Early post-interventional sonographic evaluation of prostatic artery embolization. A promising role for contrast-enhanced ultrasonography (CEUS).

AIMS: To assess the feasibility, findings and potential value of early post-interventional, contrast-enhanced ultrasonographic (CEUS) study of prostate artery embolization (PAE). MATERIAL AND METHODS: Fourteen patients treated with PAE for symptomatic benign prostatic hyperplasia were prospectively included in the study. Sonographic evaluation of the prostate included: 1) baseline transabdominal and transrectal CEUS (ta-CEUS and tr-CEUS, respectively) 1-3 days prior to PAE; 2) early post PAE CEUS, with ta-CEUS immediately post PAE and tr-CEUS 3 days post PAE; and 3) follow-up with ta-CEUS and tr-CEUS 3 months post PAE. A brief unenhanced US study preceded each CEUS. Post-therapeutic changes in size, echogenicity and enhancement of the prostate were recorded and were correlated with clinical outcomes. RESULTS: PAE resulted in clinical success in 11/14 patients (78.5%). All sonographic studies were technically adequate, with the exception of ta-CEUS immediately post PAE in 2/14 (14.2%) patients. CEUS studies immediately post PAE and 3 days post PAE showed non-enhancing, welldefined infarctions of the prostate in 10/14 patients (71.4%). There was a strong correlation between ta-CEUS immediately post PAE and tr-CEUS 3 days post PAE regarding the measurements of prostatic infarctions (r =0.98, p< 0.01). The presence of infarctions on early post PAE CEUS was associated with clinical success (p=0.01) and their extent correlated with the degree of prostate shrinkage on 3-month follow-up (r=0.84, p<0.05). The 3 cases of failed PAE showed no infarctions and no prostate shrinkage. CONCLUSIONS: Early post-interventional CEUS of PAE is feasible and may have clinical and prognostic value.

Imaging of intrahepatic progression of hepatocellular carcinoma post transarterial chemoembolization. A long-term, prospective evaluation of contrast-enhanced ultrasonography (CEUS).

AIMS: To assess the diagnostic efficacy of contrast-enhanced ultrasonography (CEUS) in the context of intrahepatic progression (IHP) of hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE). MATERIAL AND METHODS: Sixty HCC patients were prospectively included in the study. They were treated with transarterial chemoembolization (TACE)with doxorubicin-eluting microspheres (231 sessions). Imaging follow-up was performed 1 month after each session and at 3-6 month intervals after the last session of TACE and included CEUS and contrast-enhanced magnetic resonance (MR) imaging (reference modality). The diagnosis of IHP was based on mRECIST criteria and the respective findings of MR and CEUS were recorded, categorized and correlated. RESULTS: A total of 441 CEUS studies were compared with the corresponding MR studies. During a follow-up period of 5-82 months (mean: 22 months), MR diagnosed 51 cases of IHP in 34/60 (56.6%) patients. CEUS correctly diagnosed 12/14 (85.7%) cases of IHP of target tumors, 2/5 (40%) cases of IHP of non-target tumors, 13/18 (72.2%) cases of distal and 6/9 (66.6%) cases of proximal new lesions, and 5/5 (100%) cases of major vessel involvement. On a per-lesion basis, CEUS was significantly inferior to MR in the detection of new lesions (p=0.002). No false positive CEUS diagnoses of IHP were observed. 54% of the diagnostic failures of CEUS were considered clinically significant. CONCLUSION:  In the long term evaluation of HCC post TACE, CEUS appears to have limitations in the detection of IHP, which are more prominent in the case of new lesions and of progressive non-target tumors.

Application of color Doppler ultrasound in the study of small pleural effusion.

AIMS: To compare the results of gray scale ultrasound with those of color Doppler ultrasound in order to evaluate the minimal pleural effusion and to differentiate the minimal pleural effusion from pleural thickening. PATIENTS AND METHODS: We prospectively analyzed 86 patients who, according to their chest radiographs, were suspected of having minimal pleural effusion. All patients were examined by ultrasonography on gray scale and color Doppler and the presence or absence of pleural effusion was confirmed by thorax CT. Using the color Doppler examination we analyzed the fluid color sign of pleural effusion. RESULTS: In our study, the ultrasonography on gray scale in real time detected pleural effusion with 60% specificity, 100% sensitivity and 88.37% accuracy. By applying the color Doppler the specificity of the method is higher (specificity 100%, sensitivity 96.72% and accuracy 97.57%). CONCLUSIONS: The evidence of pleural effusion on grayscale ultrasound has a greater sensitivity than that of color Doppler ultrasound, but has a smaller specificity. Therefore, color Doppler ultrasound proved to be a useful diagnostic aid in gray-scale ultrasound for the assessment of minimal effusion, having the highest accuracy.

Ultrasound as a first line screening tool for the detection of renal artery stenosis: a comprehensive review.

Renal artery stenosis (RAS) is the most common underlying medical condition in secondary hypertension among adults, representing about 5% of all cases of hypertension. Early diagnosis of RAS is an important clinical objective since interventional therapy may improve or cure hypertension and preserve renal function. Contrast angiography is the currently reference standard for the diagnosis of RAS; however, its invasive nature renders it unsuitable for screening purposes. Among screening tests used for the detection of RAS (computed tomography angiography, magnetic resonance angiography, radionuclide scanning), multiple studies have shown that color Doppler ultrasound (CDUS), although highly operator-dependent, can be an effective tool in the diagnosis of RAS. CDUS imaging is a simple, safe (noninvasive) and widely available technique; in addition, the procedure is painless and well tolerated by patients. In this concrete review we will underline the established color Doppler ultrasound criteria used for the detection of RAS, highlight their limitations and see how their combination may improve the diagnostic accuracy of this method.