Original Contribution
Definition of Contrast Enhancement Phases of the Liver Using a Perfluoro-Based Microbubble Agent, Perflubutane Microbubbles

https://doi.org/10.1016/j.ultrasmedbio.2009.05.013Get rights and content

Abstract

To define the contrast enhancement phases in the liver with perflubutane microbubbles, the liver enhancement time-intensity curves were investigated in 14 healthy volunteers. The agent was injected intravenously as a bolus and the liver was imaged with an ultrasound scanner as long as 4 h after the injection. Time-intensity curves from the hepatic artery, the intrahepatic portal vein, the hepatic vein and the parenchyma of the liver were obtained from the liver ultrasound images. The arrival of the agent in the hepatic artery, the portal vein and the hepatic vein were visually distinguishable and the mean arrival times were 19.2, 24.3 and 32.2 s after the injection, respectively. The signal intensity in these vessels increased rapidly after the arrival of the contrast and gradually reverted to baseline after the peak. In contrast, within 5 min after the injection, the intensity in the parenchyma increased and reached a plateau, which persisted for at least 2 h. The contrast enhancement phases in the liver with perflubutane microbubbles could be defined as two major phases—a vascular phase, in which the vessels are enhanced between 15 s and 10 min after injection, and a Kupffer phase, in which the parenchyma is enhanced 10 min after injection. The vascular phase is divided into three subphases: the arterial phase (15 to 45 s after injection); the portal phase (45 s to 1 min after injection); and the vasculo-Kupffer phase (1 to 10 min after injection). (E-mail: [email protected])

Section snippets

Introduction and Literature

In addition to contrast-enhanced X-ray/computed tomography (CT) and magnetic resonance imaging (MRI), contrast-enhanced ultrasonography has become the new standard method for the diagnosis of liver focal lesions (Lencioni 2006; Nicolau et al. 2006; Leen et al. 2006). Different from the iodinated agent used in X-ray/CT and the gadolinium chelating agent used in MRI, the ultrasound contrast agent, which consists of microbubbles (MB), cannot be distributed into the interstitium through the

Contrast agent

Perflubutane MBs are MBs of gaseous perflubutane (C4F10) stabilized with a monomolecular membrane of hydrogenated egg phosphatidyl serine (Sontum 2008). The lyophilized formulation is suspended with 2 mL of water, where each milliliter of the suspension contains 8 μL of perflubutane MBs.

Subjects

This study was approved by the institutional review board. All subjects gave informed consent. All subjects fasted for 6 h or more before the contrast ultrasonography. This study included healthy volunteers ≥20

Vascular phase

The arrival of the agent in the hepatic artery, the portal vein and the hepatic vein was visually distinguishable (Fig. 3). The arrival time and time-to-peak intensity in the hepatic artery varied from 14–25 s after injection (mean 19.2 ± 4.4 s SD) and from 23–42 s (mean 33.5 ± 8.1 s SD), respectively. The arrival time and time-to-peak intensity at the portal vein varied from 20–30 s after injection (mean 24.3 ± 4.2 s SD) and from 34–48 s (mean 41.5 ± 6.2 s SD), respectively. The arrival time and

Discussion and Summary

In this study, we investigated TICs of liver enhancement with perflubutane MBs and defined the liver enhancement phases.

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