Levovist超声造影在肝癌疗效判断中的临床价值

目的：研究Levovist彩色多普勒超声造影对肝癌疗效判断的作用。方法：对接受过介入治疗的24个肝癌病灶进行CDFI超声造影，病灶直径1～10cm，平均3．3cm。造影剂采用Levovist(Schering AG，Berlin，Germany)。结果：24例治疗后的肝癌瘤内血流显示率由造影前的29．1％(7／24)提高至造影后的58．3％(14／24)，肿瘤内血流信号强度分级在造影后也有提高。5个病灶做了治疗前后的超声造影对比。对于造影后2例显示有瘤内血流的病灶，又追加了PEIT治疗。结论：CDFI超声造影可以提高肿瘤内血流信号检测，反映肿瘤坏死情况或有无复发，指导治疗方案的选择和制定。     

利声显对肝肿瘤血流信号和肝实质区回声增强作用的研究

目的:评价新型利声显对不同肝肿瘤的彩色多普勒信号和肝实质区回声的增强作用。材料和方法:肝肿瘤患者共44例,其中原发性肝癌35例、继发性肝癌5例、肝血管瘤3例、肝硬化结节1例。使用HP Sonos 2500型彩超仪,控头频率2.5MHz。将利声显稀释为浓度为300mg/ml的溶液,由外周静脉注入,持续观察肿瘤彩色多普勒信号增强程度及肝脏实质区回声。结果:彩色多普勒信号增强情况为:32例原发性肝癌和1例较大胆囊转移癌明显增强,3例原发性小结节型肝癌、4例转移性结节性肝癌、2例肝血管瘤轻度增强,肝硬化结节无增强。肝实质区图像清晰度改善,于4例原发性肝癌患者的肝区内又测及新的小病灶。结论:利声显可增强肝肿瘤的血流信号,且不同肝肿瘤的增强程度有差异。它对判断肿瘤的血供情况、初步分析肿瘤的病理性质,提高超声诊断的敏感性很有益处。     

经周围静脉注射Levovist彩色多普勒超声造影诊断肝肿瘤的研究

本文采用经周围静脉注射Levovist超声造影检查了30例肝脏肿瘤患者。应用Levovist后，正常肝脏血管彩色多普勒血流显像明显增强，不同的肝脏肿瘤显示了常规彩超检查没有见到的不同的血管形态，11例原发性肝癌肿块中心显示了血管。相反3例肝脏转移癌，在肿瘤周边显示了更多的血流，6例肝脏血管瘤，常规彩超检查未见明确血流，造影后在肿瘤周边见到点状或短条状血流。Levovist对于正常肝脏实质、不同肝脏肿瘤二维图像的增强作用是有差异的，它使肝脏肿瘤显示更清晰。结果表明：Levovist彩色多普勒超产造影对于肝脏肿瘤的诊断具有重要的临床应用价值。     

利声显对肝、肾、子宫肿瘤血流信号增强作用的研究

目的　评价利声显对肝、肾、子宫肿瘤彩色多普勒信号的增强作用。方法　对３５ 例原发性肝癌、５ 例继发性肝癌、３ 例肝血管瘤、１ 例肝硬化结节、３ 例肾癌、３ 例子宫肌瘤进行研究。将７ ｍｌ 浓度为３００ ｍｇ／ｍｌ 的利声显由外周静脉注入,观察肿瘤彩色多普勒信号增强程度及脏器实质区图像。结果　３２ 例原发性肝癌和１ 例较大的胆囊转移性肝癌的彩色多普勒信号明显增强,肝血管瘤的略增强,肝硬化结节的无增强,肾癌和子宫肌瘤的增强均好,且实质区图像改善,于４ 例原发性肝癌患者的肝区内又探及新的小病灶。结论　利声显对肝、肾、子宫肿瘤的血流信号均有增强作用,它对判断肿瘤的血供情况、分析肿瘤的病理性质,提高超声诊断的敏感性很有益处。     

利声显在多普勒超声心动图中的作用评价

为评价外周静脉注射造影剂利声显（Ｌｅｖｏｖｉｓｔ）对超声心动图多普勒信号的增强作用，对包括二尖瓣返流、主动脉瓣返流和房间隔缺损等３０例受试者进行研究。结果示：造影剂在右心腔显影后立即在左心腔显影；注射利声显后所有受试者的连续多普勒频谱信号评分增加，频谱示返流及分流的速度峰值及积分都增加；彩色多普勒示返流及分流束的面积和周长均增加。结论认为利声显是一种跨肺循环的造影剂，能增强二尖瓣返流、主动脉瓣返流及左向右分流的多普勒信号强度，安全性好     

彩色多普勒血流显像评价肾癌的血管性——一种新的超声造影剂的应用价值

目的：评价超声造影剂利声显对彩超检测肾细胞癌血流状况的增强效应,并探讨其临床应用价值。资料与方法：应用彩色多普勒血流显像检查１９例（个）肾细胞癌,均经手术病理证实,经周围静脉注射超声造影剂利声显（ＳＨＵ５０８Ａ）,浓度３００ｍｇ／ｍｌ,平均注射剂量７９ｍｌ。观察注射前后瘤内血流信号显像情况。结果：超声造影前１９个肾癌彩超显示４个无血流信号,１１个周边部分环绕血流,４个瘤周瘤内见散在点状、短条状血流;超声造影后,１９个肾癌瘤内血流信号均增强,１６／１９（８４．２１％）明显增强,３／１９（１５．７９％）轻度增强,增强效应主要表现为血流信号明显增多,分布区域增大,血管显示段延长,分枝更清晰完整。结论：超声造影剂利声显能显著增强肾细胞癌内彩色多普勒血流信号,更完整显示肾癌的血管形态、分布等,明显改善彩超对肾癌血供的评价,对肾肿瘤诊断有重要的临床应用价值。     

Contrast-enhanced color Doppler sonography of uveal melanomas

PURPOSE: The purpose of our study was to evaluate the use of the galactose microbubble-based contrast agent Levovist in color Doppler sonography of uveal melanomas. We also evaluated the use of the resistance index and pulsatility index in differentiating tumor-associated vessels from normal vessels in patients with uveal melanomas. METHODS: In this prospective study, 40 patients with uveal melanoma were examined with color Doppler sonography before and after the administration of the contrast agent Levovist. The Doppler signals were recorded from both the tumor and the orbit and were evaluated quantitatively and qualitatively. RESULTS: Tumor-associated vessels were detected without contrast enhancement in 36 of 40 patients and with contrast enhancement in 38 of 40 patients. The spectral characteristics of the Doppler signals did not change after the injection of Levovist. There were no differences-qualitative or quantitative-in Doppler signals between normal and tumor-associated vessels. CONCLUSIONS: The injection of Levovist slightly improved the detection of small vessels in uveal melanomas and the orbit but did not help to differentiate between normal vessels and tumoral vessels. The differentiation of a solid tumor from subretinal hemorrhage or effusion was improved.     

超声造影剂在正常人肝脏中的应用研究

经外周静脉注射，超声造影剂通过肺循环达到全身脏器和组织增强多普勒血流信号是造影剂的最新发展。我们运用Levovist对20例上常人肝脏进行了前瞻性研究，其结果显示19例多普勒血流信号增强达到Ⅲ级，占95％，1例达到Ⅱ级；平均增强开始时间、峰值出现时间和持续时间分别为14．1秒、23．6秒和167.1秒。有5例出现二维声像图增强，6例门静脉内出现点状强问声。超声造影剂能够有效增强彩色多普勒信号，有助于细小血管的显于，具有很高的潜在价值，将推动超声诊断水平的提高。     

彩色多普勒超声造影诊断肝内小占位性病变的临床研究

目的　研究经周围静脉彩色多普勒超声造影在肝内小占位性病变的鉴别诊断中的作用和意义。方法　选择 <3cm的肝内占位性病变 5 4个进行超声造影检查。其中良性病变 2 0个 (血管瘤 9个 ,局灶性结节性增生 3个 ,炎性假瘤 4个 ,术后疤痕 1个 ,肝硬化结节 3个 ) ;恶性病变 3 4个 (肝细胞肝癌 3 1个 ,肝腺瘤样增生癌变 1个 ,胃癌及结肠癌肝转移各 1个 )。造影剂采用Levovist ,剂量 2 .5g ,浓度 40 0mg/ml。结果　良性病变造影前后血流显示率分别为 3 0 % (6/2 0 )和 40 % (8/2 0 ) (P >0 .0 5 ) ;肝癌造影前后血流显示率分别为 5 3 % (18/3 4)和 94% (3 2 /3 4) (P <0 .0 1) ,造影后血流显示明显提高。结论　Levovist造影后 ,肝内病灶血流信号得到明显增强 ,彩色多普勒血流显像充分显示了肿瘤内血流分布状况 ,有利于克服肿瘤大小及深度对血流显示率的影响 ,提高小肝癌的诊断符合率     

Enhancement of hepatic hemangiomas with levovist on coded harmonic angiographic ultrasonography.

OBJECTIVE: To evaluate the pattern of contrast enhancement with Levovist on coded harmonic angiographic ultrasonography of hepatic hemangiomas. METHODS: Twenty hemangiomas were evaluated with coded harmonic angiographic ultrasonography and a microbubble contrast agent. Verification of the diagnosis of a hemangioma was made by means of dynamic computed tomography (n = 8), dynamic magnetic resonance imaging (n = 1), radionuclide scanning (n = 6), or follow-up ultrasonography (n = 5). Ultrasonographic images were obtained before contrast agent administration and with a bolus injection of 2.5 g of a microbubble contrast agent (300 mg/mL Levovist; Schering AG, Berlin, Germany) every 10 to 15 seconds for 5 minutes. The contrast enhancement patterns of the 20 hemangiomas were assessed. RESULTS: The tumor diameters as measured on ultrasonography were 7 to 97 mm (mean, 26.7 mm). Of the 20 hemangiomas, peripheral globular enhancement with progressive centripetal fill-in was shown in 15 (75%), rimlike enhancement with progressive centripetal fill-in was shown in 2 (10%), and homogeneous enhancement was shown in 1 (5%). In the remaining 2 lesions (10%), the enhancement patterns could not be seen, because they were not found on coded harmonic angiographic ultrasonography. CONCLUSIONS: Coded harmonic angiographic ultrasonography with a microbubble contrast agent can depict the typical enhancement pattern in most hepatic hemangiomas.     

Small hepatocellular carcinoma: differentiation from adenomatous hyperplasia with color Doppler US and dynamic Gd-DTPA-enhanced MR imaging

Background: To investigate the usefulness of color Doppler ultrasound (US) and dynamic Gd-DTPA-enhanced magnetic resonance (MR) imaging in the differentiation of small hepatocellular carcinoma (HCC) and adenomatous hyperplasia (AH). Methods: Thirty-eight small (3 cm or less) nodular lesions (in 38 cirrhotic patients) with US features consistent with HCC underwent evaluation with color Doppler US and MR imaging. Breath-hold T1-weighted rapid acquisition spin echo MR sequence after bolus injection of 0.1 mmol/kg gadopentetate dimeglumine was used to evaluate dynamic enhancement. US-guided tissue-core percutaneous biopsy established the diagnosis: HCC in 28 cases and AH in 10. Results: Color signals with pulsatile or continuous Doppler spectrum were demonstrated in 19 of 28 HCCs (68%) but in none of the AHs. Although there was considerable overlap in signal intensity between HCC and AH on both unenhanced T1- and T2-weighted images, early enhancement on breath-hold T1-weighted images obtained 40 s after starting contrast administration was observed in 22 of 28 HCCs (79%) but in none of the AHs. In 26 of 28 HCCs (93%), pulsatile or continuous flow at color Doppler US, early enhancement at dynamic MR imaging, or both were observed. Conclusion: Findings with color Doppler US and dynamic Gd-DTPA-enhanced MR imaging enable a reliable distinction between small HCC and AH. Received: 8 August 1994/Accepted after revision: 27 January 1995     

Artifacts in ultrasonic contrast agent studies.

Intravenously injected ultrasonic contrast agents making use of encapsulated gas microbubbles have excellent clinical potential for both color and spectral Doppler studies. However, a number of artifacts are associated with sonographic contrast agent measurements. Three artifacts were identified: (1) color "blooming," (2) increased maximum Doppler shift, and (3) spectral "bubble noise." Experiments have been conducted with Albunex and Levovist. These agents were injected into rabbits and humans to allow the cause of the artifacts to be established. Color blooming occurs soon after the bolus injection and is seen as gray scale pixels changing to color display. This is caused by the increase in flow signal strength. The apparent increase in the maximum Doppler shift frequency is due to the limited dynamic range of the spectral display. Only signals above a certain threshold are visible. As the Doppler signal power is enhanced, the highest frequency visible also increases. Finally, very large excursions can sometimes be seen in the spectral display (bubble noise). These might be due to either the breakdown of microbubbles or individual very large bubbles. The color blooming and bubble noise artifacts are easily identifiable and will not influence diagnostic management. The increase in peak Doppler shifts is more troublesome as it prevents comparison of spectral parameters obtained before and after injection of contrast agent.     

能量多普勒声学造影对兔VX_2肝癌血管显像增强的实验研究

目的 :探讨能量多普勒声学造影技术在兔 VX2 肝肿瘤中的应用价值。方法 :10只患有 VX2 肝肿瘤的新西兰白兔经外周静脉注射 L evovist,采用 ATL HDI30 0 0型超声仪的能量多普勒显像观察肿瘤血管造影增强效果。结果 :造影后 6例显示为中等量血流 ,4例显示为多量血流 ,且肿瘤中心部位的血流显示率明显增高 ,造影前无一只显示中心部血流 ,造影后有 7只显示出中心部血流并有 3只可见滋养血管走行。血流分布形态也由造影前的点状分布为主变为造影后的条状分布为主。结论 :能量多普勒声学造影明显提高兔肝 VX2 肿瘤内血流的显示率。     

能量多普勒增强造影在晚期产后胎滞留诊断中的应用

目的：探讨能量多普勒增强造影在晚期产后胎盘滞留诊断中的应用价值。方法：应用CDPI及外周静脉注射手振50％葡萄糖氟碳微泡能量多普勒增强造影对12例胎盘残留、7例胎盘粘连及2例胎盘植入患者胎盘血供进行研究，结果：造影后有残留胎盘内未见血流信号，所有粘连及植入胎盘内均见血流信号，同时血流不质量较造前明显改善。结论：能量多普勒增强造影在晚期产后胎盘滞留诊断与鉴别诊断上有较大的价值。     

Contrast-enhanced power Doppler sonography: improved detection of characteristic flow patterns in focal liver lesions

PURPOSE: The aim of this study was to evaluate whether intravenous injection of an ultrasound contrast agent aids in the visualization of focal liver lesions on power Doppler images. METHODS: Fifty patients with focal liver lesions were studied by B-mode and power Doppler sonography before and after intravenous injection of the contrast agent Levovist (galactose-based microbubbles; 10 ml of a concentration of 300 mg/ml). Thirty-two patients had malignant liver lesions (19 metastases, 12 hepatocellular carcinomas, 1 cholangiocellular carcinoma), while 18 had benign lesions (12 hemangiomas, 2 focal nodular hyperplasias, 4 others). RESULTS: After contrast medium injection, the number of lesions with no intralesional flow dropped from 18 to 9. Flow signal intensity was rated subjectively as marked on contrast-enhanced images in 17 patients; only 4 patients had marked flow on precontrast images. On precontrast studies, central flow in 10 lesions and peripheral flow in 29 lesions could be observed. After enhancement, the numbers increased to 18 and 34 lesions, respectively. CONCLUSIONS: On power Doppler images, a greater number of intratumoral vessels are seen in focal liver lesions after contrast medium administration.     

Power,spectral, and color flow Doppler enhancement by a new ultrasonographic contrast agent.

The ability of EchoGen contrast agent (Sonus Pharmaceuticals, Bothell, WA) to enhance aortic, renal, and scrotal spectral Doppler, color flow, and power Doppler sonography at doses from 0.01 ml/kg to 0.65 ml/kg was evaluated in dogs. Videotaped images were digitized and analyzed for Doppler signal strength at known postinjection times. Contrast agent increased aortic spectral Doppler peak height, spectral width, and brightness. Contrast agent increased renal and testicular color flow and power Doppler sonographic signal and enhanced the visualization of vascular anatomy. Intensity and duration of these effects increased with increasing dose of contrast agent. Enhancement effect varied in different organs. At higher doses, blooming and Doppler shift artifacts were observed and are believed to be due to machine limitation.     

Usefulness of power Doppler and contrast-enhanced sonography in the differentiation of hyperechoic renal masses

Background: In a prospective study, we compared power Doppler with and without contrast medium in the depiction of vascularity for the characterization of hyperechoic renal lesions. Methods: Forty-one hyperechoic renal expansive lesions (29 benign, 12 malignant) in 32 patients were studied with power-Doppler ultrasonography before and after administration of an echo-enhancing agent (Levovist Schering AG, Berlin, Germany). Vascular architecture of the lesions was categorized into five different patterns. Results: Power Doppler ultrasonography showed vascular structures in 25 lesions. The study enhanced with Levovist showed vascularity in eight of 16 lesions not seen on the unenhanced study. The characterization of vascular patterns with unenhanced power Doppler ultrasonography improved diagnostic accuracy compared with gray-scale ultrasonography (59% vs. 32%). The combination of B mode and power Doppler produced even greater diagnostic accuracy (78%), independent of the administration of echo-enhancing agent. Levovist administration was useful in the differential diagnosis between pseudotumor and neoplasm. Conclusion: The use of songraphic contrast agent did not increase the diagnostic accuracy of power Doppler in the differential diagnosis of hyperechoic renal lesions but was advantageous for the characterization of suspected pseudomasses. Received: 6 September 2000/Accepted: 13 December 2000     

The diagnostic value of levovist in Doppler imaging of visceral arteries in patients with abdominal angina before and after angioplasty

PURPOSE: To assess the diagnostic value of Levovist in the ultrasound imaging of visceral arteries in patients with clinical symptoms of abdominal angina, before and after percutaneous transluminal angioplasty (PTA). MATERIAL AND METHOD: During a 12-month period (2000/2001) five patients with visceral arterial stenoses had ultrasound examinations and a subsequent PTA procedure. Indications for ultrasound examination were abdominal angina symptoms persisting for 3-5 years, (postprandial abdominal pain, diarrhea, and vomiting). In all patients ultrasound examinations were performed using color and spectral Doppler before and after Levovist injections. Color Doppler images and maximum blood flow velocity in stenosed visceral arteries were assessed. Patients underwent control Doppler examinations with Levovist injections to assess the effect of PTA. RESULTS: In three patients conventional Doppler examination did not allow proper evaluation of visceral arteries, because of weak color and spectral Doppler signal and in two remaining patients visceral arteries were not visualized at all. In all five patients strong enhancement of color and spectral Doppler signal was observed after Levovist administration. In all these cases a hemodynamically significant stenosis was diagnosed: coeliac trunk-2 and superior mesenteric artery-3. PTA was performed successfully in these patients. In one of them ultrasound examination done before Levovist injection allowed good visualization of treated SMA and showed good PTA result. In the remaining four patients Doppler examination with the use of Levovist demonstrated visceral arteries well and confirmed successful PTA procedures. CONCLUSIONS: The use of Levovist makes the diagnostic efficiency of Doppler examinations much higher. In most cases it allows an unequivocal diagnosis of visceral artery stenosis in patients with abdominal angina symptoms. The Doppler examination with the use of Levovist is the method of choice in follow-up after PTA.     

Correlation between microbubble contrast-enhanced color doppler sonography and immunostaining for Kupffer cells in assessing the histopathologic grade of hepatocellular carcinoma: preliminary results

PURPOSE: The aim of this study was to determine the histopathologic grades of hepatocellular carcinomas (HCCs) on the basis of the presence of Kupffer cells, using color Doppler sonography with the liver-specific microbubble contrast agent Levovist. METHODS: Color Doppler sonograms generated by stimulated acoustic emission were obtained 7 minutes after intravenous injection of 5 ml of Levovist (300 mg/dl) in patients with histopathologically confirmed HCCs. CT scans were also obtained and evaluated, and hematoxylin and eosin staining for morphologic examination and immunostaining (anti-CD68) for detecting Kupffer cells were performed for confirmation of the sonographic findings. RESULTS: Eighteen tumors had a defect in the color Doppler signal (color void) that corresponded with the baseline gray-scale image of the tumor. On histopathologic examination, these 18 tumors were all found to be either poorly or moderately differentiated HCCs with either a marked reduction in the number of or the absence of Kupffer cells. The remaining 2 tumors showed color signals. Histopathologic examination of these 2 tumors disclosed well-differentiated components within the tumors, with Kupffer cells in the tumor tissue. CONCLUSIONS: Color Doppler sonography using a liver-specific microbubble ultrasound contrast agent appears to reflect the histopathologic features of HCCs and may thus be useful for differentiating liver tumors and determining a treatment strategy.     

In vitro quantification of flow using continuous infusion of Levovist and pairs of harmonic power Doppler images

To evaluate the potential of harmonic power Doppler to quantify perfusion using a continuous infusion of contrast, two dialysis cartridges were perfused with different flow rates adjusted between 0 to 300 mL/min, corresponding to flow ratios comprised between 300:0 and 150:150. The contrast agent (Levovist, Schering) was injected at constant rates (0.6 to 5 g/h). Sequential pairs of images showing simultaneously the cross-sections of the two filters were acquired with a HDI 5000 (ATL) and the Doppler data were processed with HDI lab software (ATL). The absolute values of the signal in the different regions-of-interest (ROI) were not closely related to flow rate. At the opposite, the rapid signal decrease between the first and the second image of each pair was inversely proportional to the flow rate. An index of perfusion [PerI = image 1/(image 1 -- image 2)] was defined. It correlated closely with the absolute and relative flow rates. For the latter, the slopes of regression were found to be independent of the infusion rate of Levovist. Thus, the use of pairs of images combined with a continuous infusion of Levovist provide a quantification of perfusion.