A Comparison of the Sensitivity of Contrast-Specific Imaging Modes on Clinical and Preclinical Ultrasound Scanners

Ultrasonic contrast agents are used routinely to aid clinical diagnosis. All premium- and mid-range scanners utilise contrast-specific imaging techniques to preferentially isolate and display the nonlinear signals generated from the microbubbles when insonated with a series of ultrasound pulses. In this manuscript the abilities of four premium ultrasound scanners to detect and display the ultrasound signal from two commercially available contrast agents—SonoVue and DEFINITY®—are compared. A flow phantom was built using tubes with internal diameters of 1.6 mm and 3.2 mm, suspended at depths of 1, 5 and 8 cm and embedded in tissue-mimicking material. Dilute solutions of SonoVue and DEFINITY® were pumped through the phantom at 0.25 mL/s and 1.5 mL/s. Four transducers were used to scan the tubes—a GE Logiq E9 (C2-9) curvilinear probe, a Philips iU22 L9-3 linear array probe, an Esaote MyLab Twice linear array LA523 (4–13 MHz) and a Fujifilm VisualSonics Vevo3100 MX250 (15–30 MHz) linear array probe. We defined a new parameter to compare the ability of the ultrasound scanners to display the contrast enhancement. This was defined as the ratio of grey-scale intensity ratio in contrast-specific imaging mode relative to the B-mode intensity from the same region-of-interest within the corresponding B-mode image. The study demonstrated that the flow rates used in this study had no effect on the contrast-specific imaging mode to B-mode (CSIM-BM) ratio for the three clinical scanners studied, with SonoVue demonstrating broadly similar CSIM-BM ratios across all 3 clinical scanners. DEFINITY® also displayed similar results to SonoVue except when insonated with the Esaote MyLab Twice LA523 transducer, where it demonstrated significantly higher CSIM-BM ratios at superficial depths

Differentiation of Inflammatory from Fibrotic Ileal Strictures Among Patients with Crohn’s Disease through Analysis of Time-intensity Curves Obtained after Microbubble Contrast Agent Injection

The aim was to assess whether the analysis of time-intensity curves obtained after microbubble contrast agent injection could differentiate inflammatory from fibrotic ileal strictures among patients with Crohn\u2019s disease (CD). Sixty-five consecutive patients (40 male and 25 female; mean age \ub1 SD, 42.2 years \ub1 12.22) with stricture of the terminal ileal loop from CD were scanned after microbubble injection. Time-intensity curves were obtained from quantitative analysis and peak enhancement, rise time, time to peak, area under the time-intensity curve (AUC), AUC during wash-in (AUCWI), and AUC during wash-out (AUCWO) were compared between patients with inflammatory vs patients with fibrotic strictures. Inflammatory (n=40) vs fibrotic strictures (n=25) differed (P<.05) in the peak enhancement, the wash-in rate, the wash-in perfusion index, AUC, AUCWI, AUCWO. The quantitative analysis of small bowel wall contrast enhancement after microbubble contrast agent injection may differentiate inflammatory from fibrotic ileal strictures in patients with CD

Imaging characteristics of pleural tumours

Malignant mesothelioma is doubtless the more known pleural tumour. However, according to the morphology code of the International Classification of Diseases for Oncology (ICDO), there are several histological types of pleural neoplasms, divided into mesothelial, mesenchymal and lymphoproliferative tumours, that may be misdiagnosed. In this paper we summarise and illustrate the incidence aspects and the clinical, pathological and radiological features of these neoplasms

Time-intensity curves obtained after microbubble injection can be used to differentiate responders from nonresponders among patients with clinically active Crohn disease after 6 weeks of pharmacologic treatment

Purpose: To assess whether contrast material-enhanced ultrasonography (US) can be used to differentiate responders from nonresponders among patients with clinically active Crohn disease after\ub1weeks of pharmacologic treatment. Materials and Methods: This prospective study was approved by our ethics committee, and written informed consent was obtained from all patients. Fifty consecutive patients (26 men and 24 women; mean age, 34.76 years\ub19) with a proved diagnosis of active Crohn disease who were scheduled to begin therapy with biologics (infliximab or adalimumab) were included, with enrollment from June 1, 2013, to June 1, 2015. In each patient, the terminal ileal loop was imaged with contrast-enhanced US before the beginning and at the end of week\ub1of pharmacologic treatment. Time-intensity curves obtained in responders (those with a decrease in the Crohn disease endoscopic index of severity score of 25-44 before treatment to 10-15 after treatment, an inflammatory score ,7, and/or a decrease 6570 in the Crohn disease activity index score compared with baseline) and nonresponders were compared with Mann-Whitney test. Results: Responders (n = 31) and nonresponders (n = 19) differed (P , .05) in the percent change of peak enhancement (240.78\ub162.85 vs 53.21\ub172.5; P = .0001), wash-in (234.8\ub167.72 vs 89.44\ub1145.32; P = .001) and washout (25.64\ub1130.71 vs 166.83\ub1204.44; P = .002) rate, wash-in perfusion index (242.29\ub159.21 vs 50.96\ub171.13; P = .001), area under the time-intensity curve (AUC; 246.17\ub148.42 vs 41.78\ub187.64; P = .001), AUC during wash-in (243.93\ub154.29 vs 39.79\ub170.85; P = .001), and AUC during washout (249.36\ub147.42 vs 42.65\ub197.09; P = .001). Responders and nonresponders did not differ in the percent change of rise time (5.09\ub149.13 vs 6.24\ub148.06; P = .93) and time to peak enhancement (8.82\ub154.5 vs 10.21\ub143.25; P = .3). Conclusion: Analysis of time-intensity curves obtained after injection of microbubble contrast material\ub1weeks after beginning pharmacologic treatment can be used to differentiate responders from nonresponders among patients with clinically active Crohn disease

Activity-based cost analysis of contrast-enhanced ultrasonography (CEUS) related to the diagnostic impact in focal liver lesion characterisation

Purpose This study was done to assess the clinicaldiagnostic impact and cost of contrast-enhanced ultrasound (CEUS) versus computed tomography (CT) and magnetic resonance (MR) imaging in the characterisation of focal liver lesions. Materials and methods CEUS with sulphur hexafluoridefilled microbubbles (SonoVue bolus 2.4 ml) was performed in 157 patients with 160 focal liver lesions identified by other diagnostic techniques. CEUS images were obtained during the arterial (15 to 35 s from contrast injection), portal venous (40 to 70 s) and late phase (up to 300 s from microbubble injection). Contrast-enhanced CT was performed with a 64- row multidetector CT. MRI was performed before and after administration of the liver-specific contrast agent gadobenate dimeglumine (Gd-BOPTA). A patient-by-patient activitybased cost analysis was performed. Results CEUS led to a change in the diagnostic workup in 131/157 patients (83.4 %) and in the therapeutic workup in 93/157 patients (59.2 %). CEUS allowed for the final diagnosis to be established in 133/157 patients (84.7 %). The full cost of CEUS was lower than that of contrast-enhanced CT and MR imaging. Conclusions CEUS determined a change in the diagnostic and therapeutic workup in the characterisation of focal liver lesions and reduced the full costs of the diagnostic process

Digital Tomosynthesis as a Problem-Solving Technique to Confirm or Exclude Pulmonary Lesions in Hidden Areas of the Chest

Objectives: To evaluate the capability of digital tomosynthesis (DTS) to characterize suspected pulmonary lesions in the so-called hidden areas at chest X-ray (CXR). Materials and Methods: Among 726 patients with suspected pulmonary lesions at CXR who underwent DTS, 353 patients (201 males, 152 females; age 71.5   10.4 years) revealed suspected pulmonary lesions in the apical, hilar, retrocardiac, or paradiaphragmatic lung zones and were retrospectively included. Two readers analyzed CXR and DTS images and provided a confidence score: 1 or 2 = definitely or probably benign pulmonary or extra-pulmonary lesion, or pulmonary pseudo-lesion deserving no further diagnostic work-up; 3 = indeterminate lesion; 4 or 5 = probably or definitely pulmonary lesion deserving further diagnostic work-up by CT. The nature of DTS findings was proven by CT (n = 108) or CXR during follow-up (n = 245). Results: In 62/353 patients the suspected lung lesions were located in the lung apex, in 92/353 in the hilar region, in 59/353 in the retrocardiac region, and in 140/353 in the paradiaphragmatic region. DTS correctly characterized the CXR findings as benign pulmonary or extrapulmonary lesion (score 1 or 2) in 43/62 patients (69%) in the lung apex region, in 56/92 (61%) in the pulmonary hilar region, in 40/59 (67%) in the retrocardiac region, and in 106/140 (76%) in the paradiaphragmatic region, while correctly recommending CT in the remaining cases due to the presence of true solid pulmonary lesion, with the exception of 22 false negative findings (60 false positive findings). DTS showed a significantly (p < 0.05) increased sensitivity, specificity, and overall diagnostic accuracy and area under ROC curve compared to CXR alone. Conclusions: DTS allowed confirmation or exclusion of the presence of true pulmonary lesions in the hidden areas of the chest

Radiological imaging of the kidney (2nd edition)

This book, now in its second edition, provides a comprehensive analysis of imaging of the kidneys, upper urinary tract, and ureters, covering the normal anatomy and anatomic variants as well as all renal and urinary system pathologies. The relevant imaging modalities are first discussed, with detailed description of their applications. The entire spectrum of kidney pathologies is then presented in a series of detailed chapters with up-to-date references, high-quality images, informative schemes, and figures showing macroscopic and microscopic surgical and pathologic specimens. Chapters relating to the latest innovations in tumor ablation, vascular and nonvascular interventional procedures, and parametric and molecular imaging have been updated to reflect progress in these rapidly evolving fields. This book will be of great interest to all radiologists, oncologists, nephrologists, and urologists who are involved in the management of kidney pathologies

Normal Radiological Anatomy of the retroperitoneum

none1noneQuaia, Emili