Innovations in Abdominal Ultrasound

152 Pages·1992·7.17 MB·English

by  R. Schlief

N.Heyder E.G.Hahn B.B.Goldberg (Eds.)
Innovations
in Abdominal
Ultrasound
With 102 Figures, Some in Color
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Hong Kong Barcelona
Budapest
Prof. Dr. med. Norbert Heyder
Prof. Dr. med. Eckhart G. Hahn
Medizinische Klinik I mit Poliklinik
der Friedrich-Alexander-Universitat Erlangen-Niirnberg
Krankenhausstrasse 12, W-8520 Erlangen, FRG
Prof. Dr. med. Barry B. Goldberg
Thomas Jefferson University Hospital, Division of Ultrasound
132 S., 10th Street, Suite 781 G, Philadelphia, PA 19107,
USA
Library of Congress Cataloging-in-Publication Data
Innovations in abdominal ultrasound 1 N. Heyder, E.G. Hahn, B.B. Goldberg (eds.).
Includes bibliographical references and index.
ISBN-13: 978-3-642-77629-8 e-ISBN-13: 978-3-642-77627-4
DOl: 10.1007/978-3-642-77627-4
1. Abdomen - Ultrasonic imaging. 2. Endoscopic
ultrasonography. 3. Abdomen - ultrasonography. I. Heydcr, N. (Norbert) II. Hahn, E.
G. (Eckhart G.) III. Goldberg, Barry B., 1937- . [DNLM: 1. Ultrasonography -
methods. 2. Ultrasonography - trcnds.
WI 900 1575] RC944.154 1992 617.5'507543 - dc20
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Preface
Since the beginnings of diagnostic ultrasound in the 1950s, each
decade has seen significant advances in this technology. Commer
cialization of ultrasound occurred during the 1960s with the
introduction of many of the clinical uses that are in existence
today. The 1970s showed the most dramatic changes with the
commercial introduction of gray-scale and real-time ultrasound.
In the 1980s many new advances were introduced, including color
Doppler, as well as a wide variety of endoluminal approaches,
including endorectal, endovaginal and transesophageal. The
decade of the 1990s promises even more significant advances with
further transducer miniaturization, three-dimensional ultra
sound, and the introduction of a variety of ultrasound contrast
agents.
With such rapid changes occurring, it becomes important to
disseminate knowledge in as rapid a fashion as possible, thus it
was quite appropriate that a meeting such as this be held to
provide an in-depth review of the many new areas of ultrasound
imaging that show promise for the future. Emphasis was on the
new uses of ultrasound in gastrointestinal diseases. Many of these
advances will, of course, also have applications in many other
areas of the body. It is hoped that those in attendance will acquire
a much broader understanding of where ultrasound is now and
where it is headed in the not too distant future.
Philadelphia, USA B. B. Goldberg
and Erlangen, FRG N. Heyder
August 1992 E. G. Hahn
Contents
Saccharide-Based Ultrasound Contrast Media:
Basic Characteristics and Results of Clinical Trials. 1
R. Schlief, R. Schurmann, and H. P. Niendorf
Ultrasound Backscatter of Liver with Particulate
Contrast Agents . . . . . . . . . . . . . . . . . . . . . . . . .. 8
T. A. Tuthill, R. B. Baggs, M. R. Violante,
and K. J. Parker
Diagnosis of Colon Tumors
and Inflammatory Large-Bowel Diseases
by Hydro-colonic Sonography . . . . . . . . . . . . . . .. 16
B. Limberg
Endoscopic Ultrasound:
Recent Advances in Gastroenterology . . . . . . . . .. 27
M. Fukuda, K. Hirata, M. Mitani, T. Mochizuki,
and H. Tatuguchi
Doppler Flowmetry in Portal Hypertension . . . . . .. 49
L. Bolondi, S. Gaiani, and L. Barbara
Color Doppler Endosonography
in the Study of Portal Hypertension . . . . . . . . . . .. 61
L. Bolondi, S. Gaiani, G. Zironi, F. Fornari, S. Siringo,
and L. Barbara
Cystogastric Catheter Drainage
of Pancreatic Collections of Fluid
Under Endoscopic/Ultrasonographic Guidance ... 70
N. Heyder, E. Gunter, and E. G. Hahn
Tumor Therapy by Ethanol Injection:
Results and Indications .................... 79
T. Livraghi
VIII Contents
Intravascular Scanning Devices
and Their Clinical Value .................... 81
K. Born, C. T: Lancee, W J. Gussenhoven, J. Roelandt,
W Li, and M. G. M. de Kroon
Advances in Ultrasound:
Contrast Agents and Endoluminal Ultrasound .... 87
B. B. Goldberg and J.-B. Liu
Possibilities of Three-Dimensional Sonography
in Obstetrics ............................ 110
A. Kratochwil
Three-Dimensional Volumetric Scans: Acquisition
Technique and Volume Content Viewing ........ 119
A. Hesse
Clinical TNM Cancer Staging with Endosonography 127
T. L. Tio
Subject Index ............................ 143
List of Authors
Bolondi, Luigi, M. D., Prof.
Clinica Medica Universita di Bologna, Policlinico S. Orsola,
Via Massarenti 9, 40138 Bologna, Italy
Born, Klaas, Ph. D., Prof.
University of Rotterdam, Thorax Centre EE 2302,
p. O. Box 1738, 3000 DR Rotterdam, The Netherlands
Fukuda, Morimichi, M. D., Prof.
Sapporo Medical College Hospital,
Department of Ultrasound and Medicine Electronics,
S.l, W.17 Chuo-ku, Sapporo 060, Japan
Goldberg, Barry B., M. D., Prof.
Thomas Jefferson University Hospital, Division of Diagnostic
Ultrasound, 132 S 10th Street, Philadelphia, PA 19107, USA
Hesse, Alexander, Dr. lng.
View Point GmbH, Talhofstr. 30, 8031 Gilching, FRG
Heyder, Norbert, M. D., Prof.
Medizinische Klinik mit Poliklinik, Universitat
Erlangen-Nurnberg, Krankenhausstr. 12, 8520 Erlangen, FRG
Kratochwil, Alfred, M. D.
Allgemeines Offentliches Krankenhaus der Kurstadt Baden,
Gynakologie, Wimmergasse 19, 2500 Baden, Austria
Limberg, Bernd, M. D.
Klinik Wolfenbuttel, Abteilung Innere Medizin,
Akademisches Lehrkrankenhaus der Universitat G6ttingen,
Alter Weg 80, 3340 WolfenbiittelJBraunschweig, FRG
Livraghi, Tito, M. D., Prof.
Department of Radiology, Ospedale Civile,
20059 Vimercate (MI), Italy
X List of Authors
SchlieJ, Reinhard, M. D., Dipl.-Phys., Dr. Ing.
Clinical Research Diagnostics, Schering AG, Postfach 6503 11,
1000 Berlin 65, FRG
Tio, Thian Lok, M. D.
Georgetown-University, Medical Center,
Department of Gastroenterology, 3800 Reservoir Road,
Washington, DC 20072197, USA
Tuthill, Theresa Anne, Ph. D.
Department of Electrical Engineering,
University of Rochester, Rochester, NY 14627, USA
Saccharide-Based Ultrasound Contrast
Media: Basic Characteristics and Results
of Clinical Trials
R. Schlief, R. Schiirmann, and H. P. Niendorf
Introduction
Signal intensity in the image is due to the acoustic backscatter behaviour of
the body region under investigation (echogenicity); it also depends on the
existence of acoustic inhomogeneities in the micrometer range. Echo
enhancing agents must, therefore provide a sufficiently large and reproduci
ble number of micrometer-sized acoustic scatterers in the body region of
diagnostic interest. Following the pioneering work of Gramiak and Shah in
1968 [1], it was reported by Meltzer and coworkers in 1980 [2] that tiny
gaseous bubbles (microbubbles), within specially prepared solutions, create
the desired echo-enhancing effect in the blood after injection. All industrial
developments known so far from publications are based on gaseous
microbubbles [3, 4]. Because of their unique acoustic properties, gaseous
bubbles therefore playa similar basic role as contrast agents in ultrasound as
that played by iodine in X-ray diagnosis and by gadolinium in magnetic
resonance imaging.
Without any further stabilisation, microbubbles have a very short life span
after intravenous injection. This causes the well-known problems of repro
ducibility of the echo-enhancing effect of self-made preparations. A further
stress test of intravascular bubble stability is pulmonary transit and the
creation of an echo-enhancing effect in the left heart cavities and arterial
vessels after intravenous injection. Very few currently known agents can do
this.
Characteristics of the Saccharide-Based Agents SH U 454
and SH U 508 A
The concept of the saccharide-based contrast agents SH U 454 and SH
U 508 A is the same: specially produced galactose microparticles that must be
suspended in either watery galactose solution (SH U 454) or sterile water (SH
U 508 A) before use. After injection, the microbubble-containing suspension
leads to a dose-dependent, sharp increase in blood echogenicity until the
tracer microparticles and microbubbles dissolve in the blood stream.
SH U 454 dissolves after dilution before reaching the left heart and
therefore may be used for B-mode and Doppler echocardiography of the right
2 R. Schlief et al.
heart ("right heart agent") and the venous system. It may also serve as an
echogenic indicator solution for investigations of fallopian tube patency.
SH U 508 A displays increased microbubble stability because of a small
change in the galenic formulation compared with SH U 454. After intrave
nous injection it leads to an increase in blood echogenicity which survives
pulmonary transit (transpulmonary agent) and finally subsides in the arterial
system. The transiently echogenic blood stream permits visualisation of the
haemodynamics in B-mode, for example for delineation of endocardial
borders, or may be employed to increase the Doppler signal intensity in the
whole vascular system.
After intravascular dissolution of the acoustically active microstructures,
the remaining tracer compound galactose is degraded mainly in the liver
(independently of insulin). Galactose is known to be non-toxic and to have no
known allergenic potential. The small total amount of air (about 100 Ill) is
excreted by respiration.
It is desirable that acoustic contrast agents in the diagnostic dosage range
lead only to minor and insignificant changes in the overall acoustic properties
of the tissue. Otherwise, scanning artefacts due to change in sound velocity or
attenuation may occur. The bubble-containing microparticle suspensions of
SH U 454 and SH U 508 A exhibit sound velocities within the range of
physiological, values, and in diagnostic concentrations and common trans
ducer frequencies only a minor increase in attenuation can be observed which
does not lead to relevant image disturbances.
A peculiarity of bubble agents is the pressure dependency of bubble
concentration and bubble diameter and consequently their backscatter
properties. As reported recently by Mottley and coworkers [5], bubble agents
show an increasing decay of echogenicity with increasing ambient pressure
within the range of blood pressure (static conditions). Whereas with the
saccharide agent SH U 454 this decay under high pressure needs up to some
minutes, with air-filled spheres of sonicated human albumin the decay time is
only some seconds. Using pressure changes with physiological frequencies
(about 1 Hz) with the saccharide agents a reversible cyclic change in
backscatter was found in vitro. This cyclic response shows a good correlation
with the values of the ambient pressure amplitudes [6]. Figure 1 shows a linear
correlation between a calculated backscatter factor and the pressure
amplitudes using SH U 508 A. Whether this behaviour can be used in future
for evaluation of pressure curves from contrast images is currently under
investigation.
Cavitation phenomena and oscillation of bubbles in the ultrasonic field
have been discussed as sources of potential hazards by inducing cell lysis.
Using ultrasound of therapeutic intensity values, Williams and coworkers [7]
found no increase in lysis of erythrocytes after introducing the microbubble
agent Echovist if the haematocrit value exceeded 5.5 %. Only at non
physiological low haematocrit values of 1 % - 2 % did a measurable increase
in cell lysis occur.