ICUS Weekly News Monitor 5-22-2015

1.  Aunt Minnie.com,  May 13, 2015,  Contrast US flexes muscle against gallbladder disease
By Erik L. Ridley
 
2.  UroToday,  May 21, 2015,  Sonographic patterns of renal lymphoma in B-mode imaging and in contrast-enhanced ultrasound (CEUS)-A retrospective evaluation     Authors:  Trenker C,, et al
 
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Aunt Minnie.com
May 13, 2015
 
Contrast US flexes muscle against gallbladder disease
By Erik L. Ridley
 
Early detection is important for all cancers, but it's particularly crucial for the often-deadly gallbladder carcinoma. Contrast-enhanced ultrasound (CEUS) can be a useful weapon in the battle to diagnose gallbladder cancer sooner, according to researchers from China.
 
In a study involving 64 patients, CEUS yielded significant improvements over conventional ultrasound in sensitivity, specificity, and accuracy for diagnosing gallbladder cancer.
 
"CEUS is a valuable imaging tool for differentiating malignant and benign gallbladder lesions," said Dr. Liping Liu from the First Hospital of Shanxi Medical University in Taiyuan. She presented the research during a session at the recent American Institute of Ultrasound in Medicine (AIUM) annual conference in Orlando, FL.
 
Importance of early detection
 
While gallbladder lesions can be benign conditions such as polyps, adenomyomatosis, adenomas, or biliary sludge, patients with malignant lesions often have a poor prognosis, Liu said. Early detection -- and subsequent surgery -- can increase the five-year survival rate, however.
 
To determine if contrast ultrasound could improve upon the performance of conventional ultrasound, the researchers studied 64 patients between August 2007 and April 2014 who were suspected of having lesions in the gallbladder based on conventional ultrasound. The 64 subjects included 22 men and 42 women with an average age of 54.3 ± 14.3 years.
 
The patients were scanned using a Logiq 9 (GE Healthcare) or MyLab 90 (Esaote) system with a contrast-tuned imaging (CnTI) protocol, along with the SonoVue ultrasound contrast agent (Bracco Imaging).
 
Of the 64 patients, 20 showed no enhancement in the gallbladder on CEUS and were diagnosed with gallbladder sludge. As a result, these patients avoided surgery, Liu said. The remaining 44 patients with solid gallbladder lesions underwent surgery; this group had 15 polyps, six cases of adenomyomatosis, three adenomas, and 20 carcinomas.
 
Performance in diagnosing gallbladder cancer
Measure Conventional ultrasound CEUS
Sensitivity 70% 95%
Specificity 83.3% 95.8%
Accuracy 77.2% 95.4%
 
The time to enhancement was 14.05 ± 3.33 seconds for malignant lesions, compared with 17.46 ± 3.92 seconds for benign lesions, a statistically significant difference (p = 0.004). The difference in time to peak intensity between malignant lesions (22.05 ± 5.93 seconds) and benign lesions (24.25 ± 5.79 seconds) did not reach statistical significance, however (p = 0.223).
 
CEUS characteristics of 44 gallbladder lesions
Characteristic Malignant (n = 20) Benign (n = 24)
Arterial-phase hypoenhancement 16 (80%) 15 (62.5%)
Arterial-phase isoenhancement 4 (20%) 9 (37.5%)
Late-phase hypoenhancement 17 (85%) 7 (29.2%)
Late-phase isoenhancement 3 (15%) 17 (70.8%)
Heterogenous enhanced pattern 12 (60%) 5 (20.8%)
Homogenous enhanced pattern 8 (40%) 19 (79.2%)
 
Contrast enhancement differences
 
Hypoenhancement of the late phase and enhancement pattern showed statistically significant differences between benign and malignant gallbladder lesions (p < 0.05).
 
"Most gallbladder carcinoma demonstrated heterogenous enhancement and hypoenhancement of the late phase because malignant tumors have vessel distortion and their tissue and structure is nonuniform," she said.
 
In addition, 14 (70%) of the 20 malignant lesions showed gallbladder wall destruction, Liu said.
 
"CEUS can reveal gallbladder cancer to infiltrate the gallbladder wall and adjacent hepatic parenchyma," she said.
 
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UroToday
Reference: Eur J Radiol. 2015 May;84(5):807-10.
doi: 10.1016/j.ejrad.2014.12.027
PubMed Abstract
PMID: 25650333
May 21, 2015
 
Sonographic patterns of renal lymphoma in B-mode imaging and in contrast-enhanced ultrasound (CEUS)-A retrospective evaluation
 
Authors:  Trenker C, Neesse A, Görg C.
Hospital of Internal Medicine, Haematology, Oncology and Immunology, University Hospital Giessen and Marburg, Baldingerstraße, Marburg, Germany; Hospital for Gastroenterology II, University Hospital Göttingen, Robert-Kochstr. 40, 37075 Göttingen, Germany; Interdisciplinary Center of Ultrasound, University Hospital Giessen and Marburg, Baldingerstraße, Marburg, Germany.  This email address is being protected from spambots. You need JavaScript enabled to view it.
 
Abstract
 
INTRODUCTION: Retrospective analysis of sonographic patterns of renal lymphoma in B-mode imaging and contrast-enhanced ultrasound (CEUS).
 
PATIENTS/METHODS: From January 2000 to June 2014, 27 patients with clinical or histologically confirmed renal lymphoma were examined with B-mode imaging, followed by CEUS in 8 cases.
 
RESULTS: In B-mode imaging renal lymphoma were hypoechoic in all 27 cases (100%). 9 patients (33.3%) had a bilateral, 18 (66.7%) patients had an unilateral lymphoma infiltration of the kidneys. 8 (29.6%) cases of small nodular, 5 (18.5%) cases of large nodular and 6 (22.2%) cases of perirenal lymphoma infiltration of the kidney were observed in B-mode imaging. Bulky-formation of renal lymphoma was detected in 6 (22.2%) patients and 2 (7.4%) patients had a diffuse lymphoma infiltration of the kidneys. In CEUS an arterial isoechoic enhancement was observed in 5 (62.5%)- and, an arterial hypoechoic enhancement was observed in 3 (37.5%) cases of renal lymphoma. A hypoechoic enhancement in the parenchymal phase was observed in 8 (100%) cases of renal lymphoma infiltration.
 
CONCLUSION: In B-mode-imaging, nodular lymphoma infiltration of the kidneys is the most common of all renal lymphoma patterns in B-mode imaging. In CEUS, renal lymphoma presented an arterial iso- or hypoechoic enhancement, followed by a hypoechoic enhancement in the parenchymal phase. In regard to the differentiation of renal lymphoma to benign lesions of the kidney, CEUS may be helpful. However, the differentiation of renal lymphoma from other malignant lesions of the kidney like renal cell carcinoma is not feasible by CEUS.

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