Purpose: To assess the feasibility of contrast-enhanced ultrasound (CEUS) with Sonazoid® for the evaluation of response to neoadjuvant chemotherapy in breast cancer patients.
Subjects and Methods: Thirty-three patients (all women, mean age 49.5 years) with 35 histologically confirmed breast cancers were evaluated. The enhancement patterns of the lesions were stored for 1 minute after bolus injection of the micro bubble contrast agent “Sonazoid®”. Time intensity curve (TIC) analysis was performed by placing the region of interest (ROI) at showing the strongest enhancement region. Time to peak (TTP, s) and mean transit time (MTT, s) were calculated. Histological evaluation of treatment response (HE) was graded from 0 to 3 according to the Japanese breast cancer guideline. The HE was further categorized into 2 groups; grade 0 to 2 was for a non-complete responder and grade 3 was for a complete responder. The Response Evaluation Criteria in Solid Tumors (RECIST) by ultrasonography (US) and contrast-enhanced MRI were also performed. Each CEUS value was compared between complete responders and non-complete responders. Statistical analysis was performed by the Mann–Whitney U test and Spearmann's rank correlation (p<0.05 was considered significant).
Results and Discussion: The HE values of responders and non-complete responders were 6 and 29 nodules, respectively. Respective post-treatment evaluation by CEUS of TTP (mean±SD, range) and MTT values were: responders, 75.7±72.0 s, 17.2 to 158.8 s and 75.7±72.0 s, 17.2 to 158.8 s: and non-complete responders, 6.0±3.0 s, 2.9 to 14.1 s and 15.6±12.5 s, 4.3 to 57.7 s. There were significant correlations between TTP and HE (ρ=0.613, p<0.01) , and MTT and HE (&rho=;0.698, p<0.01). Clinical response (RECIST) by US of PD, SD, PR and CR were 1, 7, 27, and 0, respectively. RECIST by US failed to detect CR. Clinical response (RECIST) by contrast-enhanced MRI of PD, SD, PR and CR were 1, 8, 22, and 4, respectively.
Conclusion: CEUS was judged to have a good potential for application to the evaluation of response to neoadjuvant chemotherapy in breast cancer patients.

View full abstract

Purpose: To clarify the measurement accuracy of pulsed-Doppler method (Echo method) in pulmonary to systemic flow ratio (Qp/Qs) in patients with atrial septal defect (ASD).
Subjects and Methods: We enrolled 31 consecutive ASD patients who underwent the Echo and Fick method (53±18 years, 11 males). According to Qp/Qs values obtained by two methods, the patients were divided into 3groups: match-group (Within 20% of the difference of Qp/Qs between Echo and Fick method, n＝18), underestimate-group (more than 20% lower Qp/Qs by Echo method, n＝6) and overestimate-group (more than 20% higher Qp/Qs by Echo method, n＝7)．LVOT and RVOT diameter (RVOTd), and body surface revision level of each measurement item, left and right ventricular ejection bleeding flow time speed integral value, and the angle formed by RVOTd and ultrasonic beam in RVOTd measurement cross section (RVOTd measurement angle) were compared among 3 groups.
Results and Discussion: In overall, good correlation was observed between Qp/Qs by Echo and Fick method (r＝0.70, p<0.01). Four patients (67%) of underestimate-group showed Qp/Qs values of 3 to 4 (3≤Qp/Qs<4) by Fick method. Five patients (71%) of overestimate-group had Qp/Qs values of 2 to 3 (2≤Qp/Qs<3) by Fick method. Compared with the match-group (3≤Qp/Qs<4: 17.4±2.0 mm/m², 2≤Qp/Qs<3: 19.3±1.3 mm/m²), RVOTd indexed by body surface area was significantly lower in underestimate-group (14.6±0.9 mm/m², p<0.05), and larger in overestimate-group (22.7±3.7 mm/m², p<0.05). Compared to the match-group (31.9±17.1 degree), both underestimate- and overestimate-group showed larger RVOTd measurement angle (65.0±4.5 degree, p<0.01, 63.6±11.8 degree, p<0.01), which suggests that ultrasound beam parallel to RVOT wall could induce larger measurement error of RVOT diameter due to lower lateral resolution than axial resolution or various artifacts.
Conclusion: In the measurement of RVOT, ultrasound beam perpendicular to RVOT wall could provide higher accuracy of Qp/Qs.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract