Hypervascular Liver Masses on Contrast-Enhanced Ultrasound: The Importance of Washout

Bhayana, Deepak; Kim, Tae Kyoung; Jang, Hyun‐Jung; Burns, Peter N.; Wilson, Stephanie R.

doi:10.2214/ajr.09.3375

Cited by 121 publications

(119 citation statements)

References 34 publications

(34 reference statements)

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“…The replenishment intensity time-course can be quantified with high mechanical index imaging with disruption of microbubbles within the field of view [32]. In HCC, arterial phase vascularization and portal phase washout is seen, typically less rapidly than hypervascular metastases as shown in a study of 146 hypervascular lesions [33]. CEUS has been utilized in several studies for the evaluation of therapeutic response, for example to TACE, where retention of hyperattenuating Lipiodol may mask residual tumour: one study of 29 nodular HCCs showed that CEUS was more sensitive but had a lower specificity than CECT with sensitivity and specificity of 93% and 65% and 64% and 100% respectively, where conventional angiography was the gold standard [34].…”

Section: Assessment Of Tumour Vascularizationmentioning

confidence: 99%

Functional imaging techniques in hepatocellular carcinoma

Sarker

Osmany²,

Cook

2012

Eur J Nucl Med Mol Imaging

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Section: Assessment Of Tumour Vascularizationmentioning

confidence: 99%

Functional imaging techniques in hepatocellular carcinoma

Sarker

Osmany²,

Cook

2012

Eur J Nucl Med Mol Imaging

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“…Often HCCs are hyperenhanced in the arterial phase, with an irregular or a chaotic pattern [45] that is influenced by the lesion's size [46] with mild, late, or very late "wash-out". The timing of "wash-out" is correlated with the differentiation of the tumor, therefore CEUS examination of the HCC should take a least fourfive minutes [47][48][49]. Specific algorithms have been developed, such as CEUS LI-RADS [https://www.acr.org/ Quality-Safety/Resources/LIRADS/CEUS-LIRADS], in order to standardize the reporting system and the diagnostic decision in HCC.…”

Section: Livermentioning

confidence: 99%

Romanian National Guidelines on Contrast Enhanced Ultrasound in clinical practice

et al. 2017

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Contrast-enhanced ultrasound (CEUS) allows a real-time assessment of the vascular pattern of different types of lesions, as it has no renal or liver toxicity, it lacks radiation exposure and it is also cheaper than other imaging methods, having a diagnostic capability that matches contrast-enhanced CT or MRI. In Romania CEUS is used more and more, especially by clinicians, and since some centres have extensive experience in this domain, we felt the need to disseminate our expertise in order to implement this method in as many centres as possible. These Guidelines present the clinical applications of CEUS in the liver, spleen, pancreas, kidney, testis, bowel, intra-cavitary and endoscopic ultrasound, as well as other applications.

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“…Negative enhancement or ‘washout’ during the PVP is also an important characteristic of HCC as typical tumors lack a portal venous supply. Washout of HCC in the PVP, however, is often not obvious until late (>90 s) and is generally slower and milder than that of liver metastasis [18]. Benign nodules such as regenerative nodules or dysplastic nodules are usually isoechoic or slightly hypoechoic in the HAP and PVP.…”

Section: Us Imagingmentioning

confidence: 99%

Ultrasonography, Computed Tomography and Magnetic Resonance Imaging of Hepatocellular Carcinoma: Toward Improved Treatment Decisions

et al. 2011

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Detection, characterization, staging, and treatment monitoring are major roles in imaging diagnosis in liver cancers. Contrast-enhanced ultrasonography (CEUS) using microbubble contrast agents has expanded the role of US in the detection and diagnosis of liver nodules in patients at high risk of hepatocellular carcinoma (HCC). CEUS provides an accurate differentiation between benign and malignant liver nodules, which is critical for adequate management of HCC and is also useful for guidance of percutaneous local therapy of HCC and postprocedure monitoring of the therapeutic response. The technology of multidetector-row computed tomography (MDCT) has increased spatial and temporal resolutions of computed tomography (CT). It has made possible a more precise evaluation of the hemodynamics of liver tumor, and the diagnostic accuracy of dynamic MDCT has improved. Perfusion CT can measure tissue perfusion parameters quantitatively and can assess segmental hepatic function. Dynamic MDCT with high spatial and temporal resolution enables us to reconstruct 3- and 4-dimensional imaging, which is very useful for pretreatment evaluation. Dual-energy CT makes possible the differentiation of materials and tissues in images obtained based on the differences in iodine and water densities. Monochromatic images, which can be reconstructed by dual-energy CT data, provide some improvement in contrast and show a higher contrast-to-noise ratio for hypervascular HCCs. Dynamic magnetic resonance imaging with fast imaging sequence of 3-dimensional Fourier transformation T₁-weighted gradient echo and nonspecific contrast medium can show high detection sensitivity of hypervascular HCC. However, the hepatic tissue-specific contrast medium, gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid, has become an essential contrast medium for liver imaging because of its higher diagnostic ability. It may replace CT during hepatic arteriography and during arterioportography.

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Hypervascular Liver Masses on Contrast-Enhanced Ultrasound: The Importance of Washout

Abstract: Hypervascular malignant lesions show washout except infrequent cases of HCC. Rapid washout characterizes metastases, whereas HCCs show variable, often slow, washout. However, washout is not unique to malignancy and may be seen in benign lesions.

Cited by 121 publications

References 34 publications

Functional imaging techniques in hepatocellular carcinoma

Functional imaging techniques in hepatocellular carcinoma

Romanian National Guidelines on Contrast Enhanced Ultrasound in clinical practice

Ultrasonography, Computed Tomography and Magnetic Resonance Imaging of Hepatocellular Carcinoma: Toward Improved Treatment Decisions

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