Contrast-enhanced ultrasound

The benefit in using Contrast-Enhanced Ultrasound (CEUS) has been proven over many years, not only for liver disease but also for a range of extra-hepatic indications. Liver guidelines have now also been updated on a larger international scale by a team from Europe as well as by experts from Asia and the USA. This book should help not just towards a start into a new and exciting imaging world, but also to support those who already perform CEUS on a daily basis.

Contenu
1.Basics16 1.1.Bubbles and how ultrasound systems talk to them16 1.1.1.Contrast agents for ultrasound17 1.1.1.1.Blood pool agents17 1.1.1.2.Selective uptake agents18 1.1.2.Talking to bubbles: physical principles of contrast imaging19 1.1.2.1.Bubble behavior and incident pressure19 1.1.2.2.The Mechanical Index (MI)19 1.1.2.3.Nonlinear echoes and harmonic imaging20 1.1.2.4.Harmonic B-mode imaging21 1.1.2.5.Pulse inversion imaging21 1.1.2.6.Pulse inversion Doppler imaging: amplitude and phase modulation22 1.1.2.7.Temporal Maximum Intensity Projection (MIP) imaging23 1.1.2.8.Disrupting bubbles: intermittent imaging23 1.2.Safety considerations and regulatory status26 1.3.Clinical aspects of adverse reactions28 1.4.B-mode ultrasound documentation29 1.4.1.Contrast-enhanced ultrasound (CEUS) documentation29 1.4.2.Basics of CEUS documentation30 1.4.3.CEUS documentation: Characterization of a focal liver lesion30 1.4.4.Detection of malignant liver lesions31 1.4.5.Systematic documentation of the liver: standardized sweeps32 1.4.6.Non-liver CEUS documentation32 1.5.CEUS and volume navigation / fusion imaging32 1.5.1.V-NAV Technical background32 1.5.2.How to use V-Nav32 1.5.2.1.Marking33 1.5.2.2.Fusion Imaging34 1.5.2.3.Other clinical purposes36 1.6.Examination strategies, tips & techniques36 1.6.1.Prior to a CEUS study36 1.6.2.Reasons for an insufficient contrast enhancement39 1.6.3.Dosage of contrast agent41 1.6.4.Acoustic output (MI) and bubble destruction42 1.6.5.Probe types and contrast imaging43 1.6.6.CEUS performance44 2.Liver49 2.1.Kinetics of US contrast agents49 2.2.Benign focal liver lesions50 2.2.1.Benign cystic liver lesions51 2.2.2.Focal fatty infiltration51 2.2.3.Hemangioma52 2.2.4.Focal nodular hyperplasia53 2.2.5.Hepatic adenoma54 2.2.6.Rare benign focal liver lesions57 2.3.Infectious diseases59 2.3.1.Liver infections59 2.3.2.Liver abscesses59 2.3.2.1.Parasitic focal liver diseases61 2.3.3.Other Infections62 2.4.Hepatocellular carcinoma66 2.4.1.Characterization of HCC by CEUS67 2.4.2.Detection of HCC by CEUS71 2.4.3.Diagnostic work-up for HCC based on ultrasound and CEUS71 2.5.Cholangiocarcinoma72 2.6.Detection of focal liver lesions76 2.7.Differentiation between benign and malignant liver lesions80 2.8.Evaluation and characterization of metastatic liver disease86 2.8.1.Vascular involvement88 2.9.The role of contrast enhanced ultrasound in liver surgery96 2.9.1.Background96 2.9.2.Contrast-enhanced intraoperative ultrasound (CE-IOUS) technique98 2.9.3.Characterization of focal liver lesions with CE-IOUS99 2.9.4.CE-IOUS of liver metastases100 2.9.5.Actual change in surgical mangement as a result of CE-IOUS100 2.9.6.Clinical perspective101 2.9.7.CE-IOUS of HCC102 2.9.8.Limitations of CE-IOUS103 2.9.9.Future directions and challenges104 2.10.CEUS in the follow-up after liver transplantation106 2.10.1.Vascular complications107 2.10.1.1.Hepatic artery107 2.10.1.2.Portal vein108 2.10.1.3.Inferior vena cava (IVC) and hepatic vein109 2.11.Evaluation of anti-angiogenic treatments using dynamic contrast-enhanced ultrasonography with quantification110 2.11.1.Post processing111 2.11.2.Further evaluation of DCE-US112 3.Gallbladder diseases121 3.1.Cholecystitis and complications121 3.2.Malignant tumors of the gallbladder wall125 4.Pancreas128 4.1.Pancreatic vasculature and parenchymal enhancement128 4.2.Comparison to other imaging modalities129 4.3.Examination technique130 4.4.Inflammatory diseases131 4.5.Cystic pancreatic tumors132 4.6.Solid pancreatic tumors133 5.Spleen140 5.1.Splenic vasculature and parenchymal enhancement140 5.2.Examination technique140 5.3.Diffuse splenic diseases141 5.4.Vascular splenic lesions143 5.5.Benign focal lesions144 5.6.Secundary malignant focal splenic lesions149 6.Kidneys and collective system152 6.1.Infectious diseases152 6.2.Solid renal tumors156 6.2.1.Benign renal tumors159 6.2.1.1.Angiomyolipoma159 6.2.1.2.Oncocytoma162 6.2.2.Malignant renal tumors164 6.3.Cystic renal tumors170 6.3.1.Urothelium carcinoma173 6.3.2.Renal lymphomas176 6.4.Disorders of the renal blood supply179 6.5.Transplant kidney184 6.6.Monitoring of tumor treatment: CEUS in the management of thermal ablation in renal cell cancer188 6.6.1.Pre-Interventional, peri-interventional and follow-up imaging and the potential of contrast-enhanced ultrasound (CEUS)189 7.Abdominal aortic pathologies and follow-up after endovascular aneurysm repair (EVAR)195 7.1.Normal abdominal aortic anatomy195 7.2.Abdominal aortic aneurysm (AAA)195 7.3.Aortic dissections196 7.4.Aorto-caval fistulas198 7.5.Inflammatory abdominal aortic aneurysm198 7.6.Endovascular aneurysm repair (EVAR)200 8.Neovascularization of the vessel wall: Role and diagnostic approach to neovascularization in vascular disease206 8.1.Examination technique206 8.2.CEUS in arterial lumen imaging207 8.3.Vessel wall and the process of vascularization208 9.Intracavitary contrast-enhanced ultrasound214 9.1.Study procedure214 9.1.1.Ultrasound contrast agent (UCA)214 9.1.2.Examination techniques214 9.2.Clinical applications215 9.2.1.Drainage tubes215 9.2.2.Vesico-ureteric reflux215 9.2.3.Fallopian tubes216 9.2.4.Biliary system216 9.2.5.Fistulas218 9.2.6.Other applications of intracavitary CEUS220 10.CUS of the Bowel in Inflammatory Bowel Disease222 10.1.Background222 10.2.Subjective or semi quantitative evaluation of CEUS223 10.3.Objective or quantitative / post processing of CEUS225 10.4.Influencing factors on TIC229 Index237