ICUS Weekly News Monitor 3-18-2016

1.  Journal of Ultrasound in Medicine,  Mar 1, 2016,  Off-Label Use of Ultrasound Contrast Agents for Intravenous Applications in Children; Analysis of the Existing Literature
Authors: Elsa Rosado, MD and Michael Riccabona, MD
 
2.  Acta Neurochir,  Feb 3, 2016,  CLINICAL ARTICLE - BRAIN TUMORS; Intraoperative 3D contrast-enhanced ultrasound (CEUS): a prospective study of 50 patients with brain tumours
Authors: Felix Arlt, et al
 
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Journal of Ultrasound in Medicine
Published February 2, 2016, doi: 10.7863/ultra.15.02030   JUM March 1, 2016   vol. 35  no. 3  487-496
Mar 1, 2016
 
Off-Label Use of Ultrasound Contrast Agents for Intravenous Applications in Children
Analysis of the Existing Literature
Authors: Elsa Rosado, MD and Michael Riccabona, MD
 
+ Author Affiliations
Department of Radiology, Hospital Prof Doutor Fernando Fonseca, Amadora, Portugal (E.R.); Department of Radiology, Division of Pediatric Radiology, Universitätsklinikum LKH, Graz, Austria (M.R.).
 
Address correspondence to Elsa Rosado, MD, Servico de Radiologia, Hospital Prof Doutor Fernando Fonseca, IC-19, 2720-276 Amadora, Portugal. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 
Abstract
 
Objectives—The purpose of this study was to collect and analyze the published data related to intravenous (IV) use of ultrasound (US) contrast agents in children.
 
Methods—We searched the literature to collect all of the published studies reporting the IV administration of a second-generation US contrast agent in children.
 
Results—We analyzed 9 case series and 5 case reports, as well as 5 individual cases, of pediatric contrast-enhanced US use reported in a study group that also included adults. We found that 502 children underwent contrast-enhanced US examinations (mean age, 9.7 years; range, 1 day–18 years). Most patients (89%) were injected with the sulfur hexafluoride contrast agent SonoVue (Bracco SpA, Milan, Italy). The mean dose used was 1.5 mL (range, 0.1–9.6 mL). Only 10 patients (2%) had adverse reactions related to the contrast agent administration: 1 life-threatening anaphylactic shock and 9 mild transitory adverse effects. We additionally found 38 papers in which the study groups included at least 1 child; thus, we obtained a total of 540 reported cases of off-label use of IV US contrast agents in children. The most frequent target organ was the liver, and most indications were related to space-occupying lesion characterization and abdominal evaluations after blunt trauma. Some studies also evaluated the diagnostic performance of contrast-enhanced US in different clinical scenarios and found very good accuracy. Concordance between contrast-enhanced US imaging and the respective reference-standard imaging methods ranged between 83% and 100% in different studies.
 
Conclusions—Our results support the idea that the IV use of US contrast agents in children is safe, feasible, diagnostically robust, and effective.
 
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Acta Neurochir
DOI 10.1007/s00701-016-2738-z
Feb 3, 2016
CLINICAL ARTICLE - BRAIN TUMORS
Intraoperative 3D contrast-enhanced ultrasound (CEUS):
a prospective study of 50 patients with brain tumours
Authors: Felix Arlt 1 & Claire Chalopin2 & Andrea Müns1 & Jürgen Meixensberger1,2 &
Dirk Lindner1
 
1 Klinik und Poliklinik für Neurochirurgie, Universitätsklinik Leipzig,
Liebigstrasse 20, 04103 Leipzig, Germany
2 ICCAS (Innovation Centre Computer Assisted Surgery),
Semmelweisstr 14, 04103 Leipzig, Germany
 
Abstract
Background
Reliable intraoperative resection control during surgery of malignant brain tumours is associated with the longer overall survival of patients. B-mode ultrasound (BUS) is a familiar intraoperative imaging application in neurosurgical procedures and supplies excellent image quality. However, due to resection-induced artefacts, its ability to distinguish between tumour borders, oedema, surrounding tissue and tumour remnants is sometimes limited. In experienced hands, this Bbright rim effect^ could be reduced. However, it should be determined, if contrast-enhanced ultrasound can improve this situation by providing high-quality imaging during the resection. The aim of this clinical study was to examine contrast-enhanced and three-dimensional reconstructed ultrasound (3D CEUS) in brain tumour surgery regarding the uptake of contrast agent pre- and post-tumour resection, imaging quality and in comparison with postoperative magnetic resonance imaging in different tumour entities.
 
Methods
Fifty patients, suffering from various brain tumours intra-axial and extra-axial, who had all undergone surgery with the support of neuronavigation in our neurosurgical department,
were included in the study. Their median age was 56 years (range, 28–79). Ultrasound imaging was performed before the Dura was opened and for resection control at the end of tumour resection as defined by the neurosurgeon. A high-end ultrasound (US) device (Toshiba Aplio XG®) with linear and sector probes for B-mode and CEUS was used. Navigation and 3D reconstruction were performed with a LOCALITE SonoNavigator® and the images were transferred digitally (DVI) to the navigation system. The contrast agent consists of echoic micro-bubbles showing tumour vascularisation. The ultrasound images were compared with the corresponding postoperative MR data in order to determine the accuracy and imaging quality of the tumours and tumour remnants after resection.
 
Results
Different types of tumours were investigated. High, dynamic contrast agent uptake was observed in 19 of 21 patients (90 %) suffering from glioblastoma, while in 2 patients uptake was low and insufficient. In 52.4 % of glioblastoma and grade III astrocytoma patients CEUS led to an improved delineation in comparison to BUS and showed a highresolution imaging quality of the tumour margins and tumour boarders. Grade II and grade III astrocytoma (n=6) as well as metastasis (n = 18) also showed high contrast agent uptake, which led in 50 % to an improved imaging quality. In 5 of these 17 patients, intraoperative CEUS for resection control showed tumour remnants, leading to further tumour resection. Patients treated with CEUS showed no increased neurological deficits after tumour resection. No pharmacological sideeffects occurred.
 
Conclusions
Three-dimensional CEUS is a reliable intraoperative imaging modality and could improve imaging quality. Ninety percent of the high-grade gliomas (HGG, glioblastoma and astrocytoma grade III) showed high contrast uptake with an improved imaging quality in more than 50 %. Gross total resection and incomplete resection of glioblastoma were adequately highlighted by 3D CEUS intraoperatively. This study was supported by a DFGgrant (Deutsche Forschungsgemeinschaft).
 
Registered in the EUClinical Trials Register: https://www.clinicaltrialsregister.
eu/ctr-search/search?query=eudract_number:2010-022057-42
* Felix Arlt
This email address is being protected from spambots. You need JavaScript enabled to view it.

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