Ultrasound Imaging of Focal Liver Lesions with a Second-Generation Contrast Agent

Lencioni, Riccardo; Cioni, Dania; Crocetti, Laura; Donati, Francescamaria; Franchini, Chiara; Giusti, Sabina; Bartolozzi, Carlo

doi:10.1016/s1076-6332(03)80234-9

Cited by 38 publications

(21 citation statements)

References 3 publications

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“…Recently, contrast-enhanced ultrasound (CEUS) has been convincingly reported to produce results very similar to those obtained with contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) in the characterization of various liver lesions [1][2][3][4][5][6][7][8][9][10]. This good correlation has also been observed in our institution, with the advantage that ultrasound has a superior time resolution and at least equal space resolution as CT and MRI.…”

Section: Introductionsupporting

confidence: 75%

Contrast-enhanced ultrasound: beyond the liver

Thorelius

2003

Eur Radiol

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IntroductionRecently, contrast-enhanced ultrasound (CEUS) has been convincingly reported to produce results very similar to those obtained with contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) in the characterization of various liver lesions [1][2][3][4][5][6][7][8][9][10]. This good correlation has also been observed in our institution, with the advantage that ultrasound has a superior time resolution and at least equal space resolution as CT and MRI. Consequently, in our centre, the number of examinations for liver lesion characterizations performed with CT and MRI decreased substantially whereas those performed with CEUS increased. Usually, patients are referred for a CEUS examination only when CT or MRI results are equivocal. At our centre, we regularly use CEUS for the detection and characterization of liver lesions as well as for monitoring radiofrequency (RF) ablations of liver tumours.At present, CEUS makes up about 15% of our total number of ultrasound examinations, amounting to about 1,000 cases per year. With increasing experience of this technique, we are acquiring a better knowledge of the behaviour of contrast ultrasound also in non-liver applications. Although the large majority of our CEUS cases involve liver disease, we found that there are many new clinical applications possible for other organs that may benefit from CEUS when the visualization of blood circulation is of interest or clarification of an equivocal baseline ultrasound finding is needed.This article presents our personal experience with CEUS in new application areas other than the liver and the use of CEUS in attempting to solve specific problems in individual cases. Materials and methodsIn our centre we perform CEUS using SonoVue (Bracco Imaging, Milan, Italy) a second-generation contrast agent composed of sulphur-hexafluoride microbubbles stabilized by a phospholipid shell [11]. This shell gives SonoVue microbubbles resistance to pressure and flexibility. Shell flexibility is the feature that allows microbubbles to emit harmonics and to resonate at very low acoustic pressure [mechanical index (MI)].For our CEUS examinations we used two standard equipped Siemens Acuson Sequoia ultrasound machines which were later equipped with software, which detects the non-linear fundamental frequency of microbubble response. Generally, a 2.4-ml intravenous bolus injection of SonoVue was used, always followed by a flush of 5 ml of saline. Very rarely, a second dose of SonoVue might be required. This procedure provides a very high concentration of microbubbles in the arterial phase of renal microcirculation, which can be depicted in high detail for up to 2 min delineating any lacerations and subcapsular haematomas. In the liver and spleen there is an accumulation of microbubbles lasting up to 5-6 min, which provides a clear delineation of lacerations and subcapsular haematomas. As a standard procedure, all examinations were documented as dynamic clips captured in accordance with standardized scan patterns and stored ...

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Section: Introductionsupporting

confidence: 75%

Contrast-enhanced ultrasound: beyond the liver

Thorelius

2003

Eur Radiol

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“…Contrast-specific techniques suppress linear ultrasound signals coming from tissues and use the nonlinear response of microbubbles to enhance signals from UCAs over the background. The advent of secondgeneration agents has been significant in improving the ease and the reproducibility of the examination, since low solubility gases offer improved stability and more favorable resonance behavior than air at low acoustic pressure [21] . Hence, contrast-specific imaging can be performed at a low mechanical index (usually less than 0.20), thus preventing microbubble disruption and enabling visualization of the dynamic enhancement pattern in real time over several minutes.…”

Section: Ultrasound Contrast Agents (Ucas) and Contrast-specific Techmentioning

confidence: 99%

“…near dome of diaphragm or far from the abdominal wall), especially in obese patients, remains a similar problem as in BUS. As a general rule, if BUS is suboptimal, results from CEUS may be disappointing [21] . Only a part of the liver can be evaluated in the short arterial phase after administration of the contrast agent.…”

Section: Insufficiency Of Ceus In Detection Of Fllsmentioning

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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“…Some benign hepatic nodules, mainly focal nodular hyperplasia (FNH) and hemangioma, are reported to show arterial hypervascularity [14,19,20,21,22]. All FNH show marked homegenous enhancement in the late vascular phase and moreover half of FNH show a "central stellate" or "spoke-wheel" pattern of vascularity within the nodule in the early vascular phase [19].…”

Section: Discussionmentioning

confidence: 99%

Qualitative assessment of tumor vascularity in hepatocellular carcinoma by contrast-enhanced coded ultrasound: comparison with arterial phase of dynamic CT and conventional color/power Doppler ultrasound

et al. 2004

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The purpose of this study was to evaluate the detection rate of tumor vessels and vascularity in hepatocellular carcinoma (HCC) by contrast-enhanced coded US using Levovist, and to compare with conventional color/power Doppler US (CDUS) and dynamic CT. Ninety nodules (72 hypo/isoechoic nodules, 18 hyperechoic nodules) in 61 patients were studied. We observed tumor vessels by continuous transmission at the early vascular phase (40 s following administration of Levovist) and vascularity by intermittent transmission (intervals of 2-3 s) at the late vascular phase (40 to approximately 120 s). The detection rate of tumor vessels at the early vascular phase was 97% in hypo/isoechoic nodules and 70% in hyperechoic nodules with high density in dynamic CT being higher than that by CDUS. Tumor vascularity at the late vascular phase in hypo/isoechoic and hyperechoic nodules was hyper-enhancement in 78 and 40%, iso-enhancement in 19 and 40%, and hypo-enhancement in 3 and 0%, respectively. The detection rates of tumor vessels and vascularity in hyperechoic nodules were similar to those by CDUS. The detection rates of tumor vessels and vascularity were not affected by the tumor size in HCC tumors with high density in dynamic CT. Contrast-enhanced US with Levovist was superior to CDUS and equal to dynamic CT to assess tumor vessels in hypo/isoechoic nodules. Although it was equal to CDUS for hyperechoic nodules, this modality is useful in evaluating tumor hemodynamics.

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Ultrasound Imaging of Focal Liver Lesions with a Second-Generation Contrast Agent

Cited by 38 publications

References 3 publications

Contrast-enhanced ultrasound: beyond the liver

Contrast-enhanced ultrasound: beyond the liver

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

Qualitative assessment of tumor vascularity in hepatocellular carcinoma by contrast-enhanced coded ultrasound: comparison with arterial phase of dynamic CT and conventional color/power Doppler ultrasound

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