The feasibility of contrast enhanced ultrasonography (CEUS) in the diagnosis of non-cardiac thoracic disorders of dogs and cats

Our plain-English summary of The feasibility of contrast enhanced ultrasonography (CEUS) in the diagnosis of non-cardiac thoracic disorders of dogs and cats, by N. Linta, M. Baron Toaldo, G. Bettini, et al (BMC Veterinary Research, 2017).

The study

• Authors: N. Linta, M. Baron Toaldo, G. Bettini, A. Cordella, M. Quinci, P. Pey, V. Galli, M. Cipone, A. Diana
• Journal: BMC Veterinary Research
• Published: 2017;13(1):141
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: This study describes the feasibility of Contrast Enhanced Ultrasonography (CEUS) in the diagnostic work-up of non-cardiac thoracic disorders of small animals. The second aim is to assess the usefulness of CEUS as a direct guide for sample procedures.

Results: Forty animals, 28 dogs and 12 cats, were included in the study. Thoracic disorders included 23 pulmonary lesions [primary carcinoma (14), lymphoma (1), sarcoma (1), histiocytic sarcoma (1), abscess (1) and pneumonia (5)] and 17 mediastinal lesions [lymphoma (8), thymoma (3), mesothelioma (1), melanoma (1), carcinomatous lymphadenopathy (1), mixsosarcoma (1), lipoma (1), and abscess (1)]. The majority of neoplastic pulmonary lesions showed an inhomogeneous distribution of contrast medium, whereas inflammatory lesions had a homogenous distribution with typical pulmonary vessels ramification. The majority of mediastinal malignant lesions showed an inhomogeneous distribution pattern. The lung and mediastinal abscesses had peripheral enhancement of the wall with an avascular center. All cytological and biopsy samples obtained after CEUS were diagnostic. Quantitative analysis, performed in 19/23 pulmonary lesions, showed a statistically significant difference (P < 0.0001) between the arrival time of the malignant (7.27 s - range 4.46-13.52 s) and benign (4.52 s - range 2.87-6.06 s) pulmonary lesions.

Conclusions: CEUS may be a useful tool for the evaluation of non-cardiac thoracic lesions. The contrast medium allows for the precise definition of lesion edges, the presence of necrotic areas, and the distribution of pulmonary vessels. Based on our preliminary results, the use of ultrasonographic contrast medium can be recommended for improving the diagnostic usefulness of cytology and biopsy sampling, because CEUS may help to define necrotic areas from viable tissue.

In plain English

This study from the Veterinary Teaching Hospital of the University of Bologna, Italy, prospectively tested contrast-enhanced ultrasound (CEUS) on chest lesions in 40 animals (28 dogs and 12 cats) enrolled from January 2010 to March 2015. It did not study asbestos or any other exposure. One dog had a mediastinal mesothelioma. Of the 40 lesions, 23 were in the lung and 17 in the mediastinum; 32 were malignant and eight benign. Most malignant lung lesions (16 of 17) and most malignant mediastinal lesions (10 of 15) took up the contrast unevenly, as did the mesothelioma. Four of six benign lung lesions took it up evenly. All samples taken after CEUS were diagnostic. In 19 lung lesions, contrast arrived later in the 13 malignant lesions (median 7.27 seconds) than in the 6 benign ones (median 4.52 seconds), a statistically significant difference. The authors concluded, from preliminary results, that CEUS could be recommended as a direct guide for sampling. They noted the small number of cases and that conventional ultrasound already gave most of the information needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Prospective feasibility study (case series) of an imaging technique in animals
• Who was studied: 40 animals (28 dogs and 12 cats) with non-cardiac chest lesions, recruited at the Veterinary Teaching Hospital of the University of Bologna, January 2010 to March 2015. There were 23 lung lesions and 17 mediastinal lesions; 32 were malignant and 8 benign. One mediastinal mesothelioma, in a dog, was included.
• Exposure: No asbestos or other exposure was studied. The study evaluated contrast-enhanced ultrasound using the contrast agent SonoVue, at 0.5 ml for cats and 0.05 ml/kg for dogs.
• Main results:
  • Of the 40 cases, 32 had malignant lesions and 8 had benign lesions
  • 16 of 17 malignant lung lesions showed uneven (inhomogeneous) contrast uptake with areas lacking contrast
  • 4 of 6 benign lung lesions showed even (homogeneous) contrast uptake
  • 10 of 15 malignant mediastinal lesions showed uneven contrast uptake
  • The single mediastinal mesothelioma showed uneven contrast uptake at wash-in, at peak intensity and at wash-out
  • All cytology and biopsy samples obtained after CEUS were diagnostic
  • In 19 lung lesions, median contrast arrival time was 7.27 s (range 4.46 to 13.52) in the 13 malignant lesions and 4.52 s (range 2.87 to 6.06) in the 6 benign lesions. The difference was statistically significant (P less than 0.001). The other perfusion measures did not differ significantly.
• The authors' conclusion: The authors concluded that, based on their preliminary results, CEUS can be recommended as a direct guide for sampling procedures to improve the diagnostic success of cytological and histological sampling.
• Limitations the authors state:
  • Relatively low number of cases and limited types of disease
  • Imbalance between malignant (13) and benign (6) lung lesions in the quantitative analysis may have influenced the statistics
  • Most diagnoses came from fine needle aspiration, which limited classification of lesions by histological type
  • Conventional ultrasound already provided most of the information needed to suspect benign or malignant behavior

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Sarcoma, Mesothelioma, Lymphadenopathy, Biopsy, Cytology.

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