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Focal liver lesions in contrast CT and enhanced ultrasound — Results from a multicentre study
Abstracts
ultrasonic equipment to contrast enhanced scanning and the utilisation of non-linear microbubble properties will impact the future diagnostic opportunities with ultrasound significantly.
C10.8 n
Levovist Enhanced Colour Doppler: Diagnosis of Portal Hypertensive Gastrepathy
M.J. Gebel, K. Caselitz, B. Sterath, C. Boozari, P.N. Schoefl, J.S. Meier, S. Bleck, M.P. Weber. Mums Dept. Gastroenterolosy and Hepatology, Medizinische Hochschule Hamover, Schering Inc., Berlin, FRG.
Portal hypertensive gastropathy (PHG) can cause substantial chronic blood loss in patients with portal hypertension. Up to now there exists no criteria for the diagnosis of PHG by colour Doppler. The aim of this study is to investigate if Levovist enhanced colour Doppler improves the visualisation of gastric blood flow and shows characteristic findings in PHG. Method: 21 patients (10 female, 11 male, aged 36-76 years, average 59 years) with portal hypertension (19 patients with liver cirrhosis: toxic 7, viral 9, PBC 1, cryptogenic 2; 2 patients with portal vein thrombosis without liver cirrhosis) and 9 healthy controls received 300 mg/ml (total 2.5 g) Levovist (Schering Inc, Berlin) i.v. within 5 set (written consent) during examination of the stomach wall by CD (Toshiba 270, 3,75 MHz). Enhancement of CD signals was graded (no, positive, strong positive) and compared to endoscopic findings (PHG grading according to MC Cormac, 1985, examiners unaware of CD findings). Results: Signal enhancement started 20 set after start of injection, reached maximum after 25 set and lasted for 2.30 min. Compared to gastroscopy (GS). 16/18 cases of PHG showed marked increase in CD mucosal signals (16 right pos., 1 false pos., 2 false neg., 11 right neg., sensitivity 89%, specificity 92%) consisting mainly of small mucosal arteries. There was a good agreement of PI-ID grading by endoscopy and Doppler ultrasound (r = 0.94). Conclusion: Contrast enhanced CD supports the concept of small AV-shunts as the morphological basis of PHD and seems to be a very sensitive non-invasive method for the detection of PI-ID.
Objective: To evaluate a new technique using power Doppler imaging in the detection of Colorectal Liver metastases. Subjects and Methods: 10 healthy control subjects and 15 patients with proven liver metastases were studied after 12 hours of fasting. Using ATL3000 (3.5 MHz probe) power Doppler imaging of the hepatic artery and portal vein at the porta hepatis, was performed before and after an intravenous bolus injection of 5ml of Levovist (Schering) (4OOmg/ml concentration). The whole exam which was recorded on SVHS video; Analysis of the temporal changes of the power Doppler signal intensity (PDSI) for the hepatic artery and portal vein was carried out using Adobe Photshop4 software. From the PDSI-Time curves of the hepatic artery and portal vein, contrast enhanced Doppler Perfusion index (CEDPI) which represents the relative hepatic arterial contribution of total liver blood flow can be calculates the ratio of Gl over Gl + G2 where Gl represents the gradient of the hepatic arterial contrast inflow curve and G2 the gradient of the portal venous contrast inflow curve. The time delay (I’D) in the Iirst appearance of contrast within the portal vein relative its iirst appearance in the hepatic artery was also measured. Results:
CEDPI TD (sets)
c1o.9
Contrast Enhanced Doppler Perfusion Index of Colorectal Liver Metastases
E.* Leen, J.H. Anderson, P. Horgan, R. McKee, T.G. Cooke & McArdle. adiorogY Department, Royal Infirmary, Alexandra Parade, Glasgow, G312ER
Controls: N = 1 Mean f sd
Metastases: N = 15 mean + sd
0.34 f 0.05 7.66 f 2.16
0.75 f 0.07* 12.76f 3.48*
There was significant increase in the CEDPI and TD values in patients with metastases compared with controls (*p < 0.0001). There was clear separation of the CEDPI values between the two groups. Conclusion: CEDPI measurement may be useful in the detection of colorectal liver metastases. Although this new technique is quicker to perform (3 minutes) compared with conventional spectral Doppler technique (15-30 minutes), further refinements are still required.
l-l “‘*”
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I
s3.5
Focal Liver Lesions in Contrast CT and Enhanced Ultrasound - Results tkom a Multicentre Study
W. Lees, A. Bauer, S. Delorme, M. Jennett, S. M&e. London, UK, Berlin, Gennany
Echo-enhancement increases mance of Doppler ultrasound
the diagnostic perforfor analysis of low and
Abstracts
S36
slow flow lesions. To investigate the improvement for diagnosis of focal liver lesions, a multicentre study was performed with comparison of diagnostic outcome in normal ultrasound, enhanced ultrasound and Spiral CT. Materials and Methods: Ninety patients with known or suspected liver lesions, scheduled for Spiral CT, were examined in unenhanced ultrasound (B-Mode, Colour, Power). If a lesion was found, Colour and Power Doppler of the liver lesion was performed with a standard bolus of Levovist (Schering AG) in the 300 mg/ml concentration. Thereafter Contrast enhanced Spiral CT was performed by a different investigator. Lesion vascular&y and diagnosis were recorded independently, and compared to the final discharge diagnosis. Results: For assessment of lesion vascularity (categories: hypo/iso/mixed/hyper), agreement of unenhanced and enhanced ultrasound was (k = 0.38) better than agreement of unenhanced (k = 0.23) or enhanced ultrasound (k = 0.21) to Contrast CT. The diagnostic agreement to CT was improved with the use of echoenhancement: in the examination 53 patients (59%) had the same diagnosis than in Contrast CT. The comparison to the final discharge diagnosis (excluding the enhanced ultrasound findings) yielded an agreement in 51 (57%) patients for baseline ultrasound, in 78 (87%) patients in echo-enhanced Doppler and in 73 (81%) patients for Contrast CT. Conclusions: Assessment of lesion vascularity is in reasonable agreement between ultrasound and CT. Since not only the methods, but also the contrast agents behave differently - while Echo-enhancers are strictly confined to the Blood pool, X-ray contrast also exhibits an extracellular phase - this could be expected. The value for diagnostic decision was clearly increased by the use of echo-enhances, improving the diagnostic agreement to discharge diagnosis from 57% to 87%. In comparison to final diagnostic decision, enhanced ultrasound was at lease as good as Contrast enhanced Spiral CT. Repeated examinations and follow up may be done with enhanced Ultrasound at comparable quality with less cost and radiation exposure.
study seventeen patients (age range 57-81) attending for TRUS prostate biopsy were given two intravenous injections each (a total of 34 injections) of BRl (Bracco, Milan, Italy). All patients had a focal greyscale abnormality. Greyscale (GS) and Colour Doppler Energy (CDE) was recorded at baseline in all patients and continuous S-VI-IS recordings were obtained during contrast enhancement. Injections were separated by at least 10 minutes. The focal parenchymal lesions were targeted at biopsy and random biopsies were also taken. Pathological confirmation of random and target lesions were obtained in all cases. Results: A total of 10 adenocarcinomas were found in 17 patients: target biopsy was diagnostic in 6/10 and random biopsy revealed a further 4 foci of adenocarcinoma. The remaining focal lesions constituted hyperplasia, atrophy, prostatitis or combinations of these. Of the 17 target lesions, 15 were available for vascular analysis. Lesions were characterised as to whether there were focal vessels within or around the lesion. The location and degree of enhancement of these vessels was evaluated using a combination of the baseline and the maximum enhanced postcontrast study. 5 lesions with a vascular pattern predominantly around the focal area displayed hyperplasia, atrophy or prostatitis. 10 lesions with vascularity within the focal area revealed adenocarcinoma in 5 and hyperplasia or prostatitis in 5. Conclusion: The presence of a baseline and/or an enhanced vascular pattern within a focal prostate greyscale lesion may be a useful additional indicator of the presence of malignancy. This does not obviate the need for other targeted biopsies or sextant biopsy. Further work with a larger series of patients needs to be undertaken.
w
Interpretation of Prostatic Blood Flow A Helpful Addition for Diierential Diagnosis?
R.G. Aarnink, H.P. Beerlage, J. de la Rosette. Dept. of Urology, UniversityHospital Nijmegen, The Netherlands Evaluation of BRl in Characterisation of Vascular&y in Focal Prostate Lesions P. Kiely, A. Quinn, J. Boultbee. Department of Zmagiq, Char&
Cross Hospital, London
Purpose: To evaluate BRl in characterisation of vascularity in focal prostate lesions. Materials & Methods: As part of a phase II clinical
The number of newly diagnosed prostate cancers has increased dramatically over the past decade, and the trend is expected to continue in the future. The diagnostic tests applied routinely in the urology clinic, however, perform suboptimal: the combination of prostate specific antigen value, digital rectal examination and transrectal ultrasound results in a large amount of
ultrasonic equipment to contrast enhanced scanning and the utilisation of non-linear microbubble properties will impact the future diagnostic opportunities with ultrasound significantly.
C10.8 n
Levovist Enhanced Colour Doppler: Diagnosis of Portal Hypertensive Gastrepathy
M.J. Gebel, K. Caselitz, B. Sterath, C. Boozari, P.N. Schoefl, J.S. Meier, S. Bleck, M.P. Weber. Mums Dept. Gastroenterolosy and Hepatology, Medizinische Hochschule Hamover, Schering Inc., Berlin, FRG.
Portal hypertensive gastropathy (PHG) can cause substantial chronic blood loss in patients with portal hypertension. Up to now there exists no criteria for the diagnosis of PHG by colour Doppler. The aim of this study is to investigate if Levovist enhanced colour Doppler improves the visualisation of gastric blood flow and shows characteristic findings in PHG. Method: 21 patients (10 female, 11 male, aged 36-76 years, average 59 years) with portal hypertension (19 patients with liver cirrhosis: toxic 7, viral 9, PBC 1, cryptogenic 2; 2 patients with portal vein thrombosis without liver cirrhosis) and 9 healthy controls received 300 mg/ml (total 2.5 g) Levovist (Schering Inc, Berlin) i.v. within 5 set (written consent) during examination of the stomach wall by CD (Toshiba 270, 3,75 MHz). Enhancement of CD signals was graded (no, positive, strong positive) and compared to endoscopic findings (PHG grading according to MC Cormac, 1985, examiners unaware of CD findings). Results: Signal enhancement started 20 set after start of injection, reached maximum after 25 set and lasted for 2.30 min. Compared to gastroscopy (GS). 16/18 cases of PHG showed marked increase in CD mucosal signals (16 right pos., 1 false pos., 2 false neg., 11 right neg., sensitivity 89%, specificity 92%) consisting mainly of small mucosal arteries. There was a good agreement of PI-ID grading by endoscopy and Doppler ultrasound (r = 0.94). Conclusion: Contrast enhanced CD supports the concept of small AV-shunts as the morphological basis of PHD and seems to be a very sensitive non-invasive method for the detection of PI-ID.
Objective: To evaluate a new technique using power Doppler imaging in the detection of Colorectal Liver metastases. Subjects and Methods: 10 healthy control subjects and 15 patients with proven liver metastases were studied after 12 hours of fasting. Using ATL3000 (3.5 MHz probe) power Doppler imaging of the hepatic artery and portal vein at the porta hepatis, was performed before and after an intravenous bolus injection of 5ml of Levovist (Schering) (4OOmg/ml concentration). The whole exam which was recorded on SVHS video; Analysis of the temporal changes of the power Doppler signal intensity (PDSI) for the hepatic artery and portal vein was carried out using Adobe Photshop4 software. From the PDSI-Time curves of the hepatic artery and portal vein, contrast enhanced Doppler Perfusion index (CEDPI) which represents the relative hepatic arterial contribution of total liver blood flow can be calculates the ratio of Gl over Gl + G2 where Gl represents the gradient of the hepatic arterial contrast inflow curve and G2 the gradient of the portal venous contrast inflow curve. The time delay (I’D) in the Iirst appearance of contrast within the portal vein relative its iirst appearance in the hepatic artery was also measured. Results:
CEDPI TD (sets)
c1o.9
Contrast Enhanced Doppler Perfusion Index of Colorectal Liver Metastases
E.* Leen, J.H. Anderson, P. Horgan, R. McKee, T.G. Cooke & McArdle. adiorogY Department, Royal Infirmary, Alexandra Parade, Glasgow, G312ER
Controls: N = 1 Mean f sd
Metastases: N = 15 mean + sd
0.34 f 0.05 7.66 f 2.16
0.75 f 0.07* 12.76f 3.48*
There was significant increase in the CEDPI and TD values in patients with metastases compared with controls (*p < 0.0001). There was clear separation of the CEDPI values between the two groups. Conclusion: CEDPI measurement may be useful in the detection of colorectal liver metastases. Although this new technique is quicker to perform (3 minutes) compared with conventional spectral Doppler technique (15-30 minutes), further refinements are still required.
l-l “‘*”
-
I
s3.5
Focal Liver Lesions in Contrast CT and Enhanced Ultrasound - Results tkom a Multicentre Study
W. Lees, A. Bauer, S. Delorme, M. Jennett, S. M&e. London, UK, Berlin, Gennany
Echo-enhancement increases mance of Doppler ultrasound
the diagnostic perforfor analysis of low and
Abstracts
S36
slow flow lesions. To investigate the improvement for diagnosis of focal liver lesions, a multicentre study was performed with comparison of diagnostic outcome in normal ultrasound, enhanced ultrasound and Spiral CT. Materials and Methods: Ninety patients with known or suspected liver lesions, scheduled for Spiral CT, were examined in unenhanced ultrasound (B-Mode, Colour, Power). If a lesion was found, Colour and Power Doppler of the liver lesion was performed with a standard bolus of Levovist (Schering AG) in the 300 mg/ml concentration. Thereafter Contrast enhanced Spiral CT was performed by a different investigator. Lesion vascular&y and diagnosis were recorded independently, and compared to the final discharge diagnosis. Results: For assessment of lesion vascularity (categories: hypo/iso/mixed/hyper), agreement of unenhanced and enhanced ultrasound was (k = 0.38) better than agreement of unenhanced (k = 0.23) or enhanced ultrasound (k = 0.21) to Contrast CT. The diagnostic agreement to CT was improved with the use of echoenhancement: in the examination 53 patients (59%) had the same diagnosis than in Contrast CT. The comparison to the final discharge diagnosis (excluding the enhanced ultrasound findings) yielded an agreement in 51 (57%) patients for baseline ultrasound, in 78 (87%) patients in echo-enhanced Doppler and in 73 (81%) patients for Contrast CT. Conclusions: Assessment of lesion vascularity is in reasonable agreement between ultrasound and CT. Since not only the methods, but also the contrast agents behave differently - while Echo-enhancers are strictly confined to the Blood pool, X-ray contrast also exhibits an extracellular phase - this could be expected. The value for diagnostic decision was clearly increased by the use of echo-enhances, improving the diagnostic agreement to discharge diagnosis from 57% to 87%. In comparison to final diagnostic decision, enhanced ultrasound was at lease as good as Contrast enhanced Spiral CT. Repeated examinations and follow up may be done with enhanced Ultrasound at comparable quality with less cost and radiation exposure.
study seventeen patients (age range 57-81) attending for TRUS prostate biopsy were given two intravenous injections each (a total of 34 injections) of BRl (Bracco, Milan, Italy). All patients had a focal greyscale abnormality. Greyscale (GS) and Colour Doppler Energy (CDE) was recorded at baseline in all patients and continuous S-VI-IS recordings were obtained during contrast enhancement. Injections were separated by at least 10 minutes. The focal parenchymal lesions were targeted at biopsy and random biopsies were also taken. Pathological confirmation of random and target lesions were obtained in all cases. Results: A total of 10 adenocarcinomas were found in 17 patients: target biopsy was diagnostic in 6/10 and random biopsy revealed a further 4 foci of adenocarcinoma. The remaining focal lesions constituted hyperplasia, atrophy, prostatitis or combinations of these. Of the 17 target lesions, 15 were available for vascular analysis. Lesions were characterised as to whether there were focal vessels within or around the lesion. The location and degree of enhancement of these vessels was evaluated using a combination of the baseline and the maximum enhanced postcontrast study. 5 lesions with a vascular pattern predominantly around the focal area displayed hyperplasia, atrophy or prostatitis. 10 lesions with vascularity within the focal area revealed adenocarcinoma in 5 and hyperplasia or prostatitis in 5. Conclusion: The presence of a baseline and/or an enhanced vascular pattern within a focal prostate greyscale lesion may be a useful additional indicator of the presence of malignancy. This does not obviate the need for other targeted biopsies or sextant biopsy. Further work with a larger series of patients needs to be undertaken.
w
Interpretation of Prostatic Blood Flow A Helpful Addition for Diierential Diagnosis?
R.G. Aarnink, H.P. Beerlage, J. de la Rosette. Dept. of Urology, UniversityHospital Nijmegen, The Netherlands Evaluation of BRl in Characterisation of Vascular&y in Focal Prostate Lesions P. Kiely, A. Quinn, J. Boultbee. Department of Zmagiq, Char&
Cross Hospital, London
Purpose: To evaluate BRl in characterisation of vascularity in focal prostate lesions. Materials & Methods: As part of a phase II clinical
The number of newly diagnosed prostate cancers has increased dramatically over the past decade, and the trend is expected to continue in the future. The diagnostic tests applied routinely in the urology clinic, however, perform suboptimal: the combination of prostate specific antigen value, digital rectal examination and transrectal ultrasound results in a large amount of