ICUS Weekly News Monitor 12-22-2016

1.  Health Imaging,  Dec 19, 2016,  Contrast-enhanced sonography a ‘sound’ alternative in pediatric advanced imaging     By Dave Pearson
2.  Clinical Hemorheology and Microcirculation,  Dec 8, 2016
Percutaneous irreversible electroporation (IRE) of prostate cancer: Contrast-enhanced ultrasound (CEUS) findings during follow up    Authors: Beyer LP, et al

Health Imaging
Dec 19, 2016
Contrast-enhanced sonography a ‘sound’ alternative in pediatric advanced imaging
By Dave Pearson
Off-label use of contrast-enhanced ultrasound (CEUS) may be the best advanced-imaging choice—safe, accurate and cost-effective as compared to guideline-recommended CT and MRI—for examining children in many instances, according to a British study published online Dec. 13 in the American Journal of Roentgenology.
Gibran Yusuf, MBBS, and colleagues at King’s College Hospital in London concluded as much after reviewing the medical records of all pediatric patients who were imaged with CEUS at their institution between January 2008 and December 2015.
In total, they looked at 305 cases (187 boys, 118 girls; age range, 1 month to 18 years).
Most of the exams were for characterizing liver lesions (48.2 percent) and trauma (37.1 percent); the others were for renal, vascular and intracavitary assessment (14.8 percent).
None of the patients had immediate adverse reactions, the authors report.
Only two (0.7 percent) had delayed adverse reactions (0.7 percent), and both were asymptomatic and transient (hypertension and tachycardia).
The potential cost savings of CEUS were $74 per exam over CT and $180 over MRI, the authors calculate.
In their discussion, Yusuf et al. note that, in adults, CEUS has sensitivity and specificity comparable to that of CT and MRI.
They point out that CEUS can be safer than CT, as CEUS doesn’t involve ionizing radiation, and safer than MRI, as it almost never requires sedation or anesthesia, much less gadolinium-based contrast administration.
CEUS is generally the most cost-effective of the three advanced-imaging modalities—and the authors found the modality saved their institution almost $16,000 versus what the tab would have been had MRI and CT been used where indicated per institutional norms.
The authors caution that, while CEUS is safe, the use of any contrast calls for vigilance during and after administration.
They also acknowledge the imperfect diagnostic accuracy of CEUS.
“Correlating modalities were often performed before the CEUS examination; simultaneous cross-sectional diagnostic imaging was not performed for confirmatory purposes,” they write. “Patients undergoing sonographic examination were referred for further imaging if there was any doubt in the diagnosis, but there remains the possibility of misdiagnosis, as with all methods of imaging.”
Clinical Hemorheology and Microcirculation
vol. Preprint, no. Preprint, pp. 1-6, 2016
PMID: 27935553 DOI: 10.3233/CH-168125
Dec 8, 2016
Percutaneous irreversible electroporation (IRE) of prostate cancer: Contrast-enhanced ultrasound (CEUS) findings during follow up.
Authors: Beyer LP1, Pregler B1, Nießen C1, Michalik K1, Haimerl M1, Stroszczynski C1, Jung EM1, Wiggermann P1.
1Department of Radiology, University Medical Center Regensburg, Germany.
Irreversible electroporation (IRE) is a focal non-thermal ablation technique that can be used to treat prostate cancer (Pca). The objective was to document the evolution of the volume of the prostate gland and the ablation zone after IRE of Pca.
A retrospective analysis of the image findings of CEUS 1 day, 6 weeks, 3 months and 6 months after IRE of 25 patients was conducted. The prostate gland volumes and the size of the ablation zones were documented. Changes in volume and size over time were calculated.
There was a significant volume reduction of the prostate gland in the first 3 months after ablation. The mean percentage change after 6 weeks was 34.3% with another decrease of 35.0% after 3 months. Volume did not change between month 3 and 6. Size of ablation zone measured in short- and long-axis significantly diminished until 6 months after ablation.
CEUS showed a significant involution of the prostate gland during the first 3 months and a significant decrease of the ablation zone during the first 6 months after IRE of prostate cancer.

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