Mechanism of Parenchymal Enhancement of the Liver with a Microbubble-based US Contrast Medium: An Intravital Microscopy Study in Rats

Kono, Yuko; Steinbach, Gregory C.; Peterson, Thomas; Schmid‐Schönbein, Geert W.; Mattrey, Robert F.

doi:10.1148/radiol.2241011352

Cited by 65 publications

(37 citation statements)

References 19 publications

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“…It has been suggested that the persistence of the agent within the healthy liver may be a result of the very slow flow within the sinusoids (Leen et al 2006). Indeed, experimental evidence in rats has shown that microbubble agents containing perfluorocarbon gas enhance the healthy liver by virtue of the slow flow within the sinusoids (Kono et al 2002). Because hepatic fibrosis decreases the sinusoidal volume of the hepatic parenchyma (Rockey 2001), the anatomical changes of the sinusoids occurring in a fibrotic liver could be considered as a possible explanation for the decrease in LP PSI and in PV PSI always being constantly higher as observed in our study.…”

Section: Discussionmentioning

confidence: 99%

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Liver Contrast Enhanced Ultrasound Perfusion Imaging in the Evaluation of Chronic Hepatitis C Fibrosis: Preliminary Results

Orlacchio

Bolacchi

Petrella

et al. 2011

Ultrasound in Medicine & Biology

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Abstract-We wanted to determine whether liver contrast-enhanced ultrasound (CEUS)-derived peak signal intensity (PSI) and peak signal intensity/time (PIT) predict liver fibrosis in chronic hepatitis C (CHC). Fortynine patients with CHC (METAVIR classification) and 10 control subjects were included in the study. After a bolus of 2.4 mL SonoVue (Bracco Imaging, Milan, Italy) solution was injected into a peripheral vein, the right lobe of the liver containing the right portal vein was scanned in a transverse section. Two-dimensional sonography was performed using the Philips iU22 ultrasound system (Philips Healthcare, Best, the Netherlands). A 1.0-5.0-MHz (C5-1) wideband convex transducer was used, applying the following settings in all cases. Regions of interest were manually drawn over the right liver lobe and over the portal vein (PV). Liver parenchyma PSI (LPpsi) and PIT (LPpit), portal vein PSI (PVpsi) and PIT (PVpit) were automatically calculated. dPSI was defined as the difference between PVpsi and LPpsi. A significant correlation was observed between PA PSI and fibrosis scores. When patients were stratified according to their LPpsi, a significant difference was achieved only between patients with fibrosis score 0-1 vs. 2-3 and 2 vs. 4. Statistically significant differences between all fibrosis scores, except 0 vs. 1 and 3 vs. 4 were observed when dPSI was used to stratify patients. Overall diagnostic accuracy of LPpsi and dPSI measurement for severe fibrosis by area under the receiving operator characteristic curve analysis was, respectively, 0.87 and 0.88. We suggest that liver CEUS perfusion could have the potential to be used as a complementary tool for the evaluation of liver fibrosis. However, further large-scale studies are required to accurately assess its accuracy in the evaluation of liver fibrosis. (E-mail: aorlacchio@uniroma2.it) Ó 2011 World Federation for Ultrasound in Medicine & Biology.

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Section: Discussionmentioning

confidence: 99%

“…Experimental evidence in rats has shown that microbubble agents containing perfluorocarbon gas, such as SonoVue, enhance the healthy liver by virtue of its slow flow within the sinusoids (Kono et al 2002).…”

Section: Introductionmentioning

confidence: 99%

Liver Contrast Enhanced Ultrasound Perfusion Imaging in the Evaluation of Chronic Hepatitis C Fibrosis: Preliminary Results

Orlacchio

Bolacchi

Petrella

et al. 2011

Ultrasound in Medicine & Biology

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“…The origin of the late phase is the subject of ongoing scientific discussion, and suggested mechanisms include sinusoid pooling and reticuloendothelial system or Kupffer cell uptake [23] . Both the portal and late phases provide information regarding the washout of contrast agent from the lesion compared with normal liver tissue.…”

Section: Late or Parenchymal Phasementioning

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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“…This is due to the fact that the malignant nodule is devoid of hepatic sinusoids and the UCA fails to accumulate within it and thus the nodule is seen as hypoenhancing (dark defect) during DP. 27 This feature of hypoenhancement during DP has a positive predictive value (PPV) of 86.4% and a negative predictive value (NPV) of 38%. 16 Benign lesions on the contrary remain isoenhancing to hyperenhancing in the PV and DP because the UCAs tend to get retained in the normal healthy liver due to slow flow through the sinusoids.…”

Section: Characterization Of Fllmentioning

confidence: 97%

Role of contrast enhanced ultrasound in hepatic imaging

Dhamija¹

2014

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Grey scale ultrasound (US) is the first line imaging modality used for the evaluation of liver by the radiologists and clinicians worldwide. It is a simple, inexpensive, safe and an easily available technique. US has the ability to delineate the hepatic parenchyma and differentiate the cystic from solid hepatic lesions. However, it has limited accuracy in the detection and characterization of focal liver lesions (FLL). CEUS is a major breakthrough in ultrasound imaging which evolved with the aim of overcoming these limitations of US. With the use of ultrasound contrast agents(UCAs), CEUS has the ability to detect the intranodular hemodynamics and thereby provide information of the enhancement pattern of the lesion resulting in reliable characterization of the FLL. This capability brings it at par with the cross sectional contrast enhanced imaging techniques of computed tomography and magnetic resonance imaging. UCAs are safe, non-nephrotoxic and thus can be used to evaluate patients with renal failure as well. The technique of CEUS is simple, requires few minutes to perform, portable, lacks ionising radiation and above all is a cost-effective modality. These advantages have made CEUS an established modality for hepatic imaging. Besides detection and characterization of FLL, it also plays a vital role in the management and repeated follow up of treated patients of FLL. Newer clinical applications of CEUS with promising results are also being unravelled .This review highlights the multifaceted role of CEUS in hepatic imaging and its upcoming clinical applications.

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Mechanism of Parenchymal Enhancement of the Liver with a Microbubble-based US Contrast Medium: An Intravital Microscopy Study in Rats

Cited by 65 publications

References 19 publications

Liver Contrast Enhanced Ultrasound Perfusion Imaging in the Evaluation of Chronic Hepatitis C Fibrosis: Preliminary Results

Liver Contrast Enhanced Ultrasound Perfusion Imaging in the Evaluation of Chronic Hepatitis C Fibrosis: Preliminary Results

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

Role of contrast enhanced ultrasound in hepatic imaging

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