Modified contrast-enhanced ultrasonography with the new high-resolution examination technique of high frame rate contrast-enhanced ultrasound (HiFR-CEUS) for characterization of liver lesions: First results

Abstract

AIM: To examine to what extent the high frame rate contrast-enhanced ultrasound (HiFR) diagnostic enables the conclusive diagnosis of liver changes with suspected malignancy. MATERIAL/METHODS: Ultrasound examinations were performed by an experienced examiner using a multifrequency probe (SC6-1) on a high-end ultrasound system (Resona 7, Mindray) to clarify liver changes that were unclear on the B-scan. A bolus of 1–2.4 ml of the Sulphur hexafluoride ultrasound microbubbles contrast agent SonoVue™ (Bracco SpA, Italy) was administered with DICOM storage of CEUS examinations from the early arterial phase (5–15 s) to the late phase (5–6 min). Based on the image files stored in the PACS, an independent reading was performed regarding image quality and finding-related diagnostic significance (0 not informative/non-diagnostic to 5 excellent image quality/confident diagnosis possible). References were clinical follow-up, if possible, comparison to promptly performed computed tomography or magnetic resonance imaging, in some cases also to histopathology. RESULTS: We examined 100 patients (42 women, 58 men, from 18 years to 90 years, mean 63±13 years) with different entities of focal and diffuse liver parenchymal changes, which could be detected in all cases with sufficient image quality with CEUS and with high image quality with HiFR-CEUS. Proportionally septate cysts were found in n = 19 cases, scars after hemihepatectomy with local reduced fat in n = 5 cases, scars after microwave ablation in n = 19 cases, hemangiomas in n = 9 cases, focal nodular hyperplasia in n = 8 cases, colorectal metastases in n = 15 cases, hepatocellular carcinoma (HCC) in n = 11 cases, Osler disease in n = 8 cases. The size of lesions ranged from 5 mm to 200 mm with a mean value of 33.1±27.8 mm. Conclusive diagnoses could be made by the experienced investigator in 97/100 cases with CEUS, confirmed by reference imaging, in parts by histopathology or follow-up. The image quality for HiFR CEUS was rated with a score of 3 to 5; 62 cases were assessed with an average of good (4 points), 27 cases with very good (5 points), and in 11 cases (3 points) still satisfactory despite aggravated acoustic conditions. The specificity of HIFR-CEUS was 97%, the sensitivity 97%, the positive predictive value 94%, the negative predictive value 99% and the accuracy 97% . CONCLUSION: HIFR-CEUS has demonstrated has demonstrated an improved image quality resulting in a high diagnostic accuracy. In the hands of an experienced investigator, HiFR-CEUS allows the assessment of focal and diffuse unclear liver parenchymal changes on B-scan and dynamic assessment of microcirculation in solid and vascular changes.

Current aspects of multimodal ultrasound liver diagnostics using contrast-enhanced ultrasonography (CEUS), fat evaluation, fibrosis assessment, and perfusion analysis – An update

“…HiFR-CEUS was performed in bolus technique as intravenous administration of 1–2.4 ml Sulphur hexafluoride microbubbles contrast agent SonoVuetrademark with 10 ml NaCL (saline solution) via cubital vein [ 23 ]. Possible history of contrast intolerance was considered a contraindication.…”

New Technologies in the Assessment of Carotid Stenosis: Beyond the Color-Doppler Ultrasound—High Frame Rate Vector-Flow and 3D Arterial Analysis Ultrasound

“…V-flow imaging technique can also be combined with contrast-enhanced CEUS to enhance the echogenicity of the blood pool, improving image quality. This method, for which a role is already being carved out in the literature in the evaluation of liver lesions, allows the representation of particle image velocimetry (PIV), enabling two-dimensional blood flow quantification [ 32 , 33 ].…”

Initial description of the novel handheld wireless ultrasound device TE Air with Doppler and Color Duplex imaging

“…Ultrasound diagnostics represents an important cornerstone of imaging diagnostics in many medical fields [1,2]. Using the latest high-end ultrasound techniques, highly effective means for abdominal diagnostics are available [3][4][5][6][7]. Apart from the very high equipment costs, the size and bulkiness of these devices (e.g., limited freedom of movement of the monitor screen) pose a challenge that should not be underestimated [8,9].…”