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The importance of preoperative breast MRI for patients newly diagnosed with breast cancer
Abstracts / Clinical Imaging 33 (2009) 330–333 Contrast-enhanced digital mammography (CEDM) is a recent development of digital mammography using the intravenous injection of an iodinated contrast agent in conjunction with a mammography examination. Two techniques have been developed to perform CEDM examinations: the temporal subtraction technique with acquisition of high-energy images before and after contrast medium injection and the dual energy technique with acquisition of a pair of low- and high-energy images only after contrast medium injection. The temporal subtraction technique offered the possibility to analyze the kinetic curve of enhancement of breast lesions, similarly to breast magnetic resonance imaging. The dual energy technique do not provide information about the kinetic of tumor enhancement but allows the acquisition of multiples views of the same breast or bilateral examination and is less sensitive to patient motion than temporal CEDM. Initial clinical experience has shown the ability of CEDM to map the distribution of neovasculature induced by cancer using mammography. Moreover, previous studies have shown a superiority of MX+CEDM, either for the assessment of the probability of malignancy than for BI-RADS assessment comparing to MX alone. The potential clinical applications are the clarification of mammographically equivocal lesions, the detection of occult lesions on standard mammography, particularly in dense breast, the determination of the extent of disease, the assessment of recurrent disease, and the monitoring of the response to chemotherapy. CEDM should result in a simple way to enhance the detection and the characterization of breast lesions.
Dynamic optical breast imaging: a novel technique to detect and characterize tumor vessels Fournier LS, Vanel D, Athanasiou A, Gatzemier W, Masuykov IV, Padhani AR, Dromain C, Galetti K, Sigal R, Costa A, Balleyguier C (Université de Paris Descartes, Hôpital Européen Georges Pompidou, Radiology Dept., 20 rue Leblanc, F-75015, France). Eur J Radiol 2009;69:43–49. Purpose: To prospectively determine the diagnostic accuracy of optical absorption imaging in patients with Breast Imaging Reporting and Data System (BI-RADS) 3–5 breast lesions. Materials and Methods: Forty-six patients with BI-RADS classification 3 (11%), 4 (44%), or 5 (44%) lesions underwent a novel optical imaging examination using red light to illuminate the breast. Pressure was applied on the breast, and time-dependent curves of light absorption were recorded. Curves that consistently increased or decreased over time were classified as suspicious for malignancy. All patients underwent a core or surgical biopsy. Results: Optical mammography showed a statistical difference in numbers of suspect pixels between benign (n=12) and malignant (n=35) lesions (respectively, 1325 vs. 3170, P=.002). In this population, optical imaging had a sensitivity of 74%, specificity of 92%, and diagnostic accuracy of 79%. The optical signal did not vary according to any other parameter including breast size or density, age, hormonal status, or histological type of lesions. Conclusion: Optical imaging is a low-cost, noninvasive technique, yielding physiological information dependent on breast blood volume and oxygenation. It appears to have a good potential for discriminating benign from malignant lesions. Further studies are warranted to define its potential role in breast cancer imaging.
New potential and applications of contrast-enhanced ultrasound of the breast; own investigations and review of the literature Balleyguier C, Opolon P, Mathieu MC, Athanasiou A, Garbay JR, Delaloge S, Dromain C (Radiology Department, Institut Gustave Roussy, 39 rue Camille Desmoulins, F-94805 Villejuif Cedex, France). Eur J Radiol 2008;69:14–23. Imaging of angiogenesis is a challenge for modern imaging. Velocimetry in malignant breast lesions and density of malignant vessels are very low. In breast imaging, first results of contrast-enhanced ultrasound were disappointing. Microbubbles are fragile when examined with high frequency
331
US, commonly used in breast imaging. Second-generation contrast agents increase intensively the signal level of breast lesions and new sequences like coherence pulse sequencing might be accurate to detect malignant vessels in breast lesions for characterization, to assess the extent of infiltrative breast carcinoma or to evaluate the tumor response after chemotherapy. Another interesting clinical application is the differentiation between post-operative changes and recurrences. In this review, we detail the main results obtained with contrast ultrasonography in a characterization study. In malignant lesions, enhancement was fast, starting with less than 20 s. Compared to magnetic resonance, enhancement appeared faster. Malignant vessels were predominant in the external ring of the nodule, conversely vessels were seen in the center of the lesion in benign nodules. Malignant vessels were also seen outside the lesion. This knowledge could lead the surgeon to perform a larger lumpectomy in these cases, to obtain sane margins and to reduce recurrences.
Signal intensity of normal breast tissue at MR mammography midfield: applying a random coefficient model evaluating the effect of doubling the contrast dose Marklund M, Christensen R, Torp-Pedersen S, Thomsen C, Nolsøe CP (The Parker Institute, Frederiksberg Hospital, Ndr. Fasanvej 57-59, DK-2000 Frederisberg, Denmark). Eur J Radiol 2009;69:93–101. Purpose: To prospectively investigate the effect on signal intensity (SI) of healthy breast parenchyma on magnetic resonance mammography (MRM) when doubling the contrast dose from 0.1 to 0.2 mmol/kg body weight. Materials and Methods: Informed consent and institutional review board approval were obtained. Twenty-five healthy female volunteers [median age: 24 years (range: 21–37 years) and median bodyweight: 65 kg (51–80 kg)] completed two dynamic MRM examinations on a 0.6-T open scanner. The inter-examination time was 24 h (23.5–25 h). The following sequences were applied: axial T2W TSE and an axial dynamic T1W FFED, with a total of seven frames. At Day 1, an iv gadolinium bolus injection of 0.1 mmol/kg bodyweight (Omniscan) (low) was administered. On Day 2, the contrast dose was increased to 0.2 mmol/kg (high). Injection rate was 2 ml/s (Day 1) and 4 ml/s (Day 2). Any use of estrogen containing oral contraceptives (ECOC) was recorded. Postprocessing with automated subtraction, manually traced region of interest, and recording of the SI was performed. A random coefficient model was applied. Results: We found an SI increase of 24.2% and 40% following the low and high dose, respectively (Pb.0001), corresponding to a 65% (95% CI: 37– 99%) SI increase, indicating a moderate saturation. Although not statistically significant (P=.06), the results indicated a tendency, towards lower maximal SI in the breast parenchyma of ECOC users compared to non-ECOC users. Conclusion: We conclude that the contrast dose can be increased from 0.1 to 0.2 mmol/kg bodyweight, if a better contrast/noise relation is desired, but increasing the contrast dose above 0.2 mmol/kg body weight is not likely to improve the enhancement substantially due to the moderate saturation observed. Further research is needed to determine the impact of ECOC on the relative enhancement ratio, and further studies are needed to determine if a possible use of ECOC should be considered a compromising factor, if an MRM is indicated in a young woman.
The importance of preoperative breast MRI for patients newly diagnosed with breast cancer Crowe JP, Patrick RJ, Rim A (9500 Euclid Ave. A80, Cleveland, OH 44195). Breast J 2008;15:52–60. The use of preoperative breast magnetic resonance imaging (bMRI) for patients newly diagnosed with breast cancer has been criticized for increasing the number of therapeutic mastectomies performed, as well as increasing the cost of treatment. The purpose of this report is to examine one surgeon's practice and to describe the MRI findings for patients with breast cancer to determine if those findings changed the therapeutic options for
332
Abstracts / Clinical Imaging 33 (2009) 330–333
those patients in. Data were collected prospectively between August 2003 and January 2006 for patients newly diagnosed with breast cancer. Diagnoses were made by core biopsy or fine-needle aspiration; all lesions were intact at the time of MRI. Twenty-five percent of patients were found to have previously occult, but suspicious lesions on MRI that required additional diagnostic evaluation, including ultrasound, core biopsy, excisional biopsy, or any combination; for approximately half of these patients, a separate cancer was confirmed. For most of these patients, the new lesion was ipsilateral and multicentric, and most required mastectomy. For the remaining 75% of patients, MRI confirmed the index lesion was the only area of concern, and appropriate surgical treatment was completed. Preoperative bMRI for patients newly diagnosed with breast cancer identified previously occult and separate tumors in 13% of patients, resulting in surgical treatment change for many.
Combined apical emphysema and basal fibrosis syndrome [emphysema/fibrosis syndrome]: CT imaging features and pulmonary function tests [in French] Brillet PY, Cottin V, Letoumelin P, Landino F, Brauner MW, Valeyre D, Cordier JF, Nunes H (Université Paris13, UPRES EA 2363, Bobigny, France). J Radiol 2008;90:43–51. Purpose: To describe the high-resolution CT (HRCT) imaging and functional features of the emphysema/fibrosis syndrome. Patients and Methods: A total of 61 patients were included based on HRCT. We have quantified the extent of fibrosis and emphysema lesions and a combined score was calculated. The scores were correlated to pulmonary function test parameters, and specific HRCT features were described. Results: The emphysema and fibrosis scores correlated with functional parameters of obstruction and restriction respectively. The combined score correlated with the reduction in DLCO and degree of pulmonary hypertension. Three HRCT patterns were identified: progressive transition (n=23, 38%) with diffuse emphysema (centrilobular and/or bullous) and zone of transition between bullae and honeycombing; paraseptal emphysema (n=13, 21%) with predominant subpleural bullae of enlarging size at the bases; and separate processes (n=14, 23%) with independent areas of fibrosis and emphysema. Eleven patients (18%) could not be classified. The HRCT imaging features changed based on TLC (P=.04) and FEV1/FVC (P=.01). Conclusion: The emphysema/fibrosis syndrome may be associated with different patterns on HRCT corresponding to specific profiles on pulmonary function tests.
Distinction between upper and lower gastrointestinal perforation: usefulness of the periportal free air sign on computed tomography Cho HS, Yoon SE, Park SH, Kim H, Lee Y-H, Yoon K-H (K-H. Y: Department of Radiology, Wonkwang University School of Medicine, 344-2 Sinyongdong, Jeonbuk 570-711, South Korea). Eur J Radiol 2009;69:108–113. Purpose: To evaluate the usefulness of the periportal free air (PPFA) sign on computed tomography (CT) to distinguish upper from lower gastrointestinal (GI) tract perforation. Materials and Methods: During a 30-month period, we retrospectively analyzed abdominal CT images of 53 consecutive patients with surgically proven GI tract perforation. We divided the patients into two groups, i.e., upper and lower GI tract perforation groups. According to the distribution of free air, we divided the peritoneal cavity into supramesocolic compartment and inframesocolic compartment. We observed the presence or absence of free air in each compartment in each group. When there was free air in the periportal area, it was defined as PPFA and the sign was positive. To evaluate the usefulness of the PPFA sign, we compared the PPFA sign with the falciform ligament sign and the ligamentum teres sign, both of which are well-known CT signs of pneumoperitoneum. Statistical analyses were performed with univariate and multivariate analyses using SPSS version 11.5 for significant findings among the CT signs.
Results: Free air was seen in supramesocolic compartment in 29 (97%) of 30 patients in the upper GI perforation group and in 17 (74%) of 23 in the lower GI perforation group. Free air in inframesocolic compartment did not show significant difference in either group (P=.16). The PPFA sign was seen in 28 (93%) of 30 patients with upper GI tract perforation but in only 8 (35%) of 23 patients with lower GI tract perforation (Pb.0001). The falciform ligament sign was seen in 24 (80%) of 30 patients with upper GI tract perforation and in 10 (43%) of 23 patients with lower GI tract perforation (P=.020). The ligamentum teres sign was seen in 16 (53%) of 30 patients with upper GI tract perforation and in 2 (8%) of 23 patients with lower GI tract perforation (P=.008). Multivariate logistic regression analysis showed that the PPFA sign was the only variable, which adjusted odds ratio of 15.5 (P=.002). Conclusion: The PPFA sign is a useful finding which can help to distinguish upper from lower GI tract perforation. When this sign is present, upper GI tract perforation is strongly suggested.
Follow-up of endovascular abdominal aortic aneurysm repair with contrast ultrasound (in French) Deklunder G, Sediri I, Donati T, Boivin V, Gautier C, Haulon S (Service d'Explorations Functionelles Cardio-Vasculaires, Hôpital Cardiologique CHRU de Lille, F-59037 Lille Cedex, France). J Radiol;90:141–147. Endovascular aortic aneurysm repair (EVAR) is a widely accepted treatment for anatomically fitted abdominal aortic aneurysms. The increasing use of this procedure has prompted the need for close surveillance and reliable postoperative imaging. The current tool for assessing EVAR technical success is to perform computed tomography angiography (CTA) in order to exclude endoleaks and to confirm the exclusion of the aneurysm sac. Contrast-enhanced ultrasound with low mechanical index is a promising method for follow-up of patients after EVAR. It seems to allow better identification and characterization of endoleaks than unenhanced ultrasound and even than CTA for very-low-flow endoleaks.
Can contrast-enhanced ultrasonography replace multidetectorcomputed tomography in the detection of liver metastases from colorectal cancer? Skovgaard Larsen LP, Rosenkilde M, Christensen H, Bang N, Bolvig L, Christiansen, Laurberg S (Department of Radiology Aarhus Sygehus, Aarhus University Hospital, Nørrebrogade 44, DK-8000C, Denmark). Eur J Radiol 2009;69:308–313. Purpose: To compare the sensitivity and specificity of contrast-enhanced ultrasonography (CEUS) and four-slice multidetector-computed tomography (MDCT) in the detection of liver metastases in patients with colorectal cancer (CRC). Materials and Methods: Candidates for this prospective study were 461 consecutive patients referred to the Department of Colorectal Surgery, Aarhus University Hospital, with primary or local recurrence of CRC. The patients underwent liver ultrasonography (US), CEUS, MDCT, and intraoperative ultrasonography (IOUS). Fine-needle biopsy was performed on all suspicious lesions. The examinations were interpreted blindly, and the combination of US, CEUS, biphasic MDCT, IOUS, follow-up, and biopsy was the gold standard. Results: Three hundred and sixty-five patients were included. All patients had undergone preoperative US, CEUS, and MDCT, and 65.5% had received IOUS. The gold standard found liver metastases in 54 patients (14.8%). Multidetector CT found significantly more metastases than CEUS in 15 (28%) of the patients (P=.02). In a patient-by-patient analysis, MDCT had a nonsignificantly higher sensitivity in the detection of liver metastases compared to CEUS (0.89 versus 0.80, P=.06). The specificity of CEUS (0.98) was slightly better than that of MDCT (0.94) (P=.02). Conclusion: Multidetector CT found significant more metastases than CEUS, and MDCT had in patient-by-patient analysis a nonsignificant better sensitivity (P=.06) in detecting liver metastases in patients with CRC.
Dynamic optical breast imaging: a novel technique to detect and characterize tumor vessels Fournier LS, Vanel D, Athanasiou A, Gatzemier W, Masuykov IV, Padhani AR, Dromain C, Galetti K, Sigal R, Costa A, Balleyguier C (Université de Paris Descartes, Hôpital Européen Georges Pompidou, Radiology Dept., 20 rue Leblanc, F-75015, France). Eur J Radiol 2009;69:43–49. Purpose: To prospectively determine the diagnostic accuracy of optical absorption imaging in patients with Breast Imaging Reporting and Data System (BI-RADS) 3–5 breast lesions. Materials and Methods: Forty-six patients with BI-RADS classification 3 (11%), 4 (44%), or 5 (44%) lesions underwent a novel optical imaging examination using red light to illuminate the breast. Pressure was applied on the breast, and time-dependent curves of light absorption were recorded. Curves that consistently increased or decreased over time were classified as suspicious for malignancy. All patients underwent a core or surgical biopsy. Results: Optical mammography showed a statistical difference in numbers of suspect pixels between benign (n=12) and malignant (n=35) lesions (respectively, 1325 vs. 3170, P=.002). In this population, optical imaging had a sensitivity of 74%, specificity of 92%, and diagnostic accuracy of 79%. The optical signal did not vary according to any other parameter including breast size or density, age, hormonal status, or histological type of lesions. Conclusion: Optical imaging is a low-cost, noninvasive technique, yielding physiological information dependent on breast blood volume and oxygenation. It appears to have a good potential for discriminating benign from malignant lesions. Further studies are warranted to define its potential role in breast cancer imaging.
New potential and applications of contrast-enhanced ultrasound of the breast; own investigations and review of the literature Balleyguier C, Opolon P, Mathieu MC, Athanasiou A, Garbay JR, Delaloge S, Dromain C (Radiology Department, Institut Gustave Roussy, 39 rue Camille Desmoulins, F-94805 Villejuif Cedex, France). Eur J Radiol 2008;69:14–23. Imaging of angiogenesis is a challenge for modern imaging. Velocimetry in malignant breast lesions and density of malignant vessels are very low. In breast imaging, first results of contrast-enhanced ultrasound were disappointing. Microbubbles are fragile when examined with high frequency
331
US, commonly used in breast imaging. Second-generation contrast agents increase intensively the signal level of breast lesions and new sequences like coherence pulse sequencing might be accurate to detect malignant vessels in breast lesions for characterization, to assess the extent of infiltrative breast carcinoma or to evaluate the tumor response after chemotherapy. Another interesting clinical application is the differentiation between post-operative changes and recurrences. In this review, we detail the main results obtained with contrast ultrasonography in a characterization study. In malignant lesions, enhancement was fast, starting with less than 20 s. Compared to magnetic resonance, enhancement appeared faster. Malignant vessels were predominant in the external ring of the nodule, conversely vessels were seen in the center of the lesion in benign nodules. Malignant vessels were also seen outside the lesion. This knowledge could lead the surgeon to perform a larger lumpectomy in these cases, to obtain sane margins and to reduce recurrences.
Signal intensity of normal breast tissue at MR mammography midfield: applying a random coefficient model evaluating the effect of doubling the contrast dose Marklund M, Christensen R, Torp-Pedersen S, Thomsen C, Nolsøe CP (The Parker Institute, Frederiksberg Hospital, Ndr. Fasanvej 57-59, DK-2000 Frederisberg, Denmark). Eur J Radiol 2009;69:93–101. Purpose: To prospectively investigate the effect on signal intensity (SI) of healthy breast parenchyma on magnetic resonance mammography (MRM) when doubling the contrast dose from 0.1 to 0.2 mmol/kg body weight. Materials and Methods: Informed consent and institutional review board approval were obtained. Twenty-five healthy female volunteers [median age: 24 years (range: 21–37 years) and median bodyweight: 65 kg (51–80 kg)] completed two dynamic MRM examinations on a 0.6-T open scanner. The inter-examination time was 24 h (23.5–25 h). The following sequences were applied: axial T2W TSE and an axial dynamic T1W FFED, with a total of seven frames. At Day 1, an iv gadolinium bolus injection of 0.1 mmol/kg bodyweight (Omniscan) (low) was administered. On Day 2, the contrast dose was increased to 0.2 mmol/kg (high). Injection rate was 2 ml/s (Day 1) and 4 ml/s (Day 2). Any use of estrogen containing oral contraceptives (ECOC) was recorded. Postprocessing with automated subtraction, manually traced region of interest, and recording of the SI was performed. A random coefficient model was applied. Results: We found an SI increase of 24.2% and 40% following the low and high dose, respectively (Pb.0001), corresponding to a 65% (95% CI: 37– 99%) SI increase, indicating a moderate saturation. Although not statistically significant (P=.06), the results indicated a tendency, towards lower maximal SI in the breast parenchyma of ECOC users compared to non-ECOC users. Conclusion: We conclude that the contrast dose can be increased from 0.1 to 0.2 mmol/kg bodyweight, if a better contrast/noise relation is desired, but increasing the contrast dose above 0.2 mmol/kg body weight is not likely to improve the enhancement substantially due to the moderate saturation observed. Further research is needed to determine the impact of ECOC on the relative enhancement ratio, and further studies are needed to determine if a possible use of ECOC should be considered a compromising factor, if an MRM is indicated in a young woman.
The importance of preoperative breast MRI for patients newly diagnosed with breast cancer Crowe JP, Patrick RJ, Rim A (9500 Euclid Ave. A80, Cleveland, OH 44195). Breast J 2008;15:52–60. The use of preoperative breast magnetic resonance imaging (bMRI) for patients newly diagnosed with breast cancer has been criticized for increasing the number of therapeutic mastectomies performed, as well as increasing the cost of treatment. The purpose of this report is to examine one surgeon's practice and to describe the MRI findings for patients with breast cancer to determine if those findings changed the therapeutic options for
332
Abstracts / Clinical Imaging 33 (2009) 330–333
those patients in. Data were collected prospectively between August 2003 and January 2006 for patients newly diagnosed with breast cancer. Diagnoses were made by core biopsy or fine-needle aspiration; all lesions were intact at the time of MRI. Twenty-five percent of patients were found to have previously occult, but suspicious lesions on MRI that required additional diagnostic evaluation, including ultrasound, core biopsy, excisional biopsy, or any combination; for approximately half of these patients, a separate cancer was confirmed. For most of these patients, the new lesion was ipsilateral and multicentric, and most required mastectomy. For the remaining 75% of patients, MRI confirmed the index lesion was the only area of concern, and appropriate surgical treatment was completed. Preoperative bMRI for patients newly diagnosed with breast cancer identified previously occult and separate tumors in 13% of patients, resulting in surgical treatment change for many.
Combined apical emphysema and basal fibrosis syndrome [emphysema/fibrosis syndrome]: CT imaging features and pulmonary function tests [in French] Brillet PY, Cottin V, Letoumelin P, Landino F, Brauner MW, Valeyre D, Cordier JF, Nunes H (Université Paris13, UPRES EA 2363, Bobigny, France). J Radiol 2008;90:43–51. Purpose: To describe the high-resolution CT (HRCT) imaging and functional features of the emphysema/fibrosis syndrome. Patients and Methods: A total of 61 patients were included based on HRCT. We have quantified the extent of fibrosis and emphysema lesions and a combined score was calculated. The scores were correlated to pulmonary function test parameters, and specific HRCT features were described. Results: The emphysema and fibrosis scores correlated with functional parameters of obstruction and restriction respectively. The combined score correlated with the reduction in DLCO and degree of pulmonary hypertension. Three HRCT patterns were identified: progressive transition (n=23, 38%) with diffuse emphysema (centrilobular and/or bullous) and zone of transition between bullae and honeycombing; paraseptal emphysema (n=13, 21%) with predominant subpleural bullae of enlarging size at the bases; and separate processes (n=14, 23%) with independent areas of fibrosis and emphysema. Eleven patients (18%) could not be classified. The HRCT imaging features changed based on TLC (P=.04) and FEV1/FVC (P=.01). Conclusion: The emphysema/fibrosis syndrome may be associated with different patterns on HRCT corresponding to specific profiles on pulmonary function tests.
Distinction between upper and lower gastrointestinal perforation: usefulness of the periportal free air sign on computed tomography Cho HS, Yoon SE, Park SH, Kim H, Lee Y-H, Yoon K-H (K-H. Y: Department of Radiology, Wonkwang University School of Medicine, 344-2 Sinyongdong, Jeonbuk 570-711, South Korea). Eur J Radiol 2009;69:108–113. Purpose: To evaluate the usefulness of the periportal free air (PPFA) sign on computed tomography (CT) to distinguish upper from lower gastrointestinal (GI) tract perforation. Materials and Methods: During a 30-month period, we retrospectively analyzed abdominal CT images of 53 consecutive patients with surgically proven GI tract perforation. We divided the patients into two groups, i.e., upper and lower GI tract perforation groups. According to the distribution of free air, we divided the peritoneal cavity into supramesocolic compartment and inframesocolic compartment. We observed the presence or absence of free air in each compartment in each group. When there was free air in the periportal area, it was defined as PPFA and the sign was positive. To evaluate the usefulness of the PPFA sign, we compared the PPFA sign with the falciform ligament sign and the ligamentum teres sign, both of which are well-known CT signs of pneumoperitoneum. Statistical analyses were performed with univariate and multivariate analyses using SPSS version 11.5 for significant findings among the CT signs.
Results: Free air was seen in supramesocolic compartment in 29 (97%) of 30 patients in the upper GI perforation group and in 17 (74%) of 23 in the lower GI perforation group. Free air in inframesocolic compartment did not show significant difference in either group (P=.16). The PPFA sign was seen in 28 (93%) of 30 patients with upper GI tract perforation but in only 8 (35%) of 23 patients with lower GI tract perforation (Pb.0001). The falciform ligament sign was seen in 24 (80%) of 30 patients with upper GI tract perforation and in 10 (43%) of 23 patients with lower GI tract perforation (P=.020). The ligamentum teres sign was seen in 16 (53%) of 30 patients with upper GI tract perforation and in 2 (8%) of 23 patients with lower GI tract perforation (P=.008). Multivariate logistic regression analysis showed that the PPFA sign was the only variable, which adjusted odds ratio of 15.5 (P=.002). Conclusion: The PPFA sign is a useful finding which can help to distinguish upper from lower GI tract perforation. When this sign is present, upper GI tract perforation is strongly suggested.
Follow-up of endovascular abdominal aortic aneurysm repair with contrast ultrasound (in French) Deklunder G, Sediri I, Donati T, Boivin V, Gautier C, Haulon S (Service d'Explorations Functionelles Cardio-Vasculaires, Hôpital Cardiologique CHRU de Lille, F-59037 Lille Cedex, France). J Radiol;90:141–147. Endovascular aortic aneurysm repair (EVAR) is a widely accepted treatment for anatomically fitted abdominal aortic aneurysms. The increasing use of this procedure has prompted the need for close surveillance and reliable postoperative imaging. The current tool for assessing EVAR technical success is to perform computed tomography angiography (CTA) in order to exclude endoleaks and to confirm the exclusion of the aneurysm sac. Contrast-enhanced ultrasound with low mechanical index is a promising method for follow-up of patients after EVAR. It seems to allow better identification and characterization of endoleaks than unenhanced ultrasound and even than CTA for very-low-flow endoleaks.
Can contrast-enhanced ultrasonography replace multidetectorcomputed tomography in the detection of liver metastases from colorectal cancer? Skovgaard Larsen LP, Rosenkilde M, Christensen H, Bang N, Bolvig L, Christiansen, Laurberg S (Department of Radiology Aarhus Sygehus, Aarhus University Hospital, Nørrebrogade 44, DK-8000C, Denmark). Eur J Radiol 2009;69:308–313. Purpose: To compare the sensitivity and specificity of contrast-enhanced ultrasonography (CEUS) and four-slice multidetector-computed tomography (MDCT) in the detection of liver metastases in patients with colorectal cancer (CRC). Materials and Methods: Candidates for this prospective study were 461 consecutive patients referred to the Department of Colorectal Surgery, Aarhus University Hospital, with primary or local recurrence of CRC. The patients underwent liver ultrasonography (US), CEUS, MDCT, and intraoperative ultrasonography (IOUS). Fine-needle biopsy was performed on all suspicious lesions. The examinations were interpreted blindly, and the combination of US, CEUS, biphasic MDCT, IOUS, follow-up, and biopsy was the gold standard. Results: Three hundred and sixty-five patients were included. All patients had undergone preoperative US, CEUS, and MDCT, and 65.5% had received IOUS. The gold standard found liver metastases in 54 patients (14.8%). Multidetector CT found significantly more metastases than CEUS in 15 (28%) of the patients (P=.02). In a patient-by-patient analysis, MDCT had a nonsignificantly higher sensitivity in the detection of liver metastases compared to CEUS (0.89 versus 0.80, P=.06). The specificity of CEUS (0.98) was slightly better than that of MDCT (0.94) (P=.02). Conclusion: Multidetector CT found significant more metastases than CEUS, and MDCT had in patient-by-patient analysis a nonsignificant better sensitivity (P=.06) in detecting liver metastases in patients with CRC.