Contrast enhanced ultrasonography

Zhou XD, Ren XL, Zhang J, He GB, Zheng MJ, Tian X, Li L, Zhu T, Zhang M, Wang L, Luo W (2007) Therapeutic response assessment of high intensity focused ultrasound therapy for uterine fibroid utility of contrast-enhanced ultrasonography. European Journal of Radiology 62 289-294. 

Preliminary investigations on superficial structures show that contrast-enhanced ultrasonography may prove useful for assessing superficial lymph nodes (Rubaltelli et al. 2004), thyroid and parathyroid disease (Cosgrove 2004), muscle and joint pathologies (Krix et al. 2005 Weber et al. 2006), and breast masses (Cassano et al. 2006). 

Little has been written on contrast-enhanced ultrasonography of penile disease. Only few preliminary investigations have been done in which first generation microbubble contrast agents and conventional Doppler techniques have been used. To the best of our knowledge, use of the latest generation microbubble contrast agents with contrast-specific ultrasound modes has been reported in a very limited number of cases. 

Fig. 21.3. Normal penile anatomy at contrast-enhanced ultrasonography after intracavernosal injection of SonoVue microbubbles showing homogeneous enhancement of the corpora cavarnosa. The corpus spongiosum ( ) does not enhance...

Contrary to gadolinium-based and to iodinated contrast agents, microbubbles do not diffuse out of the blood circulation. As a consequence, after intravenous microbubble administration fibrotic tissue shows no enhancement in all vascular phases. At contrast-enhanced ultrasonography, localized cavernosal tissue fibrosis presents as a circumscribed perfusion defect. Diffuse fibrotic changes present with inhomogeneous enhancement ofthe corpora cavernosa. Contrary to the normal cavernosal tissue, delayed peripheral enhancement of variable degree is often appreciable, probably by the presence of viable subalbugineal cavernosal tissue fed by peripheral vascular pathways, while poor or no contrast enhancement is appreciable in the central portion of the corpora cavernosa (Fig. 21.10). 

Fig. 21.9. Al-Ghorab shunting in a patient with ischemicpri-apism. Patency of the shunt is assessed at contrast-enhanced ultrasonography after intracavernosal contrast injection by presence of microbubbles flowing via the shunt (open arrows) towards the glans...

Krix M, Weber MA, Krakowski-Roosen H et al (2005) Assessment of skeletal muscle perfusion using contrast-enhanced ultrasonography. J Ultrasound Med 24 431-441... 

Twenty-five patients with known hepatocellular carcinoma (HCC) or liver metastases underwent a baseline examination and at least three contrast-enhanced ultrasonography examinations with ascending dose levels (0.25 1.0 4.0 mL) of BR14. There were two patients who reported mild, nonserious adverse events [54 ]. 

Contrast-enhanced computed tomography (CT) is used to identify the cause of pancreatitis and confirm the diagnosis. Magnetic resonance imaging is used to grade the severity of AP and identify bile duct abnormalities not seen on CT. Ultrasonography is useful to determine pancreatic enlargement and peripancreatic fluid collections. 

MRI and a bone scan with MDP showed wedge-shaped contrast enhancement in some patients, although these procedures were less sensitive than CT. Patchy lesions could be visualized by a bone scan with MDP in Patients 5 (Fig. 18), 12 (Fig. 33), 13 (Fig. 35), and 16 (Fig. 40). This visualization was achieved by MRI in Patients 6 [35] (Fig. 26), 16 (Fig. 22 and Fig. 39), and 21 (Fig. 45). In the future, ultrasonography with Levovist will facilitate the visualization of lesions. 

In the patients with ALPE, plain CT of the kidney (delayed CT) a few hours, 24 h, and 48 h after the administration of 40 ml contrast medium showed wedge-shaped contrast enhancement. When physicians hesitate to administer a contrast medium, patchy accumulation can be sometimes detected by magnetic resonance imaging (MRI) with gadolinium-diethylenetriaminopentoacetic acid (Gd-DTPA), bone scan with MDP, or ultrasonography with Levovist. 

Hyodo, T., Hyodo, N., Yaman a, T., Imawaii, M. Contrast-enhanced intraductal ultrasonography for thickened bile duct wall. X Gastroenterol. 2001 36 557-559... 

Milsom, J.W., Jerby, B.L., Kessler, H., Hale, J.C., Herts, B.R., O Malley, C.M. Prospective blinded comparison of laparoscopic ultrasonography vs. contrast-enhanced computerized tomography for liver assessment in patients undergoing colorectal carcinoma surgery. Dis. Colon Rect. 2000 43 44-49... 

Parente F, Greco S, Molteni M et al (2004b) Oral contrast enhanced bowel ultrasonography in the assessment of small intestine Crohn s disease. A prospective comparison with conventional ultrasound. X-ray studies, and ileocolo-noscopy. Gut 53 1652-1657... 

Campani R, Calliada F, Bottinelli O (1998) Contrast enhancing agents in ultrasonography clinical applications. Fur J Radiol 27 (Suppl 2) 161-170... 

Takayasu K, Makuuchi M, Takayama T (1990) Computed tomography of a rapidly growing hepatic hemangioma. J Comput Assist Tomogr 14 143-145 Tano S, Veno N, Tomiyama T, et al (1997) Possibility of differentiating small hyperechoic liver tumors using contrast enhanced colour Doppler ultrasonography a preliminary study. Clin Radiol 52 41-45... 

No consensus has been reached for the assessment of the renal status of cadaveric donors it can be based on simple abdominal ultrasonography (US) or contrast-enhanced CT. As the diagnosis of cerebral death moves towards requiring cerebral contrast-enhanced CT angiography, helical CT now plays an increasing role for that purpose. 

Fig. 3.6a-d. Urinary leak secondary to ureteral ischemia. Ultrasonography (a) shows a fluid collection between the lower pole of the transplant and the bladder, b On contrast-enhanced CT, fluid is noted around the graft and within the peritoneal cavity. The pelvic fluid collection ( ) has a water density at the early phase after contrast injection (c) but enhances at the late phase (d) due to the urinary leak of contrast medium... 

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