Importance of Evaluating All Vascular Phases on Contrast-Enhanced Sonography in the Differentiation of Benign from Malignant Focal Liver Lesions

Nicolau, Carlos; Vilana, R.; Catalá, Violeta; Bianchi, Luís; Gilabert, Rosa; Garcia, A. Abril; Brú, Concepció

doi:10.2214/ajr.04.1009

Cited by 152 publications

(108 citation statements)

References 28 publications

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“…Hence the portal and late phases may provide more information in the detection of small lesions in cirrhotic liver [24,25] . Evaluation of all three vascular phases has been shown to be superior to the evaluation of enhancement in the late phase alone: the sensitivity increased from 78% to 98%, and the accuracy from 81% to 93% [33] . In a study of 41 cirrhotic patients with small monofocal lesions smaller than 3 cm in diameter using contrast-enhanced Doppler ultrasound, the Table 2 Different phases of liver in contrast-enhanced ultrasound intra-tumoral arterial blood flow was detected in 95% of HCCs, compared with 28% of nonmalignant nodules [34] .…”

Section: Detection Of Malignant Flls In Cirrhotic Liver With Ceusmentioning

confidence: 99%

Detection of focal liver lesions in cirrhotic liver using contrast-enhanced ultrasound

Wong

Xu²,

Xie³

2009

WJR

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Patients with liver cirrhosis are at increased risk of hepatocellular carcinoma (HCC). Conventional or baseline ultrasound (BUS) is often used as the first-line tool for HCC surveillance or detection, but the accuracy of BUS in HCC detection or differentiation from other focal liver lesions (FLLs) is limited. Contrast-enhanced ultrasound (CEUS) represents a recent revolution in the field of ultrasonography and it has become increasingly important in the detection and evaluation of FLLs. In CEUS, HCC typically exhibits arterial hyper-enhancement and portal-venous washout represented by hypoenhanced lesions in the portal venous and late phases. The detection rate of HCC was significantly higher with CEUS compared with BUS. Even regenerative or some dysplastic nodules may exhibit arterial hyperenhancement as they are differentiated from HCC by its iso-enhancing pattern in portal and late phases. The contrast-enhancement patterns of other different types of benign and malignant FLLs, as well as their detection rates with CEUS, were also discussed.

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Section: Detection Of Malignant Flls In Cirrhotic Liver With Ceusmentioning

confidence: 99%

Detection of focal liver lesions in cirrhotic liver using contrast-enhanced ultrasound

Wong

Xu²,

Xie³

2009

WJR

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“…Doppler ultrasonography provides information on hepatic and portal vessel patency. Recent studies reported that contrast enhanced ultrasonography provides sensitive and specific criteria for the differentiation between malignant and benign liver lesions [12][13][14][15] . Preliminary data for cholangiocarcinoma suggest a behavior that is not dissimilar to metastatic lesions [14,16] .…”

Section: Ultrasonographymentioning

confidence: 99%

Diagnostic approaches for cholangiocarcinoma

Weber

Schmid²,

Prinz³

2008

WJG

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Cholangiocarcinomas arise from the epithelial cells of the bile ducts and are associated with poor prognosis. Despite new diagnostic approaches, the definite diagnosis of this malignancy continues to be challenging. Cholangiocarcinomas often grow longitudinally along the bile duct rather than in a radial direction. Thus, large tumor masses are frequently absent and imaging techniques, including ultrasound, CT, and MRI have only limited sensitivity. Tissue collection during endoscopic (ERCP) and/or percutaneous transhepatic (PTC) procedures are usually used to confirm a definitive diagnosis of cholangiocarcinoma. However, forceps biopsy and brush cytology provide positive results for malignancy in about only 50% of patients. Percutaneous and peroral cholangioscopy using fiber-optic techniques were therefore developed for direct visualization of the biliary tree, yielding additional information about endoscopic appearance and tumor extension, as well as a guided biopsy acquistion. Finally, endoscopic ultrasonography (EUS) complements endoscopic and percutaneous approaches and may provide a tissue diagnosis of tumors in the biliary region through fineneedle aspiration. In the future, new techniques allowing for early detection, including molecular m a r ke r s , s h o u l d b e d e ve l o p e d t o i m p rove t h e diagnostic sensitivity in this increasing tumor entity.

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“…When contrast agents are used, the sensitivity and specificity improve significantly and become comparable to those of CT [5]. Assessment of the hepatic vasculature throughout the early and late phases is critical for characterizing these lesions [10].…”

Section: Discussionmentioning

confidence: 99%

Can contrast-enhanced ultrasonography characterize focal liver lesions and differentiate between benign and malignant, thus providing a one-stop imaging service for patients?

Cokkinos

Blomley

Harvey

et al. 2007

Journal of Ultrasound

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KEYWORDSUltrasound; Contrast agents; Focal liver lesions; Cost benefit.Abstract Purpose: Contrast-enhanced ultrasonography (CEUS) displays high sensitivity and specificity in characterizing focal liver lesions (FLLs). We attempted to determine how often CEUS provides an unequivocal diagnosis of FLLs that does not require additional imaging studies. Materials and methods: Seventy-three patients with 146 FLLs were scanned with B-mode, Doppler, and contrast-enhanced US (2 Â 2.4 ml SonoVue, low MI, 4e6 MHz curved array transducer, Toshiba Aplio/SiemenseAcuson Sequoia). Data were digitally stored and transferred to a work station with the GE PACS system. Images were reviewed by a consultant radiologist experienced in CEUS and interpreted in accordance with the criteria for characterizing FLLs published by the European Federation of Societies for Ultrasound in Medicine and Biology. Diagnoses were compared with those based on computed tomography (CT) and/or magnetic resonance (MR) findings if these were available. However, our aim was to assess the frequency with which CEUS provided diagnoses that were considered reliable enough to exclude the need for other imaging studies. Therefore, the CEUS diagnoses were not necessarily confirmed by other methods. Results: Based on CEUS findings alone, 130/146 (89.0%) FLLs could be classified as benign or malignant, and in 118/146 (80.8%) cases, the lesion could be specifically identified. The other 28/146 (19.2%) FLLs could not be characterized based on CEUS data alone. In 58 (80.8%) of the 73 patients with multiple FLLs, CEUS findings were sufficient to establish the benign vs. malignant nature of all the patient's lesions; in 51/73 (69.9%) patients, all the lesions could also be characterized with CEUS. In the remaining cases, at least one lesion required additional imaging to determine whether it was malignant (14/73, 19.2%) or to establish its identity (22/73, 30.1%). In 4/73 (5.5%) patients, CEUS revealed additional lesions not detected on B-mode US. Conclusions: CEUS alone was sufficient to classify 89.0% of the FLLs as benign or malignant, and in 80.8% it was also regarded as sufficient to identify the lesion. It served as a one-stop diagnostic test for 80.8% of the patients, reducing the need for CTeMR scans and providing savings in terms of radiation exposure, time, and money.a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c oSommario Obiettivo: L'ecocontrastografia ha elevate sensibilitàespecificità nel caratterizzare le lesioni focali epatiche. Tuttavia, a tutt'oggi non è stata valutata come metodica di imaging decisiva tale da non richiedere altre indagini di imaging. Nel presente studio è stata valutato in quanti casi l'ecocontrastografia ha fornito risultati tali da non richiedere altre indagini di imaging (in genere TC o RM). Materiali e metodi: 73 pazienti con 146 lesioni focali epatiche sono stati esaminati con ecografia basale, Doppler e ecocontrastografia (2 Â 2.4 ml SonoVue, a basso indice meccanico (IM), trasduttori da 4e6 MHz, Toshiba Aplio/Siemen...

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Importance of Evaluating All Vascular Phases on Contrast-Enhanced Sonography in the Differentiation of Benign from Malignant Focal Liver Lesions

Abstract: Evaluation of SonoVue enhancement in all three vascular phases is superior to evaluation of SonoVue enhancement in the late phase alone, especially in patients with chronic liver disease.

Cited by 152 publications

References 28 publications

Detection of focal liver lesions in cirrhotic liver using contrast-enhanced ultrasound

Detection of focal liver lesions in cirrhotic liver using contrast-enhanced ultrasound

Diagnostic approaches for cholangiocarcinoma

Can contrast-enhanced ultrasonography characterize focal liver lesions and differentiate between benign and malignant, thus providing a one-stop imaging service for patients?

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