HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Albrecht, T. Articles by Wolf, K.-J. Search for Related Content PubMed PubMed Citation Articles by Albrecht, T. Articles by Wolf, K.-J. Social Bookmarking                      What's this?

Phase-Inversion Sonography During the Liver-Specific Late Phase of Contrast Enhancement

Improved Detection of Liver Metastases

¹ Department of Radiology and Nuclear Medicine, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Hindenburgdamm 30, D-12200 Berlin, Germany.
² Department of Surgery, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, D-12200 Berlin, Germany.

View larger version (14K): [in a new window]   Fig. 1. —Drawing shows principle of phase-inversion sonography. Two pulses that are 180° out of phase are sent immediately back-to-back, and returned signals are summed to form one sonographic frame. In case of exclusively linear scattering without distortion, this summation produces a signal void. Nonlinear response from microbubbles, including harmonic resonance and stimulated acoustic emission (SAE), distorts returned signals, and thus summation of two pulses no longer results in signal void. Resulting signal is particularly strong in presence of bubble destruction and SAE because destroyed bubble can no longer produce a response to second pulse, so that strong signal from first pulse is used without any subtraction from second pulse.

View larger version (165K): [in a new window]   Fig. 2A. —60-year-old man with carcinoma of colon and histologically proven hepatic metastases. Unenhanced baseline sonogram shows two near-isoechoic metastases (arrowheads). Note slightly hypoechoic halo.

View larger version (155K): [in a new window]   Fig. 2B. —60-year-old man with carcinoma of colon and histologically proven hepatic metastases. Phase-inversion sonogram shows enhancement of normal liver parenchyma. Note metastases (arrowheads) showing as defined hypoechoic enhancement defects. Also note residual blood-pool contrast effect (arrow) in portal vein.

View larger version (164K): [in a new window]   Fig. 3A. —72-year-old woman with bronchogenic carcinoma and hepatic metastases. Unenhanced baseline sonogram shows slightly heterogeneous liver parenchyma but no focal lesion in right lobe of liver. Three lesions were seen in left lobe (not shown).

View larger version (165K): [in a new window]   Fig. 3B. —72-year-old woman with bronchogenic carcinoma and hepatic metastases. Phase-inversion sonograms reveal multiple confirmed metastases (arrows) measuring 5-8 mm in right lobe. Note band of accentuated enhancement at and slightly proximal to focal zone position. RK = right kidney.

View larger version (146K): [in a new window]   Fig. 3C. —72-year-old woman with bronchogenic carcinoma and hepatic metastases. Phase-inversion sonograms reveal multiple confirmed metastases (arrows) measuring 5-8 mm in right lobe. Note band of accentuated enhancement at and slightly proximal to focal zone position. RK = right kidney.

View larger version (148K): [in a new window]   Fig. 3D. —72-year-old woman with bronchogenic carcinoma and hepatic metastases. Phase-inversion sonograms reveal multiple confirmed metastases (arrows) measuring 5-8 mm in right lobe. Note band of accentuated enhancement at and slightly proximal to focal zone position. RK = right kidney.

View larger version (163K): [in a new window]   Fig. 4A. —47-year-old man with cholangiocarcinoma and histologically proven hepatic metastases. Unenhanced sonogram of liver segment IV shows heterogeneous parenchyma but no focal lesions. One metastasis was seen elsewhere in liver (not shown).

View larger version (159K): [in a new window]   Fig. 4B. —47-year-old man with cholangiocarcinoma and histologically proven hepatic metastases. Phase-inversion scan of same region as A after contrast injection reveals multiple nonenhancing metastases measuring 5-25 mm. Note thin rim of accentuated enhancement surrounding several lesions.

View larger version (138K): [in a new window]   Fig. 4C. —47-year-old man with cholangiocarcinoma and histologically proven hepatic metastases. Superparamagnetic iron oxide—enhanced T2-weighted MR image confirms multiple small metastases in liver segment IV.

View larger version (154K): [in a new window]   Fig. 5A. —83-year-old woman with bladder carcinoma and histologically proven hepatic metastases. Baseline sonogram shows single ill-defined slightly hyperechoic metastasis (arrowheads) in otherwise heterogeneous liver.

View larger version (137K): [in a new window]   Fig. 5B. —83-year-old woman with bladder carcinoma and histologically proven hepatic metastases. Contrast-enhanced phase-inversion sonograms show this lesion is hypoechoic to adjacent normal parenchyma and is far more extensive (arrowheads, B) than on baseline scan. Note multiple additional metastases as small as 4 mm. Also note characteristic rim of accentuated enhancement surrounding several lesions.

View larger version (131K): [in a new window]   Fig. 5C. —83-year-old woman with bladder carcinoma and histologically proven hepatic metastases. Contrast-enhanced phase-inversion sonograms show this lesion is hypoechoic to adjacent normal parenchyma and is far more extensive (arrowheads, B) than on baseline scan. Note multiple additional metastases as small as 4 mm. Also note characteristic rim of accentuated enhancement surrounding several lesions.

View larger version (189K): [in a new window]   Fig. 5D. —83-year-old woman with bladder carcinoma and histologically proven hepatic metastases. Corresponding helical CT scans show similar extent of metastatic disease but not as many small individual lesions as phase-inversion sonogram.

View larger version (155K): [in a new window]   Fig. 5E. —83-year-old woman with bladder carcinoma and histologically proven hepatic metastases. Corresponding helical CT scans show similar extent of metastatic disease but not as many small individual lesions as phase-inversion sonogram.

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati