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Real-time blood-pool images of contrast enhanced ultrasound with Definity in the detection of tumour nodules in the liver

¹ Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuou-ku, Chiba, 260-8670, ² Toshiba Corporation, Medical Systems Company, 1385, Shimoishigami, Otawara-shi, Tochigi, 324-8550 and ³ Pharmaceutical Laboratories, Institute for Drug Discovery Research, Yamanouchi Pharmaceutical Co. Ltd., 21, Miyukigaoka, Tsukuba-shi, Ibaraki, 305-8585, Japan

View larger version (63K): [in a new window]   Figure 1. VX-2 tumour in the rabbit liver, Case 11, right lobe. (a) Non-contrast tissue harmonic image. One tumour nodule with heterogeneous ultrasound pattern was observed (arrow). The margin of the tumour nodule was not clear. Other tumour nodules were not detected. (b) Contrast-enhanced pulse subtraction harmonic image with Definity. One tumour nodule was observed as an unenhanced nodule with peripheral enhancement (arrow, white), and small tumour nodules were demonstrated as unenhanced nodules around this nodule (arrows, grey). All the tumour nodules were delineated clearly with homogeneous enhancement of the surrounding liver parenchyma. (c) Histopathological findings. One implanted tumour nodule 18 mm in size (arrow, white) and daughter tumour nodules (arrows, black) were observed. The implanted tumour was hypervascular in the peripheral area, corresponding to the peripheral enhancement in (b) and it was necrotic in the central area.

View larger version (70K): [in a new window]   Figure 2. VX-2 tumour in the rabbit liver, Case 4. (a) Non-contrast tissue harmonic image. The one detected tumour nodule had an isoechoic appearance with a central hypoechoic area (arrow, white). The ultrasound pattern of the liver parenchyma was heterogeneous, but other tumour nodules were not clear. (b) Contrast-enhanced pulse subtraction harmonic image with Definity. Homogeneous enhancement was seen in the liver parenchyma. Two tumours were observed as unenhanced nodules with clear delineation, with one of them (right side) showing peripheral enhancement (arrows, white). Small tumours were demonstrated as unenhanced nodules around the two tumour nodules (arrows, grey). (c) Histopathological findings. There were two implanted tumour nodules, 14.4 mm and 19 mm, in the liver (arrows, white and black). Small tumour nodules were observed around the implanted tumours, and were believed to be metastatic tumour nodules (arrows, grey). The tumour tissues were necrotic, but one of them (arrow, black) had tumour vessels in the peripheral area corresponding to the peripheral enhancement in (b).

View larger version (79K): [in a new window]   Figure 3. VX-2 tumour in the rabbit liver, Case 11, left lobe. (a) Non-contrast tissue harmonic image. No tumour nodules were recognized with non-contrast ultrasound in this case. (b) Contrast-enhanced pulse subtraction harmonic images with Definity. One tumour nodule (arrow, white) and small nodule (arrow, grey) were observed as unenhanced focal lesions. (c) Near the same tumour as in (b), two other small tumours were demonstrated as unenhanced nodules in the surface area of the liver. (d) Histopathological findings. One implanted tumour nodule 17 mm in size was found in the liver (arrow, white). Small tumour nodule was observed around the implanted tumour (arrow, black), and was thought to be metastatic tumour nodules. Two tumour nodules 2 mm in size were seen in the surface area of the liver (arrows, grey).