ICUS Weekly News Monitor 5-8-2015

1.  BMC Cancer,  May 8, 2015,  Reducing tumor growth and angiogenesis using a triple therapy measured with Contrast-enhanced ultrasound (CEUS)     Authors: Philipp Marius Paprottka, et al
2.  Uro Today,  May 7, 2015,  Ultrasound-guided percutaneous radiofrequency ablation treatment for renal clear cell carcinoma     Authors:  Cheng X, et al
3.  DotMed News,  May 05, 2015,  Ultrasound with contrast for pediatrics with abdominal trauma superior to CT     By John W. Mitchell
4.  Uro Today.  Apr 30, 2015,  Contrast enhanced ultrasound parametric imaging for the detection of prostate cancer     Authors: Postema A,, et al
BMC Cancer
BMC Cancer 2015, 15:373  doi:10.1186/s12885-015-1333-7
May 8, 2015
Reducing tumor growth and angiogenesis using a triple therapy measured with Contrast-enhanced ultrasound (CEUS)
Authors: Philipp Marius Paprottka1*, Svenja Roßpunt2, Michael Ingrisch1, Clemens C Cyran1, Konstantin Nikolaou1, Maximilian F Reiser1, Brigitte Mack2, Olivier Gires2, Dirk A Clevert1 and Pamela Zengel2          
* Corresponding author: Philipp M Paprottka This email address is being protected from spambots. You need JavaScript enabled to view it.
Author Affiliations:
1 Institute for Clinical Radiology, Ludwig Maximilian University Hospital, Munich, Germany
2 Institute for Ear, Nose and Throat Medicine, Ludwig Maximilian University Hospital, Munich, Germany
BMC Cancer 2015, 15:373  doi:10.1186/s12885-015-1333-7
Published: 8 May 2015
Abstract (provisional)
To evaluate the in vivo response by detecting the anti-angiogenic and invasion-inhibiting effects of a triple-combination-therapy in an experimental-small-animal-squamous-cell-carcinoma-model using the “flash-replenishment” (FR) method to assess tissue hemodynamics via contrast-enhanced-ultrasound (CEUS).
Human hypopharynx-carcinoma-cells were subcutaneously injected into the left flank of 22-female-athymic-nude-rats. After seven days of subcutaneous tumor growth, FR-measurements were performed on each rat. Treatment-group and control-group were treated every day for a period of one week, with the treatment-group receiving solvents containing a triple therapy of Upamostat?, Celecoxib? and Ilomastat? and the control-group solvents only. On day seven, follow-up measurements were performed using the same measurement protocol to assess the effects of the triple therapy. VueBox? was used to quantify the kinetic parameters and additional immunohistochemistry analyses were performed for comparison with and validation of the CEUS results against established methods (Proliferation/Ki-67, vascularization/CD31, apoptosis/caspase3).
Compared to the control-group, the treatment-group that received the triple-therapy resulted in a reduction of tumor growth by 48.6% in size. Likewise, the immunohistochemistry results showed significant decreases in tumor proliferation and vascularization in the treatment-group in comparison to the control-group of 26%(p≤0.05) and 32.2%(p≤0.05) respectively. Correspondingly, between the baseline and follow-up measurements, the therapy-group was associated with a significant(p ≤ 0.01) decrease in the relative-Blood-Volume(rBV) in both the whole tumor(wt) and hypervascular tumor(ht) areas (p≤0.01), while the control-group was associated with a significant (p≤0.01) increase of the rBV in the wt area and a non-significant increase (p≤0.16) in the ht area. The mean-transit-time (mTT) of the wt and the ht areas showed a significant increase (p≤0.01) in the follow-up measurements in the therapy group.
The triple-therapy is feasible and effective in reducing both tumor growth and vascularization. In particular, compared with the placebo-group, the triple-therapy-group resulted in a reduction in tumor growth of 48.6% in size when assessed by CEUS and a significant reduction in the number of vessels in the tumor of 32% as assessed by immunohistochemistry. As the immunohistochemistry supports the CEUS findings, CEUS using the “flash replenishment”(FR) method
Uro Today
Zhonghua Wai Ke Za Zhi. 2014 Nov;52(11):856-60
PubMed Abstract
PMID: 25604026
May 7, 2015
Ultrasound-guided percutaneous radiofrequency ablation treatment for renal clear cell carcinoma
Authors:  Cheng X, Gan W, Xu L, Yao L, Qu F, Zhang G, Li X, Guo H.
Department of Urology, the Affiliated Drum Tower Hospital of Medical School of Nanjing University, Nanjing 210008, China.  This email address is being protected from spambots. You need JavaScript enabled to view it.
OBJECTIVE: To investigate clinical outcomes of ultrasound-guided percutaneous radiofrequency ablation (USG-RFA) in patients with renal clear cell carcinoma.
METHODS: Medical records of 34 patients who underwent USG-RFA of renal clear cell carcinoma at the Department of Urology of the Affiliated Drum Tower Hospital of Medical School of Nanjing University from May 2009 to January 2014 were retrospectively reviewed, including 28 male and 6 female patients aged between 25 and 85 years (mean age 60.7 years). Of the included cases, 16 had tumors located in the left kidney, 16 in the right, 1 in the solitary kidney, and 1 in the bilateral kidney. There were 35 tumors in this study totally. The maximum diameter of the tumors was 1.8 to 5.0 cm (mean (2.7 ± 0.3) cm), of which 32 cases of renal tumors were ≤ 4.0 cm and 3 cases of renal tumors were > 4.0 cm to 5.0 cm. Pathological diagnosis were acquired by ultrasound-guided percutaneous biopsy after USG-RFA. Contrast-enhanced ultrasound was used to evaluate tumor outcomes at the time of the surgery, and multi-slice spiral CT enhanced scan and contrast-enhanced ultrasound were used to identify residues and recurrences after treatment.
RESULTS: Treatments for all the patients were finished with short postoperative hospital stay about 3-5 days. No complications related to USG-RFA were encountered in any of the cases, such as perirenal fluid collection, perirenal hematoma, and peripheral organ damage. All the cases were diagnosed as clear cell carcinoma according to pathological results. The mean follow-up period was 29 ± 6 (range 3-59) months. Of the 35 USG-RFA-treated subjects, 32 tumors ≤ 4 cm reached the standard of complete treatment after one tumor was found with residue after the first month follow-up, and two tumors were noted recurrence at the 4 and 10 months follow-up after USG-RFA. Nonetheless, no residue or recurrence occurred after secondary treatment for these 3 tumors where pathological diagnosis were acquired again. The other 3 cases with tumors > 4.0 cm to 5.0 cm underwent USG-RFA twice or three times before reaching the standard of complete treatment, of which two had twice and one tumor had three times treatments. There was no carcinoma residue or recurrence during follow-up period.
CONCLUSIONS: Percutaneous ultrasound-guided radiofrequency ablation for small renal mass (SRM) has satisfied clinical outcomes, with the advantage of less injury, lower complication rates and shorter recovery time for small size of renal clear cell carcinoma. USG-RFA may become the preferred treatment alternative for SRM.
DotMed News
May 05, 2015
Ultrasound with contrast for pediatrics with abdominal trauma superior to CT
By John W. Mitchell
Results from a recent British study indicate that children who suffer from blunt abdominal injury can effectively be diagnosed and managed with contrast enhanced ultrasound (CEUS). CEUS was deemed to be a lower cost alternative to follow-up CT and did a better job of identifying traumatic parenchymal lesions on internal organs in children with blunt force trauma to the abdomen.
“We were surprised that the accuracy of the technique was so robust, with follow up of targeted organ CEUS in children becoming the normal approach in our institution,” Dr. Annmaria Deganello, a consulting pediatrics radiologist at King’s College Hospital in London and lead researcher told DOTmed News. “The results have completely altered our practices with no detrimental effect.”
The finding is yet another recent change of practice in the ongoing effort to reduce radiation exposure in pediatric patients.
“Reduction in exposure to ionizing radiation in a young vulnerable population with the potential to reduce cancer risk; this is in line with the ALARA principle (As Low As Reasonably Achievable), which makes pediatric radiologists responsible for reducing the amount of radiation a child is exposed to, while maintaining safety and reliability of the diagnostic modality,” explained Dr. Deganello
The retro-perspective study reviewed studies of nearly 800 pediatric patients from the ages of nine months to 20 years old, conducted over a 16-year period. About 15 percent of these patients had follow-up CT studies and about a third of those patients received CEUS. This study was an extension of an earlier study to examine the use of CEUS in focal liver lesions, which Dr. Deganello said made sense, given their area of specialty focus.
“We expanded the initial study to include follow-up on blunt abdominal trauma. King’s College is a tertiary center for pediatric liver diseases and a Level I trauma center.” She added that CEUS images were “exquisitely informative.”
The King’s College study results were similar to the results of an Italian study published in March 2015. Dr. Deganello said the results of her study have not yet been published but have been presented at a recent U.S. conference and will be taught in a teaching course at the upcoming British Medical Ultrasound Conference.
Uro Today
Reference: BJU Int. 2015 Mar 6. Epub ahead of print.
doi: 10.1111/bju.13116
Apr 30, 2015
Contrast enhanced ultrasound parametric imaging for the detection of prostate cancer
Authors: Postema A, Frinking P, Smeenge M, De Reijke T, De la Rosette J, Tranquart F, Wijkstra H.  
Department of Urology, Academic Medical Center, Amsterdam, The Netherlands.
OBJECTIVE: To investigate the value of Dynamic Contrast Enhanced-Ultrasound (DCE-US) and software-generated parametric maps in predicting biopsy outcome and their potential to reduce the amount of negative biopsy cores.
PATIENTS AND METHODS: For 651 prostate biopsy locations (82 consecutive patients) we correlated the interpretation of DCE-US recordings with and without parametric maps with biopsy results. The parametric maps were generated by software that extracts perfusion parameters that differentiate benign from malignant tissue form DCE-US recordings. We performed a stringent analysis (all tumours) and a clinical analysis (clinically significant tumours). We calculated the potential reduction in biopsies (benign on imaging) and the resultant missed positive biopsies (false negatives). Additionally, we evaluated the performance in terms of sensitivity, specificity NPV, and PPV on the per-prostate level.
RESULTS: Based on DCE-US, 470/651 (72.2%) of biopsy locations appeared benign resulting in 40 false negatives (8.5%) regarding clinically significant tumour only. Including parametric maps, 411/651 (63.1%) of the biopsy locations appeared benign, resulting in 23 false negatives (5.6%). In the per-prostate clinical analysis, DCE-US classified 38/82 prostates as benign, missing 8 diagnoses. Including parametric maps, 31/82 prostates appeared benign, missing 3 diagnoses. Sensitivity, specificity, PPV and NPV were 73%, 58%, 50% and 79% for DCE-US alone and 91%, 56%, 57% and 90% with parametric maps, respectively.
CONCLUSION: DCE-US interpretation with parametric maps allows good prediction of biopsy outcome. A two-thirds reduction in biopsy cores seems feasible with only a modest decrease in cancer diagnosis.

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