The potential role of modern US in the follow-up of patients with retroperitoneal fibrosis

Abstract

ABDOMINAL IMAGINGORIGINAL ARTICLE PURPOSE We aimed to evaluate a standardized ultrasonography (US) algorithm for the visualization of pathologic para-aortic tissue in retroperitoneal fibrosis (RPF). MATERIALS AND METHODSThirty-five patients with lumbar RPF of typical extent, as determined by abdominal magnetic resonance imaging, were included. Examinations were conducted using standardized abdominal US with axial sections obtained at the levels of the renal arteries, aortic bifurcation, and both common iliac arteries. Imaging of each section was acquired with fundamental B-mode (US) and tissue harmonic imaging, respectively. In addition, we examined RPF visualized using extended fieldof-view US. RESULTSTissue harmonic imaging adequately visualized RPF of typical extent in 33 patients (94.2%). Excellent and good visualization with mild artifacts were achieved in 25 (71.4%) and six (17.1%) patients, respectively. When RPF spread along the iliac arteries, excellent visualization was achieved in 38.7% for the left side and 34.5% for the right side. There were significantly fewer diagnostic examinations for the right iliac (27.6%) than for the left one (9.7%) (P = 0.016). Overall, harmonic imaging achieved significantly better visualization than fundamental B-Mode (P < 0.001). CONCLUSIONWe described the first systematic evaluation of RPF visualization by modern US techniques. The best imaging quality was found in the typical RPF location, at the level of the aortic bifurcation. These results advocate for the presented US algorithm as an efficient follow-up alternative to cross-sectional imaging in RPF patients.

Ultrasound imaging in the diagnosis of large vessel vasculitis

“…Adiposity and overlying gas and fl uid fi lled bowel loops can signifi cantly impair the visualization of the abdominal aorta. Moreover, the extent of the infl ammatory tissue to the iliac and renal artery level could not be established by US in 23.5 % (renal arteries) to 58.8 % (right iliac artery level) in one study [86]. Therefore, in today's clinical practice US is useful for screening of CP, but should be combined with cross-sectional imaging in most cases in order to verify the diagnosis and document the full extent of the fi broinfl ammatory process.…”

“…In small studies from the 1980's, US yielded poor sensitivity for the diagnosis of CP [84,85]. With modern US technique the sensitivity has increased dramatically, reaching 94.2 % in a contemporary study comparing standardized B-mode US (tissue harmonic imaging) with MRI [86]. Adiposity and overlying gas and fl uid fi lled bowel loops can signifi cantly impair the visualization of the abdominal aorta.…”

Retroperitoneal Fibrosis and its Differential Diagnoses: The Role of Radiological Imaging

“…Die Sonografie galt als nichtadäquate Methode; neuere Publikationen von Autoren wie z. B. Kamper et al zeigen jedoch, dass die moderne Sonografie unter speziellen Rahmenbedingungen als Methode zur Verlaufskontrolle eingesetzt werden kann [24]. 35 Patienten mit mittels MRT gesicherter RPF in typischer Ausbreitung wurden sonografisch mit 4 standardisierten Schnitten (transversal auf Höhe des Nierenstiels, auf Höhe der Aortenbifurkation sowie jeweils transversal durch die Arteria iliaca communis) korreliert.…”