Low Mechanical Index Contrast-Enhanced Sonographic Findings of Pyogenic Hepatic Abscesses

Catalano, Orlando; Sandomenico, Fabio; Raso, Mauro Mattace; Siani, Alfredo

doi:10.2214/ajr.182.2.1820447

Cited by 76 publications

(43 citation statements)

References 14 publications

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“…A typical liver abscess is not difficult for diagnosis by contrast-enhanced sonography, and the enhancement features had been well depicted in previous series. 12,24 In this study, the lesion was 2.0 cm in diameter, and no liquefaction was found in the lesion, which appeared hyperenhancing during the arterial phase and hypoenhancing during the late phase. Therefore, it was difficult to differentiate it from other entities, especially HCC, without the information from clinical data.…”

Section: B a C Dmentioning

confidence: 52%

Characterization of Small Focal Liver Lesions Using Real‐time Contrast‐Enhanced Sonography

Xu¹,

Liu²,

Lü

et al. 2006

J of Ultrasound Medicine

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Objective. The purpose of this study was to assess the diagnostic performance of real-time contrastenhanced sonography in characterization of small focal liver lesions (FLLs; ≤3.0 cm in diameter). Methods. Two hundred small FLLs in 200 patients were examined by contrast-enhanced sonography using a contrastspecific mode of contrast pulse sequencing and a sulfur hexafluoride-filled microbubble contrast agent. The sonographic images were reviewed by 2 independent readers. A 5-point confidence level was used to discriminate malignant from benign FLLs, and specific diagnoses were recorded. The diagnostic performances were evaluated by receiver operating characteristic (ROC) analysis, and the interobserver agreement was analyzed by weighted κ statistics. Results. After review of contrast-enhanced sonography, ROC analysis revealed significant improvement in differentiating between malignant and benign small FLLs that the areas under the ROC curve were 0.856 at baseline sonography versus 0.954 at contrast-enhanced sonography for reader 1 (P < .001) and 0.857 versus 0.954 for reader 2 (P = .003). The sensitivity, negative predictive value, and accuracy for both readers also improved significantly after contrast agent administration (all P < .001). A better result of specific diagnosis was obtained (38.5% [77/200] he number of small focal liver lesion (FLLs) 3.0 cm or less in diameter has greatly increased in clinical practice because of the extensive use of abdominal imaging procedures in both screened and unscreened populations. Determining the natures of these lesions is crucial for treatment planning. [1][2][3][4] However, differentiation between malignancy and benignity for small FLLs may be uncertain for sonography in most of the cases. Even with the information derived from clinical and biochemical data, together with those derived from other imaging techniques, sometimes it is still hard to make a definite diagnosis because many small FLLs may not show typical manifestations on other imaging modalities, and serum tumor marker may not arise in some patients with hepatocellular carcinoma (HCC) or liver metastasis.2-5 In a recent study, Rickes et al 6 found that about 50% of nodules of HCC and 40% of

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Section: B a C Dmentioning

confidence: 52%

Characterization of Small Focal Liver Lesions Using Real‐time Contrast‐Enhanced Sonography

Xu¹,

Liu²,

Lü

et al. 2006

J of Ultrasound Medicine

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“…Septa may also enhance after contrast agent administration and show a honeycomb-like appearance (Figure 8) [79] . A recent study of CEUS in infective liver lesions showed that most liver abscesses were irregularly rim-enhanced with non-enhanced central necrotic areas; whereas infect- …”

Section: Cystic Lesionsmentioning

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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“…A hypoechoic mass with irregular thick wall, with internal septa, sometimes containing gas (bright punctate echoes with dirty shadowing), are the most frequent ultrasound features of these lesions, but not specific. CEUS brings several typical elements that lead to a positive diagnosis, such as: marginal rim enhancement in the arterial phase, with enhancement of the septa (honeycomb appearance), with no enhancement in the liquid areas, and venous hypoenhancement [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Does Contrast Enhanced Ultrasound improve the management of liver abscesses? A single centre experience

Spârchez

Radu²,

Kacsó

et al. 2015

Med Ultrason

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Liver abscess is a potentially lethal condition that requires prompt recognition and adequate treatment for a good outcome. The aim of this study was to assess the value of contrast enhanced ultrasound (CEUS) in the management of liver abscesses in the clinical practice of a single centre. Material and methods: A retrospective analysis was performed including all patients diagnosed with liver abscesses during 5 years (2010-2014) in a tertiary Department of Gastroenterology and Hepatology. The demographic data, the presence of risk factors, the cause of liver abscess, the B-mode conventional US aspect, the CEUS appearance and the patient's outcome were documented and analyzed. Results: The study group included 41 patients diagnosed with liver abscesses (17 women and 24 men, mean age 63.3±13.2 years), 16/41 (39%) of them with diabetes mellitus. A single lesion was found in 28 (68.3%) patients, and 13 (31.7%) patients had multiple abscesses. The CEUS study was conclusive for the diagnosis of liver abscess in clinical context in 38/41 cases (92.7%). All conclusive cases presented rim enhancement in the arterial phase and no enhancement in the liquid areas. The honeycomb appearance with septa enhancement was present in 17/41 (41.5%) patients. Washout of the marginal rim was found in 22/41 (53.6%) lesions. Conclusion: In our group the most frequent CEUS features found were the rim enhancement in the arterial phase and the presence of no enhancement areas, followed by the honeycomb appearance. CEUS was able to be conclusive for the diagnosis of liver abscess in almost 93% of cases.

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Low Mechanical Index Contrast-Enhanced Sonographic Findings of Pyogenic Hepatic Abscesses

Cited by 76 publications

References 14 publications

Characterization of Small Focal Liver Lesions Using Real‐time Contrast‐Enhanced Sonography

Characterization of Small Focal Liver Lesions Using Real‐time Contrast‐Enhanced Sonography

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

Does Contrast Enhanced Ultrasound improve the management of liver abscesses? A single centre experience

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