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 Frate, C. D. Articles by Ros, P. R. Search for Related Content PubMed PubMed Citation Articles by Frate, C. D. Articles by Ros, P. R. Social Bookmarking                      What's this?

Comparing Levovist-Enhanced Pulse Inversion Harmonic Imaging and Ferumoxides-Enhanced MR Imaging of Hepatic Metastases

¹ Institute of Radiology, Udine University, Via Colugna 50, 33100 Udine, Italy.
² Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston MA 02115.

View larger version (144K): [in a new window]   Fig. 1A. —60-year-old man with colorectal carcinoma and metastatic liver involvement suspected on sonography. Unenhanced sonogram of liver shows solid and isoechoic focal lesion (arrow) with hypoechoic rim visible in segment VII.

View larger version (130K): [in a new window]   Fig. 1B. —60-year-old man with colorectal carcinoma and metastatic liver involvement suspected on sonography. Pulse inversion harmonic digital sonogram shows first scan obtained 20 sec after Levovist ([SH U 508A] Schering, Berlin, Germany) injection. Twenty seconds after Levovist administration, increased conspicuity of lesion (arrow) related to increased echogenicity of surrounding and still heterogeneous liver parenchyma is seen.

View larger version (140K): [in a new window]   Fig. 1C. —60-year-old man with colorectal carcinoma and metastatic liver involvement suspected on sonography. Pulse inversion harmonic digital sonogram shows second scan obtained 100 sec after Levovist injection. At this time, conspicuity between focal lesions and normal liver is optimal, and three additional lesions (arrowheads) are now identified.

View larger version (156K): [in a new window]   Fig. 1D. —60-year-old man with colorectal carcinoma and metastatic liver involvement suspected on sonography. Pulse inversion harmonic digital sonogram shows third scan obtained 180 sec after Levovist injection. At this time, there is still good contrast between normal liver parenchyma and focal metastases, with little decrease in conspicuity. All lesions are still detectable.

View larger version (135K): [in a new window]   Fig. 1E. —60-year-old man with colorectal carcinoma and metastatic liver involvement suspected on sonography. Axial unenhanced turbo spin-echo STIR T2-weighted MR image (TR/TE, 5100/90; inversion time, 120 msec; matrix,196 x 256; number of excitations, 3; rectangular field of view, 6; field of view, 8; slice thickness, 8 mm; gap, 20%; acquisition time, 5 min 43 sec) shows multiple focal hyperintense liver lesions with ill-defined borders.

View larger version (125K): [in a new window]   Fig. 1F. —60-year-old man with colorectal carcinoma and metastatic liver involvement suspected on sonography. Axial ferumoxides-enhanced turbo spin-echo STIR T2-weighted MR image shows that accumulation of ferumoxides causes drop in signal intensity of normal parenchyma and increases contrast between lesion and liver. After ferumoxides administration, all lesions identified in unenhanced scan are confirmed, and four additional ones are depicted (arrowheads). Moreover, lesions are better defined.

View larger version (123K): [in a new window]   Fig. 2A. —63-year-old woman with colon carcinoma. Unenhanced baseline sonogram shows no definite lesions, even though liver parenchyma is not perfectly homogeneous.

View larger version (146K): [in a new window]   Fig. 2B. —63-year-old woman with colon carcinoma. Pulse inversion harmonic digital sonograms are serial scans obtained respectively at 20 (B), 100 (C), and 180 (D) sec after Levovist ([SH U 508A] Schering, Berlin, Germany) injection. One liver lesion (arrow) is visible in all scans, but is better seen in C and D, and appears hypoechoic in comparison with surrounding normal liver parenchyma, which is hyperechoic because of Levovist administration. Lesion was confirmed on MR imaging (not shown) and proven to be metastasis after resection.

View larger version (150K): [in a new window]   Fig. 2C. —63-year-old woman with colon carcinoma. Pulse inversion harmonic digital sonograms are serial scans obtained respectively at 20 (B), 100 (C), and 180 (D) sec after Levovist ([SH U 508A] Schering, Berlin, Germany) injection. One liver lesion (arrow) is visible in all scans, but is better seen in C and D, and appears hypoechoic in comparison with surrounding normal liver parenchyma, which is hyperechoic because of Levovist administration. Lesion was confirmed on MR imaging (not shown) and proven to be metastasis after resection.

View larger version (164K): [in a new window]   Fig. 2D. —63-year-old woman with colon carcinoma. Pulse inversion harmonic digital sonograms are serial scans obtained respectively at 20 (B), 100 (C), and 180 (D) sec after Levovist ([SH U 508A] Schering, Berlin, Germany) injection. One liver lesion (arrow) is visible in all scans, but is better seen in C and D, and appears hypoechoic in comparison with surrounding normal liver parenchyma, which is hyperechoic because of Levovist administration. Lesion was confirmed on MR imaging (not shown) and proven to be metastasis after resection.

View larger version (132K): [in a new window]   Fig. 3A. —52-year-old man with colorectal carcinoma who was treated with chemotherapy for liver lesions. Unenhanced sonogram of liver segment VII shows solid hyperechoic metastasis with hypoechoic rim (arrow), visible when compared with normal echogenicity of surrounding liver parenchyma.

View larger version (142K): [in a new window]   Fig. 3B. —52-year-old man with colorectal carcinoma who was treated with chemotherapy for liver lesions. Pulse inversion harmonic digital sonogram is second scan obtained at 100 sec after Levovist ([SH U 508A] Schering, Berlin, Germany) injection, after which, in comparison with unenhanced scan (A), echogenicity of normal liver parenchyma is increased. As a consequence, conspicuity of focal lesion (arrow) described in A decreased.

View larger version (134K): [in a new window]   Fig. 3C. —52-year-old man with colorectal carcinoma who was treated with chemotherapy for liver lesions. Unenhanced sonogram obtained in segment VII shows that heterogeneity of parenchyma seems to be present in subcapsular area, but isolated lesion (arrow) is not identified.

View larger version (146K): [in a new window]   Fig. 3D. —52-year-old man with colorectal carcinoma who was treated with chemotherapy for liver lesions. Pulse inversion harmonic digital sonogram is second scan obtained at 100 sec after Levovist injection. In same area as in C, hypoechoic lesion (arrow) is now visible. Vessel simulating hyperechoic lesion with hypoechoic rim is visible (arrowhead); this appearance can mimic focal lesion when there is not careful comparison between unenhanced and contrastenhanced images.

View larger version (12K): [in a new window]   Fig. 4. —Graph compares grade of lesion conspicuity (excellent [1], good [2], moderate [3], and poor [4]) obtained with different scans (unenhanced and at 20, 100, and 180 sec after contrast media administration). Graph shows that, in our experience, scan at 100 sec after Levovist ([SH U 508A] Schering, Berlin, Germany) injection shows best performance, followed by scan at 180 sec.

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati