ICUS Weekly News Monitor 5-26-17

ICUS Weekly News Monitor

26 May 2017 - 9 am Eastern

 
 
 
  1. 1.Health Imaging, May 22, 2017, High-end ultrasound with contrast superior for managing abdominal aneurysms By Dave Pearson
  2. 2.Aunt Minnie, May 16, 2017, Contrast US helps assess breast cancer treatment response By Erik L. Ridley

Health Imaging

High-end ultrasound with contrast superior for managing abdominal aneurysms

May 22, 2017

By Dave Pearson

Patients with abdominal aortic aneurysms are better served by contrast-enhanced ultrasound (CEUS) than by color Doppler for follow-up care after receiving endovascular aortic repair (EVAR), according to a study published online May 18 in Clinical Hemorheology and Microcirculation.

Researchers from Ludwig-Maximilian University of Munich in Germany and Sapienza University of Rome in Italy reviewed the cases of 41 patients. Most of them, 38 (93 percent) were male to correspond to the incidence of the often-asymptomatic problem in the population, and ages ranged from 58 to 100.

Using CEUS as the gold standard, the team found endoleaks could be detected using a high-end system in 28 patients (68 percent) with 13 patients not showing an endoleak after EVAR.

Color Doppler showed a sensitivity of 32.1 percent, a specificity of 92.3 percent, a positive predictive value of 90 percent and a negative predictive value of 38.7 percent compared to CEUS being the gold standard.

"CEUS after EVAR using a modern high-end ultrasound system is a fast and cost-effective imaging modality for the detection and follow-up of endoleaks with superior benefits compared to color Doppler," the authors conclude. "CEUS remains the initial standard-of-care examination for follow-up."

 
 
 
 
 
 

Aunt Minnie

Contrast US helps assess breast cancer treatment response

By Erik L. Ridley

May 16, 2017

Yielding comparable tumor measurements and accuracy, contrast-enhanced ultrasound (CEUS) can be a viable alternative to contrast-enhanced MRI for assessing breast cancer response to neoadjuvant chemotherapy, according to research published in the May issue of the Journal of Ultrasound in Medicine.

In a pilot study, a research team led by Dr. Sandy Lee of the University of Southern California's Keck School of Medicine found that CEUS measurements of tumor size correlated well with MRI, and both modalities produced the same accuracy for predicting how the tumors were responding to therapy. What's more, CEUS tumor measurements correlated better with pathologic tumor size than did MRI tumor measurements.

"CEUS may be a good alternative exam when MRI cannot be performed in the neoadjuvant chemotherapy setting," Lee toldAuntMinnie.com.

An alternative to MRI?

MRI is commonly used to evaluate treatment response in breast cancer patients undergoing neoadjuvant chemotherapy. Although MRI is a great tool for this job, the modality can't be used in certain patients, such as those with renal disease, a pacemaker, or an allergy to gadolinium contrast agents, according to Lee

The researchers sought to investigate the use of contrast ultrasound because it's easy to perform, has no radiation, and can be used in patients with contraindications for MRI. In addition, microbubble contrast agents have a relatively safe profile, Lee said.

In the prospective pilot study, CEUS and contrast-enhanced MRI were performed on 30 patients with invasive breast cancer lesions larger than 2 cm. Of the 30 patients, 29 had invasive ductal carcinoma and one had metaplastic carcinoma. Both imaging studies were performed before neoadjuvant chemotherapy and afterward prior to surgery (J Ultrasound Med, May 2017, Vol. 36:5, pp. 901-911).

All contrast ultrasound exams were performed using the Definity ultrasound contrast agent (Lantheus Medical Imaging) on an Epiq ultrasound system (Philips Healthcare) with a 12-MHz linear transducer or a 9-MHz curvilinear transducer, depending on the tumor size and depth. Postprocessing analysis of the CEUS data was performed at a later time using Qlab software (Philips). Blinded to the MRI results and surgical data, a dedicated breast imager with more than 15 years of experience compiled the tumor measurements.

When possible, the MRI and CEUS studies were performed on the same day. However, sometimes the exams were performed on different days due to patient scheduling limitations, according to the researchers.

Patients received dynamic contrast-enhanced MRI using a gadolinium-based contrast agent and either an Excite HD 1.5-tesla scanner (GE Healthcare) or a Symphony 1.5-tesla system (Siemens Healthineers) with a dedicated breast coil. The MRI protocol included axial and coronal short-tau inversion recovery images, a precontrast T1-weighted acquisition, and additional postcontrast T1-weighted acquisitions obtained five to seven minutes after contrast administration.

Postprocessing was performed with CADstream software (Merge Healthcare) to generate subtractions and dynamic time/signal intensity curves. Two dedicated breast imagers -- blinded to the CEUS and surgical data -- then calculated tumor measurements.

The researchers compared the CEUS and MRI results with the pathologic tissue specimens that were obtained from definitive surgical treatment, which is usually performed at their institution four to six weeks after the completion of neoadjuvant chemotherapy. Spearman coefficients (r values) were calculated to quantify the correlation between imaging and pathologic findings. The higher the r value, the higher the level of agreement.

Strong agreement

At baseline prior to treatment, contrast ultrasound and MRI both yielded a 3.1-cm median tumor size; the modalities had strong correlation (r = 0.88, p < 0.001) in tumor size measurements. The researchers noted that one patient had a deep tumor that did not enhance on baseline CEUS, but it was visible on conventional ultrasound and displayed subthreshold enhancement on MRI.

"The deep location and low vascularity of the tumor likely contributed to its lack of enhancement on the contrast-enhanced US scan," the authors wrote.

After neoadjuvant chemotherapy, agreement on tumor size dropped (r = 0.66, p = 0.004) but was still comparable. The researchers observed, however, that in a subset of 15 patients who had both CEUS and MRI studies that could be compared with tumor size at surgery, CEUS (r = 0.75, p < 0.001) correlated better with tumor size at surgery than MRI did (r = 0.42, p = 0.095).

"Contrast-enhanced US findings correlate well with MRI findings and may be even more accurate in predicting residual tumor size after [neoadjuvant chemotherapy]," the authors wrote.

In addition, contrast ultrasound and MRI were equally effective in predicting pathologic response to treatment. The modalities both accurately predicted three (75%) of the four patients who had a complete pathologic response, and eight (72.7%) of the 11 patients with a noncomplete pathological response.

While CEUS performed well in the study, the researchers noted that MRI has its own advantages.

"It can evaluate the remainder of the same breast and the contralateral breast at the same time, while CEUS is more limited to evaluating the known tumor," Lee said.

CEUS may also not be a good exam for evaluating small or deep tumors in the breast, she said.

Future work

The researchers acknowledged that their study was limited by the small number of patients. Studies with a larger patient cohort are now needed to further investigate the use of CEUS in the neoadjuvant chemotherapy setting, according to Lee.

The group is also exploring the possibility of using CEUS to determine when ultrasound-guided breast biopsies may be necessary, she said.

ICUS Weekly News Monitor 5-19-17


ICUS Weekly News Monitor

19 May 2017 - 9 am Eastern

 
 
 
  1. 1.ICUS, May 19, 2017, Professor David Cosgrove, MD, FRCR, FRCP, 1938 - 2017
  2. 2.BMUS, May 19, 2017, 4th International Paediatric CEUS Course - 19 to 20 June 2017


ICUS

Professor David Cosgrove, MD, FRCR, FRCP, 1938 - 2017

May 19, 2017

David Cosgrove

It is with enormous sorrow that the ICUS Board announces the passing of its dear friend and colleague, David Cosgrove.

David was one of the original founders of ICUS in 2008 and was a member of the Board since its inception. As Professor of Clinical Ultrasound at Imperial College, London, he was a tireless advocate for CEUS and more recently facilitated a role for ICUS in China, where ICUS now has active representation and growing relationships. His passing is a huge loss for the entire ICUS family, and he will be missed enormously as a colleague and a friend, a kind, warm, decent human being with whom it was always a pleasure to spend time. David passed away peacefully at a hospice near his home in south London.

To honor David's memory, the Board has instated a lecture series, to be known as The David Cosgrove Memorial Lecture, that will be given at the Advances in Contrast Ultrasound 'Bubble' Conference each year by an invitee chosen by the Board.

 
 
 
 
 
 

BMUS - The British Medical Ultrasound Society

4th International Paediatric CEUS Course - 19 to 20 June 2017

May 19, 2017

BMUS

The course will take place at theWindsor Walk Lecture Theatre, Fetal Medicine Research Institute, King’s College Hospital, London.Directions are available here.

This is the 4th occasion that this course has been organised and it has now grown to a full two day course.

The course is recognised as a EUROSON School, with full endorsement of the European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB) and is endorsed by the British Medical Ultrasound Society (BMUS), with continuing medical education credits provided by the Royal College of Radiologists, United Kingdom.

Registration fees (Fee includes all beverages, lunch on 2 days and course dinner)

  • EFSUMB/BMUS/AIUM member £320.00 (with letter of proof)
  • Medical or Radiology Trainee £320.00 (with letter of proof)
  • Sonographer or Ultrasound Technician £320.00
  • Non Affiliated Physician £400

Further details can be obtained from Emma in the BMUS office.

View the programme.

To register, please visit this website.

ICUS Weekly News Monitor 5-8-17

  1. ICUS,  CEUS: Basic Training for Novices - June 17th 2017,  Hosted by Dr. Stephanie Wilson,   Register Now!
  2. Uro Today, Apr 21, 2017, Feasibility of Contrast-Enhanced Intraoperative Ultrasound for Detection and Characterization of Renal Mass Undergoing Open Partial Nephrectomy       Authors: Le Ott, et al

CEUS: Basic Training for Novices

Hosted by Dr. Stephanie Wilson, Department of Radiology, University of Calgary

June 17, 2017

Register Now

Course Overview:

  • CEUS: What, why and when?
  • Microbubble Contrast Agents: Safety, uses, cost effectiveness and handling.
  • Introduction to CEUS:  Liver, kidney, other organ systems. 
  • Getting started: From set-up to optimizing performance.  
  • Hands-on demonstrations– live patient demonstrations featuring contrast agents and equipment of our sponsors
  • Knobology– Break out rooms with personalized opportunities to "touch and feel" all of the featured ultrasound systems and contrast agents, examine settings, etc.

Course Objectives

  • Understand the fundamentals of CEUS performed with microbubble contrast agents and low MI US techniques.
  • Realize the requirements for initiation of a CEUS facility.
  • Appreciate the protocol for successful performance of CEUS examinations of the liver
  • Recognize the features of common enhancement patterns for benign and malignant liver tumors.

Who Should Attend:

Radiologists, physicians performing contrast enhanced ultrasound, sonographers, technologists, residents, trainees, and other allied health care professionals.

Registration:

$125.00 Canadian dollars plus GST. Fee includes all meals and course materials food and the closing reception on Saturday Night.

Location:

University of Calgary
Training Research and Wellness Center
3280 Hospital Drive NW
Calgary AB

Accomodations:

ALOFT Calgary
Rate: 129.00 per night.

Conference Secretariat:

Heather Baylis
+1 403 519 4171
Email:   This email address is being protected from spambots. You need JavaScript enabled to view it.

 
 
 
 
 
 

Uro Today

Feasibility of Contrast-Enhanced Intraoperative Ultrasound for Detection and Characterization of Renal Mass Undergoing Open Partial Nephrectomy

Apr 21, 2017

Authors: Le Ott, Christopher Wood, Raghunandan Vikram, Madhavi Patnana, Priya Bhosale, Roland Bassett, Deepak Bedi

Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA., University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

To determine the feasibility of obtaining intraoperative contrast-enhanced ultrasound (CEUS) imaging in patients undergoing open partial nephrectomy for renal cancer. We hypothesize that the study was feasible and the addition of CEUS would improve lesion identification and characterization.

The study population consisted of 10 patients with known renal mass scheduled for intraoperative ultrasound-guided open partial nephrectomy. After dissection and exposure of the kidney by the surgeon, an intraoperative pre- and post-CEUS was performed by the radiologist. Feasibility was defined as successful imaging in 8 of 10 patients with intraoperative CEUS. Image quality, lesion conspicuity/contrast, lesion vascularity, morphology, and size were assessed and graded with pre- and post-contrast images.

Intraoperative ultrasound was successfully acquired in 10 of 11 patients for renal mass detection and characterization. One study was canceled intraoperatively as a result of clinical complications related to a difficult surgery. Tumor size ranged from 1.3 to 4.2 cm. All lesions were solid. No additional lesions were found on CEUS compared with baseline imaging. Image quality post-contrast ranged from acceptable to excellent. There were no adverse events recorded for all 10 patients.

In our feasibility study consisting of 10 patients, CEUS for detection and characterization of renal mass undergoing open partial nephrectomy was feasible and safe. Because intraoperative ultrasound during open partial nephrectomy can affect the extent of surgery, CEUS can be used to help detect and characterize renal mass for surgical planning/resection intraoperatively.

ICUS Sponsors

ICUS gratefully acknowledges its 2017 sponsors:

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Contact ICUS

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    Washington, DC 20006-1102, USA
  • Telephone: 202-408-6199

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ICUS is the world’s only professional society exclusively devoted to contrast-enhanced ultrasound (CEUS) medical imaging technology.

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