The added diagnostic value of 64-row multidetector CT combined with contrast-enhanced US in the evaluation of hepatocellular nodule vascularity: implications in the diagnosis of malignancy in patients with liver cirrhosis

Quaia, Emilio; Alaimo, Valerio; Baratella, Elisa; Medeot, Alessandro; Midiri, Massimo; Cova, Maria Assunta

doi:10.1007/s00330-008-1179-3

Cited by 30 publications

(15 citation statements)

References 29 publications

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“…11,12 Many clinical works have determined that CEUS is superior to computed tomography and equivalent to magnetic resonance imaging for characterizing solid liver masses. [13][14][15] However, reports on the use of CEUS for diagnosis of superficial lymphadenopathy are less common. In our study, 70% (31 of 44) of benign lymph nodes had a cate- Figure 1.…”

Section: Discussionmentioning

confidence: 99%

Clinical Application of Contrast-Enhanced Ultrasonography in Diagnosis of Superficial Lymphadenopathy

Liu

Song

et al. 2010

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to evaluate the value of contrast-enhanced ultrasonography (CEUS) in differential diagnosis of superficial lymphadenopathy. Methods. Ninety-four superficial enlarged lymph nodes in 94 patients were studied by conventional ultrasonography (gray scale and color Doppler) and CEUS. Contrast-enhanced sonograms were analyzed using contrast-specific quantification software. All of the results were compared with pathologic diagnoses. Results. Of the 94 lymph nodes examined, 44 were benign and 50 were malignant (33 metastases and 17 lymphomas). The sensitivity, specificity, and accuracy of conventional ultrasonography in differential diagnosis between benign and malignant nodes were 51%, 47%, and 55%, respectively. Contrast-enhanced ultrasonography showed intense homogeneous enhancement in 39 of 44 benign lymph nodes, inhomogeneous enhancement in 32 of 33 metastases, and intense homogeneous enhancement and absence of perfusion in 9 of 17 and 6 of 17 lymphomas, respectively. The sensitivity specificity, and accuracy of CEUS were 84%, 79%, and 80%. After time-intensity curve gamma variates were calculated, the area under the curve of the benign lymph nodes was greater than those of the metastatic lymph nodes and lymphomas (P < .01). Conclusions. These results indicate that the use of CEUS and contrast-specific software has a higher degree of diagnostic accuracy than conventional ultrasonography for evaluations of superficial lymphadenopathy. The contrast enhancement patterns and timeintensity curves provide valuable diagnostic information for differential diagnosis of benign and malignant lymph nodes.

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Section: Discussionmentioning

confidence: 99%

Clinical Application of Contrast-Enhanced Ultrasonography in Diagnosis of Superficial Lymphadenopathy

Liu

Song

et al. 2010

Journal of Ultrasound in Medicine

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“…The reasons for exclusion were as follows: (a) the aim of the articles was not to reveal the diagnostic value of SonoVue Ò -enhanced ultrasound, CECT, or CEMRI for identification and the characterization of FLLs (n = 827); (b) the data from the articles could not be used to construct or calculate TP, FP, FN, or TN (n = 65); (c) the reference standard was not used as histopathologic analysis or close clinical and imaging followup (except CECT or CEMRI) for at least 6 months (n = 58); (d) the data from the articles come from a combination of different imaging modalities that could not be differentiated for the assessment of single tests (n = 16); (e) the data included less than 10 patients (n = 5); (f) the articles were printed more than once (n = 3). A total of 21 studies (Wu et al 2006;Chami et al 2008;Wang et al 2008;Dai et al 2008;Strobel et al 2008;Quaia et al 2006Quaia et al , 2009Catala et al 2007;Seitz et al 2009Seitz et al , 2010D'souza et al 2009;Luo et al 2005;Regge et al 2006;Cho et al 2008;Pirovano et al 2000;Cieszanowski et al 2002;Kong et al 2008;Parikh et al 2008;Xu et al 2010;Donati et al 2010;Suzuki et al 2004) fulfilled all inclusion criteria and were selected for data extraction and data analysis (Table 1).…”

Section: Literature Searchmentioning

confidence: 99%

Diagnosis value of focal liver lesions with SonoVue®-enhanced ultrasound compared with contrast-enhanced computed tomography and contrast-enhanced MRI: a meta-analysis

Yang

Xie

Ding

et al. 2011

J Cancer Res Clin Oncol

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“…Before histological analysis, the two principal investigations necessary to characterize focal liver lesions are CT and MR. It was shown that the combined assessment of hepatocellular nodule vascularity at CT and CEUS improved diagnostic performance in the diagnosis of malignancy in patients with cirrhosis [26]. Contrast material-enhanced MR with hepatospecific contrast agents, including superparamagnetic iron oxide and gadobenate dimeglumine (Gd-BOPTA) and gadoxetic acid (Gd-EOB-DTPA), allows both dynamic and tissue-specific characterization with improved diagnostic performance in focal liver lesion characterization [27][28][29].…”

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confidence: 99%

The real capabilities of contrast-enhanced ultrasound in the characterization of solid focal liver lesions

Quaia

2010

Eur Radiol

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Contrast-enhanced US (CEUS) using intravenous agents is a rapidly evolving field even though the main clinically recognized application is the characterization of focal liver lesions. Several reports have described the improvement provided by CEUS in the characterization of focal liver lesions in comparison to unenhanced US. CEUS with low transmit power insonation allows the real-time assessment of focal liver lesion contrast enhancement and vascularity during the different dynamic phases after injection of an intravenous contrast agent. CEUS allows the accurate characterization of focal liver lesions as benign or malignant based on the lesion contrast enhancement pattern during the arterial phase and lesion vascularity during portal-late phase in comparison to the adjacent liver parenchyma. During the portal-late phase, benign lesions present prevalently a sustained contrast enhancement with hyper or isovascular appearance to the adjacent liver while malignant lesions present prevalently microbubble washout with hypovascular appearance. On the other hand, the histology of focal liver lesions can only be confidently predicted in selected cases by CEUS, as in liver haemangiomas presenting typical nodular peripheral enhancement with subsequent centripetal fill-in and focal nodular hyperplasia with central spoke wheelshaped contrast enhancement.Grey-scale ultrasound (US) is the most widespread imaging procedure for investigating the liver parenchyma due to its relative low cost, availability, safety, and high patient acceptance. However conventional unenhanced gray-scale US is somewhat limited in characterizing focal liver lesions, and several papers have described the general capabilities of contrast-enhanced US (CEUS) in improving focal liver lesion characterization [1][2][3][4][5][6][7][8][9][10][11].Recently, European Radiology has published several papers regarding the capabilities of CEUS in focal liver lesion characterization [12][13][14][15][16]. Soussan et al. [16] presented an interesting study evaluating the role of CEUS in the characterization of solid focal liver lesions in comparison to contrast-enhanced MR imaging. In this study authors analysed a series of 47 patients with 50 incidental focal liver lesions-24 focal nodular hyperplasias (FNHs), 11 hepatocellar adenomas, 10 haemangiomas, 1 focal fatty changes, and 4 malignancies including 2 hepatocellular adenomas with malignant foci, 1 hepatocellular carcinoma (HCC), and 1 epithelioid haemangioendotheliomadetected by US and scheduled for contrast-enhanced MR imaging. All patients underwent CEUS after intravenous injection of an US contrast agent consisting of sulphur hexafluoride-filled microbubbles (SonoVue, Bracco, Italy). The MR images and CEUS cine-clips of each lesion were randomly assigned to two blinded readers, with 17 and 22 years of experience in MR imaging and 8 years of experience in CEUS, who independently reviewed all the examinations and were asked to provide the most likely histological diagnosis for each focal liver lesion a...

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The added diagnostic value of 64-row multidetector CT combined with contrast-enhanced US in the evaluation of hepatocellular nodule vascularity: implications in the diagnosis of malignancy in patients with liver cirrhosis

Cited by 30 publications

References 29 publications

Clinical Application of Contrast-Enhanced Ultrasonography in Diagnosis of Superficial Lymphadenopathy

Clinical Application of Contrast-Enhanced Ultrasonography in Diagnosis of Superficial Lymphadenopathy

Diagnosis value of focal liver lesions with SonoVue®-enhanced ultrasound compared with contrast-enhanced computed tomography and contrast-enhanced MRI: a meta-analysis

The real capabilities of contrast-enhanced ultrasound in the characterization of solid focal liver lesions

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