Versatile utilization of real-time intraoperative contrast-enhanced ultrasound in cranial neurosurgery: technical note and retrospective case series

OBJECTIVE Intraoperative contrast-enhanced ultrasound (iCEUS) offers dynamic imaging and provides functional data in real time. However, no standardized protocols or validated quantitative data exist to guide its routine use in neurosurgery. The authors aimed to provide further clinical data on the versatile application of iCEUS through a technical note and illustrative case series. METHODS Five patients undergoing craniotomies for suspected tumors were included. iCEUS was performed using a contrast agent composed of lipid shell microspheres enclosing perflutren (octafluoropropane) gas. Perfusion data were acquired through a time-intensity curve analysis protocol obtained using iCEUS prior to biopsy and/or resection of all lesions. RESULTS Three primary tumors (gemistocytic astrocytoma, glioblastoma multiforme, and meningioma), 1 metastatic lesion (melanoma), and 1 tumefactive demyelinating lesion (multiple sclerosis) were assessed using real-time iCEUS. No intraoperative complications occurred following multiple administrations of contrast agent in all cases. In all neoplastic cases, iCEUS replicated enhancement patterns observed on preoperative Gd-enhanced MRI, facilitated safe tumor debulking by differentiating neoplastic tissue from normal brain parenchyma, and helped identify arterial feeders and draining veins in and around the surgical cavity. Intraoperative CEUS was also useful in guiding a successful intraoperative needle biopsy of a cerebellar tumefactive demyelinating lesion obtained during real-time perfusion analysis. CONCLUSIONS Intraoperative CEUS has potential for safe, real-time, dynamic contrast-based imaging for routine use in neurooncological surgery and image-guided biopsy. Intraoperative CEUS eliminates the effect of anatomical distortions associated with standard neuronavigation and provides quantitative perfusion data in real time, which may hold major implications for intraoperative diagnosis, tissue differentiation, and quantification of extent of resection. Further prospective studies will help standardize the role of iCEUS in neurosurgery.

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Contrast-enhanced ultrasound (CEUS) in assessing early response among patients with invasive breast cancer undergoing neoadjuvant chemotherapy

Acta Radiologica ◽

10.1177/0284185116658322 ◽

2016 ◽

Vol 58 (4) ◽

pp. 394-402 ◽

Cited By ~ 8

Author(s):

Ariel Saracco ◽

Botond K Szabó ◽

Ervin Tánczos ◽

Jonas Bergh ◽

Thomas Hatschek

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Contrast Agent ◽

Real Time ◽

Invasive Breast Cancer ◽

Early Response ◽

Contrast Enhanced Ultrasound ◽

Time Harmonic ◽

Contrast Enhanced ◽

Significant Difference

Background One of the big challenges in onco-radiology is to find a reliable imaging method that may predict early response during the first cycles of any neoadjuvant chemotherapy. Purpose To evaluate the use of real-time harmonic contrast-enhanced ultrasound (CEUS) in predicting early response in breast cancer tumors under neoadjuvant chemotherapy (NAC) treatment. Material and Methods Nineteen consecutive patients with invasive breast cancer were evaluated with a bolus dose of 2.4 mL contrast agent using CEUS, before and after two cycles of epirubicin and docetaxel. The lognormal function was used for quantitative analysis of kinetic data to evaluate early response. Results There was statistically significant difference in time-to-peak ( tp) between responders and non-responders (two sample t-test, P = 0.027) where tp was significantly longer at the week 5 than at the baseline scan among responders when compared to non-responders. Conclusion In-flow of intravascular contrast agent in tumors is significantly slower in responders at real-time harmonic CEUS, and might be effectively used for the evaluation of early response to chemotherapy in invasive breast cancer. However, further investigations in a larger and more heterogeneous population should be performed to corroborate the reliability of the method.

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Comment on the article "Real-time intraoperative contrast-enhanced ultrasound (CEUS) in vascularized spinal tumors: a technical note"

Acta Neurochirurgica ◽

10.1007/s00701-018-3628-3 ◽

2018 ◽

Vol 160 (9) ◽

pp. 1873-1874 ◽

Cited By ~ 9

Author(s):

Giuseppe Maria Della Pepa ◽

Pier Paolo Mattogno ◽

Alessandro Olivi

Keyword(s):

Real Time ◽

Technical Note ◽

Spinal Tumors ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced

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258 Real time characterization of focal liver lesions using contrast-enhanced ultrasound after the injection of sonovue, a second-generation contrast agent

Journal of Hepatology ◽

10.1016/s0168-8278(05)81670-8 ◽

2005 ◽

Vol 42 ◽

pp. 99

Keyword(s):

Contrast Agent ◽

Real Time ◽

Second Generation ◽

Focal Liver Lesions ◽

Liver Lesions ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced

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Real-time intraoperative contrast-enhanced ultrasound (CEUS) in vascularized spinal tumors: a technical note

Acta Neurochirurgica ◽

10.1007/s00701-018-3541-9 ◽

2018 ◽

Vol 160 (6) ◽

pp. 1259-1263 ◽

Cited By ~ 16

Author(s):

Giuseppe Maria Della Pepa ◽

Pier Paolo Mattogno ◽

Giuseppe La Rocca ◽

Giovanni Sabatino ◽

Alessandro Olivi ◽

...

Keyword(s):

Real Time ◽

Technical Note ◽

Spinal Tumors ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced

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Update in Contrast-Enhanced Ultrasound

Visceral Medicine ◽

10.1159/000511352 ◽

2020 ◽

Vol 36 (6) ◽

pp. 476-486

Author(s):

Steffen Beckmann ◽

Jörg H. Simanowski

Keyword(s):

Contrast Agent ◽

Contrast Medium ◽

Radiation Exposure ◽

Real Time ◽

Imaging Techniques ◽

Abdominal Cavity ◽

Contrast Enhanced Ultrasound ◽

The Real ◽

Contrast Enhanced ◽

First Choice

Background: The aim of modern medicine is to safely classify diseases for successful therapy without invasive measures. Sonography, computed tomography (CT), and magnetic resonance imaging (MRI) are potent imaging techniques. However, without contrast medium, the informative value of the 3 native methods is limited. The advantages of sonography are: no radiation exposure or previously known physically harmful interactions with tissue, proportionate disappearance of a contrast agent risk, no (probably irreversible) contrast agent deposits, and no risk of renal insufficiency. But, is that enough to compete with of even exceed CT and MRI? Summary: In this review, the state of the art of contrast-enhanced ultrasound (CEUS) in the abdominal cavity is presented. The remarkable diagnostic possibilities can unfortunately only be demonstrated here in a small number of impressive, typical case studies underpinned by the literature, so that, from one’s own perspective, the full spectrum of CEUS can be used by oneself or initiated. Within the limits of physics, the real-time dynamics of CEUS enable conclusions to be drawn, so that with the current technology, sonography, including expansion by contrast, can be considered superior to other imaging methods. It is not uncommon for CEUS to have the value of a control and reference method. Key Messages: Sonography very often enables reliable diagnostics. The introduction of a contrast agent in sonography has led to a quantum leap similar to that of other imaging techniques. Already natively, the real-time representation of dynamic events leads to a certain superiority, i.e., complete observation of the inflow and outflow phases of the contrast medium and the resulting diagnostic; tissue-specific differentiation options provide a unique selling point. Further advantages of the first-choice imaging diagnostic method are: a lack of radiation exposure, repeatability of the examination at any time, local independence, a negligible allergy rate compared to the contrast agents of other methods, and a lack of kidney and thyroid exposure or excluded deposits.

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Contrast-enhanced ultrasound using real-time contrast harmonic imaging in invasive breast cancer: comparison of enhancement dynamics with three different doses of contrast agent

Acta Radiologica ◽

10.1177/0284185114520860 ◽

2015 ◽

Vol 56 (1) ◽

pp. 34-41 ◽

Cited By ~ 6

Author(s):

Ariel Saracco ◽

Botond K Szabó ◽

Peter Aspelin ◽

Karin Leifland ◽

Ervin Tánczos ◽

...

Keyword(s):

Breast Cancer ◽

Contrast Agent ◽

Real Time ◽

Invasive Breast Cancer ◽

Harmonic Imaging ◽

Contrast Enhanced Ultrasound ◽

Contrast Enhanced ◽

Different Doses

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Contrast-enhanced ultrasound of the abdominal aorta – current status and future perspectives

VASA ◽

10.1024/0301-1526/a000749 ◽

2019 ◽

Vol 48 (2) ◽

pp. 115-125 ◽

Cited By ~ 4

Author(s):

Xin Li ◽

Daniel Staub ◽

Vasileios Rafailidis ◽

Mohammed Al-Natour ◽

Sanjeeva Kalva ◽

...

Keyword(s):

Real Time ◽

Vascular Diseases ◽

Aneurysm Rupture ◽

Vasa Vasorum ◽

Current Status ◽

Contrast Enhanced Ultrasound ◽

Aortic Diseases ◽

Cross Sectional ◽

Vascular Abnormalities ◽

Contrast Enhanced

Abstract. Ultrasound has been established as an important diagnostic tool in assessing vascular abnormalities. Standard B-mode and Doppler techniques have inherent limitations with regards to detection of slow flow and small vasculature. Contrast-enhanced ultrasound (CEUS) is a complementary tool and is useful in assessing both the macro- and microvascular anatomy of the aorta. CEUS can also provide valuable physiological information in real-time scanning sessions due to the physical and safety profiles of the administered microbubbles. From a macrovascular perspective, CEUS has been used to characterize aortic aneurysm rupture, dissection and endoleaks post-EVAR repair. With regard to microvasculature CEUS enables imaging of adventitial vasa vasorum thereby assessing aortic inflammation processes, such as monitoring treatment response in chronic periaortitis. CEUS may have additional clinical utility since adventitial vasa vasorum has important implications in the pathogenesis of aortic diseases. In recent years, there have been an increasing number of studies comparing CEUS to cross-sectional imaging for aortic applications. For endoleak surveillance CEUS has been shown to be equal or in certain cases superior in comparison to CT angiography. The recent advancement of CEUS software along with the ongoing development of drug-eluting contrast microbubbles has allowed improved targeted detection and real-time ultrasound guided therapy for aortic vasa vasorum inflammation and neovascularization in animal models. Therefore, CEUS is uniquely suited to comprehensively assess and potentially treat aortic vascular diseases in the future.

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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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