Contrast-enhanced ultrasound performance in predicting blunt splenic injuries requiring only observation and monitoring

Aims: To assess contrast enhanced ultrasound (CEUS) performance in the prediction of non-operatively managed blunt spleen injuries requiring only observation and monitoring during follow-up and to evaluate if CEUS accuracy was higher than conventional ultrasound (US) in this field.Material and methods: In 112 hemodynamic stable blunt spleen trauma patients, CEUS was performed for follow-up after computed tomography evaluation in the emergency department. CEUS and US performance were assessed considering as true negative cases patients that had not underwent interventional or surgical treatment during follow-up and were assessed as negative for splenic complications respectively by CEUS or US examinations.Results: CEUS showed sensitivity of 100%, specificity of 96.1%, positive predictive value of 69.2%, negative predictive value of 100.0% and accuracy of 96.4%. CEUS showed a significantly higher accuracy than conventional US (p=0.013).Conclusions: CEUS is a very useful imaging modality during follow-up of blunt splenic trauma non-operatively managed, allowing an efficientprediction of splenic injuries requiring only observation and monitoring during follow-up.

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Contrast-Enhanced Ultrasound: a Simple and Effective Tool in Defining a Rapid Diagnostic Work-up for Small Nodules Detected in Cirrhotic Patients during Surveillance

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.252.chu ◽

2016 ◽

Vol 25 (2) ◽

pp. 205-211 ◽

Cited By ~ 13

Author(s):

Antonio Giorgio ◽

Luca Montesarchio ◽

Piero Gatti ◽

Ferdinando Amendola ◽

Paolo Matteucci ◽

...

Keyword(s):

Predictive Value ◽

Imaging Modality ◽

Dynamic Imaging ◽

Contrast Enhanced Ultrasound ◽

Histologic Diagnosis ◽

Therapeutic Work ◽

Contrast Enhanced ◽

Arterial Vascularization ◽

Cirrhotic Patients ◽

Work Up

Background & Aims: Disappearance of portal blood flow and arterial vascularization is the hallmark of hepatocarcinogenesis. The capability of a dynamic imaging modality detecting arterial hypervascularization of small nodules is crucial to promote a rapid diagnostic and therapeutic work-up improving survival. We aimed to evaluate the capability of CEUS to detect arterial vascularization of ≤ 2 cm HCC nodules arising during surveillance so as to shorten the diagnostic and therapeutic work-up. Methods: From October 2009 to September 2014, among 1757 consecutive cirrhotic patients under surveillance with ultrasound (US), 243 patients had new single nodules 7-20 mm; 229/243 had a conclusive histologic diagnosis and comprised the study group. All patients underwent CEUS followed by enhanced MRI and US guided percutaneous 18G needle core biopsy of the nodules. Of the 229 nodules, 27 were hyperechoic, 171 hypoechoic and 31 isoechoic lesions. Results: The histology results revealed that 199/229 nodules were HCC and 30 were benign. Of 199 HCC, CEUS evidenced arterial hypervascularity in 190 nodules (95.5%) (sensitivity 94.48 %, specificity 100%, PPV 100%, NPV 76.92 %). Of the 39 CEUS arterial-unenhanced nodules, 30 were benign and 9 (23%) were well-differentiated HCC. eMRI showed arterial hypervascularity in 199 nodules (86,9%). Of these, only 193 (97%) were histologically HCCs while 6 were benign (sensitivity: 97%, specificity: 80%, PPV: 97%, NPV: 80%). Conclusions: CEUS has a great capability to detect arterial hypervascularity of small HCC. Because only 4.5% of new nodules escape the demonstration of arterial hyervascularity, CEUS must be performed immediately after conventional US to contrast the malignant fate of small lesions arising in a cirrhotic liver.. Abbreviations: CEUS: contrast-enhanced ultrasound; CT: computed tomography; HCC: hepatocellular carcinoma;MRI: magnetic resonance; NPV: negative predictive value; PPV: positive predictive value; US: ultrasonography.

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Follow-Up Imaging in Patients with Blunt Splenic or Hepatic Injury Managed Nonoperatively

The American Surgeon ◽

10.1177/000313481808400226 ◽

2018 ◽

Vol 84 (2) ◽

pp. 208-214 ◽

Cited By ~ 5

Author(s):

R. Viola Mebert ◽

Beat SchnÜRiger ◽

Daniel Candinas ◽

Tobias Haltmeier

Keyword(s):

Nonoperative Management ◽

Imaging Modality ◽

Ct Scans ◽

Lower Grade ◽

Contrast Enhanced Ultrasound ◽

Promising Alternative ◽

Contrast Enhanced ◽

Pubmed Database ◽

Hepatic Injuries

Nonoperative management of blunt splenic and hepatic injuries has become the standard of care for hemodynamically stable patients. However, nonoperative management may lead to delayed complications and appropriate follow-up is therefore crucial. The aim of this systematic literature review was to assess the role of different imaging modalities in the follow-up assessment of patients with blunt splenic or hepatic injuries using the PubMed database. Eighteen studies were found to be relevant to the topic. A total of 2725 patients were enrolled in the included studies. Both retrospective and prospective studies, but no randomized controlled trials were found. In these studies, CT, ultrasound, and contrast-enhanced ultrasound were discussed. CT was the most commonly used imaging modality. Taking into account all studies included, only one patient underwent intervention due to a complication diagnosed by follow-up CTscan in the absence of clinical signs and symptoms. This equates to a total of 920 CT scans performed to diagnose one clinically nonevident complication that required intervention. Based on the reviewed literature, routine imaging follow-up CT scans may not be indicated in asymptomatic patients with lower grade blunt splenic or hepatic injuries. Contrast-enhanced ultrasound is a promising alternative imaging modality for the follow-up of these patients.

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Negative Predictive Value of Contrast-Enhanced Ultrasound of Liver and Kidney Thermal Ablation Sites for Local Tumour Progression during Long-term Follow-up: A Retrospective Consecutive Study

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2019.06.011 ◽

2019 ◽

Vol 70 (4) ◽

pp. 434-440

Author(s):

Mostafa Atri ◽

Abdulmohsen Alrashed ◽

Ahmad Hassan ◽

Korosh Khalili ◽

Tae Kyoung Kim ◽

...

Keyword(s):

Negative Predictive Value ◽

Predictive Value ◽

Thermal Ablation ◽

Tumour Progression ◽

False Negative ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced ◽

Local Tumour ◽

Local Tumour Progression

Purpose To determine negative predictive value (NPV) of contrast-enhanced ultrasound (CEUS) to demonstrate local tumour progression (LTP) at thermal ablation (TA) sites. Methods Our institutional review board approved this retrospective study; acquisition of consent was waived. Consecutive CEUS examinations performed between 2004-2014 for TA site evaluation on patients who could not undergo enhanced computed tomography (CT) or magnetic resonance imaging (MRI), or had inconclusive CT or MRI, were retrospectively reviewed. Those reported as no abnormal enhancement in or surrounding TA site were included. CEUS examination was considered true-negative based on stability or lack of enhancement/washout on follow-up imaging for at least 1 year, and false-negative (FN), if there was an arterially enhancing focus with wash-out at or surrounding TA site on subsequent follow-up imaging. Results Study population included 56 tumours in 54 patients, 11 women, 43 men; mean age 71 years. Two patients had TA of two different hepatocellular carcinomas. Thirty-six examinations were for hepatic TA and twenty for renal TA. Lesion sizes ranged from 1 cm to 7 cm (mean 3.1 ± 1.2). Mean diameter of 7 recurrences was 13.8 mm. Overall FN rate was 12.5% (7/56). Corresponding numbers were 0% (0/20) for renal TA and 19.4% (7/36) for hepatic TA. Overall NPV of CEUS was 87.5% (49/56) (confidence interval [CI]: 78.8%–96.2%). NPV for renal TA was 100% (20/20) (CI: 100%–100%) and for hepatic TA 81.5% (29/36) (CI: 67.6 %–93.5%). Conclusion In this cohort, CEUS showed high NPV for exclusion of LTP at renal TA sites. NPV for hepatic TA sites was high but lower than renal TA.

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The Application Value of Contrast-Enhanced Ultrasound in Testicular Occupied Lesions

Computational and Mathematical Methods in Medicine ◽

10.1155/2021/9962970 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Qiping Liu ◽

Huiling Gong ◽

Hui Zhu ◽

Chunyan Yuan ◽

Bin Hu

Keyword(s):

Diagnostic Accuracy ◽

Clinical Application ◽

Benign Tumor ◽

Malignant Tumors ◽

Differential Diagnoses ◽

Contrast Enhanced Ultrasound ◽

Pathological Result ◽

Contrast Enhanced ◽

Conventional Ultrasound

Objective. To discuss the clinical application value of contrast-enhanced ultrasound (CEUS) in testicular occupied lesions. Methods. Nine conventional-ultrasound-found testicular occupied lesions which underwent CEUS meantime were analyzed retrospectively. The CEUS perfusion pattern was compared with the surgical pathological result or follow-up findings. Results. Among all the 9 testicular occupied lesions, there were 5 testicular malignant tumors, 1 testicular benign tumor, 1 testicular tuberculosis, and 2 testicular hematomas. CEUS diagnosed 6 testicular malignant tumors, 1 testicular benign tumor, and 2 testicular hematomas, and its diagnostic accuracy was about 88.9%. Conclusion. CEUS has high clinical application value in the differential diagnoses of benign and malignant testicular occupied lesions.

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The Value of Contrast-Enhanced Ultrasound in the Diagnosis of Cesarean Scar Pregnancy

BioMed Research International ◽

10.1155/2016/4762785 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 9

Author(s):

Xi Xiong ◽

Ping Yan ◽

Chunyan Gao ◽

Qiulei Sun ◽

Fenglian Xu

Keyword(s):

Predictive Value ◽

Lower Uterine Segment ◽

Youden Index ◽

Peak Time ◽

Contrast Enhanced Ultrasound ◽

Cesarean Scar Pregnancy ◽

Cesarean Scar ◽

Contrast Enhanced ◽

Significant Difference ◽

Conventional Ultrasound

Objective. To evaluate the value of contrast-enhanced ultrasound (CEUS) in the cesarean scar pregnancy (CSP).Methods. Clinical data from 92 patients with lower uterine segment pregnancy, who underwent conventional ultrasound and CEUS examination in the Department of Obstetrics and Gynecology, were collected by Xinqiao Hospital Third Military Medical University from March 2014 to March 2015. The parameters of ultrasound contrast time-intensity curve (TIC), including arrival time, time to peak, time from peak to one half, basic intensity, peak intensity, and wash-in slope, were analyzed.Results. Of the 92 cases of patients with pregnancy in the lower uterine segment, 52 cases were CSP, and 40 cases were intrauterine pregnancy. CEUS was significantly better than conventional ultrasound in terms of sensitivity, negative predictive value, Youden index, and diagnostic accuracy (P<0.05). There was no significant difference in specificity and positive predictive value (P>0.05).Conclusion. CEUS has a higher accuracy than conventional ultrasound in diagnosis of CSP.

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Predictive value of contrast-enhanced ultrasound combined with conventional ultrasound in solid renal parenchymal lesions

British Journal of Radiology ◽

10.1259/bjr.20210518 ◽

2021 ◽

pp. 20210518

Author(s):

Yingyu Cai ◽

Fan Li ◽

Zhaojun Li ◽

Xin Li ◽

Chunxiao Li ◽

...

Keyword(s):

Logistic Regression ◽

Predictive Value ◽

Contrast Enhanced Ultrasound ◽

Counting Method ◽

Scoring Method ◽

Renal Lesions ◽

Contrast Enhanced ◽

Risk Of Malignancy ◽

Conventional Ultrasound ◽

Ultrasound Features

Objective: This study aimed to develop a model to predict the risk of malignancy in solid renal parenchymal lesions based on the imaging features of combined conventional and contrast-enhanced ultrasound (CEUS). Methods: A retrospective review was performed among patients with focal solid renal parenchymal lesions on ultrasound images. Ultrasound features were characterized by two experienced radiologists independently. A multiple logistic regression analysis was performed to determine the most relevant features and to estimate the risk of malignancy. Scoring and counting methods were developed based on the most relevant features. The diagnostic performance was evaluated by the sensitivity, specificity, positive predictive value, negative predictive value and area under the receiver operating characteristic curve (AUC). Results: A total of 519 renal lesions were included in this study. The conventional ultrasound features of diameter, echogenicity, hypoechoic rim and the CEUS feature of heterogeneity were identified as the most relevant features for prediction of malignancy. The sensitivity and specificity for the logistic regression model, the scoring method and the counting method were 95.3 and 93.4%, 93.8 and 87.8%, 88.8 and 93.9%, respectively. The logistic model had the best performance for diagnosing malignant renal lesions with AUC of 0.978, compared with the scoring method and the counting method with AUCs of 0.958 and 0.965. Conclusion: The combination of contrast-enhanced ultrasound with conventional ultrasound improved the diagnostic performance of solid renal lesions based on the logistic regression model. Advances in knowledge: In this study, we revealed that the combination of CEUS and conventional ultrasound provided higher accuracy for diagnosing malignant renal tumors.

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Contrast-Enhanced Ultrasound in the Follow-Up of Endoleaks after Endovascular Aortic Repair (EVAR)

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-0043-108207 ◽

2017 ◽

Vol 38 (03) ◽

pp. 244-264 ◽

Cited By ~ 6

Author(s):

Johannes Rübenthaler ◽

Hanna Zimmermann ◽

Marco Armbruster ◽

Katharina Müller-Peltzer ◽

Florian Bogner ◽

...

Keyword(s):

Ionizing Radiation ◽

Imaging Modality ◽

Cost Effective ◽

Aortic Aneurysms ◽

Endovascular Aortic Repair ◽

Contrast Enhanced Ultrasound ◽

Perioperative Morbidity ◽

Aortic Repair ◽

Contrast Enhanced

AbstractEndovascular aortic repair (EVAR) has become established in the treatment of abdominal aortic aneurysms and shows potential benefits such as a low perioperative morbidity and a short hospitalization duration. The follow-up after EVAR primarily consists of lifelong postinterventional imaging of the aneurysm size in order to detect complications such as endoleaks or stent dislocation. Computed tomography angiography, an imaging modality that uses ionizing radiation and that relies on a contrast medium which is dependent on thyroid and renal function, is widely used for follow-up. Meanwhile, contrast-enhanced ultrasound (CEUS) has been established as a viable, fast and cost-effective imaging alternative for the follow-up and the detection of endoleaks after EVAR with the additional benefit of being a real-time non-ionizing radiation examination and having comparable or even superior diagnostic performance. This review describes the use of CEUS for follow-up after EVAR and describes the most common pathologies.

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Role of contrast-enhanced ultrasound in evaluating the efficiency of ultrasound guided percutaneous microwave ablation in patients with renal cell carcinoma

Radiology and Oncology ◽

10.2478/raon-2013-0038 ◽

2013 ◽

Vol 47 (4) ◽

pp. 398-404 ◽

Cited By ~ 24

Author(s):

Xin Li ◽

Ping Liang ◽

Jie Yu ◽

Xiao-Ling Yu ◽

Fang-Yi Liu ◽

...

Keyword(s):

Predictive Value ◽

Renal Cell ◽

Microwave Ablation ◽

Contrast Enhanced Ultrasound ◽

Mri Imaging ◽

The Third ◽

Contrast Enhanced ◽

Sensitivity Specificity ◽

Percutaneous Microwave Ablation

Abstract Background. The aim of the study was to evaluate the efficiency and feasibility of contrast-enhanced ultrasound (CEUS) with Sonovue in assessing of renal cell carcinomas (RCCs) following ultrasound (US)-guided percutaneous microwave ablation (MWA). Patients and methods. Seventy-nine patients (60 males and 19 females) with 83 lesions (mean size 3.2±1.6 cm) were treated by US-guided percutaneous MWA. The CEUS results of the third day after the ablation were compared with the synchronous contrast-enhanced computed tomography (CT)/magnetic resonance imaging (MRI) results and biopsy pathological results. The follow-up was performed by CEUS and CT/MRI after 1, 3, 6 months and every 6 months subsequently. The combination of clinical follow-up results and CT/MRI imaging findings was the reference standard of CEUS results for evaluating the therapeutic effect. The identification of residual or recurrence tumour was assessed by two blinded radiologists. Results. On the third day after MWA, CEUS showed 68 of 83 lesions (68/83, 81.9%) successfully ablated and 15 of 83 (18.1%) with residual tumours. Among residual tumours, 13 (86.7%) were confirmed by contrast-enhanced CT/MRI findings and biopsy results. The sensitivity, specificity, accuracy, positive and negative predictive value of CEUS evaluating the short-term MWA effectiveness were 100%, 97.1%, 97.6%, 86.7% and 100%, respectively. During the six years follow-up (median 26 months), the CEUS showed recurrence in 7 patients, and six of them achieved consistent results on CEUS and CT/MRI imaging. The sensitivity, specificity, accuracy, positive and negative predictive value for CEUS evaluating long-term MWA effectiveness were 85.7%, 98.7%, 97.6%, 85.7% and 98.7%, respectively. Conclusions. The post-procedural CEUS demonstrated as an effective and feasible method in evaluating a therapeutic effect of RCCs following MWA.

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Contrast-enhanced ultrasound (CEUS) reliably rules out neoplasm in developmental renal pseudotumor

Acta Radiologica ◽

10.1177/0284185120939291 ◽

2020 ◽

pp. 028418512093929

Author(s):

Paul Spiesecke ◽

Thomas Fischer ◽

Andreas Maxeiner ◽

Bernd Hamm ◽

Markus H Lerchbaumer

Keyword(s):

Predictive Value ◽

Fast Method ◽

Contrast Enhanced Ultrasound ◽

Cross Sectional ◽

Contrast Enhanced ◽

Cross Sectional Imaging ◽

Renal Pseudotumor ◽

Sectional Imaging ◽

Rule Out

Background Renal pseudotumors appear as benign cortical hypertrophies and are typically assessed by contrast-enhanced computed tomography or magnetic resonance imaging to rule out malignancy. Purpose To investigate whether contrast-enhanced ultrasound (CEUS) can rule out renal neoplasm and thus potentially reduce cross-sectional imaging and further follow-up in these patients. Material and Methods Thirty-two patients with presumption of developmental renal pseudotumor on CEUS between June 2011 and July 2019 were retrospectively analyzed. All patients were examined with a standardized renal US protocol including B-mode, color-coded duplex sonography (CCDS), and CEUS by an experienced radiologist (EFSUMB level 3). Images were retrospectively interpreted in consensus by two highly experienced radiologists. Histopathological reports, cross-sectional imaging findings, and clinical course (treatment response, long-term imaging follow-up) were defined as standard of reference. Results CEUS correctly identified 8/9 neoplastic lesions and missed one oncocytoma within the 32 included patients. Irregular vessel structure (88.9% vs. 13.0%, P = 0.007) and hyperenhancement (66.6% vs. 17.4%, P = 0.031) on CEUS were more common in neoplasm compared to developmental pseudotumors reaching statistical significance. Compared with the standard of reference, CEUS had 89% sensitivity (95% confidence interval [CI] 57–98), 96% specificity (95% CI 80–99), a positive predictive value of 89% (95% CI 57–98), and a negative predictive value of 96% (95% CI 79–99) for ruling out renal malignancy in developmental pseudotumors. Conclusion CEUS is a safe and fast method to rule out neoplasm in the diagnostic work-up of renal pseudotumors. In conjunction with B-mode and CCDS, CEUS has the potential to reduce further (invasive) diagnostic procedures.

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