Contrast-enhanced ultrasound for characterisation of hepatic lesions appearing non-hypervascular on CT in chronic liver diseases

Abstract

Objectives: The purpose of this prospective study was to elucidate the efficacy of using contrast-enhanced ultrasound to characterise focal hepatic lesions appearing non-hypervascular on contrast-enhanced CT in chronic liver diseases. Methods: The study population included 22 patients with cirrhosis or chronic hepatitis, who between them had 27 focal hepatic lesions smaller than 20 mm (mean 13.9¡3.4) that appeared non-hypervascular on contrast-enhanced CT. Contrastenhanced ultrasound with perflubutane microbubble agent (Sonazoid, 0.0075 ml kg -1 ) was performed prior to ultrasound-guided needle biopsy, and intensity analysis was done for hepatic lesions in the early phase (260 s) and late phase (600 s post injection). Results: All seven early-phase hyperenhanced lesions were hepatocellular carcinoma (HCC). 20 lesions iso-or hypoenhanced during the early phase consisted of 11 regenerative nodules (RNs) and 9 HCCs. HCC was more frequent in early-phase hyperenhanced lesions than in iso-or hypoenhanced lesions (p50.0108). Both latephase hypoenhanced lesions were HCCs, whereas 25 late-phase isoenhanced lesions consisted of 11 RNs and 14 HCCs. The enhancement patterns of the 11 RNs included isoenhanced appearance in both the early and late phases in 8 lesions, and early-phase hypoenhancement combined with late-phase isoenhancement in the remaining 3. Both of these enhancement patterns (i.e. either iso-iso or hypo-iso) were found in 9 malignant lesions, 9 (75%) of the 12 well-differentiated HCCs. Conclusion: Hypervascularity on contrast-enhanced ultrasound with Sonazoid strongly suggested HCC regardless of non-hypervascularity on CT, and late-phase hypoenhancement was another possible finding of HCC. However, characterisation of hepatic lesions with other enhancement patterns was difficult using our technique.

Management of hepatocellular carcinoma: The role of contrast-enhanced ultrasound

“…Sonazoid, unlike SonoVue, is different from pure blood-pool UCA, and its postvascular phase lasts up to 60 min, which may improve the detection rate of HCC by CEUS. CEUS with Sonazoid detects liver malignancies as defects in the postvascular phase with a sensitivity of 95%, specificity of 93%, positive predictive value (PPV) of 99%, and negative predictive value (NPV) of 97% [4,7,[14][15][16] .…”

Characteristics of Focal Liver Lesions in Arterial Phase on Contrast-enhanced Ultrasound and Contrast- -enhanced Computed Tomography – Comparative Study

“…Most studies [9][10][11][12][13][14] demonstrate that the patterns of enhancement in the same phase are comparable between 2 techniques and the ability of both techniques to identify FLL is also similar. In addition, other studies [15] suggest that CEUS is more sensitive, specific and accurate in displaying FLLs and more likely to display the small liver cancer as compared to CECT.…”

Contrast-enhanced ultrasound for the differentiation of small atypical hepatocellular carcinomas from dysplastic nodules in cirrhosis

“…CEUS has been suggested to have unique advantages with regard to the detection of hypervascularity in HCCs because of its real-time imaging capability and the intravascular properties of microbubble contrast agents of CEUS [17][18][19][20]. Therefore, CEUS was recommended in the diagnostic algorithm for hypovascular nodules by dynamic CT and MRI in the Asian Pacific Association for the Study of the Liver (APASL) and the Japanese Society of Hepatology (JSH) guidelines [21,22].…”