Department of Radiology, "Sapienza" University of Rome, Italy.
Ultraschall Med. 2010 Dec;31(6):589-95. doi: 10.1055/s-0029-1245397. Epub 2010 May 6.
To assess the efficacy of low-mechanical index contrast-enhanced ultrasonography (CEUS) in the differentiation of a series of histologically proven bladder lesions identified via conventional cystoscopy and biopsied.
36 patients (mean age: 62 years; range 45 - 72 years) with bladder lesions previously detected by color power Doppler ultrasonography (CDUS) were prospectively examined with low-mechanical index contrast-enhanced US after bolus administration of 2.4 ml of Sonovue (Bracco, Milan, Italy). All lesions were evaluated in real-time continuous scanning for 2 minutes and the videos were registered. Two ultrasound (US) experts evaluated the videos by consensus and assigned a score to the enhancement pattern. Subsequently, a specific sonographic quantification software (Qontrast, Bracco, Milan, Italy) based on pixel by pixel signal intensity over time was used to obtain contrast-enhanced sonographic perfusion maps for each lesion. Time-intensity curves (TICs) of each lesion were then extracted from the region of interest positioned within the lesion and in the closest bladder wall. The sensitivity and specificity of CDUS and CEUS were compared using McNemar's test. All patients subsequently underwent conventional cystoscopy with biopsy or transurethral resection.
22 high-grade and 14 low-grade transitional cell carcinomas (TCCs) were histologically diagnosed (mean diameter 2.1 cm; range: 1 - 4.5 cm). The sensitivity and specificity of CDUS were 86.4% (19 / 22; 95% CI = 66.7 - 95.3%) and 42.9% (6 / 14; 95% CI = 21.4 - 67.4%), respectively. The sensitivity and specificity of CEUS were 90.9% (20 / 22; 95% CI = 72.2 - 97.5%) and 85.7% (12 / 14; 95% CI = 60.1 - 95.9%), respectively. The sensitivity and specificity of CEUS using TICs were 95.4% (21 / 22; 95% CI = 78.2 - 99.2%) and 85.7% (12 / 14; 95% CI = 60.1 - 95.9%), respectively. There was no significant difference between the sensitivity of CDUS versus CEUS, CDUS versus TIC, and CEUS versus TIC (p > 0.05; McNemar's test). The specificity of CEUS and TIC was significantly higher than that of CDUS (p < 0.05; McNemar test).
CEUS is a reliable noninvasive method for differentiating low- and high-grade bladder carcinomas since it provides typical enhancement patterns as well as specific contrast-sonographic perfusion curves. However, further studies involving larger patient populations is mandatory to confirm these promising results.
评估低机械指数对比增强超声（CEUS）在鉴别一系列经传统膀胱镜和活检证实的膀胱病变中的作用。
36 例（平均年龄 62 岁；范围 45-72 岁）患者的膀胱病变先前通过彩色多普勒超声（CDUS）检测，之后经静脉团注 2.4ml SonoVue（Bracco，米兰，意大利）行低机械指数对比增强超声检查。所有病变均在实时连续扫描 2 分钟内进行评估，并记录视频。两名超声专家通过共识评估视频，并对增强模式进行评分。随后，使用基于时间的像素信号强度的特定超声定量软件（Qontrast，Bracco，米兰，意大利）获得每个病变的对比增强超声灌注图。然后从病变内和最近的膀胱壁内的感兴趣区域提取病变的时间-强度曲线（TIC）。使用 McNemar 检验比较 CDUS 和 CEUS 的敏感性和特异性。所有患者随后均接受常规膀胱镜检查加活检或经尿道切除术。
组织学诊断为 22 例高级别和 14 例低级别移行细胞癌（TCC）（平均直径 2.1cm；范围 1-4.5cm）。CDUS 的敏感性和特异性分别为 86.4%（19/22；95%CI=66.7-95.3%）和 42.9%（6/14；95%CI=21.4-67.4%）。CEUS 的敏感性和特异性分别为 90.9%（20/22；95%CI=72.2-97.5%）和 85.7%（12/14；95%CI=60.1-95.9%）。使用 TIC 的 CEUS 的敏感性和特异性分别为 95.4%（21/22；95%CI=78.2-99.2%）和 85.7%（12/14；95%CI=60.1-95.9%）。CDUS 与 CEUS、CDUS 与 TIC 以及 CEUS 与 TIC 的敏感性之间无显著差异（p>0.05；McNemar 检验）。CEUS 和 TIC 的特异性明显高于 CDUS（p<0.05；McNemar 检验）。
CEUS 是一种可靠的非侵入性方法，可用于鉴别低级别和高级别膀胱癌，因为它提供了典型的增强模式以及特定的对比超声灌注曲线。然而，需要进一步涉及更大患者人群的研究来证实这些有希望的结果。
