Combined transthoracic echocardiography and contrast‐enhanced ultrasonography to trace intravenous leiomyomatosis with intracardiac extension

Luo, Xianghong; Li, Rongjuan; Li, Zhaojun

doi:10.1111/echo.14424

Cited by 5 publications

(9 citation statements)

References 10 publications

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“…The retrospective study of contrast-enhanced ultrasound images of eight patients with IVL by Luo et al. also shows that contrast-enhanced ultrasound had apparent advantages over conventional ultrasound in displaying IVL extension ( 12 ). Contrast-enhanced ultrasonography can show filling defects in intravascular and intracardiac spaces and blood supply within the lesion ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

“…Particularly, it can detect new blood vessels in the plaque that conventional ultrasound cannot, which is important for improving risk stratification and accurately assessing stroke risk ( 22 ). Compared to CEUS with conventional ultrasound, CEUS could more intuitively reflect the internal blood supply of intrahepatic cholangiocarcinoma lesions, thus providing more valuable information for clinical diagnosis and treatment ( 12 , 23 ). In diagnosing and applying breast cancer, CEUS can fully show the micro blood flow perfusion in the lesion and more clearly show the outward invasion and growth of malignant tumors than conventional ultrasound ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

“…CEUS is a new ultrasonic technology with a better micro blood flow imaging function that can more clearly reveal the vascular microcirculation perfusion in diseased tissue ( 12 – 14 ). In addition to its good safety profile and simplicity, CEUS is also patient-friendly, has no ionizing radiation, and can enable multiplanar imaging in real time ( 15 , 16 ).…”

Section: Introductionmentioning

confidence: 99%

“…Scholars are currently using CEUS to diagnose IVL, obtaining more information than conventional ultrasound, particularly the tiny blood inside the lesion, which is critical for IVL differential diagnosis ( 18 ). IVL lesions can be well differentiated from thrombus in contrast-enhanced ultrasound ( 12 ). In addition, ultrasound plays an important role in diagnosing IVL with a better display of IVL morphology ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic value of contrast-enhanced ultrasound in intravenous leiomyomatosis: a single-center experiences

Wang

et al. 2022

Front. Oncol.

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ObjectiveIntravenous leiomyomatosis (IVL) is a rare disease, and few studies have focused on the diagnostic value of contrast-enhanced ultrasound (CEUS) in this condition. This study aimed to investigate the diagnostic value of CEUS in IVL and summarize the specific CEUS characteristics of IVL.Materials and MethodFrom December 2016 to March 2021, 93 patients admitted to our hospital with inferior vena cava (IVC) occupying lesions were prospectively enrolled and underwent detailed ultrasound multi-modality examinations, including conventional and contrast-enhanced ultrasound scans. The diagnostic value of CEUS and conventional ultrasound (CU) in IVL was compared, and the specific IVL signs were summarized.ResultsAmong the 93 patients with inferior vena cava mass, 67 were IVL while 26 were non-IVL. The inter-observer agreement of the two senior doctors was good, with Kappa coefficient = 0.71 (95% CI: 0.572–0.885). The area under the ROC curve of CU for IVL diagnosis was 0.652 (95% CI: 0.528–0.776), and its sensitivity, specificity, accuracy, positive predictive value, negative predictive value, missed diagnosis rate, and misdiagnosis rate were 61.1%, 69.2%, 63.4%, 83.7%, 40.9%, 38.8%, and 30.8%, respectively. The area under curve (AUC) for IVL diagnosis by CEUS was 0.807 (95% CI: 0.701–0.911), and the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, missed diagnosis rate, and misdiagnosis rate were 82.0%, 84.6%, 82.8%, 93.2%, 64.7%, 15.4%, and 17.9%, respectively. In CEUS mode, “sieve hole sign” and “multi-track sign” were detected in 57 lesions, and the detected rate was higher than that of CU (https://loop.frontiersin.org/people/1014187 < 0.01).ConclusionCEUS can better show the fine blood flow inside the IVL, which is important for IVL differential diagnosis. Moreover, CEUS can obtain more information about IVL diagnosis than CU, compensating for the shortcomings of CU in detecting more blood flow within the lesion. Thus, this technique has great significance for IVL diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnostic value of contrast-enhanced ultrasound in intravenous leiomyomatosis: a single-center experiences

Wang

et al. 2022

Front. Oncol.

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“…conducted by Luo and his colleges (33). In contrast to conventional ultrasonography, enhanced CT and MRI require a longer duration and pose a risk of contrast agent allergy.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic experience of intravenous leiomyomatosis with emphasis on conventional ultrasonography imaging: a single-center study

Ge,

Wang,

Wang

et al. 2023

Front. Oncol.

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ObjectiveIntravenous leiomyomatosis (IVL) is a rare and aggressive tumor type that has the potential to extend into the inferior vena cava (IVC) and is susceptible to be misdiagnosed and neglected. Despite its clinical significance, there is a paucity of research that has focused on the specific manifestations of IVL on ultrasonography. Therefore, this study aims to systematically analyze the specific ultrasound features of IVL and augment its diagnostic accuracy.Materials and methodProspective inclusion was granted to patients admitted to our hospital between December 2016 and March 2021 for an IVC-occupying lesion. Multi-modal ultrasonography, encompassing gray-scale and color Doppler, was conducted. Lesions were categorized as IVL or non-IVL based on pathological or follow-up data. Two ultrasound sonographers with over 5 years of experience read and recorded ultrasound data for all lesions, which were subsequently comparatively analyzed to identify specific signs of IVL.ResultsA total of 284 patients diagnosed with IVC-occupying lesions were included in the study. The lesion types comprised of IVL (n=67, 23.6%), IVC thrombus (n=135, 47.5%), tumor thrombus of renal carcinoma involving the IVC (n=35, 12.4%), tumor thrombus of liver carcinoma involving the IVC (n=24, 8.5%), leiomyosarcoma of the IVC (n=14, 4.9%), and tumor thrombus of adrenocortical adenocarcinoma (n=9, 4.1%). The presence of “sieve hole” and “multi-track” signs was observed in 20 IVL lesions under the grey-scale modality, while both signs were absent in the non-IVL group (P<0.01). The study found no statistically significant differences in the presentation of “sieve hole” and “multi-track” signs under the grey-scale and color Doppler modalities in cases of intravascular lithotripsy (IVL) (P>0.05). Using these two signs as diagnostic criteria for IVL, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), miss rate, misdiagnosis rate, and accuracy were determined to be 29.9%, 100%, 100%, 82.2%, 70.1%, 0, and 83.5%, respectively (AUC ROC=0.649; 95%CI: 0.537-0.761).ConclusionIVL exhibits distinct ultrasound presentations, including “sieve hole” and “multi-track” signs, which demonstrate high specificity and accuracy as diagnostic indicators. Furthermore, these signs are corroborated by pathological evidence and effectively distinguish IVL from other lesions occupying the IVC.

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Echocardiographic Characteristics and Contrast‐Enhanced Imaging of Intravenous Leiomyomatosis With Intracardiac Extension

Niu

Yang

et al. 2021

J of Ultrasound Medicine

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Objectives Intravenous leiomyomatosis (IVL) is a histologically benign but biologically aggressive tumor. This study aimed to summarize the echocardiography and contrast‐enhanced ultrasound (CEU) characteristics of IVL to provide a basis for clinical diagnosis and therapy. Methods Fourteen IVL patients with uterus leiomyoma history (female, 46.4 ± 5.6 years) were enrolled in this study from March 2008 to December 2020 in our hospital. Preoperative imaging examination data were collected, including echocardiography computed tomography data; six patients also underwent CEU. All patients underwent successful resection, confirmed by histopathology. Results Echocardiographic characteristics: The mean sizes of intracardiac parts of IVL tumors were 54.0 ± 17.9 mm (length) and 24.6 ± 9.8 mm (width). IVL tumors exhibited two echocardiography types: isoechoic solid mass (71.4%, 10/14) and anechoic cystic conduits (28.6%, 4/14), with enlargements of the right atrium (57.1%,8/14), right ventricle (1 patient, 7.1%), and inferior vena cava (57.1%, 8/14). About 21.4% of the patients (3/14) had right ventricular dysfunction. Right heart obstruction was observed in 42.8% (6/14) of the patients. CEU characteristics: the solid mass type exhibited an earlier perfusion and lower perfusion intensity than the conduits type. CEU was helpful in determining origins and pathways: from the internal iliac vein (pathway I, 71.4%), from the ovarian vein (pathway II, 14.3%), or both (14.3%). The echocardiographic appearances of the 14 cases were consistent with the features of the resection specimens. Conclusion Combined echocardiography and CEU can provide a more valuable information for the diagnosis of IVL and essential basis for treatment.

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Combined transthoracic echocardiography and contrast‐enhanced ultrasonography to trace intravenous leiomyomatosis with intracardiac extension

Cited by 5 publications

References 10 publications

Diagnostic value of contrast-enhanced ultrasound in intravenous leiomyomatosis: a single-center experiences

Diagnostic value of contrast-enhanced ultrasound in intravenous leiomyomatosis: a single-center experiences

Diagnostic experience of intravenous leiomyomatosis with emphasis on conventional ultrasonography imaging: a single-center study

Echocardiographic Characteristics and Contrast‐Enhanced Imaging of Intravenous Leiomyomatosis With Intracardiac Extension

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