Contrast enhancement patterns of hepatic tumours during the vascular phase using coded harmonic imaging and Levovist to differentiate hepatocellular carcinoma from other focal lesions

Abstract

The purpose of the study was to assess contrast enhancement patterns of hepatic tumours during the vascular phase using contrast-enhanced ultrasound and Levovist to differentiate hepatocellular carcinoma from other hepatic tumours. 89 hepatic tumours in 82 consecutive patients were evaluated using coded harmonic ultrasound imaging. The procedure used a phase inversion harmonic technique and coded technology. We observed images for 2 min from the beginning of the administration as the vascular phase using continuous transmission and intermittent transmissions of 1 s or 2 s. The contrast agent Levovist was administered intravenously as a bolus infusion of 2.5 g. Tumour vessels with flow spreading into the tumour and/or homogeneously stained hyperechoic images were observed in 34 of the 41 hepatocellular carcinomas (sensitivity, 82.9%; specificity, 93.8%). Peripheral enhancements were characteristic of intrahepatic cholangiocarcinoma and metastatic hepatic tumours (sensitivity, 60.0% and 83.3%; specificity, 65.5% and 76.4%, respectively). Pooling at the periphery or throughout the tumour was apparent only in haemangioma (sensitivity, 76.5%; specificity, 100%). A tortuous feeding artery and spoke-like vascularization were evident only in the two focal nodular hyperplasias. Contrast-enhanced ultrasound using coded harmonic ultrasound imaging and Levovist provided detailed information about tumour vascularity and contrast enhancement patterns in hepatic tumours.

Visualization of the Drainage Veins With Contrast‐Enhanced Sonography Was Useful in Diagnosis of Small Focal Nodular Hyperplasia

“…This is because of real-time observation of intratumoral blood flow, which especially provides important diagnostic findings for FNH. 8,9 Conversely, several studies on the diagnosis of FNH have shown the importance of the drainage vessels. [10][11][12] Fukukura et al 10 studied the drainage vessels of FNH by injecting gelatin into the hepatic artery and portal vein of liver from autopsy and reported 2 pathways of vascular drainage in FNH.…”

Bildgebende Diagnostik von Lebertumoren

“…Charakteristika des Hämangioms im KMUS sind wie bei der MDCT und der MRT das diskontinuierliche noduläre Enhancement an der Tumorperipherie in der arteriellen Phase und die zentripetale KM-Aufnahme in den folgenden Phasen. Die Sensitivität der KMUS zur Charakterisierung der Hämangiome wird je nach Phase und Kontrastmittel mit 72 bis 76,5%, die Spezifität mit 100% angegeben [19,53]. Die Treffsicherheit liegt bei 84 bis 91,7% [35].…”

“…Die Kontrastmittelkinetik der zentralen und peripheren CCC ist unterschiedlich, weshalb eine diagnostische Trennung hier sinnvoll ist. Unter Verwendung eines High-MI-Kontrastmittels zeigen 60% der intrahepatischen CCC ein peripheres Kontrastmittel-Enhancement 30 bis 45 s nach Injektion [19]. Gestützt auf die Informationen der postvaskulären Phase bei diesen Tumoren gelang es in einer Untersuchung [28], alle 28 intrahepatisch invasiven CCC zu detektieren und als maligne einzustufen.…”

Imaging the Liver

“…Likewise, endoscopic US (EUS) is useful for assessing the left lobe of the liver and the lymph nodes in the gastrohepatic ligament, and fine-needle aspiration of liver lesions can be performed under EUS guidance [9]. The recent addition of US contrast agents (not yet approved in the United States) for imaging the liver has shown promise in the characterization of various hepatic tumors [10].…”