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.

Role of ultrasonography and contrast-enhanced ultrasonography in a case of Krukenberg tumor

We report a case of Krukenberg tumor of gastric origin with adnexal metastasis,in which ultrasonography(US) and contrast-enhanced US(CEUS) played a key diagnostic role.An 64-year-old female patient was referred to our department for abdominal pain,nausea and ascites.US examination was performed as first line diagnostic imaging approach,confirming the presence of ascites and detecting marked thickness of the gastric wall and a right adnexal mass.CEUS was immediately performed and showed arterial enhancement followed by wash-out in the venous phase of both the gastric wall and the adnexal mass,suggesting the diagnosis of gastric cancer with right adnexal metastasis(Krukenberg syndrome).The patient underwent USguided paracentesis and esophagogastroduodenoscopy that showed linitis plastica.Cytologic examination of the peritoneal fluid revealed the presence of signetring cells,and histologic examination of the specimen obtained by endoscopic biopsy showed primary gastric mucus-producing adenocarcinoma with signetring cells.Although transvaginal US is undoubtedly the method of choice to evaluate ovarian tumors,abdominal US and CEUS can provide key diagnostic elements,supporting clinicians in the first steps of the diagnostic work-up of abdominal and pelvic masses.

Arterial-phase contrast-enhanced ultrasonography for evaluating anti-angiogenesis treatment: A pilot study

AIM:To verify whether arterial-phase contrast-enhanced ultrasonography(CEUS) of tumor parenchymal tissue is useful for evaluation of anti-angiogenesis agents.METHODS:Rabbits with liver tumor were subjected to CEUS,and images of the nodular maximal diameter in vascular phase were recorded.Image analysis was performed to plot the time intensity curve(TIC) at the tumor parenchyma,which set the diameter of the region of interest of intensity measurement.The TIC was calculated to obtain the time to peak intensity(TPI) and the magnitude of PI.Rabbits were randomly assigned to a treatment group with sorafenib and a control group.Two weeks later,the same ultrasound examination was repeated followed by pathological testing to assess the effect of sorafenib on the liver tumor.RESULTS:In four rabbits in the treatment group,the rate of change of tumor size was decreased comparedwith that of the control(the rate 2.3 vs 7.9,P = 0.02).The TPI of the treatment group elongated significantly(the rate 3.1 vs 1.1,P = 0.07 for SonoVue,2.0 vs 0.88,P = 0.09 for Sonazoid).The magnitude of PI showed no significant changes.In pathological examination,capillary diameters in the treatment group were significantly smaller than those in the control group(26.4 vs 42.8 μm,P = 0.013).CONCLUSION:Analysis of the TIC in the arterial phase of tumor tissue could evaluate the efficacy of antiangiogenesis drug treatment in liver tumor.

Establishment of Rabbit Liver VX2 Tumor Model Using Percutaneous Puncture Inoculation of Tumor Fragment Guided and Evaluated by Ultrasonography

The aim of the present study is to evaluate a method of establishing model of rabbit liver VX2 tumor using percutaneous puncture inoculation of tumor fragment guided by ultrasonography.VX2 tumor fragments were implanted into the liver of 13 New Zealand white rabbits flushed by 1 mL normal saline through percutaneous puncture needle guided by ultrasonography.Conventional ultrasonography and contrast-enhanced ultrasonography(CEUS)were performed 14 days after inoculation,and then the rabbits were sacrificed and pathologically examined.The success rate of inoculation was 100%.The average size of liver VX2 tumor was 1.7 cm×1.3 cm,CEUS of VX2 liver tumors showed the"rapid wash-in and wash-out"vascular pattern.There were significant differences between VX2 tumors and liver parenchyma in quantitative parameters of A,k and A×k(P<0.05),which meant that VX2 liver tumors were characterized by more blood flow volume and faster blood velocity than liver parenchyma.Tumor fragment flushed by normal saline into the liver through a needle may be a promising method for the induction of a hepatic tumor.And CEUS can be used for accurately assessing angiogenesis and blood perfusion of VX2 tumors.

Correlation between dynamic contrast-enhanced MRI and histopathology in the measurement of tumor and breast volume and their ratio in breast cancer patients： a prospective study

Background Earlier studies have examined the association between the diameter of primary tumors measured by magnetic resonance imaging （MRI） and histopathology in breast cancer patients. However, the diameter does not completely describe the dimensions of the breast tumor or its volumetric proportion relative to the whole breast. The association between breast tumor volume/breast volume ratios measured by these two techniques has not been reported.

Double contrast-enhanced ultrasonography of a small intestinal neuroendocrine tumor:a case report of a recommendable imaging modality

A 57-year-old male presenting with spontaneously relieved abdominal cramp and distension was admitted to theWest China Hospital.The diagnosis remained unclear after colonoscopy and computed tomography.Double contrast-enhanced ultrasonography was then performed and a neoplasm in the small intestine was suspected,supported by a thin-section computed tomography and positron emission tomography/computed tomography.This was confirmed pathologically after surgery to be a small intestinal G1 neuroendocrine tumor.Surgery was performed to remove approximately 25 cm of small bowel and a 3-cm solid mass located in the mesentery.The patient had a complete recovery and was tumor-free at the final follow-up.Small intestinal tumors including neuroendocrine tumors have always posed a diagnostic challenge.This case indicated that double contrastenhanced ultrasonography is feasible in detection of small intestinal neuroendocrine tumors,and it may be an advisable approach assisting diagnosis of small intestinal tumors.

Rate of local tumor progression following radiofrequency ablation of pathologically early hepatocellular carcinoma

AIM To evaluate whether pathologically early hepatocellular carcinoma(HCC) exhibited local tumor progression after radiofrequency ablation(RFA) less often than typical HCC.METHODS Fifty pathologically early HCCs [tumor diameter(mm): mean, 15.8; range, 10-23; follow-up days after RFA: median, 1213; range, 216-2137] and 187 typical HCCs [tumor diameter(mm): mean, 15.6; range, 6-30; follow-up days after RFA: median, 1116; range, 190-2328] were enrolled in this retrospective study. The presence of stromal invasion(namely, tumor cell invasion into the intratumoral portal tracts) was considered to be the most important pathologic finding for the diagnosis of early HCCs. Typical HCC was defined as the presence of a hyper-vascular lesion accompanied by delayed washout using contrastenhanced computed tomography or contrast-enhanced magnetic resonance imaging. Follow-up examinations were performed at 3-mo intervals to monitor for signs of local tumor progression. The local tumor progression rates of pathologically early HCCs and typical HCCs were then determined using the Kaplan-Meier method.RESULTS During the follow-up period for the 50 pathologically early HCCs, 49(98%) of the nodules did not exhibit local tumor progression. However, 1 nodule(2%) was associated with a local tumor progression found 636 d after RFA. For the 187 typical HCCs, 46(24.6%) of the nodules exhibited local recurrence after RFA. The follow-up period until the local tumor progression of typical HCC was a median of 605 d, ranging from 181 to 1741 d. Among the cases with typical HCCs, local tumor progression had occurred in 7.0%(7/187), 16.0%(30/187), 21.9%(41/187) and 24.6%(46/187) of the cases at 1, 2, 3 and 4 years, respectively. Pathologically early HCC was statistically associated with a lower rate of local tumor progression, compared with typical HCC, when evaluated using a log-rank test(P = 0.002). CONCLUSION The rate of local tumor progression for pathologically early HCCs after RFA was significantly lower than that for typical HCCs.

Mediastinal Tuberculoma Mimicking Malignant Cardiac Tumor:A Case Report

Background:The clinical manifestations of cardiac masses are diverse and lack specifi city.Here we report a cardiac mass detected by transthoracic echocardiography.Multimodality imaging and pathological fi ndings after the operation confi rmed the mass as mediastinal tuberculoma.Case presentation:A 45-year-old male patient was admitted to our hospital reporting chest tightness,weight loss,and dyspnea for 3 months after exercise.Transthoracic echocardiography showed that there were a large number of pericardial effusions and a soft tissue mass measuring 7.7 cm×4.5 cm in the upper mediastinum,which oppressed the right pulmonary artery and accelerated the blood fl ow of the left pulmonary artery.Contrast-enhanced ultrasonography showed degenerative inhomogeneous high enhancement of and an unclear boundary in the mass.Contrast-enhanced chest CT revealed punctate and patchy calcifi cation in and uneven enhancement of the mass and the lymph nodes around the aortic arch.The mass was diagnosed as a malignant mediastinal tumor.Pathological analysis of the mass revealed chronic granulomatous tuberculosis.The symptoms abated signifi cantly after antituberculosis treatment.The patient remained asymptomatic during follow-up.Conclusion:This report presents a rare case of mediastinal tuberculoma mimicking a malignant cardiac tumor.Multimodality imaging should be incorporated for differentiation of cardiac masses.

Contrast enhanced ultrasound of hepatocellular carcinoma

Sonazoid(Daiichi Sankyo,Tokyo,Japan),a secondgeneration of a lipid-stabilized suspension of a perfluorobutane gas microbubble contrast agent,has been used clinically in patients with liver tumors and for harmonic gray-scale ultrasonography(US)in Japan since January 2007.Sonazoid-enhanced US has two phases of contrast enhancement:vascular and late.In the late phase of Sonazoid-enhanced US,we scanned the whole liver using this modality at a low mechanical index(MI)without destroying the microbubbles, and this method allows detection of small viable hepatocellular carcinoma(HCC)lesions which cannot be detected by conventional US as perfusion defects in the late phase.Re-injection of Sonazoid into an HCC lesion which previously showed a perfusion defect in the late phase is useful for confirming blood flow intothe defects.High MI intermittent imaging at 2 frames per second in the late phase is also helpful in differentiation between necrosis and viable hypervascular HCC lesions.Sonazoid-enhanced US by the coded harmonic angio mode at a high MI not only allows clear observation of tumor vessels and tumor enhancement, but also permits automatic scanning with Sonazoidenhanced three dimensional(3D)US.Fusion images combining US with contrast-enhanced CT or contrastenhanced MRI have made it easy to detect typical or atypical HCC lesions.By these methods,Sonazoidenhanced US can characterize liver tumors,grade HCC lesions histologically,recognize HCC dedifferentiation, evaluate the efficacy of ablation therapy or transcatheter arterial embolization,and guide ablation therapy for unresectable HCC.This article reviews the current developments and applications of Sonazoid-enhanced US and Sonazoid-enhanced 3D US for diagnosing and treating hepatic lesions,especially HCC.

超声造影与增强MRI在眼眶肿瘤病中的诊断价值

目的:比较超声造影(CEUS)与增强磁共振扫描两种检查方法在眼眶肿瘤中的诊断价值,并探讨两者增强模式对眼眶肿瘤良恶性鉴别诊断的价值。方法:选取我院眼科2011-2013年62例眼眶占位患者均行超声造影和MRI增强检查并分别做出诊断。以病理诊断为标准,计算两种检查方法在眼眶肿瘤中的诊断符合率、敏感性及特异率;然后依照病理结果将62例患者分为良恶性两组,比较两种检查方法增强强度在眼眶肿瘤良恶性组别中表达的差异性,分析增强模式的不同对良恶性鉴别的价值;应用Sonoliver软件分析所有62例眼科超声造影的病例,处理得到肿瘤造影时间-强度曲线(TIC),获取造影剂达到时间(AT)、上升时间(RT)、达峰时间(TTP)、平均渡越时间(mTT)、半洗出时间进行定量分析;应用卡方检验及非参检验,P<0.05为差异有统计学意义。结果:1在对62列眼眶肿瘤的患者诊断中,CEUS与增强MRI的诊断符合率无差异,分别为82.3%和80.6%;敏感性分别为64.7%与70.2%,特异度分别为88.9%与84.4%,两者差异有统计学意义(P<0.05)。2在增强强度的比较中,CEUS增强强度在良恶性组别中分布存在不同(P<0.05);MRI增强强度在良恶性组别中分布无明显差异。3根据TIC获取的参数中:AT、RT、TTP、半洗出时间等参数在良恶性肿瘤分组中存在差异(P<0.05);而mTT在两者之间无明显差异。结论:超声造影在眼眶肿瘤的诊断符合率与MRI的表现无明显差异,而敏感性低于增强MRI,特异度高于增强MRI;超声造影的增强强度及造影时间-强度曲线在良恶性分组中存在明显差异,有利于进一步鉴别眼眶肿瘤的良恶性。在无法行增强MRI检查的病例中,超声造影作为一种补充检查方法有一定的临床价值。