Clinical Hemorheology and Microcirculation - Volume 49, issue 1-4

Article Type: Other

DOI: 10.3233/CH-2011-1528

Citation: Clinical Hemorheology and Microcirculation, vol. 49, no. 1-4, pp. 1-1, 2011

Authors: Antonova, Nadia

Article Type: Research Article

DOI: 10.3233/CH-2011-1451

Citation: Clinical Hemorheology and Microcirculation, vol. 49, no. 1-4, pp. 3-5, 2011

Authors: Jung, Friedrich

Article Type: Research Article

DOI: 10.3233/CH-2011-1452

Citation: Clinical Hemorheology and Microcirculation, vol. 49, no. 1-4, pp. 7-10, 2011

Authors: Reinhart, W.H.

Article Type: Research Article

DOI: 10.3233/CH-2011-1453

Citation: Clinical Hemorheology and Microcirculation, vol. 49, no. 1-4, pp. 11-27, 2011

Authors: Vázquez, Beatriz Y. Salazar | Cabrales, Pedro | Tsai, Amy G. | Intaglietta, Marcos

Article Type: Research Article

Abstract: Increasing blood and plasma viscosity is generally associated with pathological conditions, and increased cardiovascular risk, a perception based in part on studies where blood viscosity is increased to extreme values attained by hemoconcentration. Present studies, supported by epidemiological studies in humans, show that moderate increases in Hct improve cardiovascular function and vice versa. This result is due to the nonlinear regulation of peripheral vascular resistance arising from the increased production of nitric oxide following the increase of shear stress on the vascular wall due to increasing blood viscosity. Similar effects are found in when plasma viscosity is increased in the …extremely hemodiluted circulation. In both cases there is an effect at the arteriolar/capillary level, leading to a condition of improved microvascular function and supra perfusion that facilitates clearance of metabolic waste products, while maintaining oxygen delivery. Application of these findings to the design of viscogenic plasma expanders suggests a new approach for the treatment of hemorrhage that in part replaces the use of blood transfusions, making it feasible to lower the transfusion trigger to levels below than normally considered safe. Show more

Keywords: Blood viscosity, plasma viscosity, hemodilution, viscogenic plasma expansion, microcirculation, blood pressure

DOI: 10.3233/CH-2011-1454

Citation: Clinical Hemorheology and Microcirculation, vol. 49, no. 1-4, pp. 29-36, 2011

Authors: Gori, Tommaso

Article Type: Research Article

Keywords: Coronary slow flow, endothelial function, viscosity, hematocrit, platelets

DOI: 10.3233/CH-2011-1455

Citation: Clinical Hemorheology and Microcirculation, vol. 49, no. 1-4, pp. 37-42, 2011

Authors: Wiggermann, P. | Zuber-Jerger, I. | Zausig, Y. | Loss, M. | Scherer, M.N. | Schreyer, A.G. | Stroszczynski, C. | Jung, E.M.

Article Type: Research Article

Abstract: Purpose: To assess the added value of depicting tumour microvascularisation, using dynamic contrast enhanced (CEUS), during radiofrequency ablation, as a means of achieving a complete ablation (CA) of malignant liver lesions. Material and methods: 18 consecutive patients (2 female, 16 male, age range 52–79 years, mean 64.1 ± 9.9 years) with 22 histologically confirmed hepatic malignancies (HCC: n = 10, liver metastases: n = 12) underwent RFA. Before RFA treatment, conventional US, CEUS and contrast enhanced CT (ceCT) of the liver were performed. During the CT-guided RFA procedure, CEUS was performed to asses the ablation defect. In case of partial …ablation a subsequent ablation was performed with a corrected electrode position and evaluated again using CEUS. This procedure was repeated until a CA was achieved. The number of ablations per patient was recorded. Secondary efficacy parameters assessed were lesion detectability in the different imaging modalities and contrast phases. Results: Overall intraprocedural CEUS led to a change in therapeutic management in 59% of cases, resulting in 17 additional ablation cycles. Lesion detectability during CT Fluoroscopy was the sole statistical significant predictor of incomplete ablations (p = 0.008). The mean number of ablations for detectable lesions was 1.27 vs. 2.27 ablations for not detectable lesions (p = 0.002). The combined CT and CEUS RFA procedure led to a CA for all treated lesions in follow up 3 month post intervention. Conclusion: CEUS does allow a reliable and immediate assessment of therapeutic efficacy of percutaneous RFA procedures of malignant liver lesions, through the continuous dynamic evaluation of tumour microcirculation. Show more

Keywords: Contrast-enhanced ultrasound (CEUS), radiofrequency ablation, liver lesions, CT fluoroscopy

DOI: 10.3233/CH-2011-1456

Citation: Clinical Hemorheology and Microcirculation, vol. 49, no. 1-4, pp. 43-54, 2011

Authors: Uller, W. | Wiggermann, P. | Gössmann, H. | Klebl, F. | Salzberger, B. | Stroszczynski, C. | Jung, E.M.

Article Type: Research Article

Abstract: Purpose: The objective was the evaluation of microcirculation in hepatocellular carcinomas (HCC) in vivo by dynamic contrast-enhanced ultrasound (CEUS) after intravenous (i.v.) and intraarterial (i.a.) application of contrast agent during transarterial chemoembolization (TACE) using drug-eluting beads (DEB). Patients and methods: Eleven patients with HCC underwent CEUS directly before and immediately after DEB-TACE. The sonographic contrast agent was injected through the microcatheter intraarterially and intravenously. The grade of hypervascularization was evaluated before Bead application. The percentage of devascularization after Bead application was calculated and quantitative devascularization was carried out using time intensity curves (TIC). These results were compared to postinterventional angiography …after Bead application and postprocedural computed tomography. Results: The hypervascularization of HCC was marginal improved after i.a. contrast application compared to i.v. application (p = 0.163). The reduction of vascularization after Bead application correlated significant between i.a. and i.v. contrast application (p = 0.007) and decreased significant using TIC analysis (p = 0.003). Postinterventional angiography related with CEUS after i.a. sonographic contrast agent application. Extrahepatic tumor-feeding arteries were detected by a mismatch between i.a. and i.v. CEUS in one case. Conclusion: Quantification of the reduction of microvascularization using TIC analysis may be a valuable periinterventional tool during DEB-TACE. Intraprocedural CEUS with i.a. and i.v. ultrasound contrast agent injection may help finding extrahepatic tumor-feeding arteries. Show more

Keywords: Liver tumors, contrast-enhanced ultrasound, hepatocellular carcinoma, TACE

DOI: 10.3233/CH-2011-1457

Citation: Clinical Hemorheology and Microcirculation, vol. 49, no. 1-4, pp. 55-66, 2011

Authors: Rennert, J. | Georgieva, M. | Schreyer, A.G. | Jung, W. | Ross, C. | Stroszczynski, C. | Jung, E.M.

Article Type: Research Article

Abstract: Aim: To evaluate, whether image fusion of contrast enhanced ultrasound (CEUS) with CT or MRI affects the diagnosis and characterization of liver lesions or the therapeutic strategy of surgical or interventional procedures compared to the preliminary diagnosis. Material and methods: In a retrospective study the image fusion scans of CEUS with contrast enhanced CT or MRI of 100 patients (71 male, mean age 59 years, 0.3–85 years) with benign or malignant liver lesions were evaluated. Fundamental B-scan, color Doppler imaging and CEUS were performed in all patients by an experienced examiner using a multifrequency convex transducer (1–5 MHz, LOGIQ 9/GE) …and volume navigation (Vnav). After a bolus injections of up to 2.4 ml SonoVue® (BRACCO, Italy) digital raw data was stored as cine-loops up to 5 min. In 74 patients, CEUS was fused with a pre-existing ceCT, in 26 patients a ceMRI was used. Results: In all 100 patients (100%) the image quality in all modalities (ceCT, ceMRI and CEUS) was excellent or with only minor diagnostic limitations. Regarding the number of lesions revealed in image fusion of CEUS/ceCT/ceMRI and the preceding diagnostic method, concordant results were found in 84 patients. In 12 patients, additional lesions were found using fusion imaging causing subsequently a change of the therapeutical strategy. In 15 out of 21 patients with either concordant or discordant results regarding the number of lesions, image fusion allowed a definite diagnosis due to a continuous documentation of the microcirculation of the tumor and its contrast enhancement. A significant coherency (p < 0.05) among image fusion with either ceCT or ceMRI and CEUS and a subsequent change of therapeutic strategy was found. Conclusion: Image fusion with volume navigation (VNav) of CEUS with ceCT or ceMRI frequently allows a definite localization and diagnosis of hepatic lesions in patients with primary hepatic carcinoma or metastatic diseases. This might cause a change of the therapeutic strategy in many patients with hepatic lesions. Show more

DOI: 10.3233/CH-2011-1458

Citation: Clinical Hemorheology and Microcirculation, vol. 49, no. 1-4, pp. 67-81, 2011

Authors: Hornung, Matthias | Jung, Ernst Michael | Stroszczynski, Christian | Schlitt, Hans J. | Agha, Ayman

Article Type: Research Article

Abstract: Background: Contrast-enhanced ultrasonography (CEUS) represents a new diagnostic tool to localize pathological parathyroid glands. The aim of this study was to differentiate the capability of CEUS as first-line or complimentary modality for the detection of hyperfunctioning parathyroid glands. Methods: Sixty patients with pHPT were admitted to the University Hospital Regensburg between 8/2009 and 3/2011. Conventional and contrast-enhanced ultrasonography (CEUS) using a linear probe (6–9 MHz, LOGIQ E9/GE) was performed in all patients preoperatively. The sensitivity of CEUS was analyzed to determine its potential as first line or complimentary diagnostic procedure. Results: Using CEUS 98.3% of all pathological glands could be …detected in the correct quadrant whereas conventional ultrasonography (70%) (p < 0.001) revealed less sensitivity. In all patients CEUS indicated a correct side localization of the hyperfunctioning parathyroid gland. The advantage of CEUS was the detection of the early dynamic on the capillary level immediately after contrast injection. Overall, CEUS permit minimally invasive video-assisted parathyroidectomy in 45 patients. 15 patients required conventional procedure due to concomitant goiter. All patients showed normal calcium and parathyroid hormone serum levels three months after surgery. Conclusions: CEUS represents a highly sensitive diagnostic modality for localization of pathologic parathyroid glands in patients with pHPT. Nevertheless, it can only be recommended as first-line diagnostic procedure in specialized clinical centers with experienced investigators. Show more

Keywords: Primary hyperparathyroidism, contrast-enhanced ultrasonography, microcirculation

DOI: 10.3233/CH-2011-1459

Citation: Clinical Hemorheology and Microcirculation, vol. 49, no. 1-4, pp. 83-90, 2011