shu-508 and Skin-Neoplasms

INTEREST FOR DIAGNOSIS: High-frequency sonography (12-16 MHz) allows to visualize primary cutaneous melanomas. The maximal echographic thickness was measured and strongly correlated to the Breslow index (p< 10(-4)). Lesions were well defined with homogeneous hypoechoic echostructure. A study including 111 patients with a 5 years median follow-up period demonstrated that the detection of neo-vascularization by color Doppler was significantly correlated to occurrence of metastasis (p < 10(-4)). INTEREST FOR EARLY EVALUATION OF TREATMENTS: For patients with local recurrent melanomas treated by isolated limb perfusion, contrast enhanced ultrasonography allows early evaluation of therapeutic. The access to raw linear data associated to quantification software permits to estimate tumoral perfusion. Several perfusion parameters (area under the contrast tune intensity curve, maximal intensity peak, mean transit time,...) are obtained after curves modelization. A study of 40 patients with a follow-up by dynamic contrast enhanced ultrasonography at D-1, D+1, D+7 and D+30 demonstrated that means of the quantification using raw linear data was able to identify as early as D+1 patients with complete response at 3 months.

Topics: Contrast Media; Humans; Melanoma; Monitoring, Physiologic; Phospholipids; Polysaccharides; Prognosis; Skin Neoplasms; Sulfur Hexafluoride; Ultrasonography

Evaluation of colour Doppler criteria to differentiate between malignant and benign skin tumours on the basis of the degree of vascularization.. The B-mode sonomorphology and the degree of vascularization in colour Doppler of 81 clinically potentially malignant tumours of cutaneous and subcutaneous structures were analyzed and quantified by number of intratumoral vessels per sonographic slice and percentage vessel area.. Of all criteria employed, counting the intratumoral vessels visible on one ultrasound slice after application of a signal-enhancing agent led to highest sensitivity (94%) of all used criteria but the specificity was poor (64%). The highest specificity (88%) and greatest diagnostic accuracy (86%) discriminating benign and malignant lesions were found using the criterion "percentage vessel area >5.0%" after all inflamed lesions had been excluded on the basis of clinical criteria. Plain colour Doppler increased the specificity up to 97%, although the sensitivity decreased simultaneously to max. 75%. Analysis of the B-mode morphology and spectral Doppler parameter of intratumoral vessels did not contribute to the differential diagnosis.. Signal-enhanced colour Doppler sonography is a valuable tool in the pretherapeutic assessment of cutaneous lesions. This method may be relevant for therapy and prognosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Contrast Media; Female; Galactose; Humans; Male; Middle Aged; Polysaccharides; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Skin Neoplasms; Ultrasonography, Doppler, Color

The purpose of this study was to evaluate the reliability of unenhanced and enhanced power Doppler sonography in visualization of intratumoral angioneogenesis. Thirty-seven malignant melanomas, which had been implanted intra- or subcutaneously in 22 mice, were examined. Various B-mode criteria, power Doppler criteria and spectral Doppler parameters were evaluated before and after IV-application of the d-galactose-based contrast agent Levovist. After sonographic examination, all tumors were analyzed histologically with semiquantitative grading of tumoral vascularization. Unenhanced, in 70% of the tumors, no intratumoral vessels were visible using power Doppler, but only in 11% of the intracutaneous and in 0% of the subcutaneous after injection of the contrast agent. The enhanced mode was definitely superior to unenhanced Doppler in showing the intratumoral vascularity. The intratumoral vascular structure could be sufficiently analyzed in 30% of all tumors by unenhanced Doppler, but in 92% enhanced. The mean percentage vessel area increased about 433% after application of Levovist (intracutaneous: 485%, subcutaneous: 280%). Despite the missing direct correlation between the sonographically and histologically determined grade of tumor vascularization (Pearson's correlation unenhanced 0,356, p <.05/enhanced 0.395, p <.05), the correlation between the percentage vessel area and the histologic grade of vascularization was improved after application of the contrast agent (Pearson's correlation unenhanced 0.347, p <.05/enhanced 0.686, p <.01). We did not find a significant direct correlation between histologically and sonographically determined degree of vascularization. However, the correlation was improved using a d-galactose-based signal-enhancing agent in power Doppler sonography.

Topics: Animals; Contrast Media; Image Processing, Computer-Assisted; Male; Melanoma, Experimental; Mice; Mice, Inbred C57BL; Necrosis; Neovascularization, Pathologic; Polysaccharides; Skin Neoplasms; Ultrasonography, Doppler

Prospective evaluation of the diagnostic outcome of plain and signal-enhanced color Doppler sonography for the differentiation between benign and malignant cutis-involving lesions.. 39 patients with 40 suspected malignant skin lesions received an preoperative ultrasound examination before and after application of 4 g Levovist i.v. Spectral Doppler, conventional color and power Doppler were performed. The images were analyzed semiquantitatively using a specially developed software. The diagnoses were confirmed by histological analysis (37 cases) or by follow up controls (3 cases).. Whereas the B-mode criteria such as echogenoity, borderline and homogenecity, and the spectral Doppler analysis were not useful for differentiation between malignant and benign lesions, the analysis of the intratumorously visible number of vessels and of the ratio of the vascularized area using a special software, especially after injection of the signal enhancing agent, provided valuable information. In 10 of 18 benign but only in 1 of 22 malignant lesions, no intratumorous vessels were visible after application of Levovist (plain: 10/18 benign and 6/22 malignant lesions). The number of visible vessels increased strongly after signal enhancement. Using a "ratio of the vascularized area (percentage vessel area) > 5%" as a criterion of malignancy, 2 false positive and 2 false negative results were observed after application of Levovist (without/with Levovist sensitivity 73%/91%, specificity 89%/89%).. The signal-enhanced color Doppler sonography provides useful additional information for the differentiation between benign and malignant cutis-involving lesions, especially the semiquantitative vascularization analysis. The latter is superior to B-mode ultrasound and to spectral Doppler analysis. The signal enhancer increases the sensitivity, whereas the specificity remains unchanged.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Artifacts; Contrast Media; Female; Fourier Analysis; Humans; Image Enhancement; Image Processing, Computer-Assisted; Male; Middle Aged; Neovascularization, Pathologic; Polysaccharides; Prospective Studies; Sensitivity and Specificity; Skin Diseases; Skin Neoplasms; Ultrasonography, Doppler