Intra-Arterial and Intravenous Contrast-Enhanced Ultrasonography in Prostate Artery Embolization: A Case Series

Nzekwu, Emeka; Mirakhur, Ani; Lee, Angela; Bakshi, Darshan

doi:10.1016/j.jvir.2018.02.019

Cited by 5 publications

(6 citation statements)

References 12 publications

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“…Moschouris et al (93) showed that cessation of prostate perfusion at CEUS after PAE was associated with clinical success and correlated with prostate shrinkage at 3-month follow-up. Nzekwu et al (94) performed intra-arterial CEUS to confirm prostate perfusion from catheter positions and also showed extraprostatic perfusion in a sizable fraction of patients. CEUS stands to play a large role in these patients before, during, and after PAE as it becomes a more prevalent procedure in clinical practice.…”

Section: Prostate Artery Embolizationmentioning

confidence: 99%

Contrast-enhanced US for the Interventional Radiologist: Current and Emerging Applications

et al. 2020

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US is a powerful and nearly ubiquitous tool in the practice of interventional radiology. Use of contrast-enhanced US (CEUS) has gained traction in diagnostic imaging given the recent approval by the U.S. Food and Drug Administration (FDA) of microbubble contrast agents for use in the liver, such as sulfur hexafluoride lipid-type A microspheres. Adoption of CEUS by interventional radiologists can enhance not only procedure guidance but also preprocedure patient evaluation and assessment of treatment response across a wide spectrum of oncologic, vascular, and nonvascular procedures. In addition, the unique physical properties of microbubble contrast agents make them amenable as therapeutic vehicles in themselves, which can lay a foundation for future therapeutic innovations in the field in drug delivery, thrombolysis, and vascular flow augmentation. The purpose of this article is to provide an introduction to and overview of CEUS aimed at the interventional radiologist, highlighting its role before, during, and after frequently practiced oncologic and vascular interventions such as biopsy, ablation, trans arterial chemoembolization, detection and control of hemorrhage, evaluation of transjugular intrahepatic portosystemic shunts (TIPS), detection of aortic endograft endoleak, thrombus detection and evaluation, evaluation of vascular malformations, lymph angiography, and percutaneous drain placement. Basic physical principles of CEUS, injection and scanning protocols, and logistics for practice implementation are also discussed. Early adoption of CEUS by the interventional radiology community will ensure rapid innovation of the field and development of future novel procedures.

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Section: Prostate Artery Embolizationmentioning

confidence: 99%

Contrast-enhanced US for the Interventional Radiologist: Current and Emerging Applications

et al. 2020

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“…Some researchers, taking advantage of the portability and flexibility of the US-equipment, have applied US techniques in the angio-suite, where PAE is performed, for on-site evaluation of the procedure[ 21 , 26 ]. On gray-scale US, echogenic foci appear within the prostate immediately post-PAE and remain visible for a few days after the procedure[ 20 , 21 ].…”

Section: Intraprocedural Sonography Of Paementioning

confidence: 99%

“…CEUS has also been utilized for intraprocedural guidance of PAE. This technique entails sonographic imaging of the prostate with CEUS algorithm, during injection of diluted echo enhancer through the microcatheter positioned in the PA. One group[ 26 ] utilized a suspension of perflutren lipid microspheres (Definity, Lantheus Medical Imaging, North Billerica, MA, United States) diluted 1:20 in saline and injected in small aliquots (0.3-0.5 mL); diluted SonoVue can also be utilized for i.a.-CEUS[ 28 ], although it should be acknowledged that this is an off-label application. Intraarterial CEUS can be performed prior to injection of the embolic, to show the part of the prostate that is fed by the selected artery (Figure 6 ).…”

Section: Intraprocedural Sonography Of Paementioning

confidence: 99%

“…Thus, i.a.-CEUS could confirm successful selection of the PA and could prevent some cases of non-target embolization. Intraarterial CEUS could play a role in guidance of PAE, particularly when cone-beam CT equipment is not available[ 26 ]. Intraprocedural sonography may be technically challenging and acquisition of images of acceptable quality is not guaranteed: Scanning has to be performed transabdominally, under sterile drapes; the patient’s suprapubic discomfort during PAE may make compression with the transducer intolerable; the catheterized bladder is usually empty and the Foley catheter itself may be an obstacle for the ultrasound beam.…”

Section: Intraprocedural Sonography Of Paementioning

confidence: 99%

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Sonographic evaluation of prostatic artery embolization: Far beyond size measurements

Moschouris

Dimakis

Anagnostopoulou

et al. 2020

WJR

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Prostatic artery embolization (PAE) has gained acceptance as a minimally invasive, safe and effective treatment of symptomatic benign prostatic hyperplasia. Radiologic imaging is an indispensable part of post-interventional evaluation of PAE and serves both clinical and investigational purposes. In this context, ultrasonography (US) has a central and multifaceted role. Gray-scale US is routinely utilized for measurement of significant outcome parameters (prostatic volume, intra-vesical prostatic protrusion and post-void residual volume) before and after PAE. Improvement of these parameters may become more obvious one-month post-PAE, or later. Contrast-enhanced US (CEUS) with intravenous administration of a second-generation echo-enhancer can demonstrate prostatic infarcts (as enhancement defects) immediately post-PAE and monitor their resolution over time. The volume of prostatic infarcts can also be measured and compared to prostatic volume. Prostatic infarction is a definite sign of the local efficacy of PAE and a predictor of prostate shrinkage and (at least in some patients) of clinical success. CEUS can also be performed intraoperatively in the angio-suite, for on-site evaluation of the ischemic effect; a variation of this technique, with intraarterial (instead of intravenous) administration of diluted echo enhancer, can also be applied intraoperatively, to map the embolized territory and to prevent non-target embolization. Initial experience with US-elastographic techniques (shear-wave and strain elastography) has shown that they can detect and quantify the improvement of tissue elasticity post-PAE, thus providing new insights into the therapeutic mechanisms of this treatment. With utilization of high-end equipment, experience and standardized imaging protocols, US could be the primary modality for imaging evaluation of PAE.

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“…Intra-arterial contrast-enhanced ultrasonography (IA-CEUS) is a new imaging technique, which can display blood flow and tissue perfusion via a microbubble contrast agent and then achieve the purpose of real-time display of diseased vessels and tissues ( 8 , 9 ). Previous studies revealed that TACE-assisted IA-CEUS could improve the accuracy and success rate of embolization and the efficacy of drug-eluting bead transarterial chemoembolization (DEB-TACE).…”

Section: Introductionmentioning

confidence: 99%

The value of intra-procedural transcatheter intraarterial contrast-enhanced ultrasonography (IA-CEUS) in predicting the short-term efficacy of conventional transarterial chemoembolization (cTACE)

Xiang¹,

Wang²,

Li³

et al. 2020

Transl Cancer Res TCR

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Background This study aimed to evaluate whether corona enhancement and intratumor perfusion features of intra-procedural transcatheter intraarterial contrast-enhanced ultrasonography (IA-CEUS) predict short-term tumor response on follow-up contrast-enhanced magnetic resonance imaging (CE-MRI) in patients with hepatocellular carcinoma (HCC) treated with conventional transarterial chemoembolization (cTACE). Methods This trial included 39 patients with 51 HCC target lesions who underwent cTACE with IA-CEUS. The maximum cross-sectional area ratio of intratumor perfusion between pre- and post-procedure, as well as the peak value and sickness of corona enhancement immediately post-cTACE were measured respectively. Tumor response at MRI was assessed according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) guidelines. Nonparametric Spearman rank-order correlation was used to correlate the maximum cross-sectional area ratio of intratumor perfusion, the peak value, and sickness of corona enhancement of IA-CEUS immediately after cTACE with tumor response. Results The results showed that 39 patients with 51 target lesions were assessed for tumor response. Complete remission (CR), partial remission (PR), stable disease (SD), and progressive disease (PD) were 22 (43.1%), 14 (27.5%), 10 (19.6%), and 5 (9.8%), respectively. The maximum cross-sectional area ratio of intratumor perfusion moderately correlated with tumor response on CE-MRI (Spearman rho =0.513, P<0.001). Furthermore, the peak value and sickness of corona enhancement showed a good correlation with tumor response on CE-MRI respectively (Spearman rho =0.671, P<0.001, rho =0.704, P<0.001). Conclusions Intra-procedural transcatheter IA-CEUS may predict short-term tumor response in cTACE of HCC. The feature of corona enhancement immediately post-cTACE also showed a more accurate prediction when compared with the feature of intratumor infusion (rho =0.671).

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Intra-Arterial and Intravenous Contrast-Enhanced Ultrasonography in Prostate Artery Embolization: A Case Series

Cited by 5 publications

References 12 publications

Contrast-enhanced US for the Interventional Radiologist: Current and Emerging Applications

Contrast-enhanced US for the Interventional Radiologist: Current and Emerging Applications

Sonographic evaluation of prostatic artery embolization: Far beyond size measurements

The value of intra-procedural transcatheter intraarterial contrast-enhanced ultrasonography (IA-CEUS) in predicting the short-term efficacy of conventional transarterial chemoembolization (cTACE)

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