shu-508 and Liver-Cirrhosis

A number of diseases alter the normal pathophysiology of the portohepatic vascular system. The impact of these changes depends on the severity of the disease and the involvement of the entrahepatic vasculature. Cirrhosis of the liver is not a vascular disease but the effects on the liver architecture result in severe disease often accompanied by hepatic vascular changes. Alcohol abuse and viral infections are the most common causes of cirrhosis. Portal hypertension (PHT) is one of the most frequently seen sequelae of liver cirrhosis. It results in the formation of porto-systemic collateral channels which may lead to varices and hemorrhage. Primary liver cancer is also strongly associated with liver cirrhosis. Hepatocellular carcinoma (HCC) is the most common liver cancer seen in patients with cirrhosis. There are four types of HCC based on its growth patterns: infiltrative, expansive, mixed and diffuse. Raised plasma levels of alpha-fetoprotein are a characteristic of HCC. However, this marker is unreliable in patients with smaller tumors. Ultrasound is an inexpensive, non-invasive and safe diagnostic technique used to detect portal vein changes in PHT and to identify HCC lesions in the liver. Grey scale ultrasound reveals the portal vein changes and the portal-systemic collaterals which typify PHT. The technique is most useful for diagnosis or confirmation of moderate to severe disease. HCC nodules have characteristic ultrasound patterns which help in differential diagnosis. Doppler ultrasound provides functional as well as anatomical information about blood flow in the liver and is especially useful in detecting HCC and the abnormal blood vessel architecture which surrounds a tumor. However, despite their usefulness, both imaging techniques have limitations which may be improved by the use of echo-enhancing agents. Levovist(R) is a galactose-based microbubble echo-enhancing agent which has an excellent safety profile and utility in enhancing ultrasound images of the liver. It markedly improves diagnostic confidence and reduces the percentage of non-diagnostic ultrasound scans in patients with abnormal liver pathologies. The use of echo-enhanced ultrasound to diagnose liver disease may obviate the need for more expensive and invasive diagnostic procedures.

Topics: Blood Flow Velocity; Carcinoma, Hepatocellular; Contrast Media; Humans; Hypertension, Portal; Image Enhancement; Liver; Liver Cirrhosis; Liver Neoplasms; Polysaccharides; Regional Blood Flow; Ultrasonography, Doppler

The aims of this study on hepatic arterial Doppler sonography were to ascertain interobserver and interequipment variability, to investigate any potential artificial influence of the ultrasonic contrast agent on the Doppler measurements and to compare the results in healthy and cirrhotic subjects.. Doppler sonography of the left hepatic artery was performed in nine healthy and nine cirrhotic subjects by three independent observers using three different devices. Continuous infusion of the ultrasonic contrast agent SHU 508A and placebo were administered in a double blind fashion. Systolic, mean and end diastolic peak velocities as well as resistive and pulsatility indices were measured.. Equipment associated variances (5.8 - 12.7 %) of the five Doppler parameters were greater than interobserver variances (0.3 - 3.6 %). No significant differences were observed between the velocities using ultrasonic contrast agent and placebo. Systolic (65.9 +/- 3.6 vs. 47.7 +/- 4.2 cm/s mean +/- SE, p = 0.02) and mean peak velocity (35.4 +/- 1.6 vs. 24.5 +/- 1.8 cm/s, p = 0.007) were significantly higher in cirrhotic than in healthy subjects whereas the resistive and pulsatility indices were not different.. Doppler sonography of the left hepatic artery performed by various observers is reproducible as long as the same device is used. Under clinical conditions, velocities are correctly measured with the use of ultrasonic contrast agent and are elevated in patients with cirrhosis.

Topics: Adult; Aged; Analysis of Variance; Blood Flow Velocity; Calibration; Contrast Media; Double-Blind Method; Equipment Design; Female; Hepatic Artery; Humans; Liver Cirrhosis; Male; Middle Aged; Observer Variation; Polysaccharides; Prospective Studies; Pulsatile Flow; Reference Values; Ultrasonography, Doppler; Vascular Resistance

This study was aimed to assess the effect of Levovist on Doppler parameters of splanchnic hemodynamics. A total of 12 patients with cirrhosis and 12 healthy subjects underwent Doppler ultrasound (US) examination of the portal vein and of the hepatic, splenic and superior mesenteric arteries before, 5 to 8 and 12 to 15 min after the start of an 8-min long IV infusion of 2.5 g of Levovist. Mean velocity and mean diameter were calculated for the portal vein. Resistance index was determined for the arteries. A significant increase of resistance index was observed in the hepatic (0.80 +/- 0.07 vs. 0.71 +/- 0.06; p < 0.01) and splenic arteries (0.72 +/- 0.06 vs. 0.64 +/- 0.06; p < 0.01) 5 to 8 min after contrast agent injection in patients with cirrhosis, but not in controls. Neither portal vein diameter nor portal flow mean velocity changed during the test in both controls and cirrhotic patients. This effect might be related to a selective trapping of microbubbles in the altered hepatic and splenic microvasculature in patients with cirrhosis rather than being artefactual. It might have implications on harmonic imaging US protocols designed to image the cirrhotic liver in the early arterial phase.

Topics: Aged; Contrast Media; Female; Hemodynamics; Hepatic Artery; Humans; Liver Cirrhosis; Male; Middle Aged; Polysaccharides; Splanchnic Circulation; Splenic Artery; Ultrasonography, Doppler; Vascular Resistance

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

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

Liver cirrhosis (LC) is accompanied by hepatic arterializations, intrahepatic shunts, and hyperdynamic circulations. These changes shorten the arrival time (AT) of ultrasound contrast agents to the hepatic vein (HV). Whether treatment of gastric fundal varices (GVs) by balloon-occluded transvenous obliteration (B-RTO) improves the AT in LC patients was prospectively investigated.. A total of 32 LC patients with GVs and 10 normal controls (NCs) were enrolled. This study was approved by the clinical research ethics committee. Images of hepatic artery (HA), portal vein (PV), and HV were monitored after an injection of a contrast agent using quantification software. The AT before and after B-RTO in LC patients and that in NCs were compared.. All GVs were treated effectively, and indocyanine green retention rate was improved (P < 0.0001). The mean values of the HA, PV, and HV ATs in the NCs were 21.9 ± 3.3, 28.2 ± 2.0, and 40.5 ± 2.1 s, respectively. Those in LC patients were 17.4 ± 4.4, 21.9 ± 5.6, and 26.3 ± 6.7, respectively, which were shorter than those in NCs (P < 0.01, P < 0.002, P < 0.0001, respectively). However, these ATs were significantly prolonged 1 week after B-RTO, with mean values of 18.7 ± 4.8, 23.8 ± 6.0, and 30.0 ± 7.2 s (P = 0.043, P < 0.01, P < 0.001).. Obliteration of GVs shifted the AT in LC patients to the normalization, raising the possibility of improvement of arterialization and intrahepatic shunt.

Topics: Aged; Balloon Occlusion; Contrast Media; Esophageal and Gastric Varices; Female; Hepatic Artery; Hepatic Veins; Humans; Liver Circulation; Liver Cirrhosis; Liver Function Tests; Male; Microbubbles; Middle Aged; Polysaccharides; Prospective Studies; Radiography, Interventional; Treatment Outcome; Ultrasonography

We evaluated the efficacy of contrast-enhanced ultrasonography (CEUS) for the characterization of small hepatic nodules (< or =2 cm) in cirrhosis patients.. Thirty cirrhosis patients with 30 hepatic nodules (1-2 cm) were enrolled in this study. Eighteen hepatic nodules were hepatocellular carcinomas (HCC) and 12 were benign lesions. CEUS was performed using microbubble contrast (Levovist). With surrounding hepatic parenchyma as a reference, two characteristics of hepatic nodules, including arterial phase enhancement (AE) and the absence of delayed phase enhancement (ADE), were evaluated as criteria for the diagnosis of HCC. A radiologist independently reviewed the dynamic computed tomographies (CT) of 26 hepatic nodules.. CEUS showed AE in 15 nodules (13 HCC and two benign) and ADE in 17 lesions (14 HCC and three benign). For HCC, the coincidental AE of both CEUS and dynamic CT was 40%. Using both AE and ADE for HCC diagnosis, the sensitivity, specificity, accuracy, positive predictive value and negative predictive values were 55.6%, 91.7%, 70%, 90.9% and 57.9%, respectively. When using either AE or ADE for HCC diagnosis, the same parameters were 94.4%, 66.7%, 83.3%, 81% and 88.9%, respectively. One benign hepatic nodule with both AE and ADE was diagnosed as HCC 29 months after the CEUS study.. A combination of characteristics of AE and ADE as determined by CEUS was highly specific for small HCCs in cirrhosis patients. Concurrent delayed phase imaging is useful in the diagnosis of small hypovascular HCCs.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Humans; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Retrospective Studies; Ultrasonography, Doppler

Contrast enhancement in the portal vein was repeatedly observed at 1 min intervals with wide-band Doppler ultrasonography in 152 consecutive patients (132 with liver cirrhosis and HCC, 20 controls), 5 min after the injection of Levovist. The duration time of contrast enhancement in the portal vein (microbubble disappearance-time; MD-T) was measured in all patients and contrast-enhanced appearances were compared between the 5 min phase and MD-T phase in 68 HCC nodules. MD-T in patients with liver cirrhosis (572.4 +/- 117.9 s) was significantly longer than in controls (481.6 +/- 89.3 s, p < 0.05). MD-T was prolonged in patients with Child B and C compared with Child A (p < 0.05). The contrast-enhanced appearances between the two phases were different in 30 of 68 HCC nodules (44.1%), showing positive enhancement in the 5 min phase and negative enhancement in the MD-T phase. The proposed MD-T may become an essential factor for the evaluation of liver-specific sonograms.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Humans; Image Enhancement; Injections, Intravenous; Liver; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Male; Microbubbles; Middle Aged; Polysaccharides; Portal Vein; Retrospective Studies; Time Factors; Ultrasonography, Doppler

Microbubble of Levovist accumulates in liver parenchyma, and the phenomenon has been reported as late liver-specific parenchymal. The aim of the present study was to compare the parenchymal enhancement effect of Levovist with the degree of liver dysfunction.. Sixty consecutive patients who consented to be treated were enrolled in this study. Pulse-inversion ultrasonography (US) in the liver parenchymal phase of enhancement with Levovist was performed in a preoperative examination. The mechanical index of pulse-inversion US was set at 1.3. The gray-scale intensity of the non-tumor area of the liver parenchyma at the level of the focal zone was measured. The hepatic fibrosis index was measured in each liver by morphometric analysis. The correlation between the gray-scale intensity of the non-tumor area of the liver parenchyma and the hepatic fibrosis index was assessed.. There was a significant inverse correlation between the gray scale of the liver parenchyma and the hepatic fibrosis index (r = -0.809, P < 0.01). The average signal intensity of the liver parenchyma was 144.5 in a normal liver, 133.6 in chronic hepatitis, and 102.6 in liver cirrhosis, demonstrating a significant difference between a normal and cirrhotic liver (P < 0.01).. The signal intensity of a microbubble disruption of the liver parenchyma in the late phase of enhancement with Levovist was considered to reflect the degree of hepatic fibrosis.

Topics: Adult; Aged; Aged, 80 and over; Analysis of Variance; Biological Availability; Cohort Studies; Contrast Media; Female; Humans; Image Enhancement; Liver; Liver Cirrhosis; Male; Microbubbles; Middle Aged; Polysaccharides; Prospective Studies; Sensitivity and Specificity; Severity of Illness Index; Ultrasonography, Doppler

To assess the diagnostic accuracy and advantages of intrahepatic circulatory time analysis of an ultrasound contrast agent using pulse-inversion imaging as compared with recently reported noninvasive diagnostic tests for cirrhosis.. Forty patients divided into noncirrhotic (nonLC) (n = 20) and compensated cirrhotic (LC) (n = 20) groups were studied prospectively. After intravenous administration of a contrast agent, the arrival times at the hepatic artery (HA), portal vein (PV), and hepatic vein (HV) were measured by pulse-inversion imaging. Intrahepatic circulatory time was calculated as the difference between the HV and HA arrival times (HV-HA interval time) or the HV and PV arrival times (HV-PV interval time).. The HV-HA and HV-PV interval times were significantly shorter in the LC group (7.4 +/- 1.7 and 1.9 +/- 1.5 s, respectively) compared with those in the nonLC group (normal: 15.6 +/- 2.1 and 11.1 +/- 1.7 s, respectively; P < 0.001 and P < 0.001, respectively, and hepatitis: 12.8 +/- 4.1 and 7.8 +/- 4.4 s, respectively; P < 0.001 and P < 0.002, respectively). Each intrahepatic circulatory time showed the highest accuracy rate for cirrhosis in other noninvasive diagnostic tests.. This analysis, which is considered to reflect intrahepatic hemodynamic changes, is a useful noninvasive diagnostic test for compensated cirrhosis.

Topics: Adult; Aged; Biological Availability; Case-Control Studies; Contrast Media; Female; Humans; Liver Circulation; Liver Cirrhosis; Male; Middle Aged; Polysaccharides; Probability; Prospective Studies; Reference Values; Sensitivity and Specificity; Statistics, Nonparametric; Time Factors; Ultrasonography, Doppler

To study the hepatic transit time of an ultrasound contrast agent in patients with liver disease, and to evaluate the mechanism(s) of the well-established shorter cubital vein to hepatic vein transit time in cirrhosis.. Thirty-four patients scheduled for Menghini liver biopsy were studied by ultrasound after injection of 2.5 g Levovist (Schering, Berlin, Germany) into an arm vein. The time from injection until the first appearance of contrast echoes in the hepatic artery and hepatic veins was registered. Hepatic transit time was the difference between the two.. Biopsy showed cirrhosis in 9 patients, other diffuse hepatic pathology in 23 patients, and normal liver in 2 patients. Mean hepatic vein arrival time was earlier in cirrhosis than in other liver disease (19.4 s versus 26.0 s; P = 0.013), and hepatic transit time was shorter (6.6 s versus 11.6 s; P = 0.024). A hepatic transit time <10 s was found in all patients with cirrhosis, but also in 10 of 23 patients with other liver pathology.. Hepatic transit time measurement could not be used to distinguish between cirrhosis and other hepatic pathology, but a transit time = 10 s excluded cirrhosis. The earlier hepatic vein arrival time in cirrhosis is apparently mainly caused by intrahepatic shunting rather than by early arrival of contrast to the liver.

Topics: Biopsy; Contrast Media; Elbow; Female; Hepatic Artery; Hepatic Veins; Humans; Injections, Intravenous; Liver; Liver Cirrhosis; Liver Diseases; Male; Middle Aged; Polysaccharides; Portal Vein; Single-Blind Method; Time Factors; Ultrasonography; Videotape Recording

To provide the useful information for the diagnosis of liver cirrhosis by observing the morphology of peripheral hepatic vessels and the hemodynamics of microbubble arrival time in these vessels.. Twenty-one subjects including 5 normal volunteers and 16 patients (liver cirrhosis, n=10; chronic hepatitis, n=6) were studied by contrast-enhanced coded phase inversion harmonic sonography (GE LOGIQ 9 series) using a 6-8 MHz convex-arrayed wide-band transducer. The images of peripheral hepatic artery, portal and hepatic vein were observed in real-time for about 2 min after intravenous injection of Levovist. The time when microbubbles appeared in the peripheral vessels (microbubble arrival time) was also recorded. The morphologic changes of peripheral hepatic vasculature were classified as marked, slight, and no changes based on the regularity in caliber, course, ramification, and the delineation of vessels compared to normal subjects.. The microbubble arrival time at peripheral artery, portal, and hepatic vein was shorter in cirrhotic patients than in chronic hepatitis patients and normal subjects. The marked, slight and no morphologic changes of peripheral hepatic vasculature found in 5 (5/6, 83.3%), 1 (1/6, 16.7%), and 0 (0/6, 0%) liver cirrhosis patients, respectively, and in 1 (1/10, 10%), 6 (6/10, 60%), and 3 (3/10, 30%) chronic hepatitis patients, respectively. There was a significant difference between the two groups (P< 0.001).. Evaluation of the hemodynamics and morphology of peripheral hepatic vasculature by contrast-enhanced coded pulse inversion harmonic sonography can provide useful information for the diagnosis of liver cirrhosis.

Topics: Adolescent; Adult; Aged; Contrast Media; Female; Hemodynamics; Hepatic Artery; Hepatic Veins; Humans; Injections, Intravenous; Liver; Liver Cirrhosis; Male; Microbubbles; Middle Aged; Polysaccharides; Portal Vein; Ultrasonography, Doppler

To investigate if esophageal varices can be evaluated using external contrast-enhanced ultrasonography with Levovist and coded harmonic angio (CHA).. Subjects were six healthy adult volunteers and 23 patients with liver cirrhosis. After identification of the lower esophagus under B-mode scanning, 300 mg/mL of Levovist was intravenously injected into the cubital vein at a rate of 1 mL/s under observation by CHA-mode scanning. Approximately 30 s after intravenous administration, interval-delay scanning was performed every second to visualize the area around the lower esophageal lumen. The degree of ultrasonographic enhancement was assessed as either no enhancement (negative); linear enhancement along the esophageal wall (weak) or full enhancement of the esophageal lumen (strong). Endoscopic evaluation of esophageal varices was also performed.. The CHA enhancement around the lower esophageal lumen was identified in 21 of the 23 patients. Of these 21 patients, endoscopic assessments of varices were as follows: F0 in four patients, F1 in seven patients, F2 in three patients, and F3 in seven patients. Nine patients were red color sign (RCS)-positive. Regarding the relationship between ultrasonographic enhancement and endoscopic assessment, enhancement was identified as negative in all four F0 patients, negative in three and weak in three and strong in one of the seven F1 patients, weak in one and strong in two of the three F2 patients, and weak in two and strong in five of the seven F3 patients, respectively. Furthermore, of the nine RCS-positive patients, enhancement was recognized as strong in seven and weak in two patients. Ultrasonographic enhancement was identified as negative in all six healthy volunteers.. By performing contrast-enhanced CHA ultrasonography using Levovist, ultrasonographic enhancement was detectable in all patients with varices categorized as F2 or above. Because the present method is easy to perform and causes less pain to patients compared to endoscopy, it is useful for following and assessing esophageal varices in patients with liver cirrhosis.

Topics: Aged; Contrast Media; Esophageal and Gastric Varices; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Polysaccharides; Statistics, Nonparametric; Ultrasonography

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

To determine whether changes in hepatic parenchymal blood flow in cirrhotic patients can be evaluated with contrast-enhanced ultrasound (US) after Levovist administration.. Ten normal volunteers, 16 Child A and 16 Child C cirrhotic patients were evaluated with contrast-enhanced US. Frames obtained at progressively increasing pulse intervals of 2, 4, 7, and 10 seconds in the same scan plane during infusion of Levovist (300 mg/mL, 150 mL/h) have been digitally recorded. Pulse intervals versus signal intensity (PI-SI) plots were fitted to a straight line whose slope is proportional to the speed of blood in the liver parenchyma. Enhancement differences in late phase have been evaluated measuring the SI after 7 minutes from the beginning of the infusion.. The slope of the PI-SI plot of the Child A cirrhotic patients was significantly lower than the slope of the normal controls (P < 0.05); conversely, no significant differences were found between the slope of the patients with Child C cirrhosis and that of the normal controls. In comparison with the normal subjects, the average SI at late phase decreased significantly both in patients with Child A (P < 0.05) and Child C (P < 0.001) cirrhosis.. Microbubble contrast agents could provide a noninvasive tool to detect and monitor hemodynamic changes that occur in the cirrhotic liver. Changes in the hepatospecific properties at late phase have also been demonstrated.

Topics: Aged; Contrast Media; Female; Humans; Image Enhancement; Liver; Liver Circulation; Liver Cirrhosis; Male; Pilot Projects; Polysaccharides; Ultrasonography

To evaluate the capabilities of Pulse Inversion Harmonic Imaging (PIHI) with hepatospecific US contrast agent Levovist in the characterization of focal liver lesions in cirrhotic patients.. Thirty-nine focal hepatic lesions in 25 consecutive cirrhotic patients identified by conventional ultrasound (US), were evaluated by color Doppler (CD), power Doppler (PD) with spectral analysis of tumoural vessels and PIHI. PIHI was performed 30 seconds (vascular phase) and 3-5 minutes (late phase) after Levovist injection. To definitely characterize the evaluated focal hepatic lesions, helical-CT (HCT) enhancement patterns (15 patients) and/or surgical/bioptic histologic findings (10 patients) were considered as reference procedures.. Thirty focal hepatic lesions classified as hepatocellular carcinoma (HCC) by reference procedures appeared hypoechoic (n=19), isoechoic (n=5) or hyperechoic (n=6) on conventional US, with basket arterial pattern (n=10), vessels within the tumor (n=6), peripheral arterial pattern (n=4) or no vascular pattern (n=10) on CD/PD evaluation. On PIHI they appeared hyperechoic (n=26) or isoechoic (n=4) in the vascular phase, if compared to the surrounding liver parenchyma, and hypoechoic (n=23) or isoechoic (n=7) in the late phase. Four focal hepatic lesions classified as regenerative nodules (RNs) by reference procedures appeared hypoechoic on conventional US, with peripheral venous/arterial pattern (n=1) or no vascular pattern (n=3) on CD/PD. On PIHI they appeared hypoechoic (n=3) or isoechoic (n=1) in the vascular phase, remaining prevalently hypoechoic (n=3) or isoechoic (n=1) in the late phase. Five focal hepatic lesions classified as hemangioma by reference procedures appeared hyperechoic (n=4) or hypoechoic (n=1) on conventional US with few peripheral venous vessels on CD/PD. On PIHI they revealed progressive fill-in from the periphery toward the centre during the vascular and late phase after Levovist injection.. PIHI seems to be a reliable technique to characterize focal lesions in cirrhotic patients.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Hemangioma; Humans; Liver; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography, Doppler, Color

Modern ultrasound technologies can be divided into methods of visual image improvement/presentation, image quantification, and echo contrast agent applications. Image improvement can be realized by options such as Photopic, tissue harmonic imaging, and panorama methods. Parametric ultrasound quantifies observer-independent image textures. Echo contrast agents offer a better detection of tumor lesions and vascular kinetic investigations.

Topics: Contrast Media; Fatty Liver; Humans; Liver Cirrhosis; Male; Polysaccharides; Splenic Infarction; Ultrasonography

The aim of this study was to ascertain whether a new ultrasound technique, namely pulse inversion imaging, could assess the arrival of a contrast agent in the hepatic veins, and to describe possible advantages of this procedure in determining transit time over a previously described method based upon spectral Doppler quantification. 15 subjects were scanned using pulse inversion imaging. A bolus injection of 2.5 g Levovist (Schering AG, Berlin, Germany) 300 mg x ml(-1) was given into an antecubital vein. Median transit times of 16 s (range 14-20 s) were found in patients with liver cirrhosis (n=4), 22 s (range 16-27 s) in patients with focal liver lesions (n=8) and 31 s (range 30-32 s) in control subjects (n=3). The maximum interobserver variation was 2 s and the maximum intraobserver variation was 3 s (n=10). Transit time was assessed by both pulse inversion imaging and spectral Doppler quantification in six patients. Comparison of the two methods showed transit times within 2 s apart in five patients and within 5 s apart in one patient. In conclusion, it is possible to assess transit time using pulse inversion imaging. This method is simpler than a previously described method requiring computer analysis. Moreover, several liver veins can be assessed simultaneously. Different transit times were observed in different liver veins in two patients with liver tumours. A short transit time (<27 s) appears to be found only in patients with liver disease. After transit time assessment, it is possible to use the injected contrast agent for late phase imaging of the liver parenchyma.

Topics: Adult; Aged; Contrast Media; Hepatic Veins; Humans; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Middle Aged; Observer Variation; Polysaccharides; Ultrasonography

Hepatic cirrhosis is accompanied by several haemodynamic changes including arterialisation of the liver, intrahepatic shunts, pulmonary arteriovenous shunts, and a hyperdynamic circulatory state. We postulated that the hepatic first pass of a bolus of an ultrasound contrast agent injected into a peripheral vein is accelerated in patients with cirrhosis. We investigated this first pass in patients with diffuse liver disease and in normal controls to assess whether it provides useful differential diagnostic information.. We enrolled 15 patients with biopsy-proven cirrhosis, 12 patients with biopsy-proven non-cirrhotic diffuse liver disease, and 11 normal controls. We carried out continuous spectral doppler ultrasonography of a hepatic vein from 20 s before to 3 min after a peripheral intravenous bolus injection of 2.5 g Levovist. The intensity of the doppler signal was measured and used to plot time-intensity curves.. Patients with cirrhosis showed a much earlier onset of enhancement (arrival time; mean 18.3 s) and peak enhancement (mean 55.5 s) than controls (49.8 s and 97.5 s) or patients with non-cirrhotic diffuse liver disease (35.8 s and 79.7 s). All patients with cirrhosis had an arrival time of the bolus of less than 24 s, whereas the arrival time was 24 s or more in 22 of the 23 other participants. Peak enhancement was higher in patients with cirrhosis (mean 48.7 units) than in the other two groups (12.5 and 12.3 units, respectively). We found highly significant differences between the patients with cirrhosis and each of the other two groups for all variables (p<0.005), whereas we found no significant differences between non-cirrhotic patients and controls.. Our preliminary study suggests that analysis of liver transit time of a bolus of ultrasound contrast agent provides useful information about haemodynamic changes in patients with cirrhosis. Measurement of the arrival time of the bolus allows discrimination of patients with cirrhosis from controls and from patients with non-cirrhotic diffuse liver disease, and has potential as a non-invasive test for cirrhosis.

Topics: Adult; Aged; Contrast Media; Diagnosis, Differential; Diagnostic Techniques, Digestive System; Female; Hepatitis C, Chronic; Humans; Injections, Intravenous; Liver Cirrhosis; Male; Middle Aged; Pilot Projects; Polysaccharides; Time Factors; Ultrasonography

Topics: Adult; Aged; Biopsy; Blood Flow Velocity; Contrast Media; Diagnosis, Differential; Female; Humans; Injections, Intravenous; Liver Circulation; Liver Cirrhosis; Male; Middle Aged; Polysaccharides; Time Factors; Ultrasonography, Doppler

Quantitative studies were performed to investigate liver- specific uptake of the microbubble Levovist, using stimulated acoustic emission (SAE), which can detect microbubbles even when stationary or slow-moving. These comprised studies of biodistribution comparing the liver and kidney in five normal volunteers, reproducibility in 34 patients, comparison between cirrhotics and controls (n = 9 each) and maximal depth of effect at different frequencies (180 measurements in 31 patients). Stimulated acoustic emission lasted beyond 30 min, with strongly liver-specific properties in each volunteer and was highly reproducible. No difference in the amount of SAE in the superficial liver was seen between cirrhotic and normal livers, but attenuation was higher in cirrhotics. This demonstrates a frequency-dependent effect on liver SAE penetration. We conclude that the liver uptake of Levovist lasts over 30 min, is reproducible, occurs even where diffuse liver disease is present and can be used to assess tissue attenuation in a novel fashion.

Topics: Adult; Aged; Contrast Media; Female; Humans; Kidney; Liver; Liver Cirrhosis; Male; Middle Aged; Polysaccharides; Reproducibility of Results; Spleen; Ultrasonography

A study was performed to determine the visualization of the transjugular intrahepatic portosystemic stent shunt (TIPSS) and the detection of stenosis by the use of a capillary transversing signal enhancer. In 37 patients 37 colour-coded duplex sonographies were performed before and after intravenous injection of the ultrasound signal enhancer Levovist (Schering, Berlin). The examinations were evaluated using a four-category score. Special attention was paid to the detection of stenoses in the TIPSS. Transjugular portal venograms of the same day were used as gold standard. The use of Levovist provided better colour and flow signals for the portal vein end of the shunt in only 9 of 37 sonograms and for the hepatic vein end of the shunt in 37 of 39 sonograms. Eleven of 13 stenoses requiring reintervention in portal venography could be correctly identified with signal enhancer. Eleven of these 13 stenoses were located in the hepatic vein end of the shunt. Ultrasound signal enhancer can significantly improve the sonomorphological visualization especially of the hepatic vein end of TIPSS in colour-coded duplex sonography. Stenoses which usually occur in the hepatic vein end of the shunt may be better detected.

Topics: Constriction, Pathologic; Contrast Media; Female; Humans; Hypertension, Portal; Image Enhancement; Liver Cirrhosis; Male; Polysaccharides; Portasystemic Shunt, Transjugular Intrahepatic; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Duplex