Rapid low-cost hyperspectral imaging system for quantitative assessment of infantile hemangioma.

Hemangioma, the predominant benign tumor occurring in infancy, exhibits a wide range of prognoses and associated outcomes. The accurate determination of prognosis through noninvasive imaging modalities holds essential importance in enabling effective personalized treatment strategies and minimizing unnecessary surgical interventions for individual patients. The present study focuses on advancing the personalized prognosis of hemangioma by leveraging noninvasive optical sensing technologies by the development of a novel rapid hyperspectral sensor (image collection in 5 s, lateral resolution of 10 µm) that is capable of quantifying hemoglobin oxygenation and vascularization dynamics during the course of tumor evolution. We have developed a quantitative parameter for hemangioma assessment, that demonstrated agreement with the clinician's conclusion in 90% among all cases during clinical studies on six patients, who visited clinician from two to four times. The presented methodology has potential to be implemented as a supportive tool for accurate hemangioma diagnostics in clinics.

Early response assessment after CyberKnife stereotactic radiosurgery for symptomatic vertebral hemangioma by quantitative parameters from dynamic contrast-enhanced MRI.

PURPOSE: The present study aimed to explore the value of DCE-MRI to evaluate the early efficacy of CyberKnife stereotactic radiosurgery in patients with symptomatic vertebral hemangioma (SVH). METHODS: A retrospective analysis of patients with spinal SVH who underwent CyberKnife stereotactic radiosurgery from January 2017 to August 2019 was performed. All patients underwent DCE-MRI before treatment and three months after treatment. The parameters included volume transfer constant (Ktrans), transfer rate constant (Kep), and extravascular extracellular space volume fraction (Ve). RESULTS: A total of 11 patients (11 lesions) were included. After treatment, six patients (54.5%) had a partial response, five patients (45.4%) had stable disease, and three patients (27.3%) presented with reossification. Ktrans and Kep decreased significantly in the third month after treatment (p = 0.003 and p = 0.026, respectively). ΔKtrans was -46.23% (range, -87.37 to -23.78%), and ΔKep was -36.18% (range, -85.62 to 94.40%). The change in Ve was not statistically significant (p = 0.213), and ΔVe was -28.01% (range, -58.24 to 54.76%). CONCLUSION: DCE-MRI parameters Ktrans and Kep change significantly after CyberKnife stereotactic radiosurgery for SVH. Thus, DCE-MRI may be of value in determining the early efficacy of CyberKnife stereotactic radiosurgery.

Mediastinal hemangiomas: Spectrum of CT and MRI findings - retrospective case series study and systematic review of the literature.

PURPOSE: To analyze the imaging manifestations of mediastinal hemangioma (MH) by CT and MRI to aid in its successful diagnosis and preoperative evaluation. METHODS: Seventeen cases of MH diagnosed by histopathology combined with CT and MRI were retrospectively collected; and their CT and MRI features, including the lesions' site and range, shape, size, margin, density or signal, enhancement pattern, mass-cardiovascular interface, mass-pulmonary interface, and other characteristics were evaluated. RESULTS: The anterior, middle, and posterior mediastinum were involved in 13, 13, and 8 cases, respectively. The masses size varied from 20 to 233 mm. Irregular, dumbbell-like, and oval masses were found in 13, 2, and 2 cases, respectively, while with pampiniform growth in 16 cases and expansive growth in 1 case. Mixed density, homogeneous density solid masses, and heterogeneous density masses with dominant fat were found in 9, 5, and 3 cases, respectively, showing mild or significant enhancement in aortic phase while no or mild enhancement in pulmonary artery phase. Draining veins were found in 16 cases and feeding arteries in 10 cases. Phleboliths were detected in 10 cases, splenic hemangiomas in 6 cases, and left lateral-chest-wall hemangioma in 1 case. In MRI sequences, mixed signal was found on T1WI and heterogeneous hypersignal with nodular or linear hyposignal on T2WI in 5 cases, mild or significant enhancement in 4 cases, draining veins in 2 cases, and no feeding arteries or phleboliths were seen. CONCLUSION: Presence of phleboliths, pampiniform growth pattern, and aberrant draining veins are relatively specific characteristics in diagnosing MH.

[Quality standards for ultrasonographic assessment of peripheral vascular malformations and vascular tumors. Report of the french society for vascular medicine. 2018 Update]. / Standards de qualité pour la pratique de l'examen écho-Doppler dans l'étude des malformations et tumeurs vasculaires. Rapport de la Société française de médecine vasculaire (SFMV) : actualisation 2018.

The quality standards of the French Society of Vascular Medicine for the ultrasonographic assessment of vascular malformations are based on the two following requirements: (1) technical know-how: mastering the use of ultrasound devices and the method of examination; (2) medical know-how: ability to adapt the methods and scope of the examination to its clinical indication and purpose, and to rationally analyze and interpret its results. AIMS OF THE QUALITY STANDARDS: To describe an optimal method of examination in relation to the clinical question and hypothesis. To homogenize practice, methods, glossary, and reporting. To provide good practice reference points, and promote a quality process. ITEMS OF THE QUALITY STANDARDS: The 3 levels of examination; their clinical indications and goals. The reference standard examination (level 2), its variants according to clinical needs. The minimal content of the examination report; the letter to the referring physician (synthesis, conclusion and proposal for further investigation and/or therapeutic management). Commented glossary (anatomy, hemodynamics, semiology). Technical bases. Setting and use of ultrasound devices. Here, we discuss ultrasonography methods of using of ultrasonography for the assessment of peripheral vascular malformations and tumors (limbs, face, trunk).

Assessment of Infantile Hemangiomas Using a Handheld Wireless Diffuse Optical Spectroscopic Device.

BACKGROUND/OBJECTIVES: Infantile hemangiomas (IHs) are vascular tumors with the potential for significant morbidity. There is a lack of validated objective tools to assess IH severity and response to treatment. Diffuse optical spectroscopy (DOS), a noninvasive, nonionizing imaging modality, can measure total hemoglobin concentration and hemoglobin oxygen saturation in tissue to assess IH vascularity and response to treatment. Our objective was to evaluate the utility of a wireless, handheld DOS system to assess IH characteristics at selected points during their clinical course. METHODS: Thirteen subjects (initial age 5.8 ± 2.0 mos) with 15 IHs were enrolled. IHs were classified as proliferative, plateau phase, or involuting. Nine patients with 11 IHs were untreated; four patients with 4 IHs were treated with timolol or propranolol. Each IH was evaluated by placing the DOS system directly on the lesion as well a normal contralateral skin site. IH vascularity and oxygenation were scored using a newly defined normalized hypoxia fraction (NHF) coefficient. Measurements were recorded at various intervals from the initial visit to 1 to 2 years of age. RESULTS: For the nine untreated IHs, the NHF was highest at 6 months of age, during proliferation. Differences in NHFs between the proliferation and the plateau (p = 0.02) and involuting (p < 0.001) stages were statistically significant. In treated patients, the NHF normalized to 60% after 2 months. One treated IH came within 5% of the NHF for normal skin after 12 months. CONCLUSIONS: DOS can be used to assess the vascularity and tissue oxygenation of IHs and monitor their progression and response to treatment.

A radiological classification system for intraneural vascular anomalies: assessment of potential for resection with high-resolution MRI.

BACKGROUND: Intraneural hemangiomas and vascular malformations are rare, with approximately 50 cases reported in the literature. They present a therapeutic challenge; surgical resection can result in damage to the nerve and lesion recurrence is common. We introduce a new framework to classify intraneural vascular anomalies in relation to the anatomic compartments of the nerve and assess amenability to surgical resection. METHODS: We retrospectively reviewed cases of intraneural hemangiomas and vascular malformations treated at our institution between 2003 and 2013 that had high-resolution 3-T magnetic resonance imaging (MRI). A review of the literature was also performed. Our cases and reports in the literature with available MRI data were sub-categorized according to their relationship to the paraneurium and epineurium of the nerve. RESULTS: Nine patients were identified with intraneural (subparaneurial or subepineurial) vascular lesions. Two patients had a predominantly subparaneurial involvement of the nerve, six patients had predominantly subepineurial involvement, and one patient exhibited extensive involvement in both compartments. Four patients were managed surgically and the rest conservatively. Targeted resection of two subparaneurial hemangiomas provided complete relief of symptoms and freedom from recurrence at 18 month and 24 months respectively. One patient with extensive subepineurial and extraneural vascular malformations did not appear to benefit from sub-total resection with interfascicular dissection. No surgical morbidity was noted in any of the cases. CONCLUSIONS: We believe that the subparaneurial compartment-a potential space between the epineurium and paraneurium-provides a tissue plane within which benign vascular lesions can occur. Hemangiomas and vascular malformations are complex and can occupy different intraneural and extraneural compartments. The anatomic framework aids surgical decision-making and ensures that all components of the lesion are considered. We advocate a multimodal approach in the treatment of these rare lesions.

Retrospective chart review of 44 fetuses with cervicofacial tumors in the sonographic assessment.

OBJECTIVES: The aim of this retrospective study was to review and analyze ultrasonography examinations and follow-up of fetuses with cervicofacial tumors to develop bases for counseling specialist involved in perinatal treatment. METHODS: The study consisted of case series with chart review of 44 fetuses with cervicofacial tumors diagnosed in utero by ultrasonography. The study was carried in Department of Diagnosis and Prevention of Congenital Malformations, Medical University of Lodz in years 1998-2013. The analysis of the fetuses with cervicofacial tumors included assessment of fetal sonographic features, neonatal survival and in utero as well as perinatal treatments. The obtained data were analyzed by the standard statistical tests and the Pearson's Chi square test, statistical significance at p=0.05. RESULTS: Cervicofacial tumors were detected at mean 19±7 weeks of gestation. Eighty-two percent of the fetuses were males. Lymphatic malformations followed by teratomas were the most common fetal tumors in the cervicofacial region. In most cases, fetuses with cervicofacial tumors had other abnormalities. Mortality rate in our case series was 43%. In utero treatment was introduced in 6 fetuses. In 4 neonates prenatal sonographic assessment revealed upper airway patency and EXIT procedure (ex-utero intrapartum treatment) was introduced. CONCLUSION: Prenatal sonographic detection of cervicofacial tumor, in case of lymphatic malformations possibly as early as in the first trimester, in case of craniofacial teratomas, cervical teratomas, hemangiomas and thyroid tumors possibly as early as in the second trimester, and in case of epignathi possibly in the third trimester, permits planning further course of pregnancy as well as EXIT procedure before delivery.

Hemodynamic assessment of indomethacin-induced fetal heart failure in high-output state.

Hemodynamic study was performed on a 32-year-old woman presenting at 27 weeks' gestation. Ultrasound revealed a single normal fetus with mild cardiomegaly, polyhydramnios, and placental chorioangioma. Doppler study showed increased middle cerebral artery peak systolic velocity, normal Tei index, and forward flow of "a" wave with normal preload in the ductus venosus. Twelve hours after initiation of indomethacin for tocolysis, frank hydrops fetalis developed rapidly. The right ventricle showed poor contractility and performance. Markedly increased preload in ductus venosus with reversed "a" wave and pulsations in the umbilical vein were demonstrated. This study suggests that indomepacin treatment in fetal high-cardiac output state should be used with extreme caution.

[Quality standards for ultrasonographic assessment of peripheral vascular malformations and vascular tumors. Report of the French Society for Vascular Medicine]. / Standards de qualité pour la pratique de l'examen écho-doppler dans l'étude des malformations et tumeurs vasculaires. Rapport de la Société française de médecine vasculaire (SFMV).

THE QUALITY STANDARDS OF THE FRENCH SOCIETY OF VASCULAR MEDICINE FOR THE ULTRASONOGRAPHIC ASSESSMENT OF VASCULAR MALFORMATIONS ARE BASED ON THE TWO FOLLOWING REQUIREMENTS: Technical know-how: mastering the use of ultrasound devices and the method of examination. Medical know-how: ability to adapt the methods and scope of the examination to its clinical indication and purpose, and to rationally analyze and interpret its results. AIMS OF THE QUALITY STANDARDS: To describe an optimal method of examination in relation to the clinical question and hypothesis. To achieve consistent practice, methods, glossary, and reporting. To provide good practice reference points, and promote a high-quality process. ITEMS OF THE QUALITY STANDARDS: The three levels of examination; their clinical indications and goals. The reference standard examination (level 2), its variants according to clinical needs. The minimal content of the examination report; the letter to the referring physician (synthesis, conclusion and proposal for further investigation and/or therapeutic management). Commented glossary (anatomy, hemodynamics, semiology). Technical bases. Settings and use of ultrasound devices. Here, we discuss the methods of using ultrasonography for the assessment of peripheral vascular malformations and tumors.

Role of ultrasound in the assessment of benignity and malignancy of parotid masses.

OBJECTIVES: This study aimed to investigate the value of ultrasound in the identification of benign and malignant parotid masses. METHODS: Data of 189 patients with parotid gland masses undergoing ultrasound-guided fine-needle aspiration (FNA), core biopsy or surgery were reviewed retrospectively and the presumed sonographic diagnoses were compared with the histopathology. The sensitivity, specificity and accuracy of sonographic diagnoses were assessed and the sonographic characteristics of those lesions, including shape, margin, echogenicity, echotexture and vascularization, were studied. RESULTS: Of the 189 patients, the final pathological diagnosis included 18 malignant tumours and 171 benign masses; the presumed sonographic diagnoses showed 165 cases as benign and probably benign masses (11 cases were confirmed malignant, 154 cases benign) and 24 cases were diagnosed as probably malignant and malignant masses (7 cases were confirmed malignant, 17 cases benign). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ultrasound for the diagnosis of parotid gland masses were 38.9%, 90.1%, 29.2%, 93.3% and 85.2%, respectively, and accuracy for malignant masses was 20%. The sonographic characteristics of parotid masses between benign and malignant lesions had no significant differences. The parotid gland masses in this study included pleomorphic adenoma, Warthin's tumour, retention cyst, haemangiomas, chronic granuloma, lymphoma, fibrolipoma, abscess, basal cell adenoma, oncocytoma, lymphatic tuberculosis, myoepithelioma, neurilemmoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, alveolar soft part sarcoma and retinal blastoma (metastasis). CONCLUSIONS: It is challenging to use sonography for differentiating between benign and malignant parotid gland masses. To make a definite diagnosis, ultrasound-guided FNA or core biopsy is advocated.

Non-invasive assessment of benign vocal folds lesions in children by means of ultrasonography.

OBJECTIVES: Flexible fiberoptic endoscopes have made pediatric laryngeal examinations an everyday practice, even though fiberoptic-flexible laryngoscopy (FFL) is not always well tolerated in young children because of limited cooperation. Laryngeal ultrasonography (LUS) has been applied to normal and pathological findings in infants and children, allowing the assessment of subglottic hemangiomas, laryngeal stenosis and paralysis. No previous study assessed benign vocal folds lesions by LUS in children. The aim of this study is to evaluate the possibility of LUS to detect benign vocal fold lesions in children by comparing the results of FFL in 16 children with those of LUS. METHODS: Sixteen children (9 males and 7 females) with a mean age of 7.5+/-4.0 years were included in the study. Each child underwent FFL performed by a skilled phoniatrician and LUS performed blindly by an expert radiologist. RESULTS: On FFL bilateral vocal folds nodules were found in 9 patients, vocal fold cyst in 2 other patients, while in 2 children the vocal folds appeared normal. Laryngeal papyllomatosis, vocal fold polyp and vocal fold irregularity were found in only one patient. LUS enabled the diagnosis in all the 14 patients with vocal fold lesions. Bilateral hyperechoic lesions were visible in 10 patients, while hypoechoic lesions were found in three patients. No lesion were found in two children, while one patient presented with a monolateral hyperechoic lesion. CONCLUSIONS: LUS was accurate, safe, well accepted and tolerated. LUS appears to be a useful diagnostic tool for supplementing FFL in the assessment of benign vocal fold lesions in children and may represent an interesting alternative in everyday clinical practice.

[Contrast-enhanced ultrasound for the characterization of incidental liver lesions - an economical evaluation in comparison with multi-phase computed tomography]. / Kontrastverstärkter Ultraschall zur Charakterisierung von inzidentellen Leberläsionen - eine ökonomische Betrachtung im Vergleich zur Mehrphasen-Computertomografie.

AIM: The aim of the study was to conduct a cost-minimization analysis of contrast-enhanced ultrasound (CEUS) compared to multi-phase computed tomography (M-CT) as the diagnostic standard for diagnosing incidental liver lesions. METHODS: Different scenarios of a cost-covering realization of CEUS in the ambulant sector in the general health insurance system of Germany were compared to the current cost situation. The absolute savings potential was estimated using different approaches for the calculation of the incidence of liver lesions which require further characterization. RESULTS: CEUS was the more cost-effective method in all scenarios in which CEUS examinations where performed at specialized centers (122.18-186.53 euro) compared to M-CT (223.19 euro). With about 40 000 relevant liver lesions per year, systematic implementation of CEUS would result in a cost savings of 4 m euro per year. However, the scenario of a cost-covering CEUS examination for all physicians who perform liver ultrasound would be the most cost-intensive approach (e. g., 407.87 euro at an average utilization of the ultrasound machine of 25 %, and a CEUS ratio of 5 %). CONCLUSION: A cost-covering realization of the CEUS method can result in cost savings in the German healthcare system. A centralized approach as proposed by the DEGUM should be targeted.

[Real-time contrast-enhanced ultrasound in the evaluation of focal liver lesions: diagnostic efficacy and economical issues from a French multicentric study]. / Echographie de contraste temps réel dans la prise en charge diagnostique des lésions nodulaires hépatiques: évaluation des performances diagnostiques et de l'impact économique sur une étude multicentrique française.

The recent introduction of high-end ultrasound equipment combined with recent contrast agents provides marked improvements in the characterization of focal liver lesions as previously reported by monocentric studies. The aim of the present study was to evaluate the diagnostic performance of Contrast-Enhanced Ultrasonography (CEUS) using SonoVue as well as its medico-economic value for characterization of focal liver lesions. These nodules were not characterized on previous CT or conventional sonography. This prospective multicentric study conducted in 15 French centres found diagnostic performances similar to those reported for CT and MRI, with a concordance rate of 84.5%, sensitivity greater than 80% and specificity greater than 90% for all types of lesions. Higher acceptance was found for CEUS compared to other imaging modalities. Economical assessment based on examination reimbursment and contrast agent cost showed a lower cost for contrast ultrasound versus CT and MRI. This French multicentric study confirmed the high diagnostic value of CEUS for focal liver lesion characterization and demonstrated a lower economical impact compared to other imaging modalities such as CT and MRI.

[Assessment of tumour angiogenesis using contrast-enhanced ultrasound]. / Evaluation de l'angiogénèse tumorale à l'aide de l'échographie de contraste.

Microbubbles are useful for imaging tumour angiogenesis and relatively crude forms of this approach are now routinely used for subjective diagnosis, especially in the liver. 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 tumour response to anti-angiogenic drugs in humans before tumour 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-tumour therapy are expected to be tested.

[Accuracy of liver lesion assessment using automated measurement and segmentation software in biphasic multislice CT (MSCT)]. / Einfluss des vaskularisationsgrades auf die automatische segmentierung und messung von lebertumoren nach RECIST in einer biphasischen multi-slice-CT (MSCT).

PURPOSE: To assess the accuracy of liver lesion measurement using automated measurement and segmentation software depending on the vascularization level. MATERIALS AND METHODS: Arterial and portal venous phase multislice CT (MSCT) was performed for 58 patients. 94 liver lesions were evaluated and classified according to vascularity (hypervascular: 13 hepatocellular carcinomas, 20 hemangiomas; hypovascular: 31 metastases, 3 lymphomas, 4 abscesses; liquid: 23 cysts). The RECIST diameter and volume were obtained using automated measurement and segmentation software and compared to corresponding measurements derived visually by two experienced radiologists as a reference standard. Statistical analysis was performed using the Wilcoxon test and concordance correlation coefficients. RESULTS: Automated measurements revealed no significant difference between the arterial and portal venous phase in hypovascular (mean RECIST diameter: 31.4 vs. 30.2 mm; p = 0.65; kappa = 0.875) and liquid lesions (20.4 vs. 20.1 mm; p = 0.1; kappa = 0.996). The RECIST diameter and volume of hypervascular lesions were significantly underestimated in the portal venous phase as compared to the arterial phase (30.3 vs. 26.9 mm, p = 0.007, kappa = 0.834; 10.7 vs. 7.9 ml, p = 0.0045, kappa = 0.752). Automated measurements for hypovascular and liquid lesions in the arterial and portal venous phase were concordant to the reference standard. Hypervascular lesion measurements were in line with the reference standard for the arterial phase (30.3 vs. 32.2 mm, p = 0.66, kappa = 0.754), but revealed a significant difference for the portal venous phase (26.9 vs. 32.1 mm; p = 0.041; kappa = 0.606). CONCLUSION: Automated measurement and segmentation software provides accurate and reliable determination of the RECIST diameter and volume in hypovascular and liquid liver lesions. Hypervascular lesions are prone to be underestimated with regard to size in the portal venous phase and therefore should preferentially be segmented in the arterial phase.

Use of second generation contrast-enhanced ultrasound in the assessment of focal liver lesions.

Ultrasound (US) is often the first imaging modality employed in patients with suspected focal liver lesions. The role of US in the characterisation of focal liver lesions has been transformed with the introduction of specific contrast media and the development of specialized imaging techniques. Ultrasound now can fully characterise the enhancement pattern of hepatic lesions, similar to that achieved with contrast enhanced multiphasic computed tomography (CT) and magnetic resonance imaging (MRI). US contrast agents are safe, well-tolerated and have very few contraindications. Furthermore, real-time evaluation of the vascularity of focal liver lesions has become possible with the use of the newer microbubble contrast agents. This article reviews the enhancement pattern of the most frequent liver lesions seen, using the second generation US contrast media. The common pitfalls for each type of lesion are discussed. The recent developments in US contrast media and specific imaging techniques have been a major advance and this technique, in view of the intrinsic advantages of US, will undoubtedly gain popularity in the years to come.

Contrast-enhanced ultrasonography in the characterization of benign focal liver lesions: activity-based cost analysis.

PURPOSE: The aim of this study was to perform a cost analysis of contrast-enhanced ultrasonography (CEUS) in the study of benign focal liver lesions (BFLL) with indeterminate appearance on ultrasonography (US). MATERIALS AND METHODS: A decision model of patients with suspected BFLL on baseline US who subsequently underwent CEUS between 2002 and 2005 was constructed. We analysed the cost effectiveness of CEUS, considering whether or not computed tomography (CT) was necessary for the diagnosis. There were 398 patients with 213 angiomas, 41 focal nodular hyperplasias (FNH) and 154 pseudolesions (focal fatty sparing, focal fatty areas). Each patient underwent CEUS, and 98 of them were also studied by CT. All lesions were followed up. RESULTS: The cost of a single CEUS examination was 101.51 euros, and that of a single CT scan was 211.48 euros. For diagnosis of haemangiomas, we saved 1,406.97 euros in 2002, 5,315.22 euros in 2003, 10,317.78 euros in 2004 and 9,536.13 euros in 2005. For diagnosis of focal nodular hyperplasias, we saved 781.65 euros in 2003, 781.65 euros in 2004 and 1,406.97 euros in 2005. For diagnosis of pseudolesions, we saved 2,813.94 euros in 2002, 5,158.89 euros in 2003, 5,158.89 euros in 2004 and 4,220.91 euros in 2005. In the period 2002-2005, the introduction of CEUS allowed us to save a total of 47,055.33 euros in the diagnosis of benign focal hepatic liver lesions. CONCLUSIONS: This cost analysis shows that CEUS is the least expensive second-line modality after baseline US for the diagnosis of BFLL.