Purpose: Although the number of patients undergoing contrast-enhanced ultrasound (CEUS) with perflubutane has increased continuously since its introduction, its safety and efficacy in multiple patients with various chronic and concomitant disease and from multiple institutions has remained unreported. We therefore carried out a drug-use results survey to assess the safety and efficacy of perflubutane in clinical practice. Subjects and Methods: Subjects were patients to whom perflubutane had been administered for ultrasound contrast imaging of focal hepatic lesions, for which perflubutane is indicated. The survey was conducted nationwide in an attempt to collect data from 3,000 subjects. Results and Discussion: We collected data from 3,655 subjects in 257 institutions. Adverse reactions occurred in 16 of the 3,418 subjects deemed eligible for safety evaluation, and the incidence of adverse reactions was 0.5%. However, none of adverse reactions were serious. Moreover, no concerns requiring special safety measures were identified. Among the 3,283 subjects eligible for efficacy evaluation, the efficacy in tests for all purposes for CEUS in vascular imaging, in post vascular imaging, and in overall efficacy was 92.5%, 93.2%, and 94.1%, respectively. Efficacy ranged between from 83.0% and 97.5% throughout, for all purposes and in each imaging, indicating that the efficacy in clinical practice had been demonstrated. Conclusion: CEUS with perflubutane has the potential to become a safe modality for both diagnosis and therapy of hepatic focal lesions, including such uses as US-guided RFA and evaluation of therapeutic effects.

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Purpose: To prevent reocclusion after various recanalization therapies, we conducted an in vitro experiment using bovine fibrin clot and middle frequency ultrasonication to examine the ultrasonic therapeutic effect suppressing the regrowth of thrombi. Degree of ultrasonic control was quantitatively evaluated according to ultrasound (US) intensity. Methods: Discoidal clots created using bovine plasma with CaCl₂ (final concentration, 25 mM) at 37 degrees C in a circular container 15 mm in diameter and 1.5 mm deep. Fresh bovine plasma was placed on the clot after 30 minuets, and in an another container that was ultrasonicated for 30 minutes in a water bath at 37 degrees C. Growth rate was calculated by measuring change in clot thickness before and after sonication, from changes in optical absorption measured using a new precise optical system. Our new optical system utilized the relationship between spatial clot growth and US spatial intensity distribution on the discoidal clot. US conditions: frequency, 500 kHz; continuous wave intensity, 0.07 to 0.72 W/cm²; and transducer diameter; 10 mm. Results: Suppression of thrombus growth was significantly greater in the US group than in the Non-US group, in which the controlled ratio increased over the intensity range of 0.28 to 0.72 W/cm² (p⟨ 0.05). Conclusions: These results suggest that a novel US control effect of thrombus regrowth with a middle frequency and low intensity can serve as a new noninvasive method for preventing thrombotic reocclusion in clinical risks caused by the various recanalization techniques.

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Introduction: Atrial dilation and left ventricular hypertrophy in hypertensive patients are known predictive factors for cardiovascular disease. We investigated whether stratification of the cardiovascular events onset was possible from echocardiographic parameters in patients with hypertension. Subjects and methods: The subjects were 357 consecutive patients with hypertension receiving drug therapy and were aged from their 20’s through their 80’s (mean age: 64.7±13.4 years, males/females: 194/163) who had undergone echocardiographic examination. Patients with atrial fibrillation, ischemic heart disease, and more-than-moderate mitral valve regurgitation, as well as hypertensive patients in whom it was difficult to perform follow-up examinations, were excluded. The relation between the patients’ clinical characteristics, echocardiographic parameters, and incidence of cardiovascular events (heart failure, acute coronary syndrome, and stroke) were investigated. Results: Events occurred in 24 cases (11 cases of heart failure, 5 cases of acute coronary syndrome, and 8 cases of stroke) while we were observing patient progress after echocardiography (average: 821±443 days). The subjects were divided into 2 groups depending upon whether or not an event had occurred. A multivariate analysis with an explanatory variable for items for which a univariate analysis using logistic regression analysis had shown a significant difference, showed that left atrial volume index (LAVI) and left ventricular mass index (LVMI) were predictive factors for occurrence of cardiovascular events [LAVI: Odds Ratio (OR) 1.07, p=0.003, LVMI: OR 1.02, p=0.007]. LAVI and LVMI were divided into 4 grades (normal, mild, moderate, and severe) and scored from 0 to 3 points. The LALV index was defined as the total LAVI and LVMI scores of all subjects. When a survival analysis was conducted according to the Kaplan-Meier method, the incidence of cardiovascular events was significantly higher (Log-rank, p⟨0.0001) when the LALV index was higher. Conclusion: Our results suggest that quantitative evaluation using both LAVI and LVMI indices is a useful method for predicting occurrence of cardiovascular events in patients receiving hypertension therapy.

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A 68-year-old man with a hepatic tumor presented to our outpatient clinic in 2009. Ultrasonography visualized a 50 mm hypoechoic nodule in segment 6. Contrast-enhanced ultrasonography (CEUS) revealed a hypervascular spoke-wheel-like lesion in the early phase and a heterogeneous lesion in the Kupffer phase. Contrast-enhanced CT revealed enhancement of the mass with a delayed central enhancement pattern. . Contrast-enhanced MRI using Gd-EOB-DTPA showed a heterogeneous, hypervascular mass in the early phase. In the hepatobiliary phase, the mass was hypointense, and another hypointense lesion was seen in segment 2. The two nodules were diagnosed based on the imaging findings as scirrhous type hepatocellular carcinoma. The patient underwent partial hepatectomy and the pathological findings were found to correlate with the imaging.

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The patient was a 22-year-old man with left lower abdominal pain. Blood examination showed WBC, 11,900/μl; CRP, 0.3 mg/dl. Abdominal ultrasonography (US) revealed a relatively well-delineated oval hyperechoic mass (18 x 13 mm), surrounded by a hypoechoic rim in the anterior wall of the sigmoid colon corresponding to the tender area, and linear low echoes that were continuous with the hypoechoic rim, separating thick fat immediately below the abdominal wall from peritoneal fat. Doppler US showed no clear blood flow signals in the hyperechoic mass or surrounding fat tissue. When US and CT images were compared, a linear high-attenuation area in the middle of the oval mass observed in the CT images could not be identified in the US images, although the mass as a whole consisted of fat tissue. The hypoechoic rim surrounding this fatty mass was visualized as a high-attenuation area in CT images and was a swelling of the serosa. The linear low echoes observed in the US images represented the parietal peritoneum, while those of the hypertrophied fat layer represented inflammatory edema of the mesenteric fat tissue. Contrast-enhanced US (CEUS) using Sonazoid^® revealed no inflow of the contrast agent into the hyperechoic mass, but showed enhancement of the hypoechoic rim and surrounding mesenteric fatty tissue. We based our diagnosis of primary epiploic appendagitis on these results. Hemodynamic changes were recognized when US and CT images of the epiploic appendagitis lesion of this patient were compared, using Doppler and CEUS.

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Klippel-Trenaunay-Weber syndrome is a rare congenital disorder of the soft-tissue. It is characterized by multiple hemangioma and asymmetric limb hypertrophy. Although several cases have been reported in neonates, few have been reported in fetuses. We report a case of enlargement of the right leg accompanied by multiple cystic lesions detected by ultrasound examination at GA 17 weeks. Our diagnosis was Klippel-Trenaunay-Weber syndrome. We were able to monitor the progression of abnormal ultrasound findings over a period of three weeks. After having been counseled about the diagnosis and its variable prognosis, the patient elected to have her pregnancy terminated. The ultrasound findings were confirmed at necropsy. We discuss the natural history and prognosis of this syndrome.

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Purpose: Visualization of a lesion by ultrasonography (US) is indispensable in the local treatment of hepatocellular carcinoma (HCC). Although treatment using contrast US and fusion imaging technologies that combine US images with those obtained using CT and MRI is increasingly being applied to lesions undetected by B-mode US, adequate treatment is sometimes difficult to accomplish. We attempted to determine if GPS markers, which enable us to continuously track points marked on the image and display them, was useful in identifying HCC lesions that B-mode US had failed to detect and was therefore useful in guidance in local treatment. Methods: One or two GPS markers were set in an area adjacent to the target lesion in a phantom, and when the angle between the contact surface of the phantom and the probe was changed and the probe was rotated, we investigated the appearance of the guide and looked for a way to detect a target lesion more clearly. We applied our results in using contrast US. Results: To detect the target lesion and synchronize it, we had to adjust for the combined effects of the placement of the probe, the angle of the probe, and the rotation of the probe. When two GPS markers were set in an area adjacent to the target lesion and both were displayed as plus signs, it was possible to reproduce the angle and rotation angles between the probe and surface of the body. Conclusion: Clear and reproducible visualization of a target tumor is essential in the local treatment of HCC. Although has often been left up the skill of the examiner to reproduce the angle and rotation angle between the probe and body surface, image reproduction was achieved and continuous visualization of a cross-section of the target lesion was made possible by setting two GPS markers adjacent to the target lesion while controlling the probe so that both markers were displayed as plus signs.

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