Double contrast-enhanced ultrasonography improves diagnostic accuracy of T staging compared with multi-detector computed tomography in gastric cancer patients

BACKGROUND Gastric cancer(GC)is the most common malignant tumor and ranks third for cancer-related deaths among the worldwide.The disease poses a serious public health problem in China,ranking fifth for incidence and third for mortality.Knowledge of the invasive depth of the tumor is vital to treatment decisions.AIM To evaluate the diagnostic performance of double contrast-enhanced ultrasonography(DCEUS)for preoperative T staging in patients with GC by comparing with multi-detector computed tomography(MDCT).METHODS This single prospective study enrolled patients with GC confirmed by preoperative gastroscopy from July 2021 to March 2023.Patients underwent DCEUS,including ultrasonography(US)and intravenous contrast-enhanced ultrasonography(CEUS),and MDCT examinations for the assessment of preoperative T staging.Features of GC were identified on DCEUS and criteria developed to evaluate T staging according to the 8th edition of AJCC cancer staging manual.The diagnostic performance of DCEUS was evaluated by comparing it with that of MDCT and surgical-pathological findings were considered as the gold standard.RESULTS A total of 229 patients with GC(80 T1,33 T2,59 T3 and 57 T4)were included.Overall accuracies were 86.9%for DCEUS and 61.1%for MDCT(P<0.001).DCEUS was superior to MDCT for T1(92.5%vs 70.0%,P<0.001),T2(72.7%vs 51.5%,P=0.041),T3(86.4%vs 45.8%,P<0.001)and T4(87.7%vs 70.2%,P=0.022)staging of GC.CONCLUSION DCEUS improved the diagnostic accuracy of preoperative T staging in patients with GC compared with MDCT,and constitutes a promising imaging modality for preoperative evaluation of GC to aid individualized treatment decision-making.

Clinical value of oral contrast-enhanced ultrasonography in diagnosis of gastric tumors

BACKGROUND The incidence of gastric cancer remains high,and it is the sixth most common cancer and the fourth leading cause of cancer deaths worldwide.Oral contrastenhanced ultrasonography is a simple,non-invasive,and painless method for the diagnosis of gastric tumors.AIM To explore the diagnostic value of oral contrast-enhanced ultrasonography for the detection of gastric tumors.METHODS The screening results based on oral contrast-enhanced ultrasonography and electronic gastroscopy were compared with those of the postoperative pathological examination.RESULTS Among 42 patients with gastric tumors enrolled in the study,the diagnostic accordance rate was 95.2%for oral contrast-enhanced ultrasonography(n=40)and 90.5%for electronic gastroscopy(n=38)compared with postoperative pathological examination.The Kappa value of consistency test with pathological findings was 0.812 for oral contrast-enhanced ultrasonography and 0.718 for electronic gastroscopy,and there was no significant difference between them(P=0.397).For the TNM staging of gastric tumors,the accuracy rate of oral contrast enhanced ultrasonography was 81.9%for the overall T staging and 50%,77.8%,100%,and 100%for T1,T2,T3,and T4 staging,respectively.The sensitivity and specificity were both 100%for stages T3 and T4.The diagnostic accuracy rate of oral contrast-enhanced ultrasonography was 93.8%,80%,100%,and 100%for stages N0,N1-N3,M0,and M1,respectively.CONCLUSION The accordance rate of qualitative diagnosis by oral contrast-enhanced ultrasonography is comparable to that of gastroscopy,and it could be used as the preferred method for the early screening of gastric tumors.

Contrast-enhanced ultrasonography in peripheral lung consolidations: What's its actual role?

AIM:To evaluate the diagnostic accuracy of contrastenhanced ultrasonography(CEUS)in the differential diagnosis between neoplastic and non-neoplastic peripheral pleuro-pulmonary lesions.METHODS:One hundred patients with pleural or peripheral pulmonary lesions underwent thoracic CEUS.An 8 microliters/mL solution of sulfur hexafluoride microbubbles stabilized by a phospholipid shell(SonoVue)was used as US contrast agent.The clips were stored and independently reviewed by two readers,who recorded the following parameters:presence/absence of arterial enhancement,time to enhancement(TE),extent of enhancement(EE),pattern of enhancement(PE),presence/absence of wash-out,time to wash-out,and extent of wash-out.After the final diagnosis(based on histopathologic findings or follow-up of at least 15 mo)was reached,sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),positive likelihood ratio(PLR),negative likelihood ratio(NLR)of each CEUS parameter in the differential diagnosis between neoplastic and nonneoplastic lesions were calculated.Furthermore,an arbitrary score based on the ratio between the PPVs of each CEUS parameter was calculated,to evaluate if some relationship could exist between overall CEUS behaviour and neoplastic or non-neoplastic nature of the lesions.

Application of contrast-enhanced intraoperative ultrasonography in the decision-making about hepatocellular carcinoma operation

AIM:To evaluate the detection and differentiation ability of contrast-enhanced intraoperative ultrasonography(CE-IOUS) in hepatocellular carcinoma(HCC) operations.METHODS:Clinical data of 50 HCC patients were retrospective analyzed.The sensitivity,specificity,false negative and false positive rates of contrast enhanced magnetic resonance imaging(CE-MRI),IOUS and CEIOUS were calculated and compared.Surgical strategy changes due to CE-IOUS were analyzed.RESULTS:Lesions detected by CE-MRI,IOUS and CEIOUS were 60,97 and 85 respectively.The sensitivity,specificity,false negative rate,false positive rate of CEMRI were 98.2%,98.6%,98.6%,60.0%,respectively;for IOUS were 50.0%,90.9%,1.8%,1.4%,respectively;and for CE-IOUS were 1.4%,40.0%,50.0%,9.1%,respectively.The operation strategy of 9(9/50,18.0%) cases was changed according to the results of CE-IOUS.CONCLUSION:Compared with CE-MRI,CE-IOUS performs better in detection and differentiation of small metastasis and regenerative nodules.It plays an important role in the decision-making of HCC operation.

Efficacy of intra-arterial contrast-enhanced ultrasonography during transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma

AIM To assess the usefulness of intra-arterial contrastenhanced ultrasonography(IAUS) during transarterial chemoembolization(TACE) with drug-eluting beads(DEB) for hepatocellular carcinoma(HCC).METHODS Thirty two patients with 39 HCC underwent DEB-TACE guided with IAUS, and examined by contrast-enhanced ultrasonography(CEUS) or dynamic CT after DEB-TACE were enrolled in this study. CEUS findings before DEBTACE and IAUS findings were compared. Treatments judged to be complete and incomplete for lesions were appropriate and insufficient, respectively. Findings on CEUS and/or dynamic CT performed 1, 3 and 6 mo after DEB-TACE were evaluated using m RECIST(CR/PR/SD/PD).RESULTS The treatments were complete and incomplete in 26 and 13 lesions, respectively. On imaging evaluation using CEUS and/or dynamic CT one month after treatment, 25 and 1 lesions were judged to be CR and PR, respectively, and at 6 mo after treatment, the results were CR, PR, SD and PD for 24, 1, 0 and 1 of these lesions, respectively, in the 26 completely treated lesions. Of the 13 lesions in which treatment was incomplete, the results on imaging at one month after treatment were CR, PR, SD and PD for 0, 6, 4 and 3 lesions, respectively. The overall CR rate at 6 mo after treatment was 61.5%(24/39).CONCLUSION A combination of DEB-TACE with IAUS can improve the therapeutic effects in patients with HCC.

Contrast-enhanced harmonic endoscopic ultrasonography for assessment of lymph node metastases in pancreatobiliary carcinoma

AIM: To assess the usefulness of contrast-enhanced harmonic endoscopic ultrasonography(CH-EUS) for lymph node metastasis in pancreatobiliary carcinoma.METHODS: All patients suspected of pancreatobiliary carcinoma with visible lymph nodes after standard EUS between June, 2009 and January, 2012 were enrolled.In the primary analysis, patients with successful EUSfine needle aspiration(FNA) were included. The lymph nodes were assessed by several standard EUS variables(short and long axis lengths, shape, edge characteristic and echogenicity), color Doppler EUS variable [central intranodal blood vessel(CIV) presence] and CH-EUS variable(heterogeneous/homogeneous enhancement patterns). The diagnostic accuracy relative to EUSFNA was calculated. In the second analysis, N-stage diagnostic accuracy of CH-EUS was compared with EUS-FNA in patients who underwent surgical resection.RESULTS: One hundred and nine patients(143 lymph nodes) fulfilled the criteria. The short axis cutoff ≥ 13 mm predicted malignancy with a sensitivity and specificity of 72% and 85%, respectively. These values were 72% and 63% for the long axis cut-off ≥ 20 mm, 62% and 75% for the round shape variable, 81% and 30% for the sharp edge variable, 66% and 61% for the hypoechogenicity variable, 70% and 72% for the CIV-absent variable, and 83% and 91% for the heterogeneous CH-EUS-enhancement variable, respectively. CH-EUS was more accurate than standard and color Doppler EUS, except the short axis cut-off. Notably, three patients excluded because of EUS-FNA failure were correctly N-staged by CH-EUS.CONCLUSION: CH-EUS complements standard and color Doppler EUS and EUS-FNA for assessment of lymph node metastases.

Clinical value of contrast-enhanced ultrasonography in the characterization of focal liver lesions:a prospective multicenter trial

BACKGROUND: Contrast-enhanced ultrasonography (CEUS) is increasingly accepted in clinical settings for diagnostic imaging of focal liver lesions (FLLs). This study aimed to assess the efficacy of CEUS in the characterization of FLLs in comparison with final diagnosis based on gold standard assessment. METHODS: The study was approved by the local ethics committee and participating patients provided written informed consent. A total of 148 patients with 164 FLLs were studied. Unenhanced ultrasonography (US) and CEUS were performed using fundamental and harmonic imaging, respectively. Contrast enhancement was assessed during the arterial, portal and late vascular phases after intravenous administration of contrast (SonoVue (R), Bracco, Italy). Sensitivity, specificity and diagnostic accuracy of US and CEUS were compared in identifying the lesion as benign, malignant or indeterminate and its actual tumor type. Final diagnosis was established by biopsy (129/164), MR imaging (11/164) or medical history (24/164). RESULTS: When compared to the gold standard, the number of indeterminate diagnoses was reduced from 56.7% (93/164) as assessed by fundamental imaging to 6.1% (10/164) after SonoVue (R) enhanced US examination. Sensitivity and specificity improved from 49% and 25% at baseline US to 93% and 75% with CEUS, respectively (P<0.01). Diagnostic accuracy of CEUS was 88% in contrast to 41% of baseline US. CONCLUSION: SonoVue (R) enhanced US improves the characterization of FLLs and may limit the need for further investigations.

Evaluation of hepatocellular carcinoma using contrast-enhanced ultrasonography:correlation with microvessel morphology

BACKGROUND: Contrast-enhanced ultrasonography (CEUS) is an important technique for depiction and assessment of tumor vascularity. This study aimed to explore the relationship between the morphological characteristics of tumor microvessels and enhancement patterns on CEUS in hepatocellular carcinoma (HCC). METHODS: Eighty patients with HCC underwent CEUS using SonoVue before hepatectomy. Contrast-enhanced ultrasonographic enhancement patterns and quantitative parameters were recorded. The tumor tissue sections were immunostained with human CD34 monoclonal antibody. The patients were classified into a point-line type group (n=36) and a loop-strip type group (n=44) according to microvessel morphology. The microvascular density (MVD) in the different types of microvessels was calculated. The relationship between enhancement patterns of HCC lesions and morphological characteristics of tumor microvessels was analyzed. RESULTS:TS: The mean MVD in HCC was 22.4 +/- 3.5 per 0.2 mm(2) in the point-line group, and 19.6 +/- 6.7 per 0.2 mm(2) in the loop-strip group, and there was no significant difference between them (t=0.948, P=0.354). In the portal vein phase, hypoenhancement was significantly more frequent in HCC (chi(2)=4.789, P=0.029) in the loop-strip group (40/44, 90.9%) than in the point-line group (26/36, 72.2%). The time to hypoenhancement in the loop-strip group (mean 64.84 +/- 26.16 seconds) was shorter than that in the point-line group (mean 78.39 +/- 28.72 seconds) (t=2.247, P=0.022). The time to hypoenhancement was correlated with MVD in the loop-strip group (r=-0.648, P=0.001). CONCLUSIONS: The enhancement patterns on CEUS are related to tumor microvascular morphology, and the type of microvascular morphology influences CEUS characterization. CEUS, an important noninvasive imaging technique, is used to evaluate microvascular morphology and angiogenesis, providing valuable information for antiangiogenic therapy in HCC. (Hepatobiliary Pancreat Dis Jut 2010; 9:605-610)

Contrast-enhanced ultrasonography in the evaluation of incidental focal liver lesions: A cost-effectiveness analysis

AIM To determine whether contrast-enhanced ultrasonography(CEUS) as the first-line method is more costeffective in evaluating incidentally discovered focal liver lesions(FLLs) than is computed tomography(CT) and magnetic resonance imaging(MRI). METHODS Between 2010 and 2015, our prospective study enrolled 459 patients with incidentally found FLLs. The biological nature of FLLs was assessed by CEUS in all patients. CT or MRI examinations were added in unclear cases. The sensitivity and specificity of CEUS were calculated. The total costs of CEUS examinations and of the added examinations performed in inconclusive cases were calculated. Afterwards, the theoretical expenses for evaluating incidentally discovered FLLs using CT or MRI as the first-line method were calculated. The resultswere compared. RESULTS The total cost of the diagnostic process using CEUS for all enrolled patients with FLLs was 75884 USD. When the expenses for additional CT and MRI examinations performed in inconclusive cases were added, the total cost was 90540 US dollar(USD). If all patients had been examined by CT or MR as the first-line method, the costs would have been 78897 USD or 384235 USD, respectively. The difference between the cost of CT and CEUS was 3013 USD(4%) and that between MRI and CEUS was 308352 USD(406.3%). We correctly described 97.06% of benign or malignant lesions, with 96.99% sensitivity and 97.09% specificity. Positive predictive value was 94.16% and negative predictive value was 98.52%. In cases with 4 and more lesions, malignancy is significantly more frequent and inconclusive findings significantly less frequent(P < 0.001).CONCLUSION While the costs of CEUS and CT in evaluating FLLs are comparable, CEUS examination is far more costeffective in comparison to MRI.

Evaluation of Carotid Plaque Neovascularization in Patients with Diabetes Mellitus by Contrast-enhanced Ultrasonography

This study investigated the relationship between carotid plaque neovascularization and diabetes mellitus（DM） by using contrast-enhanced ultrasonography. Contrast-enhanced ultrasonography was performed in 104 patients with carotid plaque thicker than 2.0 mm. There were 36 patients with DM and 68 patients without DM. The enhanced intensity in the plaque and the ratio of enhanced intensity in the plaque to that in the lumen of the carotid artery in patients with DM were significantly greater than those in patients without DM. Our study demonstrated that the enhanced intensity in patients with DM is greater than that their counterparts without DM, suggesting that carotid plaque in DM patients may have more neovessels and may be more vulnerable.

Correlation between Enhanced Intensity of Atherosclerotic Plaque at Contrast-enhanced Ultrasonography and Density of Histological Neovascularization

Summary： The feasibility of contrast-enhanced ultrasonography in the assessment of atherosclerotic plaque neovascularization and its relation to histological findings were investigated. Abdominal aortic atherosclerotic plaque model was induced in 25 New Zealand white rabbits by a combination of high cholesterol-rich diet and balloon aortic denudation. Standard and contrast-enhanced ultrasonography was performed at the 16th week of the model induction period. The plaques were classified as echogenic plaques or echolucent plaques according to their echogenicity at standard ultrasonography. The maxi- mum thickness of plaque was measured in the longitudinal section. Time intensity curve was used to quantify the enhanced intensity of the plaque. Animals were euthanized and abdominal aortas were har- vested for histological staining of CD31 to evaluate the neovascularization density of atherosclerotic plaque. The results showed that the echolucent plaques had higher enhanced intensity during con- trast-enhanced ultrasonography and higher neovascularization density at CD31 staining than the echo- genic plaques. The enhanced intensity of atherosclerotic plaque and its ratio to lumen were well corre- lated with histological neovascularization density （r=0.75, P〈0.001; r=0.68, P〈0.001, respectively）. However, the maximum thickness of plaque was not correlated with neovascularization density （r=0.235, P=0.081）. These findings demonstrated that the enhanced intensity in the plaque and ratio of enhanced intensity to that in the lumen of abdominal aorta may be more accurate in the evaluation of plaque neovascularization than maximum thickness. Our study indicates that contrast-enhanced ultra- sonography provides us a reliable method for the evaluation of plaque neovascularization.

Contrast-enhanced ultrasonographic findings of serum amyloid A-positive hepatocellular neoplasm: Does hepatocellular adenoma arise in cirrhotic liver?

Hepatocellular adenoma(HCA) was recently classified into four pathological subtypes. There have been few studies describing the findings of contrast-enhanced ultrasonography(CEUS) of each type. Our case concerns a 78-year-old man who had undergone routine medical check-ups for hepatitis C for 11 years. Abdominal ultrasonography showed a 28 mm, hypo-echoic mass in the segment 4 of the liver. His integrating amount of drinking was 670 kg convert into ethanol. CEUS with Sonazoid demonstrated mild uniform hypo-enhancement with inflow of microbubbles from the periphery of the tumor in the arterial phase, and heterogeneously hypo-enhancement in the post vascular phase. Because the mass increased in size within 3 mo, a well differentiated hepatocellular carcinoma was suspected, and hepatic resection was performed. Microscopic findings showed homogeneous cell proliferation with low grade atypia, infiltration of inflammatory cells, ductular reactions, fatty deposit in part, and sinusoidal dilation. Immunohistochemistry revealed geographic positive for serum amyloid A(SAA), focal positive for glutaminesynthetase, diffuse and strong positive for C-reactive protein, and positive for liver-type fatty acid binding protein. These pathological features corresponded to that of an inflammatory HCA. However, we could not make a clear diagnosis, because HCAs were defined as not to arise in cirrhotic liver. Finally, this tumor was diagnosed as a SAA positive hepatocellular neoplasm.

Image of tumor metastasis and inflammatory lymph node enlargement by contrast-enhanced ultrasonography

AIM:To compare the difference between tumorinduced lymph node enlargement and inflammation-induced lymph node enlargement by contrast-enhanced ultrasonography and pathological findings. METHODS:A model of tumor-induced lymph node metastasis was prepared by embedding a VX2 tumor into the hind paws of white rabbits.A model of inflammation-induced enlargement was prepared by injecting a suspension of Escherichia coli into separate hind paws of white rabbits.Then,a solution of SonazoidTM(GE Healthcare,Oslo,Norway)was injected subcutaneously in the proximity of the lesion followed by contrast-enhanced ultrasonography of the enlarged popliteal lymph nodes. RESULTS:In the contrast-enhanced ultrasonography of the tumor-induced metastasis model,the sentinel lymph node was imaged.An area of filling defect was observed in that enlarged lymph node.In the histology examination,the area of filling defect corresponded to the metastatic lesion of the tumor.Contrast-enhanced ultrasonography of the model on inflammation-induced lymph node enlargement,and that of the acute inflam-mation model performed 3-7 d later,revealed dense staining that was comparatively uniform.The pathological findings showed acute lymphadenitis mainly due to infiltration of inflammatory cells.Contrast-enhanced ultrasonography that was performed 28 d post-infection in the acute inflammation model showed speckled staining.Inflammation-induced cell infiltration and fiberization,which are findings of chronic lymphadenitis, were seen in the pathological findings. CONCLUSION:Sentinel lymph node imaging was made possible by subcutaneous injection of SonazoidTM.Contrast-enhanced ultrasonography was suggested to be useful in differentiating tumor-induced enlargement and inflammation-induced enlargement of lymph nodes.

Loco-regional treatment of hepatocellular carcinoma:Role of contrast-enhanced ultrasonography

Hepatocellular carcinoma(HCC)is one of the few cancers for which locoregional treatments(LRTs)are included in international guidelines and are considered as a valid alternative to conventional surgery.According to Barcelona Clinic Liver Cancer classification,percutaneous treatments such as percutaneous ethanol injection,radiofrequency ablation and microwave ablation are the therapy of choice among curative treatments in patients categorized as very early and early stage,while transcatheter arterial chemoembolization is considered the better option for intermediate stage HCC.A precise assessment of treatment efficacy and surveillance is essential to optimize survival rate,whereas residual tumor requires additional treatment.Imaging modalities play a key role in this task.Currently,contrast-enhanced computed tomography/magnetic resonance imaging are considered the standard imaging modalities for this purpose.Contrast enhanced ultrasound(CEUS),using second generation contrast agents,plays an increasingly important role in detecting residual disease after LRTs.CEUS is a straightforward to perform,repeatable and cost-effective imaging modality for patients with renal failure or iodine allergies.Due to the ability to focus on single regions,CEUS can also provide high temporal resolution.Moreover,several studies have reported the same or better diagnostic accuracy as contrast-enhanced computed tomography for assessing tumor vascularity 1 mo after LRTs,and recently three-dimensional(3D)-CEUS has been reported as a promising technique to improve the evaluation of tumor response to therapy.Furthermore,CEUS could be used early after procedures in monitoring HCC treatments,but nowadays this indication is still debated,and data from literature are conflicting,especially after transcatheter arterial chemoembolization procedure.

Impact of the arterial input function on microvascularization parameter measurements using dynamic contrast-enhanced ultrasonography

AIM: To evaluate the sources of variation influencing the microvascularization parameters measured by dynamic contrast-enhanced ultrasonography (DCE-US). METHODS: Firstly, we evaluated, in vitro , the impact of the manual repositioning of the ultrasound probe and the variations in flow rates. Experiments were conducted using a custom-made phantom setup simulating a tumor and its associated arterial input. Secondly, we evaluated, in vivo , the impact of multiple contrast agent injections and of examination day, as well as the influence of the size of region of interest (ROI) associated with the arterial input function (AIF). Experiments were conducted on xenografted B16F10 female nude mice. For all of the experiments, an ultrasound scanner along with a linear transducer was used to perform pulse inversion imaging based on linear raw data throughout the experiments. Semi-quantitative and quantitative analyses were performed using two signal-processing methods. RESULTS:In vitro , no microvascularization parameters, whether semi-quantitative or quantitative, were significantly correlated (P values from 0.059 to 0.860) with the repositioning of the probe. In addition, all semiquantitative microvascularization parameters were correlated with the flow variation while only one quantitative parameter, the tumor blood flow, exhibited P value lower than 0.05 (P = 0.004). In vivo , multiple contrast agent injections had no significant impact (P values from 0.060 to 0.885) on microvascularization parameters. In addition, it was demonstrated that semi-quantitative microvascularization parameters were correlated with the tumor growth while among the quantitative parameters, only the tissue blood flow exhibited P value lower than 0.05 (P = 0.015). Based on these results, it was demonstrated that the ROI size of the AIF had significant influence on microvascularization parameters: in the context of larger arterial ROI (from 1.17 ± 0.6 mm 3 to 3.65 ± 0.3 mm 3 ), tumor blood flow and tumor blood volume were correlated with the tumor growth, exhibiting P values lower than 0.001. CONCLUSION: AIF selection is an essential aspect of the deconvolution process to validate the quantitative DCE-US method.

Diagnostic value of contrast-enhanced ultrasonography in mediastinal leiomyosarcoma mimicking aortic hematoma:A case report and review of literature

BACKGROUND Primary mediastinal leiomyosarcomas are extremely rare.We report a case of leiomyosarcoma around the thoracic and abdominal aorta,mimicking an aortic hematoma,and discuss the diagnostic value of ultrasound.CASE SUMMARY A 63-year-old female was hospitalized for abdominal pain.Initial computed tomography angiography revealed an enhanced mass around the lower thoracic and upper abdominal aorta.Aortic hematoma was strongly suspected,and stents were placed by interventional surgery.About 1 mo postoperatively,the patient was re-hospitalized because of progressive abdominal pain.Ultrasound showed that the mass had a heterogeneous echo.In contrast-enhanced ultrasound,the hyperechoic regions were filled with contrast medium after the aortic region was,indicating that the blood supply was abundant but had no direct connection with the aorta.There was no obvious contrast medium-filling in the hypoechoic area.These findings were similar to those of malignant tumors with liquefaction and necrosis.Positron emission tomography/computed tomography confirmed that the mass had a high metabolic signal similar to that of a malignant tumor.Leiomyosarcoma was confirmed by postoperative pathology.CONCLUSION Symptoms of mediastinal leiomyosarcoma surrounding the aorta may mimic aortic hematoma.Contrast-enhanced ultrasound can provide valuable and unique diagnostic clues.

Focal liver lesions in cirrhosis:Role of contrast-enhanced ultrasonography

Contrast-enhanced ultrasound(CEUS)represents a great innovation for the evaluation of focal liver lesions(FLLs).The main advantage of CEUS is the realtime imaging examination and the very low toxicity in patients with renal failure.Liver cirrhosis has been recognized as a major risk factor for the onset of hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(ICC).HCC in liver cirrhosis develops as the last step of a complex that leads to the gradual transformation from regenerative nodule through dysplastic nodule to HCC.In patients with liver cirrhosis,a surveillance program is recommended consisting of ultrasound(US)for detecting small focal lesions.A wide spectrum of benign and malignant lesions other than HCC may be found in the cirrhotic liver and their differentiation is important to avoid errors in staging diseases that may preclude potentially curative therapies.Several published studies have explored the value of CEUS in liver cirrhosis and they have been shown to have excellent diagnostic and prognostic performances for the evaluation of non-invasive and efficient diagnosis of FLLs in patients at high risk for liver malignancies.The purpose of this article is to describe and discuss CEUS imaging findings of FLLs including HCC and ICC,all of which occur in cirrhotic livers with varying prevalence.

Correlation of contrast-enhanced ultrasonography parameters of ovarian cancer with angiogenesis and cancer cell growth

Objective:To study the correlation of contrast-enhanced ultrasonography parameters of ovarian cancer with angiogenesis and cancer cell growth.Methods:Patients with ovarian tumor who underwent surgical resection in the Second People's Hospital of Liangshan Yi Autonomous Prefecture between February 2015 and June 2017 were selected as the research subjects and divided into the ovarian cancer group with ovarian cancer and the control group with benign tumor according to the postoperative pathological results of tumor. Contrast-enhanced ultrasonography was performed before operation to determine the time to peak TTP and enhanced intensity EI;the tumor lesion was collected after operation to determine the protein levels of angiogenesis molecules, cell proliferation molecules and cell invasion molecules.Results: The EI of ovarian cancer lesion tissue of ovarian cancer group was significantly higher than that of benign tumor lesion tissue of control group whereas the TTP was significantly lower than that of benign tumor lesion tissue of control group;VEGFR1, Tie-2, CGB5, NFATc1, CyclinD1, FUNDC1, IGFBP2, IGFBP3 and ZEB1 protein levels in ovarian cancer lesion tissue were significantly higher than those in benign tumor lesion tissue, positively correlated with EI level and negatively correlated with TTP level;TNFSF15, Fibulin-5, ELF5, p27Kip1, p21, FN14 and E-cadherin protein levels were significantly lower than those in benign tumor lesion tissue, negatively correlated with EI level and positively correlated with TTP level.Conclusion:The contrast-enhanced ultrasonography parameters of ovarian cancer can reflect the degree of angiogenesis and the viability of the invasive growth of cancer cells within lesions.

Correlation of contrast-enhanced ultrasonography parameters of thyroid cancer with the expression of proliferation, invasion and autophagy genes in the lesions

Objective: To explore the correlation of contrast-enhanced ultrasonography parameters of thyroid cancer with the expression of proliferation, invasion and autophagy genes in the lesions. Methods: A total of 218 patients who underwent thyroid nodule resection in this hospital between December 2014 and January 2017 were collected and divided into the thyroid adenoma group (n=129) and the thyroid cancer group (n=89) according to the pathological results. The preoperative CEUS parameter levels of thyroid cancer were reviewed, and the expression levels of proliferation, invasion and autophagy genes in tumor tissues were compared between the two groups. Pearson test was used to evaluate the correlation between the CEUS parameter levels of cancerous thyroid nodule and the malignant biological behaviors of cancer cells. Results: PI, TTP and MTT levels in thyroid cancer group were lower than those in thyroid adenoma group;PDCD4 and PP4R1 mRNA expression in tumor tissues of thyroid cancer group were lower than those of thyroid adenoma group whereas TPX2 and Twist1 mRNA expression were higher than those of thyroid adenoma group;ADAM9, BCORL1 and CXCR4 mRNA expression in tumor tissues of thyroid cancer group were higher than those of thyroid adenoma group whereas Notch-1 and ST7L mRNA expression were lower than those of thyroid adenoma group;Beclin1, LC3 and PTEN mRNA expression in tumor tissues of thyroid cancer group were significantly lower than those of thyroid adenoma group. Pearson test showed that the contrast-enhanced ultrasonography parameters of thyroid cancer were directly correlated with the expression of proliferation, invasion and autophagy genes. Conclusion: Contrast-enhanced ultrasonography can be used to identify benign and malignant thyroid nodules, and the specific CEUS parameter levels can reflect the tumor malignancy.

Correlation of contrast-enhanced ultrasonography time-intensity curve parameters of bladder cancer with the invasive growth of cancer cells and the angiogenesis in the lesion

Objective:To study the correlation of contrast-enhanced ultrasonography time-intensity curve parameters of bladder cancer with the invasive growth of cancer cells and the angiogenesis in the lesion.Methods: Patients with bladder cancer who underwent surgical resection in Ezhou Central Hospital between March 2015 and April 2017 were selected as the research subjects, they received preoperative contrast-enhanced ultrasonography, the time-intensity curve was drawn, and the parameters AT, PT, WT and PI of bladder cancer tissue and adjacent tissue were calculated;after surgery, the bladder cancer tissue and adjacent tissue were collected to measure the expression of proliferation, invasion and angiogenesis molecules.Results: AT, PT and WT levels in bladder cancer tissue were significantly lower than those in adjacent tissue whereas PI level as well as Rce1, YAP,β-catenin, c-myc, CUGBP1, Annexin-II, uPA, CXCL10, CXCR3, ILK, VEGF, COX2, HIF-1 and NAC1 mRNA expression was significantly higher than those in adjacent tissue;Rce1, YAP,β-catenin, c-myc, CUGBP1, Annexin-II, uPA, CXCL10, CXCR3, ILK, VEGF, COX2, HIF-1 and NAC1 mRNA expression in bladder cancer tissue were negatively correlated with the AT, PT and WT levels, and were positively correlated with the PI level.Conclusion: The change of the contrast-enhanced ultrasonography time-intensity curve parameters of bladder cancer is valuable for evaluating the invasive growth of cancer cells and the angiogenesis in the lesion.