Contrast-enhanced ultrasound in oncology

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Abstract

In patients with known malignant disease, 51% of liver lesions less than 1.5 cm turn out to be benign. Whether the probability of malignancy is high or low, further investigations are often necessary to definitely exclude malignancy. Contrast-enhanced ultrasonography has a prominent role in lesion characterization with a diagnostic accuracy comparable with computed tomography and magnetic resonance imaging. Anti-angiogenic treatment is common in most oncological institutions and the response evaluation is a new challenge with a research focus on the change in tumour vasculature and perfusion. In planning biopsies, CEUS can identify necrotic and viable areas of tumours and improve the diagnostic accuracy.

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Most cited references 50

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Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) - update 2008.

L Thorelius, L Bolondi, F Piscaglia … (2008)

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Characterization of focal liver lesions with SonoVue-enhanced sonography: international multicenter-study in comparison to CT and MRI.

Pierre Valette, Valérie Vilgrain, Vlastimil Valek … (2009)

To evaluate in a multicenter study whether the sonographic characterization of focal liver lesions can be improved using SonoVue-enhancement; and to compare this method with computed tomography (CT) and magnetic resonance imaging (MRI). One hundred and thirty four patients with one focal liver lesion detected in baseline ultrasound (US) were examined with conventional US, contrast-enhanced US (n = 134), contrast-enhanced CT (n = 115) and/or dynamic contrast-enhanced MRI (n = 70). The lesions were classified as malignant, benign or indeterminate and the type of lesion was determined. The final diagnosis based on the combined information of all imaging examinations, clinical information and histology (n = 32) was used. Comparisons were made to see whether the addition of contrast-enhanced US led to the improvement of the characterization of doubtful focal liver lesions. In comparison with unenhanced US, SonoVue markedly improves sensitivity and specificity for the characterization (malignant/benign) of focal liver lesions. In comparison with CT and/or dynamic MRI, SonoVue-enhanced sonography applied for characterization of focal liver lesions was 30.2% more sensitive in the recognition of malignancy and 16.1% more specific in the exclusion of malignancy and overall 22.9% more accurate. In the subgroup with confirmative histology available (n = 30), sensitivity was 95.5% (CEUS), 72.2% (CT) and 81.8% (MRI), and specificity was 75.0% (CEUS), 37.5% (CT) and 42.9% (MRI). The sensitivity and specificity of CEUS for the identification of focal nodular hyperplasia (FNH) and hemangiomas was 100% and 87%, resulting in an accuracy of 94.5%. SonoVue-enhanced sonography emerges as the most sensitive, most specific and thus most accurate imaging modality for the characterization of focal liver lesions.

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Monitoring response to anticancer therapy by targeting microbubbles to tumor vasculature.

R Brekken, Stephen Fleming, J G Carbon … (2007)

New strategies to detect tumor angiogenesis and monitor response of tumor vasculature to therapy are needed. Contrast ultrasound imaging using microbubbles targeted to tumor endothelium offers a noninvasive method for monitoring and quantifying vascular effects of antitumor therapy. We investigated the use of targeted microbubbles to follow vascular response of therapy in a mouse model of pancreatic adenocarcinoma. Microbubbles conjugated to monoclonal antibodies were used to image and quantify vascular effects of two different antitumor therapies in s.c. and orthotopic pancreatic tumors in mice. Tumor-bearing mice were treated with anti-vascular endothelial growth factor (VEGF) monoclonal antibodies and/or gemcitabine, and the localization of microbubbles to endoglin (CD105), VEGF receptor 2 (VEGFR2), or VEGF-activated blood vessels (the VEGF-VEGFR complex) was monitored by contrast ultrasound. Targeted microbubbles showed significant enhancement of tumor vasculature when compared with untargeted or control IgG-targeted microbubbles. Video intensity from targeted microbubbles correlated with the level of expression of the target (CD105, VEGFR2, or the VEGF-VEGFR complex) and with microvessel density in tumors under antiangiogenic or cytotoxic therapy. We conclude that targeted microbubbles represent a novel and attractive tool for noninvasive, vascular-targeted molecular imaging of tumor angiogenesis and for monitoring vascular effects specific to antitumor therapy in vivo.

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Author and article information

Journal

Journal ID (nlm-ta): Cancer Imaging

Journal ID (publisher-id): CI

Journal ID (publisher-id): Cancer Imaging

Title: Cancer Imaging

Publisher: e-Med

ISSN (Print): 1740-5025

ISSN (Electronic): 1470-7330

Publication date Collection: 2011

Publication date (Electronic): 3 October 2011

Volume: 11

Issue: 1A

Pages: S167-S173

Affiliations

Department of Radiology, Aarhus University Hospital, Aarhus, Denmark

Author notes

Corresponding address: Dr Hans Henrik Torp Madsen, Department of Radiology, Aarhus University Hospital, Noerrebrogade 44, Aarhus C, DK-8000, Denmark. Email: hansmads@ 123456rm.dk

Article

Publisher ID: ci119042

DOI: 10.1102/1470-7330.2011.9042

PMC ID: 3266573

PubMed ID: 22186152

SO-VID: f032e347-691f-4aa4-9548-721df9e9f945

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