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Improved Imaging of Liver Metastases with Stimulated Acoustic Emission in the Late Phase of Enhancement with the US Contrast Agent SH U 508A: Early Experience

¹ Department of Imaging, Hammersmith Hospital, Du Cane Rd, London W12 0HS, England (M.J.K.B., T.A., D.O.C., N.P., V.J., J.B.B., R.J.E.)
² Clinical Development Diagnostics, Schering, Berlin, Germany (A.B., R.S.).

View larger version (140K): [in a new window]   Figure 1a. The SAE effect illustrated in the liver of a 33-year-old healthy male volunteer. Intravenous SH U 508A (2.5 g) had been administered 5 minutes before a was obtained. (a) Color Doppler has been turned on, producing a band of strong mosaic-like parenchymal signal (arrow) on the first color Doppler frame. (b) The frame obtained immediately after a, with a delay of 0.2 second, shows a reduction in the SAE (arrow), illustrating the transience of the effect. On the following frame (not shown), SAE had almost completely disappeared. Note that SAE is maximal at the level of the focal zone.

View larger version (142K): [in a new window]   Figure 1b. The SAE effect illustrated in the liver of a 33-year-old healthy male volunteer. Intravenous SH U 508A (2.5 g) had been administered 5 minutes before a was obtained. (a) Color Doppler has been turned on, producing a band of strong mosaic-like parenchymal signal (arrow) on the first color Doppler frame. (b) The frame obtained immediately after a, with a delay of 0.2 second, shows a reduction in the SAE (arrow), illustrating the transience of the effect. On the following frame (not shown), SAE had almost completely disappeared. Note that SAE is maximal at the level of the focal zone.

View larger version (140K): [in a new window]   Figure 2a. Transverse section through the left lobe of the liver in a 53-year-old male patient with metastatic carcinoid tumor (arrow) in (a) gray-scale and (b) color SAE displays. Note that in b, SAE is confined to the liver parenchyma around the metastasis, increasing its conspicuity. Also note that there are several smaller defects (arrowheads) in the SAE inferiorly in b, which may represent further lesions.

View larger version (122K): [in a new window]   Figure 2b. Transverse section through the left lobe of the liver in a 53-year-old male patient with metastatic carcinoid tumor (arrow) in (a) gray-scale and (b) color SAE displays. Note that in b, SAE is confined to the liver parenchyma around the metastasis, increasing its conspicuity. Also note that there are several smaller defects (arrowheads) in the SAE inferiorly in b, which may represent further lesions.

View larger version (124K): [in a new window]   Figure 3a. Longitudinal section through the right lobe of the liver in a 65-year-old female patient with a metastatic islet cell tumor in (a, c) gray-scale and (b, d) color displays. The upper and lower edges of the metastasis are indicated with arrows in a. ROIs (red rectangles) have been drawn adjacent to (in a and b) and within (in c and d) this metastasis. The gray-scale and color data were quantified by using the program MATLAB to compare the differences in signal intensities between the lesion and the liver as a measure of lesion conspicuity. In this case, the color conspicuity score was 77%, and the gray conspicuity score was 3%.

View larger version (121K): [in a new window]   Figure 3b. Longitudinal section through the right lobe of the liver in a 65-year-old female patient with a metastatic islet cell tumor in (a, c) gray-scale and (b, d) color displays. The upper and lower edges of the metastasis are indicated with arrows in a. ROIs (red rectangles) have been drawn adjacent to (in a and b) and within (in c and d) this metastasis. The gray-scale and color data were quantified by using the program MATLAB to compare the differences in signal intensities between the lesion and the liver as a measure of lesion conspicuity. In this case, the color conspicuity score was 77%, and the gray conspicuity score was 3%.

View larger version (121K): [in a new window]   Figure 3c. Longitudinal section through the right lobe of the liver in a 65-year-old female patient with a metastatic islet cell tumor in (a, c) gray-scale and (b, d) color displays. The upper and lower edges of the metastasis are indicated with arrows in a. ROIs (red rectangles) have been drawn adjacent to (in a and b) and within (in c and d) this metastasis. The gray-scale and color data were quantified by using the program MATLAB to compare the differences in signal intensities between the lesion and the liver as a measure of lesion conspicuity. In this case, the color conspicuity score was 77%, and the gray conspicuity score was 3%.

View larger version (111K): [in a new window]   Figure 3d. Longitudinal section through the right lobe of the liver in a 65-year-old female patient with a metastatic islet cell tumor in (a, c) gray-scale and (b, d) color displays. The upper and lower edges of the metastasis are indicated with arrows in a. ROIs (red rectangles) have been drawn adjacent to (in a and b) and within (in c and d) this metastasis. The gray-scale and color data were quantified by using the program MATLAB to compare the differences in signal intensities between the lesion and the liver as a measure of lesion conspicuity. In this case, the color conspicuity score was 77%, and the gray conspicuity score was 3%.

View larger version (153K): [in a new window]   Figure 4a. Oblique section through the right lobe of the liver in a 65-year-old male patient with metastatic gastric carcinoma in (a) gray-scale and (b) color SAE display. a shows diffuse heterogeneity of the liver but no definite focal lesion. In b, SAE (arrow) is seen at the level of the focal zone in the liver after SH U 508A administration. A defect (arrowhead in b) in the SAE is observed; this was interpreted as a possible metastasis. (c) Axial CT scan (abdominal soft-tissue window [level, 40 HU; width, 400 HU]) obtained after iopromide administration (300 mg/mL) the same day as a and b reveals multiple hepatic metastases (arrows), as well as long-standing hepatic and splenic calcified granulomata.

View larger version (141K): [in a new window]   Figure 4b. Oblique section through the right lobe of the liver in a 65-year-old male patient with metastatic gastric carcinoma in (a) gray-scale and (b) color SAE display. a shows diffuse heterogeneity of the liver but no definite focal lesion. In b, SAE (arrow) is seen at the level of the focal zone in the liver after SH U 508A administration. A defect (arrowhead in b) in the SAE is observed; this was interpreted as a possible metastasis. (c) Axial CT scan (abdominal soft-tissue window [level, 40 HU; width, 400 HU]) obtained after iopromide administration (300 mg/mL) the same day as a and b reveals multiple hepatic metastases (arrows), as well as long-standing hepatic and splenic calcified granulomata.

View larger version (140K): [in a new window]   Figure 4c. Oblique section through the right lobe of the liver in a 65-year-old male patient with metastatic gastric carcinoma in (a) gray-scale and (b) color SAE display. a shows diffuse heterogeneity of the liver but no definite focal lesion. In b, SAE (arrow) is seen at the level of the focal zone in the liver after SH U 508A administration. A defect (arrowhead in b) in the SAE is observed; this was interpreted as a possible metastasis. (c) Axial CT scan (abdominal soft-tissue window [level, 40 HU; width, 400 HU]) obtained after iopromide administration (300 mg/mL) the same day as a and b reveals multiple hepatic metastases (arrows), as well as long-standing hepatic and splenic calcified granulomata.

View larger version (15K): [in a new window]   Figure 5. Graph demonstrates the improvement in conspicuity, assessed objectively by using ROI analysis, in 16 patients (16 lesions). Conspicuity has been measured by using gray-scale () and color SAE mode () information.

View larger version (158K): [in a new window]   Figure 6a. Longitudinal section through the right lobe of the liver in a 47-year-old male patient in (a) gray-scale and (b) SAE displays. The right lobe of the liver is normal in a, although a single lesion had been seen in segment IV on other views. In b, several color defects are seen within the right lobe. Both observers detected at least one SAE-specific lesion (arrow in b) when presented with the image pair of a and b. (c) Angiogram obtained during the parenchymal phase of selective hepatic arterial injection reveals multiple vascular deposits (arrows) of metastatic carcinoid throughout the liver, including the right lobe. Open hepatic biopsy confirmed metastatic carcinoid tumor.

View larger version (139K): [in a new window]   Figure 6b. Longitudinal section through the right lobe of the liver in a 47-year-old male patient in (a) gray-scale and (b) SAE displays. The right lobe of the liver is normal in a, although a single lesion had been seen in segment IV on other views. In b, several color defects are seen within the right lobe. Both observers detected at least one SAE-specific lesion (arrow in b) when presented with the image pair of a and b. (c) Angiogram obtained during the parenchymal phase of selective hepatic arterial injection reveals multiple vascular deposits (arrows) of metastatic carcinoid throughout the liver, including the right lobe. Open hepatic biopsy confirmed metastatic carcinoid tumor.

View larger version (125K): [in a new window]   Figure 6c. Longitudinal section through the right lobe of the liver in a 47-year-old male patient in (a) gray-scale and (b) SAE displays. The right lobe of the liver is normal in a, although a single lesion had been seen in segment IV on other views. In b, several color defects are seen within the right lobe. Both observers detected at least one SAE-specific lesion (arrow in b) when presented with the image pair of a and b. (c) Angiogram obtained during the parenchymal phase of selective hepatic arterial injection reveals multiple vascular deposits (arrows) of metastatic carcinoid throughout the liver, including the right lobe. Open hepatic biopsy confirmed metastatic carcinoid tumor.

View larger version (162K): [in a new window]   Figure 7a. Longitudinal section through the right lobe of the liver in a 47-year-old female patient. (a) While the B-mode image shows diffuse heterogeneity of the liver, it is hard to clearly define any discrete masses. (b) The SAE image, however, shows multiple defects; the largest of the defects is indicated by an arrow. Both observers detected SAE-specific defects when presented with the image pair of a and b. Metastatic squamous cell carcinoma was proved with hepatic biopsy.

View larger version (155K): [in a new window]   Figure 7b. Longitudinal section through the right lobe of the liver in a 47-year-old female patient. (a) While the B-mode image shows diffuse heterogeneity of the liver, it is hard to clearly define any discrete masses. (b) The SAE image, however, shows multiple defects; the largest of the defects is indicated by an arrow. Both observers detected SAE-specific defects when presented with the image pair of a and b. Metastatic squamous cell carcinoma was proved with hepatic biopsy.