Real-time contrast-enhanced ultrasound in diagnosing of focal spleen lesions

Objective

To investigate the features of focal spleen lesions (FSLs) on contrast-enhanced ultrasound (CEUS) imaging.

Materials and methods

CEUS with a blot injection of SonoVue was performed in 48 patients with 75 FSLs (median diameter 2.6 cm) and their perfusion characteristics were analyzed by using contrast pulse sequences (CPS) technique.

Results

Among 19 malignant lesions (10 metastases, 7 lymphoma, 1 hemangiosarcoma, 1 epithelioid hemangioendothelioma) and 56 benign lesion (23 hemangiomas, 14 cysts, 8 infarctions, 4 splenic ruptures, 3 tuberculosis, 2 abscess, 1 pseudoaneurysm, 1 lymphangioma), 25 benign lesions were demonstrated nonenhancement. For malignancy, 50.0% (5/10) metastases and 57.1% (4/7) lymphomas were showed hypoenhancement in the arterial phase, and 18 (94.7%) of malignant lesions were hypo-enhancement in the parenchymal phase. Among 31 benign lesions with enhancement, 27 (87.1%) were showed isoenhancement or hyperenhancement in the arterial phase and 22 (71.0%) lesions were isoenhancement or hyperenhancement in the parenchymal phase. The sensitivity, specificity and accuracy of diagnosis for FSLs were 91.1%, 95.0% and 92.0% for CEUS and 75.0%, 84.2% and 77.3% respectively, for the conventional baseline ultrasound (BUS).

Conclusion

Real-time CEUS can provide valuable information for the diagnosis and differential diagnosis of FSLs.     

Combined videofluoroscopy and manometry in the diagnosis of oropharyngeal dysphagia: examination technique and preliminary experience

Purpose

Dysphagia is a symptom of different pathological conditions characterised by alteration of the swallowing mechanism, which may manifest at different levels. We report our experience in the evaluation of the swallowing mechanism with combined videofluoroscopy and manometric recordings.

Materials and methods

For the combined study, we used a Dyno Compact computerised system (Menfis Biomedical s.r.l., Bologna, Italy) equipped with: (1) graphics card for the management of ultrasonographic or radiological images; (2) A.VI.U.S. dedicated software package, which enables digital-quality recording (PAL/NTSC, composite video or S-Video) of the videofluoroscopy study in AVI format with 320×240 resolution and 25 Hz acquisition frequency. The delay introduced by the process of image digitalisation is in the order of 200 ms, so for analysis purposes, the images can be considered synchronised with the manometric recordings. The videomanometry study was performed with the administration of contrast material either in bolus form or diluted. Data were collected on a specifically designed grid for the evaluation of 46 videofluoroscopic items, of which 34 are derived from the laterolateral view (seven in the oral preparatory phase, 15 in the oral transport phase and 12 in the pharyngeal phase) and 12 in the anteroposterior view (six in the oral preparatory phase and six in the oropharyngeal phase). A positive finding for the individual parameters is expressed in a binary fashion. Manometric evaluation was based on 11 items divided into four major and seven minor criteria.

Results

Dynamic videofluoroscopy swallow study combined with concurrent manometry enabled the simultaneous recording of anatomical alterations and the functional data of oropharyngeal pressure, thus providing a picture of the anatomical, biomechanical and physiological conditions of swallowing and the manner of bolus propulsion and transit.

Conclusions

An early and effective diagnosis of oropharyngeal dysphagia means being able to effectively implement appropriate rehabilitation techniques, improve the patient’s quality of life, and minimise the complications associated with swallowing disorders (choking, aspiration pneumonia, malnourishment). Distinction of the anatomical level of dysphagia is not a matter of simple classification; rather, it is essential in that different clinical presentations require different diagnostic strategies, and a precise definition of the anatomical-functional substrate is required to implement the correct therapeutic approach. This study presents the authors’ experience with the use of combined videofluoroscopy and manometry with particular emphasis on the examination technique.     

常规超声联合超声造影成像对宫颈癌诊断及分期初步研究

目的探讨常规超声联合超声造影检查(CEUS)在诊断宫颈癌及分期中的应用价值。方法对36例临床诊断为宫颈癌的患者,在术前进行超声及CEUS根据肿块部位、大小、对周围组织的侵犯情况进行分期,并与手术病理分期对照,分析其诊断宫颈癌分期的准确性。结果常规超声联合CEUS诊断宫颈癌Ⅰb、Ⅱ、Ⅲ、Ⅳ期准确率分别为100.0%(4/4)、75.0%(9/12)、92.9%(13/14)和100.0%(6/6),总准确率达88.9%(32/36),两者检查结果高度一致(Kappa值=0.866)。结论超声联合CEUS诊断宫颈癌分期的准确率较高,可以作为主要影像学检查方法之一。     

Carotid arteries: contrast-enhanced US angiography--preliminary clinical experience

B-mode ultrasonographic (US) angiography enhanced with a microbubble-based US contrast agent (FS069) was evaluated in human subjects with carotid artery disease. Results at contrast material-enhanced US angiography and duplex US were compared with those at conventional angiography. Both US angiography and duplex US accurately depicted stenoses of 70% or more compared with those depicted at conventional angiography. The percentage diameter stenosis of the internal carotid artery measured at US angiography strongly correlated with that measured at conventional angiography (r = 0.988). The percentage area stenosis measured at US angiography strongly correlated with ex vivo measurements of the resected carotid plaque at magnetic resonance imaging (r = 0.979). US angiography depicted unsuspected wall irregularities, ulceration, and dissection.     

Real-time contrast-enhanced ultrasound imaging of focal liver lesions in fatty liver

PurposeThe objective of this study was to investigate the contrast-enhanced ultrasound (CEUS) imaging features of focal liver lesions (FLLs) in fatty liver.MethodOne hundred FLLs in 98 patients with fatty liver were evaluated with real-time CEUS.ResultsAll malignant FLLs showed hyperenhancement in arterial phase and contrast washout in portal and late phases. Among the FLLs, 3.3% of hemangiomas, 12.5% of focal nodular hyperplasias (FNHs), and 2.5% of focal fatty sparing lesions showed contrast washout in the late phase. The sensitivity and specificity for the characterization of hepatocellular carcinoma, metastasis, hemangioma, FNH, and focal fatty sparing lesions were 100% and 95.6%, 60% and 100%, 93.3% and 98.6%, 87.5% and 97.8%, and 92.6% and 100%, respectively.ConclusionsCorrect characterization of FLLs in fatty liver by CEUS is possible based on their typical enhancement patterns.     

Digital tomography: description and preliminary clinical experience

Digital tomography was performed in 30 patients using a new prototype system with a PET-Scope image tube. Twenty-eight exposures are obtained during a single revolution of the x-ray source over the volume of tissue to be imaged. The sum of the radiation produced by the 28 exposures is about equivalent to a single routine exposure of the part imaged. The data accumulated can provide up to 200 tomographic sections at intervals of 5 mm. Reconstruction time for each section is 3 sec. The raw images may be reconstructed as often as desired. Algorithms are being developed to allow axial and sagittal reformations. Further work is required to improve spatial resolution and contrast and to develop algorithms to allow subtraction of blurred images above and below the reconstructed site. The authors believe that digital tomography may eventually replace most routine tomograms.     

Liver investigations: Updating on US technique and contrast-enhanced ultrasound (CEUS)

Over the past few years, the cross sectional imaging techniques (Computed Tomography – CT and Magnetic Resonance – MR) have improved, allowing a more efficient study of focal and diffuse liver diseases. Many papers had been published about the results of a routinely clinical use of the dual source/dual energy CT techniques and the use of hepatobiliary contrast agents in MR liver studies.As a consequence, these new improvements have diverted the attention away from the Ultrasound technique and its technical and conceptual evolutions.In these years of disinterest, US and especially Contrast Enhanced Ultrasound (CEUS) have consolidated and grown in their application in clinical routine for liver pathologies. In particular, thanks to the introduction of new, dedicated software packages, CEUS has allowed not only qualitative, but also quantitative analysis of lesion microcirculation, thus opening a new era in the evaluation of lesion characterization and response to therapy.Moreover, the renewed interest in liver elastography, a baseline ultrasound-based imaging modality, has led to the development of a competitive technique to assess liver stiffness and then for the evaluation of the progression towards cirrhosis, and characterization of focal liver lesions, opening the way to avoid, in selected cases, liver biopsy.The aim of this review is to offer an up-to-date overview on the state of the art of clinical applications of US and CEUS in the study of focal and diffuse liver pathologies. Besides, it aims to highlight the emerging role of perfusion techniques in the assessment of local and systemic treatment response and to show how the liver evolution from steatosis to fibrosis can be revealed by elastography.     

早期乳腺癌无创腋窝淋巴结分期的临床初步观察

目的：探讨超声检查评估乳腺癌腋窝淋巴结转移状态的临床应用价值。方法入组军事医学科学院附属医院2013年12月至2015年9月期间连续收治的282例新发 Tis-T2期乳腺癌患者,指定2名高年资超声医师行腋窝超声检查,根据淋巴结声像学参数,将患者分为转移组、未转移组或可疑组。腋窝淋巴结分期以病理学结果作为金标准,分析超声检查评估乳腺癌腋窝淋巴结转移的准确性,比较各组腋窝淋巴结转移负荷;单因素及多因素Logistic 回归分析各个声像学参数对判断腋窝淋巴结转移状态的预测价值。结果超声判断腋窝淋巴结转移组＋未转移组的灵敏度、特异度、阳性及阴性预测值、准确度分别为85．6％、87．1％、86．4％、86．3％和86．3％,Kappa 值为0．727（P ＜0．001）。在病理证实腋窝淋巴结转移患者中,超声判断未转移组的平均淋巴结转移负荷明显低于超声转移组（1．2／6．9枚,P ＜0．001）,超声判断为未转移而病理结果证实为转移的患者共16例,其中14例患者腋窝淋巴结转移负荷仅为1枚,其余2例患者分别为2枚和3枚。单因素 Logistic 回归分析显示,最大皮质厚度预测腋窝淋巴结转移诊断效能最佳（ROC 曲线下面积为0．872）;多因素 Logistic 回归分析显示,最大皮质厚度、髓质与皮质厚度比值与腋窝淋巴结转移相关（P ＜0．05）。多因素 Logistic 回归模型 ROC 曲线下面积为0．879,灵敏度及特异度分别为77．0％和85．1％。结论超声检查评估腋窝淋巴结转移具有较高的准确性;超声判断假阴性的患者腋窝淋巴结转移负荷较低。最大皮质厚度是判断腋窝淋巴结转移最主要的声像学参数。在早期乳腺癌患者中,超声检查无创评估可能是潜在的替代前哨淋巴结活检行腋窝淋巴结分期的手段。     

Multidetector row CT coronary angiography: technique and preliminary experience

PURPOSE: To report our preliminary experience with multi-slice spiral CT coronary angiography of the coronary arteries. MATERIALS AND METHODS: 50 volunteers (mean age 61 years, range 45-72) with baseline heart rates below 70 bpm underwent multi-detector row CT coronary angiography (GE Light Speed Plus, 140 kVp, 270 mA, 1.25-mm collimation, 0.5-second rotation time, high quality pitch) with retrospective ECG gating after receiving 140-150 ml of iodinated contrast medium (Iopamiro 300 mg-dl, Bracco, Italy) at a flow rate of 4 ml/sec. Three of the 50 patients had previously undergone coronary procedures (1 anterior descending artery stent, 1 left circumflex artery stent and 1 anterior descending artery percutaneous angioplasty) and three were undergoing follow-up examinations after by-pass surgery. The remaining 44 patients were asymptomatic and had no history of coronary artery disease. All CT angiograms were back-reconstructed from 20 to 80% of the diastolic cycle with 10% increments to establish the phase with fewer "stair-step" motion artefacts for each artery. Patients with heart rates above 70 bpm were administered beta-blockers during the five days preceding the examination in doses appropriate for the patient's clinical characteristics. RESULTS: The CT room occupation time ranged from 25 to 35 minutes (mean time 27') and the post-processing time from 30 to 60 minutes (mean time 40'). The left anterior descending artery was best visualised in middle diastole (70% of cardiac cycle), the circumflex artery at 60% of the cardiac cycle, and the right coronary artery at 40%. Out of 132 arteries, 19 (14.4%) were considered non-assessable due to "stair-step" motion artefacts, whereas 2 (1.5%) were only partially visualised owing to the presence of extensive wall calcifications. Among the 113 assessable arteries, we observed: 72 normal coronary arteries without stenosis or wall calcifications (54.5%); 28 arteries with minimal wall irregularities and stenoses below 50% (21.2%); 7 stenoses >50% involving the right coronary artery (no. 2), the anterior descending arteries (no. 4) and the left circumflex artery (no. 1) (5.3%). In the remaining 6 patients, optimal visualisation of the stents and venous and arterial surgical by-passes was obtained. CONCLUSIONS: Although further larger-scale studies are required to compare MSCT coronary angiography with CT coronary angiography, the application of MSCT technology to the study of the coronary arteries is a promising technique with a good potential for use in routine clinical practice. In selected patients (with baseline heart rates <70 bpm, or after beta-blocker therapy) it is able to provide very interesting results and could be used as a method of choice for following patients after interventional procedures or as a mass-screening tool to select patients to be referred for coronary angiography.     

Real-time cerebral angiography: sensitivity of a new contrast-specific ultrasound technique

BACKGROUND AND PURPOSE: To test a new contrast-specific sonography imaging method that offers visualization of the intracranial vasculature in a manner similar to that seen on angiography. MATERIALS AND METHODS: Thirty patients (35 sonography studies total) were included in the study after they provided written informed consent. The patients were scanned through the temporal bone window from both sides after intravenous injection of an ultrasound contrast agent (UCA; perflexane lipid microspheres [Imagent]). The goal was to visualize the intracranial arteries, including the middle (M1-M3), anterior (A1 and A2), and posterior (P1-P3) cerebral arteries, using an axial scanning plane. The studies were performed using a contrast-specific imaging mode, based on a phase inversion technique (transcranial ultrasound angiography [tUSA]). For sensitivity, the results were compared with x-ray angiography as the "gold standard." For interobserver reliability, 24 of 35 sonography studies were evaluated by 2 physicians with little training in transcranial sonography and by a seasoned sonographer. RESULTS: The sensitivity of tUSA ranged between 0.778 (95% confidence interval [CI] of 0.577-0.914) and 0.963 (95% CI of 0.810-0.999). The sensitivities were similar among physicians with little training in transcranial sonography and the seasoned sonographer, indicating high inter-rater reliability. Overall, tUSA provided high anatomic resolution and vascular delineation even of small vessels in the millimeter range. At peak intensity, no UCA-related artifacts were observed. CONCLUSION: tUSA provides images of the intracranial arteries similar to those obtained at angiography with high anatomic resolution, reasonable sensitivity, and interobserver reliability.     

Endovascular stenting of veins and grafts: preliminary clinical experience

Stenotic lesions of veins and bypass grafts are often difficult to dilate and have a high frequency of recurrence. In an effort to provide an endoluminal mechanical support, the new concept of transluminal vascular stenting was applied in four patients with stenoses of nonarterial vessels, including two with postoperative venous stenoses, one with a stenosed mesenteric artery graft anastomosis, and one with a long stenosis of the basilic vein distal to a hemodialysis shunt graft. All four were successfully treated with percutaneous transluminal angioplasty followed by endovascular stenting. All but one of the stented segments were patent, with no significant restenosis after a follow-up of 4 1/2-12 months. There have been previous reports of transluminal vascular stenting in the arterial system, and the preliminary results from this study suggest that endovascular stenting also may play an important role in the treatment of venous and graft stenoses. However, further follow-up and careful patient selection will have to be done to establish the long-term benefit of this new procedure.     

Independent component analysis for the examination of dynamic contrast-enhanced breast magnetic resonance imaging data: preliminary study

RATIONALE AND OBJECTIVE: An application of independent component analysis (ICA) is reported for the detection and characterization of breast lesions in dynamic contrast-enhanced MRI. The ICA technique, which uses a novel statistical algorithm to separate mixed signal sources of unknown nature, enables the extraction of spatial and temporal features of dynamic MRI data. MATERIALS AND METHODS: Six patients with confirmed lesion diagnosis (three with malignancy and three with benign condition) participated in this study. T1-weighted MRI covering both breast volumes was dynamically acquired in every 90 seconds after the bolus injection of contrast media using three-dimensional fast low-angle shot sequence (3-D FLASH). RESULTS: With the application of the ICA, differential signal responses were delineated from benign and malignant lesions, and areas with high temporal correlations with the extracted signal components were selectively visualized. CONCLUSIONS: The results suggest that ICA allowed for an identification of lesion morphology and lesion-specific dynamic enhancement patterns.     

Real-time contrast-enhanced ultrasound-guided biopsy of focal hepatic lesions not localised on B-mode ultrasound

Objective

To prospectively evaluate the technical feasibility of percutaneous real-time contrast-enhanced ultrasound (CEUS) guided biopsy of focal hepatic lesions that are not confidently localised on B-mode US.

Methods

The study included 44 patients (mean age, 61.3 years) whose biopsy target could not be confidently localised on B-mode US performed by two independent radiologists. Biopsy was attempted under the guidance of both CEUS and B-mode US simultaneously displayed on a single monitor. Final diagnosis was established based on the pathological examination of the biopsy specimen as well as on clinical and radiological follow-up.

Results

The size and depth of the target lesions were 18.0?±?9.0 mm (mean ± SD) and 41.8?±?17.2 mm respectively. Five patients with negative or indistinct CEUS findings did not undergo biopsy, while 39 patients completed the biopsy. In 38 of the 39 patients, the biopsy result was concordant with the final diagnosis. In the remaining one patient, the biopsy failed to prove metastasis. As there were six cases of technical failure, the technical success rate was 86% (38/44). The sensitivity in diagnosing malignancy was 88% (30/34).

Conclusion

Real-time CEUS-guided biopsy is technically feasible for hepatic focal lesions that are not confidently localised on B-mode US.     

Initial clinical experience with contrast-enhanced digital breast tomosynthesis

RATIONALE AND OBJECTIVES: Contrast-enhanced digital mammography and digital breast tomosynthesis are two imaging techniques that attempt to increase malignant breast lesion conspicuity. The combination of these into a single technique, contrast-enhanced digital breast tomosynthesis (CE-DBT), could potentially integrate the strengths of both. The objectives of this study were to assess the clinical feasibility of CE-DBT as an adjunct to digital mammography, and to correlate lesion enhancement characteristics and morphology obtained with CE-DBT to digital mammography, ultrasound, and magnetic resonance (MR). MATERIALS AND METHODS: CE-DBT (GE Senographe 2000D; Milwaukee, WI) was performed as a pilot study in an ongoing National Cancer Institute-funded grant (P01-CA85484) studying multimodality breast imaging. Thirteen patients with ACR BI-RADS category 4 or 5 breast lesions underwent imaging with digital mammography, ultrasound, MR, and CE-DBT. CE-DBT was performed at 49 kVp with a rhodium target and a 0.27-mm copper (Alfa Aesar, Ward Hill, MA) filter. Preinjection and postinjection DBT image sets were acquired in the medial lateral oblique projection with slight compression. Each image set consists of nine images acquired over a 50-degree arc and was obtained with a mean glandular x-ray dose comparable to two conventional mammographic views. Between the precontrast and postcontrast DBT image sets, a single bolus of iodinated contrast agent (1 ml/kg at 2 ml/s, Omnipaque-300; Amersham Health Inc., Princeton, NJ) was administered. Images were reconstructed using filtered-backprojection in 1-mm increments and transmitted to a clinical PACS workstation. RESULTS: Initial experience suggests that CE-DBT provides morphologic and vascular characteristics of breast lesions qualitatively concordant with that of digital mammography and MR. CONCLUSION: As an adjunct to digital mammography, CE-DBT may be a potential alternative tool for breast lesion morphologic and vascular characterization.     

MR-based full-body preventative cardiovascular and tumor imaging: technique and preliminary experience

Recent improvements in hardware and software, lack of side effects, as well as diagnostic accuracy make magnetic resonance imaging a natural candidate for preventative imaging. Thus, the purpose of the study was to evaluate the feasibility of a comprehensive 60-min MR-based screening examination in healthy volunteers and a limited number of patients with known target disease. In ten healthy volunteers (7 men, 3 women; mean age, 32.4 years) and five patients (4 men, 1 woman; mean age, 56.2 years) with proven target disease we evaluated the performance of a comprehensive MR screening strategy by combining well-established organ-based MR examination components encompassing the brain, the arterial system, the heart, the lungs, and the colon. All ten volunteers and five patients tolerated the comprehensive MR examination well. The mean in-room time was 63 min. In one volunteer, insufficient colonic cleansing on the part of the volunteer diminished the diagnostic reliability of MR colonography. All remaining components of the comprehensive MR examination were considered diagnostic in all volunteers and patients. In the five patients, the examination revealed the known pathologies [aneurysm of the anterior communicating artery (n=1), renal artery stenosis (n=1), myocardial infarct (n=1), and colonic polyp (n=2)]. The outlined MR screening strategy encompassing the brain, the arterial system, the heart, the lung, and the colon is feasible. Further studies have to show that MR-based screening programs are cost-effective in terms of the life-years saved.     

Magnetic resonance colonography: comparison of contrast-enhanced three-dimensional vibe with two-dimensional FISP sequences: preliminary experience

PURPOSE: The purpose of this study was to compare a dark-lumen magnetic resonance colonography (MRC) approach with a True FISP-based bright-lumen technique concerning presence of artifacts and the detection rate of colorectal pathologies. MATERIALS AND METHODS: Thirty-seven patients with suspected colorectal lesions were included in this trial. The colon was filled with 2500 mL of tap water. Two-dimensional True FISP datasets as well as T1-weighted GRE sequences (pre- and post intravenous contrast) were acquired. The detection rate of colorectal masses and inflammatory lesions was determined for both techniques separately. Besides, image quality was assessed. All patients underwent conventional colonoscopy as the standard of reference. RESULTS: By means of dark-lumen MRC datasets, all polyps >5 mm were correctly diagnosed, whereas 4 polyps <5 mm were missed. Sensitivity of dark-lumen MRC amounted to 78.9%. There were no false-positive results: residual stool could correctly be differentiated from colorectal masses. The True FISP-based bright-lumen MRC, however, failed to detect 2 additional polyps resulting in a sensitivity of 68.4%. Furthermore, bright-lumen MRC led to false-positive results in 5 patients. Both techniques visualized inflammatory bowel disease in 5 patients. However, image quality of True FISP was rated superior to that of dark-lumen MRC. CONCLUSION: Dark-lumen MRC proved to be superior over bright-lumen MRC regarding the detection of colorectal masses. However, True FISP imaging can turn out to be helpful as a result of high image quality and motion insensitivity.     

CT-guided iliosacral screw placement: technique and clinical experience

OBJECTIVE: The purpose of this study was to describe the technique of and experience in using CT guidance for percutaneous iliosacral screw placement in patients with unstable pelvic fractures. CONCLUSION: CT-guided iliosacral screw placement is a safe and accurate procedure that can be performed by radiologists in a radiology suite.