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Evaluation of Indeterminate Renal Masses with CEUS
S32
Ultrasound in Medicine and Biology
Results: Time-resolved PA flow estimation was within 2.3% to the invasive gold standard. Non-PVP processed data yield 50 to 100% higher flow readings. PA waveform indicated delayed time-to-peak compared with aortic waveform. Conclusion: Similar to cardiac MRI, PVP is essential in cardiac flow imaging. Doppler power serves as a non-invasive method without the need for contrast injection.
SS 16.10 The Importance of Intraoperative Transesophageal Echocardiography for Endovascular Repair of Thoracic Aortic Dissection and Pulmonary Vein Stenosis: Twenty-One Case Reviews, Single-Centre Experience S. Kudrnova,1 A. Doros,2 A. Apor,3 L. Geller,1 K. H€uttl1 1 Cardiology Center, Semmelweis University, Budapest/HU, 2 Transplantation and Surgery, Semmelweis University, Budapest/HU, 3 Semmelweis University, Budapest/HU Purpose: TEE represents a sensitive imaging modality for aortic and pulmonary vein disease. We review our experience with multiplanar TEE in planning and execution of percutaneous treatment of iatrogenic pulmonary vein stenosis and thoracic aortic dissections. Material & Methods: Ten PVS interventions were performed using 3D TEE supplementing angiography for transeptal puncture guidance, stent positioning, blood-flow monitoring, pre- and-post procedural pressure and velocity gradient measurements. TEE has been used in 11 EVAR cases to identify the extent of the aneurysmal sac, guide stent deployment and subsequently detect flow within the aneurysmal sac. Results: TEE offered crucial spatial information about the atria, foramen ovale, PVostia, stent positioning, pre- and-postprocedural pressure and velocity gradients in all ten cases of PVS interventions. Realtime TEE has shown to be a valuable tool for identifying aortic pathology (11 cases), confirming guidewire placement into the true lumen (8), aiding stentgraft positioning (11) and the most sensitive imaging modality for endoleak detection immediately after stentgraft deployment (2). TEE provided useful information regarding cardiac function during endovascular procedures. Conclusion: Intraoperative TEE has in our centre proved to be an essential supplement to angiography in providing fast and complete pathomorphological information, improving spatial orientation, allowing continuous monitoring of the procedures and thus significantly increasing their safety, accuracy, and efficacy, also improving their outcomes and not less importantly, lowering radiation dose and contrast material use.
SS 16.11 Real-Time Sonographic Position Monitoring of Central Venous Catheters by Microbubble-Injection: Development of a New Procedure S. S. Schellknecht,1 F. H. Seeger,2 M. Campo Dell’ortho,3 R. Breitkreutz4 1 Universit€ at, Johann-Wolfgang-Goethe-Universit€at, Frankfurt am Main/DE, 2Johann-Wolfgang-Goethe-Universit€at, Frankfurt am Main/DE, 3Kerckhoff Klinik Bad Nauheim, Bad Nauheim/DE, 4 Universit€ atsklinikum des Saarlandes, Homburg/Saar/DE Purpose: This study aimed to develop a new non-invasive, ultrasoundbased procedure to determine orthotopic central venous catheter (CVC) position by sonographic detection of injected microbubbles (MB). Material & Methods: With approval of the local ethics committee n 5 95 patients with CVC or other catheters were examined. The appearance of MB in the right heart can be observed after injection of agitated saline in the subcostal four-chamber view. MB represent themselves hyperechogenic and dissolve later. By M-Mode registration, time of appear-
Volume 37, Number 8S, 2011 ance can be quantified. To determine positioning, time of appearance of MB, workflow and physicians evaluation were analysed. Results: Orthotopic position was confirmed in 95 patients when MB appeared in the right heart in less than one second after injection with a reliability of 100%. In 8 patients, quantitatively measured appearance of MB was 0.56 (0.2) seconds (mean, (SD)). In 5 patients with peripheral venous catheters MB were observed later than 2 sec after injection and in one patient with a heterotopic CVC within 1-2 seconds after injection. Duration of the procedure was 146 (111) seconds (mean, (SD)). Physician’s impression of practicalness was 91% (linear analogue self assessment). Conclusion: Ultrasound-based real-time position monitoring of CVC by this new description of the MB-injection technique has the potential to serve as an alternative to X-ray or other methods.
Sun, Aug 28, 2011 Hall G SS 17 10:30-12:00 Genitourinary 2 - Renal Mass Lesions SS 17.02 Evaluation of Indeterminate Renal Masses with CEUS R. G. Barr Radiology, Radiology Consultants Inc, Youngstown/OH/US Purpose: To evaulate the utility of CEUS in evaluating indeterminate renal masses. Material & Methods: The records of 721 patients referred over 11 years for CEUS for an indeterminate renal mass identified on another imaging study were reviewed. Exams prompting the CEUS were reviewed for Bozniac classification. State-of-the-art equipment at the time the exams was used. Definity and Optison were used at recommended doses for the contrast-specific software at that time exams were performed. One to three doses were utilized. Lesions were classified as benign or malignant based on lesion blood flow as previously described. Results: CEUS was performed in 721 patients who had 1018 lesions (2161mm). Of these lesions 306 (30.0%) had a confirmed diagnosis after work-up while 712 (70.0%) continued in follow-up. Of the 306 lesions with definitive diagnosis, 142 (46.4%) were malignant and 164 (53.6%) were benign. CEUS classified 142/142 pathologic malignant lesions as malignant and 159/164 pathologic benign lesions as benign, resulting in a positive predictive value of 100% and a negative predictive value of 97%. Of the 712 lesions without definitive diagnosis 673 (94.5%) were classified as benign, 32 (4.5%) were classified as malignant, and 7 (1.0%) were classified as indeterminate. Conclusion: CEUS can characterize indeterminate renal masses with high positive or negative predictive value.
SS 17.03 Importance of CEUS in Recurrent Renal Carcinoma Treated with VEGF-Inhibitor Bevacizumab M. L. Gliga,1 A. Gomotarceanu,2 D. Podeanu,3 C. Cozma,2 I. Torok,1 S. Voicu,1 A. Botianu,1 G. Dogaru,4 A. Vacar5 1 Internal Medicine, University of Medicine and Pharmacy, Targu Mures/RO, 2Topmed medical Center, targu Mures/RO, 3Radiology, University of Medicine and Pharmacy, Tg Mures/RO, 4Nephrology, University of Medicine and Pharmacy, Tg Mures/RO, 5Oncology, County Hospital, Tg Mures/RO Purpose: We report a case admitted to the nephrology department for the recurrence of a right renal cell carcinoma, one year after right
Ultrasound in Medicine and Biology
Results: Time-resolved PA flow estimation was within 2.3% to the invasive gold standard. Non-PVP processed data yield 50 to 100% higher flow readings. PA waveform indicated delayed time-to-peak compared with aortic waveform. Conclusion: Similar to cardiac MRI, PVP is essential in cardiac flow imaging. Doppler power serves as a non-invasive method without the need for contrast injection.
SS 16.10 The Importance of Intraoperative Transesophageal Echocardiography for Endovascular Repair of Thoracic Aortic Dissection and Pulmonary Vein Stenosis: Twenty-One Case Reviews, Single-Centre Experience S. Kudrnova,1 A. Doros,2 A. Apor,3 L. Geller,1 K. H€uttl1 1 Cardiology Center, Semmelweis University, Budapest/HU, 2 Transplantation and Surgery, Semmelweis University, Budapest/HU, 3 Semmelweis University, Budapest/HU Purpose: TEE represents a sensitive imaging modality for aortic and pulmonary vein disease. We review our experience with multiplanar TEE in planning and execution of percutaneous treatment of iatrogenic pulmonary vein stenosis and thoracic aortic dissections. Material & Methods: Ten PVS interventions were performed using 3D TEE supplementing angiography for transeptal puncture guidance, stent positioning, blood-flow monitoring, pre- and-post procedural pressure and velocity gradient measurements. TEE has been used in 11 EVAR cases to identify the extent of the aneurysmal sac, guide stent deployment and subsequently detect flow within the aneurysmal sac. Results: TEE offered crucial spatial information about the atria, foramen ovale, PVostia, stent positioning, pre- and-postprocedural pressure and velocity gradients in all ten cases of PVS interventions. Realtime TEE has shown to be a valuable tool for identifying aortic pathology (11 cases), confirming guidewire placement into the true lumen (8), aiding stentgraft positioning (11) and the most sensitive imaging modality for endoleak detection immediately after stentgraft deployment (2). TEE provided useful information regarding cardiac function during endovascular procedures. Conclusion: Intraoperative TEE has in our centre proved to be an essential supplement to angiography in providing fast and complete pathomorphological information, improving spatial orientation, allowing continuous monitoring of the procedures and thus significantly increasing their safety, accuracy, and efficacy, also improving their outcomes and not less importantly, lowering radiation dose and contrast material use.
SS 16.11 Real-Time Sonographic Position Monitoring of Central Venous Catheters by Microbubble-Injection: Development of a New Procedure S. S. Schellknecht,1 F. H. Seeger,2 M. Campo Dell’ortho,3 R. Breitkreutz4 1 Universit€ at, Johann-Wolfgang-Goethe-Universit€at, Frankfurt am Main/DE, 2Johann-Wolfgang-Goethe-Universit€at, Frankfurt am Main/DE, 3Kerckhoff Klinik Bad Nauheim, Bad Nauheim/DE, 4 Universit€ atsklinikum des Saarlandes, Homburg/Saar/DE Purpose: This study aimed to develop a new non-invasive, ultrasoundbased procedure to determine orthotopic central venous catheter (CVC) position by sonographic detection of injected microbubbles (MB). Material & Methods: With approval of the local ethics committee n 5 95 patients with CVC or other catheters were examined. The appearance of MB in the right heart can be observed after injection of agitated saline in the subcostal four-chamber view. MB represent themselves hyperechogenic and dissolve later. By M-Mode registration, time of appear-
Volume 37, Number 8S, 2011 ance can be quantified. To determine positioning, time of appearance of MB, workflow and physicians evaluation were analysed. Results: Orthotopic position was confirmed in 95 patients when MB appeared in the right heart in less than one second after injection with a reliability of 100%. In 8 patients, quantitatively measured appearance of MB was 0.56 (0.2) seconds (mean, (SD)). In 5 patients with peripheral venous catheters MB were observed later than 2 sec after injection and in one patient with a heterotopic CVC within 1-2 seconds after injection. Duration of the procedure was 146 (111) seconds (mean, (SD)). Physician’s impression of practicalness was 91% (linear analogue self assessment). Conclusion: Ultrasound-based real-time position monitoring of CVC by this new description of the MB-injection technique has the potential to serve as an alternative to X-ray or other methods.
Sun, Aug 28, 2011 Hall G SS 17 10:30-12:00 Genitourinary 2 - Renal Mass Lesions SS 17.02 Evaluation of Indeterminate Renal Masses with CEUS R. G. Barr Radiology, Radiology Consultants Inc, Youngstown/OH/US Purpose: To evaulate the utility of CEUS in evaluating indeterminate renal masses. Material & Methods: The records of 721 patients referred over 11 years for CEUS for an indeterminate renal mass identified on another imaging study were reviewed. Exams prompting the CEUS were reviewed for Bozniac classification. State-of-the-art equipment at the time the exams was used. Definity and Optison were used at recommended doses for the contrast-specific software at that time exams were performed. One to three doses were utilized. Lesions were classified as benign or malignant based on lesion blood flow as previously described. Results: CEUS was performed in 721 patients who had 1018 lesions (2161mm). Of these lesions 306 (30.0%) had a confirmed diagnosis after work-up while 712 (70.0%) continued in follow-up. Of the 306 lesions with definitive diagnosis, 142 (46.4%) were malignant and 164 (53.6%) were benign. CEUS classified 142/142 pathologic malignant lesions as malignant and 159/164 pathologic benign lesions as benign, resulting in a positive predictive value of 100% and a negative predictive value of 97%. Of the 712 lesions without definitive diagnosis 673 (94.5%) were classified as benign, 32 (4.5%) were classified as malignant, and 7 (1.0%) were classified as indeterminate. Conclusion: CEUS can characterize indeterminate renal masses with high positive or negative predictive value.
SS 17.03 Importance of CEUS in Recurrent Renal Carcinoma Treated with VEGF-Inhibitor Bevacizumab M. L. Gliga,1 A. Gomotarceanu,2 D. Podeanu,3 C. Cozma,2 I. Torok,1 S. Voicu,1 A. Botianu,1 G. Dogaru,4 A. Vacar5 1 Internal Medicine, University of Medicine and Pharmacy, Targu Mures/RO, 2Topmed medical Center, targu Mures/RO, 3Radiology, University of Medicine and Pharmacy, Tg Mures/RO, 4Nephrology, University of Medicine and Pharmacy, Tg Mures/RO, 5Oncology, County Hospital, Tg Mures/RO Purpose: We report a case admitted to the nephrology department for the recurrence of a right renal cell carcinoma, one year after right