Dynamická kontrastní ultrasonografie (CEUS - contrast-enhanced ultrasound) je poměrně novou zobrazovací modalitou, která umožňuje hodnotit průběh opacifikace cév a tkání, a to nejen v dopplerovském, ale i ve dvourozměrném ultrasonografickém obrazu. Největšího uplatnění u dětí dosud metoda nalezla v diagnostice ložiskového postižení jater a při hodnocení poúrazových změn parenchymatózních orgánů dutiny břišní. Autoři prezentují své dosavadní zkušenosti s využitím metody při diagnostice fokálních lézí jater u dětí.
Dynamic contrast enhanced ultrasound (CEUS) is a novel imaging method that enables assessment of blood vessels and tissues. Among the methods used for CEUS are Doppler and double space ultrasound imaging. In children, this method can be used to diagnose focal liver lesions and to assess traumatic lesions of the abdomen. The authors demonstrate their contemporary experience of using this method to diagnose focal liver lesions in children.
Cieľ: Kontrastná ultrasonografia (z angl. contrast-enhanced ultrasound – CEUS) predstavuje diagnostickú metódu, ktorá umožňuje dynamické zobrazenie tkaniva v reálnom čase so zaznamenávaním charakteristického vzoru vysycovania ložiska kontrastnou látkou. Cieľom autorov je poukázať na význam tejto zobrazovacej modality v diferenciálnej diagnostike tumorov pečene u novorodeneckých pacientov prostredníctvom dvoch kazuistických prípadov. Metodika: Po intravenóznej aplikácii kontrastnej látky s výlučne intravaskulárnou distribúciou sa v jednotlivých fázach CEUS vyšetrenia zaznamenáva intenzita signálu kontrastnej látky v ložisku pečene a jeho okolí. V priebehu artériovej fázy je hodnotená vaskularizácia ložiska, následne v portálnej a neskorej fáze je možné podrobnejšie hodnotiť dignitu lézie. Výsledky: Dvaja novorodenci s tumoróznym ložiskom pečene podstúpili CEUS vyšetrenie s cieľom bližšej charakterizácie lézie. Na základe CEUS vyšetrenia boli u týchto novorodencov diagnostikované hemangióm a hepatoblastóm. U pacientov sme nezaznamenali nežiadúce účinky v súvislosti s intravenóznym podaním kontrastnej látky. Záver: Podľa našich doterajších skúseností je CEUS vyšetrenie vhodná diagnostická metóda v diferenciálnej diagnostike tumoróznych lézií pečene aj u pacientov v novorodeneckom veku. Realizácia a následná interpretácia výsledkov si však vyžadujú zaškolený zdravotný personál.
Aim: Contrast-enhanced ultrasound (CEUS) is a novel diagnostic method that enables dynamic imaging of tissues in real time with recording characteristic pattern of bearing contrast agent in liver lesion. The aim of the authors is to point out the importance of this imaging modality in the differential diagnosis of liver tumors in newborns through the presentation of two case reports. Methodology: After intravenous application of microbubble contrast agent with exclusively intravascular distribution the signal intensity is recorded in the individual phases of the examination in liver lesion and its surroundings. During the arterial phase the vascularization of the lesion is evaluated, in the portal and late phase is possible to specify the dignity of the liver lesion more precisely. Results: Two newborns with liver tumors underwent CEUS examination with the aim of closer characterization of the lesion. Based on the CEUS in these newborns were diagnosed hemangioma and hepatoblastoma. We did not observe any adverse effects related to the intravenous administration of the contrast agent. Conclusion: According to our expiriences so far is CEUS a suitable diagnostic method in differential diagnosis of liver tumors also at patients of neonatal age. Realization and interpretation of results reguire trained medical staff.
- Keywords
- kontrastní ultrasonografie,
- MeSH
- Contrast Media MeSH
- Humans MeSH
- Liver Neoplasms * diagnostic imaging MeSH
- Infant, Newborn MeSH
- Ultrasonography methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Infant, Newborn MeSH
- Publication type
- Case Reports MeSH
Cíl. Retrospektivní studie srovnává výtěžnost CEUS, CT a MR. Cílem práce bylo stanovit přesnost (úspěšnost) jednotlivých zobrazovacích metod vzhledem k histologickému ověření a zjistit, nakolik jsou jednotlivé metody schopny rozlišit mezi benigním a maligním ložiskem obecně, navrhnout optimální diagnostický algoritmus. Metoda. Retrospektivní hodnocení souboru 62 pacientů mezi roky 2005-2009, kterým byla diagnóza histologický ověřena. US vyšetření byla prováděna na přístroji ATL HDI 5000 režimem pulzní inverze, na IU 22 Phillips režimy pulzní inverze a pulzní modulace. CT na Siemens Somatom plus či Phillips Brilliance 64, v minimálně ve dvou dynamických postkontrastních fázích, MR vyšetření na Phillips Achieva 1,5T, s použitím hepato-specifických kontrastních látek a dynamického postkontrastního čtyřfázového vyšetření. Kromě procentuálního vyjádření přesnosti jednotlivých metod vzhledem k histologickému ověření byly metody hodnoceny také stran senzitivity, specificity, pozitivní a negativní prediktivní hodnoty vzhledem k jejich schopnosti identifikovat maligní ložisko. Výsledky. V přesnosti metody shodnout se s histologickým vyšetřením MR dosahovala shody v 85,7%, CEUS v 82%, CT v 62%. Ve schopnosti identifikovat v játrech maligní ložisko: MR senzitivita 93,8% a specificita 100%, CEUS 91,4% a 92,3% a CT 77,8% a 88,5%. Pozitivní prediktivní hodnoty (PPV): MR100%, CEUS 94% a CT 90%. Negativní (NPV): MR 92 %, CEUS 90 % a CT 74%. Závěr. Hodnoty senzitivity, specificity a úspěšnosti metody kontrastního ultrazvukového vyšetření naměřené na našem souboru korelují s hodnotami uváděnými v literatuře a potvrzují, že tato metoda má své významné místo v diagnostickém algoritmu ložiskových lézí jater.
Aim. Co compare retrospectively study of different imaging modalities (CEUS, CT, MR) and to determine the hit rate of these modalities with regard to histological diagnose and with respect to distinguish between benign and malignant lesion in general, the proposal of optimal diagnostic algorithm of focal liver lesions. Method. Retrospective evaluation of th group of 62 patients examined from 2005 to 2009 with histological evaluation. US examinations were done on ATL HDI 5000 and IU 22 Phillips. CT examinations on Siemens Somatom plus or Phillips Brilliance (64), using dynamic postcontrast examination. MR on Phillips Achieva 1.5 T, using hepatospecific contrast agents and dynamic postcontrast examination in 4 phases. Beyond the hit rate of the modalities with regard to histological diagnose also the sensitivity, specificity, positive predictive values and negative predictive values to distiguish malignant lesion from benign were evaluated. Results. Concerning the histological diagnose, MR has the hit rate of 85.7%, CEUS - 82%, CT - 62%. For differentiation between malignant and benign lesion MR sensitivity was 93,8% and specificity 100%, CEUS 91.4% and 92.3% , CT 77.8% and 88.5%. PPV were 100%, 94% and 90% and NPV 92%, 90% and 74% for MR, CEUS and CT respectively. Conclusion. Our sensitivity, specificity, PPV, NPV and hit rates well correlate with those described in literature, confiming that CEUS is meaningful diagnostic tool in the diagnostic algortithm of focal liver lesions.
- Keywords
- diagnóza diferenciální, játra, ultrazvuk,
- MeSH
- Diagnosis MeSH
- Diagnosis, Differential MeSH
- Sulfur Hexafluoride diagnostic use MeSH
- Histological Techniques MeSH
- Hyperplasia MeSH
- Contrast Media diagnostic use classification MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods utilization MeSH
- Microbubbles MeSH
- Liver Neoplasms ultrasonography MeSH
- Liver Diseases ultrasonography MeSH
- Tomography, X-Ray Computed methods utilization MeSH
- Cell Proliferation MeSH
- Retrospective Studies MeSH
- Sensitivity and Specificity MeSH
- Statistics as Topic MeSH
- Ultrasonography methods utilization MeSH
- Check Tag
- Humans MeSH
OBJECTIVE: To evaluate the prevalence of spoke-wheel pattern and typical symptoms of focal nodular hyperplasia (FNH) by means of dynamic contrast-enhanced ultrasonography (CEUS) in relation to lesion size. METHODS: Twenty-eight patients were included in the trial, in whom, based on the CEUS, we raised suspicion of hypervascularized liver lesion; there were 30 lesions altogether. The final diagnosis of FNH was verified by means of CT, MRI or lesion biopsy. Majority of patients (26) were females, compared to 2 male, with average age of 33.3 years. Average lesion size was 45.6 mm. Besides the ultrasound examination, we used also "blood pool" ultrasound contrast agent of second generation, sulphur hexafluoride (BR1); we evaluated enhancement of the lesion until the late stage-within 5 min from application. RESULTS: In lesions larger than 3 cm (n=20), stellate vascular enhancement was found in 19 cases (95.0%) early in arterial phase. As for lesions smaller than 3 cm (n=10), spoke-wheel pattern was observed only in 3 cases (30%) and lesions smaller than 2 cm practically did not show this phenomenon at all (n=1; 17%). Generally, symptom of spoke-wheel pattern was observed in 22 cases, i.e. in 73.3%. In total, central scar was present in 63.3% (n=19) of cases. In lesions larger than 3 cm, it was present in 85.0% (n=17), in lesions smaller than 3 cm in 20% (n=2). CONCLUSION: Contrast-enhanced ultrasonography can be the final diagnostic method for FNH larger than 3 cm which has typical spoke-wheel vessel structure on CEUS. If this phenomenon is not present and the central scar is not visible, specific diagnosis of FNH cannot be based solely on CEUS findings.
- MeSH
- Arteries ultrasonography MeSH
- Adult MeSH
- Endosonography methods MeSH
- Sulfur Hexafluoride diagnostic use MeSH
- Focal Nodular Hyperplasia ultrasonography MeSH
- Liver ultrasonography MeSH
- Contrast Media MeSH
- Middle Aged MeSH
- Humans MeSH
- Microbubbles MeSH
- Adolescent MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
Aims: To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (MRI) in the diagnosisof BI-RADS-5 type of microcalcifi cations of the breast, to compare the size of the microcalcifi cation lesions usingmammography (MG) and MRI, and to determine the value of MRI in surgery for microcalcifi cations. The study alsodetermines the morphology of microcalcifi cation lesions, assesses kinetic curves and compare MRI features of ductalcarcinoma in situ (DCIS) for diff erent histopathological grades. Methods: Our group consisted of 32 patients with mammographically detected BI-RADS 5 microcalcifi cations.The MRI was done in this group of women which was later followed by stereotactic vaccum-assisted biopsy (SVAB).Surgery was performed on all patients with a biopsy that resulted in a diagnosis of breast cancer or atypical ductalhyperplasia (ADH). Results: Of our group of 32 patients, there were 35 mammograhically detected microcalcifi cation lesions, 32 DCIS,one ADH and two benign fi ndings according to the fi nal histology.The microcalcifi cation lesions were larger using MRI than in MG in 10 women. We diagnosed DCIS multifocalityin 6 women and bilateral carcinoma in one woman. As with kinetic curve assessment, we found in 67 % of DCIS arapid rise, 27 % a moderate and in 6 % a slow initial rise. With the pattern of enhancement in the delayed phase, wefound in 30 % of DCIS a washout pattern, 67 % a plateau and in 3 % a persistent pattern. Noted diff erence betweenhigh and low grade DCIS was confi rmed. Conclusions: MRI sensitivity in the detection of DCIS was 94 % in our group of patients and was the sole evidencefor detection of multifocality and bilateral incidence of carcinoma. In 26 % of women the outcome of MRI was themost important for converting breast conserving surgery to mastectomy.
- MeSH
- Biopsy methods utilization MeSH
- Carcinoma, Ductal, Breast diagnosis MeSH
- Financing, Organized MeSH
- Histological Techniques methods utilization MeSH
- Evaluation Studies as Topic MeSH
- Calcinosis diagnosis MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods utilization MeSH
- Mammography methods utilization MeSH
- Breast Neoplasms diagnosis MeSH
- Image Processing, Computer-Assisted methods utilization MeSH
- Sensitivity and Specificity MeSH
- Statistics as Topic MeSH
- Ultrasonography, Mammary methods utilization MeSH
- Check Tag
- Humans MeSH
- Female MeSH
PURPOSE: Dynamic contrast-enhanced ultrasound (DCE-US) can be used for calculating organ perfusion. By combining bolus injection with burst replenishment, the actual mean transit time (MTT) can be estimated. Blood volume (BV) can be obtained by scaling the data to a vessel on the imaging plane. The study aim was to test interobserver agreement for repeated recordings using the same ultrasound scanner and agreement between results on two different scanner systems. MATERIALS AND METHODS: Ten patients under evaluation for exocrine pancreatic failure were included. Each patient was scanned two times on a GE Logiq E9 scanner, by two different observers, and once on a Philips IU22 scanner, after a bolus of 1.5 ml Sonovue. A 60-second recording of contrast enhancement was performed before the burst and the scan continued for another 30 s for reperfusion. We performed data analysis using MATLAB-based DCE-US software. An artery in the same depth as the region of interest (ROI) was used for scaling. The measurements were compared using the intraclass correlation coefficient (ICC) and Bland Altman plots. RESULTS: The interobserver agreement on the Logiq E9 for MTT (ICC=0.83, confidence interval (CI) 0.46-0.96) was excellent. There was poor agreement for MTT between the Logiq E9 and the IU22 (ICC=-0.084, CI -0.68-0.58). The interobserver agreement for blood volume measurements was excellent on the Logiq E9 (ICC=0.9286, CI 0.7250-0.98) and between scanners (ICC=0.86, CI=0.50-0.97). CONCLUSION: Interobserver agreement was excellent using the same scanner for both parameters and between scanners for BV, but the comparison between two scanners did not yield acceptable agreement for MTT. This was probably due to incomplete bursting of bubbles in some of the recordings on the IU22.
- Publication type
- Journal Article MeSH
Dynamic contrast-enhanced ultrasound (DCE-US) imaging is a promising diagnostic method, which enables the evaluation of tissue perfusion via different parameters. The mean transit time and time-to-peak parameters are the main time parameters and their values depend on the model used for the approximation of the noisy perfusion curves. In this paper, we described a new comparison of different perfusion models using a tissue mimicking phantom. The following models were compared: log-normal, lagged, Erlang, Gamma and the local density random walk model. We discovered that the mean-square error is not the best criterion for model evaluation. More important is the comparison between the estimated time perfusion parameters and the physical parameters of the developed tissue mimicking phantom. Based on the statistical analysis, we can suggest that for the DCE-US perfusion analysis more models should be used, excluding the log-normal model, which gives the highest error of mean transit time value.
- MeSH
- Algorithms * MeSH
- Models, Biological * MeSH
- Phantoms, Imaging MeSH
- Indicator Dilution Techniques * MeSH
- Image Interpretation, Computer-Assisted methods MeSH
- Contrast Media analysis pharmacokinetics MeSH
- Humans MeSH
- Computer Simulation MeSH
- Reproducibility of Results MeSH
- Sensitivity and Specificity MeSH
- Ultrasonography methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Evaluation Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Comparative Study MeSH
Cíl: Moderní přístroje magnetické rezonance (MR) se silou magnetického pole 3 Tesla (T) dávají nové možnosti v diagnostice karcinomu prostaty. Práce srovnává výsledky multiparametrické 3T MR prostaty s výsledky transrektální biopsie prostaty za ultrasonografické kontroly (TRUS), a zjišťuje tak možnou úlohu MR v algoritmu diagnostiky karcinomu prostaty. Materiál a metoda: Od 4/2011 do 4/2013 (dále 1. období) bylo indikováno 354 mužů k provedení 3T MR prostaty. U 192 (54,2 %) z těchto pacientů bylo MR vyšetření provedeno před biopsií prostaty, u zbylých 162 (45,8 %) po biopsii (u pozitivní biopsie kvůli zpřesnění stagingu, u negativní biopsie při přetrvávající elevaci PSA). K zjištění možné změny výsledků po 2 letech od zahájení studie byla za období 5/2013 až 12/2013 (dále 2. období) vyhodnocena kontrolní skupina pacientů (se stejnou indikací) v počtu 162 mužů - z nich byla u 119 provedena MR před biopsií, u zbylých 43 pacientů po biopsii. Vyšetřovací protokol 3T MR zahrnoval provedení T2 váženého obrazu, MR spektroskopie, difuzně váženého zobrazení a dynamického kontrastního zobrazení. Suspektní nálezy (z biopsie i MR) byly počítány jako nálezy pozitivní. Výsledky: Průměrný věk všech pacientů byl 65,4 (41-82) let. Průměrná hodnota PSA činila v 1. období 16,03 ng/ml (1,41-523), ve 2. období 11,5 ng/ml (2,02-75). Celková senzitivita MR byla v 1. vs. 2. období 87, 6 % vs. 81,4 %, specificita 56,5 % vs. 68,4 %. Rozdíly ve výsledcích u pacientů s MR před a po biopsii byly patrné především u specificity - 46,7 % vs. 70,7 % v 1. období a 62,9 % vs. 92, 9 % ve 2. období. Nejzkušenější radiolog dosáhl senzitivity 83,9 % a specificity 85 %, druhý pak senzitivity 71,4 % a specificity 50 %. Závěr: V 1. období byla zjištěna poměrně vysoká senzitivita (87,6 %) a nižší specificita (56,5 %) 3T MR při detekci karcinomu prostaty. Ve 2. období se lehce snížila senzitivita na 81,4 % a naopak zvýšila specificita na 68,4 %. Byl zaznamenán významný vztah mezi zkušeností radiologa a jeho úspěšností popisu MR. Příčinou nízké specificity však nemusí být selhání metodiky MR, ale neschopnost biopticky karcinom zachytit. Při biopsii prováděné po MR se zaměřujeme na radiologem popsaná ložiska karcinomu. U již biopticky verifikovaného karcinomu využíváme výsledky MR k rozhodování o typu léčby.
Aim: Modern magnetic resonance immaging (MRI) with 3 Tesla (T) magnetic field opens new possibilities in the diagnostics of prostate cancer. The aim of this study is to compare the results of 3 T MRI of the prostate with the results of transrectal ultrasound (TRUS)-guided biopsy of the prostate and to determine the role of 3 T MRI in the diagnostics of prostate cancer. Material and methods: In the period from 4/2011 to 4/2013 (1st period) 354 men were evaluated using 3T MRI of the prostate. One hundered ninety two of them (54.2%) underwent MRI before TRUS biopsy of the prostate (pacients with a clinical suspicion of prostate cancer), the remaining 162 participants (45.8%) underwent MRI after TRUS biopsy (patients with at least one negative biopsy and ongoing suspicion of prostate cancer, or those requiring staging before radical prostatectomy). To determine potential developments in the outcome 2 years after beginning of the study, we evaluated control group of 162 men in the period from 5/2013 to 12/2013 (2nd period). One hundered nineteen patients (73.5%) underwent MRI before TRUS biopsy, the remaining 43 (26.5%) underwent MRI after TRUS biopsy. The protocol of 3T MRI included triplane T2 weighted MRI, MR spectroscopy, diffusion-weighted imaging and dynamic contrast-enhanced MRI. Suspect results (according to either biopsy or MRI) were considered positive. Results: The mean age was 65.4 years (41-82), mean PSA 16.03 ng/ml (1.41-523) in the 1st period and 11.5 ng/ml (2.02-75) in the 2nd period. Sensitivity of MRI was 87.6% and 81.4% in the 1st and 2nd period respectively. Specificity was 56.5% and 68.4% in 1st and 2nd period respectively. Differences between results in patients with MRI before and after biopsy were apparent mainly in specificity which was 46.7% before vs. 70.7% after (in the 1st period) and 62.9% before vs. 92.9% after (in the 2nd period). The most experienced radiologist achieved sensitivity of 83.9% and specificity of 85%, the secon most experienced radiologist achieved sensitivity 71.4% and specificity 50%. Conclusion: In the 1st period our study showed a relatively high sensitivity (87.56%) and low specificity (56.52%) of 3T MRI of the prostate in the diagnostics of prostate cancer. In the 2nd period the sensitivity had slightly decreased to 81.4%, and contrary to that specificity had increased to 68.4%. Significant relationship between the experience of radiologist and success rate of MRI diagnosis was detected. The reason for low specificity is not necessarily the failure of MRI but it can be the inability to detect cancer using prostate biopsy. In cases where the biopsy is performed after MRI we focus on cancer loci described on MRI. In cases where the cancer has been verified by biopsy we use MRI results to select an optimal treatment.
- Keywords
- T MR prostaty, karcinom prostaty, TRUS biopsie,
- MeSH
- Biopsy methods utilization MeSH
- Early Diagnosis MeSH
- Evaluation Studies as Topic MeSH
- Carcinoma diagnosis epidemiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging * classification instrumentation trends utilization MeSH
- Prostatic Neoplasms diagnosis MeSH
- Aged MeSH
- Neoplasm Staging MeSH
- Ultrasound, High-Intensity Focused, Transrectal * methods utilization MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
Ultrasonografie je důležitou vyšetřovací metodou při zobrazení ledvin. Hlavní výhodou je dostupnost, neinvazivita a nízké náklady vyšetření. V současné době lze provádět 3D a 4D zobrazení, pro diagnostiku ložiskových lézí ledvin je možno použít harmonické zobrazení, jsou dostupné kontrastní látky pro ultrazvuková vyšetření, a v poslední době byla použita elastografie in vivo pro zobrazení expanzí ledvin. Probíhá intenzivní výzkum zkoumající možnosti ultrasonografie při diagnostice renálních tumorů.
Ultrasonography is important diagnostic modality in examination of kidneys. Availability, noninvasivity, low costs and relative inexpensivity are main advantages. Is possible to perform 3D and 4D imaging. Harmonic imaging can be used in imaging of renal masses and contrast agents are available for contrast-enhanced studies. Sonoelastography in the imaging of renal masses has been applied in vivo recently. There is an increasing flow of data from studies investigating the role of ultrasonography in the evaluation of renal masses.
- Keywords
- renální tumor, SonoVue, Optison,
- MeSH
- Diagnostic Techniques, Urological MeSH
- Contrast Media diagnostic use MeSH
- Humans MeSH
- Microbubbles MeSH
- Kidney Neoplasms diagnosis MeSH
- Nonlinear Dynamics MeSH
- Computer Simulation MeSH
- Signal Processing, Computer-Assisted MeSH
- Ultrasonography, Doppler methods utilization MeSH
- Ultrasonography methods utilization MeSH
- Ultrasonics MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
