Combining Fusion and Contrast-enhanced ultrasound CEUS

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ACUSON Sequoia Ultrasound System Combining Fusion and Contrast-enhanced ultrasound CEUS Case study The scientific overlay is not that of the individual pictured and is not from a device of Siemens Healthineers. It was modified for better visualization. Ultrasound is an effective tool for interventional Case study procedures that provides real-time, dynamic information and is radiation free. Inherent challenges with ultrasound such as bowel gas, or low conspicuity lesions detection, History can be overcome with modalities such as CT (Computed 24-year-old female with aggressive Adrenal Cortical Tomography) or MRI (Magnetic Resonance Imaging). Carcinoma and liver metastasis was treated with However, these modalities lack the real-time advantage surgical removal of the primary cancerous area and of ultrasound imaging. Thanks to advancements in liver metastasis. Surgical notes included a bleeding technology, ultrasound can now be fused with images complication resulting in the insertion of metallic from CT or MRI that provides dynamic, multi-modality clips. Pathology determined the resection margin imaging that can provide greater diagnostic confidence. of the metastatic area within the liver was not clear (R1 classification) and the patient was referred for This synchronous association of ultrasound with CT radiotherapy. As part of the radiotherapy treatment or MRI, allows the clinician to exploit the strengths of protocol, a contrast-enhanced MRI was ordered and each imaging modality (i.e. the real-time aspect of performed, however the patient had an allergic reaction ultrasound) and minimize the weaknesses (i.e. lesions to the MRI contrast agent. A three-month follow-up was with low conspicuity on US). We can further refine this scheduled to assess the effectiveness of the radiotherapy synchronous partnership with the addition of contrast- on the resection margins. Due to the contraindication enhanced ultrasound (CEUS). Ultrasound contrast agents of the MRI contrast, an alternate assessment plan was are non-nephrotoxic and can provide helpful vascular required. It was decided that a non-contrast MRI in information in the characterization of liver masses or conjunction with a contrast-enhanced ultrasound (CEUS) active disease during the real-time ultrasound exam. would be used to assess the treatment effectiveness. To ensure the area of treatment was thoroughly The ACUSON Sequoia ultrasound system offers superior investigated, the Fusion technology available on the contrast agent imaging that provides the user with ACUSON Sequoia ultrasound system would be employed exceptional contrast sensitivity and penetration. Using during the CEUS examination. the combination of both Fusion and contrast-enhanced ultrasound provides additional diagnostic information that is easily obtained with both automated and manual options for easy Fusion alignments. SIEMENS Healthineers Imaging and Discussion Fig. 1: HD Zoom of the 5C1 ABD The focus of the three-month follow-up was to ROI depicting metallic TIB:0,64 TIC:2,16 TIS:0,64 surgical clips in the MI:1,39 43B/Sek 98% determine if the resection margin still contained treatment area 2D H Mittel 0dB/DB70 active tumor tissue or if the radiotherapy was LD 2 UA 3 SkalaC/T5 D2 successful in eradicating the metastatic tissue. The non-contrast T2 MRI images easily demonstrated the hypointense treated area and associated hyperintense border. The images were of limited value in determining residual tumor activity due to the lack of contrast agent. A 2D ultrasound of the HD Z region-of-interest (ROI) was performed. In addition to surgical clips known to be within the treated area, Fig. 2: Fused MRI and ABD the ultrasound showed liver parenchyma with low 2D ultrasound images. TIC. 250 TIS.6.58 Treated area (outlined MI: 1.05 208/5OK conspicuity compared to the surrounding tissue in blue) is aligned using automatic segmentation B/DB70 [Fig. 1]. The MRI images were uploaded to the ACUSON Sequoia system and the Fusion technology was activated. Automatic segmentation was used in the Fusion planning phase to effectively align the treated area [blue circle Fig. 2]. Injected microbubble contrast agent showed the treatment area to be hypoechoic Fig. 3: Arterial phase, in the Arterial phase [Fig. 3], which was maintained 18 seconds elapsed into the Portal Venous phase [Fig. 4]. Based on the hypo-enhanced characteristics of the ROI with CEUS, it was concluded there were no new lesions present. Conclusion In this case where a more traditional contrast agent was contraindicated, the combination of Fusion and CEUS provided an exceptional alternative to this patient for follow-up imaging and definitive diagnosis. Fig. 4: Portal Venous phase, 1 minute, 36 seconds elapsed Clinical images courtesy of Professor Thomas Fischer, Charité Universitätsmedizin, Berlin Siemens Healthineers Headquarters Legal Manufacturer Siemens Healthcare GmbH Siemens Medical Solutions USA, Inc. Henkestr. 127 Ultrasound 91052 Erlangen, Germany 22010 S.E. 51st Street Phone: +49 9131 84-0 Issaquah, WA 98029, USA Phone: 1-888-826-9702 Published by Siemens Medical Solutions USA, Inc. · HOOD05162003156600 · 8872 0121 online · ©Siemens Medical Solutions USA, Inc., 2021