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0253: Burst Mode Ultrasound with Contrast Agent Injures Cardiomyocytes in Vivo
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Ultrasound in Medicine and Biology
Volume 35, Number 8S, 2009
all segments were significantly lower that those in group A (P ⬍O.O5).however, radial velocity, strain, strain rate and LVEF in group A, B, C, D were of no statistical significance(P ⬎O.O5).The pathological examination demonstrated that the damage severity was progressively increased from groups B to C to D. Conclusions: The different VVI between longitudinal and radial contractility was helpful for our recognition of early adriamycin-induced myocardial pathological damage by imaging method. Keywords: Velocity Vector Imaging, Adriamycin, Left ventricular, Longitudinal, Radial
were 3,112 examinees positive for HBs antigen, 2,759 with family history of liver diseases and 2,137 with previous transfusion. Of the total 10,550 cases examined, 78 HCC cases (0.74%) were detected, besides other malignant tumors reached 91cases. The serum battery tests were carried out in parallel and a significant number of sera disclosed liver dysfunction and nonAnonB hepatitis related sera were later identified as C type hepatitis. A total of 60 cases received treatment: surgical resection, TAE:, PEIT, and TAI. The cumulative survival rate was calculated by Kaplan-Meier method.
0253
0256
Burst Mode Ultrasound with Contrast Agent Injures Cardiomyocytes in Vivo Douglas L Miller, University of Michigan, United States Chunyan Dou, United States Benedict R Lucchesi, United States
Value of Contrast Enhanced Ultrasound in Diagnosis of Early Hepatocellular Carcinoma Min-Hua Chen, Peking University, China
Premature ventricular complexes (PVCs) have been reported for ultrasound with gas body contrast agent for diagnostic B-mode and also for burst mode at substantially lower peak rarefactional pressure amplitudes (PRPAs). For B mode, injured cardiomyocytes have been associated with the PVCs. The objective was to determine if the PVCs induced by burst mode at lower PRPAs are associated with cardiomyocyte injury. Anesthetized hairless rats were exposed to focused 1.5 MHz ultrasound in a water bath. Evans blue dye was injected IP at 100 mg/kg in saline. 2 ms bursts or square envelopes of 1.8 s pulses with 230 s spacing (simulated B-mode) were triggered 1:4 at end systole during 300 s exposures. Definity™ contrast agent was diluted in saline and infused IV at 10 L/kg/min. PVCs were observed on ECG recordings and stained cardiomyocytes were counted in frozen sections from heart samples taken the next day. Results are reported as means ⫾ one standard deviation for 5-rat groups. Pulsed ultrasound at 2.0 MPa PRPA induced 148⫾50 PVCs and 960⫾220 stained cardiomyocytes, both statistically significant relative to shams (P⬍0.01), but neither effect was significant at 1.0 MPa. Ultrasound bursts produced significant (P⬍0.01) PVCs and stained cardiomyocytes of 222⫾17 and 370⫾239, respectively, at 1.0 MPa and 77⫾43 and 271⫾74, respectively, at 0.5 MPa, but not at 0.25 MPa. PVCs induced by burst mode ultrasound at substantially lower PRPAs than for pulsed ultrasound were associated with a significant increase in irreversible cardiomyocyte injury. 0254 Mass Survey for Hepatocellular Carcinoma in High Risk Groups Morimichi Fukuda, Sapporo Med. University, Japan Hepatocellular carcinoma(HCC) is the most common cause of cancer death in Asia, including Japan, and despite remarkable advances in the diagnosis and treatment of HCC, prognosis remains poor and early detection of HCC is an urgent subject. As early as 1981, we have investigated ultrasound mass screening of groups with a high risk for HCC, once a year in the five major cities in Hokkaido Prefecture, Japan, for 10 years with collaboration of volunteer groups. To facilitate efficient screening, high-risk group for HCC were selected: previous history of liver disease, with liver dysfunction, with family history of liver disease, with previous blood transfusion, and carriers of hepatitis B virus and with a history of non-A, non-B viral hepatitis. US examination was carried out using 5 - 7 units of real time US machines by sonographers under supervision by sonologist. Of a total of 10,550 cases examined, sex ratio was 1.39/1.0 males, the average age was 48.8 year for males and 49.5 years for females. There
Purpose: To identify enhancing phases of liver in contrast enhanced ultrasound (CEUS) and enhancing features of hepatocellular carcinoma (HCC). Methods: CEUS were performed in 253 HCC of 206 patients with liver cirrhosis. The enhancing start times after injection for hepatic artery, portal vein, and liver parenchyma and peak parenchymal enhancing time were recorded. Enhancing patterns of HCC were also analyzed. The diagnostic value of CEUS for HCC was evaluated. Results: CEUS process is divided into four phases after contrast injection: arterial phase (5.8 - 18.4 seconds) begins when hepatic artery shows enhancement, portal venous phase (8.7 - 23.8 seconds) begins when portal vein shows enhancement, parenchymal phase (17.6 - 38.1 seconds) begins when parenchymal enhancement reaches peak, and delayed phase (180 360 seconds). In 253 HCC, 94.1% (238 lesions) showed arterial enhancement, and 5.9% (15 lesions) portal enhancement. There were 7.5% (19 lesions) HCC washed out in portal venous phase, 77.1% (195 lesions) in parenchymal phase, and 11.1% (28 lesions) in delayed phase. Eleven HCC (4.3% ) showed no contrast wash out. In arterial phase, 60.1% of the HCC showed gross homogeneous enhancement, 33.2% showed heterogeneous enhancement or necrosis, and 2.4% peripheral nodular enhancement. There were 4.3% HCC showed delayed enhancement. There were 53.4% HCC showed basket-like feeding vessels or tortuous vessels inside the tumor in arterial phase. “Early-in-early-out” and “early-in-late-out” patterns were seen in 91.7% HCC, and 2.4% were “early-in-no-out”. Atypical patterns of “late-in-early-out” and “late-in-late/no-out” were seen in 6% HCC. Conclusion: CEUS diagnostic criteria of HCC is proposed based on enhancing timings, enhancing and wash out patterns of the lesions. 0259 The Diagnosis of Fetal Anomalies in the 1st Trimester Beryl Benacerraf, WFUMB Councillor, United States Sonographic evaluation of the first-trimester fetus is now far more prevalent, owing to the incorporation of the nuchal translucency measurement in the standard screening of most pregnant women. We are, therefore, given the opportunity to evaluate 11- to 13-week fetuses on a regular basis. This evaluation can be done in 2-D and 3-D and includes careful visualization of the contour of the fetus. Detectable abnormalities include encephaloceles, acrania, anterior abdominal wall defects, limb-body wall defects, and amniotic band syndrome. These are abnormalities in which the contour of the fetus is disrupted. Other anomalies also detectable in some cases include heart defects, intracranial abnormalities, severe skeletal dysplasias, and, of course, chromosomal abnormalities. There is a definite trend toward the earlier examination of the fetus, so that major malformations can be detected before the second trimester. The types of malformations detectable early will be shown during this lecture.
Ultrasound in Medicine and Biology
Volume 35, Number 8S, 2009
all segments were significantly lower that those in group A (P ⬍O.O5).however, radial velocity, strain, strain rate and LVEF in group A, B, C, D were of no statistical significance(P ⬎O.O5).The pathological examination demonstrated that the damage severity was progressively increased from groups B to C to D. Conclusions: The different VVI between longitudinal and radial contractility was helpful for our recognition of early adriamycin-induced myocardial pathological damage by imaging method. Keywords: Velocity Vector Imaging, Adriamycin, Left ventricular, Longitudinal, Radial
were 3,112 examinees positive for HBs antigen, 2,759 with family history of liver diseases and 2,137 with previous transfusion. Of the total 10,550 cases examined, 78 HCC cases (0.74%) were detected, besides other malignant tumors reached 91cases. The serum battery tests were carried out in parallel and a significant number of sera disclosed liver dysfunction and nonAnonB hepatitis related sera were later identified as C type hepatitis. A total of 60 cases received treatment: surgical resection, TAE:, PEIT, and TAI. The cumulative survival rate was calculated by Kaplan-Meier method.
0253
0256
Burst Mode Ultrasound with Contrast Agent Injures Cardiomyocytes in Vivo Douglas L Miller, University of Michigan, United States Chunyan Dou, United States Benedict R Lucchesi, United States
Value of Contrast Enhanced Ultrasound in Diagnosis of Early Hepatocellular Carcinoma Min-Hua Chen, Peking University, China
Premature ventricular complexes (PVCs) have been reported for ultrasound with gas body contrast agent for diagnostic B-mode and also for burst mode at substantially lower peak rarefactional pressure amplitudes (PRPAs). For B mode, injured cardiomyocytes have been associated with the PVCs. The objective was to determine if the PVCs induced by burst mode at lower PRPAs are associated with cardiomyocyte injury. Anesthetized hairless rats were exposed to focused 1.5 MHz ultrasound in a water bath. Evans blue dye was injected IP at 100 mg/kg in saline. 2 ms bursts or square envelopes of 1.8 s pulses with 230 s spacing (simulated B-mode) were triggered 1:4 at end systole during 300 s exposures. Definity™ contrast agent was diluted in saline and infused IV at 10 L/kg/min. PVCs were observed on ECG recordings and stained cardiomyocytes were counted in frozen sections from heart samples taken the next day. Results are reported as means ⫾ one standard deviation for 5-rat groups. Pulsed ultrasound at 2.0 MPa PRPA induced 148⫾50 PVCs and 960⫾220 stained cardiomyocytes, both statistically significant relative to shams (P⬍0.01), but neither effect was significant at 1.0 MPa. Ultrasound bursts produced significant (P⬍0.01) PVCs and stained cardiomyocytes of 222⫾17 and 370⫾239, respectively, at 1.0 MPa and 77⫾43 and 271⫾74, respectively, at 0.5 MPa, but not at 0.25 MPa. PVCs induced by burst mode ultrasound at substantially lower PRPAs than for pulsed ultrasound were associated with a significant increase in irreversible cardiomyocyte injury. 0254 Mass Survey for Hepatocellular Carcinoma in High Risk Groups Morimichi Fukuda, Sapporo Med. University, Japan Hepatocellular carcinoma(HCC) is the most common cause of cancer death in Asia, including Japan, and despite remarkable advances in the diagnosis and treatment of HCC, prognosis remains poor and early detection of HCC is an urgent subject. As early as 1981, we have investigated ultrasound mass screening of groups with a high risk for HCC, once a year in the five major cities in Hokkaido Prefecture, Japan, for 10 years with collaboration of volunteer groups. To facilitate efficient screening, high-risk group for HCC were selected: previous history of liver disease, with liver dysfunction, with family history of liver disease, with previous blood transfusion, and carriers of hepatitis B virus and with a history of non-A, non-B viral hepatitis. US examination was carried out using 5 - 7 units of real time US machines by sonographers under supervision by sonologist. Of a total of 10,550 cases examined, sex ratio was 1.39/1.0 males, the average age was 48.8 year for males and 49.5 years for females. There
Purpose: To identify enhancing phases of liver in contrast enhanced ultrasound (CEUS) and enhancing features of hepatocellular carcinoma (HCC). Methods: CEUS were performed in 253 HCC of 206 patients with liver cirrhosis. The enhancing start times after injection for hepatic artery, portal vein, and liver parenchyma and peak parenchymal enhancing time were recorded. Enhancing patterns of HCC were also analyzed. The diagnostic value of CEUS for HCC was evaluated. Results: CEUS process is divided into four phases after contrast injection: arterial phase (5.8 - 18.4 seconds) begins when hepatic artery shows enhancement, portal venous phase (8.7 - 23.8 seconds) begins when portal vein shows enhancement, parenchymal phase (17.6 - 38.1 seconds) begins when parenchymal enhancement reaches peak, and delayed phase (180 360 seconds). In 253 HCC, 94.1% (238 lesions) showed arterial enhancement, and 5.9% (15 lesions) portal enhancement. There were 7.5% (19 lesions) HCC washed out in portal venous phase, 77.1% (195 lesions) in parenchymal phase, and 11.1% (28 lesions) in delayed phase. Eleven HCC (4.3% ) showed no contrast wash out. In arterial phase, 60.1% of the HCC showed gross homogeneous enhancement, 33.2% showed heterogeneous enhancement or necrosis, and 2.4% peripheral nodular enhancement. There were 4.3% HCC showed delayed enhancement. There were 53.4% HCC showed basket-like feeding vessels or tortuous vessels inside the tumor in arterial phase. “Early-in-early-out” and “early-in-late-out” patterns were seen in 91.7% HCC, and 2.4% were “early-in-no-out”. Atypical patterns of “late-in-early-out” and “late-in-late/no-out” were seen in 6% HCC. Conclusion: CEUS diagnostic criteria of HCC is proposed based on enhancing timings, enhancing and wash out patterns of the lesions. 0259 The Diagnosis of Fetal Anomalies in the 1st Trimester Beryl Benacerraf, WFUMB Councillor, United States Sonographic evaluation of the first-trimester fetus is now far more prevalent, owing to the incorporation of the nuchal translucency measurement in the standard screening of most pregnant women. We are, therefore, given the opportunity to evaluate 11- to 13-week fetuses on a regular basis. This evaluation can be done in 2-D and 3-D and includes careful visualization of the contour of the fetus. Detectable abnormalities include encephaloceles, acrania, anterior abdominal wall defects, limb-body wall defects, and amniotic band syndrome. These are abnormalities in which the contour of the fetus is disrupted. Other anomalies also detectable in some cases include heart defects, intracranial abnormalities, severe skeletal dysplasias, and, of course, chromosomal abnormalities. There is a definite trend toward the earlier examination of the fetus, so that major malformations can be detected before the second trimester. The types of malformations detectable early will be shown during this lecture.