title: Perfusion quantification of vascular malformations using contrast-enhanced ultrasound (CEUS) with time intensity curve analysis before and after treatment: First results.
abstract: OBJECTIVE
  Aim of this pilot-study was to quantify perfusion changes of vascular malformations before and after the first interventional treatment using contrast-enhanced ultrasound (CEUS).
  
  
  METHODS
  29 patients (10 male, 19 female) between 6 and 63 years (mean 28.1 years) with 12 arterio-venous (AVM) and 17 venous malformations (VM) were examined before and after their first percutaneous interventional treatment. CEUS was performed with a 2.4 ml bolus injection of sulfur-hexafluorid microbubbles, and a 6-9 MHz mulitfrequency transducer. A 60 sec cine sequence was recorded and regions of interest (10 mm×30 mm) were defined in the centre, and the margins of the vascular malformation as well as in the surrounding healthy tissue. Time Intensity Curves (TIC) were analysed, and Time to Peak (TTP) as well as Area under the Curve (AUC) were calculated.
  
  
  RESULTS
  For VM there was a significant perfusion difference (p < 0.05) in AUC between centre and the surrounding tissue before (323.1 vs. 130.4 rU) and after treatment (331.0 vs. 106.9 rU). There was no significant difference for TTP in ROIs of VM (19.1 vs. 26.5 sec). After the treatment there was a significant decrease in AUC for all three regions in AVMs, and an increase in TTP for AVM. However TTP for AVM in the centre ROI still remained shorter than in the surrounding tissue even after therapy (20.9 vs. 25.4 sec).
  
  
  CONCLUSIONS
  CEUS with TIC analysis is a promising imaging method for the evaluation of perfusion before and after percutaneous treatment of vascular malformations. AUC decrease indicates therapy-induced changes in perfusion of VM whereas an increase in TTP shows therapy-related changes in AVM.
authors.affiliation: Institute of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Wiesinger
authors.affiliation: Institute of Dermatology, University Hospital Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schreml
authors.affiliation: Institute of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany.
authors.forename: W A
authors.initials: WA
authors.lastname: Wohlgemuth
authors.affiliation: Institute of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Stroszczynski
authors.affiliation: Institute of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee, Regensburg, Germany.
authors.forename: E M
authors.initials: EM
authors.lastname: Jung
mesh_terms: D000293:Adolescent; D000328:Adult; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging*; D002648:Child; D003287:Contrast Media / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: Contrast-enhanced ultrasound (CEUS); TIC analysis; arterio-venous malformation; venous malformation