Contrast enhanced harmonic ultrasound for differentiating breast tumors – First results

Article type: Research Article

Authors: Jung, Ernst Michael^; | Jungius, Karl-Peter | Rupp, Nikolaus | Gallegos, María | Ritter, Gunter | Lenhart, Markus | Clevert, Dirk-Andre | Kubale, Reinhard

Affiliations: Department of Diagnostic Radiology, Passau Hospital – Teaching Hospital of the University of Regensburg, Germany | Spitalzentrum Oberwallis, Departement Radiologie, Brig, Switzerland | Department of Mathematics and Computer Science, University of Passau, Germany | University of Regensburg, Department of Diagnostic Radiology, Regensburg, Germany | Institute of Radiology, Sonography and Nuclear Medicine, Pirmasens, Germany

Note: [] Corresponding author: Dr. med. Ernst Michael Jung, Departement of Diagnostic Radiology, Passau Hospital, Innstrasse 76, D-94032 Passau, Germany. Tel.: +49 851 5300 2366; Fax: +49 851 5300 2202; E-mail: emjung@web.de.

Abstract: Purpose: To investigate the extent to which indeterminate lesions of the breast can be differentiated in the early and late phase after bolus injection of the ultrasound contrast medium Optison®. Materials and methods: Fifty female patients (mean age: 49 years) with a altogether 53 preoperatively impalpable indeterminate breast tumors, 20 fibroadenomas and 33 carcinomas, were examined by B-mode imaging and contrast medium-enhanced ultrasound with power Doppler (three patients had multifocal carcinomas). The tumors had a diameter of 5–15 mm (mean diameter: 9 mm). Histological confirmation was performed in all lesions by vacuum biopsies and/or surgical preparation. All examinations were performed with a multifrequency linear array probe (5–10 MHz, Logiq9 and Logiq 7, GE). Power Doppler (PD) and B-mode imaging as well as tissue harmonic imaging (THI) were employed. A bolus of 0.5 ml Optison® was injected intravenously and spreading of the contrast enhancement and washout in the tumors were followed for at least 20 minutes. A low mechanical index was chosen to avoid early destruction of the microbubbles. Maximum tumor size was measured and tumors vessels were evaluated in digital cine ultrasound sequences. Results: Without CM administration, 14 of 19 tumor lesions smaller than 10 mm could be distinguished better from the surrounding tissue with THI compared to fundamental B-mode imaging. Both benign (17/20) and malignant (30/33) tumors exhibited increased tumor marginal vessels or intratumoral vessels in the early phase after CM injection. A diffuse contrast medium accumulation was observed in the late phase (8–18 min, mean: 12 min) in 30 of 33 malignant tumors, but in none of the benign tumors. The diagnostic confirmation for this late enhancement was there with 90% for the malignant tumors. Conclusion: After intravenous bolus administration of Optison®, breast carcinomas appear to have a prolonged diffuse enhancement of central tumor vasularity in the late phase compared to an earlier marginal vascularity of fibroadenomas.

Keywords: Breast neoplasms, US, ultrasound, contrast media, ultrasound, power Doppler studies, ultrasound, harmonic studies

Journal: Clinical Hemorheology and Microcirculation, vol. 33, no. 2, pp. 109-120, 2005