ICUS Weekly News Monitor 1-23-2009

1.  Cardiosource, American College of Cardiology,  Jan 21, 2009
Title: Acute Mortality in Hospitalized Patients Undergoing Echocardiography With and Without an Ultrasound Contrast Agent (Multicenter Registry Results in 4,300,966 Consecutive Patients)
Topic: Noninvasive Cardiology
Author(s): Main ML, Ryan AC, Davis TE, Albano MP, Kusnetzky LL, Hibberd M.


____________
Cardiosource
American College of Cardiology
Jan 21, 2009

Title: Acute Mortality in Hospitalized Patients Undergoing Echocardiography With and Without an Ultrasound Contrast Agent (Multicenter Registry Results in 4,300,966 Consecutive Patients)
Topic: Noninvasive Cardiology
Author(s): Main ML, Ryan AC, Davis TE, Albano MP, Kusnetzky LL, Hibberd M.
 
Study Question: What is the short-term mortality for hospitalized patients undergoing echocardiography with and without perflutren lipid microsphere (PLM) contrast agent?
Methods: This was a retrospective review of 4,300,966 consecutive patients identified in the Premier Perspective Database (hospital-based, service-level, comparative database) undergoing clinically indicated echocardiography between January 1, 2002 and October 31, 2007. Patient demographics, illness severity, risk of mortality, and 1-day mortality were collected. Controlling for demographic and clinical covariate differences, the 1-day mortality was compared between patients who did and did not receive PLM at the time of echocardiography.
Results: During the study period, 4,300,966 patients underwent echocardiography without (n = 4,242,712) and with PLM (n = 58,254). The 1-day mortality was 1.08% and 1.06%, respectively. Multivariate logistic regression revealed that patients receiving PLM contrast agent were 24% less likely to die. Overall, the PLM contrast agent group was older, sicker, more likely to die, and more likely to have a Food and Drug Administration (FDA) defined (2007) contraindication to ultrasound contrast agent use.
Conclusions: There was no significant difference in crude 1-day mortality between patients who did and did not receive PLM contrast agent while undergoing echocardiography.
Perspective: The new warnings and contraindications for ultrasound contrast agent issued in October of 2007 were based on a relatively small number of temporally related deaths. Following further investigation, these warnings were relaxed in July of 2008; however, concern remains regarding the use of these agents in critically ill patients. This study supports the findings of a recent single institution study, which did not demonstrate any mortality difference with the use of ultrasound contrast agent. Based on the unstable cardiopulmonary conditions, as defined by the FDA in 2007, more patients in the PLM group for this study had one of these contraindications. However, the mortality rate was equal between groups and the risk of mortality, when covariates were controlled for, was 24% lower in the PLM group. Despite the large sample size, this study is limited by the relatively low usage rate of ultrasound contrast agent. However, the compelling findings of this study warrant further assessment by clinicians and federal agencies regarding the indications for clinical use and “box label” warnings for ultrasound contrast agent.  Jennifer C. Hirsch, M.D., F.A.C.C.

ICUS Weekly News Monitor 1-16-2009

1.  MarketWatch,  Jan. 14, 2009,    Learn about the Biologic Imaging Reagents: Technologies and Global Markets

2.  Globe Newswire,  Jan 13, 2009,    Vital Images and Toshiba Sign Co-development Agreement; New Agreement Expands Relationship With Toshiba; Supports Collaboration On Technology Advancement

3.  Drugdevelopment-technology.com,  Jan 12, 2009,    HM Pharma Consultancy Publishes New Market Report on Molecular Imaging


_____________
MarketWatch
Jan. 14, 2009

Learn about the Biologic Imaging Reagents: Technologies and Global Markets

NEW YORK, Jan 14, 2009 (BUSINESS WIRE) -- Reportlinker.com announces that a new market research report related to the Diagnostic equipment industry is available in its catalogue.
Biologic Imaging Reagents: Technologies and Global Markets
http://www.reportlinker.com/p099465/Biologic-Imaging-Reagents-Technologies-and-Global-Markets.html
INTRODUCTION
STUDY GOALS AND OBJECTIVES
BCC's goal for this study is to determine the global market and future demand growth for biologic imaging reagents over a five-year period from 2008 to 2013. Our particular interest is to characterize and quantify the biologic imaging reagents market potential by technology, reagent type and end user market. We also evaluate future growth opportunities in emerging biologic imaging reagents such as quantum dots, nanoparticles, fluorescent proteins and supermolecules.
Imaging reagent types covered include fluorescent probes and dyes; fluorescent proteins; nanoparticles; fullerene and dendrimer supermolecules; magnetic resonance imaging; ultrasound and x-ray contrast reagents; and imaging radiopharmaceuticals.
Our key objective is to present a comprehensive discussion of where the state-of-the-art is in biologic imaging reagents and forecast the future commercial potential for the key market segments. This discussion will provide a basis for companies to make strategic choices about developing new products and markets, or employing biologic imaging reagents. The study will benefit reagent and instrument manufacturers; users of biologic imaging reagents; medical instrument companies; life sciences tools companies; diagnostic and drug manufacturers; biotechnology companies; and developers of nanotechnologies.
REASONS FOR DOING THE STUDY
Biologic imaging reagents play an important role in the medical, pharmaceutical, diagnostic, biotechnology and life sciences tools industries. Imaging and detection technologies are used extensively in medicine, biotechnology and pharmaceutical research. Traditional imaging techniques, such as x-ray, computer tomography (CT), ultrasound (US), magnetic resonance imaging (MRI) and nuclear medicine (NM), mainly analyze anatomy and morphology and cannot detect changes at the molecular level. However, new developments in biotechnology allow us to image at the cellular and molecular level, paving the way for earlier diagnosis and treatment of disease. Biologic imaging reagents play a critical role in this medical revolution.
At the same time, tremendous advances in genomics, proteomics and cellular analysis are assisted by imaging technologies including fluorescent dyes and probes, quantum dot nanoparticles, and fluorescent proteins. Growth in technologies such as biochips, DNA sequencing, and PCR relies on sensitive biologic fluorescent imaging reagents.
Advances in technologies that are used in biologic imaging reagents are also moving forward at a rapid pace. These technologies include nanotechnology, biologic targeting, microfluidics, supramolecular chemistry and protein engineering. Rapid developments across a number of technology fields promise to change the biologic imaging industry by enabling novel imaging reagents and unique market opportunities. This report analyzes these developments and their impact on the future markets for biologic imaging reagents.
Given these market and technology dynamics, it is especially timely to examine the biologic imaging reagents market.
INTENDED AUDIENCE
We have compiled a study of existing and future imaging reagent technologies that will be commercially important in the major end user segments including life science research tools, drug discovery and development, and diagnostics. We present the various imaging reagent technologies, including fluorescent probes and dyes; nanomaterials; fluorescent proteins; supermolecules; contrast reagents, and imaging radiopharmaceuticals. We also examine the industry growth driving forces; product types; market applications; companies and industry alliances and acquisitions; future market potential and product sales forecasts for the period 2008 through 2013. We project the future use of biologic imaging reagents in the main end user segments and by technology.
This study will be of particular interest to life science research tools suppliers, pharmaceutical manufacturers, diagnostics, biotechnology, genomics, proteomics, nanotechnology and supramolecular companies. It will also be of interest to companies making products for medical imaging, microarrays, lab on a chip, polymerase chain reaction (PCR), molecular diagnostics assays, fluorescence in-situ hybridization (FISH), fluorescence activated cell sorting (FACS) as well as medical researchers and clinicians.


______________
Globe Newswire
Jan 13, 2009

Vital Images and Toshiba Sign Co-development Agreement
New Agreement Expands Relationship With Toshiba; Supports Collaboration On Technology Advancement

MINNEAPOLIS, Jan. 13, 2009 (GLOBE NEWSWIRE) -- Vital Images, Inc. (Nasdaq:VTAL), a leading provider of advanced visualization and analysis software, and Toshiba Medical Systems Corporation (Toshiba), have signed a co-development and collaboration agreement in which they will enter into a mutual license of intellectual property and will jointly invest to develop and deliver innovative technology advancements for Toshiba's modalities, including the Aquilion(tm) ONE CT scanner, and Vital Images' advanced visualization software solutions.

The companies recently announced the renewal of their distribution agreement, which has been extended until 2013. The lengthened term of the new contract, complemented by the co-development and collaboration agreement, enables the companies to jointly drive new technology and closely collaborate in developing and launching industry-leading advanced visualization solutions for medical imaging.

"We have had a close working relationship with Toshiba on Vitrea fX and Aquilion ONE for the past few years," said Vikram Simha, chief technology officer at Vital Images. "However, this agreement establishes a new development framework enabling our companies to more rapidly create innovations, intellectual property and next-generation technologies for all Toshiba modalities."

"Toshiba believes that the new agreements recently signed with Vital Images for distribution and development will continue to enhance and extend our strategic partnership with Vital Images. These agreements will help us achieve our joint goal to deliver unique clinical capabilities leveraging industry-leading technology from both Toshiba and Vital Images," said Yasuo Nobuta, general manager of CT Division, Toshiba Medical Systems Corp. "Toshiba looks to strengthen its collaboration with Vital Images to develop industry-leading solutions."

About the Aquilion One and Vitrea fX

Toshiba's Aquilion ONE is the first dynamic volume CT scanner. This system revolutionizes patient care by non-invasively providing structural and function information key to diagnostic decision and reducing diagnostic time for life-threatening conditions, such as stroke and heart disease, from days and hours to mere minutes. Unlike any other CT system, the Aquilion ONE can scan an entire organ in one rotation, dramatically cutting the exam time as well as radiation and contrast doses. Each Aquilion ONE ships with a Vitrea fX solution -- designed in collaboration with Toshiba for the Aquilion ONE. Vitrea fX has both FDA marketing clearance and CE Mark approval. Aquilion ONE is a trademark of Toshiba Medical Systems Corporation.

About Toshiba Medical Systems Corporation

Toshiba Medical Systems Corporation is an independent group company of Toshiba Corporation. The company is a global leading provider of diagnostic medical imaging systems and comprehensive medical solutions, such as CT scanners, X-ray, Ultrasound, Nuclear Medicine, MRI equipment, and information systems for medical institutions. Toshiba Corporation is a leader in information and communications systems, electronic components, consumer products and power systems. Toshiba Corporation has approximately 198,000 employees and annual sales of $77 billion. For more information, visit www.medical.toshiba.com, www.toshiba.com.

About Vital Images, Inc.

Vital Images, Inc., established in 1988 and headquartered in Minneapolis, is a leading provider of advanced visualization software solutions. The company's technology gives radiologists, cardiologists, oncologists and other medical specialists, time-saving productivity and communications tools that can be accessed throughout the enterprise and via the Web for easy use in the day-to-day practice of medicine. Vital Images also has offices in Europe and Asia. For more information, visit www.vitalimages.com.

Forward-Looking Statements

Except for the historical information contained herein, the matters discussed in this news release are forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 and are intended to enjoy the protection of the safe harbor for forward-looking statements provided by that Act. These statements involve risks and uncertainties which could cause results to differ materially from those projected, including but not limited to dependence on market growth, challenges associated with international expansion, the ability to predict product, customer and geographic sales mix, regulatory approvals, the timely introduction, availability and acceptance of new products, the impact of competitive products and pricing, dependence on major customers, the ability to successfully manage operating costs, fluctuations in quarterly results, approval of products for reimbursement and the level of reimbursement, general economic conditions and other factors detailed from time to time in Vital Images' SEC reports, including its annual report on Form 10-K for the year ended December 31, 2007. Vital Images encourages you to consider all of these risks, uncertainties and other factors carefully in evaluating the forward-looking statements contained in this release. As a result of these matters, changes in facts, assumptions not being realized or other circumstances, the company's actual results may differ materially from the expected results discussed in the forward-looking statements contained in this release. The forward-looking statements made in this release are made only as of the date of this release, and the company undertakes no obligation to update them to reflect subsequent events or circumstances.

CONTACT:  Vital Images, Inc.
          Michael H. Carrel, President and Chief Executive Officer
          (952) 487-9500
          www.vitalimages.com




Drugdevelopment-technology.com
Jan 12, 2009

HM Pharma Consultancy Publishes New Market Report on Molecular Imaging

Vienna, Austria - Insight Pharma Reports has published HM Pharma Consultancy's new report on molecular imaging, the enabling integrative technology that is constantly finding new applications in the life science industry.

Molecular imaging has proved extremely useful across the entire drug development pipeline, from drug target discovery to routine clinical diagnostics. The technologies employed range from optical proximity assays, which visualize the binding of ligands to receptors in living cells to tomography of patients' bodies based on positrons emitted by radioactive tracers.

"A most impressive cutting-edge technology spectrum is being put to work to visualize molecular events of biological relevance in basic biology, transitional research, and advanced routine diagnostics," said report author Hermann AM Mucke. "Molecular imaging can add incredible value to almost any cellular, animal and human research that is conducted today. This is true for academic as well as pharmaceutical investigations."

As a result of this diversity in several dimensions, there is no single 'molecular imaging market.' Rather, there are several partially connected markets: for optical cellular imaging in R&D, consisting of a market for advanced microscopes and a market for optical probes; for near-infrared imaging of laboratory animals, divided into an equipment and a probe market; for tomographic scanners (based on X-rays, magnetic resonance, or nuclear isotopes, alone or in combination, and in different sizes for laboratory animals and humans); for ultrasound imaging equipment; for X-ray, magnetic resonance, and ultrasound contrast agents which concern molecularly or metabolically differentiating agents; and for radioactive isotopic probes, assisted by a secondary market for the logistics of those probes that decay particularly rapidly but can only be manufactured in cyclotrons. An overarching market of computer systems and software takes care of the processing, analysis, and storage of the captured images.

HM Pharma Consultancy's report investigates all these aspects, along with the technology that constitutes their underpinning, and adds additional information from a survey of molecular imaging researchers. The report, titled Biomedical Imaging: From Drug Target Discovery to Medical Diagnostics is available from Insight Pharma Reports, a division of the Cambridge Healthtech Institute.

For details on buying the report, please visit Insight Pharma Reports' website, or call Rose LaRaia at +1 781 972 5444.

ICUS Weekly News Monitor 1-9-2009

1.  Auntminnie,  Jan 8, 2009,    JACC study shows no additional risk from echo contrast agents
By Eric Barnes

2.  Physics in Medicine and Biology,  Feb 2009,    Toward contrast-enhanced microwave-induced thermoacoustic imaging of breast cancer: an experimental study of the effects of microbubbles on simple thermoacoustic targets    By Alireza Mashal, John H Booske and Susan C Hagness

3.  PR Newswire,  Jan 5, 2009,  Micro-Bubble Echo Contrast Procedures Continue to Rebound in October 2008

4.  JACC (Journal of the American College of Cardiology),  Dec 31, 2008    Safety and Efficacy of Commercially Available Ultrasound Contrast Agents for Rest and Stress Echocardiography

5.  World Journal of Gastroenterology,  Dec 29, 2008,    How to enhance nonthermal effects of ultrasound    By Lin Tian


___________
Auntminnie
Jan 8, 2009

JACC study shows no additional risk from echo contrast agents
By Eric Barnes

Despite recent safety warnings, ultrasound contrast agents are safe and effective for assessing patients during echocardiography, concludes a massive review of more than 42,000 patients examined at three institutions in the U.S.
The retrospective study, which appears in this month's Journal of the American College of Cardiology, found no significant differences in death rate or myocardial infarction (MI) between patients who received ultrasound contrast agents and those who did not during stress echocardiography.
In 2007, the U.S. Food and Drug Administration (FDA) mandated the placement of a black box warning for ultrasound contrast agents Definity from Lantheus Medical Imaging (North Billerica, MA) and Optison from GE Healthcare (Chalfont St. Giles, U.K.), following reports of 11 deaths that occurred around the time of their administration.
The warning was modified in July 2008 to exclude only the most unstable patients from use of the agents. However, many institutions had long since stopped using echo contrast, a product that proponents believe significantly improves the quality of many exams that would otherwise be unreadable.
Echo contrast's utility was highlighted in this month's JACC article, authored by Dr. Melda Dolan, from Saint Louis University Hospital in Missouri, as well as colleagues from University of Nebraska Medical Center in Omaha and the Mayo Clinic in Rochester, MN (JACC, January 2009, Vol. 53, pp. 32-38).
"Unfortunately, up to 30% of studies are deemed technically difficult due to poor image quality, making these studies very challenging to interpret," the authors wrote. "Patients with large body habitus, chest wall deformities, and severe chronic lung disease are at higher risk of having suboptimal image quality. Furthermore, bedside echocardiograms are frequently ordered to identify the cause of hemodynamic instability and respiratory failure in critically ill patients."
But while the deaths reported prior to the black box warning (10 from Definity, one from Optison) were temporally related to use of the agents, no causal link was ever found, and many researchers believe that none exists.
"As has been the case, serious adverse events (death or nonfatal MI) within 24 hours of contrast use could be easily explained by the patient's underlying condition at the time of the study or to induced ischemia during stress echocardiography," the authors wrote.
Single-center studies had shown no additional morbidity or mortality resulting from use of the agents; however, their safety had not been comprehensively reviewed in a multicenter setting, Dolan and colleagues wrote. Therefore, the present study aimed to comprehensively define the risks and benefits of ultrasound contrast agents in patients undergoing stress echocardiography.
The group analyzed the records of 42,408 patients at three different institutions who had baseline suboptimal images and/or underwent nuclear myocardial perfusion imaging and received contrast agents between 1999 and 2007. Of these, 18,749 had stress echocardiography exams. Measured outcomes included death and myocardial infarction within 30 minutes, 24 hours, or during long-term follow-up.
Results
There were no deaths or MIs among the 23,659 patients who received contrast for suboptimal resting studies or myocardial perfusion studies. There was one death and five nonfatal MIs within 24 hours of contrast administration.
"This was not different from a matched cohort of 15,989 patients not receiving contrast," Dolan and colleagues wrote. "In the matched group of 5,900 consecutive patients with optimal resting studies and no contrast use, no events occurred within 30 minutes, but seven nonfatal MIs and one death occurred within 24 hours."
Among the 18,749 patients who underwent stress echocardiography, there were no deaths or MIs within 30 minutes, and there was one death and five nonfatal MIs (three after Definity, two after Optison) within 24 hours.
There was no reason to believe that the use of contrast agents contributed to any of the MIs, or to the death of the stress echocardiography patient, who had developed frequent runs of ventricular tachycardia requiring intravenous antiarrhythmic therapy, according to the authors. This patient eventually developed disseminated intravascular coagulation. On day 11, dobutamine stress echocardiography and real-time myocardial contrast echocardiography with Optison contrast were performed without complication, but within 24 hours the patient developed recurring ventricular tachycardia and died 22 hours after contrast administration.
Similarly, at 30 days there were no statistically significant differences between patients undergoing dobutamine stress echocardiography or exercise stress electrocardiography with or without contrast.
In the 10,788 patients who received contrast, 37 (0.34%) died and 68 (0.63%) experienced an MI. In a matched cohort of 15,989 patients who did not receive contrast, there were 62 (0.39%) deaths and 73 (0.46%) MIs.
Additionally, there were no significant differences in 4,011 patients who received contrast for suboptimal image quality during echocardiography versus a matched group of 1,923 patients who had optimal images and did not require contrast.
"Endocardial border visualization in patients with suboptimal images resulted in comparable sensitivity (81% vs. 73%) and diagnostic accuracy (82% vs. 77%) for wall motion analysis compared with patients with optimal image quality," the authors wrote. "At long-term follow-up, abnormal wall motion and/or myocardial perfusion predicted adverse outcomes (20.6%) when compared with patients with normal studies (3.7%)."
Image quality improved with contrast use
Significant incremental value was derived from contrast use at all three participating centers, which used contrast-enhanced left ventricular opacification to yield sensitivity and specificity equivalent to that of patients who had optimal image quality without contrast, the authors wrote.
"The ability of stress echocardiography to detect coronary artery disease is clearly related to the ability to visualize all myocardial segments in each coronary artery territory," they wrote.
When echo studies need to be cancelled due to suboptimal windows and contrast is not available, the alternative tests usually involve the use of ionizing radiation and additional costs and risk to the patient, they added.
In addition, myocardial perfusion imaging with contrast, though not yet FDA approved, added significant incremental value to dobutamine stress echocardiography, the group wrote.
The study was large, but its retrospective design was a limitation, and different cohorts were used to compare patients who received contrast with those who did not, the authors noted.
"The risks of both short-term and long-term events, defined as nonfatal MI and death, after contrast administration are very low and are no different than in patients not receiving contrast during stress echocardiography," Dolan and colleagues concluded. "Contrast use in patients with suboptimal images improves feasibility and accuracy of stress echocardiography testing. Failure to use contrast agents in patients with suboptimal images may result in a misdiagnosis and/or additional alternative imaging techniques with greater inherent risks."
Experience in this and other recent studies comprising more than 60,000 patients demonstrates that "there is no evidence to suggest a causal relationship between the use of commercially available contrast and serious adverse events," they wrote. "The findings in this study provide physicians with the confidence to use contrast agents during stress testing when clinically indicated."


____________________________
Physics in Medicine and Biology
Feb 2009  Issue #3

Toward contrast-enhanced microwave-induced thermoacoustic imaging of breast cancer: an experimental study of the effects of microbubbles on simple thermoacoustic targets
By Alireza Mashal, John H Booske and Susan C Hagness

Department of Electrical and Computer Engineering, University of Wisconsin, Madison, WI, USA
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. , This email address is being protected from spambots. You need JavaScript enabled to view it. and This email address is being protected from spambots. You need JavaScript enabled to view it.

Abstract. Microwave-induced thermoacoustic tomography (MI-TAT) is an imaging technique that exploits dielectric contrast at microwave frequencies while creating images with ultrasound resolution. We propose the use of microbubbles as a dielectric contrast agent for enhancing the sensitivity of MI-TAT for breast cancer detection. As an initial investigation of this concept, we experimentally studied the extent to which the microwave-induced thermoacoustic response of a dielectric target is modified by the presence of air-filled glass microbubbles. We created mixtures of ethylene glycol with varying weight percentages of microbubbles and characterized both their microwave properties (0.5–6 GHz) and thermoacoustic response when irradiated with microwave energy at 3 GHz. Our data show that the microbubbles considerably lowered the relative permittivity, electrical conductivity and thermoacoustic response of the ethylene glycol mixtures. We hypothesize that the interstitial infusion of microbubbles to a tumor site will similarly create a smaller thermoacoustic response compared to the pre-contrast-agent response, thereby enhancing sensitivity through the use of differential imaging techniques.


_____________
PR Newswire
Jan 5, 2009

Micro-Bubble Echo Contrast Procedures Continue to Rebound in October 2008
(Decision Resources, Inc.)

Both Definity(R) and OptisonTM Usage Increased During the Same Study Period, According To New Data from Arlington Medical Resources

MALVERN, Pa., Jan. 5 /PRNewswire/ -- Arlington Medical Resources (AMR), a provider of premier market intelligence for the pharmaceutical and diagnostic imaging industries, finds that the number of micro-bubble echo contrast procedures performed in October 2008 have increased by more than 50 percent, to nearly 18,000 procedures, when compared to May 2008. Micro-bubble echo contrast procedures began declining sharply in October 2007, from nearly 55,000 procedures in September 2007, as a result of a black box warning issued by the FDA in October 2007.

A revised black box warning issued in May 2008 has contributed to this rebound as well as physicians and sonographers reestablishing protocols for contrast usage in their institutions. A micro-bubble echo contrast agent is administered intravenously and used for contrast enhancement during echocardiographic procedures.

The newly released edition of the U.S. Echocardiography Monthly Monitor also finds that both Lantheus Medical Imaging's Definity(R) and GE Healthcare's OptisonTM -- the two FDA approved micro-bubble echo contrast agents -- realized increased usage during the same study period.

"Continued interest in ultrasound contrast is evident with the recently released American Society of Echocardiography Consensus Statement on the Clinical Applications of Ultrasonic Agents in Echocardiography and the formation of the International Contrast Ultrasound Society (ICUS)," stated Anna Fisher, analyst at AMR.


Why Pharmaceutical & Medical Device Companies Need this Information

The U.S. Echocardiography Monthly Monitor enables pharmaceutical and medical device companies to monitor the utilization rates of echocardiography in the U.S. It is the timeliest data available to gauge movement and direction of the volume of echocardiography studies being performed and cardiac ultrasound contrast agent and pharmacological stressing agent usage.

About the U.S. Echocardiography Monthly Monitor

The U.S. Echocardiography Monthly Monitor is a monthly syndicated audit of echocardiography procedures, ultrasound contrast agents and pharmacologic stress agents used in hospitals and office-based cardiology settings. The study quantifies echocardiography procedure volumes on a national scale, split by type of echo, contrast/non-contrast, type of contrast and stressing method where applicable. The data is available 30 days after the end of each study month.

About AMR

AMR (www.AMR-data.com) serves the market intelligence needs of the pharmaceutical and diagnostic imaging industries. Research includes clinical inpatient databases that directly link anti-infective drug with indication/procedure, formulary and stocking status tracking studies, drug purchasing audits and diagnostic imaging procedure volume/contrast media usage audits. AMR is a Decision Resources, Inc. company.

About Decision Resources, Inc.

Decision Resources, Inc. is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Please visit Decision Resources, Inc. at www.DecisionResourcesInc.com.

All company, brand or product names contained in this document may be trademarks or registered trademarks of their respective holders.

    For more information, contact:

    Natalia Morales
    Decision Resources
    781-296-2691
    This email address is being protected from spambots. You need JavaScript enabled to view it.

    Elizabeth Marshall
    Decision Resources, Inc.
    781-296-2563
    This email address is being protected from spambots. You need JavaScript enabled to view it.

Website: http://www.decisionresourcesinc.com//


_____________________________________________
JACC (Journal of the American College of Cardiology)
Dec 31, 2008

Safety and Efficacy of Commercially Available Ultrasound Contrast Agents for Rest and Stress Echocardiography
A Multicenter Experience

Melda S. Dolan, MD*,*, Simil S. Gala, MD*, Saritha Dodla, MD, Sahar S. Abdelmoneim, MD, Feng Xie, MD, David Cloutier, MS, Michelle Bierig, MPH, RDCS, RDMS*, Sharon L. Mulvagh, MD, FACC, FRCP, Thomas R. Porter, MD, FACC, FASE and Arthur J. Labovitz, MD, FACC, FACP, FCCP, FASE*
* Division of Cardiology, Saint Louis University Hospital, St. Louis, Missouri
 Section of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska
 Division of Cardiology, Mayo Clinic, Rochester, Minnesota

Manuscript received May 16, 2008; revised manuscript received August 14, 2008, accepted August 25, 2008.

* Reprint requests and correspondence: Dr. Melda S. Dolan, Division of Cardiology, Saint Louis University, 3635 Vista Avenue, 14th Floor, St. Louis, Missouri 63110-0250 (Email: This email address is being protected from spambots. You need JavaScript enabled to view it. ).

Objectives: The authors sought to define the risks versus benefits of ultrasound contrast agents in patients undergoing stress echocardiography.

Background: The Food and Drug Administration recently placed a "black box" warning on the ultrasound contrast agents Definity (Bristol-Myers Squibb Medical Imaging, Billerica, Massachusetts) and Optison (GE Healthcare, Princeton, New Jersey) after their use was temporally related to 4 deaths. The safety of contrast has not been systematically evaluated.

Methods: We retrospectively analyzed 42,408 patients at 3 different institutions who had baseline suboptimal images and/or underwent myocardial perfusion imaging and received contrast agents; 18,749 of these underwent stress echocardiography. The outcomes (death and myocardial infarction [MI]) within 30 min, 24 h, and during long-term follow-up were recorded.

Results: No deaths or MIs were observed within 30 min; 1 death and 5 nonfatal MIs were observed within 24 h. This was not different from a matched cohort of 15,989 patients not receiving contrast. At 1 h and at 30 days after contrast administration, no significant differences in death rates or MIs were observed between patients who did and did not receive contrast during their stress echocardiogram. Endocardial border visualization in patients with suboptimal images resulted in comparable sensitivity (81% vs. 73%, p = NS) and diagnostic accuracy (82% vs. 77%, p = NS) for wall motion analysis compared with patients with optimal image quality. At long-term follow-up, abnormal wall motion and/or myocardial perfusion predicted adverse outcomes (20.6%) when compared with patients with normal studies (3.7%).

Conclusions: Despite recent warnings regarding echocardiographic contrast, our findings indicate it is a safe and useful diagnostic tool in assessment of patients suspected of having coronary artery disease.


_____________________________
World Journal of Gastroenterology
Dec 29, 2008

How to enhance nonthermal effects of ultrasound
By Lin Tian

In recent years HIFU has been widely used for the treatment of solid tumors, such as liver tumor, bone tumor, and breast cancer. The mechanism for therapeutic actions of HIFU includes thermal effects and non-thermal effects with the latter dominated by cavitational effects. Adjusting acoustic parameters of pulsed high intensity focused ultrasound (PHIFU) can control thermal effects and non-thermal effects; short duty cycle and high intensity favors the occurrence of cavitation. Ultrasound contrast agent (UCA) can enhance cavitational effects. Lesions caused by non-thermal effects have characteristic pathological changes quite different from those of thermal lesions.

A research article to be published on November 21, 2008 in the World Journal of Gastroenterology addresses this question. The research group led by Professor Zhi-Biao Wang from Department of Biomedical Engineering of Chongqing Medical University used PHIFU with short duty cycle and high intensity combined with UCA to damage rabbit liver VX2 tumour by non-thermal effect, and the non-thermal damage was evaluated by histopathology.

Liver VX2 tumor model were established in 20 rabbits, which were then divided randomly into PHIFU combined with UCA group (PHIFU+UCA group) and sham group, with 10 rabbits in each group. In the PHIFU+UCA group, 0.2 mL of SonoVue was injected intravenously, followed by rapid injection of 1 mL normal saline. Fifteen seconds after the injection, the tumours were exposed to HIFU with ISP 5900W/cm2 for 90 seconds. Rabbits were sacrificed one day after HIFU exposure. Specimens of the exposed tumor tissues were obtained and observed pathologically under light microscope and transmission electron microscope. The remaining exposed tumor tissues were sent for TTC staining. Before TTC staining, tumor tissues in both the sham and the PHIFU+UCA group resembled gray fish meat; after TTC staining, the tumour tissues were uniformly stained red, with a clear boundary between tumor tissue and normal tissue. For PHIFU + UCA group, light microscopy displayed abundant vacuoles of various sizes in the cytoplasm and in some cells, chromatin margination and karyopyknosis were present. Electron microscopic examination revealed presence of karyopyknosis and chromatin margination in some cells, intercellular space widening, the presence of high electron-density apoptotic bodies and many vacuoles of various sizes in the cytoplasm.

This study found that PHIFU combination with UCA can enhance non-thermal effects of ultrasound, and the pathological characteristics of the non-thermal damage is different from those of thermal damage. Immunohistochemical detection found that PHIFU combined with UCA can promote tumor cell apoptosis and inhibit tumor cell proliferation, which will be reported in another article.

ICUS Sponsors

ICUS gratefully acknowledges its 2017 sponsors:

dentons-logo2

silver-level

samsung-logo

siemens-new-original

philips-icus-logo

Contact ICUS

  • Address: 1900 K Street, N.W.
    Washington, DC 20006-1102, USA
  • Telephone: 202-408-6199

About ICUS

ICUS is the world’s only professional society exclusively devoted to contrast-enhanced ultrasound (CEUS) medical imaging technology.

Learn more...

You are here: Home ICUS Weekly News