Hungarian Radiology

[Role of contrast enhanced ultrasound in clinical practice]


DECEMBER 15, 2008

Hungarian Radiology - 2008;82(07-08)

[Ultrasound contrast agents consist of micro bubbles which can be visualized during their short intravascular and parenchymal transit time. An US system with special software, a small amount of intravenous contrast agent and a skilled operator is necessary to produce a successful study. This method can also be introduced into the clinical practice in our country. Careful indications and well performed studies can reduce the number of unnecessary CT and MR studies and biopsies. Contrast enhanced US has special clinical significance in the detection and characterization of focal liver masses, monitoring drug and local treatment effects of different abdominal tumors and in the case of injury of abdominal parenchymal organs.]



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[Modern CT and MRI scanners can give an exact and rapid diagnosis in the case of most cystic renal masses. Dilemma in their diagnosis is whether or not the changes need surgical intervention. The question of follow-up is decided with the use of the Bosniak classification. To characterize the cystic changes excellent quality, multiphasic MDCT examination is necessary with the following parameters: 80-120 mls. of non-ionic iodinated intravenous contrast material given with an injector at 3 ml/sec flow-rate with saline flush technique, unenhanced and post-contrast scans obtained at 35 and 70 seconds, with more scans at 120-300 seconds, as deemed necessary. A collimation of 16x1.5 mm with an overlap of 50% should be aimed for. Through the primary data we perform a reconstruction of 2 mm, with an option to create volume-rendered image sin the post-processing phase, as necessary. With the help of this CT protocol we can measure the different criterions of Bosniak classification in the cystic masses like minimal, smooth or irregular wall thickening, with or without enhancement. We can recognize hairline thin or thickened septa, fine or irregular (thick or nodular) calcifications, solid component with or without contrast enhancement. Using these criteria each cystic mass can be assigned to a Bosniak cystic category (I, II, IIF, III and IV)]

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