Read iu22_cust_story_weskott.pdf text version

Improved visualization of focal hepatic lesions

Advancing the quality of patient care with contrast enhanced ultrasound

Who/where Dr. Hans-Peter Weskott Siloah Hospital Hannover, Germany

According to the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), ultrasound contrast agents, in conjunction with contrast specific imaging techniques, are increasingly accepted in clinical use for diagnostic imaging and post-interventional workup in several organs.

Display of real-time images at substantially higher spatial and temporal resolution make contrast enhanced ultrasound (CEUS) a valuable alternative to other modalities such as contrast enhanced computed tomography (CECT)1. This is especially true for the liver, where CEUS is used to detect and characterize focal hepatic lesions, as well as plan and guide minimally invasive procedures such as RF ablation and biopsy. The challenge is achieving superior microbubble visualization and penetration for both normal and difficult anatomy in order to support clinical decision making. Quality imaging is essential The Central Ultrasound Department at Siloah Hospital in Hannover, Germany supports four institutional specialties: oncology, cardiology, gastroenterology, and urology, as well as a highly acclaimed surgery department. As head of Central Ultrasound, Dr. Hans-Peter Weskott employs the latest in ultrasound technology completing as many as 80 examinations each day, of which 5 to 7 percent are CEUS exams. For Dr. Weskott, detection and characterization of focal hepatic lesions constitute the majority of non-cardiac CEUS applications at Siloah Hospital. Critical to success is the ability to image both normal patients and those who suffer from obesity, fatty liver disease, cirrhosis, and other challenging anatomy. "What we really must have," stresses Dr. Weskott, "are ultrasound devices and probes that penetrate better without sacrificing advantages like good spatial and temporal resolution."

Challenge Provide all types of patients with optimum care and physicians with lesion clarity during contrast enhanced ultrasound examinations

Solution Improve penetration and visualization of focal hepatic lesions using Philips iU22 in conjunction with C5-1 abdominal transducer and coded contrast harmonics

"I've been using the Philips iU22 for eight or nine months now and I am astonished how good the grayscale image quality is, how impressive the contrast resolution seems to be, and how many lesions that are similar to normal liver tissue you can detect with the latest C5-1 transducer." ­ Dr. Weskott

Using the Philips iU22 intelligent ultrasound system with the C5-1 PureWave abdominal transducer and coded contrast harmonics pulsing technology, Dr. Weskott and his staff experience the advantages of deeper penetration and higher resolution to visualize micro-vascular structures and blood flow kinetics throughout the entire liver--even in patients with challenging anatomy. Technology with a Philips edge Worldwide, Dr. Weskott is recognized as a luminary in the field of applied ultrasound and internal medicine, and assesses new technologies for applicability to improving CEUS. His response to the recent acquisition of Philips ultrasound technology has been quite positive, "I've been using the Philips iU22 for eight or nine months now and I am astonished how good the grayscale image quality is, how impressive the contrast resolution seems to be, and how many lesions that are similar to normal liver tissue you can detect with the latest C5-1 transducer." "I must say it is astonishing how well the C5-1 works in the far field," says Weskott. "When you activate penetration I would have expected to have seen a brighter image in the far field, but it is very detailed, it has a very high spatial resolution. This is really a big step forward."

In addition, the iU22's latest pulsing technology, coded contrast harmonics, enhances the C5-1 performance to further improve image quality--especially in challenging anatomy. While conventional pulsing schemes used in CEUS may trade spatial resolution for penetration, Philips coded contrast harmonics increases the signal-to-noise ratio to improve penetration and sensitivity in order to maintain spatial resolution. Dr. Weskott understands that he cannot detect all the lesions in the liver that are clinically relevant without using contrast agents, "so detection," he points out, "is the first and most striking difference when being compared to non-contrast enhanced studies." Yet, detection is only one of many ways in which CEUS is used to gain access to more information throughout the entire patient cycle of care. Clarity across contrast phases CEUS allows the physician to characterize a focal hepatic lesion by observing the tumor's micro-vascularization and blood flow kinetics. Observation across the tumor's arterial, portal and late (parenchymal) phases can help determine whether a lesion is likely malignant or benign. The wash in behavior of

contrast bubbles allows a more detailed characterization of focal liver lesions. During the arterial phase different entities of liver tumors like FNH, hemangiomas or the vascularity of malignant diseases can be defined and help monitoring the effect of tumor treatment. The importance of observing these phases is described by Dr. Weskott, Dr. Weskott describes the importance of observing these phases, "The portal venous and the late phase are the phases in which the contrast agent in a malignant lesion is being washed out so the main differences between benign and malignant lesions is their behavior during these phases." He continues, "When we observe the contrast behavior or the kinetics over time, we realize which lesions wash out and which don't. We've found the C5-1 transducer along with coded contrast harmonics to be the perfect tools for clearly detecting microbubbles during these phases." Dr. Weskott finds the C5-1 transducer provides new insights during the initial arterial phase. As he states, "Using second generation contrast agents such as SonoVue*, we find that the arterial phase gives us a lot of additional information to better characterize lesions, such as the hypervascularity of hepatocellular carcinomas.

*

SonoVue is a registered trademark of Bracco Diagnostics, Inc.

The C5-1's excellent sensitivity is evident when looking at the arterial phase. In fact, the sensitivity is so good you actually need very little contrast to demonstrate the vasculature of the tumor." An added benefit Dr. Weskott has also observed another benefit from the combination of the C5-1 PureWave transducer and coded contrast harmonics. A typical CEUS focal liver lesion exam may call for 2 milliliters (ml) of ultrasound contrast agent. Standard transducers require this dosage to deliver diagnostic quality images. Dr. Weskott has observed that with the C5-1, "As a result of this probe's high sensitivity, we've found you only have to administer small amounts of contrast agent. In fact we've started to use doses below 0.5 ml. I remember one young patient in particular with a focal nodular hyperplasia in the near field. I needed to administer only 0.1 ml which was sufficient to show the vasculature of the tumor."

A valuable tool across the care cycle CEUS can play a role as the imaging modality for the ablation process in each of the following procedural steps2: · Pre-treatment assessment of lesion vascularity · Guidance of the ablation needle or probe · Immediate assessment of the therapeutic results · Post-ablation follow-up Dr. Weskott puts the iU22 and C5-1 to just such use, "After RF or microwave ablation, for example, we like to know as early as possible if the treatment has been successful or if there is still any residual tumor tissue that must be treated." Over the course of a treatment regimen CEUS may also be used to monitor the efficacy of certain therapies such as chemotherapy or anti-angiogenic drug therapy where regular serial exams and comparison of changes to micro-vascular structure can aid in tracking a patient's response to the drugs. As Weskott

explains, "For follow-up, CEUS is also a very important tool. In malignant diseases, chemotherapy is the leading type of on-going therapy our patients receive, so we would like to get an answer as to how efficient this therapy was." Throughout the patient cycle of care, Dr. Weskott uses the Philips iU22 system and the C5-1 PureWave transducer. Advanced, comprehensive CEUS solutions provide him with the confident ability to image difficult anatomy and acquire outstanding real-time images. Weskott concludes, "I can tell you that with this system and the new technology that Philips offers, we have increased our diagnostic confidence, spent less money per patient, and delivered throughout the cycle of care with continued effectiveness."

"I can tell you that with this system and the new technology that Philips offers, we have increased our diagnostic confidence, spent less money per patient, and delivered throughout the cycle of care with continued effectiveness." ­ Dr. Weskott

Claudon, M., Cosgrove, D., Albrecht,T., et al. Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS)-- Update 2008, European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), Ultraschall in der Medizin 2008: 29: 28-44.

1,2

Philips Healthcare is part of Royal Philips Electronics How to reach us www.philips.com/healthcare [email protected] fax: +31 40 27 64 887 Asia +852 2821 5888 Europe, Middle East, Africa +49 7031 463 2254 Latin America +55 11 2125 0744 North America + 1 425 487 7000 800 285 5585 (toll free, US only) Philips Healthcare Global Information Center P.O. Box 1286 5602 BG Eindhoven The Netherlands

© 2009 Koninklijke Philips Electronics N.V. All rights are reserved. Philips Healthcare reserves the right to make changes in specifications and/or to discontinue any product at any time without notice or obligation and will not be liable for any consequences resulting from the use of this publication. Printed in The Netherlands 4522 962 43231/795 * MAR 2009

Information

4 pages

Report File (DMCA)

Our content is added by our users. We aim to remove reported files within 1 working day. Please use this link to notify us:

Report this file as copyright or inappropriate

188779