shu-508 and Neoplasm-Metastasis

This study was conducted to assess changes in tumor vascularity using contrast-enhanced ultrasonography in patients with pancreatic carcinoma under systemic chemotherapy and to examine the correlation among vascular change, clinicopathologic factors, and outcome.. Forty-one consecutive patients with histopathologically confirmed pancreatic carcinoma who had distant metastases and were under systemic chemotherapy were recruited. Contrast-enhanced ultrasonography was performed before and after 1 and 2 cycles of treatment.The vascular signals from the tumor were continuously recorded,and the highest signal intensity was selected and classified into 5 categories by their intensity.. As for the tumor response determined by dynamic computed tomography after 2 cycles, 6 patients showed a partial response, 25 remained stable, and in 10 patients, the disease progressed. A significant relationship was observed between vascular change after 1 cycle and tumor response (P G 0.001). Progression-free survival and overall survival were significantly short in the case of patients showing increased vascularity after 1 and 2 cycles of chemotherapy, compared with those who did not (P G 0.001).. Contrast-enhanced ultrasonography was useful to evaluate tumor vascular changes and thereby the effect of systemic chemotherapy, as well as the prognosis of patients with advanced pancreatic carcinoma.

Topics: Adenocarcinoma; Antineoplastic Agents; Contrast Media; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Metastasis; Neovascularization, Pathologic; Pancreatic Neoplasms; Polysaccharides; Predictive Value of Tests; Time Factors; Tomography, Spiral Computed; Treatment Outcome; Ultrasonography, Doppler

Six adult healthy Beagles were used to investigate the hepatic perfusion dynamics of Levovist, a contrast agent used in contrast harmonic imaging (CHI). In addition, 8 dogs with hepatocellular carcinoma (HCC) and 2 dogs with metastatic hepatic hemangiosarcoma (HSA) were used to characterize both the CHI findings with Levovist. In the Beagles, the start of intravenously injected Levovist into the aorta between the cranial mesenteric and renal arteries and the portal vein at the hepatic hilum were 5.47 +/- 1.52 sec and 16.03 +/- 3.39 sec, respectively. As a characteristic CHI finding in the 8 dogs with HCC, the early arterial phase showed a fine network of blood flow enhanced at the surrounding region and within the tumor in all the 8 dogs (100%), and the post vascular phase demonstrated a defect in the whole tumor and an enhancement of the surrounding hepatic tissues in 7 dogs (87.5%). In the 2 dogs with HSA, characteristic finding in which the early arterial and late vascular phases showed a rim contrast enhancement pattern, and the post vascular phase revealed that the whole tumor lacked contrast enhancement and the surrounding hepatic tissues was clearly enhanced. In dogs, the start of the early arterial and late vascular phases, and the characterizations of the CHI findings in HCC and HSA were suggested to be similar to those in humans. Therefore, CHI is thought to be useful for the diagnosis of HCC and metastatic hepatic HSA in dogs as well as in humans.

Topics: Animals; Carcinoma, Hepatocellular; Contrast Media; Dog Diseases; Dogs; Female; Hemangiosarcoma; Liver; Liver Neoplasms; Male; Neoplasm Metastasis; Polysaccharides; Ultrasonography

The purpose of this study was to investigate the efficacy of late-phase pulse inversion harmonic imaging (PIHI) in detecting occult metastases and to compare the results with helical computed tomography (CT) in a group of patients whose fundamental liver sonographic results were normal.. Thirty-two patients (21 women and 11 men; age range, 20-87 years) with a known primary malignancy were enrolled in the study. The patients were evaluated with conventional sonography, unenhanced PIHI, and PIHI 3 minutes after the injection of Levovist (SH U 508A; Schering AG, Berlin, Germany). All patients also underwent triphasic helical CT within 1 week after sonography. In 1 patient, mangafodipir-enhanced magnetic resonance imaging was performed as part of the clinical workup.. After Levovist injection, in 4 (12.5%) of 32 patients, at least 1 hypoechoic lesion was detected by PIHI; multiple lesions were shown in 1 patient. The mean diameter of newly detected lesions was 12 mm. Triphasic helical CT also showed all of the lesions that were detected by PIHI. The diagnoses were confirmed by biopsy and CT findings in 2 patients and by the typical CT and magnetic resonance imaging findings in 1 patient. For the fourth patient, the diagnosis was confirmed by follow-up and CT. Conclusions. Late-phase PIHI is comparable to helical CT for detecting occult hepatic metastases, but it protects patients from the potentially hazardous effects of radiation and iodinated contrast agents. Further series involving a larger number of patients are needed to determine its place in the evaluation of cancer staging and treatment planning.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Female; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Metastasis; Polysaccharides; Sensitivity and Specificity; Tomography, Spiral Computed; Ultrasonography

In contrast-enhanced 1.5 harmonic imaging sonography, images are obtained in a band intermediate between the fundamental and the 2nd harmonic components. In the present study, we investigated the usefulness of 1.5 harmonic imaging sonography with the use of the contrast agent Levovist for the diagnosis of hepatocellular carcinoma (HCC), metastatic hepatic tumor, and hepatic hemangioma. The subjects in this study were 64 patients with 70 nodules of hepatic tumors (42 nodules in 36 cases of hepatocellular carcinoma, 20 nodules in 20 cases of metastatic hepatic tumor, and 8 nodules in 8 cases of hepatic hemangioma). Contrast enhancement of tumors acquired in the early, portal, and late phases with 1.5 harmonic imaging sonography were compared to classify the tumors. 1.5 harmonic imaging sonography of HCC showed contrast enhancement of 36 nodules (85.7%). Hypervascular enhancement in the early phase, which was maintained in the portal phase, changed to images with no contrast enhancement with partial persistence of contrast enhancement in the late phase. 1.5 harmonic imaging sonography of metastatic hepatic tumor showed hypervascular enhancement of the margin of 20 nodules (100%) in the early and portal phases, which changed to images with no contrast enhancement in the late phase. 1.5 harmonic imaging sonography of hepatic hemangiomas maintained hypervascular enhancement on the tumor margin of 5 nodules (62.5%) in the early and portal phases. When early phase 1.5 harmonic imaging sonography did not show hypervascular enhancement in 3 nodules (37.5%), and late-phase images confirmed that these 3 nodules were hypervascular enhancement on the tumor margin. 1.5 harmonic imaging sonography of hepatic tumors (hepatocellular carcinoma, metastatic hepatic tumor and hepatic hemangioma) provided characteristic findings of contrast enhancement in the early, portal, and late phases, and will contribute to differential diagnosis.

Topics: Adult; Aged; Aged, 80 and over; Angiography; Carbon Dioxide; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Hemangioma; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Polysaccharides; Ultrasonography

The aim of this study was to evaluate capabilities of pulse inversion harmonic imaging (PIHI) with Levovist in detection of liver metastases compared with conventional ultrasound (US) and helical CT (HCT). One hundred sixty consecutive patients with known malignancies were evaluated by conventional US, PIHI 2 min (40 patients) or 4 min (120 patients) after Levovist injection and HCT. Conspicuity and number of the identified metastatic lesions were evaluated and assessed by statistical analysis (significance p<0.05). Mean diameter of the smallest identified metastases was computed for conventional US, PIHI and HCT. In cases where PIHI revealed more lesions suspicious for metastases than HCT, intraopertive US with surgical biopsy or 3-6-month US follow-up were performed to confirm diagnosis. Images were stored on magneto-optical disk and evaluated off-line by a dedicated software. Metastases conspicuity was significantly improved on PIHI if compared with conventional US ( p<0.05). In 49 patients all the employed imaging techniques did not reveal any lesion, whereas in the remaining 111 patients, 28 patients revealed more than five metastatic lesions and 83 patients presented from one to five metastatic lesions. In comparison with conventional US, PIHI revealed more metastases in 39/83 (47%), the same number in 44/83 (53%) and a lower number in 0/83 (0%) patients. In comparison with HCT, PIHI revealed more metastases in 10/83 (12%), the same number in 61/83 (74%) and a lower number in 12/83 (14%) patients. Average number +/- SD (standard deviation) of confirmed metastases for patients was 2.21+/-1.6 for conventional US, 3.1+/-2.44 for PIHI and 3.05+/-2.41 for HCT. The difference between PIHI and conventional US was statistically significant ( p<0.0001), whereas the difference between PIHI and HCT was not significant ( p=0.9). The smallest identified metastases presented 3-mm mean diameter on PIHI, 5-mm on HCT and 7-mm on conventional US. PIHI with Levovist is a reliable technique in metastases detection.

Topics: Aged; Aged, 80 and over; Chi-Square Distribution; Cohort Studies; Contrast Media; Female; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Polysaccharides; Probability; Prospective Studies; Sensitivity and Specificity; Statistics, Nonparametric; Tomography, Spiral Computed; Ultrasonography