25:189-200. [PMID: 37369049 DOI: 10.11152/mu-4013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
In this second part of the topic the hepatic pseudoaneurysm, hepatic infarction, and pylephlebitis are discussed as acute and potentially life-threatening hepatic vascular diseases. The focus is on their appearance on B-mode ultrasonography, duplex ultrasonography, and contrast-enhanced ultrasonography. Zahn's pseudo infarction is an important differential diagnosis to wedge-shaped hepatic infarction in this context. Knowledge of the data should help raise awareness of these rare findings, to come up with relevant differential diagnoses in the corresponding clinical situation, to interpret the ultrasound images correctly and thus to initiate the appropriate diagnostic and therapeutic steps in time.
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Affiliation(s)
- Kathleen Moller
- 1Sana Hospital Lichtenberg, Medical Department I/Gastroenterology, Berlin, Germany
| | - Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, Marburg, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch-Oderland, Department of Internal Medicine, Strausberg, Germany, Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg, Neuruppin, Germany
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Germany
| | - Chiara De Molo
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Adrian Lim
- 9Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Ruth Thees-Laurenz
- Zentrum für Radiologie, Neuroradiologie, Sonographie und Nuklearmedizin. Krankenhaus der Barmherzigen Brüder Trier, Germany
| | - Siegbert Faiss
- Sana Hospital Lichtenberg, Medical Department I/Gastroenterology, Berlin, Germany
| | - Christoph F Dietrich
- 1Department Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland.
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27
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Safai Zadeh E, Alhyari A, Kroenig J, Görg C, Trenker C, Dietrich CF, Findeisen H. B-mode ultrasound and contrast-enhanced ultrasound for evaluation of pneumonia: A pictorial essay. Australas J Ultrasound Med 2023; 26:100-114. [PMID: 37252619 PMCID: PMC10225008 DOI: 10.1002/ajum.12332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Due to their often peripheral pleural-based location, pneumonias can be visualised by B-mode ultrasound. Therefore, sonography can be used as an alternative imaging modality to chest X-ray in suspected cases of pneumonia. Depending on the clinical background of the patient, and various underlying pathological mechanisms, a heterogeneous pattern of pneumonia is seen in both B-mode lung ultrasound and contrast-enhanced ultrasound. Here, we describe the spectrum of sonographic manifestations of pneumonic/inflammatory consolidation on B-mode lung ultrasound and contrast-enhanced ultrasound.
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Affiliation(s)
- Ehsan Safai Zadeh
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical InfectiologyUniversity Hospital Giessen and Marburg, Philipps University MarburgMarburgGermany
| | - Amjad Alhyari
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical InfectiologyUniversity Hospital Giessen and Marburg, Philipps University MarburgMarburgGermany
| | - Johannes Kroenig
- Department of Pulmonary and Critical Care MedicineUniversity Hospital Giessen and Marburg, Philipps University MarburgMarburgGermany
| | - Christian Görg
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical InfectiologyUniversity Hospital Giessen and Marburg, Philipps University MarburgMarburgGermany
| | - Corinna Trenker
- Haematology, Oncology and ImmunologyUniversity Hospital Giessen and Marburg, Philipps University MarburgMarburgGermany
| | | | - Hajo Findeisen
- Interdisciplinary Centre of Ultrasound DiagnosticsUniversity Hospital Giessen and Marburg, Philipps University MarburgMarburgGermany
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28
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Matrood S, Görg C, Safai Zadeh E, Alhyari A. Hepatic perivascular epithelioid cell tumor (PEComa): contrast-enhanced ultrasound (CEUS) characteristics-a case report and literature review. Clin J Gastroenterol 2023; 16:444-449. [PMID: 36964879 DOI: 10.1007/s12328-023-01779-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/23/2023] [Indexed: 03/26/2023]
Abstract
Perivascular epithelioid cell tumors (PEComa) are rare mesenchymal neoplasms that arise from soft tissue of various organs such as the stomach, intestines, and lungs. We report a rare case of a primary PEComa of the liver and its characteristics on contrast-enhanced ultrasound (CEUS) in a 51-year-old female patient with an incidental finding of a hypoechoic liver lesion with peripheral hypervascularization on Doppler ultrasound. CEUS showed homogenous hypervascularity in the arterial phase that was consistent in the portal phase. In the late phase, a central washout phenomenon was evident. Histopathologic findings on sonographic biopsy of the lesion revealed a mesenchymal tumor with positivity for melanocytic markers Human Melanin Black-45 (HMB45) and Melan-A consistent with a PEComa. Despite the absence of high-risk features for malignancy, surgical resection was recommended due to the uncertain malignant potential of PEComas. The patient refused the operation and preferred sonographic follow-up; the lesion was stable over a period of 2 years. CEUS can provide valuable information regarding PEComa. After histological confirmation, the choice between resection and a watchful waiting must be made on individual basis.
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Affiliation(s)
- Sami Matrood
- Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
| | - Christian Görg
- Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Marburg, Philipps-University Marburg, University Hospital Giessen and Marburg, Baldingerstraße, 35042, Marburg, Germany
| | - Ehsan Safai Zadeh
- Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Marburg, Philipps-University Marburg, University Hospital Giessen and Marburg, Baldingerstraße, 35042, Marburg, Germany
| | - Amjad Alhyari
- Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany.
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Marburg, Philipps-University Marburg, University Hospital Giessen and Marburg, Baldingerstraße, 35042, Marburg, Germany.
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29
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Möller K, Braden B, Culver EL, Jenssen C, Zadeh ES, Alhyari A, Görg C, Ignee A, Hocke M, Dong Y, Sun S, Faiss S, Dietrich CF. Secondary sclerosing cholangitis and IgG4-sclerosing cholangitis - A review of cholangiographic and ultrasound imaging. Endosc Ultrasound 2023; 12:181-199. [PMID: 36588352 PMCID: PMC10237613 DOI: 10.4103/eus-d-22-00208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/08/2022] [Indexed: 01/01/2023] Open
Abstract
Sclerosing cholangitis (SC) represents a spectrum of chronic progressive cholestatic diseases of the intrahepatic and/or extrahepatic biliary system characterized by patchy inflammation, fibrosis, and stricturing. Primary and secondary SC must be distinguished given the different treatment modalities, risks of malignancy, and progression to portal hypertension, cirrhosis, and hepatic failure. This review focuses on secondary SC and the pathogenic mechanisms, risk factors, clinical presentation, and novel imaging modalities that help to distinguish between these conditions. We explore the detailed use of cholangiography and ultrasound imaging techniques.
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Affiliation(s)
- Kathleen Möller
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | - Emma L. Culver
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland GmbH, Strausberg, Wriezen, Germany
- Brandenburg Institute of Clinical Medicine at Medical University Brandenburg, Neuruppin, Germany
| | - Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Amjad Alhyari
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - André Ignee
- Department of Internal Medicine – Gastroenterology and Rheumatology; Klinikum Wuerzburg Mitte, Wuerzburg, Germany
| | - Michael Hocke
- Medical Department II, Helios Klinikum Meiningen, Meiningen, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Siyu Sun
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Liaoning Province, China
| | - Siegbert Faiss
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Christoph F. Dietrich
- Department of Internal Medicine (DAIM), Hirslanden Private Hospital, Beau Site, Salem und Permanence, Bern, Switzerland
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Safai Zadeh E, Görg C, Prosch H, Horn R, Jenssen C, Dietrich CF. The Role of Thoracic Ultrasound for Diagnosis of Diseases of the Chest Wall, the Mediastinum, and the Diaphragm-Narrative Review and Pictorial Essay. Diagnostics (Basel) 2023; 13:767. [PMID: 36832255 PMCID: PMC9956010 DOI: 10.3390/diagnostics13040767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/29/2023] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
The diagnostic capabilities of ultrasound extend far beyond the evaluation of the pleural space and lungs. Sonographic evaluation of the chest wall is a classic extension of the clinical examination of visible, palpable, or dolent findings. Unclear mass lesions of the chest wall can be differentiated accurately and with low risk by additional techniques such as color Doppler imaging, contrast-enhanced ultrasound, and, in particular, ultrasound-guided biopsy. For imaging of mediastinal pathologies, ultrasound has only a complementary function but is valuable for guidance of percutaneous biopsies of malignant masses. In emergency medicine, ultrasound can verify and support correct positioning of endotracheal tubes. Diaphragmatic ultrasound benefits from the real-time nature of sonographic imaging and is becoming increasingly important for the assessment of diaphragmatic function in long-term ventilated patients. The clinical role of thoracic ultrasound is reviewed in a combination of narrative review and pictorial essay.
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Affiliation(s)
- Ehsan Safai Zadeh
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Christian Görg
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria
| | - Rudolf Horn
- Center da Sandà Val Müstair, 7536 Sta. Maria, Switzerland
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland, 15344 Strausberg, Germany
- Brandenburg Institute of Clinical Ultrasound, Medical University Brandenburg, 16816 Neuruppin, Germany
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, 3018 Bern, Switzerland
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Findeisen H, Westhoff C, Trenker C, Görg C, Krönig J, Safai Zadeh E, Safai Zadeh E. Pulmonary Cystic Echinococcosis in Contrast-enhanced Ultrasound - A Case Report. J Ultrason 2023; 23:39-42. [PMID: 36879999 PMCID: PMC9985186 DOI: 10.15557/jou.2023.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/28/2022] [Indexed: 01/12/2023] Open
Abstract
Aim of the study Pulmonary cystic echinococcosis is a parasitic infection transmitted by dogs and occurring in livestock-raising areas. It is included among the neglected tropical diseases, according to the World Health Organization. Imaging plays a pivotal role in the diagnosis of this disease. While cross-sectional imaging modalities such as computed tomography and magnetic resonance imaging are preferred, lung ultrasound may be another feasible technique. Case description We report a case of pulmonary cystic echinococcosis in a 26-year-old woman who was examined by contrast-enhanced ultrasound, which showed marked annular enhancement around the hydatid cyst, mimicking a superinfected cyst. Conclusions Contrast-enhanced ultrasound examination in pulmonary cystic echinococcosis should be studied in a larger population to determine the value of additional contrast administration. In the present case report, no superinfected echinococcal cyst was seen despite marked annular contrast enhancement.
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Affiliation(s)
- Hajo Findeisen
- Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christina Westhoff
- Institute of Pathology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Corinna Trenker
- Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany.,Department of Hematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Johannes Krönig
- University Hospital Giessen and Marburg, Philipps University Marburg, Department of Medicine, Pulmonary and Critical Care Medicine, Marburg, Germany
| | - Ehsan Safai Zadeh
- Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | | | | | | | - Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany; Department of Hematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
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Findeisen H, Westhoff C, Friedrich Dietrich C, Trenker C, Alhyari A, Safai Zadeh E, Görg C, Görg C. Inflammatory Pseudotumor of the Omentum in Contrast-enhanced Ultrasound. J Ultrason 2023; 23:32-34. [PMID: 36880005 PMCID: PMC9985187 DOI: 10.15557/jou.2023.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/06/2022] [Indexed: 01/11/2023] Open
Abstract
Aim of the study Inflammatory pseudotumor is a rare benign tumor that can occur at various body sites. Due to its rare occurrence and histological variety radiological data is heterogeneous and limited. Case description We present a case of a 71-year-old man with inflammatory pseudotumor of the omentum. Contrast-enhanced ultrasound perfusion pattern showed homogeneous, isoechoic enhancement in the arterial phase with a washout phenomenon in the parenchymal phase, mimicking a peritoneal carcinomatosis. Conclusions Inflammatory pseudotumor represents a rare, but important benign differential diagnostic option when considering a malignant disorder. Contrast-enhanced ultrasound is helpful in identifying vital tissue for a targeted biopsy for subsequent histological examination that is essential for the exclusion of malignancy.
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Affiliation(s)
- Hajo Findeisen
- Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christina Westhoff
- Institute for Pathology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | | | - Corinna Trenker
- Department of Hematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Amjad Alhyari
- Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Ehsan Safai Zadeh
- Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- Department of Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
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Möller K, Tscheu T, De Molo C, Serra C, Cui XW, Dong Y, Hocke M, Lim A, Zadeh ES, Görg C, Srivastava D, Henning S, Jenssen C, Berzigotti A, Jung M, Dietrich CF. Comments and illustrations of the WFUMB CEUS liver guidelines: rare congenital vascular pathology. Med Ultrason 2022; 24:461-472. [PMID: 36191244 DOI: 10.11152/mu-3879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In this overview of vascular changes of the liver, variations in the liver vessels are discussed, in addition to congenital malformations such as Abernethy malformation, patent ductus venosus Arantii and hereditary hemorrhagic telangiectasia (OslerWeber-Rendu disease). Particular attention is paid to focal liver lesions, especially focal nodular hyperplasia (FNH), but also other solid tumours that develop as a result of altered liver vascularisation. The article focuses on the ultrasonic appearances and changes of the liver, depicted in B-mode sonography, Doppler studies and in contrast-enhanced ultrasonography (CEUS). The clinical manifestations of these conditions associated with other organ systems are also highlighted.
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Affiliation(s)
- Kathleen Möller
- Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany
| | - Theresa Tscheu
- Department Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Chiara De Molo
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Carla Serra
- Interventional, Diagnostic and Therapeutic Ultrasound Unit, Department of Medical and Surgical Sciences, IRCCS, Azienda Ospedaliero-Universitaria Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Germany
| | - Adrian Lim
- Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, UK
| | - Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - David Srivastava
- Department Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Stephan Henning
- Clinic for Pediatrics/ Gastroenterology, Nephrology and Metabolic Medicine, Charité - University Medicine Berlin, Campus Virchow Clinic, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch-Oderland, Department of Internal Medicine, Strausberg, Germany; Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg, Neuruppin, Germany
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Michael Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland.
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Dong Y, Koch J, Alhyari A, Safai Zadeh E, Görg C, Wang WP, Berzigotti A, Dietrich CF. Ultrasound Elastography for Characterization of Focal Liver Lesions. Z Gastroenterol 2022; 61:399-410. [PMID: 36516951 DOI: 10.1055/a-1957-7370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractFocal liver lesions (FLL) are typically detected by conventional ultrasound or other
imaging modalities. After the detection of FLL, further characterization is essential, and
this can be done by contrast-enhanced imaging techniques, e.g., contrast-enhanced ultrasound
(CEUS) and magnetic resonance imaging (MRI) or by means of biopsy with histological
evaluation. Elastographic techniques are nowadays integrated into high-end ultrasound systems
and their value for the detection of severe liver fibrosis and cirrhosis has been shown in
studies and meta-analyses. The use of an ultrasound elastographic technique for the
differentiation of malignant and benign liver tumors is less well-established. This review
summarizes the current data on utility and performance of ultrasound elastography for the
characterization of FLL.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jonas Koch
- Department Allgemeine Innere Medizin, Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Amjad Alhyari
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Ehsan Safai Zadeh
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital Fudan University, Shanghai, China
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Berne, Switzerland
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin, Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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Alhyari A, Geisler L, Eilsberger F, Dietrich CF, Findeisen H, Trenker C, Görg C, Safai Zadeh E. „Hyposplenie“, eine weitgehend unerkannte Immunschwäche: Ist die Sonografie hilfreich? Z Gastroenterol 2022. [PMID: 36413992 DOI: 10.1055/a-1901-9569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
ZusammenfassungDas Immundefizienzsyndrom der funktionellen Hyposplenie/Asplenie ist weitgehend unerkannt.
Die Goldstandardprozedur stellt die Technetium-99m-Szintigrafie von hitzedenaturierten
Erythrozyten (TSZ) sowie der Nachweis von pitted Erythrozyten oder Howell-Jolly-Körperchen
(HJB) dar. Erste Arbeiten weisen darauf hin, dass dieses Krankheitsbild mit einer kleinen Milz
assoziiert ist. Ziel der vorliegenden Übersicht ist es, den Stellenwert der B-Bild-Sonografie
und der kontrastunterstützten Sonografie bei der Immunschwäche der Hyposplenie
darzustellen.
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Affiliation(s)
- Amjad Alhyari
- Klinik für Gastroenterologie, Endokrinologie, Stoffwechsel und klinische Infektiologie, und Interdisziplinäres Ultraschallzentrum, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Germany
| | - Lisa Geisler
- Interdisziplinäres Ultraschallzentrum, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Germany
| | - Friederike Eilsberger
- Klinik für Nuklearmedizin, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Germany
| | - Christoph F. Dietrich
- Allgemeine Innere Medizin (DAIM) Kliniken Beau Site, Salem und Permanence, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Hajo Findeisen
- Interdisziplinäres Ultraschallzentrum, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Germany
| | - Corinna Trenker
- Hämatologie/Onkologie/Immunologie, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Germany
| | - Christian Görg
- Klinik für Gastroenterologie, Endokrinologie, Stoffwechsel und klinische Infektiologie, und Interdisziplinäres Ultraschallzentrum, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Germany
| | - Ehsan Safai Zadeh
- Klinik für Gastroenterologie, Endokrinologie, Stoffwechsel und klinische Infektiologie, und Interdisziplinäres Ultraschallzentrum, Universitätsklinikum Gießen und Marburg - Standort Marburg, Marburg, Germany
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Möller K, Safai Zadeh E, Görg C, Dong Y, Cui XW, Faiss S, Dietrich CF. Prevalence of benign focal liver lesions and non-hepatocellular carcinoma malignant lesions in liver cirrhosis. Z Gastroenterol 2022; 61:526-535. [PMID: 36413993 DOI: 10.1055/a-1890-5818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AbstractLiver cirrhosis is associated with an increased risk of developing hepatocellular carcinoma (HCC). However, other benign and malignant liver lesions may co-exist or may be the only focal liver lesion (FLL) detected. Compared to HCC, comparatively little is known about the frequency and natural history of benign FLL in patients with established liver cirrhosis.This review analyses the prevalence and frequency of benign and malignant FLL others than hepatocellular carcinoma (HCC) in liver cirrhosis including imaging and autopsy studies. Understanding these data should be helpful in avoiding misdiagnoses.
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Affiliation(s)
| | - Ehsan Safai Zadeh
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Philipps University Marburg, Marburg, Germany
| | - Yi Dong
- Zhongshan Hospital Fudan University, Shanghai, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Christoph F. Dietrich
- Allgemeine Innere Medizin (DAIM) Kliniken Beau Site, Salem und Permanence, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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Trenker C, Görg C, Burchert A, Michel C, Kipper K, Westhoff CC, Keber CU, Safai Zadeh E. Presentation of Chloromas in B-Mode Ultrasound and Contrast-Enhanced Ultrasound. Ultrasound Med Biol 2022; 48:1933-1940. [PMID: 35778304 DOI: 10.1016/j.ultrasmedbio.2022.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/28/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
Chloromas, also referred to as myeloid sarcomas, describe rare extramedullary tumor aggregates of malignant myeloid progenitor cells. The aim of this study was investigate the diagnostic features and characteristics of chloromas using contrast-enhanced ultrasound (CEUS). Between July 2007 and April 2021, 15 patients with 20 myeloid neoplasms and suspected chloroma manifestations were examined using B-mode US (B-US) and CEUS. Clinical data and B-US (echogenicity, border, size) and CEUS (hyper-, iso-, hypo- or complex enhancement) characteristics were retrospectively analyzed. Absolute and relative frequencies were determined. In B-US, the chloromas were most frequently hypo-echoic (n = 15, 75%). In addition, a hyperechoic (n = 2, 10%) or echocomplex (n = 3, 15%) presentation was observed. On CEUS, 7 chloromas (35%) had an arterial hyperenhancement, 8 (40%) an iso-enhancement and 3 (15%) a complex enhancement. Two chloromas (10%) did not exhibit any enhancement. We describe for the first time CEUS and B-US patterns of chloromas. They are typically hypo-echoic on B-US and have a strong iso- or hyperenhancement on CEUS, which may help in the differential diagnosis of some unclear masses (e.g., hematoma, abscess) in patients with myeloid neoplasias. Nevertheless, histology is necessary for a reliable diagnosis.
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Affiliation(s)
- Corinna Trenker
- Department of Internal Medicine, Hematology, Oncology and Immunology, University Hospital Marburg und Giessen, Marburg, Hessen, Germany.
| | - Christian Görg
- Gastroenterology and Interdisciplinary Center of Ultrasound, Department of Internal Medicine, University Hospital Marburg and Giessen, Marburg, Hessen, Germany
| | - Andreas Burchert
- Department of Internal Medicine, Hematology, Oncology and Immunology, University Hospital Marburg und Giessen, Marburg, Hessen, Germany
| | - Christian Michel
- Department of Internal Medicine, Hematology, Oncology and Immunology, University Hospital Marburg und Giessen, Marburg, Hessen, Germany
| | - Katharina Kipper
- Gastroenterology and Interdisciplinary Center of Ultrasound, Department of Internal Medicine, University Hospital Marburg and Giessen, Marburg, Hessen, Germany
| | | | - Corinna Ulrike Keber
- Department of Pathology, University Hospital Marburg und Giessen, Marburg, Hessen, Germany
| | - Ehsan Safai Zadeh
- Gastroenterology and Interdisciplinary Center of Ultrasound, Department of Internal Medicine, University Hospital Marburg and Giessen, Marburg, Hessen, Germany.
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Alhyari A, Görg C, Alakhras R, Dietrich CF, Trenker C, Safai Zadeh E. HCC or Something Else? Frequency of Various Benign and Malignant Etiologies in Cirrhotic Patients with Newly Detected Focal Liver Lesions in Relation to Different Clinical and Sonographic Parameters. Diagnostics (Basel) 2022; 12:diagnostics12092079. [PMID: 36140481 PMCID: PMC9497913 DOI: 10.3390/diagnostics12092079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: To investigate the frequency of different benign and malignant focal liver lesions (FLLs) in relation to clinical and sonographic features among patients with liver cirrhosis (LC) and newly detected FLLs. Methods: This study was a retrospective analysis of 225 cirrhotic patients with newly detected FLLs who underwent hepatic ultrasound (US) examinations at our university hospital from 2011 to 2022. The diagnosis of FLLs was based on histology and/or consensus radiological criteria, in accordance with the current diagnostic guidelines. The FLLs were classified into benign (bFLLs) or malignant (mFLLs) lesions and the latter group was subclassified into HCC and non-HCC mFLLs. The frequency, clinical parameters, and sonographic features of the different groups were examined and compared. Results: Of the 225 FLLs, 154 (68.4%) were mFLLs and 71 (31.6%) bFLLs. HCC was the most frequent subcategory of FLLs (132; 58.7%). There were (22; 9.8%) non-HCC mFLLs with 11 (4.9%) metastases and 11 (4.9%) non-HCC primary liver tumors. Regenerative nodules (RNs) were the most frequent form of bFLLs (25; 11.1%), followed by simple cysts (22; 9.8%) and hemangiomas (14; 6.2%). The other bFLLs (10; 14.1%) were fat deposition/sparing (5), hematomas (2), abscesses (2), and echinococcal cysts (1). The distribution of bFLLs and HCC and non-HCC mFLLs varied significantly according to the clinical scenarios. HCC mFLLs were more frequent in males (p = 0.001), in those with no history of active non-hepatic primary malignant disease (NHPMD) (p < 0.001), in those with a hepatitis B or C etiology of LC (p = 0.002), when located in the right lobe (p = 0.008), and when portal vein thrombosis was present (p = 0.03). Conclusion: In cirrhotic patients with newly detected FLLs, the non-HCC etiology was more frequently diagnosed in lesions that were located in the left lobe, in females, and in patients with a history of active NHPMD. Thus, the lower frequency of HCC in the abovementioned groups demonstrated that a cautious implementation of the current consensus radiological criteria would be required for these groups, particularly in patients with an active NHPMD, given the fact that the consensus criteria were not validated in these populations. A more active diagnostic approach may ultimately be needed for these patients. Large prospective studies are needed to validate these findings.
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Affiliation(s)
- Amjad Alhyari
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany
- Correspondence: ; Tel.: +49-6421-58-61538
| | - Christian Görg
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Raed Alakhras
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, 3013 Bern, Switzerland
| | - Corrina Trenker
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany
- Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Ehsan Safai Zadeh
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany
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Trenker C, Kümpel J, Michel C, Safai Zadeh E, Dietrich CF, Timmesfeld N, Neubauer A, Burchert A, Görg C. Assessment of Early Therapy Response of Non-Hodgkin's and Hodgkin's Lymphoma Using B-Mode Ultrasound and Dynamic Contrast-Enhanced Ultrasound. J Ultrasound Med 2022; 41:2033-2040. [PMID: 34846074 DOI: 10.1002/jum.15887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Here we asked, whether contrast enhanced ultrasound (CEUS) enables to judge early treatment response in malignant lymphoma as a potential guidance for further treatment. METHODS From May 2017 to May 2018, 21 patients with histologically confirmed diagnosis of lymphoma were examined by B-mode ultrasound (B-US) and CEUS at fixed early time points after commencing therapy (days [d] 0, 15 and 30 after therapy start) and contrast enhancement patterns in target lymphoma lesions were quantified using Bracco-VUE Box® (DCE-US). To estimate the potential value of CEUS-enhancement patterns for early response prediction, patients were grouped according to their best achieved actual response into complete remission (CR) patients, partial remission (PR) patients or progressive disease (PD) patients. RESULTS Between d0, d15 and d30, CR-patients showed a median lymphoma shrinking by 34% in B-US. PD-patients experienced a median lymphoma size reduction by 44% on day 15, but lymphoma mass again increased by 20% between d15 and d30. In contrast, the median CEUS enhancement intensity, as assessed by the area under the curve (AUC) was increasing at d15 in CR and PD patients (CR to 152%, PD: to 126%), but decreased at d30 to 14% in CR patients and 22% in PD patients. CONCLUSIONS While early response assessment using B-US might be useful to predict treatment response in lymphoma, CEUS and DCE-US-although often feasible-do not provide additional value in this regard.
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Affiliation(s)
- Corinna Trenker
- Hospital of Internal Medicine: Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Marburg, Germany
- Philipps University Marburg, Marburg, Germany
| | - Jessica Kümpel
- Philipps University Marburg, Marburg, Germany
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Marburg, Germany
| | - Christian Michel
- Hospital of Internal Medicine: Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Marburg, Germany
- Philipps University Marburg, Marburg, Germany
| | - Ehsan Safai Zadeh
- Philipps University Marburg, Marburg, Germany
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Marburg, Germany
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Bern, Switzerland
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-Universität Bochum, Bochum, Germany
| | - Andreas Neubauer
- Hospital of Internal Medicine: Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Marburg, Germany
- Philipps University Marburg, Marburg, Germany
| | - Andreas Burchert
- Hospital of Internal Medicine: Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Marburg, Germany
- Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- Philipps University Marburg, Marburg, Germany
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Marburg, Germany
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Safai Zadeh E, Dietrich CF, Kmoth L, Trenker C, Alhyari A, Ludwig M, Görg C. Peripheral Pulmonary Lesions in Confirmed Pulmonary Arterial Embolism: Follow-up Study of B-Mode Ultrasound and of Perfusion Patterns Using Contrast-Enhanced Ultrasound (CEUS). J Ultrasound Med 2022; 41:1713-1721. [PMID: 34694040 DOI: 10.1002/jum.15852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 05/18/2023]
Abstract
PURPOSE This retrospective study aimed to describe the B-mode lung ultrasound (B-LUS) and contrast-enhanced ultrasound (CEUS) follow-up patterns of peripheral pulmonary lesions (PPLs) in patients with confirmed pulmonary embolism (PE). PATIENTS AND METHODS Data from 27 patients with a confirmed diagnosis of PE and PPLs over 5 mm from October 2009 to November 2018 were included retrospectively in the study. The inclusion criteria were performance of a baseline CEUS examination, a short-term B-LUS and CEUS follow-up, and a long-term B-LUS follow-up of PPLs. The homogeneity of enhancement of PPLs (homogeneous/inhomogeneous/absent) on CEUS and the presence and size of PPLs on B-LUS were evaluated. RESULTS A total of n = 25/27 (92.6%) lesions showed absent or inhomogeneous enhancement during baseline examination or short-term follow-up, indicating impaired perfusion. On short-term CEUS follow-up, 9/27 cases (33.3%) showed a pattern shift. On B-LUS long-term follow-up, 26/27 lesions (96.3%) were detectable for an average of 10 weeks (range 3-32 weeks). The size of reference lesions was significantly reduced at the time of the final follow-up examination (P < .05). CONCLUSION B-LUS follow-up showed that, in patients with confirmed PE, PPLs had a delayed regression. On CEUS follow-up examination, various perfusion patterns of PPLs were observed, indicating the different ages and the variable reparative processes of pulmonary infarction. In PPLs independent of the underlying signs and symptoms, follow-up B-LUS and CEUS examinations may be helpful for a possible retrospective diagnosis of peripheral pulmonary infarction suggestive of PE.
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Affiliation(s)
- Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University of Marburg, Marburg, Germany
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Laila Kmoth
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University of Marburg, Marburg, Germany
| | - Corinna Trenker
- Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University of Marburg, Marburg, Germany
| | - Amjad Alhyari
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipps University of Marburg, Marburg, Germany
| | - Michael Ludwig
- Clinic for Internal Medicine, Bundeswehrkrankenhaus Berlin, Berlin, Germany
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University of Marburg, Marburg, Germany
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipps University of Marburg, Marburg, Germany
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Safai Zadeh E, Huber KP, Dietrich CF, Trenker C, Martin E, Beutel B, Wollenberg B, Görg C. The Value of Lung Ultrasound to Detect the Early Pleural and Pulmonary Pathologies in Nonhospitalized COVID-19-Suspected Cases in a Population With a Low Prevalence of COVID-19 Infection: A Prospective Study in 297 Subjects. J Ultrasound Med 2022; 41:1397-1403. [PMID: 34480772 PMCID: PMC8661560 DOI: 10.1002/jum.15822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES This prospective study aimed to evaluate the value of B-mode lung ultrasound (LUS) for the early diagnosis of coronavirus disease 2019 (COVID-19) infection in nonhospitalized COVID-19 suspected cases in a population with a low prevalence of disease. METHODS From April 2020 to June 2020, in an ambulatory testing center for COVID-19-suspected cases, 297 subjects were examined by LUS before a nasopharyngeal swab was taken for a reverse transcription polymerase chain reaction (RT-PCR) test. The following LUS findings were defined as pathological ultrasound findings and were analyzed: the presence of 1) pleural effusion, 2) B-lines, 3) fragmented visceral pleura, 4) consolidation, and 5) air bronchogram in the consolidation. The LUS findings were compared with the RT-PCR test results. RESULTS The result of the RT-PCR test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive in 11 and negative in 286 subjects, and the prevalence of COVID-19 infection in the study participants was 3.7%. On LUS, a pathological finding could be detected in 56/297 (18.9%) study participants. The LUS revealed a sensitivity of 27.3%, a specificity of 81.5%, a positive predictive value of 5.4%, a negative predictive value of 96.7%, and a diagnostic accuracy of 79.9% for the identification of COVID-19 infection. CONCLUSIONS For the identification of COVID-19 infection, LUS is highly sensitive to the patient spectrum and to the prevalence of the disease. Due to the low diagnostic performance in nonhospitalized COVID-19 cases in low-prevalence areas, LUS cannot be considered to be an adequate method for making a diagnosis in this group.
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Affiliation(s)
- Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound DiagnosticsUniversity Hospital Giessen and Marburg, Philipps University MarburgMarburgGermany
| | - Katharina P. Huber
- Interdisciplinary Center of Ultrasound DiagnosticsUniversity Hospital Giessen and Marburg, Philipps University MarburgMarburgGermany
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin (DAIM)Kliniken Hirslanden Bern, Beau Site, Salem und PermanenceBernSwitzerland
| | - Corinna Trenker
- Haematology, Oncology and ImmunologyUniversity Hospital Giessen and Marburg, Philipps University MarburgMarburgGermany
| | - Evelyn Martin
- Department of Anaesthesiology and Intensive Care MedicinePhilipps University MarburgMarburgGermany
| | - Björn Beutel
- Department of PneumologyUniversity Hospital Giessen and Marburg, Philipps University MarburgMarburgGermany
| | | | - Christian Görg
- Interdisciplinary Center of Ultrasound DiagnosticsUniversity Hospital Giessen and Marburg, Philipps University MarburgMarburgGermany
- Gastroenterology, Endocrinology, Metabolism and Clinical InfectiologyUniversity Hospital Giessen and Marburg, Philipps University MarburgMarburgGermany
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Alhyari A, Görg C, Dietrich CF, Trenker C, Strauch L, Safai Zadeh E. ARFI elastography of the omentum: feasibility and diagnostic performance in differentiating benign from malignant omental masses. BMJ Open Gastroenterol 2022; 9:bmjgast-2022-000901. [PMID: 35523459 PMCID: PMC9083433 DOI: 10.1136/bmjgast-2022-000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/18/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To evaluate the feasibility and diagnostic performance of acoustic radiation force impulse (ARFI) elastography in different omental masses (OM). Design This was a retrospective analysis of 106 patients with OM defined as omental thickness ≥1 cm, who underwent abdominal B-mode ultrasound (US) and standardised ARFI examinations of the OM between September 2018 and June 2021 at our university hospital. A cytohistological confirmation was available in 91/106 (85.8%) of all OM, including all 65/65 (100%) malignant OM (mOM) and 26/41 (63.4%) of benign OM (bOM). In 15/41 (36.6%) of bOM; cross-sectional imaging and or US follow-up with a mean duration of 19.8±3.1 months was performed. To examine the mean ARFI velocities (MAV) for potential cut-off values between bOM and mOM a receiver operating characteristic analysis was implemented. Results The MAV in the mOM group (2.71±1.04 m/s) was significantly higher than that of bOM group (1.27±0.87 m/s) (p<0.001). Using 1.97 m/s as a cut-off yielded a sensitivity and specificity of 76.9% and 85.4%, respectively, in diagnosing mOM (area under the curve=0.851, 95% CI=0.774 to 0.928). Conclusion ARFI elastography is feasible in the omentum and may represent a good non-invasive additional tool in differentiating bOM from mOM.
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Affiliation(s)
- Amjad Alhyari
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße Marburg, Marburg, Germany .,Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Marburg, Germany, Marburg, Germany.,Interdisciplinary Centre of Internal Medicine, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße Marburg, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße Marburg, Marburg, Germany.,Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Marburg, Germany, Marburg, Germany.,Interdisciplinary Centre of Internal Medicine, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße Marburg, Marburg, Germany
| | - Christoph Frank Dietrich
- Department of Internal Medicine, Kliniken Hirslanden Bern, Salem und Permanence, Bern, Switzerland
| | - Corrina Trenker
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße Marburg, Marburg, Germany.,Interdisciplinary Centre of Internal Medicine, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße Marburg, Marburg, Germany.,Haematology, Oncology and Immunology, Universitatsklinikum Giessen und Marburg - Standort Marburg, Marburg, Germany
| | - Lena Strauch
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße Marburg, Marburg, Germany
| | - Ehsan Safai Zadeh
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße Marburg, Marburg, Germany.,Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Marburg, Germany, Marburg, Germany.,Interdisciplinary Centre of Internal Medicine, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße Marburg, Marburg, Germany
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Alhyari A, Görg C, Dietrich CF, Trenker C, Ludwig M, Safai Zadeh E. Diagnostic Performance of Point Shear Wave Elastography Using Acoustic Radiation Force Impulse Technology in Peripheral Pulmonary Consolidations: A Feasibility Study. Ultrasound Med Biol 2022; 48:778-785. [PMID: 35151527 DOI: 10.1016/j.ultrasmedbio.2021.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
The aim of the study described here was to evaluate the diagnostic performance of lung ultrasound point shear wave elastography using acoustic radiation force impulse (ARFI) in peripheral pulmonary consolidations (PPCs). A total of 87 patients with PPCs diagnosed from April to December 2020 were included retrospectively in the study. The inclusion criteria were (i) a PPC >1 cm; (ii) valid ARFI measurements; and (iii) confirmation of the diagnosis of a PPC by histocytological examination and/or clinical and radiological follow-up. The presence of pleural effusions and mean ARFI velocities (MAVs) of PPCs were evaluated. To examine the MAV for potential cutoff values between benign and malignant PPCs, a receiver operating characteristic analysis was implemented. In total, 48 of 87 PPCs (55.2%) were accompanied by pleural effusions. Benign PPCs had significantly lower MAVs than malignant PPCs (1.82 ± 0.97 m/s vs. 3.05 ± 0.73 m/s, p < 0.001). Selecting 2.21 m/s as a cutoff value yielded a sensitivity and specificity of 89.7% and 75.9%, respectively, in diagnosing malignant PPCs (area under the curve = 0.852, 95% confidence interval: 0.773-0.931). In summary, ARFI elastography may be an additional non-invasive tool for differentiating benign from malignant PPCs. Furthermore, the feasibility of using ARFI elastography in PPCs associated with pleural effusions was proved. However, there is some degree of overlap between different disease entities, and diagnosis should always take into account the clinical background.
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Affiliation(s)
- Amjad Alhyari
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, Marburg, Germany; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstrße Marburg, Germany.
| | - Christian Görg
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, Marburg, Germany; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstrße Marburg, Germany
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Corinna Trenker
- Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, Marburg, Germany
| | - Michael Ludwig
- Clinic for Internal Medicine, Bundeswehrkrankenhaus Berlin, Berlin, Germany
| | - Ehsan Safai Zadeh
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, Marburg, Germany; Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstrße Marburg, Germany.
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Safai Zadeh E, Baumgarten MA, Dietrich CF, Görg C, Neesse A, Trenker C, Alhyari A. Frequency of synchronous malignant liver lesions initially detected by ultrasound in patients with newly diagnosed underlying non-hematologic malignant disease: a retrospective study in 434 patients. Z Gastroenterol 2022; 60:586-592. [PMID: 34670295 DOI: 10.1055/a-1649-8857] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION This study described the frequency of malignant synchronous focal liver lesions (FLLs) in patients with newly diagnosed non-hematologic malignant disease. METHODS From June 2013 to January 2017, 434 patients with synchronous FLLs and newly diagnosed underlying malignant disease were included in the study. The diagnosis of the FLLs was made by histology and/or contrast-enhanced imaging. The final medical report was used for analysis in the study. RESULTS Of the 434 liver lesions, 258 (59.4%) were malignant and 176 (40.6%) benign. All malignant lesions were metastases. The benign liver lesions were comprised of 93 cysts (21.4%), 52 hemangiomas (12.0%), 20 focal fatty sparing (4.6%), 4 focal nodular hyperplasia (0.9%), 3 unspecified benign lesions (0.7%), 2 regenerative nodules (0.5%), 1 calcification (0.2%), and 1 adenoma (0.2%). Diseases with the highest percentage frequency of synchronous malignant FLLs were cholangiocarcinoma with 86.7%, neuroendocrine tumor with 72.7%, and pancreatic carcinoma with 72.0%. Gastric carcinoma (33.3%), breast carcinoma (44.4%), and urothelial cell carcinoma (45.5%) were the diseases with the lowest percentage frequency of synchronous malignant FLLs. CONCLUSION In total, the frequency of malignant synchronous FLLs in newly diagnosed non-hematologic malignant disease was 59.4%. In particular, cholangiocarcinoma, neuroendocrine tumor, and pancreatic carcinoma were the diseases with the highest rate of synchronous malignant FLLs.
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Affiliation(s)
- Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Martin Axel Baumgarten
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Beau Site, Salem und Permanence, Bern, Kliniken Hirslanden Bern, Bern, Switzerland
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg/ Lahn, Germany
| | - Albrecht Neesse
- Gastroenterology,Gastrointestinal Oncology and Endocrinology, University Medicine Goettingen, Göttingen, Germany
| | - Corinna Trenker
- Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Amjad Alhyari
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg/ Lahn, Germany
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Safai Zadeh E, Görg C, Prosch H, Jenssen C, Blaivas M, Laursen CB, Jacobsen N, Dietrich CF. WFUMB Technological Review: How to Perform Contrast-Enhanced Ultrasound of the Lung. Ultrasound Med Biol 2022; 48:598-616. [PMID: 35067423 DOI: 10.1016/j.ultrasmedbio.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/18/2021] [Accepted: 11/23/2021] [Indexed: 05/09/2023]
Abstract
The use of ultrasound has revolutionized the evaluation of pulmonary complaints and pathology. Historically, most lung ultrasound uses described are limited to B-mode, M-mode and occasionally color Doppler. However, the use of contrast can significantly expand the diagnostic capabilities of lung ultrasound. Ultrasound contrast enables significant expansion of therapeutic and intervention capabilities. We provide a detailed description of contrast administration, phases and uses in lung ultrasound. Additionally provided are example contrast use cases and illustrative examples of contrast use in a wide range of lung ultrasound applications including pneumonia, atelectasis, pulmonary embolism and neoplasms. Clinical practice examples will help providers incorporate contrast use into their lung ultrasound practice.
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Affiliation(s)
- Ehsan Safai Zadeh
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstrasse, Marburg, Germany; Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstrasse, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstrasse, Marburg, Germany; Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstrasse, Marburg, Germany
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Christian Jenssen
- Krankenhaus Märkisch-Oderland, Department of Internal Medicine, Strausberg, Germany; Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg, Neuruppin, Germany
| | - Michael Blaivas
- University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Odense Respiratory Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Niels Jacobsen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Odense Respiratory Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, Bern, Switzerland.
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Safai Zadeh E, Keber CU, Dietrich CF, Westhoff CC, Günter C, Beutel B, Alhyari A, Trenker C, Görg C. Perfusion Patterns of Peripheral Pulmonary Granulomatous Lesions Using Contrast-Enhanced Ultrasound (CEUS) and Their Correlation with Immunohistochemically Detected Vascularization Patterns. J Ultrasound Med 2022; 41:565-574. [PMID: 33955572 DOI: 10.1002/jum.15730] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/11/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE To describe the perfusion patterns of peripheral pulmonary granulomatous lesions (PPGLs) by contrast-enhanced ultrasound (CEUS) and their correlation with vascularization patterns (VPs) represented by immunohistochemical (CD34) endothelial staining. PATIENTS AND METHODS From January 2007 until September 2020, 10 consecutive patients with histologically confirmed PPGLs were investigated by CEUS. The time to enhancement, classified as early pulmonary-arterial (PA) pattern of enhancement versus delayed bronchial-arterial (BA) pattern of enhancement, the extent of enhancement, classified as marked or reduced, the homogeneity of enhancement, classified as homogeneous or inhomogeneous, and the decrease of enhancement, classified as rapid washout (<120 seconds) or a late washout (≥120 seconds), were analyzed retrospectively. Furthermore, the tissue samples from the study patients and as a control group, 10 samples of normal lung tissue obtained by autopsy, and 10 samples of lung tissue with acute pneumonia obtained by autopsy were immunohistochemically stained with CD34 antibody. The presence of avascular areas (AAs) and the VPs were evaluated in all tissue samples. RESULTS On CEUS, all PPGLs showed a reduced inhomogeneous BA pattern of enhancement and a rapid washout (<120 seconds). On CD34 staining, all PPGLs showed central AAs in granulomas and a chaotic VP similar to angiogenesis in lung tumors. The lung tissue in control groups revealed on CD34 staining a regular alveolar VP. CONCLUSION The PPGLs on CEUS show an identical perfusion pattern similar to those of malignant lesions. Furthermore, for the first time, neoangiogenesis was demonstrated as a histopathological correlate to BA pattern of enhancement on CEUS.
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Affiliation(s)
- Ehsan Safai Zadeh
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Corinna U Keber
- Institute of Pathology and Cytology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Bern, Switzerland
| | - Christina C Westhoff
- Institute of Pathology and Cytology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christina Günter
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Björn Beutel
- Pneumology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Amjad Alhyari
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Corinna Trenker
- Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
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Alhyari A, Görg C, Dietrich CF, Kawohl S, Safai Zadeh E. Diagnostic Performance of Point Shear Wave Elastography (pSWE) Using Acoustic Radiation Force Impulse (ARFI) Technology in Mesenteric Masses: A Feasibility Study. Diagnostics (Basel) 2022; 12:diagnostics12020523. [PMID: 35204612 PMCID: PMC8870845 DOI: 10.3390/diagnostics12020523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 02/06/2023] Open
Abstract
Purpose: To evaluate the diagnostic performance of ultrasound point shear wave elastography (pSWE) using acoustic radiation force impulse (ARFI) technology in different benign and malignant mesenteric masses (MMs). Methods: A total of 69 patients with MMs diagnosed from September 2018 to November 2021 were included retrospectively in the study. The inclusion criteria were (1) an MM over 1 cm; (2) valid ARFI measurements; and (3) confirmation of the diagnosis of an MM by histological examination and/or clinical and radiological follow-up. To examine the mean ARFI velocities (MAVs) for potential cut-off values between benign and malignant MMs, a receiver operating characteristics analysis was implemented. Results: In total, 37/69 of the MMs were benign (53.6%) and 32/69 malignant (46.4%). Benign MMs demonstrated significantly lower MAVs than mMMs (1.59 ± 0.93 vs. 2.76 ± 1.01 m/s; p < 0.001). Selecting 2.05 m/s as a cut-off value yielded a sensitivity and specificity of 75.0% and 70.3%, respectively, in diagnosing malignant MMs (area under the curve = 0.802, 95% confidence interval 0.699–0.904). Conclusion: ARFI elastography may represent an additional non-invasive tool for differentiating benign from malignant MMs. However, to validate the results of this study, further prospective randomized studies are required.
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Affiliation(s)
- Amjad Alhyari
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (A.A.); (S.K.); (E.S.Z.)
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (A.A.); (S.K.); (E.S.Z.)
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany
- Correspondence: ; Tel.: +49-6421-58-61538; Fax: +49-6421-58-62825
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, 3018 Bern, Switzerland;
| | - Svenja Kawohl
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (A.A.); (S.K.); (E.S.Z.)
| | - Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (A.A.); (S.K.); (E.S.Z.)
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany
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Safai Zadeh E, Görg C, Dietrich CF, Görlach J, Alhyari A, Trenker C. Contrast-Enhanced Ultrasound for Evaluation of Pleural Effusion: A Pictorial Essay. J Ultrasound Med 2022; 41:485-503. [PMID: 33782994 DOI: 10.1002/jum.15705] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/19/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
B-mode ultrasound (B-US) is the standard imaging modality to evaluate pleural effusion. The value of B-US for assessing the malignancy of a pleural effusion (PE) is limited. For this purpose, computed tomography (CT) and thoracoscopy are the methods of choice to evaluate an effusion. The aim of this Pictorial Essay is to demonstrate contrast-enhanced ultrasound (CEUS) as a method in addition to B-US and CT for the evaluation of PE taking into account the clinical background. The characteristic patterns of pleural pathologies, effusion morphology, and associated lung parenchymal consolidations are presented.
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Affiliation(s)
- Ehsan Safai Zadeh
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Jannis Görlach
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Amjad Alhyari
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Corinna Trenker
- Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
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Findeisen H, Görg C, Hartbrich R, Dietrich CF, Görg K, Trenker C, Safai Zadeh E. Contrast-enhanced ultrasound is helpful for differentiating benign from malignant parietal pleural lesions. J Clin Ultrasound 2022; 50:90-98. [PMID: 34664724 DOI: 10.1002/jcu.23088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION To describe the value of contrast-enhanced ultrasound (CEUS) for the differentiation of malignant from benign parietal pleural lesions (PPLs). MATERIALS AND METHODS From November 2005 to June 2019, 63 patients with histologically/cytologically confirmed PPLs were investigated by CEUS. On CEUS, the extent of enhancement (EE; marked or reduced/absent) and the homogeneity of enhancement (HE; homogeneous or inhomogeneous) were analyzed retrospectively. RESULTS In total, 24/63 lesions were benign, and 39/63 lesions were malignant. On CEUS, 11/24 benign and 36/39 malignant lesions showed a marked enhancement. A marked enhancement was significantly more frequently associated with malignancy compared with benign lesions (p < 0.001). In five cases, due to the absence of enhancement, it was not possible to determine the HE. In the remaining cases, 9/20 benign and 19/38 malignant lesions showed an inhomogeneous enhancement (p = 0.79). CONCLUSION On CEUS, marked enhancement was significantly more frequently associated with malignant compared with benign lesions. However, some benign lesions, such as chronic inflammatory processes, may also show a marked enhancement. Therefore, the interpretation of perfusion patterns in these lesions must always take into account the clinical background of the patient.
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Affiliation(s)
- Hajo Findeisen
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Ruby Hartbrich
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, Bern, Switzerland
| | - Konrad Görg
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Corinna Trenker
- Hematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Ehsan Safai Zadeh
- Interdisciplinary Centre of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
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Zadeh ES, Dietrich CF, Trenker C, Alhayri A, Görg C. Transcutaneous B-mode ultrasound (TUS) and contrast-enhanced ultrasound (CEUS) pattern of mediastinal tumors: a pictorial essay. J Ultrason 2021; 21:e340-e347. [PMID: 34970446 PMCID: PMC8678700 DOI: 10.15557/jou.2021.0056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/02/2021] [Indexed: 12/29/2022] Open
Abstract
Sound reflection from bony structures and from air-filled lung parenchyma limits transcutaneous B-mode thoracic ultrasound of the mediastinum. Computed tomography and magnetic resonance imaging of the thorax are the primary overview imaging modalities for mediastinal pathologies. However, pathological processes originating from the mediastinum can be sonographically visualized and evaluated in the presence of displacing or infiltrative growth. The aim of this pictorial essay is to demonstrate contrast-enhanced ultrasound as a method complementing B-mode ultrasound, computed tomography, and magnetic resonance imaging for the evaluation of mediastinal tumors, taking into account the clinical background. The characteristic perfusion patterns of mediastinal pathology are presented.
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Affiliation(s)
- Ehsan Safai Zadeh
- Interdisciplinary Centre of Ultrasound Diagnostics; Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße Marburg, Germany
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, Switzerland
| | - Corinna Trenker
- Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipps University Marburg, Germany
| | - Amjad Alhayri
- Interdisciplinary Centre of Ultrasound Diagnostics; Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße Marburg, Germany
| | - Christian Görg
- Interdisciplinary Centre of Ultrasound Diagnostics; Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße Marburg, Germany
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