AIM： To evaluate the contrast-enhanced endosonography as a method of differentiating inflammation from pancreatic carcinoma based on perfusion characteristics of microvessels. METHODS： In 86 patients with suspected ...AIM： To evaluate the contrast-enhanced endosonography as a method of differentiating inflammation from pancreatic carcinoma based on perfusion characteristics of microvessels. METHODS： In 86 patients with suspected chronic pancreatitis （age： 62± 12 years; sex： f/m 38/48）, pancreatic lesions were examined by conventional endo- scopic B-mode, power Doppler ultrasound and contrastenhanced power mode （Hitachi EUB 525, SonoVue, 2.4 mL, Bracco） using the following criteria for malignant lesions： no detectable vascularisation using conventional power Doppler scanning, irregular appearance of arterial vessels over a short distance using SonoVue contrastenhanced technique and no detectable venous vessels inside the lesion. A malignant lesion was assumed if all criteria were detectable [gold standard endoscopic ultrasound （EUS）-guided fine needle aspiration cytology, operation]. The criteria of chronic pancreatitis without neoplasia were defined as no detectable vascularisation before injection of SonoVue, regular appearance of vessels over a distance of at least 20 mm after injection of SonoVue and detection of arterial and venous vessels. RESULTS： The sensitivity and specifidty of conventional EUS were 73.2% and 83.3% respectively for pancreatic cancer. The sensitivity of contrast-enhanced EUS increased to 91.1% in 51 of 56 patients with malignant pancreatic lesion and the specificity increased to 93.3% in 28 of 30 patients with chronic inflammatory pancreatic disease.CONCLUSION： Contrast-enhanced endoscopic ultrasound improves the differentiation between chronic pancreatitis and pancreatic carcinoma.展开更多
Background Renal clear cell carcinoma （RCCC） is the most common malignant renal tumor. It is highly malignant, does not cause clinical symptoms in its early stages, and cannot be diagnosed using conventional ultraso...Background Renal clear cell carcinoma （RCCC） is the most common malignant renal tumor. It is highly malignant, does not cause clinical symptoms in its early stages, and cannot be diagnosed using conventional ultrasound. This study was aimed to investigate the contrast-enhanced ultrasound （CEUS） mode and characteristics of the time-intensity curve for RCCC and its pathological basis. Methods Forty-two patients with pathologically diagnosed RCCC underwent CEUS examination before surgery. The patients＇ kidneys were visualized after injection of contrast agents using the Technos MPX DU8. We analyzed the CEUS mode, time-intensity curve, and pathological findings. Results The detection rate of RCCC with conventional ultrasound was about 71%, while the rate using CEUS was 100%. Larger tumors （33 cases） showed non-uniform enhancement with defective filling. CEUS modes were divided into 4 types： type Ⅰ, ＂quick in and out＂ （26.19%, 11/42）; type Ⅱ, ＂quick in and slow out＂ （40.48%, 17/42）; type Ⅲ, ＂Simultaneous in and out＂ （16.67%, 7/42）; and type Ⅳ ＂slow in and out＂ （16.67%, 7/42）. All types had a close correlation to the pathological basis. Time-intensity curve of CEUS consisted of 3 phases, the perfusion phase, regression phase, and lag phase. Cases of types Ⅰ and Ⅲ only had a perfusion and regression phase, those of type Ⅱ and Ⅳ had a perfusion phase, regression phase, and lag phase. Quantitative analysis of the time-intensity curve showed that the time-to-peak （FTP） of the lesions was shorter than that of normal renal parenchyma （P 〈0.0001）, the mean value of the up slope rate of the absolute value of lesions was higher than that of the ipsilateral normal renal parenchyma （P 〈0.0001）, and that the mean value of descent slope rate of the absolute value of lesions was lower than that of the ipsilateral normal renal parenchyma （P 〈0.0001）. Conclusions CEUS is useful in detecting small vessels in tumors. Although there are several differen展开更多
Background Endometrial carcinoma is one of the most common gynecological malignancies among women.Early diagnosis and correct preoperative evaluation of myometrial invasion are necessary to improve the prognosis.This ...Background Endometrial carcinoma is one of the most common gynecological malignancies among women.Early diagnosis and correct preoperative evaluation of myometrial invasion are necessary to improve the prognosis.This study aimed to determine whether features and time-intensity curves （TIC） of transvaginal contrast-enhanced ultrasound （CEUS） differ from those of conventional ultrasound for endometrial carcinoma,and to further explore the clinical role of transvaginal CEUS in the early diagnosis of endometrial carcinoma.Methods Forty women with a normal uterus and seventy-nine patients with endometrial carcinoma were examinedby the transvaginal CEUS with SonoVue （Bracco,Imaging B.V,Switzerland）.The enhancement patterns and TIC of lesions were analyzed.The results of CEUS were compared with those of conventional ultrasound and pathology.Results In the early and late enhanced stages,the intensity of enhancement of the normal endometrium was always lower than that in the myometrium,and the boundary between normal endometrium and myometrium was clear.A total of 65.8% （52/79） of lesions presented with inhomogeneous enhancement,34.2% （27/79） presented with homogeneous enhancement; 60.8% （48/79） presented with hyperechoic enhancement,27.8% （22/79） presented with isoechoic enhancement,and 11.4% （9/79） presented with hypoechoic enhancement.The average arrival time,time to peak,rise time,half-wash out time of lesions were shorter than of normal endometrium （P 〈0.05）.The average peak intensity,relative rise in intensity,half-wash out intensity of lesions were higher than of normal endometrium （P〈0.05）.There were 49 （must be and may be present） cases of endometrial carcinoma by ultrasound （US）; 24 cases were consistent with pathology results,16 cases were underestimated and 9 cases were overestimated.There were 72 （must be and may be present） cases of endometrial carcinoma by CEUS; 53 cases were consistent with pathology results,12 cases were underestimated and 7 cases we展开更多
Conventional ultrasound(US)is the first-line imaging investigation for biliary diseases.However,it is lack of the ability to depict the microcirculation of some lesions which may lead to failure in diagnosis for some ...Conventional ultrasound(US)is the first-line imaging investigation for biliary diseases.However,it is lack of the ability to depict the microcirculation of some lesions which may lead to failure in diagnosis for some biliary diseases.The use of contrast-enhanced US(CEUS)has reached the field of bile duct disease in recent years and promising results have been achieved.In this review,the methodology,image interpretation,enhancement pattern,clinical usefulness,and indications for CEUS in the biliary system are summarized.CEUS may be indicated in the biliary system under the following circumstances:(1)Where there is a need to make a characterization of intrahepatic cholangiocarcinoma(ICC);(2)For differentiation diagnosis between ICC and other tumors(i.e.hepatocellular carcinoma or liver metastasis)or infectious diseases;(3)For differentiation diagnosis between biliary cystadenoma and biliary cystadenocarcinoma;(4)To detect malignant change in Caroli’s disease;(5)To depict the extent of Klatskin’s tumor with greater clarity;(6)To make a distinction between gallbladder cholesterol polyp,adenoma and polypoid cancer;(7)To make a distinction between chronic cholecystitis with thickened wall and gallbladder cancer;(8)For differentiation diagnosis between motionless sludge and gallbladder cancer;(9)For differentiation diagnosis between common bile duct cancer and sludge or stone without acoustic shadowing;and(10)In patients who are suspected of having a drop of their percutaneous transhepatic cholangiodrainage tube,US contrast agent can be administered to through the tube detect the site of the tube.展开更多
Hepatocellular carcinoma （HCC） has a decisive influence on the prognosis of cirrhotic patients. Although α-fetoprotein （AFP） is a known and specific tumor maker for HCC, it is not suitable for the screening and s...Hepatocellular carcinoma （HCC） has a decisive influence on the prognosis of cirrhotic patients. Although α-fetoprotein （AFP） is a known and specific tumor maker for HCC, it is not suitable for the screening and surveillance of HCC because of its poor predictive value and low sensitivity. The use of imaging modalities is essential for the screening, diagnosis and treatment of HCC. Ultrasound （US） plays a major role among them, because it provides real-time and non-invasive observation by a simple and easy technique. In addition, US-guided needle puncture methods are frequently required for the diagnosis and/or treatment process of HCC. The development of digital technology has led to the detection of blood flow by color Doppler US, and the sensitivity for detecting tumor vascularity has shown remarkable improvement with the introduction of microbubble contrast agents. Moreover, near realtime 3-dimensional US images are now available. As for the treatment of HCC, high intensity focused ultrasound （HIFU） was developed as a novel technology that provides transcutaneous ablation effect without needle puncture. These advancements in the US field have led to rapid progress in HCC management, and continuing advances are expected. This article reviews the current application of US for HCC in clinical practice.展开更多
Living donor liver transplantation(LDLT) has beenwidely used to treat end-stage liver disease with improvement in surgical technology and the application of new immunosuppressants. Vascular complications after liver t...Living donor liver transplantation(LDLT) has beenwidely used to treat end-stage liver disease with improvement in surgical technology and the application of new immunosuppressants. Vascular complications after liver transplantation remain a major threat to the survival of recipients. LDLT recipients are more likely to develop vascular complications because of their complex vascular reconstruction and the slender vessels. Early diagnosis and treatment are critical for the survival of graft and recipients. As a non-invasive, cost-effective and non-radioactive method with bedside availability, conventional gray-scale and Doppler ultrasonography play important roles in identifying vascular complications in the early postoperative period and during the follow-up. Recently, with the detailed vascular tracing and perfusion visualization, contrastenhanced ultrasound(CEUS) has significantly improved the diagnosis of postoperative vascular complications. This review focuses on the role of conventional grayscale ultrasound, Doppler ultrasound and CEUS for early diagnosis of vascular complications after adult LDLT.展开更多
Ultrasonic imaging is becoming the most popular medical imaging modality,owing to the low price per examination and its safety.However,blood is a poor scatterer of ultrasound waves at clinical diagnostic transmit freq...Ultrasonic imaging is becoming the most popular medical imaging modality,owing to the low price per examination and its safety.However,blood is a poor scatterer of ultrasound waves at clinical diagnostic transmit frequencies.For perfusion imaging,markers have been designed to enhance the contrast in B-mode imaging.These so-called ultrasound contrast agents consist of microscopically small gas bubbles encapsulated in biodegradable shells.In this review,the physical principles of ultrasound contrast agent microbubble behavior and their adjustment for drug delivery including sonoporation are described.Furthermore,an outline of clinical imaging applications of contrast-enhanced ultrasound is given.It is a challenging task to quantify and predict which bubble phenomenon occurs under which acoustic condition,and how these phenomena may be utilized in ultrasonic imaging.Aided by high-speed photography,our improved understanding of encapsulated microbubble behavior will lead to more sophisticated detection and delivery techniques.More sophisticated methods use quantitative approaches to measure the amount and the time course of bolus or reperfusion curves,and have shown great promise in revealing effective tumor responses to anti-angiogenic drugs in humans before tumor shrinkage occurs.These are beginning to be accepted into clinical practice.In the long term,targeted microbubbles for molecular imaging and eventually for directed anti-tumor therapy are expected to be tested.展开更多
The development of ultrasound contrast agents with excellent tolerance and safety profiles has notably improved liver evaluation with ultrasound(US)for several applications,especially for the detection of metastases.I...The development of ultrasound contrast agents with excellent tolerance and safety profiles has notably improved liver evaluation with ultrasound(US)for several applications,especially for the detection of metastases.In particular,contrast enhanced ultrasonography(CEUS)allows the display of the parenchymal microvasculature,enabling the study and visualization of the enhancement patterns of liver lesions in real time and in a continuous manner in all vascular phases,which is similar to contrast-enhanced computed tomography(CT)and contrast-enhanced magnetic resonance imaging.Clinical studies have reported that the use of a contrast agent enables the visualization of more metastases with significantly improved sensitivity and specificity compared to baseline-US.Furthermore,studies have shown that CEUS yields sensitivities comparable to CT.In this review,we describe the state of the art of CEUS for detecting colorectal liver metastases,the imaging features,the literature reports of metastases in CEUS as well as its technique,its clinical role and its potential applications.Additionally,the updated international consensus panel guidelines are reported in this review with the inherent limitations of this technique and best practice experiences.展开更多
文摘AIM： To evaluate the contrast-enhanced endosonography as a method of differentiating inflammation from pancreatic carcinoma based on perfusion characteristics of microvessels. METHODS： In 86 patients with suspected chronic pancreatitis （age： 62± 12 years; sex： f/m 38/48）, pancreatic lesions were examined by conventional endo- scopic B-mode, power Doppler ultrasound and contrastenhanced power mode （Hitachi EUB 525, SonoVue, 2.4 mL, Bracco） using the following criteria for malignant lesions： no detectable vascularisation using conventional power Doppler scanning, irregular appearance of arterial vessels over a short distance using SonoVue contrastenhanced technique and no detectable venous vessels inside the lesion. A malignant lesion was assumed if all criteria were detectable [gold standard endoscopic ultrasound （EUS）-guided fine needle aspiration cytology, operation]. The criteria of chronic pancreatitis without neoplasia were defined as no detectable vascularisation before injection of SonoVue, regular appearance of vessels over a distance of at least 20 mm after injection of SonoVue and detection of arterial and venous vessels. RESULTS： The sensitivity and specifidty of conventional EUS were 73.2% and 83.3% respectively for pancreatic cancer. The sensitivity of contrast-enhanced EUS increased to 91.1% in 51 of 56 patients with malignant pancreatic lesion and the specificity increased to 93.3% in 28 of 30 patients with chronic inflammatory pancreatic disease.CONCLUSION： Contrast-enhanced endoscopic ultrasound improves the differentiation between chronic pancreatitis and pancreatic carcinoma.
文摘Background Renal clear cell carcinoma （RCCC） is the most common malignant renal tumor. It is highly malignant, does not cause clinical symptoms in its early stages, and cannot be diagnosed using conventional ultrasound. This study was aimed to investigate the contrast-enhanced ultrasound （CEUS） mode and characteristics of the time-intensity curve for RCCC and its pathological basis. Methods Forty-two patients with pathologically diagnosed RCCC underwent CEUS examination before surgery. The patients＇ kidneys were visualized after injection of contrast agents using the Technos MPX DU8. We analyzed the CEUS mode, time-intensity curve, and pathological findings. Results The detection rate of RCCC with conventional ultrasound was about 71%, while the rate using CEUS was 100%. Larger tumors （33 cases） showed non-uniform enhancement with defective filling. CEUS modes were divided into 4 types： type Ⅰ, ＂quick in and out＂ （26.19%, 11/42）; type Ⅱ, ＂quick in and slow out＂ （40.48%, 17/42）; type Ⅲ, ＂Simultaneous in and out＂ （16.67%, 7/42）; and type Ⅳ ＂slow in and out＂ （16.67%, 7/42）. All types had a close correlation to the pathological basis. Time-intensity curve of CEUS consisted of 3 phases, the perfusion phase, regression phase, and lag phase. Cases of types Ⅰ and Ⅲ only had a perfusion and regression phase, those of type Ⅱ and Ⅳ had a perfusion phase, regression phase, and lag phase. Quantitative analysis of the time-intensity curve showed that the time-to-peak （FTP） of the lesions was shorter than that of normal renal parenchyma （P 〈0.0001）, the mean value of the up slope rate of the absolute value of lesions was higher than that of the ipsilateral normal renal parenchyma （P 〈0.0001）, and that the mean value of descent slope rate of the absolute value of lesions was lower than that of the ipsilateral normal renal parenchyma （P 〈0.0001）. Conclusions CEUS is useful in detecting small vessels in tumors. Although there are several differen
文摘Background Endometrial carcinoma is one of the most common gynecological malignancies among women.Early diagnosis and correct preoperative evaluation of myometrial invasion are necessary to improve the prognosis.This study aimed to determine whether features and time-intensity curves （TIC） of transvaginal contrast-enhanced ultrasound （CEUS） differ from those of conventional ultrasound for endometrial carcinoma,and to further explore the clinical role of transvaginal CEUS in the early diagnosis of endometrial carcinoma.Methods Forty women with a normal uterus and seventy-nine patients with endometrial carcinoma were examinedby the transvaginal CEUS with SonoVue （Bracco,Imaging B.V,Switzerland）.The enhancement patterns and TIC of lesions were analyzed.The results of CEUS were compared with those of conventional ultrasound and pathology.Results In the early and late enhanced stages,the intensity of enhancement of the normal endometrium was always lower than that in the myometrium,and the boundary between normal endometrium and myometrium was clear.A total of 65.8% （52/79） of lesions presented with inhomogeneous enhancement,34.2% （27/79） presented with homogeneous enhancement; 60.8% （48/79） presented with hyperechoic enhancement,27.8% （22/79） presented with isoechoic enhancement,and 11.4% （9/79） presented with hypoechoic enhancement.The average arrival time,time to peak,rise time,half-wash out time of lesions were shorter than of normal endometrium （P 〈0.05）.The average peak intensity,relative rise in intensity,half-wash out intensity of lesions were higher than of normal endometrium （P〈0.05）.There were 49 （must be and may be present） cases of endometrial carcinoma by ultrasound （US）; 24 cases were consistent with pathology results,16 cases were underestimated and 9 cases were overestimated.There were 72 （must be and may be present） cases of endometrial carcinoma by CEUS; 53 cases were consistent with pathology results,12 cases were underestimated and 7 cases we
文摘Conventional ultrasound(US)is the first-line imaging investigation for biliary diseases.However,it is lack of the ability to depict the microcirculation of some lesions which may lead to failure in diagnosis for some biliary diseases.The use of contrast-enhanced US(CEUS)has reached the field of bile duct disease in recent years and promising results have been achieved.In this review,the methodology,image interpretation,enhancement pattern,clinical usefulness,and indications for CEUS in the biliary system are summarized.CEUS may be indicated in the biliary system under the following circumstances:(1)Where there is a need to make a characterization of intrahepatic cholangiocarcinoma(ICC);(2)For differentiation diagnosis between ICC and other tumors(i.e.hepatocellular carcinoma or liver metastasis)or infectious diseases;(3)For differentiation diagnosis between biliary cystadenoma and biliary cystadenocarcinoma;(4)To detect malignant change in Caroli’s disease;(5)To depict the extent of Klatskin’s tumor with greater clarity;(6)To make a distinction between gallbladder cholesterol polyp,adenoma and polypoid cancer;(7)To make a distinction between chronic cholecystitis with thickened wall and gallbladder cancer;(8)For differentiation diagnosis between motionless sludge and gallbladder cancer;(9)For differentiation diagnosis between common bile duct cancer and sludge or stone without acoustic shadowing;and(10)In patients who are suspected of having a drop of their percutaneous transhepatic cholangiodrainage tube,US contrast agent can be administered to through the tube detect the site of the tube.
文摘Hepatocellular carcinoma （HCC） has a decisive influence on the prognosis of cirrhotic patients. Although α-fetoprotein （AFP） is a known and specific tumor maker for HCC, it is not suitable for the screening and surveillance of HCC because of its poor predictive value and low sensitivity. The use of imaging modalities is essential for the screening, diagnosis and treatment of HCC. Ultrasound （US） plays a major role among them, because it provides real-time and non-invasive observation by a simple and easy technique. In addition, US-guided needle puncture methods are frequently required for the diagnosis and/or treatment process of HCC. The development of digital technology has led to the detection of blood flow by color Doppler US, and the sensitivity for detecting tumor vascularity has shown remarkable improvement with the introduction of microbubble contrast agents. Moreover, near realtime 3-dimensional US images are now available. As for the treatment of HCC, high intensity focused ultrasound （HIFU） was developed as a novel technology that provides transcutaneous ablation effect without needle puncture. These advancements in the US field have led to rapid progress in HCC management, and continuing advances are expected. This article reviews the current application of US for HCC in clinical practice.
基金Supported by the Department of Science and technology of Sichuan ProvinceChina+2 种基金No.2013JY0147the National Natural Science Foundation of ChinaNo 81371556
文摘Living donor liver transplantation(LDLT) has beenwidely used to treat end-stage liver disease with improvement in surgical technology and the application of new immunosuppressants. Vascular complications after liver transplantation remain a major threat to the survival of recipients. LDLT recipients are more likely to develop vascular complications because of their complex vascular reconstruction and the slender vessels. Early diagnosis and treatment are critical for the survival of graft and recipients. As a non-invasive, cost-effective and non-radioactive method with bedside availability, conventional gray-scale and Doppler ultrasonography play important roles in identifying vascular complications in the early postoperative period and during the follow-up. Recently, with the detailed vascular tracing and perfusion visualization, contrastenhanced ultrasound(CEUS) has significantly improved the diagnosis of postoperative vascular complications. This review focuses on the role of conventional grayscale ultrasound, Doppler ultrasound and CEUS for early diagnosis of vascular complications after adult LDLT.
文摘Ultrasonic imaging is becoming the most popular medical imaging modality,owing to the low price per examination and its safety.However,blood is a poor scatterer of ultrasound waves at clinical diagnostic transmit frequencies.For perfusion imaging,markers have been designed to enhance the contrast in B-mode imaging.These so-called ultrasound contrast agents consist of microscopically small gas bubbles encapsulated in biodegradable shells.In this review,the physical principles of ultrasound contrast agent microbubble behavior and their adjustment for drug delivery including sonoporation are described.Furthermore,an outline of clinical imaging applications of contrast-enhanced ultrasound is given.It is a challenging task to quantify and predict which bubble phenomenon occurs under which acoustic condition,and how these phenomena may be utilized in ultrasonic imaging.Aided by high-speed photography,our improved understanding of encapsulated microbubble behavior will lead to more sophisticated detection and delivery techniques.More sophisticated methods use quantitative approaches to measure the amount and the time course of bolus or reperfusion curves,and have shown great promise in revealing effective tumor responses to anti-angiogenic drugs in humans before tumor shrinkage occurs.These are beginning to be accepted into clinical practice.In the long term,targeted microbubbles for molecular imaging and eventually for directed anti-tumor therapy are expected to be tested.
文摘The development of ultrasound contrast agents with excellent tolerance and safety profiles has notably improved liver evaluation with ultrasound(US)for several applications,especially for the detection of metastases.In particular,contrast enhanced ultrasonography(CEUS)allows the display of the parenchymal microvasculature,enabling the study and visualization of the enhancement patterns of liver lesions in real time and in a continuous manner in all vascular phases,which is similar to contrast-enhanced computed tomography(CT)and contrast-enhanced magnetic resonance imaging.Clinical studies have reported that the use of a contrast agent enables the visualization of more metastases with significantly improved sensitivity and specificity compared to baseline-US.Furthermore,studies have shown that CEUS yields sensitivities comparable to CT.In this review,we describe the state of the art of CEUS for detecting colorectal liver metastases,the imaging features,the literature reports of metastases in CEUS as well as its technique,its clinical role and its potential applications.Additionally,the updated international consensus panel guidelines are reported in this review with the inherent limitations of this technique and best practice experiences.
