Medical Device Dailys

VIENNA, Austria — The giant of contrast enhancement agents for ultrasound imaging and the "silent partner" of medical imaging software are collaborating on a novel approach to diagnosing liver tumors, and potentially to monitor the effects of therapy.

Bracco (Milan, Italy) and TomTec (Munich, Germany) introduced SonoLiver, a PC-based software for radiologists to review off-line dynamic images of blood perfusion in the liver.

Using Bracco's contrast agent SonoVue and reviewing the images within TomTec's Image-Arena simplifies workflow for radiologists and increases diagnostic confidence in characterizing focal liver lesions.

"No one has any kind of application for quantifying perfusion in Contrast Enhanced Ultrasound (CEUS)," said Bernard Mumm, president/CTO of TomTec.

"There are a lot of contrast agents out there and many more organs, such as prostate, kidneys or breasts," he told Medical Device Daily during the recent European Congress of Radiology.

"I see quite a future in this considering all the upcoming new treatments for cancer. Whenever there needs to be a careful monitoring of patients under cancer treatment, then there is a need for this technology," he said.

"A cancer patient cannot be scanned by computed tomography (CT) or be X-rayed every three weeks, it is too much," he said.

"There is a real and unmet need for using new tools like SonoVue and ultrasound, which brings the problem back to software, which is what TomTec does best," he said.

TomTec generates just 20% of its revenues from direct sales of branded products. The remaining 80% is generated through licensing of its medical imaging software and algorithms to original equipment manufacturers (OEMs) such as Philips (Eindhoven, the Netherlands), Toshiba (Tokyo), GE Healthcare (Waukesha, Wisconsin) or in ophthalmology, Carl Zeiss (Jena, Germany) (Medical Device Daily, Sept. 12, 2008).

"Bracco knows everything about micro bubbles and they have acquired a tremendous expertise working with ultrasound OEMs to adapt their contrast enhancement products to specific procedures," explained Mumm.

"Where they do not have an expertise is in software for CEUS visualization, especially where there is a need to quantify an actvitiy through the data that is collected during a scan," he said.

Mumm said TomTec worked for almost three years with the Bracco research and development group in Geneva to develop SonoLiver.

The new software was being displayed simultaneously at Bracco and TomTec during ECR 2009 and Ralf Ludwig, TomTec's product manager for SonoLiver said Bracco reported a high interest among radiologists.

He told MDD there have been pre-market sales of the software.

"What is new about this is that it is visualization capabilities dedicated to one organ, like the SonoVue agent," he said.

The liver has a specific perfusion system, he explained with an arterial input and a venal outflow like other organs but also with a third system feeding blood to the lungs to be reoxegenated and then through the heart to be recirculated.

These three systems create a different perfusion behavior requiring the liver to work through distinct phases of moving the blood and SonoLiver software is optimized to quantify this behavior.

The software compares a tumor or lesion with health parenchyma, the functional parts of the organ that are essential to its function and generate a a time-intensity curve that can be displayed.

Properties in the contrast agent SonoVue can be distinguished to first to detect whether there is a tumor, and then to characterize the tumor type, not only whether it is benign or maligant, but also which variety it is among the long list of possible liver tumors.

TomTec created a visualization tool called Dynamic Vascular Pattern assigns color values to the intensity of contrast agent accumulation and displays it for the radiologist, looking very much like a color Doppler image generated in ultrasound imaging.

Ludwig said that once the software was given to radiologists, TomTec quickly received suggestions about how to improve workflow and how the software could be used to help further in completing a diagnosis and examination of the data.

An automatic report feature was added to generate a single page containing images selected by the radiologist from the scan, a table of the data, and two charts for time-intensity of perfusion.

The software is designed to be used with mid- to high-end ultrasound equipment from any manufacturer that has a low Mechanical Index contrast technology.

Also at ECR 2009, Siemens Healthcare (Erlangen, Germany) showed the latest expansion of its imaging portfolio with the addition of the Biograph TruePoint 16-slice PET•CT imager. The company said the Biograph TruePoint PET•CT imaging family is the first portfolio of imaging systems to include high-definition PET•CT and now expands its offering with 16-slice CT capabilities.

"The introduction of this particular system is critical as we continue to search for the balance between innovation and access. The likelihood that universal adoption of PET•CT technology will increase with accessibility is a shared industry vision. As an industry leader, it is our responsibility to make that vision more readily attainable," said Michael Reitermann, CEO of molecular Imaging for Siemens Healthcare. "The Biograph TruePoint 16-slice PET•CT is a means to achieve that end, with high-performance technology housed in an economical package," he said.

Siemens said Biograph TruePoint 16-slice PET•CT represents a "viable solution" for healthcare providers at an affordable price and offers features such as high-definition PET and routine 10-minute, whole-body imaging.

The system reflects features of Siemens' flagship Biograph mCT model. It is equipped with a 500-pound (227 kg) capacity patient bed and efficient workflow system, the company said, adding that the system offers "faster scan speeds at lower patient doses; important when patients need multiple scans for oncology treatment planning and follow-up."

The complete Biograph family of PET•CT imagers now offers options in TruePoint PET•CT for 6-slice, 16-slice, 40-slice and 64-slice CT configurations, as well as the Biograph mCT technology platform with 40-slice, 64-slice and 128-CT slice capabilities.

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