By Dr. Luigi Solbiati, Dr. Alberto Martegani, Dr. Edward Leen, Dr. Jean Michel Correas, Dr. Peter N. Burns, Dr. Dirk Becker (auth.)
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Extra info for Contrast-Enhanced Ultrasound of Liver Diseases
Marked changes occur in the sinusoidal endothelial cells in response to liver injury, for example, fibrosis or cirrhosis. All of these yield reduced endothelial permeability. The most striking feature is that the number of fenestrae decreases. In addition, a real continuous basal membrane forms beneath the endothelium. The space of Disse becomes filled with collagen bundles, thus further reducing the access of solutes to liver cells. This so-called capillarization of sinusoids has functional implications that have been documented using multiple indicator dilution curves in cirrhotic human and rat livers.
This concept is consistent with the observation that glycogen stores are refilled first in the perivenous hepatocytes whereas glycogen degradation starts periporta1ly. In the postabsorptive phase, glycogen is degraded to glucose in the periportal hepatocytes. As the glucose proceeds down the sinu·soid it is taken up by perivenous cells and degraded to lactate. Lactate is again released into the circulation and, if unused by the peripheral circulation, it is used as a substrate for gluconeogenesis by periportal cells.
Other indications are under development (Rosenberg 2002). DefinityTM is approved in the USA for improvement of delineation of the left ventricular border and is marketed by Bristol Myers Squibb (formerly marketed by DuPont). Defin- Chapter 2 • Ultrasound Contrast Agents ity is also approved in Canada for LVO, liver and kidney imaging. 6 Imagent™ Imagent™ (AFO 145, Alliance Pharmaceuticals, San Diego, CA, USA) is composed of surfactants, sodium chloride and phosphate buffers, presented as a dry powder in a vial that also contains gaseous perfluorohexane (Pelura 1998).