RESUMEN
The feasibility of using subharmonic aided pressure estimation (SHAPE) to noninvasively estimate interstitial fluid pressure (IFP) was studied. In vitro, radiofrequency signals, from 0.2 ml/l of Definity (Lantheus Medical Imaging, N Billerica, MA) were acquired within a water-tank with a Sonix RP ultrasound scanner (Analogic Ultrasound, Richmond, BC, Canada; fT/R=6.7/3.35 MHz and fT/R=10/5 MHz) and the subharmonic amplitudes of the signals were compared over 0-50 mmHg. In vivo, five swine with naturally occurring melanomas were studied. Subharmonic signals were acquired from tumours and surrounding tissue during infusion of Definity and compared to needle-based pressure measurements. Both in vitro and in vivo, an inverse linear relationship between hydrostatic pressure and subharmonic amplitude was observed with r(2)=0.63-0.95; p<0.05, maximum amplitude drop 11.36 dB at 10 MHz and -8 dB, and r(2) as high as 0.97; p<0.02 (10 MHz and -4/-8 dB most promising), respectively, indicating that SHAPE may be useful in monitoring IFP.
Asunto(s)
Líquido Extracelular/diagnóstico por imagen , Melanoma/diagnóstico por imagen , Acústica , Animales , Medios de Contraste/administración & dosificación , Diseño de Equipo , Estudios de Factibilidad , Fluorocarburos/administración & dosificación , Presión Hidrostática , Fantasmas de Imagen , Porcinos , Transductores , Ultrasonografía/métodosRESUMEN
Incident acoustic output (IAO) dependent subharmonic signal amplitudes from ultrasound contrast agents can be categorized into occurrence, growth or saturation stages. Subharmonic aided pressure estimation (SHAPE) is a technique that utilizes growth stage subharmonic signal amplitudes for hydrostatic pressure estimation. In this study, we developed an automated IAO optimization algorithm to identify the IAO level eliciting growth stage subharmonic signals and also studied the effect of pulse length on SHAPE. This approach may help eliminate the problems of acquiring and analyzing the data offline at all IAO levels as was done in previous studies and thus, pave the way for real-time clinical pressure monitoring applications. The IAO optimization algorithm was implemented on a Logiq 9 (GE Healthcare, Milwaukee, WI) scanner interfaced with a computer. The optimization algorithm stepped the ultrasound scanner from 0% to 100% IAO. A logistic equation fitting function was applied with the criterion of minimum least squared error between the fitted subharmonic amplitudes and the measured subharmonic amplitudes as a function of the IAO levels and the optimum IAO level was chosen corresponding to the inflection point calculated from the fitted data. The efficacy of the optimum IAO level was investigated for in vivo SHAPE to monitor portal vein (PV) pressures in 5 canines and was compared with the performance of IAO levels, below and above the optimum IAO level, for 4, 8 and 16 transmit cycles. The canines received a continuous infusion of Sonazoid microbubbles (1.5 µl/kg/min; GE Healthcare, Oslo, Norway). PV pressures were obtained using a surgically introduced pressure catheter (Millar Instruments, Inc., Houston, TX) and were recorded before and after increasing PV pressures. The experiments showed that optimum IAO levels for SHAPE in the canines ranged from 6% to 40%. The best correlation between changes in PV pressures and in subharmonic amplitudes (r=-0.76; p=0.24), and between the absolute PV pressures and the subharmonic amplitudes (r=-0.89; p<0.01) were obtained for the optimized IAO and 4 transmit cycles. Only for the optimized IAO and 4 transmit cycles did the subharmonic amplitudes differ significantly (p<0.01) before and after increasing PV pressures. A new algorithm to identify optimum IAO levels for SHAPE has been developed and validated with the best results being obtained for 4 transmit cycles. The work presented in this study may pave the way for real-time clinical applications of estimating pressures using the subharmonic signals from ultrasound contrast agents.
Asunto(s)
Algoritmos , Determinación de la Presión Sanguínea/métodos , Medios de Contraste/química , Compuestos Férricos/química , Hierro/química , Óxidos/química , Presión Portal/fisiología , Vena Porta/diagnóstico por imagen , Ultrasonografía/métodos , Acústica , Animales , Perros , Aumento de la Imagen/métodosRESUMEN
OBJECTIVE: To demonstrate the feasibility of simultaneous dual fundamental grayscale and subharmonic imaging on a modified commercial scanner. MOTIVATION: The ability to generate signals at half the insonation frequency is exclusive to ultrasound contrast agents (UCA). Thus, subharmonic imaging (SHI; transmitting at f(0) and receiving at f(0)/2) provides improved visualization of UCA within the vasculature via suppression of the surrounding tissue echoes. While this capability has proven useful in a variety of clinical applications, the SHI suppression of surrounding tissue landmarks (which are needed for sonographic navigation) also limits it use as a primary imaging modality. In this paper we present results using a commercial ultrasound scanner modified to allow imaging in both grayscale (f(0)=4.0 MHz) and SHI (f(0)=2.5 MHz, f(0)/2=1.25 MHz) modes in real time. METHODS: A Logiq 9 ultrasound scanner (GE Healthcare, Milwaukee, WI) with a 4C curvilinear probe was modified to provide this capability. Four commercially available UCA (Definity, Lantheus Medical Imaging, North Billerica, MA; Optison, GE Healthcare, Princeton, NJ; SonoVue, Bracco Imaging, Milan, Italy; and Sonazoid, GE Healthcare, Oslo, Norway) were all investigated in vitro over an acoustic output range of 3.34 MPa. In vivo the subharmonic response of Sonazoid was investigated in the portal veins of four canines (open abdominal cavity) and four patients with suspected portal hypertension. RESULTS: In vitro, the four UCA showed an average maximum subharmonic amplitude of 44.1±5.4 dB above the noise floor with a maximum subharmonic amplitude of 48.6±1.6 dB provided by Sonazoid. The average in vivo maximum signal above the noise floor from Sonazoid was 20.8±2.3 dB in canines and 33.9±5.2 dB in humans. Subharmonic amplitude as a function of acoustic output in both groups matched the S-curve behavior of the agent observed in vitro. The dual grayscale imaging provided easier sonographic navigation, while the degree of tissue suppression in SHI mode varied greatly on a case by case basis. CONCLUSIONS: These results demonstrate the feasibility of dual grayscale and SHI on a modified commercial scanner. The ability to simultaneously visualize both imaging modes in real time should improve the applicability of SHI as a future primary clinical imaging modality.
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Medios de Contraste/farmacocinética , Hipertensión Portal/diagnóstico por imagen , Ultrasonografía/instrumentación , Albúminas/farmacocinética , Análisis de Varianza , Animales , Perros , Estudios de Factibilidad , Compuestos Férricos/farmacocinética , Fluorocarburos/farmacocinética , Humanos , Hierro/farmacocinética , Óxidos/farmacocinética , Fosfolípidos/farmacocinética , Proyectos Piloto , Hexafluoruro de Azufre/farmacocinéticaRESUMEN
In other imaging modalities three-dimensional (3D) data displays are well established; not so in ultrasound. Due to the real-time requirements of ultrasound the time available to compute 3D displays is limited, particularly when flow data is acquired with Doppler techniques. Consequently, it is only recently that improvements in computer processing power have resulted in useful vascular 3D ultrasound scans. Many manufacturers have now implemented free-hand 3D power Doppler capabilities on their scanners. However, to obtain flow signals from smaller vessels associated e.g., with tumor neovascularity, may very well require the introduction of a microbubble based ultrasound contrast agent into the blood stream. Given the up to 30 dB enhancement of Doppler signals produced by the contrast microbubbles quite spectacular vascular 3D images are feasible. Moreover, new contrast imaging techniques, such as harmonic imaging, have now permitted 3D vascular information to be acquired and displayed in grayscale with the associated improvement in resolution. In this paper we will review different aspects of contrast enhanced vascular 3D ultrasound imaging including implementation, contrast specific techniques and in vivo imaging.
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Vasos Sanguíneos/diagnóstico por imagen , Medios de Contraste , Ultrasonografía Doppler/métodos , Animales , Humanos , Aumento de la ImagenRESUMEN
The purpose of this study was to investigate if Sonazoid, a new ultrasound (US) contrast agent, can improve the delineation of areas with normal and decreased blood flow in the prostate. Sonazoid was administered in the dose range of 0.00625-0.0375 microL microbubbles/kg into five anaesthetised mongrel adult male dogs. Transrectal power Doppler imaging of the prostate was performed in 2-D and 3-D with a C9-5 end-fire probe, using an HDI 3000 scanner. An area of decreased blood flow was created by inducing tissue ablation with a CL60 laser system, to mimic an avascular lesion. A subjective assessment of the intraprostatic vessels and the prostate vascular architecture was performed, with and without Sonazoid, before and after inducing the abnormal site. Visibility of the prostate blood flow improved following Sonazoid injection (p < 0.001). A symmetric, radial vascular pattern was identified in the normal prostate prior to tissue ablation, but only on the enhanced images. After tissue ablation, a disturbance of the normal vascular pattern and identification of areas with lack of blood flow was possible, following Sonazoid injection. Furthermore, the location and size of these areas were verified in all dogs by gross histology examination. Sonazoid enhances the visibility of the prostate vascular architecture and improves, thereby the delineation of areas with normal and decreased blood flow.
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Medios de Contraste , Compuestos Férricos , Hierro , Óxidos , Próstata/irrigación sanguínea , Ultrasonografía Doppler , Animales , Vasos Sanguíneos/diagnóstico por imagen , Perros , Masculino , Próstata/diagnóstico por imagen , Flujo Sanguíneo RegionalRESUMEN
OBJECTIVE: To assess the feasibility and usefulness of contrast-enhanced sonography for tumor detection and guidance of liver VX2 tumor ablation and to evaluate post radiofrequency ablation effectiveness. METHODS: VX2 tumors were implanted into the livers of 6 rabbits. Both conventional and harmonic gray scale and power Doppler imaging were performed with a commercially available scanner to evaluate the liver tumors before and after intravenous injection of a sonographic contrast agent before and after radiofrequency ablation. Contrast-enhanced imaging was used to detect the tumors before ablation, to guide needle insertion, and to measure the ablation sites after radiofrequency ablation. Pathologic examination was performed for comparison. RESULTS: Three tumors were seen without contrast enhancement, whereas 10 tumors (<1 cm) were detected with contrast enhancement. Intentionally, 2 tumors were completely ablated and 5 tumors were partially ablated. In 3 cases, incompletely ablated tumors could only be identified on contrast-enhanced Doppler imaging by enhancing the detection of residual tumor vascularity. There was excellent concordance between sonographic imaging and gross pathologic findings. CONCLUSIONS: Contrast-enhanced sonographic imaging appears useful for detection of liver tumors and for guiding and monitoring tumor ablation therapies.
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Ablación por Catéter , Aumento de la Imagen , Neoplasias Hepáticas Experimentales/diagnóstico por imagen , Neoplasias Hepáticas Experimentales/cirugía , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/cirugía , Ultrasonografía Doppler/métodos , Animales , Medios de Contraste , Estudios de Factibilidad , ConejosRESUMEN
This study evaluates a new reticuloendothelium specific sonographic contrast agent NC100100 (Sonazoid) for detection of liver VX-2 tumors in rabbits. Gray scale imaging of five groups of three rabbits, with hepatic VX-2 tumors implanted 7, 10, 12, 14, and 18 days previously, was performed prior to injection of Sonazoid (dosages, 0.01-0.5 ml/kg). Sonazoid produces induced acoustic emission after uptake in the liver. Therefore, harmonic gray scale images were obtained immediately after injection as well as delayed (by up to 2(1/2) h). Five rabbits (one from each group) also had angiography performed, while all animals were evaluated by pathologic examination. Non-contrast enhanced sonography detected 17 of 61 tumors (29%), as well as three false-positives, while the addition of Sonazoid detected 57 tumors (93%) and one false-positive (P<0.001). Acoustic emission made 2 x 2 mm tumors (invisible in conventional B-mode sonography) clearly perceivable in harmonic gray scale. In the subgroup that received angiography, 12 of 36 tumors (33%) were detected with conventional sonography compared to 22 tumors (61%) seen with angiography (P = 0.002). After injection of Sonazoid the ultrasonographic detection rate increased to 97% (35 of 36 tumors), which was a significant improvement over angiography (P = 0.00024). Improved detection of hepatic VX-2 tumors with second harmonic gray scale imaging of Sonazoid is possible because of this agent's acoustic emission capabilities.
Asunto(s)
Medios de Contraste , Compuestos Férricos , Aumento de la Imagen , Hierro , Neoplasias Hepáticas Experimentales/diagnóstico por imagen , Óxidos , Animales , Hígado/diagnóstico por imagen , Sistema Mononuclear Fagocítico/diagnóstico por imagen , Trasplante de Neoplasias , Conejos , Sensibilidad y Especificidad , Células Tumorales Cultivadas , UltrasonografíaRESUMEN
RATIONALE AND OBJECTIVES: To evaluate the sonographic appearance of normal prostate vascularity in dogs before and after injection of a new ultrasound contrast agent, NC100100. METHODS: Thirty-five intravenous injections of NC100100, in doses ranging from 0.00625 to 0.05 microL microbubbles/kg, were administered to seven anesthetized mongrel male dogs. Transrectal color Doppler imaging and power Doppler imaging were used to perform the assessment. The visibility of the vascular pattern of the prostate was assessed, including dynamics of contrast inflow, blood flow symmetry, and duration times. RESULTS: Before contrast administration, the vascular pattern was poorly visualized in all cases. After contrast injection, the visibility of the vascular architecture improved significantly for both modalities. Independent of the imaging method used, higher doses tended to be more effective than lower doses. Contrast kinetics in the prostate vessels was demonstrated with a mean time from injection of the ultrasound contrast agent to enhancement of the Doppler signals in the subcapsular arteries (+/-1 SD) of 13+/-3 seconds, and the ultrasound contrast agent reached the central periurethral veins 3 to 6 seconds later. A spokelike radial pattern of internal prostatic vessels observed with enhanced ultrasound could also be seen on silicone microfil x-ray images. The Doppler enhancement persisted for a mean time ( +/-1 SD) of 904 seconds (approximately 15 minutes) +/- 225 seconds and tended to increase with increasing dose. CONCLUSIONS: NC100100 significantly improves the detection of blood flow in the normal canine prostate and allows more accurate depiction of the vascular architecture of the prostate.
Asunto(s)
Compuestos Férricos , Hierro , Óxidos , Próstata/irrigación sanguínea , Próstata/diagnóstico por imagen , Animales , Medios de Contraste , Perros , Masculino , Flujo Sanguíneo Regional , Ultrasonografía Doppler en ColorRESUMEN
OBJECTIVE: Serial Doppler ultrasonography and long-term neurodevelopmental follow-up outcomes were evaluated prospectively in neonates whose right common carotid artery (RCCA) was reconstructed after extracorporeal membrane oxygenation (ECMO). METHODS: Children with RCCA reconstruction (n = 34) were monitored for 3.5 to 4.5 years by Doppler ultrasonography for arterial patency, and 28 had IQ testing by 5 years. A comparison group consisted of 35 infants who had RCCA ligation after ECMO. Neonatal electroencephalograms and computed tomography/magnetic resonance imaging scans were also compared. RESULTS: Reconstructions were successful (<50% RCCA stenosis by Doppler ultrasonography) in 26 (76%) of 34 children, 3 (9%) had >/=50% stenosis, and 5 (15%) had occlusion. No significant differences were seen between reconstructed and ligated groups in neonatal complications or ECMO courses. Occurrence of marked neonatal electroencephalographic abnormalities did not differ between groups. Abnormalities on computed tomography/magnetic resonance imaging scans (4 of 31 vs 11 of 29, P =.025) and cerebral palsy (0 of 34 vs 5 of 35, P =.054) were more common in infants with RCCA ligation. No differences were seen in developmental or IQ scores between the 2 groups, and 4 in each group had cognitive handicaps (at least 1 IQ score <70). CONCLUSIONS: Most RCCA reconstructions remained patent, with 24% showing significant stenosis or occlusion. Compared with a historical control group, patients with RCCA reconstruction had fewer brain scan abnormalities and tended to be less likely to have cerebral palsy. RCCA reconstruction after venoarterial ECMO may improve outcome.
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Arteria Carótida Común/cirugía , Oxigenación por Membrana Extracorpórea , Peso al Nacer , Arteria Carótida Común/diagnóstico por imagen , Electroencefalografía , Estudios de Seguimiento , Edad Gestacional , Humanos , Recién Nacido , Pruebas de Inteligencia , Ligadura , Imagen por Resonancia Magnética , Resultado del Tratamiento , Ultrasonografía , Grado de Desobstrucción VascularRESUMEN
PURPOSE: To evaluate the recently developed ultrasonographic (US) contrast agent SHU 563A, which is specifically taken up by the reticuloendothelial system (RES). MATERIALS AND METHODS: Color Doppler imaging (CDI) was performed in a gel phantom, with SHU 563A microbubbles in stationary suspension. CDI was performed in vivo in five woodchucks with natural hepatomas and in 12 rabbits before and after intravenous bolus injections of SHU 563A (0.16-0.48 mL/kg). After a 15-135-minute delay, the liver and spleen were scanned again, and the image findings were compared with pathologic analysis results. RESULTS: Phantom CDI demonstrated a random mosaic color pattern in spite of the lack of flow. This phenomenon, which is associated with bubble rupture, is termed induced acoustic emission. In vivo, delayed imaging demonstrated acoustic emission signals in normal parenchyma, whereas no mosaic color was seen in regions lacking reticuloendothelial cells (e.g., tumors). Four of 12 VX-2 tumors detected with pathologic analysis were detected with US alone; the remaining eight tumors were detected by using US with contrast agent (100%, P = .0078). Nine of 20 hepatomas were detected at baseline US, whereas 17 were detected after administration of SHU 563A (P = .0215). Acoustic emission enabled detection of hepatic tumors as small as 3 mm in diameter. CONCLUSION: CDI with SHU 563A demonstrates a random mosaic color pattern, even without flow. The characteristic appearance of acoustic emission signals provides a distinctive method of visualizing normal hepatic tissues and substantially improves the detectability of hepatic tumors.
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Medios de Contraste , Enbucrilato , Hígado/diagnóstico por imagen , Bazo/diagnóstico por imagen , Ultrasonografía Doppler en Color , Animales , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/veterinaria , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/veterinaria , Neoplasias Hepáticas Experimentales/diagnóstico por imagen , Marmota , Fantasmas de Imagen , Polímeros , Conejos , Sensibilidad y EspecificidadRESUMEN
Hypobaric activation is a new injection technique for use with the contrast agent EchoGen and, in this study, the agent's ability to produce parenchymal enhancement in vivo, with and without prior hypobaric activation, was investigated. Injections, ranging in dose from 0.05 to 0.5 mL/kg, were administrated through a peripheral vein to eight woodchucks with multiple hepatomas. At the 0.10 mL/kg dose level, seven of eight injections following hypobaric activation (88%) resulted in definite parenchymal enhancement. Conversely, dosages of 0.10 mL/kg without prior hypobaric activation produced no grey-scale changes. Only at the 0.4 and 0.5 mL/kg dosage level did the conventional administration technique obtain similar results (4 of 5 injections increased the echogenicity for a 0.4 mL/kg dose). These differences were statistically significant (p = 0.031). In vitro experiments were conducted to establish the physical mechanisms behind hypobaric activation. Relative measurements of contrast microbubble sizes were performed with a phase Doppler particle analyzer after hypobaric and after conventional (bolus) activation. Hypobaric activation produced approximately 20 times more microbubbles per unit volume than the conventional method. In conclusion, this investigation has demonstrated the benefits of prior hypobaric activation when performing in vivo contrast studies with EchoGen and determined the physical mechanisms behind this new injection technique. Hypobaric activation of EchoGen increases contrast enhancement and reduces dose size.
Asunto(s)
Carcinoma Hepatocelular/diagnóstico por imagen , Medios de Contraste , Fluorocarburos , Neoplasias Hepáticas/diagnóstico por imagen , Animales , Presión Atmosférica , Carcinoma Hepatocelular/veterinaria , Fluorocarburos/administración & dosificación , Inyecciones Intravenosas , Neoplasias Hepáticas/veterinaria , Marmota , Distribución Aleatoria , Ultrasonografía DopplerRESUMEN
The purpose of this study was to determine the feasibility and usefulness of using an ultrasonographic contrast agent to enhance the sonographic detection of bleeding sites in a canine model. SH U 563, an ultrasound contrast agent that elicits acoustic emission (i.e., random transient Doppler shifts produced by contrast particle rupture) even when stationary, was used. Acoustic emission is identified as a mosaic pattern on color Doppler imaging. A total of 13 active bleeding sites were created within intraabdominal organs (kidney and spleen, n = 3), the urinary tract (n = 3), and the gastrointestinal tract (n = 7) in three canine models. Gray scale and color Doppler imaging studies were performed prior to and after each of 13 individual intravenous contrast agent administrations. Imaging results were compared to gross pathologic findings. After contrast agent administration, pooling of contrast medium-containing blood in the regions adjacent to bleeding sites could be detected with color Doppler imaging as regions with the characteristic acoustic emission color display. After injection gray scale imaging failed to demonstrate the location or extent of hemorrhaging adequately. A linear relationship existed between the blood loss due to gastrointestinal tract bleeding and the amount of acoustic emission detected (r2 = 0.81). SH U 563 combined with color Doppler imaging improves the detection of bleeding sites in a variety of locations throughout the body.
Asunto(s)
Medios de Contraste , Hemorragia/diagnóstico por imagen , Aumento de la Imagen , Ultrasonografía Doppler en Color , Animales , Modelos Animales de Enfermedad , Perros , Estudios de Factibilidad , Femenino , Hemorragia Gastrointestinal/diagnóstico por imagen , Polímeros , Enfermedades Urológicas/diagnóstico por imagenRESUMEN
Within the last decade safe and practical ultrasound contrast agents have been introduced. Most of these are based on gas-filled microbubbles, which markedly enhance Doppler signals and, in some cases, also gray-scale images. The clinical improvements expected from ultrasound contrast is reviewed. Tissue-specific contrast agents constitute another area of potential clinical significance. One particular agent is taken up by the reticulo-endothelial system and produces so-called acoustic emission signals when imaged. An introduction to the unique clinical applications of acoustic emission is given. Harmonic imaging is a new contrast-specific imaging modality, which utilizes the nonlinear properties of some agents in an attempt to alleviate current limitations of ultrasound contrast studies. Examples of harmonic images are presented.
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Medios de Contraste , Ultrasonografía , Acústica , Vasos Sanguíneos/diagnóstico por imagen , Medios de Contraste/química , Medios de Contraste/farmacocinética , Diseño de Fármacos , Ecocardiografía , Gases , Humanos , Aumento de la Imagen , Sistema Mononuclear Fagocítico/diagnóstico por imagen , Sistema Mononuclear Fagocítico/metabolismo , Ultrasonografía DopplerRESUMEN
PURPOSE: To quantify the effect of distal resistance on arterial flow patterns. MATERIALS AND METHODS: Spectral Doppler tracings were obtained from the suprarenal aorta, infrarenal aorta, and proximal renal arteries of 10 volunteers and from the common, internal, and external carotid arteries (CCA, ICA, and ECA, respectively) of 31 volunteers. Early systolic acceleration (ESA), peak systolic velocity (PSV), end diastolic velocity (EDV), and waveform morphology were evaluated. An in vitro flow model of a compliant vessel in a branched pattern was created to simulate the renal and carotid circulations. RESULTS: ESA and PSV were significantly lower in the renal artery than in the suprarenal aorta (P < .01). ESA decreased significantly from the CCA to the ICA (P < .001) but only minimally from the CCA to the ECA (P > .20). EDV increased slightly from the CCA to the ICA but decreased substantially in the ECA. As distal resistance was increased in the in vitro model, ESA was more rapid, systole was shortened, EDV was decreased, and PSV was increased. CONCLUSION: As blood flows into the low-resistance renal artery or ICA, antegrade flow is shifted into the latter portion of the cardiac cycle, resulting in apparent prolongation of systole and forward flow throughout diastole. As blood flows into the higher-resistance ECA, diastolic flow is diminished. The in vitro model reproduces these Doppler flow patterns by means of manipulation of distal resistance.
Asunto(s)
Aorta Abdominal/diagnóstico por imagen , Arterias Carótidas/diagnóstico por imagen , Arteria Renal/diagnóstico por imagen , Ultrasonografía Doppler , Ultrasonografía Intervencional , Adulto , Velocidad del Flujo Sanguíneo , Femenino , Humanos , Masculino , Modelos Cardiovasculares , Flujo Pulsátil , Resistencia VascularRESUMEN
The objective of this study was to demonstrate the feasibility of endoluminal ultrasonography as an adjunct to endoscopy for the evaluation of urothelial neoplasms. An endoluminal ultrasound system using a 12.5 or 20 MHz transducer housed in a 6.2 French catheter was used intraureterally in 38 patients being evaluated endoscopically for suspected tumors in the renal pelvis or ureter. The ultrasonographic, endoscopic, and pathologic findings were evaluated. The location, size, and sonographic characteristics of the tumors in the upper urinary tract were well demonstrated. The information obtained by this technique can be used to guide endoscopic biopsy and laser ablation of the tumor. Endoluminal ultrasonography also has proved helpful in defining the location of a tumor relative to an adjacent vessel and in identifying crossing vessels that cause extrinsic filling defects in the ureter. In a few pathologically correlated cases, endoluminal ultrasonography was accurate in assessing invasion. We have evaluated successfully a variety of non-neoplastic filling defects in relatively few cases. Determination of the eventual usefulness of this technique awaits greater clinical experience and large clinical trials.
Asunto(s)
Carcinoma de Células Transicionales/diagnóstico por imagen , Endosonografía , Neoplasias Renales/diagnóstico por imagen , Pelvis Renal , Neoplasias Ureterales/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/diagnóstico por imagen , Carcinoma de Células Renales/patología , Carcinoma de Células Transicionales/patología , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasias Ureterales/patologíaRESUMEN
OBJECTIVE: The value of sonographic guidance during video-assisted thoracoscopic surgery (VATS) was studied in 13 patients with one or more peripheral pulmonary nodules who later underwent wedge resection. SUBJECTS AND METHODS: After a review of the chest radiographs and CT scans of each patient, sonographic guidance for VATS was requested by the attending surgeon when the nodule or nodules in question were determined to be too small or too deep in the lung parenchyma from the pleural surface for location by VATS. A multifrequency (5.0-, 6.5-, or 7.5-MHz) sonographic probe was introduced through a thoracoscopic port during VATS. The nodule or nodules in question were located by intraoperative sonography or determined by inspection and confirmed by sonography before wedge resection. The size and location of each lesion and the time needed for sonographic guidance were recorded. RESULTS: Sonography revealed a peripheral pulmonary nodule in 12 of the 13 patients. Of these, it confirmed the suspected location of the pulmonary nodule in six. In the remaining six patients, the surgeon was unable to locate the nodule without the use of sonography. The additional operative time required for sonographic guidance during VATS averaged 7.5 min. However, the time commitment of radiology personnel during surgery varied and was sometimes lengthy (maximum, 150 min). CONCLUSION: Sonographic guidance during thoracoscopy helped to locate lesions and determine their size and proximity to pleural surfaces. Sonographic guidance can be done safely and can be completed expeditiously. Unlike percutaneous hookwire techniques, sonographic guidance does not require an additional invasive procedure to locate the peripheral pulmonary nodule.
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Endoscopía , Enfermedades Pulmonares/cirugía , Toracoscopía , Ultrasonografía Intervencional , Anciano , Femenino , Humanos , Enfermedades Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Nódulo Pulmonar Solitario/diagnóstico por imagen , Nódulo Pulmonar Solitario/cirugíaRESUMEN
OBJECTIVE: The objective of this investigation was to determine if high-frequency jet ventilation (HFJV) used early in the treatment of premature infants with respiratory distress syndrome was effective in reducing pulmonary morbidity without increasing the occurrence of adverse neurologic outcomes. STUDY DESIGN: A total of 73 premature infants who met the inclusion criteria (gestational age of less than 33 weeks, birth weight of more than 500 g, age of less than 24 hours, need for assisted ventilation with peak inspiratory pressure of more than 16 and FIO2 more than 0.30, and roentgenographic evidence of respiratory distress syndrome) were randomized to either conventional (n = 36) or to high-frequency jet (n = 37) ventilation. Our goals were to maintain the infants on the assigned ventilator for at least 7 days unless they could either be extubated or meet crossover criteria. Univariate analyses were initially used to compare the two groups. Stepwise logistic regression was subsequently used to assess whether various factors independently influenced adverse outcomes. RESULTS: The two groups of infants were similar in all obstetrical, perinatal, and neonatal demographic characteristics. The mean birth weight and gestational age in the conventional group were 930 g and 26.6 weeks and in the HFJV group, 961 g and 26.9 weeks. The infants were randomized at similar ages (7.1 and 7.3 hours of life, respectively). Their prerandomization ventilator settings and arterial blood gases were nearly identical. There were no differences in pulmonary outcomes (occurrence of air leaks, need for oxygen or ventilation at 36 weeks postconception), and there were no differences in the mean number of days oxygen was required, number of days ventilated, or length of hospital stay. Infants ventilated with HFJV were significantly more likely to develop cystic periventricular leukomalacia (10 vs 2, P = .022) or to have a poor outcome (grade IV hemorrhage, cystic periventricular leukomalacia, or death) (17 vs 7, P = .016). Logistic regression analysis revealed HFJV to be a significant independent predictor of both cystic periventricular leukomalacia and a poor outcome. The presence of hypocarbia was not an independently significant predictor of adverse outcomes. CONCLUSIONS: With the HFJV treatment strategy that we used, use of the high-frequency jet ventilator in the early management of premature infants with respiratory distress syndrome resulted in significantly more adverse outcomes than in those treated with conventional mechanical ventilation.
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Ventilación de Alta Frecuencia/efectos adversos , Recien Nacido Prematuro , Leucomalacia Periventricular/etiología , Evaluación de Resultado en la Atención de Salud , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Presión Sanguínea , Hemorragia Cerebral/etiología , Femenino , Edad Gestacional , Humanos , Recién Nacido , Masculino , Respiración con Presión Positiva , Estudios Prospectivos , Intercambio Gaseoso Pulmonar , Respiración Artificial , RiesgoRESUMEN
Harmonic imaging is a new contrast-specific imaging modality, which utilizes the nonlinear properties of microbubble-based sonographic contrast agents by transmitting at the fundamental frequency but receiving at the second harmonic frequency. The feasibility of improving the detection of slow, small-volume blood flow using real-time harmonic imaging has been investigated in vivo. Proteinaceous microspheres (FS069) were administrated to four dogs, two woodchucks (with multiple hepatomas), and one rabbit. Three different scanners were used to obtain real-time images of kidneys and liver (including vessels) in harmonic and conventional gray scale and color flow modes. The duration of contrast enhancement lasted significantly longer in harmonic than in conventional modes (on average 87 s; P = 0.008). Harmonic images were less susceptible to artifacts, such as acoustic shadowing, and a clear increase in the (flow) signal-to-noise ratio was observed. These preliminary in vivo results demonstrate the feasibility of performing real-time, contrast-enhanced harmonic imaging, but further studies are required to establish clinical efficacy.
Asunto(s)
Medios de Contraste , Aumento de la Imagen/métodos , Animales , Carcinoma Hepatocelular/diagnóstico por imagen , Perros , Estudios de Factibilidad , Riñón/diagnóstico por imagen , Hígado/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Marmota , Microesferas , Conejos , UltrasonografíaRESUMEN
BACKGROUND AND OBJECTIVE: Previous data from our institution indicate that mechanically ventilated premature infants are at increased risk for cystic periventricular leukomalacia (CPVL), particularly if hypocapnia occurs. High-frequency jet ventilation (HFJV) may produce substantial hypocapnia. We sought to investigate whether hypocapnia during HFJV is associated with the development of CPVL. METHODS: Sixty-seven premature infants (mean gestational age, 27.2 weeks; mean birth weight, 1001 g) underwent HFJV for a mean of 44 (range, 8 to 70) hours during the first 3 days of life. All infants were followed with serial neurosonograms at least weekly until 6 to 8 weeks of age and every 2 to 4 weeks thereafter until discharge. To assess the cumulative effects of hypotension, acidosis, hypoxemia, and hypocarbia during the first 3 days of life on the development of PVL, we developed a quantitative assessment in which we assigned threshold levels at particular critical values of these parameters (such as a mean PaCO2 of 20 mm Hg) and calculated an area above the curve between longitudinally connected values of these parameters and the threshold levels. RESULTS: Nine of the 67 infants died before 21 days of life. Of the 58 who survived beyond 21 days, large CPVL (> 5 mm in size) developed in 18 infants. Infants with cysts were similar in birth weight, gestational age, and virtually all other antepartum, intrapartum, and postpartum parameters compared with the 40 neonates in whom CPVL did not develop. However, infants with CPVL were significantly more likely to have moderate or severe periventricular echodensities preceding development of CPVL and periventricular echodensities that persisted for a longer period. We did not find an effect of hypotension, acidosis, or hypoxemia on the development of CPVL. There were no differences in the mean PaCO2, the absolute low PaCO2 values, the ranges of low PaCO2 between groups, or area above the curve measurements at threshold levels of 15 and 20 mm Hg, respectively. However, logistic regression analysis revealed that infants with CPVL were independently significantly more likely to have greater cumulative hypocarbia below a threshold level of 25 mm Hg during the first day of life (odds ratio, 5.43; 95% confidence interval, 1.33 to 22.2). CONCLUSIONS: Hypocarbia produced by treatment with HFJV during the first 3 days of life is associated with the subsequent development of CPVL. The mechanisms for the development of CPVL among premature infants treated with HFJV need to be established.
Asunto(s)
Ventilación con Chorro de Alta Frecuencia/efectos adversos , Hipocapnia/complicaciones , Enfermedades del Prematuro/etiología , Leucomalacia Periventricular/etiología , Dióxido de Carbono/análisis , Ecoencefalografía , Humanos , Recién Nacido , Enfermedades del Prematuro/diagnóstico por imagen , Leucomalacia Periventricular/diagnóstico por imagenRESUMEN
Interferon (IFN) upregulates tumor antigenic expression and enhances tumor uptake of radiolabeled tumor-specific monoclonal antibody (MAb). IFN also increases tumor blood flow. The relationship between these phenomena was investigated. Human melanoma tumors grown in nude mice were used as the experimental tumor model, and 99mTc-MEM136 as an MAb. Tumor blood flow was monitored by ultrasound Color Doppler Imaging (CDI) and Laser Doppler Flowmetry (LDF) techniques. Tumor blood flow increased at 20 min after administration of IFN. Enhancement lasted for about 60 min before the blood flow returned to the original baseline level. Tissue distribution of 99mTc-MEM136 was studied under different experimental schemes. Tumor uptake of 99mTc-MEM136 enhanced significantly only in experimental scheme A (5.5 +/- 0.2% ID/g vs. 3.0 +/- 0.9% ID/g in control group, p = 0.04). In this scheme IFN was given 30 min prior to the administration of 99mTc-MEM136, and the animals were sacrificed 1.5 h later. No upregulation of anti-genic expression was reported at this time. The increased tumor uptake at this early period appeared to be the result of enhanced tumor blood flow.