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World J Gastroenterol. Apr 7, 2014; 20(13): 3590-3596
Published online Apr 7, 2014. doi: 10.3748/wjg.v20.i13.3590
Contrast-enhanced ultrasound in the diagnosis of nodules in liver cirrhosis
Tae Kyoung Kim, Hyun-Jung Jang
Tae Kyoung Kim, Hyun-Jung Jang, Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto ON M5G 2N2, Canada
Author contributions: All authors contributed to this work.
Correspondence to: Tae Kyoung Kim, MD, Professor, Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto ON M5G 2N2, Canada. taekyoung.kim@uhn.ca
Telephone: +1-416-3403372 Fax: +1-416-5930502
Received: November 29, 2013
Revised: January 4, 2014
Accepted: February 26, 2014
Published online: April 7, 2014
Processing time: 126 Days and 13.1 Hours
Abstract

Contrast-enhanced ultrasound (CEUS) using microbubble contrast agents are useful for the diagnosis of the nodules in liver cirrhosis. CEUS can be used as a problem-solving method for indeterminate nodules on computed tomography (CT) or magnetic resonance imaging (MRI) or as an initial diagnostic test for small newly detected liver nodules. CEUS has unique advantages over CT and MRI including no renal excretion of contrast, real-time imaging capability, and purely intravascular contrast. Hepatocellular carcinoma (HCC) is characterized by arterial-phase hypervascularity and later washout (negative enhancement). Benign nodules such as regenerative nodules or dysplastic nodules are usually isoechoic or slightly hypoechoic in the arterial phase and isoechoic in the late phase. However, there are occasional HCC lesions with atypical enhancement including hypovascular HCC and hypervascular HCC without washout. Cholangiocarcinomas are infrequently detected during HCC surveillance and mostly show rim-like or diffuse hypervascularity followed by rapid washout. Hemangiomas are often found at HCC surveillance and are easily diagnosed by CEUS. CEUS can be effectively used in the diagnostic work-up of small nodules detected at HCC surveillance. CEUS is also useful to differentiate malignant and benign venous thrombosis and to guide and monitor the local ablation therapy for HCC.

Keywords: Hepatocellular carcinoma; Liver cirrhosis; Dysplastic nodule; Contrast ultrasound; Imaging

Core tip: Contrast-enhanced ultrasound is a relatively new imaging technique that can be effectively used in the diagnostic algorithms for liver nodules detected in hepatocellular carcinoma surveillance. There are several unique advantages of this technique that make this imaging technique very useful.