Ultrasound B-lines for detection of late lung fibrosis in breast cancer patients after radiation therapy.

BACKGROUND AND PURPOSE: Radiation therapy (RT) for breast cancer after conservative surgery can be life-saving but remains associated with significant late side effects, including lung fibrosis, detected by chest CT. Aim of this study was to assess whether lung ultrasound (LUS) may detect late lung fibrosis through the biomarker of B-lines. MATERIALS AND METHODS: We evaluated 30 women (median age 67 years, range 46-80 years) about 3-8 years after RT (follow up 38-101 months, median 58 months) for left (n = 12) or right (n = 18) breast cancer (stage 1, n = 24; stage 2, n = 6), treated with total dose 40.5 - 50.00 Gy with/without boost dose). In all, both treated and contralateral hemithorax were evaluated. LUS was performed and B-lines evaluated with a 28-region antero-lateral scan, from second to fifth intercostal spaces, along the mid-axillary, anterior axillary, mid-clavicular, and parasternal lines. In each space, the B-lines were counted from 0 = black lung to 10 = white lung. The sum of B-lines in all spaces generated the B-line score of each hemithorax. RESULTS: Median B-line score was higher in the irradiated site than in the contralateral control hemithorax (9, 1st-3rd quartiles: 2-23 vs 3, 1st-3rd quartiles: 1-4; P < 0.05). In the treated hemithorax, higher mean lung doses ( > median value of 2.7 Gy) were associated with more B-lines when compared to lower doses (< 2.7 Gy): 9 vs 5, p <0.001. CONCLUSION: RT in female breast cancer survivors is associated with increase in B-lines in the targeted hemithorax, likely due to lung fibrosis, and related to the lung mean dose. LUS can provide a simple "echo-marker" of lung fibrosis.

The Potential Role of Lung Ultrasound B-Lines for Detection of Lung Radio-Induced Toxicity in Breast Cancer Patients after Radiation Therapy.

BACKGROUND AND PURPOSE: Breast cancer patients exposed to doses of radiation after radiotherapy could develop toxicity to lung. Lung ultrasound (LUS) is able to detect interstitial lung disease by the evaluation of B-lines. The aim of our study was to assess the number of B-lines to diagnose lung involvement after chest radiotherapy. MATERIALS AND METHODS: We measured LUS B-lines in the treated and contralateral lung of 20 breast cancer patients, 1-3 months after the end of radiotherapy and 1 year after previous LUS. The sum of the B-lines number in the 72 sites on anterior and posterior chest yielded a global B-lines score. RESULTS: B-lines were more numerous in treated (median: 21; 1st-3rd quartiles: 11-31) versus untreated hemithorax (median: 3; 1st-3rd quartiles: 1-5) in both examination at T1-3 months (Kolmogorov-Smirnov test P < 0.001) and T1 year (median: 21; 1st-3rd quartiles: 12-28 vs. median: 4; 1st-3rd quartiles: 1-10; Kolmogorov-Smirnov test P < 0.01). Within the treated hemithorax, B-lines were more frequent in the anterior than in the posterior chest in both examination at T1-3 months (Kolmogorov-Smirnov test: P < 0.0001) and T1 year (Kolmogorov-Smirnov test: P < 0.01). Abnormal scores (B-lines>5) were present in 17/20 treated versus 7/20 untreated hemithoraxes (85.0 vs. 35.0%, P < 0.01) in the first LUS and likewise in 16/17 treated versus 7/17 in untreated hemithorax (94.1% vs. 41.2%, P < 0.01) after 1-year follow-up. CONCLUSION: Among women receiving radiotherapy after breast cancer, B-lines are present predominantly in the irradiated lung. These data suggest that B-lines by LUS could provide, at a subclinical stage, a radiation-free biomarker of radiotherapy-induced lung damage.

Contrast-enhanced ultrasound (CEUS) of lesions occupying renal space. Indications, limits, personal experience.

In focal kidney disease, contrast-enhanced ultrasound (CEUS) using 2nd generation contrast enhancement allows continuous dynamic assessment of the arterial, venous and late perfusion phases of the renal parenchyma, as well as of focal lesions. CEUS is particularly useful in cases of an uncertain diagnosis after the performance of unenhanced ultrasound (US) and echocolorDoppler (ECD) (e.g. dromedary humps, hypertrophic column of Bertin, outcomes of pyelonephritis), and for differential diagnosis of simple cysts with a suspicious appearance (e.g. cysts with a dense content, calcified cysts) and complex cysts of Bosniak types 2, 3 and 4. Instead, lesions shown to be solid at unenhanced US must be directly evaluated by computed tomography (CT) or magnetic resonance imaging (MRI), both to gain a panoramic view and because CEUS is often unable to reveal the precise nature of such lesions. In agreement with the literature, this experience (18 cases) confirms the utility of CEUS in the diagnosis of renal pseudolesions and complex cystic formations, reducing both the risk of radiation exposure and the use of the more costly CT and MRI methodologies.

US with contrast medium in the diagnosis of abdominal Castleman's disease.

Castleman's disease belongs to a heterogeneous group of rare lymphoproliferative disorders of uncertain cause. A literature review yielded 31 cases of Castleman's disease with an abdominal localization. Retroperitoneal, mesenteric and pelvic sites have been reported and the diagnosis was incidental in almost all cases and detected at US, CT scan or MRI and angiography. If the lymphadenopathy was less than 5 cm, centripetal, homogeneous contrast enhancement was apparent during CT scan or MRI, versus dyshomogeneous enhancement for a lymph node with a diameter above 5 cm. In our case, similar vascular behavior after administration of contrast medium was observed with ultrasound, CT scan or MRI. Further studies with ultrasound contrast media are needed to confirm this particular behavior in order to avoid the use of MRI and CT scans in cases of localized abdominal masses in the future.