shu-508 and Chronic-Disease

The development of new contrast agents and new imaging methods has lead to an emerging field of applications for myocardial contrast echocardiography (MCE) in patients suffering from chronic ischemic heart disease. Echo contrast allows the assessment of myocardial perfusion (MP) by imaging the coronary microcirculation. Several echocardiographic modalities are available, the main difference between them being the acoustic power needed to perform the study. MP is evaluated by assessing the changes in myocardial videointensity that occur after intravenous contrast injection. Evaluation of these patients is performed by using different techniques. Evaluation of coronary stenosis may be performed by using stress tests or without its use. Coronary artery stenosis > 50% of the coronary luminal diameter reveals a decreased hyperemic response when myocardial oxygen demand is increased. Different methods to evaluate the presence of relevant coronary stenosis have been developed: evaluation of myocardial blood flow reserve, evaluation of myocardial blood volume, and evaluation of the transmural distribution of myocardial blood flow. The combination of wall motion analysis with MCE assessment has been demonstrated to achieve the best balance between sensitivity (86%) and specificity (88%), with the highest accuracy (86%). Without the need of any stress, the ratio systolic/diastolic myocardial blood volume has been described to increase with the presence of a epicardial coronary stenosis and it may be measured by MCE. Myocardial viability is also one of the potentials of MCE. Microvascular integrity, demonstrated by MCE, is an indicator of preserved viability and predicts functional recovery that has been validated in the setting of chronic left ventricular dysfunction secondary to chronic coronary artery disease and in the setting of post acute myocardial infarction left ventricular dysfunction.. contrast echocardiography provides an interesting tool that offers the potential of a complete evaluation of patients with chronic coronary artery disease. This includes both diagnostic and prognostic evaluation.

Topics: Albumins; Blood Volume; Chronic Disease; Contrast Media; Coronary Circulation; Coronary Disease; Echocardiography; Fluorocarbons; Humans; Microcirculation; Phospholipids; Polysaccharides; Prognosis; Sulfur Hexafluoride

The purpose of this study is to examine the effectiveness of intravenously injectable sonographic contrast medium for color Doppler sonographic diagnosis of deeply located hepatocellular carcinoma. Subjects were 7 hepatocellular carcinomas, an adenomatous hyperplasia and a hemangioma located more than 7 cm below the abdominal surface. Levovist, a galactose-based sonographic contrast medium was injected through median cubital vein as a phase-two clinical study, and the pre- and post-enhanced color Doppler sonographic findings of these lesions were compared. The incidence of the positive findings for hepatocellular carcinoma increased from 29% (2/7) to 86% (6/7) of hepatocellular carcinoma after contrast enhancement. Positive findings were 0% in other cases even after enhancement. Levovist brought a certain improvement in the visualization of the tumor vessel by color Doppler sonography without any noteworthy side effects. Contrast enhancement was useful for the diagnosis of liver lesions suspected to be hepatocellular carcinoma by ordinary sonography, but could not be confirmed by color Doppler sonography.

Topics: Adult; Aged; Blood Flow Velocity; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Female; Galactose; Hepatitis; Humans; Injections, Intravenous; Liver Circulation; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography, Doppler, Color

Although hypervascular appearance is characteristic in hepatocellular carcinoma (HCC), hepatic nodules without hypervascular appearance are sometimes found in patients with chronic liver disease (CLD). The aim of the present study was to clarify the efficacy of contrast-enhanced ultrasound (CEUS) with Levovist to characterize small, non-hypervascular hepatic nodules on contrast-enhanced computed tomography (CECT) in patients with CLD.. The subject was 41 hepatic nodules (<30 mm, 18.5 +/- 5.6 mm) which showed non-hypervascular appearance on CECT in 35 patients with CLD; their histological results were 31 HCC (15 well, 14 moderate, and two poor) and 10 regenerative nodules (RN). CEUS with Levovist was performed under intermittent scanning (1-s interval) using APLIO at the early phase and the liver-specific phase, and the contrast enhancement of the nodule was assessed in comparison to that of the surrounding liver parenchyma. The contrast-enhanced findings with the time-intensity analysis were compared with the histological results.. Twelve nodules with weak enhancement in the liver-specific phase were HCC, regardless of their early-phase appearances. The other 29 nodules with equivalent or weak enhancement in the early phase and equivalent enhancement in the liver-specific phase were 19 HCC and 10 RN. Among them, the maximum-intensity ratio of tumor to non-tumor in the early phase was significantly higher in HCC than in RN (P < 0.01, n = 16), and the receiver-operating characteristic analysis showed a sensitivity of 1.0 and a specificity of 0.83 for their characterization.. CEUS with Levovist may be an alternative to biopsy to characterize small, non-hypervascular hepatic nodules on CECT in patients with CLD.

Topics: Biopsy, Needle; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Feasibility Studies; Humans; Liver Diseases; Liver Neoplasms; Microbubbles; Polysaccharides; Predictive Value of Tests; Time Factors; Tomography, X-Ray Computed; Ultrasonography

Power Doppler ultrasound (US) with time-intensity curves was used to study renal graft function both in the absence of disease and with complications (acute tubular necrosis and chronic rejection) in an attempt to identify pathognomonic patterns. Time-intensity curves allow representation of the kidneys' wash-in and wash-out phases after intravenous administration of sonographic contrast material.. Fifty-six asymptomatic renal transplant patients (36 men and 20 women), 19 of whom had altered creatinine clearance levels, were studied by power Doppler US with time-intensity curves followed by biopsy. Ten asymptomatic patients with normal creatinine clearance levels were used as controls.. Time-intensity curve analysis enabled identification of three groups of patients: group A, consisting of 27 patients showing peak enhancement between 50 and 65 s from intravenous administration of contrast material; group B, consisting of 16 patients with peak enhancement between 135 and 235 s; group C, consisting of three patients with peak enhancement between 100 and 130 s.. Data showed significant variations according to renal graft function (no abnormality, acute tubular necrosis or chronic rejection). Although confirmation by a larger series is required, our findings appear to indicate pathognomonic patterns in patients with chronic rejection and acute tubular necrosis.

Topics: Adult; Biopsy; Chronic Disease; Contrast Media; Creatinine; Female; Graft Rejection; Humans; Image Enhancement; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Male; Microbubbles; Middle Aged; Polysaccharides; Predictive Value of Tests; Sensitivity and Specificity; Time Factors; Ultrasonography, Doppler; Ultrasonography, Doppler, Duplex

Quantitative intravenous myocardial contrast echocardiography (MCE) has been shown to measure regional myocardial blood flow velocity noninvasively.. To determine whether quantitative intravenous MCE could be used clinically to predict functional recovery after revascularization in patients with chronic coronary artery disease.. Twenty-eight patients with chronic stable coronary artery disease and resting regional left ventricular dysfunction were included in this study. The study permits myocardial perfusion analysis by intravenous MCE before revascularization with continuous infusion of Levovist and intermittent ultrasonic exposure. Wall motion assessment by echocardiography at rest was repeated after long-term follow-up period (7 +/- 2 months). In dysfunctional segments, we analyzed myocardial perfusion quantitatively by fitting to an exponential function, Y = A(1 - e-betat) to obtain the rate of rise (beta) of background-subtracted intensity, which represented myocardial blood flow velocity.. Of the 101 revascularized dysfunctional segments, MCE was adequately visualized in 91 (90%) segments, and wall motion was recovered in 45 (49%) segments. The value of beta in the recovery segments was significantly higher than that in nonrecovery segments (0.80 +/- 0.50 vs 0.39 +/- 0.24, P < 0.001). The value of beta > 0.5 predicted recovery of segmental function with a sensitivity of 71%, specificity of 78%.. Quantitative intravenous MCE can predict functional recovery after revascularization in patients with chronic coronary artery disease.

Topics: Aged; Blood Flow Velocity; Chronic Disease; Contrast Media; Coronary Angiography; Coronary Artery Disease; Coronary Circulation; Echocardiography; Female; Follow-Up Studies; Humans; Injections, Intravenous; Logistic Models; Male; Middle Aged; Myocardial Revascularization; Polysaccharides; Predictive Value of Tests; Recovery of Function; Ventricular Function, Left

Liver cirrhosis is associated with haemodynamic changes. Using Levovist, we measured and compared Doppler signal arrival and peak enhancement times in the hepatic vein of patients with cirrhosis (n= 12) or chronic liver disease (n= 16) and in 12 healthy subjects. There were six patients with Child stage A, one patient with B, and five patients with C. The signal was recorded starting 20 s before contrast infusion until 2 h 20 min after its end. A software of the ultrasound (US) machine automatically sampled time-intensity values. Arrival times were significantly shorter (P < 0.001) in cirrhotic than non-cirrhotic (chronic liver disease + controls) and in patients with Child stage C compared with A. Differences in peak enhancement were weakly significant between cirrhotic and chronic patients (P < 0.04) and highly significant between the former and controls (P < 0.001), whereas differences between Child stages C and A were not significant (P > 0.05). Finally, cirrhotic patients had arrival times consistently shorter than 17 s. Automatic time-intensity curve analysis made measurements objective and conceptual error systematic, thus identifiable. Analysis of the passage of Levovist at the hepatic vein can thus become a non-invasive, well-tolerated and cost-effective diagnostic and monitoring tool in a larger number of patients with liver disease.

Topics: Analysis of Variance; Case-Control Studies; Chronic Disease; Contrast Media; Female; Hemodynamics; Hepatic Veins; Humans; Liver Cirrhosis; Male; Middle Aged; Polysaccharides; Software; Statistics, Nonparametric; Ultrasonography

We sought to evaluate whether contrast-enhanced Doppler echocardiography can improve the noninvasive estimation of hemodynamic variables in left ventricular (LV) dysfunction. Right-heart catheterization and Doppler echocardiography were simultaneously performed in 45 patients with LV dysfunction (ejection fraction: 29 +/- 7%) in sinus rhythm. Noninvasive variables were estimated as follows: cardiac output by pulsed Doppler of LV outflow tract; pulmonary capillary wedge pressure by a regression equation including mitral and pulmonary venous flow variables; pulmonary artery mean pressure from the calculated systolic and diastolic pulmonary artery pressures; and pulmonary vascular resistance from the previous measurements according to hemodynamic definition. Contrast enhancement increased the feasibility of pulmonary capillary wedge pressure estimation from 60% to 100%; of pulmonary artery mean pressure from 42% to 91%; and of pulmonary vascular resistance from 42% to 91%. Strong correlations between invasive and noninvasive hemodynamic variables were found: r = 0.90, standard error of the estimate (SEE) 0.45 L/min for cardiac output; r = 0.90, SEE 3.1 mm Hg for pulmonary capillary wedge pressure; r = 0.93, SEE 3.7 mm Hg for pulmonary artery mean pressure; and r = 0.85 SEE 1.0 Wood units for pulmonary vascular resistance. Weaker correlations for PAMP (r = 0.82, SEE 5.6 mm Hg) and PVR (r = 0.66, SEE 1.7 Wood units) were apparent prior to contrast enhancement. When patients were separated according to PVR threshold values, the contrast allowed the correct placement of 88% of patients, whereas only 57% were correctly assigned without it. The contrast increased accuracy and reduced interobserver variability in the evaluation of hemodynamic variables. The contrast-enhanced study is capable of increasing the value of noninvasive hemodynamic assessment in LV dysfunction.

Topics: Adult; Aged; Cardiomyopathy, Dilated; Chronic Disease; Contrast Media; Echocardiography, Doppler; Female; Hemodynamics; Humans; Image Enhancement; Infusions, Intravenous; Male; Middle Aged; Observer Variation; Polysaccharides; Pulmonary Wedge Pressure; Systole; Vascular Resistance; Ventricular Dysfunction, Left

The use of low frequency probes allows to overcome the resistance of the skull and evaluate Willis's circle by B-mode and Trans-Cranial Color-Doppler (TCCD) to obtain morphological and functional information related to brain circulation during pathologic conditions. With the new software available today modern technology allow us to measure the transient scattering produced by the rupture of the contrast medium microbubbles and estimate the presence of the contrast medium both in macro- and microcircle. In this way it is possible to appraise parenchymal perfusion. This study aims to assess the intracranial micro- and macrocircle using TCCD with contrast medium (Levovist) and to compare the results with the patients' clinical signs.. We studied 21 subjects aged 45-73 years (mean 68 years) with atheromatous uncomplicated plaques in the internal carotid artery producing varying degrees of stenosis and 10 healthy controls. The examinations were performed using an ATL HDI 3000 ultrasound machine with a Phased Array 3.25 MHz probe. The mechanic index was calibrated to high values to obtain rupture of the microbubbles under insonation. Intensity/time curves of transient scattering were extrapolated for both the cerebral macrocircle and the parenchymal microcircle in the region of interest.. The curves were compared with the clinical presentation of the different classes of patients and the results obtained were consistent in showing a clinical pattern of perfusional deficit in subjects with symptoms of chronic brain ischemia. In particular, it was possible to compare the morphologic data relative to the contrast medium decay curves with the patient's clinical condition, confirming the suspicion of cerebral microcircle pathology.. Thanks to improvements in the software and to the definition of effective algorithms, contrast-enhanced TCCD will be able to provide information on brain perfusion in a simple, inexpensive and relatively non-invasive manner.

Topics: Adult; Aged; Algorithms; Brain Ischemia; Carotid Artery Diseases; Carotid Artery, Internal; Carotid Stenosis; Cerebrovascular Circulation; Chronic Disease; Contrast Media; Humans; Intracranial Arteriosclerosis; Middle Aged; Polysaccharides; Software; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Transcranial