Source and clinical motivation of orders for contrast-enhanced sonography (CEUS) of the liver: A prospective single-center survey

Abstract

KEYWORDSContrast-enhanced sonography; Liver; Focal liver lesions; Indications; Patient referral.Abstract Contrast-enhanced sonography (CEUS) has become a routine part of diagnostic imaging of the liver. Its possibilities, limitations, and indications have been defined in adequately large clinical series and in guidelines and recommendations. We prospectively evaluated physicians' orders for hepatic CEUS received in the radiology department of a large oncology center in Naples, Italy from May 2009 to April 2010. Radiologists performing the CEUS examinations filled out a form that included patient demography, source and type of patient referral, and clinical indications for the examination. During the study period, 564 patients aged 17e86 years (mean, 58 years) were referred to our department for CEUS liver studies (total: 644; 491 outpatient studies, 153 inpatient studies). This included 4 examinations that were ordered by the patient's physician but not performed by our staff. The majority of the CEUS examinations (n Z 583; 90.5%) were regularly scheduled procedures ordered by clinical specialists from our center (77.3%) or other centers (11.8%); by general practitioners (on their own initiative) (0.8%); or by other figures (0.6%). The remaining 61 examinations (9.5%) were unscheduled procedures done on the initiative of a radiologist following conventional sonography (US). Fewer than half (47.8%) of the examinations were requested as first-line assessments. The others were ordered to clarify inconclusive findings generated by conventional US (30%) or by a more sophisticated imaging study (CT, MRI, PET) (16.1%) or to resolve discrepancies between CT, MRI, and/or PET findings (6%). CEUS is a relatively noninvasive, low-cost imaging study that is simple to perform and requires no particular patient preparation. This may explain its increasing use to clarify doubts raised by conventional US and other more sophisticated imaging studies.Sommario L'ecografia con mezzo di contrasto (CEUS) è ormai entrata nella routine dell'imaging, quantomeno del fegato, essendo le sue possibilità, limiti e indicazioni state definite in base a casistiche adeguate e secondo linee guida e raccomandazioni. Valutiamo la tipologia delle richieste di esami CEUS eseguiti presso un singolo centro oncologico. Maggio 2009 -aprile 2010 abbiamo raccolto dati prospettici sugli esami di CEUS epatica praticati. Il singolo radiologo, che eseguiva ciascun esame CEUS, compilava la scheda di raccolta dati: anagrafica del paziente, tipologia della provenienza, tipologia del richiedente, quesito clinico. Si trattava di 564 pazienti di 17-86 anni (media 58) ai quali abbiamo praticato 644 esami CEUS epatici (491 esami ambulatoriali, 153 esami su degenti); 4 casi in cui la CEUS era stata richiesta, ma non praticata venivano comunque inclusi. La CEUS era programmata in 583 casi e decisa estemporaneamente nei rimanenti 61. Il richiedente era: lo stesso operatore che si trovava a eseguire l'ecografia (US) convenzionale nel 9,5% dei casi, uno specialista interno ...

Contrast enhancement ultrasound application in focal liver lesions characterization: a retrospective study about guidelines application (SOCEUS–CEUS survey)

“…Contrast medium injection addition to a conventional ultrasound study increases considerably accuracy and diagnostic confidence [11][12][13], therefore imposing CEUS application in liver focal lesions characterization detected at conventional ultrasound. Furthermore, it is reported CEUS application after non-diagnostic investigations (CT, MRI or CT-PET) [14][15][16][17][18][19].…”

Focal masses in a non-cirrhotic liver: The additional benefit of CEUS over baseline imaging

“…[60]. A prospective evaluation of physicians requests for hepatic CEUS in a large Italian oncology center found 16.1% and 6% of CEUS examinations had been ordered to clarify inconclusive findings of radiological cross-sectional imaging (CT, MRI, PET) or to resolve discrepancies between CT, MRI and/or PET findings, respectively [61].…”