Guide Contrast-enhanced ultrasound in clinical practice: liver, prostate, pancreas, kidney and lymph nodes

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Contrast Enhanced Ultrasound of Liver Diseases

Klerkx, W. Longitudinal 3. J Magn Reson Imaging. Download references. All authors reviewed the manuscript for important intellectual content and approved its final version prior to submission. Correspondence to Johannes Linxweiler. Publisher's note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Transabdominal Contrast-Enhanced Ultrasonography of Pancreatic Cancer

If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. The meta-regression analysis was performed to explore the potential sources of heterogeneity. Table 3 shows the relationship between the characteristics of studies and the diagnostic OR. These data suggested that there was no relationship between the characteristics of studies and the diagnostic OR.

The forest plots Figures 3 — 7 showed that the studies by Zenk et al 27 and Moritz et al 32 were outliers. Therefore, subgroup analysis excluding outliers was performed, which implied that the heterogeneities were almost eliminated in pooled estimates Table 4. Table 3 Meta-regression analysis of the possible sources of heterogeneity. The histological status of LNs is a very powerful prognostic indicator for patients with carcinoma and lymphoma.

US has proven to be a valuable technique for evaluating superficial LNs. However, imaging alone is not accurate enough to guide clinical staging and treatment decisions for patients with carcinoma and lymphoma. In this context, CEUS is a simple approach which can allow evaluation of tissue perfusion in real time and extends US examination by a few minutes. This tool has also been shown to be very useful in the differential diagnosis of lymphadenopathy. Therefore, we performed meta-regression analysis to find the potential source of heterogeneity among the studies.

Our results revealed that there was no relationship between the characteristics of studies and the diagnostic OR. The forest plots Figures 2 — 5 showed that the studies by Zenk et al 27 and Moritz et al 32 were outliers. Therefore, subgroup analysis excluding outliers was performed, which revealed that the heterogeneities were almost eliminated in pooled estimates Table 4. Contrast harmonic-enhanced US imaging is a relatively new technique that can detect the microcirculation and parenchymal perfusion of lesions with a very low mechanical index, thus allowing minimum bubble destruction and a prolonged time of microvascularization assessment.

Over recent years, contrast harmonic-enhanced US has been most commonly used for diagnosis of LNs. The enhanced microvascular pattern is a visualized diagnostic standard. Generally, malignant LNs are inhomogeneous, with early impregnation, perfusion defects, peripheral perfusion, or mixed patterns with heterogenic hyperperfusion. These characteristics of microvascular pattern seem to be reliable features of malignant LNs. Although the objective CEUS parameters concerning the kinetics of contrast agent are significant, their predictive ability is not yet reliable enough for routine clinical use.

In addition, Scheipers et al have reported that the computer-guided self-learning analysis systems may help to identify investigator-independent classification characteristics. Consequently, further random, blinded, and multicenter studies should be performed to confirm the optimal CEUS parameters and cutoffs to differentiate malignant LNs from benign LNs before this approach can be applicable in practice. Perfusion software with higher accuracy should be developed to optimize measurement of functional parameters and to improve the accuracy of CEUS in diagnosing superficial metastatic LNs.

Patients with lymphoma, which have a more variable CEUS appearance, are regarded as a special group because the microvascular pattern of lymphoma partially overlaps with reactive and metastatic LNs. Additionally, since there are very few published studies that are in general based on a very limited sample, the CEUS microvascular pattern for lymphomatous nodes still remains controversial.

Therefore, further random, blinded, large sample, and multicenter studies are required to assess the CEUS pattern of lymphoma and to assess the ultimate benefit of CEUS in diagnosing patients with lymphoma before this approach can be applied in practice. The present study has some limitations. Firstly, various diagnostic standards for CEUS were used in the selected studies, as well as different study designs, contrast agents, and contrast modes. Accordingly, it is very plausible that many variations in characteristics of these studies may lead to the heterogeneity. Secondly, we did not include articles written in other languages besides English.

Thirdly, some studies were also excluded because of insufficient data; although we tried to contact the authors to obtain additional data, unfortunately the data were still not sufficient. CEUS, as a novel imaging modality for the characterization of superficial LNs, showed a high sensitivity and specificity in diagnosing superficial metastatic LNs. The different diagnostic standards, contrast agents, and contrast modes contributed to a considerable level of heterogeneity among the studies.

A uniform standard for distinguishing benign from metastatic LNs is needed for further clinical application. Contrast-enhanced ultrasonography compared to gray-scale and power doppler in the diagnosis of peripheral lymphadenopathy. Eur J Radiol. Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US. Detection of cervical lymph node metastasis in head and neck cancer patients with clinically N0 neck-a meta-analysis comparing different imaging modalities. BMC Cancer.

Sonographic appearances of cervical lymph nodes: variations by age and sex.

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Prostate cancer: contrast-enhanced us for detection. J Radiol. Contrast-enhanced endoscopic ultrasonography in digestive diseases. J Gastroenterol. Validation of a technique using microbubbles and contrast enhanced ultrasound CEUS to biopsy sentinel lymph nodes SLN in pre-operative breast cancer patients with a normal grey-scale axillary ultrasound. Eur J Surg Oncol.

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