Detection and Characterization of Focal Liver Lesions

Ichikawa, Tomoaki; Saito, Kazuhiro; Yoshioka, Naoki; Tanimoto, Akihiro; Gokan, Takehiko; Takehara, Yasuo; Kamura, Takeshi; Gabata, Toshifumi; Murakami, Takamichi; Ito, Katsuyoshi; Hirohashi, Shinji; Nishie, Akihiro; Saito, Yoko; Onaya, Hiroaki; Kuwatsuru, Ryohei; Morimoto, Akihito; Ueda, Koji; Kurauchi, Masayo; Breuer, Josy

doi:10.1097/rli.0b013e3181caea5b

Cited by 217 publications

(43 citation statements)

References 37 publications

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“…Finally, patients with chronic hepatitis, hepatic cirrhosis or severe fatty liver will make liver lesions difficult to detect on conventional ultrasound. [35][36][37][38] In the current study, pre-treatment conventional ultrasound showed that inconspicuous lesions accounted for 64.3% of all the lesions confirmed by CECT/CEMRI, thus conventional ultrasound-guided RFA is not suitable for them. Instead, guidance by other imaging modalities or referral to other treatment methods had to be carried out.…”

Section: Discussioncontrasting

confidence: 50%

Fusion imaging of contrast-enhanced ultrasound and contrast-enhanced CT or MRI before radiofrequency ablation for liver cancers

Wang

et al. 2016

BJR

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Objective: To investigate the usefulness of fusion imaging of contrast-enhanced ultrasound (CEUS) and CECT/ CEMRI before percutaneous ultrasound-guided radiofrequency ablation (RFA) for liver cancers. Methods: 45 consecutive patients with 70 liver lesions were included between March 2013 and October 2015, and all the lesions were identified on CEMRI/CECT prior to inclusion in the study. Planning ultrasound for percutaneous RFA was performed using conventional ultrasound, ultrasound-CECT/CEMRI and CEUS and CECT/CEMRI fusion imaging during the same session. The numbers of the conspicuous lesions on ultrasound and fusion imaging were recorded. RFA was performed according to the results of fusion imaging. Complete response (CR) rate was calculated and the complications were recorded. Results: On conventional ultrasound, 25 (35.7%) of the 70 lesions were conspicuous, whereas 45 (64.3%) were inconspicuous. Ultrasound-CECT/CEMRI fusion imaging detected additional 24 lesions thus increased the number of the conspicuous lesions to 49 (70.0%) (70.0% vs 35.7%; p , 0.001 in comparison with conventional ultrasound). With the use of CEUS and CECT/CEMRI fusion imaging, the number of the conspicuous lesions further increased to 67 (95.7%, 67/70) (95.7% vs 70.0%, 95.7% vs 35.7%; both p , 0.001 in comparison with ultrasound and ultrasound-CECT/CEMRI fusion imaging, respectively). With the assistance of CEUS and CECT/CEMRI fusion imaging, the confidence level of the operator for performing RFA improved significantly with regard to visualization of the target lesions (p 5 0.001). The CR rate for RFA was 97.0% (64/66) in accordance to the CECT/CEMRI results 1 month later. No procedure-related deaths and major complications occurred during and after RFA. Conclusion: Fusion of CEUS and CECT/CEMRI improves the visualization of those inconspicuous lesions on conventional ultrasound. It also facilitates improvement in the RFA operators' confidence and CR of RFA. Advances in knowledge: CEUS and CECT/CEMRI fusion imaging is better than both conventional ultrasound and ultrasound-CECT/CEMRI fusion imaging for lesion visualization and improves the operator confidence, thus it should be recommended to be used as a routine in ultrasound-guided percutaneous RFA procedures for liver cancer.

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Section: Discussioncontrasting

confidence: 50%

Fusion imaging of contrast-enhanced ultrasound and contrast-enhanced CT or MRI before radiofrequency ablation for liver cancers

Wang

et al. 2016

BJR

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“…The drug information sheets of Bayer Healthcare (available at http://www.info.pmda.go.jp/go/ pack/7290415G1020_1_07/) report that the rate of adverse effects of Gd-EOB-DTPA was 76/1755 (4.3%) for regulatory approval in Japan. Ichikawa and colleagues reported an incidence of adverse reactions to Gd-EOB-DTPA of 9.6%, 14 and we documented an even lower incidence (8/980, 0.82%). One reason for the discrepancy may be that we adopted a relatively slow injection of contrast agent (5,340 patients with 0.5 mL/s injection rate), and no patients experienced pain or swelling around the injection site.…”

Section: Discussionsupporting

confidence: 41%

Incidence and Severity of Acute Adverse Reactions to Four Different Gadolinium-based MR Contrast Agents

et al. 2014

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Purpose: Differences in acute adverse reactions to different gadolinium (Gd)-based contrast agents have not been thoroughly evaluated. We investigated the relationships among the incidence and severity of acute adverse reactions, backgrounds of patients, and 4 types of different Gd-based contrast agents (gadopentetate dimeglumine, gadoteridol, gadoterate meglumine, and gadoxetate disodium).Materials and Methods: We retrospectively reviewed the radiological records of 10,595 consecutive patients (4,343 female; 6,252 male; mean age, 63.8 « 14.0 years) who underwent contrast-enhanced magnetic resonance imaging between August 2006 and March 2011. Adverse reactions were classified as mild, moderate, and severe according to the definition of the American College of Radiology. The incidence of adverse reactions were compared on the basis of clinical characteristics and type, dose, and delivery methods of contrast agents by univariate and multivariate logistic regression analyses.Results: The incidence of overall reactions was 0.45% (48/10,595); 45 reactions were mild and three were moderate. No severe reactions were observed. Although the incidence of adverse reactions did not differ significantly between male and female patients, younger individuals were at higher risk for acute adverse reactions. The contrast injection rate and contrast dose were not significantly related to the incidence of adverse reactions. The incidence of adverse reactions was significantly higher for gadoxetate disodium (0.82%) than gadopentetate dimeglumine (0.43%).Conclusion: The incidence of acute adverse reactions elicited by Gd-based contrast agents injection was only 0.45%. Younger age was a risk factor for acute reactions. All 4 agents were found to be safe, although gadoxetate disodium showed a relatively higher incidence of adverse reactions.

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“…There have also been sporadic reports demonstrating that tumors showing signal reduction in the hepatocyte phase of EOB-MRI included dysplastic nodules, and that tumors showing no signal reduction in the hepatocyte phase included early HCC (early well-differentiated HCC). In the light of the fact that the diagnosis of early HCC is impossible without the thorough examination of resected specimens, features such as stromal invasion cannot be diagnosed definitively without examination of the entire resected sample, the report by Ichikawa et al [62] based exclusively on the examination of resected samples is highly reliable. This study involved the diagnosis of all samples by a specialist in liver pathology, that is an author of the liver pathology consensus paper [63], and suggested that Gd-EOB-MRI is the best imaging tool and may have a differential diagnostic ability comparable to that of a pathologist specializing in the liver (table 3; fig.…”

Section: Improvements In Mrimentioning

confidence: 99%

Diagnostic Imaging of Hepatocellular Carcinoma: Recent Progress

Kudo

2011

Oncology

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The diagnostic imaging of hepatocellular carcinoma (HCC) has recently undergone marked progress. The advent of the ultrasound (US) contrast agent Sonazoid, approved in January 2007, and magnetic resonance imaging (MRI) with the liver-specific MRI contrast agent gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA-MRI), approved in January 2008, are of particular significance. Sonazoid contrast-enhanced US (Sonazoid-CEUS) is useful not only for the diagnosis of HCC, but also for guiding treatment and assessing treatment response. Sonazoid-CEUS has proven to be particularly effective for screening and staging, which used to be considered impossible with CEUS, through the introduction of the newly developed diagnostic technique of defect reperfusion imaging. It is still not possible if other vascular agents such as SonoVue and Definity are used. In particular, Gd–EOB-DTPA-MRI has been suggested to be much more reliable in the differentiation of early HCC from precancerous dysplastic nodules than any other modalities such as multidetector raw computed tomography, dynamic MRI, and superparamagnetic iron oxide-MRI. A decrease in contrast uptake in the hepatocyte phase observed on EOB-MRI is strongly suggestive of cancer, and the absence of early staining in the arterial phase suggests early HCC. The differential diagnostic capacity of Gd-EOB-DTPA-MRI is considered to far exceed that of what were previously the most useful imaging techniques, computed tomography (CT) during hepatic arteriography or CT during arterial portography, and to be comparable to that of the pathological diagnosis by pathologists specialized in liver.

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Detection and Characterization of Focal Liver Lesions

Cited by 217 publications

References 37 publications

Fusion imaging of contrast-enhanced ultrasound and contrast-enhanced CT or MRI before radiofrequency ablation for liver cancers

Fusion imaging of contrast-enhanced ultrasound and contrast-enhanced CT or MRI before radiofrequency ablation for liver cancers

Incidence and Severity of Acute Adverse Reactions to Four Different Gadolinium-based MR Contrast Agents

Diagnostic Imaging of Hepatocellular Carcinoma: Recent Progress

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