shu-508 and Carcinoma--Renal-Cell

Tumoral growth is an angiogenesis-dependent event. Although there are studies about the importance of histopathologic angiogenesis in various malignancies, the assessment of the angiogenesis by radiologic techniques is not well established. The aim of this study was to investigate the efficacy of echo contrast-enhanced power Doppler ultrasonography (PDUS) in determining the angiogenic status of renal cell carcinoma (RCC).. Power Doppler ultrasonography was performed before and after intravenous administration of an echo contrast agent in 42 patients with renal masses. Twenty-one of these renal masses were diagnosed as RCC histopathologically, and these 21 patients were reevaluated retrospectively. The color pixel ratios of selected images were calculated as the ratio of the number of pixels showing power Doppler signals to the total number of pixels within the lesion. The results were compared with the histopathologic microvessel density (MVD).. A significant correlation was found between color pixel ratio and MVD values in both PDUS techniques. The use of the echo contrast agent improved this correlation and P values (Spearman rho from 0.436 to 0.551; P from .048 to .01).. Color pixel ratio values reflect the MVD in RCC. Therefore, these results suggest that preoperative quantification of angiogenesis can be possible with the help of PDUS in RCC.

Topics: Adult; Aged; Carcinoma, Renal Cell; Female; Humans; Image Processing, Computer-Assisted; Kidney Neoplasms; Male; Middle Aged; Neovascularization, Pathologic; Polysaccharides; Ultrasonography

Our objective was to evaluate whether contrast-specific ultrasound (US) technique pulse inversion harmonic imaging (PIHI) with Levovist could reveal differential morphological features in solid and cystic renal masses. Twenty-six renal masses in 26 patients were evaluated by PIHI after Levovist injection with intermittent high mechanical index stimulation, performed every 10-15 s during arterial and delayed phase. Helical CT (HCT; n=6) or histological findings on surgical/bioptic specimen ( n=20) were considered as the reference procedures for definitive diagnosis. Eleven solid renal cell carcinomas (RCCs), 1 embryonal matanephric adenoma (EMA), 7 angiomyolipomas (AMLs), 4 cystic RCCs and 3 complex inflammatory cysts were identified. Solid RCCs revealed a much higher ( p<0.05) contrast enhancement than AMLs with typical pattern on conventional US ( n=6). The EMA and AML with atypical pattern on conventional US ( n=1) revealed intense contrast enhancement during arterial phase, progressively decreasing during delayed phase. Cystic RCCs and complex inflammatory cysts revealed intense contrast enhancement on the peripheral thick wall during arterial phase decreasing on delayed phase. The PIHI has been shown to differentiate solid RCC from typical AML by contrast enhancement assessment after Levovist injection, but differential diagnosis both in solid and in cystic renal masses still remains difficult.

Topics: Aged; Angiomyolipoma; Carcinoma, Renal Cell; Contrast Media; Female; Humans; Kidney Diseases, Cystic; Kidney Neoplasms; Male; Polysaccharides; Tomography, Spiral Computed; Ultrasonography

We evaluated the efficacy of contrast-enhanced color Doppler ultrasonography with a galactose-based echo contrast agent, Levovist, for the diagnosis of renal mass lesions. The final pathologic diagnosis of eight renal mass lesions was renal cell carcinoma in 6 patients, transitional cell carcinoma in 1 patient and renal cyst in 1 patient (age range, 47 to 77 years; mean, 59.1). Especially in patients with renal cell carcinoma, contrast-enhanced color Doppler ultrasonography showed enhancement of mass lesion blood flow signal intensities. In all patients, contrast enhancement was demonstrated. Diagnostic capacity was improved in all patients, excluding 2 in whom mass lesion blood flow was detected by plain color Doppler ultrasonography. Furthermore, in patients with transitional cell carcinoma, the hemodynamics of mass lesions could be visualized, and diagnostic capacity was high. Contrast-enhanced color Doppler ultrasonography with Levovist, showed markedly higher mass lesion blood flow than that obtained by the plain color Doppler procedure, improving diagnostic capacity. This procedure was useful for diagnosing renal mass lesions.

Topics: Aged; Carcinoma, Renal Cell; Carcinoma, Transitional Cell; Contrast Media; Female; Humans; Kidney Diseases, Cystic; Kidney Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography, Doppler, Color

To evaluate the diagnostic potential of echo-enhanced ultrasonography (US) for depicting the vascularization pattern of renal cell carcinoma (RCC), and calculating the first-pass effect using harmonic imaging, against that obtained by triphasic helical computed tomography (CT).. Sixty patients with surgically confirmed RCC underwent US using B-mode and power Doppler methods with or without an intravenous microbubble echo-enhancing agent. After depicting and defining the tumour extent by B-mode US, the first-pass effect/enhancement by the echo-enhancing agent within the lesion, and that of a reference area of unaffected renal cortex, were recorded on-line by calculating the mean pixel intensity. Time-intensity curves, i.e. the rise time and gradient of both the suspected tumour and reference areas, were constructed.. Using B-mode US, the extent of all tumours was delineated (mean tumour size 3.8 cm, SD 0.6). After applying the microbubble agent all tumours were enhanced, whereas the perfusion was decreased (in 48%), increased (in 16%) or similar (in 36%) compared with the cortical reference area. Using the Hounsfield classification, these results correlated well with the hypo/hypervascularity shown on CT.. Ultrasonography has considerable potential in diagnosing RCC, if combined with echo-enhancing methods, harmonic imaging and computer-based calculation of tumour vascularization. Dynamic US studies should provide a diagnostic yield similar to that of CT.

Topics: Carcinoma, Renal Cell; Contrast Media; Diagnosis, Computer-Assisted; Humans; Kidney Neoplasms; Neovascularization, Pathologic; Pilot Projects; Polysaccharides; Ultrasonography, Doppler, Color

The term "pseudotumor" is used to refer to several anatomic variants that can simulate a renal mass, the most frequent of which are hypertrophied column of Bertin, persistence of fetal lobation, and the dromedary or splenic hump. We describe the findings of power Doppler US after the ultrasound contrast agent (Levovist, Schering, Berlin, Germany) administration in 4 patients with a renal focal lesion in whom gray-scale and baseline power Doppler US was not able to certainly differentiate pseudotumor from neoplasm.

Topics: Adult; Carcinoma, Renal Cell; Contrast Media; Diagnosis, Differential; Female; Humans; Image Enhancement; Kidney; Kidney Diseases; Kidney Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography, Doppler

We describe three cases where biopsies from various tumors were guided by contrast enhancement of tumor perfusion. After i.v. administration of Levovist (Schering AG, Berlin, Germany), the tumors showed both hyper- and hypovascular areas. Biopsies from the latter showed marked necrosis or fibrosis. This may cause biopsies not being conclusive. To ensure fully diagnostic biopsies from irregular tumors we propose the biopsy to be performed from the most vascular part demonstrated by contrast enhancement.

Topics: Abdominal Neoplasms; Biopsy; Breast Neoplasms; Carcinoma, Renal Cell; Contrast Media; Female; Humans; Liver Neoplasms; Middle Aged; Neurofibrosarcoma; Polysaccharides; Ultrasonography, Interventional

The purpose of this study was to evaluate the feasibility of microvascular imaging using contrast-enhanced color and power Doppler sonography. Ten patients with a focal lesion of the kidney were examined. Three patients were investigated with the polymeric butylcyanacrylate-based contrast agent SHU 563A, and the remaining patients were investigated with the galactose-based agent Levovist. It was possible to observe the microvascularization with Levovist during the blood pool phase of the agent over a period of 1 to 3 s at 1 min and 2 min after injection. With SHU 563A, microvascular imaging was possible 0.50 s after injection and lasted for 10.35 min. No intratumoral signals were seen in cysts (n = 6) and the investigated abscess. Weak intratumoral polychromatic effects were observed in both renal cell carcinomas in this series. Metastasis could be differentiated from healthy parenchyma due to lack of the polychromatic effect. SHU 563A is appropriate for performing microvascular imaging. The Levovist-induced polychromatic effects are smaller, of shorter duration, and observable only during the blood pool phase; thus, the expected diagnostic benefit is limited.

Topics: Blood Vessels; Carcinoma, Renal Cell; Contrast Media; Enbucrilate; Female; Humans; Injections; Kidney Neoplasms; Male; Polymers; Polysaccharides; Prospective Studies; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color

At present, we have two methods of enhanced ultrasonography in the diagnosis of renal tumors. One is the ultrasound B-mode imaging enhancement under renal arterial infusion of carbon dioxide microbubbles, a contrast agent for US, and the other is the color Doppler signal enhancement under intra-venous injection of galactose-based echo contrast agent, SH/TA-508. Renal cell carcinoma were imaged from the very beginning of the injection of CO2 through the time complete washout from the kidney. On the other, intra-tumor color Doppler signals were remakedly emphasized after SH/TA-508 administration. Enhanced ultrasonography is useful in the detection of small renal cell carcinoma and differential diagnosis of renal masses.

Topics: Aged; Carbon Dioxide; Carcinoma, Renal Cell; Contrast Media; Humans; Image Enhancement; Infusions, Intravenous; Kidney Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography, Doppler