Double contrast-enhanced two-dimensional and three-dimensional ultrasonography for evaluation of gastric lesions.
OBJECTIVE
To investigate the value of two-dimensional (2D) and three-dimensional (3D) double contrast-enhanced ultrasonography (DCUS) imaging for evaluation of gastric lesions.


METHODS
2D and 3D DCUS imaging with both oral and intravenous administrations of contrast agents was used to assess gastroscopiclly-confirmed gastric lesions in 46 patients with benign and malignant diseases. Initially, liquid-based ultrasound contrast agent (Xinzhang®) was given orally at dose of 500-600 mL for conventional ultrasound examination of the gastric lesions, and then a microbubble-based contrast agent (SonoVue) was injected intravenously at dose of 1.2-2.4 mL in bolus fashion to assess the perfusion pattern of the lesions using contrast imaging modes. The parameters derived from time-intensity curves including the arrival time (AT), time to peak (TTP), peak intensity (PI) and enhanced intensity (EI) were measured on the 2D DCUS imaging. 3D DCUS of the lesions was acquired to demonstrate the value of this imaging mode.


RESULTS
There were 22 cases with benign lesions including chronic gastritis (n = 5), gastric ulcer (n = 9), gastric polyps (n = 3), gastric stromal tumors (n = 5), and 24 cases with malignant lesions including gastric cancer (n = 20), gastric cardia carcinoma (n = 3) and post-operative recurrent gastric cancer (n = 1) in the study. The oral contrast-enhanced ultrasonography (CEUS) imaging of the stomach clearly demonstrated the anatomy of the stomach and morphologic features of gastric lesions. With optimal scanning window and imaging display under oral CEUS, intravenous CEUS clearly showed the perfusion of gastric lesions with various characteristic manifestations. Both 2D and 3D DCUS images clearly demonstrated normal gastric wall as a three-layer structure, from the inside out, hyperechoic mucosa, hypoechoic muscularis and hyperechoic serosa, respectively. There were statistical significant differences of AT (8.68 ± 2.06 vs 10.43 ± 2.75, P = 0.017), PI (34.64 ± 6.63 vs 29.58 ± 8.22, P = 0.023) and EI (29.72 ± 6.69 vs 22.66 ± 7.01, P = 0.001) between malignant lesions and normal gastric wall. However, no differences of AT, PI and EI between benign lesions and normal gastric wall tissue were found. 3D DCUS could intuitively display morphological features and vascularities of the lesions with multiplanar and volume views. 3D DCUS imaging provided comprehensive information complementary to 2D imaging. The crater or wellhead appearances and feeding vessels as well as distorted nourishing vasculature of gastric carcinoma were better seen with 3D imaging than 2D imaging.


CONCLUSIONS
DCUS imaging can simultaneously display the anatomic and perfusion features of gastric lesions. 3D DCUS can provide additional information to 2D DCUS for evaluation of gastric lesions.
Department of Ultrasound, The 117th Hospital of PLA, Hangzhou 310013, Zhejiang Province, China. xuyyzh@hzcnc.com
Hong
H
Shi
Xiu-Hua
XH
Yu
Xin-Zhang
XZ
Guo
Yuan
Y
Guo
Hong
H
Zhang
Bin
B
Qian
Zhang-Rui
ZR
Wei
Li
L
Li
Xian-Chen
XC
Wang
Zi-Xiang
ZX
Kong
D061605:Administration, Intravenous; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005756:Gastritis / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D013276:Stomach Ulcer / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography / Q000379:methods*
D003287:Contrast Media