Yuko Kono MD, Presenter: Nothing to Disclose

Tarek I Hassanein MD, Abstract Co-Author: Nothing to Disclose

Elliot A Alpert MD, Abstract Co-Author: Nothing to Disclose

Claude B. Sirlin MD, Abstract Co-Author: Nothing to Disclose

Julie M Winn MD, Abstract Co-Author: Nothing to Disclose

Robert Frederick Mattrey MD, Abstract Co-Author: Nothing to Disclose

Ultrasound contrast media (USCM) are approved for cardiac imaging in the USA and for cardiac and radiological imaging worldwide. We have used USCM off-label in our radiology practice for the care of patients. In this study we report our experience on the impact USCM had on the workup and management of these patients.

95 patients were studied between April 2000 and April 2006 at a single institute with one of the FDA approved USCM (Optison, Definity, and Imagent) because of a clinical need. The institutional review board approved the study because of off-label use. Ultrasound was performed with a Siemens Elegra or Antares with multiple intravenous injections of USCM. Images were acquired with contrast specific imaging software (phase inversion or CPS) in gray-scale using low MI real-time and intermittent techniques. The outcome was classified into 7 categories: no effect (A), increased confidence (B), could have changed management (C), changed diagnosis in a minor (D) or major degrees (E) but did not affect management, changed or made the diagnosis and eliminated another test (F), or changed management (G).

The reason for the study was to confirm or characterize liver lesion(s) (n=59), assess vascular patency (n=18 including 7 TIPS), evaluate renal abnormality (n=13) and assess 2 spleen, 2 abdominal wall and 1 pancreatic lesions. The reasons of the US contrast studies varied but were mostly because the pre-contrast imaging workup including CT and MRI was inconclusive. We used on average 3 to 4 injections of 0.2 to 1ml contrast per injection. The outcome of contrast enhanced ultrasound was A in 24 (25%), B in 31 (33%), C in 7 (7 %), D in 14 (15%), E in 1 (1%), F in 10 (11%), and G in 8 (8%). No adverse events were observed.

Although the number of patients is small and they were highly selected, USCM added critically valuable information in 75% of the cases (B-G) without added risk and at the bedside. USCM changed patient management in about 20% of cases (F and G).

USCM is useful in many radiological applications and helps clinical practice. We need USCM approval for radiological applications in the USA.

Kono, Y, Hassanein, T, Alpert, E, Sirlin, C, Winn, J, Mattrey, R, Impact of Ultrasound Contrast Media (USCM) on Clinical Radiology Practice in the USA.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4429184.html