Contrast-Enhanced Subharmonic Ultrasound Imaging in Improving Characterization of Adnexal Masses in Patients Undergoing Surgery

Study Overview
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Brief Summary
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This pilot clinical trial studies how well contrast-enhanced subharmonic ultrasound imaging works in improving the characterization of adnexal masses in patients undergoing surgery. Contrast-enhanced subharmonic ultrasound imaging uses high-frequency sound waves to produce images of internal organs and when combined with an ultrasound agent such as perflutren lipid microspheres, may help improve imaging and management of adnexal masses.

Detailed Description
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PRIMARY OBJECTIVES: I. To develop qualitative subharmonic imaging (SHI) or SHI-derived quantitative biomarkers. II. To generate pilot data for a study to evaluate if they improve the characterization of benign and malignant adnexal masses compared to standard ultrasound or contrast enhanced magnetic resonance imaging (MRI) or the risk of malignancy index (RMI). SECONDARY OBJECTIVES: I. To compare the SHI depiction of adnexal masses' neovascularity in humans to intra-tumoral microvascular density (iMVD) obtained from CD31 an immunohistochemical marker of angiogenesis.

Official Title
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Subharmonic Contrast Ultrasound for Improved Characterization for Adnexal Masses-A Pilot Study

Conditions
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Adnexal Mass

Intervention / Treatment
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* Drug: Perflutren Lipid Microspheres
* Procedure: Contrast-Enhanced Subharmonic Ultrasound Imaging


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Be diagnosed with an adnexal mass Be scheduled for surgery to remove the adnexal mass Be clinically stable If a female of child-bearing potential, must have a negative pregnancy test Be conscious and able to comply with study procedures Have read and signed the Institutional Review Board (IRB)-approved informed consent form for participating in the study Exclusion Criteria: Females who are pregnant or nursing Patients who have received an investigational drug in the 30 days before study drug administration, or will receive one within 72 hours (h) afterwards Patients with known or suspected right-to-left, bi-directional, or transient right-to-left cardiac shunts Patients with pulmonary hypertension or unstable cardiopulmonary conditions Patients currently on chemotherapy or with other primary cancers requiring systemic or hepatic loco-regional treatment Patients who are clinically unstable, patients who are seriously or terminally ill with a life expectancy of less than 1 month, and patients whose clinical course are unpredictable; for example: Patients on life support or in a critical care unit Patients with unstable occlusive disease (e.g., crescendo angina) Patients with clinically unstable cardiac arrhythmias, such as recurrent ventricular tachycardia Patients with uncontrolled congestive heart failure (New York Heart Association [NYHA] class IV) Patients with recent cerebral hemorrhage Patients who have undergone surgery within 24 hours prior to the study sonographic examination Patients with a history of anaphylactic allergy to Definity, manifested by one or more of the following symptoms: generalized urticaria, difficulty in breathing, swelling of the mouth and throat, hypotension, or shock Patients with congenital heart defects Patients with severe emphysema, pulmonary vasculitis, or a history of pulmonary emboli Patients with respiratory distress syndrome Patients with thrombosis within the splenic vein

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: contrast-enhanced subharmonic ultrasound imaging<br>Patients receive perflutren lipid microspheres IV. After 15 minutes, patients receive perflutren lipid microspheres IV again over 5 minutes and undergo contrast-enhanced subharmonic ultrasound imaging over 60 minutes. | Drug: Perflutren Lipid Microspheres<br>* Given IV<br>* Other names: Definity;Procedure: Contrast-Enhanced Subharmonic Ultrasound Imaging<br>* Undergo contrast-enhanced subharmonic ultrasound imaging<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Diagnostic Accuracy of Subharmonic Ultrasound Imaging Compared to Standard Ultrasound or Contrast Enhanced Magnetic Resonance Imaging (MRI) | The techniques will be compared using an analysis of variance (ANOVA) method (i.e., baseline ultrasound imaging, SHI, or MRI) as the dependent variable and outcome as the independent variables. Diagnostic accuracy of lesion identification as no lesion seen, definitely benign, indeterminate or definitely malignant based on independent reads by experience radiologists for SHI with and without contrast vs contrast-enhanced MRI (quantitative analysis). For qualitative analysis, digital images from the SHI imaging were reviewed by the independent radiologists for interpretation. Diagnostic accuracy reported as percentage of lesions correctly identified through SHI as compared to ultrasound or MRI as the gold standard. | Baseline scan to day of surgery | 
| Accuracy of SHI Characterization Compared to the Risk of Malignancy Index | The ability of SHI to accurately characterize lesions as benign from malignant masses as compared to other imaging (ultrasound or MRI) and pathology will be analyzed using logistic regression and receiver operating characteristic (ROC) analyses. | Baseline scan to day of surgery |