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Angiogenesis imaging – ultrasound

Imaging Sciences Department, Imperial College, Hammersmith Hospital, London, UK

View larger version (97K): [in a new window]   Figure 1. Power Doppler of a hepatocellular carcinoma. Power Doppler reveals the neovasculature of this large hepatocellular carcinoma. Note the complex, tortuous architecture of the tumour vessels, the smallest of which are around a millimetre in diameter.

View larger version (9K): [in a new window]   Figure 2. Chart of colour Doppler signals from breast carcinomas undergoing chemotherapy. The clinical response, assessed by size measurements, lagged behind the quantitative change in colour Doppler signals which could be used as an early indicator of response (from Kedar et al [16]).

View larger version (86K): [in a new window]   Figure 3. Spectral Doppler signals from a tumour. Pancreatic carcinomas are relatively hypovascular but in this example a spectral Doppler trace could be obtained by using colour Doppler to guide positioning the sample volume. It shows continuing flow through diastole indicating a low resistance to flow consistent with failure of vasomotor regulation or perhaps, the presence of arteriovenous shunts.

View larger version (14K): [in a new window]   Figure 4. Resistance index (RI) and vascular endothelial growth factor (VEGF). In these patients with cervical carcinoma, the resistance index was lower in tumours with increased VEGF with a regression index of –0.4 (p=0.004). This non-invasive index of flow resistance could be used as a marker of tumour aggressivity (from Lee [25]).

View larger version (43K): [in a new window]   Figure 5. Enhanced colour Doppler in prostatic cancer. Colour Doppler has been advocated as a way to improve the well-known poor sensitivity of ultrasound for detecting prostatic cancer. Only weak colour signals could be obtained on the conventional scan (a) but after administration of the microbubble contrast agent SonoVue, there was marked enhancement in the left side of the prostate (b). Biopsy of this region demonstrated cancer.

View larger version (37K): [in a new window]   Figure 6. Contrast-enhanced colour Doppler to predict response of prostatic cancer. In a group of patients undergoing androgen deprivation treatment for prostatic cancer, the area under the time–intensity curve (AUC) after injection of Levovist (upper graph) was compared with serum prostate specific antigen (PSA) levels (lower graph). Note the expanded time-scale of the vascularity index. Generally both indices showed similar time courses with a rapid fall and eventually a secondary rise. However, in two cases (orange and red traces) the vascularity either failed to fall or rose earlier than the PSA and these patients were subsequently found to have escaped from hormone control (from Eckerley et al [18]).

View larger version (40K): [in a new window]   Figure 7. Agent detection imaging (ADI). The grey-scale scan in this patient with a known malignancy shows two areas suspicious for metastases (arrowheads in (a)). In the ADI mode, obtained several minutes after injection of a liver-specific contrast agent, these lesions are more clearly seen but additional lesions that were not apparent appear (arrows in (b)). The effect depends on the destruction of microbubbles that fill the microcirculation of the normal liver but rapidly wash out of the tumour's microcirculation.

View larger version (39K): [in a new window]   Figure 8. Vascular recognition imaging. A subtle lesion (arrowhead in (a)) suggests a metastasis in this patient with a known colorectal carcinoma. Using a low power (MI 0.1) microbubble-specific mode in which the contrast information is shown in the colour overlay, a peripheral feeding vessel (arrowhead in (b)) is seen the arterial phase at 17 s. Later ((c), 41 s) the contrast medium has washed out of the tumour but is continuing to accumulate in the large vascular volume of the liver so that the metastasis now appears as a prominent colour defect, leaving no doubt as to its presence. (In this mode motion of contrast medium in large vessels is shown as red or blue, according to their flow direction relative to the transducer, while stationary blood (i.e. the microcirculation) is depicted in green.) (SonoVue kindly supplied by Bracco, Milan.)