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.

Bladder tumor staging: comparison of contrast-enhanced and gray-scale ultrasound.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of contrast-enhanced sonography in comparison with conventional sonography in differentiating muscle-infiltrating and superficial neoplasms of the urinary bladder. SUBJECTS AND METHODS: Conventional and contrast-enhanced sonography were performed on 34 consecutively registered patients with bladder tumors. All examinations were reviewed by two independent sonologists. At gray-scale sonography, interruption of the hyperechoic bladder wall was considered the main diagnostic criterion for differentiating superficial and infiltrating tumors. At contrast-enhanced sonography, a tumor was considered superficial when the hypoenhancing muscle layer of the bladder wall was intact; disruption of the muscle layer by enhancing tumor tissue was considered diagnostic of infiltration. A level of confidence in the diagnosis of tumor infiltration of the muscle layer was assigned on a 5-degree scale. Receiver operating characteristic analysis was used to assess overall confidence in the diagnosis of muscle infiltration by tumor at both conventional and contrast-enhanced sonography. Histologic diagnosis was obtained for all patients. RESULTS: Final pathologic staging revealed 25 superficial tumors (Ta-T1 disease) and nine muscle-infiltrating tumors (>T1). Conventional sonography depicted five of nine muscle-infiltrating tumors, and contrast-enhanced sonography depicted all nine. The diagnostic performance of contrast-enhanced sonography approached that of the reference standard (area under the receiver operating characteristic curve, 0.996), but the diagnostic performance of gray-scale ultrasound was worse (area under curve, 0.613). CONCLUSION: Our study showed that contrast-enhanced sonography is better than conventional sonography for differentiating muscle-infiltrating and superficial neoplasms of the urinary bladder.

Anatomical and clinical study on effects of sonography with pulse inversion and microbubble contrast in rabbit kidney.

Aim of the present study was to evaluate by transmission electron microscope (TEM) modifications in rabbit kidney-parenchyma after submission to ultrasound contrast agent (UCA) with Pulse Inversion Harmonic Imaging (PIHI). Seven inbred male albino rabbits were divided into three groups: 1) control group (n = 1 animal); 2) sonicated group (n = 3 animals); 3) sonicated group with UCA injection (CEUS) (n = 3 animals). The first group was not exposed to ultrasonography (US) and/or UCA. The second and third groups underwent baseline US and later to US with PIHI with a high mechanical index; in the third group UCA was simultaneously administered. Ultrastructural studies and image analysis were blindly performed on 50 samples (2mm3), including cortex and medulla, by two experienced pathologists with TEM. By TEM observations of the first and second groups showed no structural modifications of renal cortex and medulla. TEM observations of the third group showed ultrastructural changes of renal corpuscle, proximal and distal convoluted tubules and collecting tubules; further in the most of observed sections the filtration membrane had an alteration of typical trilaminar pattern and vacuolisation of glomerular endothelial cells with irregular edges. Therefore in rabbit kidney submitted to CEUS some ultrastructural modifications were observed.

[The ultrasound microbubble contrast in the diagnosis and the decisional iter of the treatment of the traumatic spleen lesions]. / L'ecografia con mezzo di contrasto nella diagnosi e nell'iter decisionale del trattamento delle lesioni traumatiche spleniche.

AIM OF THE STUDY: To estimate our 3-year experience on the diagnosis and monitoring of the spleen traumatic lesions with the employment of ultrasound microbubbles contrast. METHOD: From the 174 patients who were joints to our department in regimen of urgency for abdominal traumatic lesions, we have estimated 24 patiens including our criteria. The selected patients have been subordinate to the echographic examination with microbubbles contrast and to TC multi-detector (MDCT) with contrast with multiphasic technique. RESULTS: The echographic examination has evidenced 4 patients with abdominal fluid deposit without spleen parenchimal damage and 8 patients with morphofunctional alterations of the spleen. After the introduction of the contrast in 12 patients it has been evidenced a homogenous enhancement of the spleen parenchyma and in the remaining 12 patients the enhancement has turned out dishomogenous. From 24 patients examinated with CT with contrast, the traumatic breach of the spleen was demonstrated in same the 12 patients. CONCLUSION: It comes noticed the increased sensibility of the methodical CT with contrast and microbubbles contrast, that reaches up the 100% respect of the traditional echography whose sensibility turns out 66%. The CT remains the methodical gold-standard for the spleen traumatic lesions. Our experience suggests that the microbubbles contrast introduces the same one sensibility and it is preferred for follow-up and the corrected management of the patient.