|
1
|
Duan Y, Shi S, Long H, Zhong X, Tan Y, Liu G, Wu G, Qin S, Xie X, Lin M. A Bi-modal Temporal Segmentation Network for Automated Segmentation of Focal Liver Lesions in Dynamic Contrast-enhanced Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2025; 51:759-767. [PMID: 39952824 DOI: 10.1016/j.ultrasmedbio.2024.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Revised: 12/16/2024] [Accepted: 12/20/2024] [Indexed: 02/17/2025]
Abstract
OBJECTIVE To develop and validate an automated deep learning-based model for focal liver lesion (FLL) segmentation in a dynamic contrast-enhanced ultrasound (CEUS) video. METHODS In this multi-center and retrospective study, patients with FLL who underwent dynamic CEUS exam were included from September 2021 to December 2021 (model development and internal test sets), and from March 2023 to May 2023 (external test sets). A bi-modal temporal segmentation network (BTS-Net) was developed and its performance was evaluated using Dice score, intersection over union (IoU) and Hausdorff distance, and compared against several segmentation methods. Time-intensity curves (TICs) were obtained automatically from BTS-Net and manually de-lineated by an experienced radiologist, and evaluated by intra-class correlation and Pearson correlation co-efficients. Multiple characteristics were analyzed to evaluate the influencing factors of BTS-Net. RESULTS A total of 232 patients (160 men, median age 56 y) with single FLL were enrolled. BTS-Net achieved mean Dice scores of 0.78, 0.74 and 0.80, mean IoUs of 0.67, 0.62 and 0.68, and mean Hausdorff distances of 15.83, 16.01 and 15.04 in the internal test set and two external test sets, respectively. The mean intra-class correlation and Pearson correlation co-efficients of TIC were 0.89, 0.92 and 0.98, and 0.91, 0.93 and 0.99, respectively. BTS-Net demonstrated a significantly higher mean Dice score and IoU in large (0.82, 0.72), homogeneous positive enhanced (0.81, 0.70) or stable (0.81, 0.70) lesions in pooled test sets. CONCLUSION Our study proposed BTS-Net for automated FLL segmentation of dynamic CEUS video, achieving favorable performance in the test sets. Downstream TIC generation based on BTS-Net performed well, demonstrating its potential as an effective segmentation tool in clinical practice.
Collapse
Affiliation(s)
- Yu Duan
- Department of Medical Ultrasonics, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Siyuan Shi
- Research and Development Department, Illuminate, LLC, Shenzhen, China
| | - Haiyi Long
- Department of Medical Ultrasonics, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xian Zhong
- Department of Medical Ultrasonics, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yang Tan
- Department of Medical Ultrasonics, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guangjian Liu
- Department of Medical Ultrasonics, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guanghua Wu
- Department of Medical Ultrasonics, SanMing First Hospital, Sanming, China
| | - Si Qin
- Department of Medical Ultrasonics, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Manxia Lin
- Department of Medical Ultrasonics, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
|
2
|
Huang H, He DN, Lu RF, Tong WJ, Wang Y, Qin S, Wen R, Wu SH, Ruan SM, Liu GJ, Lu MD, Kuang M, Wang W, Cheng MQ, Yang H, Chen LD. The role of contrast-enhanced ultrasound in the radiological classification of liver observations identified by CT and MRI. LA RADIOLOGIA MEDICA 2025:10.1007/s11547-025-01995-z. [PMID: 40126795 DOI: 10.1007/s11547-025-01995-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Accepted: 03/05/2025] [Indexed: 03/26/2025]
Abstract
BACKGROUND & AIMS Timely and accurate diagnosis of hepatocellular carcinoma (HCC) is essential for improving patient outcomes and guiding treatment. This multicenter study aimed to optimize the diagnostic workflow for HCC through a step-wise combination of CT/MRI and contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS). METHODS This was a multicenter, retrospective analysis of prospectively recruited high-risk HCC participants with liver observations from 4 institutions, between January 2017 and December 2021. These participants initially underwent CT/MRI followed by CEUS, with observations categorized according to CT/MRI/CEUS LI-RADS. Three step-wise diagnostic strategies were evaluated, starting with CT/MRI and followed by CEUS, and compared to CT/MRI LI-RADS alone. Performance metrics included AUC, accuracy, sensitivity, specificity, PPV, and NPV, using pathology or over one year of follow-up as standards. The impact on clinical decisions was measured by false-negative, false-positive, and biopsy rates. RESULTS Of 1264 participants, 874 (69%) were confirmed as HCC. The step-wise strategies outperformed CT/MRI LI-RADS. Strategy-3, which involved subsequent CEUS for CT/MRI LR-3/4 observations, significantly improved sensitivity (88.8% vs. 79.9%, P < 0.001) while maintaining comparable specificity (88.2% vs. 91.3%, P > 0.05). Strategy-3 reduced biopsy rate (31.5-22.4%, P = 0.028) and decreased false-negative rate (20.1-11.2%, P < 0.001). Additionally, 96% (55/57) of CT/MRI LR-3 and 97% (77/79) of CT/MRI LR-4 observations were accurately diagnosed and treated as HCC, with 61% (74/121) of CT/MRI LR-4 observations avoiding biopsy with CEUS-assisted. CONCLUSION A step-wise approach using CT/MRI followed by CEUS for LR-3/4 observations improved the diagnostic performance and further refined clinical decision-making in HCC. TRIAL REGISTRATION Clinical Trial Registration Number: ChiCTR-DDD-16010089.
Collapse
Affiliation(s)
- Hui Huang
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Laboratory, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou, 510080, People's Republic of China
| | - Dan-Ni He
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Laboratory, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou, 510080, People's Republic of China
- Department of Medical Ultrasonics, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Rui-Fang Lu
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Laboratory, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou, 510080, People's Republic of China
| | - Wen-Juan Tong
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Laboratory, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou, 510080, People's Republic of China
| | - Ying Wang
- Department of Medical Ultrasound, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Si Qin
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Rong Wen
- Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, No 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
| | - Shao-Hong Wu
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Laboratory, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou, 510080, People's Republic of China
| | - Si-Min Ruan
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Laboratory, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou, 510080, People's Republic of China
| | - Guang-Jian Liu
- Department of Medical Ultrasonics, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ming-De Lu
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Laboratory, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou, 510080, People's Republic of China
| | - Ming Kuang
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Laboratory, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou, 510080, People's Republic of China
| | - Wei Wang
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Laboratory, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou, 510080, People's Republic of China
| | - Mei-Qing Cheng
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Laboratory, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou, 510080, People's Republic of China.
| | - Hong Yang
- Department of Medical Ultrasound, the First Affiliated Hospital of Guangxi Medical University, No 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
| | - Li-Da Chen
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Laboratory, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Rd 2, Guangzhou, 510080, People's Republic of China.
| |
Collapse
|
|
3
|
Murad V, Jang HJ, Kim TK. Unraveling distinctions between contrast-enhanced ultrasound and CT/MRI for liver mass diagnosis. Ultrasonography 2025; 44:19-30. [PMID: 39604095 PMCID: PMC11717683 DOI: 10.14366/usg.24163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 10/11/2024] [Accepted: 10/16/2024] [Indexed: 11/29/2024] Open
Abstract
Contrast-enhanced ultrasound (CEUS) offers a distinctive approach to liver mass diagnosis by utilizing intravenous contrast agents for enhanced visualization of vascular structures and tissue characterization. This review highlights the unique advantages of CEUS compared to computed tomography (CT) and magnetic resonance imaging (MRI), particularly focusing on the Liver Imaging Reporting and Data System framework. Key differences include CEUS's realtime imaging capability, which minimizes arterial phase mistiming and improves detection of hyperenhancing lesions, and its ability to provide detailed washout patterns. Also, CEUS's intravascular nature and lower risk of adverse reactions make it a safer alternative for patients with renal impairment or those contraindicated for CT/MRI.
Collapse
Affiliation(s)
- Vanessa Murad
- University Medical Imaging Toronto, Joint Department of Medical Imaging - University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, Canada
| | - Hyun-Jung Jang
- University Medical Imaging Toronto, Joint Department of Medical Imaging - University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, Canada
| | - Tae Kyoung Kim
- University Medical Imaging Toronto, Joint Department of Medical Imaging - University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
|
4
|
Dai T, Zhu H, Qiao M, Song Y, Sun Y, Meng X, Sun Z. Training on contrast-enhanced ultrasound LI-RADS classification for resident radiologists: a retrospective comparison of performance after training. Insights Imaging 2024; 15:205. [PMID: 39143424 PMCID: PMC11324635 DOI: 10.1186/s13244-024-01786-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 07/20/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVES To evaluate the effects and benefits of training radiology residents on contrast-enhanced ultrasound (CEUS) according to the Liver Imaging Reporting and Data System (LI-RADS). METHODS In total, 234 patients at high risk of hepatocellular carcinoma (HCC) who underwent CEUS were enrolled, including 27 lesions in the education set and 207 lesions in the test sets (a-d). Forty-five radiology residents and 4 radiology experts involved in CEUS LI-RADS training individually reviewed the test sets before, immediately after, and 3-months after training. The consistency with kappa values of the description of CEUS features, the classification of focal liver lesions (FLLs), and the diagnostic performance were evaluated. RESULTS The level of agreement between the radiology experts and residents improved after training (all p < 0.05), while there were no significant differences between the post-training and 3-months post-training results (all p > 0.05). The sensitivity, specificity, positive predictive value, and area under the curve (AUC) based on the CEUS LI-RADS classification of the radiology experts in the diagnosis of HCC were 62.9%, 96.4%, 96.3%, and 0.796, respectively. The diagnostic performance of the radiology residents significantly improved after training (all p < 0.05). Misunderstanding of definitions and subjective interpretation of images were the main reasons for disagreement with multiple responses. CONCLUSION Dedicated CEUS LI-RADS training improved the performance of radiology residents in diagnosing FLLs and their agreement with radiology experts on CEUS features. Images and videos to explain typical features of the training were essential to improve agreement between the radiology experts and residents. CRITICAL RELEVANCE STATEMENT Agreement on lesion descriptors between radiology experts and residents can improve with training. KEY POINTS The diagnostic performance of less experienced radiologists for diagnosing HCC could be improved by training. Images and videos to explain typical features during training were essential. Agreement on lesion descriptors between radiology experts and residents improved after training.
Collapse
Affiliation(s)
- Ting Dai
- China-Japan Union Hospital of Jilin University, No. 126, Xiantai Avenue, Shier Road District, 130033, Changchun, Jilin, China
| | - Hongjing Zhu
- The First Hospital of Jilin University, No. 71, Xinmin Avenue, Chaoyang District, 130033, Changchun, Jilin, China
| | - Meng Qiao
- China-Japan Union Hospital of Jilin University, No. 126, Xiantai Avenue, Shier Road District, 130033, Changchun, Jilin, China
| | - Yuxuan Song
- China-Japan Union Hospital of Jilin University, No. 126, Xiantai Avenue, Shier Road District, 130033, Changchun, Jilin, China
| | - Yu Sun
- Changchun Sixth Hospital, No. 3188 Yatai Avenue, Kuancheng District, Changchun, 130033, Jilin, China
| | - Xia Meng
- China-Japan Union Hospital of Jilin University, No. 126, Xiantai Avenue, Shier Road District, 130033, Changchun, Jilin, China.
| | - Zhixia Sun
- China-Japan Union Hospital of Jilin University, No. 126, Xiantai Avenue, Shier Road District, 130033, Changchun, Jilin, China.
| |
Collapse
|
|
5
|
Lin XJ, Luo HC. Rare infiltrative primary hepatic angiosarcoma: A case report and review of literature. World J Gastrointest Oncol 2024; 16:3341-3349. [PMID: 39072148 PMCID: PMC11271798 DOI: 10.4251/wjgo.v16.i7.3341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/07/2024] [Accepted: 06/11/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND The most primary sites of angiosarcoma are the skin, breast gland, and soft tissues. Primary hepatic angiosarcoma (PHA) is a rare malignant tumor of mesothelial tissue originating from the liver. PHA often presents with multiple intrahepatic foci or metastasis at the time of presentation due to its nonspecific clinical presentation and highly aggressive nature. There are no established or effective treatment guidelines for PHA, so early detection and early treatment are of great value for patient survival. Unfortunately, there is a paucity of literature on the imaging features of PHA, making the diagnosis and treatment of this disease a considerable challenge. CASE SUMMARY In this case report, we present a 59-year-old man who initially presented with abdominal pain and radiating pain in the right shoulder. Magnetic resonance imaging and positron emission tomography-computed tomography revealed multiple intrahepatic nodules that needed to be differentiated from tumors of vascular epithelial origin and tumors with progressive enhancement features, and signs of tumor metastasis were assessed. The patient was then subjected to contrast-enhanced ultrasonography (CEUS) to further clarify the extent of tumor infiltration and the state of microcirculatory perfusion. The manifestations observed on CEUS were similar to the classical characteristic presentation of hepatocellular carcinoma, called "quick wash-in and quick wash-out". In addition, CEUS showed that the lesion exhibited gradual infiltration and growth along the liver pedicle structures with no invading blood vessels. Finally, based on pathological and immunohistochemical tests and the above imaging manifestations, it was confirmed that the patient had infiltrating PHA, which is a rare pathological type of PHA. The patient underwent transcatheter arterial chemoembolization and chemotherapy. Four months after the onset of symptoms, the follow-up radiological examination revealed poor treatment efficacy and rapid deterioration. CONCLUSION This case report complements the imaging modalities of a rare infiltrative PHA, in which CEUS and quantitative analysis are found to offer substantial advantages in characterizing the microcirculatory perfusion of the lesion, providing clinicians with diagnostic information at the earliest opportunity to make a diagnosis and develop a treatment strategy to prolong the patient survival.
Collapse
Affiliation(s)
- Xiao-Jing Lin
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Hong-Chang Luo
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| |
Collapse
|
|
6
|
Wilson SR, Burrowes DP, Merrill C, Caine BA, Gupta S, Burak KW. Unique portal venous phase imaging discordance between CEUS and MRI: a valuable predictor of intrahepatic cholangiocarcinoma? Abdom Radiol (NY) 2024; 49:11-20. [PMID: 37804423 DOI: 10.1007/s00261-023-04031-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE We have long noted unique portal venous phase (PVP) imaging discordance of focal liver masses between CEUS, showing rapid marked washout, and MRI, showing progressive or sustained enhancement. We postulate association of this unique discordance with intrahepatic cholangiocarcinoma (ICC) and causal relationship to different contrast agent behavior. We investigate this unique discordance, propose its clinical significance for ICC diagnosis, and confirm further histologic associations. METHODS Cases were collected within our CEUS department and from pathology records over a ten-year interval. This retrospective review includes 99 patients, 73 with confirmed ICC and 26 other diagnoses, showing unique PVP discordance. The CEUS and MRI enhancement characteristics were compared for all patients. RESULTS Unique discordance is identified in 67/73 (92%) ICC and difference between the PVP appearance on MRI and CEUS is statistically significant (p < 0.0001). Arterial phase enhancement did not show statistically significant difference between CEUS and MRI, p > 0.05. Other diagnoses showing unique discordance include especially lymphoma (n = 7), sclerosed hemangioma (n = 6), HCC (n = 4), metastases (n = 2), and other rare entities. CONCLUSION ICC shows this discrepant intermodality enhancement pattern in a statistically significant number of cases and should be considered along with other LR-M features in at-risk patients. Discordance is also rarely seen in a number of other liver lesions.
Collapse
Affiliation(s)
- Stephanie R Wilson
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
- Division of Gastroenterology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
- Foothills Medical Centre (FMC), 1403-29 Street NW, Calgary, AB, T2N 2T9, Canada.
| | - David P Burrowes
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Foothills Medical Centre (FMC), 1403-29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Christina Merrill
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Foothills Medical Centre (FMC), 1403-29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Benjamin A Caine
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Foothills Medical Centre (FMC), 1403-29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Saransh Gupta
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Foothills Medical Centre (FMC), 1403-29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Kelly W Burak
- Division of Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Foothills Medical Centre (FMC), 1403-29 Street NW, Calgary, AB, T2N 2T9, Canada
| |
Collapse
|
|
7
|
Cerrito L, Ainora ME, Di Francesco S, Galasso L, Gasbarrini A, Zocco MA. The Role of Contrast-Enhanced Ultrasound (CEUS) in the Detection of Neoplastic Portal Vein Thrombosis in Patients with Hepatocellular Carcinoma. Tomography 2023; 9:1976-1986. [PMID: 37888746 PMCID: PMC10610687 DOI: 10.3390/tomography9050154] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the principal primary liver cancer and one of the most frequent malignant tumors worldwide in patients with chronic liver disease. When diagnosed at an advanced stage, it is often associated with portal vein tumor thrombosis (PVTT), which heavily affects patients' prognosis. Imaging evaluation is crucial in PVTT detection and staging; computed tomography and magnetic resonance are the principal diagnostic tools. Contrast-enhanced ultrasound (CEUS) is a non-invasive and easily repeatable method that can also be used in patients with impaired renal function. It represents an important means for the identification of PVTT, particularly differentiating neoplastic and non-neoplastic thrombosis through the analysis of ultrasound enhancement characteristics of the thrombosis (arterial hyperenhancement and portal washout), thus allowing more refined disease staging, appropriate treatment planning, and response evaluation, along with prognosis assessment.
Collapse
Affiliation(s)
| | | | | | | | | | - Maria Assunta Zocco
- CEMAD Centro Malattie dell’Apparato Digerente, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore Roma, Largo A. Gemelli, 8, 00168 Roma, Italy; (L.C.); (M.E.A.); (S.D.F.); (L.G.); (A.G.)
| |
Collapse
|
|
8
|
Wen R, Huang W, Song R, Qin L, Wu Y, Peng Y, Huang X, He Y, Yang H. Differences between CEUS LI-RADS and CECT LI-RADS in the diagnosis of focal liver lesions in patients at risk for HCC. BMC Med Imaging 2023; 23:122. [PMID: 37697248 PMCID: PMC10496202 DOI: 10.1186/s12880-023-01088-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/22/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVES To compare the inter-modality consistency and diagnostic performances of the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) and contrast-enhanced computed tomography (CECT) LI-RADS in patients at risk for hepatocellular carcinoma (HCC), so as to help clinicians to select a more appropriate modality to follow the focal liver lesions (FLLs). METHODS This retrospective study included untreated 277 FLLs from 247 patients who underwent both CEUS and CECT within 1 month. The ultrasound contrast medium used was SonoVue. FLL categories were independently assigned by two ultrasound physicians and two radiologists using CEUS LI-RADS v2017 and CECT LI-RADS v2018, respectively. The diagnostic performances of CEUS and CECT LI-RADS were evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value. Cohen's Kappa was employed to evaluate the concordance of the LI-RADS category. RESULTS The inter-modality consistency for CEUS and CECT LI-RADS was 0.31 (p < 0.001). HCC was more frequently observed in CECT LR-3 and LR-4 hepatic lesions than in CEUS (7.3% vs. 19.5%, p < 0.001). The specificity and PPV of CEUS and CECT LR-5 for the diagnosis of HCC were 89.5%, 95.0%, and 82.5%, 94.4%, respectively. The sensitivity of CEUS LR-5 + LR-M for the diagnosis of hepatic malignancies was higher than that of CECT (93.7% vs. 82.7%, p < 0.001). The specificity and PPV of CEUS LR-M for the diagnosis of non-HCC malignancies were lower than those of CECT (59.7% vs. 95.5%, p < 0.001; 23.4% vs. 70.3%, p < 0.001). CONCLUSIONS The inter-modality consistency between the CEUS and CECT LI-RADS categories is fair. CEUS LI-RADS was more sensitive than CECT LI-RADS in terms of identifying hepatic malignancies, but weaker in terms of separating HCC from non-HCC malignancies.
Collapse
Affiliation(s)
- Rong Wen
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Weiche Huang
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Rui Song
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Lanhui Qin
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yuquan Wu
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yuting Peng
- Department of Medical Ultrasound, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Xiongyan Huang
- Department of Pathology, The Affiliated Minzu Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yun He
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Hong Yang
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
| |
Collapse
|
|
9
|
Bae JS, Lee JY, Suh KS, Hong SK, Yoon JH, Kim YJ, Yu SJ, Lee JH, Cho EJ, Lee YB, Han JK. Characterization of hepatobiliary phase hypointense nodules without arterial phase hyperenhancement on gadoxetic acid-enhanced MRI via contrast-enhanced ultrasound using perfluorobutane. Abdom Radiol (NY) 2023; 48:2321-2330. [PMID: 37097451 DOI: 10.1007/s00261-023-03901-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) on gadoxetic acid-enhanced MRI (GA-MRI) may be nonmalignant cirrhosis-associated nodules or hepatocellular carcinomas (HCCs). We aimed to characterize HBP hypointense nodules without APHE on GA-MRI by performing contrast-enhanced ultrasound using perfluorobutane (PFB-CEUS). METHODS In this prospective, single-center study, participants at high-risk of HCC having HBP hypointense nodules without APHE at GA-MRI were enrolled. All participants underwent PFB-CEUS; if APHE and late, mild washout or washout in the Kupffer phase were present, the diagnosis of HCC was established according to the v2022 Korean guidelines. The reference standard consisted of histopathology or imaging. The sensitivity, specificity, and positive/negative predictive values of PFB-CEUS for detecting HCC were calculated. Associations between clinical/imaging features and the diagnosis of HCC were evaluated with logistic regression analyses. RESULTS In total, 67 participants (age, 67.0 years ± 8.4; 56 men) with 67 HBP hypointense nodules without APHE (median size, 1.5 cm [range, 1.0-3.0 cm]) were included. The prevalence of HCC was 11.9% (8/67). The sensitivity, specificity, and positive and negative predictive values of PFB-CEUS for detecting HCC were 12.5%(1/8), 96.6%(57/59), 33.3%(1/3) and 89.1%(57/64), respectively. Mild-moderate T2 hyperintensity on GA-MRI (odds ratio, 5.756; P = 0.042) and washout in the Kupffer phase on PFB-CEUS (odds ratio, 5.828; P = 0.048) were independently associated with HCC. CONCLUSION Among HBP hypointense nodules without APHE, PFB-CEUS was specific for detecting HCC, which had a low prevalence. Mild-moderate T2 hyperintensity on GA-MRI and washout in the Kupffer phase on PFB-CEUS may be useful to detect HCC in those nodules.
Collapse
Affiliation(s)
- Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Su Jong Yu
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Eun Ju Cho
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Yun Bin Lee
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| |
Collapse
|
|
10
|
Hu J, Burrowes DP, Caine BA, Gibson N, Bhayana D, Medellin A, Burak KW, Wilson SR. Nodules Identified on Surveillance Ultrasound for HCC: CEUS or MRI as the Initial Test? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1181-1190. [PMID: 36807925 DOI: 10.1002/jum.16183] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Following positive surveillance ultrasound (US), magnetic resonance imaging (MRI) is recommended for further characterization. We propose contrast-enhanced ultrasound (CEUS) shows equivalent efficacy. METHODS This prospective institutional review board approved study recruited 195 consecutive at-risk patients with a positive surveillance US. All had CEUS and MRI. Biopsy (n = 44) and follow-up are gold standard. MRI and CEUS results are classified according to liver imaging reporting and data system (LI-RADS) and patient outcome. RESULTS As an US-based modality, CEUS is superior in confirming findings from surveillance US, correlation in 189/195 (97%) on CEUS compared to 153/195 (79%) on MRI. Within these negative MRI examinations, there are 2 hepatocellular carcinoma (HCC) and 1 cholangiocarcinoma (iCCA) diagnosed on CEUS and proven by biopsy. From 195 patients, there are 71 malignant diagnoses from all sources, including 58 LR-5 (45 on MRI and 54 on CEUS) and 13 others, including HCC outside of LR-5 category, and LR-M with biopsy proven iCCA (3 on MRI and 6 on CEUS). CEUS and MRI show concordant results in the majority of patients (146/195, 75%), including 57/146 malignant and 89/146 benign diagnoses. There are 41/57 concordant LR-5 and 6/57 concordant LR-M. When CEUS and MRI are discordant, CEUS upgraded 20 (10 biopsy-proven) from MRI LR-3/4 to CEUS LR-5 or LR-M by showing washout (WO) that MRI failed to show. Additionally, CEUS characterized time and intensity of WO and diagnosed 13/20 LR-5 by showing late and weak WO and 7 LR-M by showing fast and marked WO. CEUS is 81% sensitive and 92% specific in diagnosing malignancy. MRI is 64% sensitive and 93% specific. CONCLUSIONS CEUS performance is at least equivalent if not superior to MRI for initial evaluation of lesions from surveillance US.
Collapse
Affiliation(s)
- Jinghui Hu
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - David P Burrowes
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Benjamin A Caine
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Nicolas Gibson
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Deepak Bhayana
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Alexandra Medellin
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Kelly W Burak
- Medicine and Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie R Wilson
- Radiology and Medicine, Division of Gastroentrology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
|
11
|
Ainora ME, Cerrito L, Liguori A, Mignini I, De Luca A, Galasso L, Garcovich M, Riccardi L, Ponziani F, Santopaolo F, Pompili M, Gasbarrini A, Zocco MA. Multiparametric Dynamic Ultrasound Approach for Differential Diagnosis of Primary Liver Tumors. Int J Mol Sci 2023; 24:8548. [PMID: 37239893 PMCID: PMC10218249 DOI: 10.3390/ijms24108548] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/28/2023] [Accepted: 05/01/2023] [Indexed: 05/28/2023] Open
Abstract
A correct differentiation between hepatocellular carcinoma (HCC) and intracellular cholangiocarcinoma (ICC) is essential for clinical management and prognostic prediction. However, non-invasive differential diagnosis between HCC and ICC remains highly challenging. Dynamic contrast-enhanced ultrasound (D-CEUS) with standardized software is a valuable tool in the diagnostic approach to focal liver lesions and could improve accuracy in the evaluation of tumor perfusion. Moreover, the measurement of tissue stiffness could add more information concerning tumoral environment. To explore the diagnostic performance of multiparametric ultrasound (MP-US) in differentiating ICC from HCC. Our secondary aim was to develop an US score for distinguishing ICC and HCC. Between January 2021 and September 2022 consecutive patients with histologically confirmed HCC and ICC were enrolled in this prospective monocentric study. A complete US evaluation including B mode, D-CEUS and shear wave elastography (SWE) was performed in all patients and the corresponding features were compared between the tumor entities. For better inter-individual comparability, the blood volume-related D-CEUS parameters were analyzed as a ratio between lesions and surrounding liver parenchyma. Univariate and multivariate regression analysis was performed to select the most useful independent variables for the differential diagnosis between HCC and ICC and to establish an US score for non-invasive diagnosis. Finally, the diagnostic performance of the score was evaluated by receiver operating characteristic (ROC) curve analysis. A total of 82 patients (mean age ± SD, 68 ± 11 years, 55 men) were enrolled, including 44 ICC and 38 HCC. No statistically significant differences in basal US features were found between HCC and ICC. Concerning D-CEUS, blood volume parameters (peak intensity, PE; area under the curve, AUC; and wash-in rate, WiR) showed significantly higher values in the HCC group, but PE was the only independent feature associated with HCC diagnosis at multivariate analysis (p = 0.02). The other two independent predictors of histological diagnosis were liver cirrhosis (p < 0.01) and SWE (p = 0.01). A score based on those variables was highly accurate for the differential diagnosis of primary liver tumors, with an area under the ROC curve of 0.836 and the optimal cut-off values of 0.81 and 0.20 to rule in or rule out ICC respectively. MP-US seems to be a useful tool for non-invasive discrimination between ICC and HCC and could prevent the need for liver biopsy at least in a subgroup of patients.
Collapse
Affiliation(s)
- Maria Elena Ainora
- CEMAD Digestive Disease Center, Fondazione PoliclinicoUniversitario “A. Gemelli” IRCCS, Catholic University of Rome (Italy), 00168 Rome, Italy
| | - Lucia Cerrito
- CEMAD Digestive Disease Center, Fondazione PoliclinicoUniversitario “A. Gemelli” IRCCS, Catholic University of Rome (Italy), 00168 Rome, Italy
| | - Antonio Liguori
- CEMAD Digestive Disease Center, Fondazione PoliclinicoUniversitario “A. Gemelli” IRCCS, Catholic University of Rome (Italy), 00168 Rome, Italy
| | - Irene Mignini
- CEMAD Digestive Disease Center, Fondazione PoliclinicoUniversitario “A. Gemelli” IRCCS, Catholic University of Rome (Italy), 00168 Rome, Italy
| | - Angela De Luca
- Internal Medicine, University Hospital, 70100 Bari, Italy
| | - Linda Galasso
- CEMAD Digestive Disease Center, Fondazione PoliclinicoUniversitario “A. Gemelli” IRCCS, Catholic University of Rome (Italy), 00168 Rome, Italy
| | - Matteo Garcovich
- CEMAD Digestive Disease Center, Fondazione PoliclinicoUniversitario “A. Gemelli” IRCCS, Catholic University of Rome (Italy), 00168 Rome, Italy
| | - Laura Riccardi
- CEMAD Digestive Disease Center, Fondazione PoliclinicoUniversitario “A. Gemelli” IRCCS, Catholic University of Rome (Italy), 00168 Rome, Italy
| | - Francesca Ponziani
- CEMAD Digestive Disease Center, Fondazione PoliclinicoUniversitario “A. Gemelli” IRCCS, Catholic University of Rome (Italy), 00168 Rome, Italy
| | - Francesco Santopaolo
- CEMAD Digestive Disease Center, Fondazione PoliclinicoUniversitario “A. Gemelli” IRCCS, Catholic University of Rome (Italy), 00168 Rome, Italy
| | - Maurizio Pompili
- CEMAD Digestive Disease Center, Fondazione PoliclinicoUniversitario “A. Gemelli” IRCCS, Catholic University of Rome (Italy), 00168 Rome, Italy
| | - Antonio Gasbarrini
- CEMAD Digestive Disease Center, Fondazione PoliclinicoUniversitario “A. Gemelli” IRCCS, Catholic University of Rome (Italy), 00168 Rome, Italy
| | - Maria Assunta Zocco
- CEMAD Digestive Disease Center, Fondazione PoliclinicoUniversitario “A. Gemelli” IRCCS, Catholic University of Rome (Italy), 00168 Rome, Italy
| |
Collapse
|
|
12
|
Zhu JY, He HL, Jiang XC, Bao HW, Chen F. Multimodal ultrasound features of breast cancers: correlation with molecular subtypes. BMC Med Imaging 2023; 23:57. [PMID: 37069528 PMCID: PMC10111677 DOI: 10.1186/s12880-023-00999-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/15/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVES To investigate whether multimodal intratumour and peritumour ultrasound features correlate with specific breast cancer molecular subtypes. METHODS From March to November 2021, a total of 85 patients with histologically proven breast cancer underwent B-mode, real-time elastography (RTE), colour Doppler flow imaging (CDFI) and contrast-enhanced ultrasound (CEUS). The time intensity curve (TIC) of CEUS was obtained, and the peak and time to peak (TTP) were analysed. Chi-square and binary logistic regression were used to analyse the connection between multimodal ultrasound imaging features and breast cancer molecular subtype. RESULTS Among 85 breast cancers, the subtypes were as follows: luminal A (36 cases, 42.4%), luminal B (20 cases, 23.5%), human epidermal growth factor receptor-2 positive (HER2+) (16 cases, 18.8%), and triple negative breast cancer (TNBC) (13 cases, 15.3%). Binary logistic regression models showed that RTE (P < 0.001) and CDFI (P = 0.036) were associated with the luminal A cancer subtype (C-index: 0.741), RTE (P = 0.016) and the peak ratio between intratumour and corpus mamma (P = 0.036) were related to the luminal B cancer subtype (C-index: 0.788). The peak ratio between peritumour and intratumour (P = 0.039) was related to the HER2 + cancer subtype (C-index: 0.859), and CDFI (P = 0.002) was associated with the TNBC subtype (C-index: 0.847). CONCLUSIONS Multimodal ultrasound features could be powerful predictors of specific breast cancer molecular subtypes. The intra- and peritumour CEUS features play assignable roles in separating luminal B and HER2 + breast cancer subtypes.
Collapse
Affiliation(s)
- Jun-Yan Zhu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Ultrasound, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Han-Lu He
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Ultrasound, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiao-Chun Jiang
- Department of Ultrasound, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hai-Wei Bao
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fen Chen
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Department of Ultrasound, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
| |
Collapse
|
|
13
|
Guo J, Wang BH, He M, Fu P, Yao M, Jiang T. Contrast-enhanced ultrasonography for early prediction of response of neoadjuvant chemotherapy in breast cancer. Front Oncol 2022; 12:1026647. [PMID: 36531048 PMCID: PMC9753903 DOI: 10.3389/fonc.2022.1026647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/18/2022] [Indexed: 07/29/2023] Open
Abstract
Neoadjuvant chemotherapy (NAC) is widely accepted as a primary treatment for inoperable or locally advanced breast cancer before definitive surgery. However, not all advanced breast cancers are sensitive to NAC. Contrast-enhanced ultrasonography (CEUS) has been considered to assess tumor response to NAC as it can effectively reflect the condition of blood perfusion and lesion size. Therefore, this study aimed to evaluate the diagnostic performance of CEUS to predict early response in different regions of interest in breast tumors under NAC treatment. This prospective study included 82 patients with advanced breast cancer. Parameters of TIC (time-intensive curve) between baseline and after the first cycle of NAC were calculated for the rate of relative change (Δ), including Δpeak, ΔTTP (time to peak), ΔRBV (regional blood volume), ΔRBF (regional blood flow) and ΔMTT (mean transit time). The responders and non-responders were distinguished by the Miller-Payne Grading (MPG) system and parameters from different regions of tumors were compared in these two groups. For ROI 1(the greatest enhancement area in the central region of the tumor), there were significant differences in Δpeak1, ΔRBV1 and ΔRBF1 between responders and non-responders. For ROI 2 (the greatest enhancement area on edge of the tumor), there were significant differences in Δpeak2 and ΔRBF2 between the groups. The Δpeak1 and ΔRBF2 showed good prediction (AUC 0.798-0.820, p ≤ 0.02) after the first cycle of NAC. When the cut-off value was 0.115, the ΔRBF2 had the highest diagnostic accuracy and the maximum NPV. Quantitative TIC parameters could be effectively used to evaluate early response to NAC in advanced breast cancer.
Collapse
Affiliation(s)
- Jiabao Guo
- Department of Ultrasound Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Bao-Hua Wang
- Department of Ultrasound Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Mengna He
- Department of Ultrasound Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Peifen Fu
- Department of Breast Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Minya Yao
- Department of Breast Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Tian’an Jiang
- Department of Ultrasound Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| |
Collapse
|
|
14
|
Li J, Ye X, Wang J, Yuan G, He S. A comparative study of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging and contrast-enhanced ultrasound in the detection of intrahepatic lesion. Medicine (Baltimore) 2022; 101:e30482. [PMID: 36086711 PMCID: PMC10980474 DOI: 10.1097/md.0000000000030482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/02/2022] [Indexed: 11/27/2022] Open
Abstract
We evaluated the diagnostic performance of both gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) and contrast-enhanced ultrasound (CEUS) for focal liver lesions, especially for the detection of small (<2 cm) intrahepatic lesions. We retrospectively reviewed patients who underwent Gd-EOB-DTPA-MRI and CEUS before liver resection and compared Gd-EOB-DTPA-MRI and CEUS in the detection of focal liver lesions. A total of 216 patients were included, and 309 lesions were found. The sensitivity values of MRI and CEUS for the main lesion were both more than 95%, and the coincidence rates were both more than 80%. Regarding lesions <2 cm, 135 such lesions were detected by MRI, whereas only 85 were detected by CEUS. For lesions <2 cm, the sensitivity, specificity, and coincidence rates of MRI were significantly better than those of CEUS. Among 27 patients, 50 more lesions were detected by MRI than CEUS, 56% (28/50) of which were malignant. For the large lesion, the diagnostic performance is similar between Gd-EOB-DTPA-MRI and CEUS, and the sensitivity and coincidence rates of both methods are high. Gd-EOB-DTPA-MRI is likely to detect small (<2 cm) focal intrahepatic lesions.
Collapse
Affiliation(s)
- Jiangfa Li
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, China
- Key Laboratory of high-incidence-Tumor Prevention & Treatment (Guangxi Medical University), Ministry of Education; Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor
| | - Xiaofei Ye
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jiming Wang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guandou Yuan
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Songqing He
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Key Laboratory of high-incidence-Tumor Prevention & Treatment (Guangxi Medical University), Ministry of Education; Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor
| |
Collapse
|
|
15
|
Wilson A, Lim A. Microvascular imaging: new Doppler technology for assessing focal liver lesions. Is it useful? Clin Radiol 2022; 77:e807-e820. [DOI: 10.1016/j.crad.2022.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/09/2022]
|
|
16
|
Ruan SM, Cheng MQ, Huang H, Hu HT, Li W, Xie XY, Lu MD, Kuang M, Lin MX, Wang W. Application of the CT/MRI LI-RADS Treatment Response Algorithm to Contrast-Enhanced Ultrasound: A Feasibility Study. J Hepatocell Carcinoma 2022; 9:437-451. [PMID: 35620274 PMCID: PMC9128751 DOI: 10.2147/jhc.s353914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/09/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (TRA) is still in development. The aim of this study was to explore whether the CT/MRI LI-RADS TRA features were applicable to CEUS in evaluating the liver locoregional therapy (LRT) response. Patients and Methods This study was a retrospective review of a prospectively maintained database of patients with hepatocellular carcinoma undergoing ablation between July 2017 and December 2018. The standard criteria for a viable lesion were a histopathologically confirmed or typical viable appearance in the follow-up CT/MRI. Performance of the LI-RADS TRA assessing tumor viability was then compared between CEUS and CT/MRI. Inter-reader association was calculated. Results A total of 244 patients with 389 treated observations (118 viable) were evaluated. The sensitivity and specificity of the CEUS TRA and CT/MRI LI-RADS TRA viable categories for predicting viable lesions were 55.0% (65/118) versus 56.8% (67/118) (P = 0.480) and 99.3% (269/271) versus 96.3% (261/271) (P = 0.013), respectively. The PPV of CEUS was higher than that of CT/MRI (97.0% vs 87.0%). Subgroup analysis showed that the sensitivity was low in the 1-month assessment for both CEUS (38.1%, 16/42) and CT/MR (47.6%, 20/42) and higher in the 2–6-month assessment for both CEUS (65.7%, 23/35) and CT/MR (62.9%, 22/35). Interobserver agreements were substantial for both CEUS TRA and CT/MRI LI-RADS TRA (κ, 0.74 for both). Conclusion The CT/MRI LI-RADS TRA features were applicable to CEUS TRA for liver locoregional therapy. The CEUS TRA for liver locoregional therapy has sufficiently high specificity and PPV to diagnose the viability of lesions after ablation.
Collapse
Affiliation(s)
- Si-Min Ruan
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Mei-Qing Cheng
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Hui Huang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Hang-Tong Hu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Wei Li
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Ming-De Lu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Ming Kuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Man-Xia Lin
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Wei Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People’s Republic of China
- Correspondence: Man-Xia Lin; Wei Wang, Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People’s Republic of China, Tel/Fax +86-20-87765183, Email ;
| |
Collapse
|
|
17
|
Atri M, Jang HJ, Kim TK, Khalili K. Contrast-enhanced US of the Liver and Kidney: A Problem-solving Modality. Radiology 2022; 303:11-25. [PMID: 35191740 DOI: 10.1148/radiol.211347] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Contrast-enhanced US (CEUS) has an important role as a supplement to CT or MRI in clinical practice. The main established utilizations are in the liver and the kidney. The primary advantages of CEUS compared with contrast-enhanced CT or MRI relate to its superior contrast resolution, real-time continuous scanning, pure intravascular nature, portability, and safety-especially in patients with renal impairment or CT or MRI contrast agent allergy. This article focuses on the use of CEUS in the liver and kidney.
Collapse
Affiliation(s)
- Mostafa Atri
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Hyun-Jung Jang
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Tae Kyoung Kim
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Korosh Khalili
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| |
Collapse
|
|
18
|
Dong Y, Wang WP, Lee WJ, Meloni MF, Clevert DA, Chammas MC, Tannapfel A, Forgione A, Piscaglia F, Dietrich CF. Hepatocellular carcinoma in the non-cirrhotic liver. Clin Hemorheol Microcirc 2022; 80:423-436. [PMID: 34842182 DOI: 10.3233/ch-211309] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Liver cirrhosis is an established high-risk factor for HCC and the majority of patients diagnosed with HCC have cirrhosis. However, HCC also arises in non-cirrhotic livers in approximately 20 %of all cases. HCC in non-cirrhotic patients is often clinically silent and surveillance is usually not recommended. HCC is often diagnosed at an advanced stage in these patients. Current information about HCC in patients with non-cirrhotic liver is limited. Here we review the current knowledge on epidemiology, clinical features and imaging features of those patiens.
Collapse
Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Health Science and Technology and Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Maria Franca Meloni
- Radiology Department of Interventional Ultrasound Casa di Cura Igea, Milano, Italy Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Dirk-Andre Clevert
- Department of Radiology, Interdisciplinary Ultrasound-Center, University of Munich-Grosshadern Campus, Munich, Germany
| | - Maria Cristina Chammas
- Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Antonella Forgione
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Beau Site, Salem und Permanence, Hirslanden, Bern, Switzerland
| |
Collapse
|
|
19
|
Burrowes DP, Medellin A, Harris AC, Milot L, Lethebe BC, Wilson SR. Characterization of Focal Liver Masses: A Multicenter Comparison of Contrast-Enhanced Ultrasound, Computed Tomography, and Magnetic Resonance Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2581-2593. [PMID: 33576003 DOI: 10.1002/jum.15644] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/23/2020] [Accepted: 12/11/2020] [Indexed: 05/14/2023]
Abstract
OBJECTIVES To demonstrate the usefulness of contrast-enhanced ultrasound (CEUS) for the evaluation of focal liver masses via a direct comparison to standard ultrasound and computed tomography/magnetic resonance imaging (CT/MRI). METHODS A cohort of 214 patients with previously undiagnosed focal liver masses were included from 5 different centers. Each patient was imaged using CEUS and CT and/or MRI. Anonymized and randomized images were interpreted by 4 separate blind readers from 3 of the participating centers (2 readers for CEUS and 2 readers for CT/MRI). Readers were blinded to patient demographics and past medical history. Readers were asked to decide if the lesion was benign or malignant, provide a final diagnosis for the lesion, and provide a confidence interval. Results were compared to truth standard from pathology or expert consensus. RESULTS In determination of malignancy, CEUS had a sensitivity of 95%, specificity of 82%, PPV of 82%, NPV of 95%, statistically better than standard ultrasound (sensitivity 82%, specificity 56%, PPV 60%, NPV 78%) with P < .01 and not statistically different from CT (sensitivity 90%, specificity 73% PPV 81%, NPV 86%) or MRI (sensitivity 85%, specificity 79%, PPV 68%, NPV 91%) with P ≥ .01. In assigning a final diagnosis, CEUS had an accuracy of 78% statistically better than standard ultrasound (46%) with P < .01 and not statistically different from CT (68%) or MRI (71%) with P > .01. CONCLUSIONS In the evaluation of focal liver lesions, both for determination of malignancy and in accuracy of final diagnosis, CEUS performs better than standard ultrasound and at least equivalent to both CT and MRI.
Collapse
Affiliation(s)
- David P Burrowes
- Department of Radiology, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Alexandra Medellin
- Department of Radiology, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Allison C Harris
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurent Milot
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Brendan C Lethebe
- Clinical Research Unit, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Stephanie R Wilson
- Department of Radiology, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Medicine, Division of Gastroenterology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Diagnostic Imaging, Foothills Medical Centre, Calgary, Alberta, Canada
| |
Collapse
|
|
20
|
Barr RG, Wilson SR, Lyshchik A, McCarville B, Darge K, Grant E, Robbin M, Wilmann JK, Chong WK, Fleischer A, Paltiel HJ. Contrast -Enhanced Ultrasound: State of the Art in North America. Ultrasound Q 2021; 36:206-217. [PMID: 32890323 DOI: 10.1097/ruq.0000000000000514] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Society of Radiologists in Ultrasound convened a panel of specialists in contrast-enhanced ultrasound (CEUS) to produce a white paper on noncardiac CEUS in North America. The panel met in Chicago, Illinois, on October 24 and 25, 2017. The recommendations are based on analysis of current literature and common practice strategies and are thought to represent a reasonable approach to introduce the advantages of this safe and noninvasive technique for the benefit of our patients. Characterization of liver nodules, and pediatric vascular and intravesicular applications comprise the approved indications for CEUS in the United States. They, along with the very successful off-label use of CEUS for the kidney, are included in this publication.Other off-label uses are presented with emphasis on their value and literature support in the online version.
Collapse
Affiliation(s)
| | | | | | | | - Kassa Darge
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Edward Grant
- University of Southern California, Los Angeles, CA
| | | | | | | | | | | |
Collapse
|
|
21
|
Utility of contrast-enhanced ultrasound for solid mass surveillance and characterization in children with tuberous sclerosis complex: an initial experience. Pediatr Nephrol 2021; 36:1775-1784. [PMID: 33582872 DOI: 10.1007/s00467-020-04835-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/04/2020] [Accepted: 10/20/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with tuberous sclerosis complex (TSC) can develop solid kidney masses from childhood. Imaging surveillance is done to detect renal cell carcinoma (RCC) and angiomyolipomas (AML), including AMLs at risk for hemorrhage. Intravenous contrast-enhanced ultrasound (CEUS) may be useful for screening as ultrasound is well tolerated by children and ultrasound contrast agents (UCA) are not nephrotoxic. METHODS Retrospective review of kidney CEUS exams of pediatric TSC patients. Qualitative CEUS analysis by consensus of 3 radiologists assessed rate, intensity, and pattern of lesion enhancement. Quantitative CEUS analysis was performed using Vuebox®. Where available, abdominal MRI was analyzed qualitatively for the same features and quantitatively by in-house-developed software. Time-intensity curves were generated from both CEUS and MRI where possible. Appearance of lesions were compared between CEUS and MRI and histology where available. RESULTS Nine masses in 5 patients included one histologically proven RCC and 8 AMLs diagnosed by imaging. Quantitative CEUS of RCC showed malignant features including increased peak enhancement 162%, rapid wash-in rate 162%, and elevated washout rate 156% compared to normal kidney tissue; versus AML which was 68%, 105%, and 125%, respectively. All masses were hypoenhancing on MRI compared to normal kidney tissue; MR dynamic contrast study offered no distinction between RCC and AML. The only MRI feature differentiating RCC from AML was absence of fat. CONCLUSION Temporal resolution afforded by CEUS was useful to distinguish malignant from benign kidney masses. CEUS may prove useful for screening, characterizing, and follow-up of kidney lesions in pediatric TSC patients.
Collapse
|
|
22
|
Caraiani C, Boca B, Bura V, Sparchez Z, Dong Y, Dietrich C. CT/MRI LI-RADS v2018 vs. CEUS LI-RADS v2017-Can Things Be Put Together? BIOLOGY 2021; 10:412. [PMID: 34066607 PMCID: PMC8148521 DOI: 10.3390/biology10050412] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/17/2021] [Accepted: 04/30/2021] [Indexed: 12/27/2022]
Abstract
Different LI-RADS core documents were released for CEUS and for CT/MRI. Both documents rely on major and ancillary diagnostic criteria. The present paper offers an exhaustive comparison of the two documents focusing on the similarities, but especially on the differences, complementarity, and added value of imaging techniques in classifying liver nodules in cirrhotic livers. The major diagnostic criteria are defined, and the sensitivity and specificity of each major diagnostic criteria are presented according to the literature. The existing differences between techniques in assessing the major diagnostic features can be then exploited in order to ensure a better classification and a better clinical management of liver nodules in cirrhotic livers. Ancillary features depend on the imaging technique used, and their presence can upgrade or downgrade the LI-RADS score of an observation, but only as far as LI-RADS 4. MRI is the imaging technique that provides the greatest number of ancillary features, whereas CEUS has fewer ancillary features than other imaging techniques. In the final part of the manuscript, some recommendations are made by the authors in order to guidephysicians as to when adding another imaging technique can be helpful in managing liver nodules in cirrhotic livers.
Collapse
Affiliation(s)
- Cosmin Caraiani
- Department of Medical Imaging, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania;
| | - Bianca Boca
- Department of Medical Imaging, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania;
- Department of Radiology, County Clinical Emergency Hospital Cluj-Napoca, 400006 Cluj-Napoca, Romania;
- Department of Radiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
| | - Vlad Bura
- Department of Radiology, County Clinical Emergency Hospital Cluj-Napoca, 400006 Cluj-Napoca, Romania;
- Department of Radiology, Addenbrooke’s Hospital and University of Cambridge, Cambridge CB2 0QQ, UK
| | - Zeno Sparchez
- Department of Gastroenterology and Hepatology, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, 400158 Cluj-Napoca, Romania
- 3rd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
| | - Yi Dong
- Ultrasound Department, Zhongshan Hospital, Fudan University, Shanghai 200032, China;
| | - Christoph Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, 3013 Bern, Switzerland;
| |
Collapse
|
|
23
|
Huang Z, Zhou P, Li S, Li K. MR versus CEUS LI-RADS for Distinguishing Hepatocellular Carcinoma from other Hepatic Malignancies in High-Risk Patients. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1244-1252. [PMID: 33610338 DOI: 10.1016/j.ultrasmedbio.2021.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/06/2021] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
Distinguishing between other hepatic malignancies (OMs) and hepatocellular carcinoma (HCC) is vital to allow clinicians to determine optimal treatment and assess prognosis in patients at high risk for HCC. This study evaluated the performance of the Liver Imaging Reporting and Data System (LI-RADS) using magnetic resonance imaging (MRI) versus contrast-enhanced ultrasonography (CEUS) for differentiating HCC from OMs in patients at high risk for HCC. This retrospective study consecutively enrolled 106 high-risk patients with HCC and 52 high-risk patients with OMs. Patients underwent both MRI and CEUS, with histologic diagnosis as a reference standard. The diagnostic performance of MR versus CEUS LI-RADS was calculated and compared. The performance of the modified CEUS LI-RADS criteria was also evaluated and compared. Our research found that MRI features significantly differed between patients with OMs and those with HCC (p < 0.05), with sensitivities of 34.6%-69.2% and specificities of 83.0%-95.3% for diagnosing OMs and an LI-RADS M (LR-M): definite or probable malignancy, not specific for hepatocellular carcinoma sensitivity of 90.4% and specificity of 83.0% for diagnosing OM. CEUS features also significantly differed between patients with OM and HCC (p < 0.05), with sensitivities of 11.5%-96.2% and specificities of 23.6%-100% for diagnosing OMs, and an LR-M sensitivity of 98.1% and specificity of 84.0% for diagnosing OMs. Accuracies of category LR-M did not significantly differ between MR and CEUS LI-RADS (85.4% vs. 88.6%, p = 0.724). After reclassification of category LR-M nodules to category LR-5 if they exhibited clear intratumoral non-enhanced area boundaries and no punched-out appearance before 5 min, accuracy increased from 88.6% to 96.8% for CEUS LR-M and from 84.8% to 91.1% for CEUS LR-5. LR-M accuracies were significantly higher for the modified version of the CEUS LI-RADS than for MR LI-RADS (96.8% vs. 85.4%, respectively, p = 0.04). CEUS LI-RADS and MR LI-RADS can effectively be used to distinguish HCC from OMs. In patients at high risk of HCC, performance may be further improved by using a modified CEUS LI-RADS classification system in which category LR-M lesions are considered LR-5 if they have clear intratumoral non-enhanced area boundaries and do not have a punched-out appearance.
Collapse
Affiliation(s)
- Zhe Huang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - PingPing Zhou
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - ShanShan Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaiyan Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
|
24
|
Chen Y, Wang W. Differentiation between hepatocellular carcinoma and intrahepatic cholangiocarcinoma using contrast-enhanced ultrasound: A systematic review and meta-analysis. Clin Hemorheol Microcirc 2021; 79:293-309. [PMID: 33935070 DOI: 10.3233/ch-211145] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM To explore the diagnostic ability of contrast-enhanced ultrasound (CEUS) in distinguishing intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC). MATERIALS AND METHODS PubMed, EMBASE, Cochrane Library, and Web of Science were systematically searched for studies reporting the diagnostic accuracy of CEUS in differentiating ICC from HCC. The diagnostic ability of CEUS was assessed based on the pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and area under the curve (AUC) with 95% confidence intervals (CIs). The methodologic quality was assessed by the QUADAS-2 tool. Subgroup analyses, meta-regression and investigation of publication bias were performed to identify the source of heterogeneity. RESULTS A total of eight studies were included, consisting of 1,116 patients with HCC and 529 with ICC. The general diagnostic performance of CEUS in distinguishing ICC and HCC were as follows: pooled sensitivity, 0.92 (95% CI: 0.84-0.96); pooled specificity, 0.87 (95% CI: 0.79-0.92); pooled PLR, 7.1 (95% CI: 4.1-12.0); pooled NLR, 0.09 (95% CI: 0.05-0.19); pooled DOR, 76 (95% CI: 26-220) and AUC, 0.95(95% CI: 0.93-0.97). Different liver background may be a potential factor that influenced the diagnostic accuracy of CEUS according to the subgroup analysis, with the pooled DOR of 89.67 in the mixed liver background group and 46.87 in the cirrhosis group, respectively. Six informative CEUS features that may help differentiate HCC from ICC were extracted. The three CEUS features favoring HCC were arterial phase hyperenhancement(APHE), mild washout and late washout (>60s); the three CEUS favoring ICC were arterial rim enhancement, marked washout and early washout(<60s). No potential publication bias was observed. CONCLUSION CEUS showed great diagnostic ability in differentiating ICC from HCC, which may be promising for noninvasive evaluation of these diseases.
Collapse
Affiliation(s)
- Yanling Chen
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenping Wang
- Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
|
25
|
Shao YY, Wang SY, Lin SM. Management consensus guideline for hepatocellular carcinoma: 2020 update on surveillance, diagnosis, and systemic treatment by the Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan. J Formos Med Assoc 2021; 120:1051-1060. [PMID: 33199101 DOI: 10.1016/j.jfma.2020.10.031] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/28/2020] [Accepted: 10/30/2020] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality in Taiwan. The Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan had established a management consensus guideline in 2016. The current recommendations focus on updating critical issues regarding the management of HCC, including surveillance, diagnosis, and systemic treatment. For surveillance, the updated guideline suggests the role of dynamic computed tomography or magnetic resonance imaging and contrast-enhanced ultrasound (CEUS) in selected patients. For diagnosis, this update incorporates CEUS and recognizes the role of gadoxetic acid-enhanced magnetic resonance imaging. For systemic therapy, the updated guideline summarizes the multiple choices of targeted therapy, immune checkpoint inhibitors, and the combination of both. Through this update of the management consensus guideline, patients with HCC can benefit from receiving optimal diagnostic and therapeutic modalities.
Collapse
Affiliation(s)
- Yu-Yun Shao
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shen-Yung Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shi-Ming Lin
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
| |
Collapse
|
|
26
|
Wang F, Numata K, Chuma M, Miwa H, Moriya S, Ogushi K, Okada M, Otani M, Inayama Y, Maeda S. A study on the inconsistency of arterial phase hypervascularity detection between contrast-enhanced ultrasound using sonazoid and gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid magnetic resonance imaging of hepatocellular carcinoma lesions. J Med Ultrason (2001) 2021; 48:215-224. [PMID: 33721130 DOI: 10.1007/s10396-021-01086-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/24/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE By analyzing possible factors contributing to imaging misevaluation of arterial phase (AP) vascularity, we aimed to provide a more proper way to detect AP hypervascularity of hepatocellular carcinomas (HCCs) using the noninvasive imaging modalities magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS). METHODS We retrospectively recruited 164 pathologically confirmed HCC lesions from 128 patients. Using CEUS with Sonazoid (SCEUS) and gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid MRI (EOB-MRI), AP vascularity of the lesions was evaluated and inconsistencies in interpretation were examined. Indicators of margin, echogenicity, and halo and mosaic signs of lesions on grayscale US; depth of lesions on SCEUS; and tumoral homogeneity, signal contrast ratio of lesions to the surrounding area on precontrast and AP images on EOB-MRI, and histological grade were investigated. RESULTS When precontrast images were used to adjust the AP enhancement ratio, the proportion of inconsistent interpretations of AP vascularity declined from 26.2% (43/164; 29 non-hypervascularity instances using EOB-MRI and 14 using SCEUS) to 16.5% (27/164; 7 using EOB-MRI and 20 using SCEUS). Greater lesion depth (P = 0.017), ill-defined tumoral margin (P = 0.028), absence of halo sign (P = 0.034), and histologically early HCC (P = 0.007) on SCEUS, and small size (P = 0.012) and heterogeneity (P = 0.013) of lesions and slight enhancement (low AP enhancement ratio) (P = 0.018 and 0.009 before and after adjustment) on EOB-MRI, may relate to undetectable hypervascularity. CONCLUSIONS SCEUS and EOB-MRI may show discrepancies in evaluating AP vascularity in the case of deep, ill-defined, heterogeneous, slightly enhanced lesions, and histologically early HCCs. We recommend adjusting AP with precontrast images in EOB-MRI, and combining both modalities to detect hypervascularity.
Collapse
Affiliation(s)
- Feiqian Wang
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.,Ultrasound Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Makoto Chuma
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Haruo Miwa
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Satoshi Moriya
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Katsuaki Ogushi
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Masahiro Okada
- Department of Radiology, Nihon University School of Medicine, Tokyo, 173-8610, Japan
| | - Masako Otani
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Kanagawa, 232-0024, Japan
| | - Yoshiaki Inayama
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Kanagawa, 232-0024, Japan
| | - Shin Maeda
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanagawa, 236-0004, Japan
| |
Collapse
|
|
27
|
Doll J, Streblow J, Weber MA, Schmidmaier G, Fischer C. The AMANDUS Project PART II-Advanced Microperfusion Assessed Non-Union Diagnostics with Contrast-Enhanced Ultrasound (CEUS): A Reliable Diagnostic Tool for the Management and Pre-operative Detection of Infected Upper-Limb Non-unions. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:478-487. [PMID: 33342619 DOI: 10.1016/j.ultrasmedbio.2020.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
The management of upper-limb non-unions can be challenging, especially when infection is existent. Thus, pre-operative detection of infection plays a relevant role in non-union treatment. This study investigated in a large cohort the diagnostic potential of contrast-enhanced ultrasound (CEUS) as stand-alone method for differentiating between aseptic and infected upper-limb non-unions. Osseous perfusion of 50 upper-extremity non-unions (radius/ulna, n = 20; humerus, n = 22; clavicle, n = 8) was prospectively assessed with CEUS before revision surgery. The perfusion was quantified via time-intensity curves and peak enhancement (in arbitrary units). Significant perfusion differences between aseptic and infected non-unions could be detected (peak enhancement, p < 0.001). The sensitivity and specificity for the detection of infected upper-limb non-unions were 80% and 94.3% (cutoff peak enhancement: 130.8 arbitrary units). CEUS reliably differentiates between aseptic and infected upper-limb non-unions. Consequently, CEUS should be integrated into the daily diagnostic routine algorithm to plan non-union revision surgery more precisely as a single- or multi-step procedure.
Collapse
Affiliation(s)
- Julian Doll
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany.
| | - Jan Streblow
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany; Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Fischer
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| |
Collapse
|
|
28
|
Wang J, Ye X, Li J, He S. The diagnostic performance of gadoxetic acid disodium-enhanced magnetic resonance imaging and contrast-enhanced ultrasound in detecting hepatocellular carcinoma: A meta-analysis. Medicine (Baltimore) 2021; 100:e24602. [PMID: 33578564 PMCID: PMC7886422 DOI: 10.1097/md.0000000000024602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 01/12/2021] [Indexed: 01/05/2023] Open
Abstract
The purpose of this study was to identify and compare the diagnostic performance of gadolinium-ethoxybenzyl-diethyltriethylenetriacetic acid (Gd-EOB-DTPA) enhanced magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) in hepatocellular carcinoma (HCC).Two researchers searched PubMed, EMBASE, and Cochrane Library databases from the inception of each database to 10 February 2020, to find comparative studies of Gd-EOB-DTPA-MRI and CEUS in detection of HCC.The study included eight studies (374 patients). MRI is superior to CEUS in diagnostic sensitivity of HCC, P = .03. The diagnostic sensitivity of MRI in lesions with a diameter of less than 30 mm was significantly higher than that of CEUS, P = .04. MRI and CEUS had no significant difference in diagnostic specificity of HCC, P = .95. Summary Receiver Operating Characteristics (SROC) of MRI showed a larger than that of CEUS, but with P > .05.Gd-EOB-DTPA-MRI showed higher sensitivity than CEUS for hepatocellular carcinoma lesions, especially for lesions of less than 30 mm across.
Collapse
|
|
29
|
Son JH, Choi SH, Kim SY, Lee SJ, Park SH, Kim KW, Won HJ, Shin YM, Kim PN. Accuracy of contrast-enhanced ultrasound liver imaging reporting and data system: a systematic review and meta-analysis. Hepatol Int 2020; 14:1104-1113. [PMID: 33170416 DOI: 10.1007/s12072-020-10102-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/22/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM After the introduction of the contrast-enhanced ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS), several studies have reported on its performance, but the reported data vary considerably. Therefore, we performed a systematic review and meta-analysis to determine the diagnostic performance of CEUS LI-RADS in patients at risk for hepatocellular carcinoma (HCC) and investigate the causes of study heterogeneity. METHODS Original studies published until May 30, 2020, investigating the diagnostic performance of CEUS LI-RADS were identified in the MEDLINE, EMBASE, and Cochrane library databases. Study quality was assessed using the QUADAS-2 tool. Meta-analytic summary sensitivity and specificity for the diagnosis of HCC were calculated using a bivariate random-effects model. Meta-regression analysis was performed to explore the causes of study heterogeneity. RESULTS Of the 105 articles screened, eight studies were finally analyzed (5428 hepatic observations). The summary sensitivity and specificity of CEUS LI-RADS category 5 (LR-5) for diagnosing HCC were 73% [95% confidence interval (CI) 65-79%; I2 = 93%] and 95% (95% CI 91-97%; I2 = 89%), respectively. Substantial study heterogeneity was noted in both sensitivity and specificity. Study heterogeneity was significantly associated with the proportion of cases of HCC and the type of reference standard (p ≤ 0.05). CONCLUSION CEUS LI-RADS had high pooled specificity for diagnosing HCC but suboptimal pooled sensitivity. Substantial study heterogeneity was found, which was significantly associated with the proportion of cases of HCC and the type of reference standard.
Collapse
Affiliation(s)
- Jung Hee Son
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - So Jung Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hyung Jin Won
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Yong Moon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Pyo-Nyun Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| |
Collapse
|
|
30
|
Sugimoto K, Kakegawa T, Takahashi H, Tomita Y, Abe M, Yoshimasu Y, Takeuchi H, Kasai Y, Itoi T. Usefulness of Modified CEUS LI-RADS for the Diagnosis of Hepatocellular Carcinoma Using Sonazoid. Diagnostics (Basel) 2020; 10:diagnostics10100828. [PMID: 33076435 PMCID: PMC7602639 DOI: 10.3390/diagnostics10100828] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023] Open
Abstract
The Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) was introduced for classifying suspected hepatocellular carcinoma (HCC). However, it cannot be applied to Sonazoid. We assessed the diagnostic usefulness of a modified CEUS LI-RADS for HCC and non-HCC malignancies based on sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Patients with chronic liver disease at risk for HCC were evaluated retrospectively. Nodules ≥1 cm with arterial phase hyperenhancement, no early washout (within 60 s), and contrast defects in the Kupffer phase were classified as LR-5. Nodules showing early washout, contrast defects in the Kupffer phase, and/or rim enhancement were classified as LR-M. A total of 104 nodules in 104 patients (median age: 70.0 years; interquartile range: 54.5-78.0 years; 74 men) were evaluated. The 48 (46.2%) LR-5 lesions included 45 HCCs, 2 high-flow hemangiomas, and 1 adrenal rest tumor. The PPV of LR-5 for HCC was 93.8% (95% confidence interval (CI): 82.8-98.7%). The 22 (21.2%) LR-M lesions included 16 non-HCC malignancies and 6 HCCs. The PPV of LR-M for non-HCC malignancies, including six intrahepatic cholangiocarcinomas, was 100% (95% CI: 69.8-100%). In conclusion, in the modified CEUS LI-RADS for Sonazoid, LR-5 and LR-M are good predictors of HCC and non-HCC malignancies, respectively.
Collapse
|
|
31
|
Dietrich CF, Nolsøe CP, Barr RG, Berzigotti A, Burns PN, Cantisani V, Chammas MC, Chaubal N, Choi BI, Clevert DA, Cui X, Dong Y, D'Onofrio M, Fowlkes JB, Gilja OH, Huang P, Ignee A, Jenssen C, Kono Y, Kudo M, Lassau N, Lee WJ, Lee JY, Liang P, Lim A, Lyshchik A, Meloni MF, Correas JM, Minami Y, Moriyasu F, Nicolau C, Piscaglia F, Saftoiu A, Sidhu PS, Sporea I, Torzilli G, Xie X, Zheng R. Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver - Update 2020 - WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:562-585. [PMID: 32707595 DOI: 10.1055/a-1177-0530] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS), first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications.The 2012 guideline requires updating as previously the differences of the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including the United States Food and Drug Administration (FDA) approval as well as the extensive Asian experience, to produce a truly international perspective.These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCA) and are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis to improve the management of patients.
Collapse
Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
- Johann Wolfgang Goethe Universitätsklinik Frankfurt, Germany
| | - Christian Pállson Nolsøe
- Center for Surgical Ultrasound, Dep of Surgery, Zealand University Hospital, Køge. Copenhagen Academy for Medical Education and Simulation (CAMES). University of Copenhagen, Denmark
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA and Southwoods Imaging, Youngstown, Ohio, USA
| | - Annalisa Berzigotti
- Hepatology, University Clinic for Visceral Surgery and Medicine, DBMR, Inselspital, University of Bern, Switzerland
| | - Peter N Burns
- Dept Medical Biophysics, University of Toronto, Imaging Research, Sunnybrook Research Institute, Toronto
| | - Vito Cantisani
- Uos Ecografia Internistico-chirurgica, Dipartimento di Scienze Radiologiche, Oncologiche, Anatomo-Patologiche, Policlinico Umberto I, Univ. Sapienza, Rome, Italy
| | - Maria Cristina Chammas
- Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Dirk-André Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mirko D'Onofrio
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - J Brian Fowlkes
- Basic Radiological Sciences Division, Department of Radiology, University of Michigan Health System, Ann Arbor, MI, United States
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Pintong Huang
- Department of Ultrasound in Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Andre Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland, Department of Internal Medicine, Strausberg/Wriezen, Germany
| | - Yuko Kono
- Departments of Medicine and Radiology, University of California, San Diego, USA
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Nathalie Lassau
- Imaging Department. Gustave Roussy and BIOMAPS. Université Paris-Saclay, Villejuif, France
| | - Won Jae Lee
- Department of Radiology and Center For Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Departments of Health and Science and Technology and Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London United Kingdom
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | | | - Jean Michel Correas
- Service de Radiologie Adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Fuminori Moriyasu
- Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Carlos Nicolau
- Radiology Department, Hospital Clinic. University of Barcelona, Barcelona, Spain
| | - Fabio Piscaglia
- Unit of Internal Medicine, Dept of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Adrian Saftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, King's College London, London
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary & General Surgery, Humanitas University & Research Hospital, Rozzano, Milano, Italy
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, The 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
|
32
|
Dietrich CF, Nolsøe CP, Barr RG, Berzigotti A, Burns PN, Cantisani V, Chammas MC, Chaubal N, Choi BI, Clevert DA, Cui X, Dong Y, D'Onofrio M, Fowlkes JB, Gilja OH, Huang P, Ignee A, Jenssen C, Kono Y, Kudo M, Lassau N, Lee WJ, Lee JY, Liang P, Lim A, Lyshchik A, Meloni MF, Correas JM, Minami Y, Moriyasu F, Nicolau C, Piscaglia F, Saftoiu A, Sidhu PS, Sporea I, Torzilli G, Xie X, Zheng R. Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the Liver-Update 2020 WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2579-2604. [PMID: 32713788 DOI: 10.1016/j.ultrasmedbio.2020.04.030] [Citation(s) in RCA: 267] [Impact Index Per Article: 53.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/16/2020] [Accepted: 04/24/2020] [Indexed: 05/14/2023]
Abstract
The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast-enhanced ultrasound, first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology. The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications. The 2012 guideline requires updating as, previously, the differences in the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including U.S. Food and Drug Administration approval and the extensive Asian experience, to produce a truly international perspective. These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCAs) and are intended to create standard protocols for the use and administration of UCAs in liver applications on an international basis to improve the management of patients.
Collapse
Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland; Johann Wolfgang Goethe Universitätsklinik, Frankfurt, Germany.
| | - Christian Pállson Nolsøe
- Center for Surgical Ultrasound, Dep of Surgery, Zealand University Hospital, Køge. Copenhagen Academy for Medical Education and Simulation (CAMES). University of Copenhagen, Denmark
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA; Southwoods Imaging, Youngstown, Ohio, USA
| | - Annalisa Berzigotti
- Hepatology, University Clinic for Visceral Surgery and Medicine, DBMR, Inselspital, University of Bern, Switzerland
| | - Peter N Burns
- Department of Medical Biophysics, University of Toronto, Imaging Research, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Vito Cantisani
- Uos Ecografia Internistico-chirurgica, Dipartimento di Scienze Radiologiche, Oncologiche, Anatomo-Patologiche, Policlinico Umberto I, Univ. Sapienza, Rome, Italy
| | - Maria Cristina Chammas
- Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Dirk-André Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mirko D'Onofrio
- Department of Radiology, G. B. Rossi University Hospital, University of Verona, Verona, Italy
| | - J Brian Fowlkes
- Basic Radiological Sciences Division, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Pintong Huang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Andre Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland, Department of Internal Medicine, Strausberg/Wriezen, Germany
| | - Yuko Kono
- Departments of Medicine and Radiology, University of California, San Diego, California, USA
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Nathalie Lassau
- Imaging Department, Gustave Roussy and BIOMAPS, Université Paris-Saclay, Villejuif, France
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Departments of Health and Science and Technology and Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London, United Kingdom
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Jean Michel Correas
- Service de Radiologie Adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Fuminori Moriyasu
- Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Carlos Nicolau
- Radiology Department, Hospital Clinic. University of Barcelona, Barcelona, Spain
| | - Fabio Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Adrian Saftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, King's College London, London, United Kingdom
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary & General Surgery, Humanitas University & Research Hospital, Rozzano, Milan, Italy
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
|
33
|
|
|
34
|
Wilson SR, Barr RG. Contrast-Enhanced Ultrasonography of the Abdomen. ADVANCES IN CLINICAL RADIOLOGY 2020; 2:213-233. [DOI: 10.1016/j.yacr.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
|
|
35
|
Kim TH, Yoon JH, Lee JM. Emerging Role of Hepatobiliary Magnetic Resonance Contrast Media and Contrast-Enhanced Ultrasound for Noninvasive Diagnosis of Hepatocellular Carcinoma: Emphasis on Recent Updates in Major Guidelines. Korean J Radiol 2020; 20:863-879. [PMID: 31132813 PMCID: PMC6536788 DOI: 10.3348/kjr.2018.0450] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 02/03/2019] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular carcinoma (HCC) can be noninvasively diagnosed on the basis of its characteristic imaging findings of arterial phase enhancement and portal/delayed “washout” on computed tomography (CT) and magnetic resonance imaging (MRI) in cirrhotic patients. However, different specific diagnostic criteria have been proposed by several countries and major academic societies. In 2018, major guideline updates were proposed by the Association for the Study of Liver Diseases, European Association for the Study of the Liver (EASL), Korean Liver Cancer Association and National Cancer Center (KLCA-NCC) of Korea. In addition to dynamic CT and MRI using extracellular contrast media, these new guidelines now include magnetic resonance imaging (MRI) using hepatobiliary contrast media as the first-line diagnostic test, while the KLCA-NCC and EASL guidelines also include contrast-enhanced ultrasound (CEUS) as the second-line diagnostic test. Therefore, hepatobiliary MR contrast media and CEUS will be increasingly used for the noninvasive diagnosis and staging of HCC. In this review, we discuss the emerging role of hepatobiliary phase MRI and CEUS for the diagnosis of HCC and also review the changes in the HCC diagnostic criteria in major guidelines, including the KLCA-NCC practice guidelines version 2018. In addition, we aimed to pay particular attention to some remaining issues in the noninvasive diagnosis of HCC.
Collapse
Affiliation(s)
- Tae Hyung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
| |
Collapse
|
|
36
|
Negrão de Figueiredo G, Mueller-Peltzer K, Schwarze V, Marschner C, Zhang L, Rübenthaler J, Siepmann T, Illigens B, Clevert D. Long-term study analysis of contrast-enhanced ultrasound in the diagnosis of focal nodular hyperplasia. Clin Hemorheol Microcirc 2020; 74:441-452. [DOI: 10.3233/ch-190710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- G. Negrão de Figueiredo
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - K. Mueller-Peltzer
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - V. Schwarze
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
| | - C. Marschner
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
| | - L. Zhang
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
| | - J. Rübenthaler
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
| | - T. Siepmann
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - B.W. Illigens
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - D.A. Clevert
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
| |
Collapse
|
|
37
|
Wang DC, Jang HJ, Kim TK. Characterization of Indeterminate Liver Lesions on CT and MRI With Contrast-Enhanced Ultrasound: What Is the Evidence? AJR Am J Roentgenol 2020; 214:1295-1304. [PMID: 32182094 DOI: 10.2214/ajr.19.21498] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
OBJECTIVE. CT or MRI is most commonly used for characterizing focal hepatic lesions. However, findings on CT and MRI are occasionally indeterminate. Contrast-enhanced ultrasound (CEUS), with its unique characteristics as a purely intravascular contrast agent and real-time evaluation of enhancement, is a useful next step. The purpose of this article is to review the evidence for performing CEUS in the assessment of indeterminate hepatic lesions seen on CT and MRI. CONCLUSION. CEUS is a useful problem-solving tool in the evaluation of liver lesions that are indeterminate on CT and MRI. Uses include detection of arterial phase hyperenhancement; differentiation between hepatocellular carcinoma and intrahepatic cholangiocarcinoma; determination of benign versus malignant tumor thrombus, benign versus neoplastic cystic hepatic lesions, and hepatocellular adenoma versus focal nodular hyperplasia; and monitoring for recurrence in postablative therapies. CEUS can help establish a confident diagnosis and determine the need for further invasive diagnosis or treatment.
Collapse
Affiliation(s)
- David C Wang
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 585 University Ave, Toronto, ON M5G 2N2, Canada
| | - Hyun-Jung Jang
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 585 University Ave, Toronto, ON M5G 2N2, Canada
| | - Tae Kyoung Kim
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, 585 University Ave, Toronto, ON M5G 2N2, Canada
| |
Collapse
|
|
38
|
Patil PG, Reddy P, Rawat S, Ananthasivan R, Sinha R. Multimodality Approach in Detection and Characterization of Hepatic Metastases. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2020. [DOI: 10.1055/s-0039-3402100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
AbstractEarly detection of liver metastases is important in patients with known primary malignancies. This plays an important role in treatment planning and impacts on further management of certain primary malignancies.Magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography-computed tomography scans are reported to have high accuracy in the diagnosis of intrahepatic lesions. MRI in particular has the advantages of its high tissue sensitivity and its multiparametric approach.Hepatic metastatic lesions have considerable overlap in their radiological appearance, and in this article the imaging appearance of various hepatic metastasis and approach is described.
Collapse
Affiliation(s)
- Pooja G. Patil
- Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
| | - Pramesh Reddy
- Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
| | - Sudarshan Rawat
- Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
| | - Rupa Ananthasivan
- Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
| | - Rakesh Sinha
- Department of Radiology, South Warwickshire NHS Foundation Trust, Warwick, United Kingdom
| |
Collapse
|
|
39
|
Wilson SR, Burns PN, Kono Y. Contrast-Enhanced Ultrasound of Focal Liver Masses: A Success Story. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1059-1070. [PMID: 32059917 DOI: 10.1016/j.ultrasmedbio.2019.12.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 06/10/2023]
Abstract
The epidemic of increasing fatty liver disease and liver cancer worldwide, and especially in Western society, has given new importance to non-invasive liver imaging. Contrast-enhanced ultrasound (CEUS) using microbubble contrast agents provides unique advantages over computed tomography (CT) and magnetic resonance imaging (MRI), the currently established methods. CEUS provides determination of malignancy and allows excellent differential diagnosis of a focal liver mass, based on arterial phase enhancement patterns and assessment of the timing and intensity of washout. Today, increased use of CEUS has provided safe and rapid diagnosis of incidentally detected liver masses, improved multidisciplinary management of nodules in a cirrhotic liver, facilitated ablative therapy for liver tumors and allowed diagnosis of hepatocellular carcinoma without biopsy. Benefits of CEUS include the dynamic real-time depiction of tumor perfusion and the fact that it is a purely intravascular agent, accurately reflecting tumoral and inflammatory blood flow. CEUS has many similarities to contrast-enhanced CT and MRI but also unique differences, which are described. The integration of CEUS into a multimodality imaging setting optimizes patient care.
Collapse
Affiliation(s)
- Stephanie R Wilson
- Department of Radiology, and Division of Gastroenterology, Department of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada.
| | - Peter N Burns
- Department of Medical Biophysics, University of Toronto, Imaging Research, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Yuko Kono
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Diego, San Diego, CA
| |
Collapse
|
|
40
|
Makoyeva A, Kim TK, Jang HJ, Medellin A, Wilson SR. Use of CEUS LI-RADS for the Accurate Diagnosis of Nodules in Patients at Risk for Hepatocellular Carcinoma: A Validation Study. Radiol Imaging Cancer 2020; 2:e190014. [PMID: 33778701 PMCID: PMC7983739 DOI: 10.1148/rycan.2020190014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/27/2019] [Accepted: 01/20/2020] [Indexed: 02/06/2023]
Abstract
Purpose To validate the contrast agent-enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) algorithm for accurate diagnosis of hepatocellular carcinoma (HCC) and categorization of all nodules encountered in patients at risk for HCC. Materials and Methods A single-center retrospective review of 196 nodules in 184 patients at risk for HCC (consisting of 139 HCCs, 18 non-HCC malignancies, and 39 benign nodules) was performed in a three-reader blinded read format, with the use of the CEUS LI-RADS algorithm. Pathologic confirmation was available for 143 nodules (122 HCCs, 18 non-HCC malignancies, and three benign nodules). Nodule sizes ranged between 1.0 and 16.2 cm. Nodules assessed with contrast-enhanced US were assigned various CEUS LI-RADS categories by three blinded readers. CEUS LI-RADS categorization was then compared against histopathologic findings, concurrent CT, and/or MR images or follow-up imaging to assess diagnostic accuracy of CEUS LI-RADS. In addition, the proportion of HCC in all LI-RADS (LR) categories, univariable and multivariable feature analysis, and interrater agreement using Light κ were determined. Results The LR-5 category, determined through radiologist categorization of nodules using the CEUS LI-RADS criteria, showed sensitivity, specificity, positive predictive value, and negative predictive value of 86% (119 of 139), 96% (55 of 57), 98% (119 of 121), and 73% (55 of 75), respectively, for the diagnosis of HCC. Two false-positive cases of LR-5 included a cholangiocarcinoma and a combined hepatocellular and cholangiocarcinoma. The remainder of the cholangiocarcinomas in the sample (n = 8) were appropriately categorized as LR-M. Multivariable logistic regression analysis showed that washout of greater than 60 seconds was the contrast-enhanced US feature most predictive of HCC diagnosis, whereas washout of less than 60 seconds was the feature most predictive of nonhepatocellular malignancy. The proportion of HCC nodules categorized in the LR-M and LR-4 categories was 35% and 20%, respectively. Light κ agreement between readers for LI-RADS categorization was 90%. Conclusion This study showed excellent specificity for the CEUS LI-RADS LR-5 category, allowing for confident imaging diagnosis of HCC, without necessity for pathologic confirmation. In addition, there was accurate differentiation of HCC from non-HCC malignancies and benign nodules. Only a single cholangiocarcinoma was misdiagnosed as category LR-5, with the remainder of the cholangiocarcinomas in the sample appropriately characterized as category LR-M.Keywords: Abdomen/GI, Evidence Based Medicine, Liver, Neoplasms-Primary, Ultrasound-Contrast© RSNA, 2020.
Collapse
Affiliation(s)
- Alina Makoyeva
- From the Departments of Radiology (A. Makoyeva, A. Medellin, S.R.W.) and Medicine (S.R.W.), University of Calgary, Foothills Medical Centre, 1403 29th St NW, Calgary, AB, Canada T2N 2T9; and Department of Medical Imaging, University of Toronto, Toronto, Canada (T.K.K., H.J.J.)
| | - Tae Kyoung Kim
- From the Departments of Radiology (A. Makoyeva, A. Medellin, S.R.W.) and Medicine (S.R.W.), University of Calgary, Foothills Medical Centre, 1403 29th St NW, Calgary, AB, Canada T2N 2T9; and Department of Medical Imaging, University of Toronto, Toronto, Canada (T.K.K., H.J.J.)
| | - Hyun-Jung Jang
- From the Departments of Radiology (A. Makoyeva, A. Medellin, S.R.W.) and Medicine (S.R.W.), University of Calgary, Foothills Medical Centre, 1403 29th St NW, Calgary, AB, Canada T2N 2T9; and Department of Medical Imaging, University of Toronto, Toronto, Canada (T.K.K., H.J.J.)
| | - Alejandra Medellin
- From the Departments of Radiology (A. Makoyeva, A. Medellin, S.R.W.) and Medicine (S.R.W.), University of Calgary, Foothills Medical Centre, 1403 29th St NW, Calgary, AB, Canada T2N 2T9; and Department of Medical Imaging, University of Toronto, Toronto, Canada (T.K.K., H.J.J.)
| | - Stephanie R. Wilson
- From the Departments of Radiology (A. Makoyeva, A. Medellin, S.R.W.) and Medicine (S.R.W.), University of Calgary, Foothills Medical Centre, 1403 29th St NW, Calgary, AB, Canada T2N 2T9; and Department of Medical Imaging, University of Toronto, Toronto, Canada (T.K.K., H.J.J.)
| |
Collapse
|
|
41
|
Bartolotta TV, Terranova MC, Gagliardo C, Taibbi A. CEUS LI-RADS: a pictorial review. Insights Imaging 2020; 11:9. [PMID: 32020352 PMCID: PMC7000618 DOI: 10.1186/s13244-019-0819-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/21/2019] [Indexed: 12/12/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) greatly improved the diagnostic accuracy of US in the detection and characterization of focal liver lesions (FLLs), and it is suggested and often included in many international guidelines as an important diagnostic tool in the imaging work-up of cirrhotic patients at risk for developing hepatocellular carcinoma (HCC). In particular, CEUS Liver Imaging Reporting and Data System (LI-RADS) provides standardized terminology, interpretation, and reporting for the diagnosis of HCC. The aim of this pictorial essay is to illustrate CEUS features of nodules discovered at US in cirrhotic liver according to LI-RADS categorization.
Collapse
Affiliation(s)
- Tommaso Vincenzo Bartolotta
- BiND Department: Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Del Vespro, 129 90127, Palermo, Italy.
- Department of Radiology, Fondazione Istituto Giuseppe Giglio Ct.da Pietrapollastra, Via Pisciotto, 90015, Cefalù (Palermo), Italy.
| | - Maria Chiara Terranova
- BiND Department: Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Del Vespro, 129 90127, Palermo, Italy
| | - Cesare Gagliardo
- BiND Department: Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Del Vespro, 129 90127, Palermo, Italy
| | - Adele Taibbi
- BiND Department: Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Del Vespro, 129 90127, Palermo, Italy
| |
Collapse
|
|
42
|
Kang HJ, Kim JH, Joo I, Han JK. Additional value of contrast-enhanced ultrasound (CEUS) on arterial phase non-hyperenhancement observations (≥ 2 cm) of CT/MRI for high-risk patients: focusing on the CT/MRI LI-RADS categories LR-3 and LR-4. Abdom Radiol (NY) 2020; 45:55-63. [PMID: 31332503 DOI: 10.1007/s00261-019-02132-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine the added value of CEUS on arterial phase non-hyperenhancement (APNHE) observations (LR-3 and LR-4) of CT/MRI in high-risk patients. METHODS Forty-three patients with APNHE observations (≥ 2 cm) from CT/MRI were prospectively enrolled in this IRB-approved study and underwent CEUS. All observations were assessed by LI-RADS for CT/MRI and CEUS. The hemodynamic findings were compared. The mean follow-up period was 11.8 ± 2.1 months. Reference standard was made on 34-APNHE observations based on biopsy (n = 2), surgery (n = 2), and follow-up image (n = 30). RESULTS The median of observation size was 2.3 cm (IQR 2.0-2.5 cm). Among the 43-APNHE observations, 12-observations (27.9%) were further presented as arterial phase hyperenhancement (APHE) in CEUS with early (n = 1, CEUS LR-M), late (n = 10, CEUS LR-5), or no (n = 1, CEUS LR-4) washout. Compared to CT, CEUS presented concordant enhancement patterns in 16 (44.4%) in AP and 20 (55.6%) in PVP, respectively. Similarly, 13 (59.1%) and 14 (63.6%) observations showed concordant enhancement patterns between CEUS and MRI in AP and PVP, respectively. Of the 34-APNHE observations with final diagnosis (hepatocellular carcinoma [HCC] n = 12; intrahepatic cholangiocarcinoma [IHCC], n = 1; non-malignancy, n = 21), 4 HCCs (33.3%) and 1 IHCC (100%) were additionally diagnosed by CEUS, while 1 non-malignant lesion (4.5%) was misdiagnosed as HCC by CEUS. CONCLUSION Adding CEUS to APNHE observations from CT/MRI would be useful not only for definitely diagnosing HCC (CEUS LR-5) but also for other malignancies (CEUS LR-M). The discordance of dynamic features between the LI-RADS for CEUS and CT/MRI may reflect the different properties of contrast media, although the systems are not interchangeable.
Collapse
Affiliation(s)
- Hyo-Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul, 03080, South Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, 03080, South Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, 03080, South Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, 03080, South Korea.
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, 03080, South Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, 03080, South Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, 03080, South Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, 03080, South Korea
| |
Collapse
|
|
43
|
Hu J, Bhayana D, Burak KW, Wilson SR. Resolution of indeterminate MRI with CEUS in patients at high risk for hepatocellular carcinoma. Abdom Radiol (NY) 2020; 45:123-133. [PMID: 31440801 DOI: 10.1007/s00261-019-02181-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To show the contribution of CEUS to characterization of indeterminate MRI observations in high-risk patients for hepatocellular carcinoma (HCC). METHODS From July to December 2015, 42 consecutive patients referred to CEUS with indeterminate MRI scans comprise our study cohort. There are 50 indeterminate nodule-like observations and 10 arterial phase hyperenhancing foci, suggesting pseudolesions/arterio-portal shunts. MRI and CEUS lesions are classified according to their enhancement features in all phases and Liver Imaging and Reporting Data System (LI-RADS) in a blind read format. Clinical pathologic correlation and 24 months follow-up are performed. RESULTS A majority, 37/50 (74%), of indeterminate nodule-like observations have arterial phase enhancement without washout on MRI. CEUS further characterizes enhancement and shows washout in 14/37 (38%). In total, CEUS diagnoses 16 malignant lesions in 14 patients including 14 HCC and 2 ICC. 12/16 (75%) malignant lesions are confirmed by biopsy or follow-up. Ultrasound identification of a nodule differentiates real nodules from pseudolesions. Of the ten suspected arterial-portal shunts on MRI, two show a real nodule on ultrasound, confirmed as an HCC and a regenerative nodule. 15/42 (36%) patients have LI-RADS escalated from LR-3 or 4 on MRI to LR-4 or 5 on CEUS. Overall, the sensitivity of CEUS is (13/16) 81.3% and specificity is (37/37) 100% for malignant diagnosis. CONCLUSION Grayscale ultrasound detects true nodules. Dynamic CEUS detects and characterizes washout, correctly predicting HCC. CEUS is complimentary to MRI and can serve as a problem-solving tool when MRI is indeterminate.
Collapse
|
|
44
|
Zhao H, Liu X, Lei B, Cheng P, Li J, Wu Y, Ma Z. Impact of thyroid nodule sizes on the diagnostic performance of Korean thyroid imaging reporting and data system and contrast-enhanced ultrasound. Clin Hemorheol Microcirc 2019; 72:317-326. [PMID: 30856106 DOI: 10.3233/ch-180545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Huaqun Zhao
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Xueling Liu
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Bei Lei
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Ping Cheng
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Jian Li
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Yedong Wu
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| | - Zhen Ma
- Department of Ultrasound, The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, Nanning, Guangxi, China
| |
Collapse
|
|
45
|
Current Imaging Standards for Nonmetastatic Benign and Malignant Liver Tumors. Surg Oncol Clin N Am 2019; 28:539-572. [PMID: 31472905 DOI: 10.1016/j.soc.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The accurate diagnosis of a liver mass can usually be established with a thorough history, examination, laboratory inquiry, and imaging. The necessity of a liver biopsy to determine the nature of a liver mass is rarely necessary. Contrast-enhanced computed tomography and magnetic resonance are the standard of care for diagnosing liver lesions and high-quality imaging should be performed before performing a biopsy. This article discusses current consensus guidelines for imaging of liver masses, as well as masses found on surveillance imaging. The ability to accurately characterize lesions requires proper use and understanding of the technology and expert interpretation.
Collapse
|
|
46
|
Doll J, Gross S, Weber MA, Schmidmaier G, Fischer C. The AMANDUS Project-Advanced Microperfusion Assessed Non-Union Diagnostics With Contrast-Enhanced Ultrasound (CEUS) for the Detection of Infected Lower Extremity Non-Unions. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2281-2288. [PMID: 31155406 DOI: 10.1016/j.ultrasmedbio.2019.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 06/09/2023]
Abstract
The pre-operative determination of infection plays a decisive role in non-union treatment. This study investigated in a large cohort the diagnostic potential of contrast-enhanced ultrasound (CEUS) as stand-alone method for the differentiation between aseptic and infected non-unions. Of 109 patients with lower extremity non-unions (tibia n = 78, femur n = 31) osseous perfusion with CEUS was prospectively assessed before revision surgery. The perfusion was quantified via time-intensity curves and peak enhancement (PE) (arbitrary unit [au]). Significant perfusion differences between aseptic and infected non-unions were evident (PE, p < 0.001). The sensitivity and specificity for the detection of infected tibial and femoral non-unions could be determined with 85.1% and 88.7% (cutoff PE: 81.2 au). CEUS illustrates tibial and femoral non-union perfusion in real time and discriminates reliably between aseptic and infected non-unions. Consequently, when CEUS is integrated into the diagnostic routine algorithm, non-union revision surgery can be planned more accurately as a single or multistep procedure.
Collapse
Affiliation(s)
- Julian Doll
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, HTRG - Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Sascha Gross
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, HTRG - Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany; Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, HTRG - Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Fischer
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, HTRG - Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany.
| |
Collapse
|
|
47
|
Bansal S, Gui J, Merrill C, Wong JK, Burak KW, Wilson SR. Contrast-enhanced US in Local Ablative Therapy and Secondary Surveillance for Hepatocellular Carcinoma. Radiographics 2019; 39:1302-1322. [PMID: 31348734 DOI: 10.1148/rg.2019180205] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma (HCC) has a high incidence of recurrence following therapy. Therefore, secondary surveillance (scheduled follow-up imaging after treatment) is an important part of disease management. The recent approval in the United States for use of a microbubble-based contrast agent for US liver imaging promotes the increased use of contrast-enhanced US (CEUS) in patients with HCC. Although the criteria for the diagnosis of HCC at CEUS are well described, there is a paucity of published literature describing the role of CEUS in ablative therapy and secondary surveillance. In the setting of ablative therapy, CEUS can have vital roles, including patient selection, intraprocedural guidance, and immediate postprocedural assessment. Although CEUS is not widely used, the authors found that it can be used to accurately detect residual or recurrent tumor, characterize the geographic pattern of recurrence (intrazonal, extrazonal, segmental, or remote), and assess for tumor in vein. In addition, similar to primary surveillance, secondary surveillance includes assessment of the entire liver for evaluation of new nodules. Arterial phase hyperenhancement is the reference standard characteristic of disease recurrence at secondary surveillance with CEUS. ©RSNA, 2019 See discussion on this article by Rodgers.
Collapse
Affiliation(s)
- Sanjay Bansal
- From the Department of Diagnostic Imaging, Foothills Medical Centre, 1403 29 St NW, Calgary, AB, Canada T2N 2T9 (S.B., J.G., C.M., J.K.W., S.R.W.); and Departments of Medicine, Division of Gastroenterology and Hepatology (K.W.B., S.R.W.), and Radiology (J.K.W., S.R.W.), University of Calgary, Calgary, Alberta, Canada
| | - Jonathan Gui
- From the Department of Diagnostic Imaging, Foothills Medical Centre, 1403 29 St NW, Calgary, AB, Canada T2N 2T9 (S.B., J.G., C.M., J.K.W., S.R.W.); and Departments of Medicine, Division of Gastroenterology and Hepatology (K.W.B., S.R.W.), and Radiology (J.K.W., S.R.W.), University of Calgary, Calgary, Alberta, Canada
| | - Christina Merrill
- From the Department of Diagnostic Imaging, Foothills Medical Centre, 1403 29 St NW, Calgary, AB, Canada T2N 2T9 (S.B., J.G., C.M., J.K.W., S.R.W.); and Departments of Medicine, Division of Gastroenterology and Hepatology (K.W.B., S.R.W.), and Radiology (J.K.W., S.R.W.), University of Calgary, Calgary, Alberta, Canada
| | - Jason K Wong
- From the Department of Diagnostic Imaging, Foothills Medical Centre, 1403 29 St NW, Calgary, AB, Canada T2N 2T9 (S.B., J.G., C.M., J.K.W., S.R.W.); and Departments of Medicine, Division of Gastroenterology and Hepatology (K.W.B., S.R.W.), and Radiology (J.K.W., S.R.W.), University of Calgary, Calgary, Alberta, Canada
| | - Kelly W Burak
- From the Department of Diagnostic Imaging, Foothills Medical Centre, 1403 29 St NW, Calgary, AB, Canada T2N 2T9 (S.B., J.G., C.M., J.K.W., S.R.W.); and Departments of Medicine, Division of Gastroenterology and Hepatology (K.W.B., S.R.W.), and Radiology (J.K.W., S.R.W.), University of Calgary, Calgary, Alberta, Canada
| | - Stephanie R Wilson
- From the Department of Diagnostic Imaging, Foothills Medical Centre, 1403 29 St NW, Calgary, AB, Canada T2N 2T9 (S.B., J.G., C.M., J.K.W., S.R.W.); and Departments of Medicine, Division of Gastroenterology and Hepatology (K.W.B., S.R.W.), and Radiology (J.K.W., S.R.W.), University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
|
48
|
Cheung HMC, Karanicolas PJ, Coburn N, Law C, Milot L. Late Gadolinium Hyperintensity of Suspected Colorectal Liver Metastases on Gadofosveset-Enhanced Magnetic Resonance Imaging: A Predictor of Benignity and a Potential Problem-Solving Tool. Can Assoc Radiol J 2019; 70:239-245. [PMID: 31272725 DOI: 10.1016/j.carj.2019.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 02/27/2019] [Accepted: 03/19/2019] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Late gadolinium hyperintensity (LGH) is sometimes seen in colorectal liver metastasis (CRLM) and represents a significant diagnostic pitfall due to overlap with LGH in benign hemangiomas; therefore, the objective of this study was to determine the prevalence of LGH and the ability of LGH to differentiate between CRLM and benign lesions with intravascular (gadofosveset) vs extracellular contrast agents (gadobutrol). METHODS Patients with known colorectal cancer and suspected liver lesions were prospectively recruited into this institutional review board-approved, single institution study and received magnetic resonance imaging of the liver with gadofosveset and gadobutrol. The prevalence of LGH for CRLMs and solid benign lesions was determined. Receiver operating characteristics curves were determined for the presence of LGH as a predictor of benignity. The utility of LGH to differentiate between CRLM and solid benign lesions using gadofosveset vs gadobutrol was compared using the generalized estimating equation. RESULTS Twenty-five patients with 131 solid focal liver lesions were recruited. The prevalence of LGH of CRLMs was 11.2% (95% confidence interval [CI]: 0.5%-21.8%) with gadofosveset vs 63.7% (95% CI: 45.7%-81.7%) with gadobutrol. The area under the receiver operating characteristic curve for the presence of LGH as a predictor of benignity was 0.86 using gadofosveset vs 0.75 using gadobutrol. Both LGH (P = .003) and the interaction of contrast agent and LGH (P = .003) statistically significantly differentiated CRLM from benign lesions. CONCLUSION LGH is more common with extracellular than with intravascular contrast agents and is statistically significantly associated with benign lesions rather than metastases.
Collapse
Affiliation(s)
- Helen M C Cheung
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Paul J Karanicolas
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Coburn
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Calvin Law
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Laurent Milot
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
|
49
|
Bartolotta TV, Taibbi A, Midiri M, Lagalla R. Contrast-enhanced ultrasound of hepatocellular carcinoma: where do we stand? Ultrasonography 2019; 38:200-214. [PMID: 31006227 PMCID: PMC6595127 DOI: 10.14366/usg.18060] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/09/2019] [Accepted: 02/25/2019] [Indexed: 12/12/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) represents a significant breakthrough in ultrasonography (US), and it is being increasingly used for the evaluation of focal liver lesions (FLLs). CEUS is unique in that it allows non-invasively assessment of liver perfusion in real time throughout the vascular phase, which has led to dramatic improvements in the diagnostic accuracy of US in the detection and characterization of FLLs, the choice of therapeutic procedures, and the evaluation of response. Currently, CEUS is included as a part of the suggested diagnostic work-up of FLLs, including in cirrhotic patients with hepatocellular carcinoma, resulting in better patient management and cost-effective delivery of therapy.
Collapse
Affiliation(s)
| | - Adele Taibbi
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Roberto Lagalla
- Department of Radiology, University of Palermo, Palermo, Italy
| |
Collapse
|
|
50
|
Garcovich M, Faccia M, Meloni F, Bertolini E, de Sio I, Calabria G, Francica G, Vidili G, Riccardi L, Zocco MA, Ainora ME, Ponziani FR, De Gaetano AM, Gasbarrini A, Rapaccini GL, Pompili M. Contrast-enhanced ultrasound patterns of hepatocellular adenoma: an Italian multicenter experience. J Ultrasound 2019; 22:157-165. [PMID: 30306412 PMCID: PMC6531526 DOI: 10.1007/s40477-018-0322-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/14/2018] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Hepatocellular adenoma (HCA) is a rare benign monoclonal neoplasm, recently categorized on genetic and histopathological basis into four subtypes with different biological behaviors. Since contrast-enhanced ultrasonography (CEUS) is nowadays a well-established technique for liver nodule characterization, the aim of our study was to assess CEUS features of HCAs to identify criteria that correlate with different HCA subtypes as compared to histopathologic examination and other imaging modalities. METHODS We retrospectively analyzed data of patients with histology-proven HCA who underwent CEUS, computed tomography or magnetic resonance imaging (MRI) in seven different Italian ultrasound units. RESULTS The study enrolled 19 patients (16 females; 69% with concomitant/prior use of oral contraceptives): the mean size of all HCAs was 4.2 cm (range 1.6-7.1 cm); 14/19 had inflammatory HCAs (I-HCA), 1/19 β-catenin-activated HCA, and the others unclassified HCAs. On CEUS, during the arterial phase, all but one HCA displayed a rapid enhancement, with 89% of these showing centripetal and 11% centrifugal filling pattern, whereas during the portal and late venous phase 58% of HCA showed washout and the remaining 42% displayed persistent enhancement. In particular, among I-HCAs 7/14 showed no washout, 3/14 and 4/14 showed washout in the portal or late phase, respectively. CONCLUSIONS This dataset represents one of the few published experiences on HCAs and CEUS in Italy and shows that HCAs are hypervascularized in the arterial phase usually with a centripetal flow pattern and have a heterogeneous behavior in portal and late phase. In particular, occurrence of delayed washout on CEUS but not on MRI is frequently observed in the subtype of I-HCA.
Collapse
Affiliation(s)
- Matteo Garcovich
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Mariella Faccia
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Franca Meloni
- Department of Interventional Ultrasound, Casa di Cura Igea, Milan, Italy
- Department of Radiology, University of Wisconsin-Madison, Madison, USA
| | - Emanuela Bertolini
- Department of Internal Medicine, Hepatology and Gastroenterology, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Ilario de Sio
- Hepatogastroenterology Unit, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Giosuele Calabria
- IX Interventional Ultrasound Unit for Infectious Diseases, AORN dei Colli, Cotugno Hospital, Naples, Italy
| | - Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Gianpaolo Vidili
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Laura Riccardi
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Maria Assunta Zocco
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Maria Elena Ainora
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Francesca Romana Ponziani
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Anna Maria De Gaetano
- Department of Radiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Gian Ludovico Rapaccini
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Maurizio Pompili
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| |
Collapse
|