Original Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 21, 2012; 18(31): 4136-4144
Published online Aug 21, 2012. doi: 10.3748/wjg.v18.i31.4136
Double contrast-enhanced two-dimensional and three-dimensional ultrasonography for evaluation of gastric lesions
Hong Shi, Xiu-Hua Yu, Xin-Zhang Guo, Yuan Guo, Hong Zhang, Bin Qian, Zhang-Rui Wei, Li Li, Xian-Chen Wang, Zi-Xiang Kong
Hong Shi, Xiu-Hua Yu, Hong Zhang, Bin Qian, Zhang-Rui Wei, Li Li, Xian-Chen Wang, Zi-Xiang Kong, Department of Ultrasound, The 117th Hospital of PLA, Hangzhou 310013, Zhejiang Province, China
Xin-Zhang Guo, Department of Ultrasound, The Zhejiang Suichang Hospital, Suichang 323300, Zhejiang Province, China
Yuan Guo, Department of Cardiothoracic Surgery, Prince of Wales Hospital Randwick, Sydney NSW 2031, Australia
Author contributions: Shi H, Yu XH and Guo XZ designed the research, analyzed the ultrasonography, took care of patients, wrote and recruited the paper; Zhang H, Qian B, Li L, Wang XC and Kong ZX collected the data and took care of patients; Guo Y wrote the paper; Wei ZR did the statistical analysis of the data.
Supported by A key medical project in Nanjing Military District of the Chinese People’s Liberation Army, No. 09Z039
Correspondence to: Hong Shi, MD, Department of Ultrasound, The 117th Hospital of PLA, Hangzhou 310013, Zhejiang Province, China. xuyyzh@hzcnc.com
Telephone: +86-571-87348842 Fax: +86-571-87348500
Received: October 15, 2011
Revised: February 10, 2012
Accepted: April 9, 2012
Published online: August 21, 2012

AIM: To investigate the value of two-dimensional (2D) and three-dimensional (3D) double contrast-enhanced ultrasonography (DCUS) imaging for evaluation of gastric lesions.

METHODS: 2D and 3D DCUS imaging with both oral and intravenous administrations of contrast agents was used to assess gastroscopiclly-confirmed gastric lesions in 46 patients with benign and malignant diseases. Initially, liquid-based ultrasound contrast agent (Xinzhang®) was given orally at dose of 500-600 mL for conventional ultrasound examination of the gastric lesions, and then a microbubble-based contrast agent (SonoVue) was injected intravenously at dose of 1.2-2.4 mL in bolus fashion to assess the perfusion pattern of the lesions using contrast imaging modes. The parameters derived from time-intensity curves including the arrival time (AT), time to peak (TTP), peak intensity (PI) and enhanced intensity (EI) were measured on the 2D DCUS imaging. 3D DCUS of the lesions was acquired to demonstrate the value of this imaging mode.

RESULTS: There were 22 cases with benign lesions including chronic gastritis (n = 5), gastric ulcer (n = 9), gastric polyps (n = 3), gastric stromal tumors (n = 5), and 24 cases with malignant lesions including gastric cancer (n = 20), gastric cardia carcinoma (n = 3) and post-operative recurrent gastric cancer (n = 1) in the study. The oral contrast-enhanced ultrasonography (CEUS) imaging of the stomach clearly demonstrated the anatomy of the stomach and morphologic features of gastric lesions. With optimal scanning window and imaging display under oral CEUS, intravenous CEUS clearly showed the perfusion of gastric lesions with various characteristic manifestations. Both 2D and 3D DCUS images clearly demonstrated normal gastric wall as a three-layer structure, from the inside out, hyperechoic mucosa, hypoechoic muscularis and hyperechoic serosa, respectively. There were statistical significant differences of AT (8.68 ± 2.06 vs 10.43 ± 2.75, P = 0.017), PI (34.64 ± 6.63 vs 29.58 ± 8.22, P = 0.023) and EI (29.72 ± 6.69 vs 22.66 ± 7.01, P = 0.001) between malignant lesions and normal gastric wall. However, no differences of AT, PI and EI between benign lesions and normal gastric wall tissue were found. 3D DCUS could intuitively display morphological features and vascularities of the lesions with multiplanar and volume views. 3D DCUS imaging provided comprehensive information complementary to 2D imaging. The crater or wellhead appearances and feeding vessels as well as distorted nourishing vasculature of gastric carcinoma were better seen with 3D imaging than 2D imaging.

CONCLUSION: DCUS imaging can simultaneously display the anatomic and perfusion features of gastric lesions. 3D DCUS can provide additional information to 2D DCUS for evaluation of gastric lesions.

Keywords: Contrast-enhanced ultrasonography, Gastric lesions, Two-dimensional imaging, Three-dimensional imaging, Contrast media