The value of contrast-enhanced ultrasound (CEUS) using a high-end ultrasound system in the characterization of endoleaks after endovascular aortic repair (EVAR).

PURPOSE: To evaluate the value of contrast-enhanced ultrasound (CEUS) using a high-end ultrasound system in the characterization of endoleaks after endovascular aortic repair (EVAR). MATERIAL AND METHODS: In this mono-center study, 41 patients were retrospectively analyzed after being examined using a modern high-end ultrasound system (RS80A with Prestige, Samsung Medison Co., Ltd., Seoul, Korea). The maximum diameters of the aneurysms were measured in two planes (right-left and ventral-dorsal). The performance of Color Doppler in comparison to CEUS was evaluated and CEUS was considered as the gold standard in endoleaks detection. RESULTS: 41 patients were included in the study. Between June and December 2016, mostly male patients (n = 38; 92,7%) were examined, corresponding to the incidence of abdominal aortic aneurysms in the population. Average age was 75±8 years (range 58-100 years). Average diameter of the treated aneurysm-sacs was 5,04±1.5 cm (range 2.7-10.5 cm) in the right-left plane and 4,75±1.36 cm (range 2.8-8.9 cm) in the ventral-dorsal plane. Using CEUS as the gold standard endoleaks could be detected in 28 patients (68,3%) with 13 patients not showing an endoleak after EVAR. Color Doppler showed a sensitivity of 32.1%, a specificity of 92.3%, a positive predictive value (PPV) of 90.0% and a negative predictive value (NPV) of 38,7% compared to CEUS being the gold standard. CONCLUSION: CEUS after EVAR using a modern high-end ultrasound system is a fast and cost-effective imaging modality for the detection and follow-up of endoleaks with superior benefits compared to Color Doppler. CEUS remains the initial standard-of-care examination for follow-up.

Diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in monitoring vascular complications in patients after liver transplantation - diagnostic performance compared with histopathological results.

PURPOSE: To analyse the diagnostic performance of contrast-enhanced ultrasound (CEUS) in patients with vascular complications and transplant rejection compared to histopathological results. MATERIALS AND METHODS: Our study consisted of 45 retrospectively analysed patients that underwent liver transplantations between January 1993 and December 2015 and developed post-transplant vascular complications with transplant rejection. CEUS examinations took place between September 2006 and December 2015. CEUS findings were correlated with histopathological results. RESULTS: CEUS showed a sensitivity of 61.5%, a specificity of 100.0%, a positive predictive value (PPV) of 100.0% and a negative predictive value (NPV) of 86,5% in the detection of vascular complications with post-transplant rejection. 5 examinations were reported as normal whereas the histopathological result showed a transplant rejection (false-negative). CONCLUSION: CEUS might be a useful additional non-invasive technique for the assessment of vascular complications with post-transplant rejection in patients after liver transplantation.

[Sonoelastography in daily clinical routine]. / Ultraschallelastographie in der klinischen Routinediagnostik.

CLINICAL ISSUE: In the daily clinical routine characterization of focal lesions using native B­mode classical ultrasound and color Doppler can be difficult or insufficient; therefore, additional diagnostic information must be taken into consideration. STANDARD RADIOLOGICAL METHODS: Standard radiological methods in the daily clinical routine include native B­mode ultrasound and color Doppler ultrasound. METHODICAL INNOVATIONS: Using sonoelastography it is possible to evaluate and characterize tissue properties and focal lesions regarding their stiffness to acquire additional information on a noninvasive basis. PERFORMANCE: Sonoelastography enables the differentiation between benign and malignant lesions especially in organs that can be easily evaluated using ultrasound. This particularly includes the liver, the thyroid gland, the breasts and the testicles. Regarding the liver, sonoelastography techniques can also be used for evaluation of the tissue flexibility in the diagnostics of fibrosis and cirrhosis. ACHIEVEMENTS: Nowadays, elastography is implemented into every modern ultrasound system and has been established as a supplementary examination technique to the conventional ultrasound techniques. PRACTICAL RECOMMENDATIONS: Sonoelastography should be used in cases with unclear findings as an additional noninvasive tool for the differentiation between benign and malignant lesions.

Comparison of portable ultrasound system and high end ultrasound system in detection of endoleaks.

PURPOSE: To compare the value of a portable ultrasound system and a high end ultrasound system in detection of endoleaks after EVAR. MATERIAL AND METHODS: In this retrospective study, a cohort of 25 patients underwent both standard examination using a portable ultrasound system (Philips VISIQ) and a second examination using a high end ultrasound system (Philips EPIQ 7). The examination included B-mode and color Doppler in detection of endoleaks. Additional the maximum diameter of the aneurysm was measured in two planes (right-left and ventral-dorsal). The gold standard was contrast-enhanced ultrasound (CEUS) in detection of endoleaks. RESULTS: 25 patients were included in the study. Patients were predominantly male (n = 23) with an average age of 73,30±7.82 years (range 54-85). Diameters of the treated aneurysms were in the right-left plane 5,32±1.88 cm and ventral-dorsal 4,99±1.78 cm using the high end system. Diameters of the treated aneurysms were in the right-left plane 5,30±1.82 cm and ventral-dorsal 4,87±1.74 cm using portable ultrasound system. In 80% of the cases CEUS could detect an endoleak. Whereas the high end system could detect in B-mode 40% and color Doppler 45% of the cases an endoleak. The portable system could detect in B-mode 30% and in color Doppler 35% of the cases an endoleak. On both systems in B-mode a false positive endoleak was found on the same patient. All high flow endoleaks, which needed intervention, could be detected on all systems. CONCLUSION: The high end ultrasound system does not seem to have an additional advantage in the measurement of the aneurysm diameter. Due to a higher resolution, more endoleaks could be detected in B-mode and color Doppler by using the high end system. The presence of small endoleaks could only be detected by using contrast enhanced ultrasound on an high end ultrasound system. High flow endoleaks could be reliable seen on both systems.

Neurogenic inflammation and colliquative lymphadenitis with persistent orthopox virus DNA detection in a human case of cowpox virus infection transmitted by a domestic cat.

Cowpox viruses are orthopoxviruses that may survive in the environment for years. Rodents are regarded as the primary hosts, but transmission to other species has been reported. This report describes a cowpox virus infection in a cat with subsequent transmission to its owner leading to protracted, atypical and severe clinical signs. A young cat presented with multiple crusts and plaques on the neck, muzzle and tail base. The owner developed an erythematous lesion with elevated margins, central necrosis and crust formation below the left breast, a neurogenic inflammation, enlarged regional lymph nodes, a colliquative lymphadenitis and concomitant flu-like symptoms. Cultures were taken at the first visit from the cat's lesional skin and the patient's skin, and polymerase chain reaction with sequencing of the haemagglutinin region of both were positive for cowpox virus. The patient was treated with various antibiotics and methylprednisolone and was in clinical remission after 7 months.

Value of high-resolution contrast-enhanced ultrasound in detection and characterisation of endoleaks after EVAR.

PURPOSE: To compare the value of high-resolution contrast-enhanced ultrasound in the detection and characterisation of endoleaks after EVAR. MATERIAL AND METHODS: In this retrospective study, a cohort of 80 patients underwent both standard examination using a curved array 5 MHz transducer and a second examination using a curved array 9 MHz transducer. The examination included B-mode, color Doppler and contrast-enhanced ultrasound using the Philips EPIQ 7 scanner. RESULTS: 80 patients were included in the study. CEUS was used as the preferred examination in determining the presence of an endoleak. The sensitivity and specificity for the detection of endoleak using the 5 MHz transducer was: CEUS (96.8%, 100%), Color Doppler (47.6%, 94.1%), B-mode (15.8%, 94.1%), while for the 9 MHz transducer: CEUS (100%, 100%), Color Doppler (39.7%, 94.1%), B-mode (23.8%, 24.1%). CONCLUSION: High resolution ultrasound (9 MHz) in detection and characterization of endoleaks after EVAR has some minor advantages in comparison to lower resolution ultrasound (5 MHz).

High resolution compression elastography and color doppler sonography in characterization of breast fibroadenoma.

PURPOSE: To evaluate the use of color Doppler sonography and free hand sonoelastography in the assessment of breast fibroadenomas according to their size and shape. MATERIALS AND METHODS: From December 2012 to March 2013 women with 16 solid breast masses, classified as BI-RADS category 3 or 4 were examined with B-mode ultrasound, sonoelastography and color Doppler sonography. Lesions were subdivided according to their shape in round, ovoid or macrolobulated and according to their size (<2.0 cm or ≥2.0 cm). Two readers assessed sonoelastographic findings at 12.5 MHz using the tsukuba elasticity score and results of Doppler sonography using a score of 0, 1 or 2, depending on the degree of perfusion. RESULTS: Among the 16 examined lesions 3 showed a round shape, 9 were ovoid and in 4 cases a macrolobulated appearance could be seen. No significant differences concerning Tsukuba-score depending on various shapes of fibroadenomas in B-mode sonography could be shown (p = 0.91) and also comparison of Tsukuba-scores and size of masses revealed no significant differences (p = 1.0). Sizes of fibroadenomas ≥2 cm were significantly associated with an increased vascularization of the lesions (p = 0.04) and a macrolobulated appearance in B-mode sonography (p = 0.04). CONCLUSION: The combination of color Doppler sonography and sonoelastography in addition to B-mode sonography leads to an increased accuracy in distinguishing benign from malignant breast masses and to an improvement in characterization of fibroadenomas independent of their shape or size.

Comparison of contrast-enhanced ultrasound and compression elastography in the follow-up after endovascular aortic aneurysm repair.

PURPOSE: To compare compression elastography and contrast enhanced ultrasound in the follow-up after endovascular aortic aneurysm repair. MATERIAL AND METHODS: In this retrospective study a cohort of 33 patients with both CEUS and elastography follow-up examinations after EVAR were included. The examinations were done with a Siemens S 2000 with curved array 4 MHz multi-frequency transducer. RESULTS: Regarding our inclusion and exclusion criteria we obtained 33 patients. CEUS was used as the preferred examination in determining the presence of an endoleak. The true positive rate for the detection of Endoleaks with compression elastography was 42.4% (14/33), the false positive rate was 12.1% (4/33), the true negative rate was 15.2% (5/33) and the false negative rate was 30.3% (10/33). The sensitivity of compression elastography was therefore 58.3% and the specifity was 55.6%. Kappa coefficient was 0.115. CONCLUSION: Compression elastography does not seem to have any additional advantages in the detection and classification of endoleaks in comparison to CEUS.

Value of high resolution compression elastography and color doppler sonography in characterisation of breast lesions: comparison of different high-frequency transducers.

PURPOSE: To evaluate the additional effect of higher frequent linear probes than 12.5 MHz in color Doppler sonography and free hand sonoelastography of benign and malignant breast masses and to compare different color encodings in sonoelastography. MATERIALS AND METHODS: From December 2012 to March 2013, 37 patients with benign or malignant breast masses were prospectively included in this study. All solid masses have been histologically proven. Two readers assessed sonoelastographic findings at 12.5 MHz vs. 17 MHz according to the tsukuba elasticity score and additionally different color encodings were compared. Results of Doppler sonography using a score of 0, 1 or 2, depending on the degree of perfusion, also were assessed at 12.5 MHz vs. 17 MHz. RESULTS: Among the 37 examined breast masses there were 10 cysts, 16 fibroadenomas and 11 carcinomas. Median participant age was 49.0 years. Use of color Doppler sonography enabled to distinguish cysts from solid breast masses (p < 0.001), without an improvement at 17 MHz. Additional sonoelastography significantly improved the specificity in solid breast masses (p < 0.001). No changes could be seen using different colors in sonoelastography. CONCLUSION: Combination of color Doppler sonography and sonoelastography can increase the accuracy in distinguishing benign from malignant breast masses. The use of linear probes with a higher frequency than 12.5 MHz does not show any benefit, neither in color Doppler sonography nor in sonoelastography.

[Elastography as an additional tool in breast sonography. Technical principles and clinical applications]. / Elastographie als Zusatzmodalität der Mammasonographie. Technische Grundlagen und klinische Anwendungsmöglichkeiten.

In recent years the use of elastography in addition to sonography has become a routine clinical tool for the characterization of breast masses. Whereas free hand compression elastography results in qualitative imaging of tissue stiffness due to induced compression, shear wave elastography displays quantitative information of tissue displacement. Recent studies have investigated the use of elastography in addition to sonography and improvement of specificity in differentiating benign from malignant breast masses could be shown. Therefore, additional use of elastography could help to reduce the number of unnecessary biopsies in benign breast lesions especially in category IV lesions of the ultrasound breast imaging reporting data system (US-BI-RADS).