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IMO 1220 New sonographical approaches in the evaluation of the vascular architecture and resistive index (RI) in focal nodular hyperplasias (FNH) of the liver
INTERNAL MEDICINE
IMO 1220 New sonographical approaches in the evaluation of the vascular architecture and resistive index (RI) in focal nodular hyperplasias (FNH) of the liver. M. Upgowitzer, C. Kugler , R. Stacher, L. Machan, R. Groell Purpose: To assessthe value of a new transpumonary, galactosebaseQ intravascular contrast agent, SHLJ 508A (Lcvovist”), without and with the combimmtion of harmonic imaging and the three-dimensional power Doppler mode in the depiction of the intratumoral vascularity and the assessmentof hemodynamic parameters (RI) in FNH’s of the liver. Methods and Material: 12 patients with anamncstically known or histologically proven FNH’s of the liver underwent examination with 400 mg/ml SHU 508A (L.cvovist@)after informed consent to evaluate the intratumoral vascular pattern of their lesions. In some patients the three-dimensional power Doppler mode and the first harmonic response after administration of the contrast agent were applied. The protocol was approved by the Ethics Committee of the Chamber of Physicians. Results: The mean signal enhancement of SHU 508A in the lesions was 3 IO sec.Only in superficially located lesions in the left lobe of the liver, the improved signal-to clutter ratio of the contrast agent enabled a clear depiction of the tumor vascularity compared with power Doppler. Lesions less than 3 cm show no typical vascular pattern. Three-dimensional power mode and harmonic imaging shows a “glomcrula-like“ vascular appearance of lesions larger than 3 cm. Mean RI’s (0,5 1) ofthe feeding artery were iignificantly lower than the mean RI’s (0,68) of the main hepatic arteries. Conclusion: New technical development in sonography, such as power Doppler, harmonic imaging and three-dimensional ultrasound, and transpuhnonary “microbubble contrast agents“ enable the depiction of a typical intratumoral vascular pattern of FNH’s of the liver. Lesions with a diameter less than 3 cm however remain sonographically indifferent.
IMO 1221
s25
IMO 1222 COLLOR
DOPPLER Gorski
ULTRASOUND LESIONS C A, Sehmillevitch
IN SPLEEN J, Mueher
FOCAL
M.
This paper presents the malts obtained with collar dopplcr ia 20 patients witb spleen focal ksioas. There were no flow evidence in 9 cases of lympboma metastasis and three cysts. III two hemaagiomas of the spleen, collor doppler showed venous peripheric flow and ao flow in one. Two otber spleen lesioas showed peripheric flow and hrned to be abcesscs. We bad three eases of met&tases of other organs with arterial flow ia the central regioa ia two, and peripheric flow in one.
IMO 1223
Echo-enhanced Doppler sonography in TIPS: Correlation of color- and power Doppler sonograpby witb unenbanced Doppler sonography and angiographic findings.
DOPPLER ULTRASOUND IS USEFUL HEMODYNAMIC MRASUREMRNTS UNDERGOING LIVER TRANSPLANTATION.
M.M. Uuowitzer, C. Kuglcr, K.A. Hausegger.L. Machan, R. Gr6ll. R. Stacber;Dept. of Radiology, Universityof Gra/. Austria
Gerona, J. Torres, M. Ciardullo, E. de Santib&es, R. Mastai. Secci6n Ecagrafia, Servicio de Diagn6stieo par Itigenes, Servicio de Cirugia, Sexi6n H&ado, Servicio de Clinica M&x, Hospital Italiano, Buenos Aires, Argentina.
m: The value of echo-enhancedcolor/power Doppler sonography in the evaluation of transjugular intrahepatioc portosystemicshunts (TIPS) was assessedand comparedwith unenhanccdDoppler sonographyand portal angiography. Material and Methods: 3 1 stentsin 30 patients were examined with unenhanced conventional color- and power Doppler sonography. angiogmphy and, after randomtilation, allocated to echo-enhanced conventional color Doppler sonographyor echo-enhancedpower Doppler sonography.For ccho-enhanccmentSHU 508A (Lcvovist”, Schering AC?,Germany), a suspensionconsisting of galactosepalmitic acid -air bubbles with a mean size of 4 pm and certain transpulmonary stability, was applied intravenously.Stent -patency - occlusion had to be assessedand present stenoses(%) to be quantified. The diagnostic confidenceof unenhanced- vs. echoenhanced Doppler sonographywas assessedand eorrclated. &I&: In the diagnosis of stcnt patency/occlusionecho-enhanced Doppler sonographyyielded a sensitivityand specificityof 100% vs. 100 /89% w&h unenhanced Doppler sonography.Evaluating hemodynamically significant stenoses(diameter reduction > 50%. poflosystemicgradient 2 15 mmHg), echo-enhancedDoppler sonographywas superior with a sensitivityof 82% and a specilicity of X3% vs. 64 I 80%. In the diagnosis of a any stnlt stenosisechoenhanced Doppler sonographyyielded 78 / lOO% vs. 47 / 50%. No Significant diagnostic improvement could be achievedwith the application of the power Doppler mode. The diagnostic confidence was significantly (p < 0,001) increasedwith echo-enhancement. Conclusion: Echo-enhanced Doppler sonograpbywill provide *why-like” images of TIPS with significant increase of sensitivityand specificityin the diagnosis of stent patencyand in the detection of Slent stenoses,especiallyin patients with poor acoustic propertics. Although the transpulmonary stability of Lcvov@ is limited, the assessmentof hemodynamic parameterswithin focal stenoseswill be markedly improved by echoenhancement. Echoenhanced Doppler sonography might replace angiography as the prima9 follow-up examination of TIPS.
TO IN
EVALUATE SEQURNTIAI. CIRRHOTIC PATIENTS D. fih’am~, 2. W&burg, S.
Hyperdynamiccirculation in cirrhotic patients is characterized by a high cardiac output ( CO ) and a low peripheral vascular resistance( PVR ). Splanclmic circulation is also hyperkinetic, with an increase on portal blood flow ( PBF ). The effect of liver txanspIantation in this circulatory abnormalities is controversial. The discrepancies could be due in part to methodological differences.The aim of the present studywas to evaluatesystemicand splanchnic hemodynamics in I2 einhotic patients before and at 3 and 6 months after orthotopic liver transplantation ( OLT ) using Doppler technique. These results were compared with those obtained in 8 heahhy subjects. After 3 months, OLT was accompanied by an increase in mean arterial pressure(78*9vs98*7mmHg,pcO.O5),adecrease in cardiac index ( 4.0 f 1.0vs 3.4 f 0.6 L’min.m2,us ) and a marked increase in PVR ( 800 f 205 vs 1563 f 308 dyn.cnr5, p < 0.05 ), PBF was also signiticanUy incnxxd ( 829 f 130 vs 1494 f 200 ml/ruin, p < 0.05 ), These hemcdynamic changes were more pmnounced at 6 months, mean arterial pressure ( 10 f 8 mmHg ), cardiac index ( 3.0 f 1.0 L/min.m2, p < 0.01 ), PVR ( 1680 f 405 dyn.cmM5) and PBF ( 1520 f 180 mlhin ). In the healthy control group, mean arterial pressure ( 95 f 6 nunHg,us ), cardiac index ( 2.9 f 0.9 Umin.m2as ) and PVR ( 1480 f 380 dyn.cmm5,ns ) values were similar to that owained after 6 months of OLT. Homer, PBF was still significantly elevated at 6 months ( 1520 f 180 vs 910 f 140 mI/min, p < 0.05 ). This study shows that systemichemodynamic parameters are normalized early afler OLT. However, splanchnic hyperemia is still evident al least 6 months after OLT. In addition, our results suggest that Doppler technique allows non invasiveestimations of PBF and CO in OLT, which up to now required invasivehemcdynamic studies.
IMO 1220 New sonographical approaches in the evaluation of the vascular architecture and resistive index (RI) in focal nodular hyperplasias (FNH) of the liver. M. Upgowitzer, C. Kugler , R. Stacher, L. Machan, R. Groell Purpose: To assessthe value of a new transpumonary, galactosebaseQ intravascular contrast agent, SHLJ 508A (Lcvovist”), without and with the combimmtion of harmonic imaging and the three-dimensional power Doppler mode in the depiction of the intratumoral vascularity and the assessmentof hemodynamic parameters (RI) in FNH’s of the liver. Methods and Material: 12 patients with anamncstically known or histologically proven FNH’s of the liver underwent examination with 400 mg/ml SHU 508A (L.cvovist@)after informed consent to evaluate the intratumoral vascular pattern of their lesions. In some patients the three-dimensional power Doppler mode and the first harmonic response after administration of the contrast agent were applied. The protocol was approved by the Ethics Committee of the Chamber of Physicians. Results: The mean signal enhancement of SHU 508A in the lesions was 3 IO sec.Only in superficially located lesions in the left lobe of the liver, the improved signal-to clutter ratio of the contrast agent enabled a clear depiction of the tumor vascularity compared with power Doppler. Lesions less than 3 cm show no typical vascular pattern. Three-dimensional power mode and harmonic imaging shows a “glomcrula-like“ vascular appearance of lesions larger than 3 cm. Mean RI’s (0,5 1) ofthe feeding artery were iignificantly lower than the mean RI’s (0,68) of the main hepatic arteries. Conclusion: New technical development in sonography, such as power Doppler, harmonic imaging and three-dimensional ultrasound, and transpuhnonary “microbubble contrast agents“ enable the depiction of a typical intratumoral vascular pattern of FNH’s of the liver. Lesions with a diameter less than 3 cm however remain sonographically indifferent.
IMO 1221
s25
IMO 1222 COLLOR
DOPPLER Gorski
ULTRASOUND LESIONS C A, Sehmillevitch
IN SPLEEN J, Mueher
FOCAL
M.
This paper presents the malts obtained with collar dopplcr ia 20 patients witb spleen focal ksioas. There were no flow evidence in 9 cases of lympboma metastasis and three cysts. III two hemaagiomas of the spleen, collor doppler showed venous peripheric flow and ao flow in one. Two otber spleen lesioas showed peripheric flow and hrned to be abcesscs. We bad three eases of met&tases of other organs with arterial flow ia the central regioa ia two, and peripheric flow in one.
IMO 1223
Echo-enhanced Doppler sonography in TIPS: Correlation of color- and power Doppler sonograpby witb unenbanced Doppler sonography and angiographic findings.
DOPPLER ULTRASOUND IS USEFUL HEMODYNAMIC MRASUREMRNTS UNDERGOING LIVER TRANSPLANTATION.
M.M. Uuowitzer, C. Kuglcr, K.A. Hausegger.L. Machan, R. Gr6ll. R. Stacber;Dept. of Radiology, Universityof Gra/. Austria
Gerona, J. Torres, M. Ciardullo, E. de Santib&es, R. Mastai. Secci6n Ecagrafia, Servicio de Diagn6stieo par Itigenes, Servicio de Cirugia, Sexi6n H&ado, Servicio de Clinica M&x, Hospital Italiano, Buenos Aires, Argentina.
m: The value of echo-enhancedcolor/power Doppler sonography in the evaluation of transjugular intrahepatioc portosystemicshunts (TIPS) was assessedand comparedwith unenhanccdDoppler sonographyand portal angiography. Material and Methods: 3 1 stentsin 30 patients were examined with unenhanced conventional color- and power Doppler sonography. angiogmphy and, after randomtilation, allocated to echo-enhanced conventional color Doppler sonographyor echo-enhancedpower Doppler sonography.For ccho-enhanccmentSHU 508A (Lcvovist”, Schering AC?,Germany), a suspensionconsisting of galactosepalmitic acid -air bubbles with a mean size of 4 pm and certain transpulmonary stability, was applied intravenously.Stent -patency - occlusion had to be assessedand present stenoses(%) to be quantified. The diagnostic confidenceof unenhanced- vs. echoenhanced Doppler sonographywas assessedand eorrclated. &I&: In the diagnosis of stcnt patency/occlusionecho-enhanced Doppler sonographyyielded a sensitivityand specificityof 100% vs. 100 /89% w&h unenhanced Doppler sonography.Evaluating hemodynamically significant stenoses(diameter reduction > 50%. poflosystemicgradient 2 15 mmHg), echo-enhancedDoppler sonographywas superior with a sensitivityof 82% and a specilicity of X3% vs. 64 I 80%. In the diagnosis of a any stnlt stenosisechoenhanced Doppler sonographyyielded 78 / lOO% vs. 47 / 50%. No Significant diagnostic improvement could be achievedwith the application of the power Doppler mode. The diagnostic confidence was significantly (p < 0,001) increasedwith echo-enhancement. Conclusion: Echo-enhanced Doppler sonograpbywill provide *why-like” images of TIPS with significant increase of sensitivityand specificityin the diagnosis of stent patencyand in the detection of Slent stenoses,especiallyin patients with poor acoustic propertics. Although the transpulmonary stability of Lcvov@ is limited, the assessmentof hemodynamic parameterswithin focal stenoseswill be markedly improved by echoenhancement. Echoenhanced Doppler sonography might replace angiography as the prima9 follow-up examination of TIPS.
TO IN
EVALUATE SEQURNTIAI. CIRRHOTIC PATIENTS D. fih’am~, 2. W&burg, S.
Hyperdynamiccirculation in cirrhotic patients is characterized by a high cardiac output ( CO ) and a low peripheral vascular resistance( PVR ). Splanclmic circulation is also hyperkinetic, with an increase on portal blood flow ( PBF ). The effect of liver txanspIantation in this circulatory abnormalities is controversial. The discrepancies could be due in part to methodological differences.The aim of the present studywas to evaluatesystemicand splanchnic hemodynamics in I2 einhotic patients before and at 3 and 6 months after orthotopic liver transplantation ( OLT ) using Doppler technique. These results were compared with those obtained in 8 heahhy subjects. After 3 months, OLT was accompanied by an increase in mean arterial pressure(78*9vs98*7mmHg,pcO.O5),adecrease in cardiac index ( 4.0 f 1.0vs 3.4 f 0.6 L’min.m2,us ) and a marked increase in PVR ( 800 f 205 vs 1563 f 308 dyn.cnr5, p < 0.05 ), PBF was also signiticanUy incnxxd ( 829 f 130 vs 1494 f 200 ml/ruin, p < 0.05 ), These hemcdynamic changes were more pmnounced at 6 months, mean arterial pressure ( 10 f 8 mmHg ), cardiac index ( 3.0 f 1.0 L/min.m2, p < 0.01 ), PVR ( 1680 f 405 dyn.cmM5) and PBF ( 1520 f 180 mlhin ). In the healthy control group, mean arterial pressure ( 95 f 6 nunHg,us ), cardiac index ( 2.9 f 0.9 Umin.m2as ) and PVR ( 1480 f 380 dyn.cmm5,ns ) values were similar to that owained after 6 months of OLT. Homer, PBF was still significantly elevated at 6 months ( 1520 f 180 vs 910 f 140 mI/min, p < 0.05 ). This study shows that systemichemodynamic parameters are normalized early afler OLT. However, splanchnic hyperemia is still evident al least 6 months after OLT. In addition, our results suggest that Doppler technique allows non invasiveestimations of PBF and CO in OLT, which up to now required invasivehemcdynamic studies.