Detection of peripheral embolic consolidations using contrast‐enhanced ultrasonography in patients with no evidence of pulmonary embolism on computed tomography: A pilot study

Trenker, Corinna; Apitzsch, Jonas; Pastor, Santiago Martín; Bartelt, S.; Neeße, Albrecht; Goerg, Christian

doi:10.1002/jcu.22511

Cited by 23 publications

(41 citation statements)

References 24 publications

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“…Wedge‐shaped or round nonenhancing lesions or those with inhomogeneous enhancement were defined as characteristic patterns for EPL in CEUS . Interestingly, we observed similar patterns in patients with clinical suspected PE and negative CTPA scan …”

Section: Introductionsupporting

confidence: 68%

“…All six patients presented in this case series met the following criteria: (a) clinical suspicion of PE, (b) negative CTPA, (c) peripheral pleural defects with B-mode LUS and CEUS patterns consistent with EPL as described previously, 7,8 and (d) US-guided biopsy of at least one representative pleural lesion for exclusion of metastasis/tumor. Three patients were female, and three were male.…”

Section: Patients Materials and Methodsmentioning

confidence: 94%

“…Nevertheless, 15% of symptomatic PE are embolisms at the subsegment level, which cannot always be detected in CTPA . Sonographically, the effects of a subsegmental PE can be observed as nonenhancing lesions or those with inhomogeneous CEUS enhancement, even if they were not detected by CTPA …”

Section: Discussionmentioning

confidence: 99%

“…7 Interestingly, we observed similar patterns in patients with clinical suspected PE and negative CTPA scan. 8 This led to the hypothesis that CEUS is capable of narrowing a diagnostic gap in the detection of peripheral PE. In light of the differential diagnoses of small peripheral pleural defects, especially malignant tumors, metastases with necrotic areas, scar tissues, and melting inflammatory consolidations, a histological examination generally needs to be considered.…”

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confidence: 99%

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Histological validation of pulmonary infarction detected with contrast‐enhanced ultrasound in patients with negative computed tomography pulmonary angiogram: A case series

Trenker

Dohse

Ramaswamy

et al. 2019

J of Clinical Ultrasound

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Objective The purpose of this case series is to evaluate the diagnostic potential of contrast‐enhanced ultrasound (CEUS) in patients with clinically suspected pulmonary embolism (PE), suspicious pleural lesions, and negative computed tomography pulmonary angiogram (CTPA). Patients/Methods Between January 2017 and January 2018, we examined patients with an intermediate or a high‐risk Wells score and a negative CTPA with lung B‐mode ultrasound (LUS). In a total of six patients, pleural defects were identified and further examined by CEUS. Nonenhancing lesions or those with inhomogeneous enhancement were considered to be suspicious for an embolic event and biopsied for histological validation. The data analysis was retrospective. Results In LUS, the lesions had an average size of 2.4 cm (range 2‐3 cm). Five were hypoechoic and one was complex. The shape was wedge shaped (n = 5) or round (n = 1), and the number was solitary (n = 4) or multiple (n = 2) with dorsobasal localization (n = 6). Three lesions were nonenhancing, and three had an inhomogeneous enhancement with areas with complete absence of enhancement. The histological examination showed pulmonary infarction in all six cases, and in one patient also cells of a lung carcinoma. Conclusion Our case series demonstrates the diagnostic potential of CEUS for detecting peripheral pulmonary infarction in patients with clinically suspected PE and negative CTPA scan regarding PE. A histological validation or a narrow follow‐up might be warranted in some cases.

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Section: Introductionsupporting

confidence: 68%

Section: Patients Materials and Methodsmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Histological validation of pulmonary infarction detected with contrast‐enhanced ultrasound in patients with negative computed tomography pulmonary angiogram: A case series

Trenker

Dohse

Ramaswamy

et al. 2019

J of Clinical Ultrasound

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“…Trenker C et al 2018 [20] Lei Z et al 2017 [21] Trenker C et al 2017 [22] Bai J et al 2016 [23] Wang S et al 2016 [24] Hong-xia Z et al 2016 [25] Bartelt S et al 2016 [26] Dong Y et al 2015 [27] Wang J et al 2015 [28] Sartori S et al 2013 [29] Cao BS et al 2013 [30] Linde HN et al 2012 [31] Qureshi NR et al 2011 [32] Caremani M et al 2008 [33] Gorg C et al 2006 [34] Sperandeo M et al 2006 [35] -=Low risk, /=High risk, . Table 3 Risk of bias and applicability concerns of included randomized controlled, non-randomized controlled and non-randomized noncontrolled studies using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.…”

Section: --mentioning

confidence: 99%

Clinical Applications of Contrast-Enhanced Thoracic Ultrasound (CETUS) Compared to Standard Reference Tests: A Systematic Review

et al. 2020

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Introduction Contrast-enhanced ultrasound is utilized in an increasing array of medical fields, including thoracic medicine. However, the technique is still relatively new and only sporadically mentioned in current guidelines and recommendations. The aim of this systematic review is to provide a literature overview and to critically appraise the current clinical applications of contrast-enhanced thoracic ultrasound (CETUS). Materials and Methods A systematic literature search using major electronic databases and in accordance with PRISMA guidelines was performed. Studies with a primary focus on CETUS of thoracic disorders compared to a standard reference test were included. The QUADAS-2 tool was used for quality assessment of the studies. Results The search identified 43 articles: 1 randomized controlled study, 6 non-randomized controlled studies, 16 non-randomized non-controlled studies, 5 case series, 10 single case reports, and 5 animal studies. The overall risk of bias was judged to be high. Diagnostic accuracy measurements of noninvasive applications of CETUS were only reported in a few studies and they were too dissimilar for meta-analysis. Six studies compared CETUS-guided versus ultrasound-guided transthoracic needle biopsy of thoracic masses. They individually reported a significant increase in diagnostic accuracy in favor of CETUS guidance but were too heterogeneous for meta-analysis. Conclusion The current literature on CETUS is overall heterogeneous with a few high evidence level studies, small study populations and a high risk of bias. CETUS-guided biopsy is the most frequent clinical application and increases diagnostic accuracy compared to ultrasound guidance by an average of 14.6 percentage points.

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Mediastinal Masses in Contrast‐Enhanced Ultrasound ‐ Retrospective Analysis of 58 Cases

Trenker

Dietrich

Holland³

et al. 2020

J of Ultrasound Medicine

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Objectives To determine contrast enhancing features of mediastinal masses (ML) using transcutaneous contrast‐enhanced ultrasound (CEUS). Methods Retrospective analysis of n = 58 patients with histologically confirmed ML, which were examined in the period from October 2005 to February 2018 using transcutaneous B‐mode ultrasound and CEUS. In n = 29 (50%) histological confirmation was performed by ultrasound guided core‐needle biopsy. The lesions were evaluated using CEUS in regard to the enhancement pattern (hyper‐, iso‐, hypoenhancement, non‐enhancement, homogenous, inhomogenous) compared to enhancement of the spleen as an in vivo reference. Results N = 53 (91.4%) of ML were malignant (m) (lymphoma n = 36, metastasis n = 11, thymoma n = 2, teratoma n = 1, sarcoma n = 2, seminoma n = 1). In n = 5 (8.6%) cases there was a benign (b) histology (thyroid tissue n = 2, thymus residue n = 1, ganglioneurinoma n = 1, scar tissue: n = 1). In ultrasound, n = 53 (91.4%; (48 = m, 5 = b)) were hypoechoic, n = 5 (8.6%, (5 = m,0 = b)) hyperechoic. In CEUS, n = 35 lesions presented an arterial isoenhancement (60.3%; 33 = m, 2 = b). An arterial hypoenhancement had n = 21 (36.2%, (20 = m,1 = b)), and no enhancement showed n = 2 (3.5%, (0 = m, 2 = b) of the ML. A parenchymal isoenhancement was observed in n = 1 (1.7%, (1 = m, 0 = b)), a hypoenhancement in n = 54 (93.1%; 51 = m, 3 = b) of the patients and almost no enhancement in n = 3 ML (5.2%, (1 = m, 2 = b).) The enhancement was homogeneous in n = 26 (44.8%, (25 = m,1 = b)) cases, in n = 31 (53.5%, (28 = m,3 = b)) inhomogeneous and n = 1 (1.7%) benign lesion was exclusively cystic. Conclusion In CEUS, mediastinal tumor formations showed variable arterial enhancement, followed by parenchymal hypoenhancement (wash‐out).

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Detection of peripheral embolic consolidations using contrast‐enhanced ultrasonography in patients with no evidence of pulmonary embolism on computed tomography: A pilot study

Cited by 23 publications

References 24 publications

Histological validation of pulmonary infarction detected with contrast‐enhanced ultrasound in patients with negative computed tomography pulmonary angiogram: A case series

Histological validation of pulmonary infarction detected with contrast‐enhanced ultrasound in patients with negative computed tomography pulmonary angiogram: A case series

Clinical Applications of Contrast-Enhanced Thoracic Ultrasound (CETUS) Compared to Standard Reference Tests: A Systematic Review

Mediastinal Masses in Contrast‐Enhanced Ultrasound ‐ Retrospective Analysis of 58 Cases

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