shu-508 and Cicatrix

Contrast medium enhanced harmonic ultrasound is a recently developed ultrasound technique that improves the assessment of renal parenchymal vascularity. We performed a preliminary study to define the ability of contrast enhanced ultrasound with harmonic imaging to detect and localize renal scars in a porcine model of experimentally induced pyelonephritis.. Vesicoureteral reflux was surgically induced in 10 pigs weighing 10 kg. with the contralateral kidney serving as a control. Approximately 4 weeks after the creation of vesicoureteral reflux cystography confirmed reflux. Infection was induced by placing a suspension of paraffin broth impregnated with Escherichia coli in the bladder of each pig. At 4 to 8 weeks (mean 6.5) after the induction of infection a radiologist blinded to the side of the previous procedure performed conventional gray scale ultrasound, color Doppler ultrasound and contrast enhanced ultrasound with harmonic power imaging. The animals were sacrificed; the kidneys were inspected and tissues from the upper, mid and lower poles were sent for culture and histological examination. Histology results were compared with the findings of the 3 ultrasound modalities.. All 10 pigs survived the surgical procedures with no complications. Post-contrast harmonic ultrasound images were available in 9 pigs (18 renal units). Harmonic ultrasound revealed decreased blood flow in 11 renal units, including the upper pole in 7, lower pole in 3, and upper and lower poles in 2. Renal tissue cultures were positive in 11 renal units (6 refluxing units). Histological findings revealed fibrosis in 10 renal units (8 refluxing units). Harmonic ultrasound findings in these 10 renal units showed 9 with changes consistent with inflammation or scars. Using histological results as the gold standard for renal injury harmonic ultrasound was more sensitive than gray scale ultrasound for detecting renal injury with 90% sensitivity, 75% specificity, 81% positive predictive value and 85% negative predictive value.. Preliminary results indicate that contrast enhanced ultrasound with harmonic imaging is a sensitive method for determining renal scarring without the need for radiation exposure. It may be prove to be a useful adjunct for evaluating children who present with urinary tract infection.

Topics: Animals; Cicatrix; Contrast Media; Escherichia coli Infections; Female; Kidney; Polysaccharides; Predictive Value of Tests; Pyelonephritis; Sensitivity and Specificity; Swine; Ultrasonography

MRI is the most reliable method to differentiate scar and recurrent carcinoma of the breast after surgical treatment. This study compares MRI and color-coded ultrasound with and without echo signal amplifier (ESA).. Forty-two patients with suspected recurrent tumors were enrolled in this prospective study, with 38 patients after breast conserving therapy and 4 after mastectomy. All patients had a clinical examination, mammography (n = 38), real time ultrasound (US), color-coded ultrasound without and with ESA (Levovist(R), Schering, Berlin), and dynamic MRI. The criteria used for duplex ultrasound were tumor vascularisation and flow pattern. The results were compared with histologic findings or the results of follow-up examinations for at least 12 months.. The detection of penetrating or central vessels proved to be an accurate sign of malignancy in duplex ultrasound. With the application of ESA, additional vessels were detected within the lesions, increasing the diagnostic accuracy (83 % with ESA versus 79 % without ESA). The sensitivity of color-coded ultrasound improved from 64 % to 86 % with echo signal amplifier. The specificity was 86 % without and 82 % with echo signal amplifier. MRI was found to have a sensitivity of 100 % and a specificity of 82 %. The same 5 lesions were false positive on MRI and color-coded US after Levovist(R). No lesion without signs of vascularity within or in its vicinity was malignant.. Color-coded ultrasound seems to be a promising method in the differentiation between scar and recurrence. Lesions with penetrating or central vessels have a high probability of being malignant, whereas lesions without any signs of vascularity inside or nearby have a high probability of being benign. Advantage of contrast-enhanced US is its ubiquitous availability.

Topics: Breast; Breast Neoplasms; Cicatrix; Contrast Media; Diagnosis, Differential; False Positive Reactions; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Mammography; Mastectomy, Modified Radical; Neoplasm Recurrence, Local; Polysaccharides; Prospective Studies; Sensitivity and Specificity; Time Factors; Ultrasonography, Doppler, Color; Ultrasonography, Mammary

To determine the scope of improving the distinction between a postoperative scar and the recurrence of a breast carcinoma through the use of the ultrasound echo enhancer Levovist?. In 23 patients with 26 lesions a colour-coded duplex sonography examination before and after administration of Levovist was performed. The parameters investigated were: degree of enhancement, number of tumour vessels and the pattern of vascular morphology and anatomy.. Recurrences (n = 15) demonstrated a greater number of vessels and a stronger enhancement after administration of Levovist. Individual vessels were also visible in scars (n = 11). Further evaluations with respect to the pattern of the tumour vascularization are therefore necessary with the exception of one false positive and one negative result a clear distinction was possible.. The administration of the ultrasound echo enhancer clearly improved the otherwise difficult distinction between a scar and a tumour recurrence through sonography and mammography. Further studies with larger number of patients are necessary to establish the value of the method.

Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Cicatrix; Contrast Media; Diagnosis, Differential; False Negative Reactions; False Positive Reactions; Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Polysaccharides; Prospective Studies; Reproducibility of Results; Ultrasonography, Doppler, Color

To evaluate the benefit of echo-contrast-enhanced Doppler sonography in the differentiation of benign vs. malignant breast lesions after surgical removal of a malignant breast mass.. Thirty-eight patients referred for biopsy of a palpable, suspicious scar lesion 1-15 years (mean 3.3 years) after surgery for breast cancer were examined. During baseline ultrasound examination a subjective scoring system of the vascularity, the number, the regularity of vessels' course and their Doppler parameters were assessed. After injection of an ultrasound contrast agent (Levovist) the same scoring system was applied to the parameters together with enhancement kinetics, enhancement intensity and enhancement pattern. Any increase in the scoring level of two or more characteristics (vascularity, number of vessels, intensity of enhancement in the tumor or regularity score of vessels in the lesion) was defined as suspicious for malignancy. A marked increase of enhancement in the immediate tumor periphery was also regarded as suspicious for malignancy. The sonographic results were assessed prospectively and correlated with the histology of the lesion.. Of the 38 patients with a clinically-suspicious scar lesion, there were 28 true scars and 10 malignant scar lesions. All scar lesions showed no or slight vascularity on baseline sonography. After Echocontrast-enhancement a significant increase in tumor vascularity and the number of tumor vessels could be demonstrated in all 10 malignant lesions but in only one of the 28 benign scars.. Scars pose inherent technical problems for optimal mammography. Sonographic evaluation of the vascularity of the lesion with contrast enhancing agents showed improved diagnostic accuracy in the hands of an experienced examiner.

Topics: Adult; Aged; Aged, 80 and over; Blood Flow Velocity; Blood Vessels; Breast Neoplasms; Cicatrix; Contrast Media; Diagnosis, Differential; Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Polysaccharides; Sensitivity and Specificity; Ultrasonography, Doppler, Color; Ultrasonography, Mammary