shu-508 and Hyperplasia

The purpose of this study was to evaluate the clinical usefulness of a galactose-based, IV sonographic contrast agent for assessing tumor vascularity and diagnosing hepatocellular carcinoma.. We used color Doppler sonography with the sonographic contrast agent to examine 22 patients with 26 hepatic nodules (18 hepatocellular carcinomas, four hemangiomas, two adenomatous hyperplasias, and two metastatic tumors). In all 26 lesions, intratumoral arterial flow signals were examined before and after IV injection of the sonographic contrast agent at three concentrations (200, 300, and 400 mg/ml), and the findings on color Doppler sonograms of each lesion were correlated with angiographic findings.. Conventional color Doppler sonograms showed flow in nine hepatocellular carcinomas (50%) and one hemangioma (25%). When the contrast agent was used, color Doppler sonograms showed intratumoral arterial flow in 11 hepatocellular carcinomas (61%) and one hemangioma (25%) at a concentration of 200 mg/ml, in 14 hepatocellular carcinomas (78%) and 1 hemangioma (25%) at 300 mg/ml, and in 15 hepatocellular carcinomas (83%) and two hemangiomas (50%) at 400 mg/ml. The detectability of intratumoral arterial flow was improved by the contrast agent, especially in hepatocellular carcinomas smaller than 30 mm in diameter. Angiography revealed neovascularization or staining in 15 hepatocellular carcinomas, four hemangiomas, and none of the adenomatous hyperplasias or metastatic tumors. Among 15 angiographically hypervascular hepatocellular carcinomas, the detection rate of intratumoral arterial flow with contrast-enhanced color Doppler sonography was 73% at 200 mg/ml, 93% at 300 mg/ml, and 100% at 400 mg/ml. No intratumoral Doppler signals were depicted with the use of contrast agent in any angiographically undetected tumors.. Preliminary findings on contrast-enhanced color Doppler sonograms correlate well with angiographic findings for evaluating tumor vascularity. This noninvasive technique may be useful in diagnosing hypervascular hepatocellular carcinomas.

Topics: Adenoma; Adult; Aged; Angiography; Carcinoma, Hepatocellular; Contrast Media; Female; Hemangioma; Humans; Hyperplasia; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Pulsatile Flow; Regional Blood Flow; Ultrasonography, Doppler, Color

The differential diagnosis of focal hepatic lesions is a current problem even though many study methods are available. Color Doppler US has been recently suggested as a diagnostic technique capable of depicting lesion vascularization patterns to better understand lesion nature. However, this examination is often difficult and long. In this study, we investigated the role of a US contrast agent SH U 508 A (Levovist) enhancing the color Doppler signals for easier and better depiction of lesion vascularization. Seventy-four patients with one or more focal hepatic lesions (mean diameter: 5.6 cm) were examined. The lesions were 38 HCCs, 4 cholangiocarcinomas, 1 intrahepatic biliary duct carcinoma, 1 case of multiple adenomas, 2 regenerations nodules in cirrhosis, 2 cases of FNH, 18 metastases and 8 hemangiomas. In 54 cases the US contrast agent allowed the visualization of some vessels inside the lesions which had been missed at baseline examinations. Moreover, the vessels which had been depicted on baseline images were better demonstrated. In all but one patient with severe hepatic steatosis, normal parenchymal vessels were markedly enhanced. Our results in the different kinds of tumors are here reported.

Topics: Color; Contrast Media; Diagnosis, Differential; Hemangioma; Humans; Hyperplasia; Liver; Liver Cirrhosis; Liver Neoplasms; Polysaccharides; Ultrasonography

Lesions of focal nodular hyperplasia are hypervascular, benign focal liver lesions whose differentiation from other focal liver lesions is of significant clinical relevance. The purpose of this study was to investigate the echo-enhancing agent SHU 508A (Levovist) in the evaluation of focal nodular hyperplasia with Doppler sonography. We examined 49 patients with 71 lesions of focal nodular hyperplasia in the liver with gray scale and power Doppler sonography. In all patients Levovist was administered intravenously in a concentration of 300 to 400 mg galactose per milliliter. Visualization of the feeding vessels and the vascularity of the lesions were evaluated, and the resistive indices in the feeders and the hepatic arteries were assessed. In comparison with unenhanced power Doppler sonography, echo-enhanced power Doppler sonography yields a higher sensitivity in the detection of the feeding artery (97% versus 82%) in focal nodular hyperplasia and in the depiction of the radial vascular architecture in such lesions, especially those located in the left lobe of the liver. Lesions less than 3 cm in diameter do not consistently show a characteristic vascular architecture with echo-enhanced Doppler sonography. The resistive index of the tumor-feeding artery (mean, 0.51 +/- 0.09) is significantly (P < 0.0001) lower than that of the hepatic artery (mean, 0.65 +/- 0.06) and decreases as the size of the focal nodular hyperplasia increases. The administration of Levovist may improve the signal-to-noise ratio and thus visualization of the vascular architecture in focal nodular hyperplasia. Lesions located in the left lobe of the liver, which commonly are subject to disturbing motion artifacts in color Doppler sonography, will significantly benefit from the administration of Levovist. Echo-enhanced power Doppler sonography, however, is not capable of depicting a characteristic vascular pattern in small (< or = 3 cm) lesions of focal nodular hyperplasia that would guarantee a specific diagnosis.

Topics: Adult; Contrast Media; Female; Humans; Hyperplasia; Image Enhancement; Liver; Middle Aged; Polysaccharides; Sensitivity and Specificity; Ultrasonography, Doppler

This study involved a prospective evaluation of the reliability of sonography, and especially duplex sonography, in confirmation of the benign nature of enlarged cervical lymph nodes.. In 53 untreated patients with enlarged cervical lymph nodes, B-mode, plain, and d-galactose-enhanced color duplex sonography were performed. The B-mode sonomorphology was analyzed for the structure of vascularization. Quantitative parameters such as maximum flow velocity, pulsatility index, and resistive index were also assessed. The benignity of the lymph nodes was confirmed by microscopic analysis.. The B-mode showed 20 homogeneous lymph nodes, 23 with a central echogenoic line covering less than one third, and 10 with a distinct hilus sign extending to more than one third of the lymph node diameter. Microscopically, the least fibrotic or chronic inflammatory changes in the parenchyma were observed in the homogeneous lymph nodes, whereas those with central echogeneoity had fibrotic and lipoid hilus changes. Histologically, all lymph nodes had normal afferent and efferent hilus vessels. In 37 lymph nodes, the vessel structure could be reliably visualized by both plain and enhanced color duplex sonography, whereas in 16 it could only be demonstrated after the use of signal enhancement. Nine of 53 lymph nodes had Solbiati-(L/T-) indices below 2, which were suggestive of malignancy. Quantitative flow parameters did not provide useful information.. Color duplex analysis of enlarged lymph nodes is a useful method for assessment of benignity, especially after application of a signal-enhancing agent.

Topics: Adult; Aged; Aged, 80 and over; Blood Flow Velocity; Carcinoma, Squamous Cell; Contrast Media; Feasibility Studies; Female; Head and Neck Neoplasms; Humans; Hyperplasia; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neck; Polysaccharides; Prospective Studies; Pulsatile Flow; Reproducibility of Results; Ultrasonography, Doppler, Color; Vascular Resistance

To evaluate the characterisation of liver lesions using power Doppler sonography before and after intravenous injection of the ultrasound contrast agent Levovist.. 39 patients with 41 liver lesions (10 haemangiomas, 2 focal nodular hyperplasias (FNH), 2 focal fatty infiltrations, 1 echinococcal lesion, 11 hepatocellular carcinomas, 14 metastases and one cholangiocarcinoma) were evaluated prospectively. Power Doppler images before and after intravenous injection of the ultrasound contrast agent Levovist were analysed by two radiologists and one gastroeterologist, who subjectively classified the distribution (peripheral, central, diffuse) and amount (none, minimal, moderate and strong) of flow pattern in each sonographic examination. Histological verification was obtained in all liver lesions, except in haemangiomas, where MR imaging and in one FNH where scintigraphy was regarded as sufficient proof.. On the whole, power Doppler sonography after contrast injection was superior to unenhanced power Doppler-sonography in 20 liver lesions and equal in 7. After contrast injection, previously visible flow was enhanced in 14 patients, in 6 lesions flow was detected, which was not seen before in the power mode. Moderate or strong flow signals were detected before contrast injection in 8/26, post contrast injection in 18/26 malignant tumours. Contrawise, 13/15 benign lesions did show any or only minimal flow signals before and 10/15 after contrast injection.. Intratumoural flow signals favour a malignant tumour. The absence of flow signals is a frequent finding in benign lesions but does not rule out malignancy.

Topics: Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Echinococcosis, Hepatic; Fatty Liver; Hemangioma; Humans; Hyperplasia; Liver; Liver Diseases; Liver Neoplasms; Polysaccharides; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Lidofenin; Ultrasonography, Doppler

Focal nodular hyperplasias (FNH) are hypervascular, benign focal liver lesions. Differentiation of FNH from other focal liver lesions is of clinical importance. The purpose of this study was to examine the impact of a new, transpulmonary echo-enhancing agent SHU 508A (Levovist) and recent Doppler techniques in the sonographic evaluation of FNH. 43 patients with 61 focal nodular hyperplasias of the liver were examined with grey scale ultrasound and power Doppler ultrasound. Levovist, a galactose-air-microbubble suspension was administered intravenously in all patients, either by bolus injection (400 mg ml-1) or continuous pump-infusion (300 mg ml-1). Visualization of the feeding vessels and vascularity of the lesions were evaluated. The resistance indexes (RI) in the feeding vessel and the hepatic artery were assessed and compared with the diameters of the FNH. The mean diameter of FNH was 4.3 cm (+/- 1.0). Echo enhanced power Doppler ultrasound was superior to unenhanced power Doppler ultrasound in the detection of the feeding artery (85% vs. 98%) in FNH and depicted the internal vascular architecture more clearly, especially in lesions located in the left lobe of the liver. Lesions smaller than 3 cm did not show a characteristic vascular architecture with echo enhanced Doppler ultrasound. The resistance index of the feeding artery (mean: 0.51 +/- 0.08) is significantly (p < 0.0001) lower than that of the hepatic artery (mean 0.65 +/- 0.06) with a mean difference of -0.14 +/- 0.01 in the same patient. The RI of the feeding artery significantly decreased as the size of the FNH increased, whereas RI differences between the hepatic artery and the feeding artery increased with lesion size. Intravenous (i.v.) bolus injection of the contrast agent will depict the hypervascular nature of FNH more clearly than i.v. infusion, although the latter will significantly prolong the diagnostic window. In conclusion, i.v. infusion of Levovist improves the visualization of the feeding artery and the radiating vascular architecture in FNH located in the left lobe of the liver due to improved signal-to-noise ratio and results in more effective suppression of motion artefacts. Although echo enhanced Doppler ultrasound improves the detection of the low resistance arterial feeding vessel in small FNH, it will not, however, reveal a specific vascular pattern in these lesions.

Topics: Adult; Contrast Media; Female; Humans; Hyperplasia; Liver; Liver Diseases; Middle Aged; Polysaccharides; Ultrasonography, Doppler

Patients with focal liver lesions (hemangioma, focal nodular hyperplasia, adenoma, hepatocellular carcinoma, metastatic lesions, focal fatty lesion) received the ultrasound contrast agent Levovist (300 mg/mL and 400 mg/mL) intravenously. This ultrasound contrast agent (a suspension of micrometer-sized microparticles of galactose and microscopic gaseous bubbles) can pass through the lungs without impairment. After the administration of Levovist, increased color flow signals were detected in the liver. Five of 6 patients with metastatic liver lesions showed previously undetected blood flow in the rim of the tumor. In 4 patients with hepatocellular carcinoma, enhanced signal intensity was observed in the vessels of the rim and in 3 of those patients in the center of the tumor. One patient with adenoma and one patient with focal nodular hyperplasia showed signal enhancement in the central area of the tumor. No signal enhancement was observed in hemangiomas, a focal fatty lesion, or in a carcinoid metastatic lesion. Levovist increased the echointensity of normal and tumor vessels in liver lesions. This new ultrasound contrast agent led to the detection of tumor vessels previously not detectable by conventional color flow imaging.

Topics: Adenoma; Adult; Carcinoid Tumor; Carcinoma, Hepatocellular; Contrast Media; Fatty Liver; Female; Hemangioma; Humans; Hyperplasia; Image Enhancement; Injections, Intravenous; Liver; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Regional Blood Flow; Ultrasonography, Doppler, Color