Contrast-enhanced US improved sensitivity and specificity in the detection of hepatic metastases.

Contrast-enhanced phase-inversion sonography in the liver-specific phase of contrast enhancement using Levovist provides a marked improvement in the detection of hepatic metastases relative to unenhanced conventional sonography, without loss of specificity. Phase-inversion sonography was particularly advantageous in detecting small metastases and may be a competitive alternative to CT and MR imaging.

Background. Early haemodynamic assessment is of particular importance in the evaluation of haemodynamically compromised patients, but is often precluded by the invasiveness and complexity of the established cardiac output (CO) monitoring techniques. The FloTrac TM /Vigileo TM system allows minimally invasive CO determination based on the arterial pressure waveform derived from any standard arterial catheter, and the algorithm underlying CO calculation was recently modified to allow a more precise estimate of aortic compliance.Methods. Using the new software, we studied 25 haemodynamically unstable patients who had a radial artery catheter and underwent invasive haemodynamic monitoring with the PiCCO TM system. PiCCO TM -derived transpulmonary thermodilution and pulse contour CO (reference-CO) were compared with the CO values obtained with the FloTrac TM /Vigileo TM system (AP-CO). Reported CO values are indexed to body surface area. Agreement between reference-CO and AP-CO recorded during routine clinical care was assessed using Bland -Altman statistics.Results. Overall bias between the reference-CO and the AP-CO (n¼324) was 0.68 litre min 21 m 22 with a high percentage error of +58.8% (95% limits of agreement +1.94 l min 21 m 22 ). There was a significant difference (P,0.001) between the radial and the femoral mean arterial pressures, and bias was significantly larger for a mean pressure difference of .5 mm Hg (0.93 vs 0.57 litre min 21 m 22 , P¼0.032). No connection was found between the norepinephrine dose and the CO agreement.Conclusions. Despite the updated algorithm, AP-CO still showed a limited agreement with the reference-CO and systematically underestimated the CO so that the method is not suitable to replace invasive CO monitoring at present.

With use of SH U 508A-enhanced agent detection imaging, liver lesion characterization and diagnostic performance are significantly improved.

Abstract-The introduction of automated oscillometric blood pressure monitors was the basis for today's widespread use of blood pressure self-measurement. However, in atrial fibrillation, there is a controversial debate on the use of oscillometry because there is a high variability of heart rate and stroke volume. To date, the accuracy of oscillometric blood pressure monitoring in atrial fibrillation has only been investigated using auscultatory sphygmomanometry as reference method, which may be biased by arrhythmia as well. We performed a cross-sectional study in 102 patients (52 sinus rhythm, 50 atrial fibrillation) assessing the accuracy of an automated and validated oscillometric upper arm (M5 Professional, Omron) and wrist device (R5 Professional, Omron) to invasively assessed arterial pressure. Blood pressure values were calculated as the mean of 3 consecutive measurements. Systolic and diastolic blood pressure did not significantly differ in patients with sinus rhythm and atrial fibrillation, independent of the method of measurement (P>0.05 each). The within-subject variability of the oscillometric measurements was higher in patients with atrial fibrillation compared with sinus rhythm (P<0.01 each). The biases of systolic and diastolic blood pressure, however, did not significantly differ in presence or absence of atrial fibrillation in Bland-Altmann analysis (P>0.05 each). In conclusion, atrial fibrillation did not significantly affect the accuracy of oscillometric measurements, if 3 repeated measurements were performed. (Hypertension. 2013;62:579-584.)

Detection of hepatic metastases is substantially improved by low MI real time contrast enhanced ultrasound with SonoVue compared to conventional B-mode sonography.

IntroductionThe liver has several features that make it a common site for metastases from malignancies of other organs. These are the dual blood supply via the portal vein and the hepatic artery, the high volume of blood flow (about a quarter of the cardiac output), the microscopic vascular anatomy which favours tumour cell trapping, and the major role that the liver plays in metabolism that provides an ideal environment for rapid growth [1]. Therefore, in 25-50% patients with a known malignancy, liver metastases are found at the time of diagnosis with decreasing frequency in colon, gastric, pancreatic, breast and lung cancer [2].Accurate and timely detection of hepatic metastases is very important because of the far-reaching therapeutic and prognostic implications. Especially after the recent improvements in liver resection and thermoablation of metastases from colorectal carcinoma, liver imaging has become more demanding. Accurate assessment of the number, size and segmental location of liver metastases is required for treatment planning and so as to identify patients that are suitable for surgical or interventional therapy.Besides metastases, there are a number of other, mainly benign, types of focal liver lesions which have to be differentiated from metastases. Benign liver lesions are very common: their prevalence has been reported to be more than 20% in non-selected autopsy series [3,4]. As a consequence of this, in patients with extrahepatic malignancy, about 50% of solid lesions smaller than 2 cm are benign [5,6]. The most common benign liver lesions are simple cysts, but they are usually easily recognised as such by imaging. More challenging is the characterisation of common solid lesions such as haemangiomas, focal nodular hyperplasia (FNH) and focal fatty change/sparing. Adenomas are much rarer and occur almost exclusively in patients on sex hormone medication. Other rare but relevant benign lesions include focal hepatic infections: pyogenic, parasitic or fungal abscesses. Furthermore, there is a worldwide increase in primary malignant liver lesions, namely hepatocellular carcinomas (HCC), of which 80% are associated with cirrhosis and/or chronic viral hepatitis [3], and this is an important differential diagnostic clue. Other primary malignant liver lesions such as cholangiocarcinoma are much rarer.The cross-sectional imaging methods used for liver imaging (computed tomography) (CT), magnetic resonance imaging (MRI) and grey-scale ultrasound (US) are based on assessment of lesion morphology. The use of contrast agents increases both sensitivity and specificity of lesion detection considerably and provides crucial additional information about the dynamic contrast behaviour for lesion characterisation. In contrast to CT and MRI, US is inexpensive and widely available with no radiation exposure and good patient acceptance. US is therefore often the first-line investigation for hepatic screening of cancer patients. However, mainly due to a lack of contrast agents, US used to be less sensitive and less spe...

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