Contrast-Enhanced Ultrasound Findings and Differential Diagnosis of Hepatic Epithelioid Angiomyolipoma Compared with Hepatocellular Carcinoma

Hepatic epithelioid angiomyolipoma (EAML) has malignant potential that can easily be misdiagnosed as hepatocellular carcinoma (HCC), but the treatment options of these conditions are different. This retrospective study investigated whether contrast-enhanced ultrasound (CEUS) can differentiate EAML from HCC. We included 24 patients with pathologically confirmed EAML and 36 patients with HCC who underwent pre-operative conventional ultrasound and CEUS. The conventional ultrasound and CEUS features of the two groups were analyzed. Time intensity curves (TICs) were analyzed for all lesions using quantitative perfusion analysis software. This study found that significant differences existed between the EAML and HCC groups in terms of clinical features such as sex, age, symptoms, alpha-fetoprotein and history of hepatitis B virus infection (p < 0.05). Tumor size, number, border and echogenicity on conventional ultrasound were significantly different between EAML and HCC (p < 0.05). Regarding CEUS, EAML was more likely to have a centripetal enhancement pattern than HCC (p < 0.05). The tumor enhancement degree in the delayed phase in CEUS was significantly different between EAML and HCC (p < 0.05). Quantitative analysis of CEUS parameters revealed that the wash-in area under the curve (AUC) was larger in EAML than in HCC (p < 0.05). Time to peak was significantly shorter in EAML than in HCC (p < 0.05). The peak intensity was significantly stronger in EAML than in HCC (p < 0.05). Regarding the diagnostic performance of CEUS parameters that showed statistical significance on univariate analysis, the sensitivity and specificity for distinguishing EAML from HCC was 66.7%–100.0% and 55.6%–91.7%, respectively. Overall, CEUS could be valuable in differentiating EAML from HCC. Specific features such as the centripetal filling and prolonged enhancement patterns on CEUS, higher peak intensity, bigger wash-in AUC and shorter time to peak on TICs may contribute to a more confirmative differential diagnosis of EAML.     

Contrast-Enhanced Ultrasound Characteristics of Breast Cancer: Correlation with Prognostic Factors

The purpose of the work described here was to investigate the correlation of contrast-enhanced ultrasound (CEUS) characteristics with prognostic factors in breast cancer. Forty-five consecutive breast cancer patients were studied with CEUS. All patients were diagnosed with invasive ductal carcinoma on the basis of biopsy or surgery results. Lack of blood perfusion of the tumor was identified in 2 cases; blood perfusion was observed in 43 cases. Enhancement was heterogeneous in 25 cases, and centripetal in 25 cases. A blood perfusion defect was present in 27 cases. Enhancement shape was irregular in 37 cases, margins were poorly defined in 34 cases, and penetrating vessels were present in 32 cases. Compared with the surrounding normal tissue, tumor tissue had faster rising times and times to peak and higher peak intensities and wash-in slopes; the differences between the two groups were statistically significant (p < 0.05). Compared with the interior of the tumor, the periphery had faster times to peak and higher peak intensities and wash-in slopes (p < 0.05). Heterogeneous enhancement, perfusion defect, centripetal enhancement and penetrating vessels were correlated with prognosis (p < 0.05). Overall, some CEUS characteristics of breast cancer were associated with prognostic factors that can predict breast cancer prognosis in vivo.     

Role of Contrast-Enhanced Ultrasound in the Pre-operative Diagnosis of Cervical Lymph Node Metastasis in Patients with Papillary Thyroid Carcinoma

The objective of this study was to prospectively evaluate the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) in differentiating between benign and metastatic cervical lymph nodes in patients with papillary thyroid cancer (PTC). Three hundred nineteen cervical lymph nodes (162 metastatic from PTC and 157 benign) were evaluated using conventional ultrasonography (US) and CEUS before biopsy or surgery. Metastatic lymph nodes more often manifested centripetal or asynchronous perfusion, hyper-enhancement, heterogeneous enhancement, perfusion defects and ring-enhancing margins than benign lymph nodes at pre-operative CEUS (all p values < 0.001). The area under the receiver operating characteristic curve (AUC) for the combination of conventional US and CEUS (0.983, 95% confidence interval [CI]: 0.971–0.994) was higher than that of conventional US alone (0.929, 95% CI: 0.899–0.958) and CEUS (0.911, 95% CI: 0.876–0.947). In conclusion, CEUS is a promising tool in conjunction with conventional US for the pre-operative prediction of metastatic cervical lymph nodes in patients with PTC.     

Impact of Revision of the LR-M Criteria on the Diagnostic Performance of Contrast-Enhanced Ultrasound LI-RADS

This study was aimed at revising the LI-RADS M category (LR-M) criteria to improve the diagnostic performance categories LR-5 and LR-M of the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) Version 2017. We enrolled 264 patients (264 nodules) with a risk for hepatocellular carcinoma (HCC). The nodules were assigned specific CEUS LI-RADS categories. Washout onset times for all nodules were noted. The diagnostic performance of LR-5 and LR-M was analyzed based on the different early washout criterion for the LR-M category. The positive predictive values in LR-5, LR-4 and LR-3 were 98.6%, 72.2% and 16.7%, respectively, and that for non-HCC malignancies in LR-M was 25.0%. Patients in the LR-M category were reclassified using 45 s as the early washout criterion. LR-5 had higher sensitivity (65.5% vs. 76.2%, p = 0.012) and area under the receiver operating characteristic curve (0.80 vs. 0.85, p = 0.001) for HCC diagnosis after reclassification. LR-M also had higher specificity (71.4% vs. 81.3%, p = 0.010) in diagnosing non-HCC malignancies after reclassification. Our findings suggest CEUS LR-5 is effective for HCC diagnosis. The use of 45 s as the time criterion of early washout for LR-M can improve LR-5 and LR-M performance in the diagnosis of HCC and non-HCC malignancies, respectively.     

Predicting Long-Term Hepatocellular Carcinoma Response to Transarterial Radioembolization Using Contrast-Enhanced Ultrasound: Initial Experiences

Conventional cross-sectional imaging done shortly after radioembolization of hepatocellular carcinoma (HCC) does not reliably predict long-term response to treatment. This study evaluated whether quantitative contrast-enhanced ultrasound (CEUS) can predict the long-term response of HCC to yttrium-90 (Y-90) treatment. Fifteen patients underwent CEUS at three time points: immediately following treatment and 1 and 2 wk post-treatment. Response 3–6 mo after treatment was categorized on contrast-enhanced magnetic resonance imaging by two experienced radiologists using the Modified Response Evaluation Criteria in Solid Tumors. CEUS data were analyzed by quantifying tumor perfusion and residual fractional vascularity using time–intensity curves. Patients with stable disease on magnetic resonance imaging had significantly greater fractional vascularity 2 wk post-treatment (65.15%) than those with partial or complete response (13.8 ± 9.9%, p = 0.007, and 14.9 ± 15.4%, p = 0.009, respectively). Complete responders had lower tumor vascularity at 2 wk than at post-operative examination (–38.3 ± 15.4%, p = 0.045). Thus, this pilot study suggests CEUS may provide an earlier indication of Y-90 treatment response than cross-sectional imaging.     

Ultrasound and Contrast-enhanced Ultrasound Findings after Percutaneous Irreversible Electroporation of Hepatic Malignant Tumors

The aim of this study was to describe ultrasound (US) and contrast-enhanced ultrasound (CEUS) findings immediately and 1 d after percutaneous irreversible electroporation (IRE) of hepatic malignant tumors. Immediately after IRE, the ablation zone was shown to be a gradually expanding hypo-echoic area around the electrodes. The microcirculation of the ablation zone was markedly reduced on CEUS (before vs. immediately after, p < 0.001), and the macrocirculation within the ablation zone was preserved. At 1 d after IRE, the ablation zones lost their hypo-echogenicity to become iso-echoic or hyper-echoic (before vs. 1 d after, p = 0.004; immediately after vs. 1 d after, p = 0.002). At this time, further elimination of microcirculation was confirmed on CEUS (before vs. 1 d after, p < 0.001; immediately after vs. 1 d after, p = 0.003). The size of the ablation zone, which measured by US, was strongly correlated with that measured by CEUS (length: r: = 0.929, width: r = 0.940, p < 0.001), was significantly enlarged immediately after IRE and shrunk 1 d after IRE.     

Evaluation of posttreatment response of hepatocellular carcinoma: comparison of ultrasonography with second-generation ultrasound contrast agent and multidetector CT

We evaluated the ability of one-month follow-up contrast-enhanced ultrasound (CEUS) with second-generation contrast agent in monitoring radio frequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) treatments of hepatocellular carcinoma (HCC). One-hundred forty-eight HCCs were studied using CEUS: 110 nodules were treated with RFA [41/110 RFA were performed using a pretreatment and an immediate postablation evaluation using CEUS (group 1); 69/110 using only US guidance (group 2)] and 38 nodules treated with TACE. For statistical analysis, McNemar test was used. Overall complete response was observed in 107/148 nodules (92/110 treated with RFA and 15/38 with TACE). A better rate of complete response was found in group 1 compared to group 2 (92.7% vs. 78.3%). In RFA treatment, CEUS showed a sensitivity of 83.3% and a specificity of 100% (diagnostic accuracy of 97%) using MDCT as reference standard with no statistical difference (p > 0.05). CEUS detected all cases of incomplete response in HCC treated with TACE using angiography as reference standard (diagnostic accuracy 100%). We recommend assessing residual intratumoral flow on CEUS during RFA procedure to determine the necessity of immediate additional treatment. In case of positive CEUS results, HCC treated with TACE should be considered still viable.     

MR versus CEUS LI-RADS for Distinguishing Hepatocellular Carcinoma from other Hepatic Malignancies in High-Risk Patients

Distinguishing between other hepatic malignancies (OMs) and hepatocellular carcinoma (HCC) is vital to allow clinicians to determine optimal treatment and assess prognosis in patients at high risk for HCC. This study evaluated the performance of the Liver Imaging Reporting and Data System (LI-RADS) using magnetic resonance imaging (MRI) versus contrast-enhanced ultrasonography (CEUS) for differentiating HCC from OMs in patients at high risk for HCC. This retrospective study consecutively enrolled 106 high-risk patients with HCC and 52 high-risk patients with OMs. Patients underwent both MRI and CEUS, with histologic diagnosis as a reference standard. The diagnostic performance of MR versus CEUS LI-RADS was calculated and compared. The performance of the modified CEUS LI-RADS criteria was also evaluated and compared. Our research found that MRI features significantly differed between patients with OMs and those with HCC (p < 0.05), with sensitivities of 34.6%–69.2% and specificities of 83.0%–95.3% for diagnosing OMs and an LI-RADS M (LR-M): definite or probable malignancy, not specific for hepatocellular carcinoma sensitivity of 90.4% and specificity of 83.0% for diagnosing OM. CEUS features also significantly differed between patients with OM and HCC (p < 0.05), with sensitivities of 11.5%–96.2% and specificities of 23.6%–100% for diagnosing OMs, and an LR-M sensitivity of 98.1% and specificity of 84.0% for diagnosing OMs. Accuracies of category LR-M did not significantly differ between MR and CEUS LI-RADS (85.4% vs. 88.6%, p = 0.724). After reclassification of category LR-M nodules to category LR-5 if they exhibited clear intratumoral non-enhanced area boundaries and no punched-out appearance before 5 min, accuracy increased from 88.6% to 96.8% for CEUS LR-M and from 84.8% to 91.1% for CEUS LR-5. LR-M accuracies were significantly higher for the modified version of the CEUS LI-RADS than for MR LI-RADS (96.8% vs. 85.4%, respectively, p = 0.04). CEUS LI-RADS and MR LI-RADS can effectively be used to distinguish HCC from OMs. In patients at high risk of HCC, performance may be further improved by using a modified CEUS LI-RADS classification system in which category LR-M lesions are considered LR-5 if they have clear intratumoral non-enhanced area boundaries and do not have a punched-out appearance.     

Contrast-enhanced ultrasound for the diagnosis of hepatic adenoma

Nine hepatic adenomas (HA) diagnosed by contrast-enhanced ultrasound (CEUS) among 123 liver lesions (89 patients) were evaluated retrospectively; five were confirmed through pathological diagnosis. Time-intensity curves (TIC), contrast medium arriving time (AT), peak time (PT) and retrogression time (RT) for HA were compared with 30 hepatocellular carcinomas (HCC) and six focal nodular hyperplasias (FNH). Significant differences existed between HA and poorly-differentiated HCC in AT, PT and RT, and between HA and well-differentiated HCC in AT. Differential diagnosis between HA and FNH was determined only through their different perfusion and arterial morphological features: HA showed typical perfusion characteristic of 'fast-in, slow-out', with a centripetal or mixed-filling pattern in the arterial phase, while FNH showed a centrifugal filling pattern. In conclusion, CEUS was helpful for identifying HA but it may be relatively difficult to distinguish between HA and some well-differentiated HCC or FNH.     

Value of Contrast-Enhanced Ultrasound in Differentiating Clinically Atypical Subacute Thyroiditis from Papillary Thyroid Carcinomas

Our objective was to provide the various sonographic characteristics of clinically atypical subacute thyroiditis (CAST) in distinguishing CAST from papillary thyroid carcinomas (PTCs) by using conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS). Forty-six CAST patients and 50 PTC patients were enrolled in this study. We evaluated the size, shape, margin, echogenicity, calcification, vascularity and CEUS parameters for each nodule. The final diagnosis of CAST was confirmed via fine-needle aspiration (FNA) or surgery. Of the 46 CASTs, 13 (28.3%) were confirmed by surgery to be benign, and 33 (71.7%) were proven by FNA to be benign. Univariate analysis indicated that compared with PTCs, CAST lesions more frequently had wider-than-taller shapes, blurred margins, the absence of microcalcifications, peripheral high echogenicity, the absence of internal vascularity, hypo-enhancement, centrifugal perfusion and a peak intensity index <1 and area under the curve index <1 on pre-operative US and CEUS. A multivariate analysis revealed that clear margins, microcalcifications and centripetal perfusion were independent characteristics related to PTCs for their differentiation from CAST (all p values <0.05). Our study indicated that the pre-operative multiparameter US characteristics may serve as a useful tool for distinguishing CAST from malignant thyroid nodules to avoid surgical excisions or unnecessary FNAs.     

Vascularity of Intra-testicular Lesions: Inter-observer Variation in the Assessment of Non-neoplastic Versus Neoplastic Abnormalities After Vascular Enhancement With Contrast-Enhanced Ultrasound

The aim of this study is to assess the additional benefit of contrast-enhanced ultrasound (CEUS) over conventional ultrasonography (US) in identifying intra-testicular abnormalities among observers of different experiences. In this study, 91 focal testicular lesions (46 neoplastic, 45 non-neoplastic) imaged with gray-scale US/Doppler US and CEUS were classified using a 5-point scale. Three experienced and four inexperienced observers rated each lesion using gray-scale/color Doppler US alone and then with the addition of CEUS. Improved diagnostic specificity and accuracy with the addition of CEUS was observed for both experienced (specificity: 71.1% vs. 59.3%, p = 0.005; accuracy: 83.5% vs. 76.9%, p = 0.003) and inexperienced observers (specificity: 75.6% vs. 51.7%, p = 0.005; accuracy: 80.2% vs. 72.0%, p < 0.001). Significant inter-observer variability between the experienced and inexperienced observers when assessing conventional US alone was eliminated with the addition of CEUS. CEUS improves diagnostic accuracy of focal intra-testicular lesions for both experienced and inexperienced observers and reduces inter-observer variability in inexperienced operators.     

The AMANDUS Project—Advanced Microperfusion Assessed Non-Union Diagnostics With Contrast-Enhanced Ultrasound (CEUS) for the Detection of Infected Lower Extremity Non-Unions

The pre-operative determination of infection plays a decisive role in non-union treatment. This study investigated in a large cohort the diagnostic potential of contrast-enhanced ultrasound (CEUS) as stand-alone method for the differentiation between aseptic and infected non-unions. Of 109 patients with lower extremity non-unions (tibia n = 78, femur n = 31) osseous perfusion with CEUS was prospectively assessed before revision surgery. The perfusion was quantified via time-intensity curves and peak enhancement (PE) (arbitrary unit [au]). Significant perfusion differences between aseptic and infected non-unions were evident (PE, p < 0.001). The sensitivity and specificity for the detection of infected tibial and femoral non-unions could be determined with 85.1% and 88.7% (cutoff PE: 81.2 au). CEUS illustrates tibial and femoral non-union perfusion in real time and discriminates reliably between aseptic and infected non-unions. Consequently, when CEUS is integrated into the diagnostic routine algorithm, non-union revision surgery can be planned more accurately as a single or multistep procedure.     

The AMANDUS Project PART II—Advanced Microperfusion Assessed Non-Union Diagnostics with Contrast-Enhanced Ultrasound (CEUS): A Reliable Diagnostic Tool for the Management and Pre-operative Detection of Infected Upper-Limb Non-unions

The management of upper-limb non-unions can be challenging, especially when infection is existent. Thus, pre-operative detection of infection plays a relevant role in non-union treatment. This study investigated in a large cohort the diagnostic potential of contrast-enhanced ultrasound (CEUS) as stand-alone method for differentiating between aseptic and infected upper-limb non-unions. Osseous perfusion of 50 upper-extremity non-unions (radius/ulna, n = 20; humerus, n = 22; clavicle, n = 8) was prospectively assessed with CEUS before revision surgery. The perfusion was quantified via time-intensity curves and peak enhancement (in arbitrary units). Significant perfusion differences between aseptic and infected non-unions could be detected (peak enhancement, p < 0.001). The sensitivity and specificity for the detection of infected upper-limb non-unions were 80% and 94.3% (cutoff peak enhancement: 130.8 arbitrary units). CEUS reliably differentiates between aseptic and infected upper-limb non-unions. Consequently, CEUS should be integrated into the daily diagnostic routine algorithm to plan non-union revision surgery more precisely as a single- or multi-step procedure.     

Quantitative Evaluation of Combretastatin A4 Phosphate Early Efficacy in a Tumor Model with Dynamic Contrast-Enhanced Ultrasound

Combretastatin A4 phosphate (CA4P) is a vascular disrupting agent that rapidly shuts down blood supply to tumors. Early monitoring of tumor perfusion plays a crucial role in determining the optimal strategy to managing treatment and guiding future therapy. The aim of this study was to investigate the potential value of dynamic contrast-enhanced ultrasound (CEUS) in quantitative evaluation of tumor perfusion at an early stage in CA4P therapy. Central and peripheral perfusion of tumors was detected by CEUS pre-treatment (0?h) and 2, 12 and 48?h after CA4P injection. Two perfusion parameters, maximum intensity (IMAX) and time to peak (TTP), were calculated from the time–intensity curve. After CEUS, the efficacy of CA4P was immediately confirmed by immunofluorescence assay and hematoxylin and eosin, Hoechst 33342 and fluorescein isothiocyanate–lectin staining. In CEUS of the center region of tumors, IMAX gradually decreased from 0 to 12?h and regrew at 48?h (p?<?0.01). TTP increased only at 2?h. In the peripheral regions, IMAX did not change obviously from 0 to 12?h (p?>?0.05) and just increased at 48?h (p?<?0.01). The TTP of peripheral regions had the same tendency to vary tendency as that of center regions. In addition, microvascular density (MVD), vascular perfusion and necrotic area of the tumor were quantitatively analyzed. A close correlation between IMAX and MVD was observed in the center areas of tumors (r?=?0.72, p?<?0.01), whereas the correlation between IMAX and MVD in peripheral areas was weak (r?=?0.37, p?<?0.01). However, IMAX was positively correlated with tumor perfusion in both center and peripheral areas of tumors (r?=?0.82, p?<?0.01, and r?=?0.63, p?<?0.01, respectively). Consequently, IMAX was a reliable indicator of tumor perfusion evaluation by CEUS. The use of CEUS to quantify tumor perfusion could a promising method for the early detection of tumor responses in anti-vascular treatment.     

Effects of Noradrenaline and Adenosine Triphosphate on the Degree on Contrast Enhancement in a Rabbit Model of Atherosclerosis during Contrast-Enhanced Ultrasonography

The aim of the study is to assess the effects of vasoactive agents on the degree of contrast enhancement in experimental atherosclerotic plaque during contrast-enhanced ultrasonography (CEUS). Abdominal aortic atherosclerosis was induced in 25 New Zealand white rabbits by a combination of cholesterol-rich diet and balloon endothelial denudation. Standard ultrasonography and CEUS were performed at baseline and during intravenous infusion of noradrenaline or adenosine triphosphate (ATP). The degree of contrast enhancement of the plaque after injection of contrast material was quantified by calculating the enhanced intensity in the plaque. The infusion of noradrenaline induced significant increase in systolic blood pressure (84 ± 13 mm Hg vs. 112 ± 20 mm Hg, p = 0.011) and significant decrease in the enhanced intensity in the plaque (7.52 ± 1.32 dB vs. 5.88 ± 1.33 dB, p < 0.001) during CEUS. The infusion of ATP resulted in the significant decrease in systolic blood pressure (80 ± 13 mm Hg vs. 65 ± 11 mm Hg, p = 0.005) and increase in the enhanced intensity in the plaque (7.52 ± 1.32 dB vs. 8.84 ± 1.55 dB, p < 0.001) during CEUS. The degree of contrast enhancement within an experimental atherosclerotic plaque during CEUS can be influenced by vasoactive agents and hemodynamic status.     

Comparison of Contrast-Enhanced Ultrasound versus Contrast-Enhanced Magnetic Resonance Imaging for the Diagnosis of Focal Liver Lesions Using the Liver Imaging Reporting and Data System

The aim of this retrospective study was to evaluate the Liver Imaging Reporting and Data System (LI-RADS) categorization of focal liver lesions (FLLs) on contrast-enhanced ultrasound (CEUS) in comparison with contrast-enhanced magnetic resonance imaging (CE-MRI). A total of 63 patients with 84 FLLs were included in the final study population, after review of the electronic medical records and clinical data. Two trained radiologists evaluated all CEUS and CE-MRI images independently. They assigned a LI-RADS category to each FLL and assessed major features based on CEUS LI-RADS Version 2017 and computed tomography/MRI LI-RADS Version 2018. The generalized estimating equation method was used to compare the diagnostic performance of the LI-RADS algorithm between CEUS and CE-MRI. The sensitivity of LR-5/LR-TIV (tumor in vein) categories for diagnosing hepatocellular carcinoma (HCC) differed significantly between CEUS and CE-MRI (88.9% [40/45], 95% confidence interval [CI]: 76.5%–95.2%), versus 64.4% (29/45; 95% CI: 49.8%–76.8%), p = 0.006; 82.2% (37/45; 95% CI: 68.7%–90.7%), versus 62.2% (28/45; 95% CI: 47.6%–74.9%), p = 0.034. Inter-observer agreement was substantial for assigning LR-5 on both CEUS and CE-MRI. For both reviewers, there was a higher frequency of LR-5 (44.0% vs. 25.0%, p = 0.009; 42.9% vs. 26.2%, p = 0.023) in CEUS compared with CE-MRI. Arterial phase hyper-enhancement (APHE) was less frequently observed on CEUS than on CE-MRI (46.4% vs. 61.9%, p = 0.044). However, the washout appearance was observed more frequently on CEUS than on CE-MRI (50.0% vs. 28.6%, p = 0.004). Inter-observer agreement between the two reviewers on APHE and washout appearance was excellent for both CEUS and CE-MRI. These findings suggest that CEUS had a much higher sensitivity than CE-MRI in the diagnosis of HCC using LI-RADS, and although the frequencies of major features differed, inter-observer agreement between the two reviewers on major features of HCC was excellent for both CEUS and CE-MRI.     

A Study on Correlation between Contrast-Enhanced Ultrasound Parameters and Pathological Features of Diabetic Nephropathy

The objective of this study was to evaluate the correlation between contrast-enhanced ultrasound (CEUS) parameters and histopathological features in patients with diabetic nephropathy (DN). Sixty-two patients with DN (44 men, mean age: 52.61 ± 10.63 y) were enrolled. They underwent renal biopsy for DN at the Department of Ultrasound, PLA Hospital, between May 2017 and February 2020. Renal tissue was obtained by ultrasound-guided percutaneous needle biopsy. CEUS was performed, and time–intensity curves (TICs) and renal perfusion parameters were analyzed. Differences in CEUS parameters were analyzed according to the glomerular classification and interstitial fibrosis–tubular atrophy (IFTA) score. Continuous variables were evaluated using the analysis of variance or Mann–Whitney U-test. Discontinuous variables were compared with the χ²-test. Spearman correlation analyses evaluated associations among quantitative ultrasound perfusion parameters and histopathological characteristics. Peak enhancement (PE), wash-in rate (WiR), wash-in perfusion index (WiPI) and wash-out rate (WoR) of the cortex, and their cortex/medulla ratios, decreased with increasing glomerular classification grade (p < 0.05). The fall time (FT) of the cortex, and their cortex/medulla ratios, increased with increasing glomerular classification grade (p < 0.05). There were no significant differences in the CEUS parameters for different IFTA scores. The perfusion volume-relevant parameters (such as PE, WiR and WiPI) had a negative correlation (p < 0.05), while the perfusion time-relevant parameters (such as RT and FT) had a positive correlation (p < 0.05), with the severity of glomerular lesions, glomerulosclerosis rate and number of Kimmelstiel–Wilson lesions. The CEUS parameters of the cortex could reflect pathological characteristics, especially changes in glomerular lesions.     

Intrahepatic Transit Time Predicts Liver Fibrosis in Patients with Chronic Hepatitis B: Quantitative Assessment with Contrast-Enhanced Ultrasonography

We investigated the use of contrast-enhanced ultrasonography (CEUS) with quantitative measurements to assess the stages of liver fibrosis in patients with chronic hepatitis B. One-hundred twenty-two patients with chronic hepatitis B were divided into three groups according to the Scheuer scoring system pathologically and according to clinical evidence: mild fibrosis (S0 and S1, n = 36); moderate fibrosis (S2 and S3, n = 24); and cirrhosis (S4 and clinically typical cirrhosis, n = 62). CEUS of hepatic vessels and parenchyma was performed using the Cadence contrast pulse sequencing technique, with an intravenous bolus injection of a contrast agent (SonoVue). Real-time CEUS imaging of the liver was recorded and analyzed offline. Contrast arrival time, baseline, and peak intensity in the hepatic artery, portal vein, right hepatic vein, and liver parenchyma were used to calculate intrahepatic transit times, hepatic artery to hepatic vein transit time (HA-HVTT) and portal vein to hepatic vein transit time (PV-HVTT), as well as increased signal intensity (ISI). The correlations between these quantitative parameters and the stages of fibrosis were analyzed using Spearman rank correlation coefficients. HA-HVTT and PV-HVTT were shortened gradually with the progression of liver fibrosis. PV-HVTT was statistically significant differences existed between the two paired groups (mild vs. moderate vs. cirrhosis groups, p < 0.001), whereas HA-HVTT was changed significantly between mild and moderate or cirrhosis groups (p < 0.001). HA-HVTT and PV-HVTT changes were significantly correlated with liver fibrosis severity (r = −0.5930, p < 0.001; r = −0.8215, p < 0.001). Area under receiver operating characteristic curves for HA-HVTT and PV-HVTT were 0.891 ± 0.034 and 0.955 ± 0.020 at fibrosis scores ≥S2, and 0.785 ± 0.040 and 0.946 ± 0.018 at fibrosis score ≥S4, respectively. ISI values in the portal vein and liver parenchyma decreased with the severity of fibrosis. This study demonstrated that hepatic CEUS with quantitative measurements of intrahepatic transit time reflected the severity of liver fibrosis. The real-time CEUS imaging with use of software-based quantitative analysis could provide reliable information of hepatic hemodynamic changes to noninvasively assess the severity of liver fibrosis in patients with chronic hepatitis B. (E-mail: ding.hong@zs-hospital.sh.cn)     

超声造影动脉期增强模式对肝脏局灶性病变的诊断价值

目的探讨超声造影动脉期增强模式对肝脏局灶性病变的诊断价值。方法对81个肝脏局灶性病变进行超声造影检查,对其中25例病灶行微血管显像（MFI）,分析超声造影动脉期增强模式的诊断价值以及MFI显像技术对于增强模式判断的帮助。结果超声造影向心性增强对肝血管瘤诊断的敏感性85.7%、特异性100%、阳性预测值100%、阴性预测值98.7%、准确性98.8%;环状增强对于肝转移瘤诊断的敏感性80.0%、特异性98.2%、阳性预测值95.2%、阴性预测值91.7%、准确性92.6%;超声造影动脉期离心性增强在肝细胞肝癌也可见到,25例病灶使用MFI后对其中14例（14/25,56.0%）动脉期增强模式的判断有帮助,对离心性增强模式及向心性增强模式的判断帮助尤为明显。结论超声造影动脉期向心性增强及环状增强分别对于肝血管瘤及肝转移瘤有很好的诊断价值,离心性增强可见于肝细胞肝癌,MFI技术的应用对于增强模式的判断有帮助。     

Contrast-Enhanced Ultrasound Evaluation of Renal Blood Perfusion Changes After Percutaneous Transluminal Renal Angioplasty and Stenting for Severe Atherosclerotic Renal Artery Stenosis

This study used contrast-enhanced ultrasound (CEUS) to evaluate changes in renal cortical blood perfusion after percutaneous transluminal renal angioplasty and stenting (PTRAS) for severe renal artery stenosis (RAS) (≥70%). CEUS was performed in 21 patients with 24 severe RASs that underwent PTRAS. Renal cortical perfusion was quantitatively evaluated by comparing time intensity curve (TIC) parameters for SonoVue (Bracco, Milan, Italy) contrast enhancement, including peak intensity (PI), time to peak (TTP), mean transmit time (MTT), curve ascending slope (S), area under the curve (AUC), AUC-wash-in and AUC-wash-out. The parameters PI, TTP, MTT and S differed significantly between the pre-intervention and post-intervention TIC analysis (p < 0.05). Of the 24 pre-intervention curve appearances, 58.3% (14/24) improved after operation. The PI difference correlated positively with the estimated glomerular filtration rate difference (r = 0.433, p < 0.05). In conclusion, changes in some ultrasound perfusion parameters on CEUS and the shape of the TIC can be used to quantitatively and intuitively evaluate renal cortical blood perfusion change after PTRAS.