ICUS Weekly News Monitor 7-12-2018

1.Diagnostic Imaging, Interest in Pediatric Contrast Ultrasound Is High Among Radiologists, Jul 2, 2018

2.Clinical Radiology, The added value of contrast-enhanced ultrasound to conventional ultrasound in differentiating benign and malignant solid breast lesions: a systematic review and meta-analysis, July 2018 Authors: M. Wubulihasimu, et al

3.World Neurosurgery, Emerging Strategies and Future Perspective in Neuro-Oncology Using Transcranial Focused Ultrasonography Technology, June 8, 2018 Authors: Giada Toccaceli, et al

 

Diagnostic Imaging

Interest in Pediatric Contrast Ultrasound Is High Among Radiologists

Jul 2, 2018

Education and training are needed to support radiologists who plan to adopt contrast ultrasound for children into practice, according to the results of a survey published in the journal Pediatric Radiology.

In response to the recent approval by the United States Food and Drug Administration for an oral ultrasound contrast agent for IV and intravesical administration in children, researchers from Pennsylvania, California, Massachusetts, Tennessee, Ohio, North Carolina, Maryland, Florida, and Washington surveyed pediatric radiologists about the usage, interest in, and barriers for contrast-enhanced ultrasound in their patients.

The Contrast-Enhanced Ultrasound Task Force of the Society for Pediatric Radiology (SPR) surveyed the membership of the SPR in January 2017 regarding their current use and opinions about contrast-enhanced US in pediatrics. A total of 1,218 surveys went out and 325 responses (26.7 percent) were received.

The results showed that 166 of the 325 respondents (51.1 percent) practiced in either a university or academic affiliated group. The most widely used ultrasound contrast agent was Lumason, 52.3 percent (23/44). While lack of expertise and training were reported barriers, all respondents who were not currently using ultrasound contrast agents were considering future use.

The researchers concluded that there was high interest in using pediatric contrast in ultrasound, but education and training are needed to support members who plan to adopt contrast ultrasound into practice.

 
 
 
 
 
 

Clinical Radiology

The added value of contrast-enhanced ultrasound to conventional ultrasound in differentiating benign and malignant solid breast lesions: a systematic review and meta-analysis

July 2018

Authors: M. Wubulihasimu, M. Maimaitusun, X.-L. Xu, X.-D. Liu'Correspondence information about the author X.-D. LiuEmail the author X.-D. Liu, B.-M. Luo'Correspondence information about the author B.-M. LuoEmail the author B.-M. Luo

DOI: https://doi.org/10.1016/j.crad.2018.06.004

Abstract

Highlights

•Adding CEUS to conventional US could improve the diagnostic specificity and accuracy for breast cancers, with little reduction of the sensitivity.

•The methods of adding CEUS to the conventional US differed among studies and a uniform standard might be needed for further clinical application.

•CEUS-rerated BI-RADS might have a higher diagnostic performance in BI-RADS 3–5 lesions.

Aim

To investigate the added value of contrast-enhanced ultrasound (CEUS) to the conventional ultrasound (US) in the diagnosis of breast lesions.

Materials and methods

PubMed, EMBASE, and Web of Science were searched for relevant studies published between 24 May 2005, and 29 October 2017. Studies incorporating CEUS into the conventional US were included. The reference standard was set by means of histopathological findings. The quality assessment of diagnostic studies (QUADAS) instrument was used to assess the quality of the included studies. Meta-Disc version 1.4. was used to calculate the sensitivity, specificity, summary receiver-operating characteristic (sROC) curves, and area under the curve (AUC). Meta-regression with Stata 12.0 was used to compare the diagnostic accuracy of the two techniques.

Results

Five studies, comprising 992 patients, were eligible for this meta-analysis. For conventional US, the pooled sensitivity and specificity for were 0.87 (95% confidence interval [CI]: 0.84–0.91) and 0.80 (95% CI: 0.76–0.84), respectively, the AUC was 0.9049. For CEUS-rerated US, the pooled sensitivity and specificity were 0.93 (95% CI: 0.90–0.95) and 0.87 (95% CI: 0.84–0.90). The AUC was 0.9482. Meta-regression showed the sensitivity of CEUS-rerated US did not differ from conventional US (p=0.29), while specificity showed significant difference (p<0.01). There was evidence of between-study heterogeneity regarding sensitivity and specificity for both assessments.

Conclusions

Adding CEUS to conventional US could improve the diagnostic performance in differentiating benign from malignant solid breast lesions, whilst retaining high sensitivity, especially in Breast Imaging-Reporting and Data System (BI-RADS) 3–5 lesions. A uniform standard to distinguish benign from malignant lesions might be needed for further clinical application.

 
 
 
 
 
 

World Neurosurgery

Emerging Strategies and Future Perspective in Neuro-Oncology Using Transcranial Focused Ultrasonography Technology

Published online: June 8, 2018

World Neurosurgery, Vol. 117, p84–91

DOI: https://doi.org/10.1016/j.wneu.2018.05.239

Authors: Giada Toccaceli1,5, Roberto Delfini2, Claudio Colonnese3,4, Antonino Raco1, Simone Peschillo5

1NESMOS Departmente Division of Neurosurgery, 2 Department of Human Neurosciences, Neurosurgery, and 3 Department of Human Neurosciences, Neuroradiology, University of Rome, “Sapienza”, Rome; 4 IRCCS INMNeuromed, Pozzilli, Italy; and 5Endovascular Neurosurgery, Policlinico Umberto I, Rome, Italy

To whom correspondence should be addressed: Simone Peschillo, M.D., Ph.D.

Abstract

Highlights

•FUS conveys an ultrasound beam at target points at certain frequencies.

•The objective of the research was to apply FUS to the treatment of intracranial neoplastic diseases.

•We review the latest studies to take stock of the potential of FUS.

•New mini invasive therapies may become main players in the treatment of brain neoplasms, aided by FUS.

Background

Despite the progress achieved in recent years, the prognosis of patients with primary brain tumors remains poor. Research efforts have therefore focused on identifying more effective and minimally invasive treatment methods. Magnetic resonance–guided transcranial focused ultrasonography (MRgFUS) is a consolidated minimally invasive therapeutic technique, which has recently acquired a role also in the treatment of some nononcologic intracranial diseases.

Methods

We reviewed the latest studies to take stock of the potential of MRgFUS.

Results

The objective of the research in the last decade was to apply FUS also to the treatment of intracranial neoplastic diseases, using both the thermal effects (thermal ablation) and, above all, the ability to permeabilize the blood-brain barrier and modify the tumor microenvironment. This strategy may allow the use of drugs that are poorly active on the central nervous system or active selectively at high doses, minimize the side effects, and substantially modify the prognosis of patients affected by these diseases.

Conclusions

In the future, targeted drug delivery, immunotherapy, and gene therapy will probably become main players in the treatment of brain neoplasms, with the aid of MRgFUS. In this way, it will be possible to directly intervene on tumor cells and preserve healthy tissue.

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ICUS gratefully acknowledges its 2017 sponsors:

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