The efficacy of contrast enhanced ultrasound, compared to arteriography and computed tomography in the detection of endoleak type 2

Introduzione Gli endoleak di tipo 2 persistenti (ELIIp) possono presentarsi in più del 10% dei pazienti sottoposti a riparazione endovascolare degli aneurismi dell’aorta addominale (EVAR) potendo portare alla progressione e rottura dell’aneurisma. L’embolizzazione intraoperatoria della sacca aneurismatica residua in pazienti selezionati ad alto rischio di sviluppo degli ELIIp può risultare efficace nel ridurre la loro incidenza; tuttavia il follow up di questi pazienti può essere inficiato dalla presenza degli artefatti causati dai materiali utilizzati. Lo scopo del nostro studio è stato quello di analizzare l’ecografia con mezzo di contrasto (CEUS) e paragonarla alla TC con mezzo di ontrasto (angioTC) ed al color-Doppler (ECD) nella diagnosi degli ELIIp. Metodi Fra il 2012 ed il 2013 i pazienti sottoposti ad EVAR con caratteristiche morfologiche preoperatorie a rischio di sviluppo di ELIIp [pervietà di più di sei efferent patent vessels (EPV) e/o VR (thrombus volume ratio) inferiore al 40% individuati in TC] sono stati sottoposti alla procedura aggiuntiva di embolizzazione mediante spirali metalliche della sacca aneurismatica residua; sono quindi stati sottoposti a 12 mesi ad ecografia color-Doppler (ECD) e con mdc (CEUS) ed angioTC(CTA). Risultati La concordanza fra CEUS ed ECD è risultata moderata, (k ═ 0.475, p < 0.030), confermata dal Mc Nemar test p ═ 1.000; quella fra CEUS e CTA è risultata ottima, (k ═ 0.893, p < 0.001), Mc Nemar test p ═ 1.000. L’ analisi delle caratteristiche emodinamiche degli endoleak (sia di inflow che outflow) non ha dimostrato la presenza di un impatto significativo della cinetica dei leak sulla sensibilità dell’angioTC (p ═ 0.127, p ═ 1.000, rispettivamente). Conclusioni La CEUS nei pazienti sottoposti ad embolizzazione della sacca aneurismatica residua è risultata più sensibile dell’ECD e dell’angioTC nella diagnosi di endoleaks di tipo II, e non presenta difficoltà correlate con gli artefatti causati dalle spirali metalliche.Introduction Persistent type II endoleaks (ELIIp) may occur in up to 10% of patients underwent endovascular aneurysm repair (EVAR) and may lead to aneurysm progression and rupture. Intraoperative abdominal aortic aneurysm repair (AAA)- sac embolization in selected high-risk patients can be effective to reduce their incidence; however the follow up of these patients can be compromised by the artefacts of embolisation materials. Aim of our study was compare contrast enhanced ultrasound (CEUS) with computer tomography angiography (CTA) and color-Doppler ultrasound (CDU) in the detection of ELIIp. Methods Between 2012 and 2013 all patients with morphological features with high risk for ELIIp [more than six efferent patent vessels -EPV- and/ or VR (thrombus volume ratio) inferior to 40% analysed in CTA], underwent EVAR with adjunctive intra-procedural AAA-sac coil embolization; they have been evaluated at 12 months with Color-Doppler Ultrasound, Contrast Enhanced Ultrasound (CEUS) and Computer Tomography Angiography (CTA). Results Moderate concordance was found between CEUS and CDU (k ═ 0.475, p < 0.030), confirmed by Mc Nemar test p ═ 1.000; whereas optimal concordance between CEUS and CTA was detected, Mc Nemar test p ═ 1.000. Analysis of haemodynamical features (both inflow and outflow) doesn’t show a significant impact of leaks’kinetic on CTA sensitivity (p ═ 0.127, p ═ 1.000 respectively). Conclusions CEUS in patients that underwent sac-embolization during EVAR showed more sensitivity than CDU and CTA on the detection of ELIIp, and is not affected by artefacts of coils

Comments and illustrations of the WFUMB CEUS liver guidelines: Rare benign focal liver lesion, part I.

Improved detection and characterization of common focal liver lesions (FLL) are the main topics of the World Federation for Ultrasound in Medicine and Biology (WFUMB) guidelines on the use of contrast-enhanced ultrasound (CEUS). On stateof-the-art CEUS imaging, to create a library of rare FLL, especially concerning their atypical imaging characteristics, might be helpful for improving clinical diagnostic efficiency. In this review, we aim to summarize the ultrasound and CEUS features of rare benign FLL. Currently there are limited reports and images published

Comments and illustrations of the WFUMB CEUS liver guidelines: Rare benign focal liver lesion, part II.

It is important to be familiar with the typical imaging features of the uncommon or even extremely rare focal liver lesions (FLL). Current guidelines of the World Federation for Ultrasound in Medicine and Biology (WFUMB) is aimed at assessing the usefulness of contrast enhanced ultrasound (CEUS) in the management of various FLL. In this review, we aim to summarize the ultrasound and CEUS characteristics with literature review of some extremely rare benign FLL, which might be helpful for improving diagnostic efficiency clinically

Contrast enhanced ultrasound of sentinel lymph nodes

Sentinel lymph nodes are the first lymph nodes in the region that receive lymphatic drainage from a primary tumor. The detection or exclusion of sentinel lymph node micrometastases is critical in the staging of cancer, especially breast cancer and melanoma because it directly affects patient’s prognosis and surgical management. Currently, intraoperative sentinel lymph node biopsies using blue dye and radioisotopes are the method of choice for the detection of sentinel lymph node with high identification rate. In contrast, conventional ultrasound is not capable of detecting sentinel lymph nodes in most cases. Contrast enhanced ultrasound with contrast specific imaging modes has been used for the evaluation and diagnostic work-up of peripherally located suspected lymphadenopathy. The method allows for real-time analysis of all vascular phases and the visualization of intranodal focal “avascular” areas that represent necrosis or deposits of neoplastic cells. In recent years, a number of animal and human studies showed that contrast enhanced ultrasound can be also used for the detection of sentinel lymph node, and may become a potential application in clinical routine. Several contrast agents have been used in those studies, including albumin solution, hydroxyethylated starch, SonoVue®, Sonazoid® and Definity®. This review summarizes the current knowledge about the use of ultrasound techniques in detection and evaluation of sentinel lymph node.Węzły wartownicze są pierwszymi węzłami chłonnymi na drodze spływu chłonki z okolicy guza pierwotnego. Wykluczenie lub potwierdzenie mikroprzerzutów w węźle wartowniczym odgrywa istotną rolę w ustalaniu stanu zaawansowania nowotworu, szczególnie nowotworu piersi i czerniaka, ponieważ bezpośrednio wpływa na rokowanie i wybór metody chirurgicznego leczenia. Obecnie śródoperacyjna biopsja węzłów wartowniczych z użyciem niebieskiego barwnika oraz radioizotopów są metodami z wyboru umożliwiającymi zidentyfikowanie węzłów wartowniczych. W przeciwieństwie do biopsji standardowe badanie ultrasonograficzne z reguły nie pozwala na ich uwidocznienie. Dzięki badaniu ultrasonograficznemu z użyciem środka kontrastującego oraz opcji obrazowania właściwych dla ultrasonografii ze środkami kontrastującymi można zdiagnozować położone obwodowo nieprawidłowe węzły chłonne. Metoda ta umożliwia ocenę węzłów w czasie rzeczywistym w każdej fazie naczyniowej, a także na uwidocznienie wewnątrzwęzłowych ogniskowych obszarów „nieunaczynionych”, które reprezentują obszary martwicy lub skupiska komórek nowotworowych. W ostatnich latach w wielu badaniach przeprowadzanych na zwierzętach i u ludzi wykazano, że badanie ultrasonograficzne z użyciem środka kontrastującego może uwidocznić węzeł wartowniczy i stać się rutynowym badaniem diagnostycznym. W badaniach tych zastosowano kilka środków kontrastujących, takich jak roztwór albuminy, skrobia hydroksyetylowana oraz SonoVue®, Sonazoid® i Definity®. Niniejsza praca stanowi podsumowanie obecnej wiedzy dotyczącej zastosowania ultrasonografii w diagnostyce węzłów chłonnych wartowniczych

Comments and illustrations of the WFUMB CEUS liver guidelines: rare congenital vascular pathology.

In this overview of vascular changes of the liver, variations in the liver vessels are discussed, in addition to congenital malformations such as Abernethy malformation, patent ductus venosus Arantii and hereditary hemorrhagic telangiectasia (OslerWeber-Rendu disease). Particular attention is paid to focal liver lesions, especially focal nodular hyperplasia (FNH), but also other solid tumours that develop as a result of altered liver vascularisation. The article focuses on the ultrasonic appearances and changes of the liver, depicted in B-mode sonography, Doppler studies and in contrast-enhanced ultrasonography (CEUS). The clinical manifestations of these conditions associated with other organ systems are also highlighted

Point quantification elastography in the evaluation of liver elasticity in healthy volunteers: a reliability study based on operator expertise

Purpose: The assessment of liver fibrosis is essential in the management of patients with chronic liver diseases. Liver biopsy is considered the gold standard procedure for this purpose, though the recent development of new elastosonographic techniques to measure liver stiffness (LS) noninvasively is promising. Point quantification elastography (PQE) showed good results but less is known about the level of skill needed to obtain reliable results. The aim of the study was to evaluate the reproducibility of PQE in assessing LS in healthy subjects comparing three operators with different expertise. Methods: Between December 2012 and April 2013, 50 consecutive healthy volunteers (18 males, 32 females), median age 30\ua0years (range 25\u201366) and BMI 22.4 (range 16.7\u201333.6) were submitted to PQE (iU22 Philips, Bothell, WA, USA) by three operators: two US and elastography providers (one expert and one with intermediate skill) and a skilled transient elastography (Fibroscan) operator with no expertise in US. Intra- and inter-observer agreements were assessed by intraclass correlation coefficient (ICC). Results: PQE measurement was obtained in all subjects by all evaluators. No significant differences of mean liver stiffness were found among operators (P = 0.980). Intra-observer agreement was excellent 0.918 (0.941 for expert, 0.917 for intermediate and 0.888 for novice). The ICC of the inter-observer agreement among the three ratters was excellent (0.882) and was higher in normal than overweight patients (0.923 vs. 0.603; P = 0.011). Conclusion: PQE is a reliable and reproducible non-invasive method for the assessment of LE, and can be performed also by a non-experienced operator

Infectious Pneumonia and Lung Ultrasound: A Review

The application of thoracic ultrasound examination has not long been developed because ultrasound’s interaction with the lung does not generate an anatomical image but an artifactual one. Subsequently, the evaluation of pulmonary artifacts and their correlation to specific diseases allowed the development of ultrasound semantics. Currently, pneumonia still represents one of the main causes of hospitalization and mortality. Several studies in the literature have demonstrated the ultrasound features of pneumonia. Although ultrasound cannot be considered the diagnostic gold standard for the study of all lung diseases, it has experienced an extraordinary development and growth of interest due to the SARS-CoV-2 pandemic. This review aims to provide essential information on the application of lung ultrasound to the study of infectious pneumonia and to discuss the differential diagnosis

Utility of Doppler-Ultrasound and Liver Elastography in the Evaluation of Patients with Suspected Pregnancy-Related Liver Disease

Grayscale abdomen ultrasound (US) is routinely performed in pregnant women with suspected pregnancy-related liver dysfunction, but its diagnostic yield is very low. We aimed to investigate the association between Doppler-US findings, liver stiffness measurement (LSM) and different causes of pregnancy-related liver dysfunction. This is a prospective cohort study of pregnant women referred to our tertiary center for any suspected gastrointestinal disease between 2017 and 2019 and undergoing Doppler-US and liver elastography. Patients with previous liver disease were excluded from the analysis. For group comparisons of categorical and continuous variables, the chi-square test or Mann–Whitney test, and the McNemar test were used, as appropriate. A total of 112 patients were included in the final analysis, of whom 41 (36.6%) presented with suspected liver disease: 23 intrahepatic cholestasis of pregnancy (ICP), six with gestational hypertensive disorders and 12 cases with undetermined causes of elevated liver enzymes. Values of LSM were higher and significantly associated with a diagnosis of gestational hypertensive disorder (AUROC = 0.815). No significant differences at Doppler-US or LSM were found between ICP patients and controls. Patients with undetermined causes of hypertransaminasemia showed higher hepatic and splenic resistive indexes than controls, suggesting splanchnic congestion. The evaluation of Doppler-US and liver elastography is clinically useful in patients with suspected liver dysfunction during pregnancy. Liver stiffness represents a promising non-invasive tool for the assessment of patients with gestational hypertensive disorders

Spontaneous Evolution of COVID-19 Lung Sequelae: Results from a Double-Step Follow-Up

none12noBackground: Few studies have reported a double-step follow-up of patients after hospitalization for COVID-19. Objectives: We designed an observational double-step follow-up study with a clinical, functional, and radiological evaluation at 2 and 6 months after COVID-19. The primary outcome was to describe symptoms, spirometry, and 6-minute walking test (6MWT) at 2 and 6 months. Secondary outcomes were to identify if the lowest PaO2/FiO2 during hospitalization is related with functional and radiological evolution and to assess the correlation between radiological and functional abnormalities at 6 months. Methods: Symptoms, spirometry, and 6MWT were assessed at 2 and 6 months; arterial blood gas, chest x-ray, and lung ultrasound were performed at 2 months; body plethysmography, diffusing capacity for carbon monoxide (DLCO), and CT scan were performed at 6 months. Results: Sixty-four per cent and 42% of patients reported at least one symptom at 2 and 6 months, respectively. The most common 6-month functional alteration was DLCO impairment (57% of patients). An improvement of FEV1, FVC, and 6MWT was observed between 2 and 6 months (p &lt; 0.001). Patients with PaO2/FiO2 &lt;200 during hospitalization performed worse at 6MWT at 2 and 6 months (p &lt; 0.05) and reported more extended radiological abnormalities at 6 months (p &lt; 0.001) compared with patients with PaO2/FiO2&gt;200. At 6 months, more extended radiological abnormalities were related with worse 6MWT, DLCO, and total lung capacity (p &lt; 0.05). Discussion: DLCO and 6MWT impairment seem to be the functional hallmark of COVID-19 and are related with the severity of acute pneumonia. At 6 months, radiological abnormalities were related to functional impairment.mixedFerioli, Martina; Prediletto, Irene; Bensai, Serena; Betti, Sara; Daniele, Federico; Di Scioscio, Valerio; Modolon, Cecilia; Rimondi, Maria Rita; De Molo, Chiara; Serra, Carla; Nava, Stefano; Fasano, LucaFerioli, Martina; Prediletto, Irene; Bensai, Serena; Betti, Sara; Daniele, Federico; Di Scioscio, Valerio; Modolon, Cecilia; Rimondi, Maria Rita; De Molo, Chiara; Serra, Carla; Nava, Stefano; Fasano, Luc