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Inzerillo A, Meloni MF, Taibbi A, Bartolotta TV. Loco-regional treatment of hepatocellular carcinoma: Role of contrast-enhanced ultrasonography. World J Hepatol 2022; 14:911-922. [PMID: 35721286 PMCID: PMC9157715 DOI: 10.4254/wjh.v14.i5.911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/26/2021] [Accepted: 04/21/2022] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the few cancers for which locoregional treatments (LRTs) are included in international guidelines and are considered as a valid alternative to conventional surgery. According to Barcelona Clinic Liver Cancer classification, percutaneous treatments such as percutaneous ethanol injection, radiofrequency ablation and microwave ablation are the therapy of choice among curative treatments in patients categorized as very early and early stage, while transcatheter arterial chemoembolization is considered the better option for intermediate stage HCC. A precise assessment of treatment efficacy and surveillance is essential to optimize survival rate, whereas residual tumor requires additional treatment. Imaging modalities play a key role in this task. Currently, contrast-enhanced computed tomography/magnetic resonance imaging are considered the standard imaging modalities for this purpose. Contrast enhanced ultrasound (CEUS), using second generation contrast agents, plays an increasingly important role in detecting residual disease after LRTs. CEUS is a straightforward to perform, repeatable and cost-effective imaging modality for patients with renal failure or iodine allergies. Due to the ability to focus on single regions, CEUS can also provide high temporal resolution. Moreover, several studies have reported the same or better diagnostic accuracy as contrast-enhanced computed tomography for assessing tumor vascularity 1 mo after LRTs, and recently three-dimensional (3D)-CEUS has been reported as a promising technique to improve the evaluation of tumor response to therapy. Furthermore, CEUS could be used early after procedures in monitoring HCC treatments, but nowadays this indication is still debated, and data from literature are conflicting, especially after transcatheter arterial chemoembolization procedure.
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Affiliation(s)
- Agostino Inzerillo
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
| | | | - Adele Taibbi
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
| | - Tommaso Vincenzo Bartolotta
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
- Department of Radiology, Fondazione Istituto G. Giglio Hospital, Cefalù 90015, Italy
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Bartolotta TV, Randazzo A, Bruno E, Taibbi A. Focal liver lesions in cirrhosis: Role of contrast-enhanced ultrasonography. World J Radiol 2022; 14:70-81. [PMID: 35646291 PMCID: PMC9124982 DOI: 10.4329/wjr.v14.i4.70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/16/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) represents a great innovation for the evaluation of focal liver lesions (FLLs). The main advantage of CEUS is the real-time imaging examination and the very low toxicity in patients with renal failure. Liver cirrhosis has been recognized as a major risk factor for the onset of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). HCC in liver cirrhosis develops as the last step of a complex that leads to the gradual transformation from regenerative nodule through dysplastic nodule to HCC. In patients with liver cirrhosis, a surveillance program is recommended consisting of ultrasound (US) for detecting small focal lesions. A wide spectrum of benign and malignant lesions other than HCC may be found in the cirrhotic liver and their differentiation is important to avoid errors in staging diseases that may preclude potentially curative therapies. Several published studies have explored the value of CEUS in liver cirrhosis and they have been shown to have excellent diagnostic and prognostic performances for the evaluation of non-invasive and efficient diagnosis of FLLs in patients at high risk for liver malignancies. The purpose of this article is to describe and discuss CEUS imaging findings of FLLs including HCC and ICC, all of which occur in cirrhotic livers with varying prevalence.
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Affiliation(s)
- Tommaso Vincenzo Bartolotta
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
- Department of Radiology, Fondazione Istituto G. Giglio Hospital, Cefalù 90015, Italy
| | - Angelo Randazzo
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
| | - Eleonora Bruno
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
| | - Adele Taibbi
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
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Bartolotta TV, Taibbi A, Randazzo A, Gagliardo C. New frontiers in liver ultrasound: From mono to multi parametricity. World J Gastrointest Oncol 2021; 13:1302-1316. [PMID: 34721768 PMCID: PMC8529919 DOI: 10.4251/wjgo.v13.i10.1302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/17/2021] [Accepted: 08/24/2021] [Indexed: 02/06/2023] [Imported: 08/29/2023] Open
Abstract
Modern liver ultrasonography (US) has become a “one-stop shop” able to provide not only anatomic and morphologic but also functional information about vascularity, stiffness and other various liver tissue properties. Modern US techniques allow a quantitative assessment of various liver diseases. US scanning is no more limited to the visualized plane, but three-dimensional, volumetric acquisition and consequent post-processing are also possible. Further, US scan can be consistently merged and visualized in real time with Computed Tomography and Magnetic Resonance Imaging examinations. Effective and safe microbubble-based contrast agents allow a real time, dynamic study of contrast kinetic for the detection and characterization of focal liver lesions. Ultrasound can be used to guide loco-regional treatment of liver malignancies and to assess tumoral response either to interventional procedures or medical therapies. Microbubbles may also carry and deliver drugs under ultrasound exposure. US plays a crucial role in diagnosing, treating and monitoring focal and diffuse liver disease. On the basis of personal experience and literature data, this paper is aimed to review the main topics involving recent advances in the field of liver ultrasound.
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Affiliation(s)
- Tommaso Vincenzo Bartolotta
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
- Radiology Department, Fondazione Istituto G. Giglio Hospital, Cefalù 90015, Italy
| | - Adele Taibbi
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
| | - Angelo Randazzo
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
| | - Cesare Gagliardo
- Department of Biopathology and Medical and Forensic Biotechnologies, University of Palermo, Palermo 90127, Italy
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Bartolotta TV, Randazzo A, Bruno E, Alongi P, Taibbi A. Focal Pancreatic Lesions: Role of Contrast-Enhanced Ultrasonography. Diagnostics (Basel) 2021; 11:diagnostics11060957. [PMID: 34073596 PMCID: PMC8228123 DOI: 10.3390/diagnostics11060957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023] [Imported: 08/29/2023] Open
Abstract
The introduction of contrast-enhanced ultrasonography (CEUS) has led to a significant improvement in the diagnostic accuracy of ultrasound in the characterization of a pancreatic mass. CEUS, by using a blood pool contrast agent, can provide dynamic information concerning macro- and micro-circulation of focal lesions and of normal parenchyma, without the use of ionizing radiation. On the basis of personal experience and literature data, the purpose of this article is to describe and discuss CEUS imaging findings of the main solid and cystic pancreatic lesions with varying prevalence.
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Affiliation(s)
- Tommaso Vincenzo Bartolotta
- BiND Department: Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Del Vespro, 129, 90127 Palermo, Italy; (T.V.B.); (A.R.); (E.B.); (A.T.)
- Department of Radiology, Fondazione Istituto Giuseppe Giglio Ct.da Pietrapollastra, Via Pisciotto, Cefalù, 90015 Palermo, Italy
| | - Angelo Randazzo
- BiND Department: Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Del Vespro, 129, 90127 Palermo, Italy; (T.V.B.); (A.R.); (E.B.); (A.T.)
| | - Eleonora Bruno
- BiND Department: Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Del Vespro, 129, 90127 Palermo, Italy; (T.V.B.); (A.R.); (E.B.); (A.T.)
| | - Pierpaolo Alongi
- Department of Radiology, Fondazione Istituto Giuseppe Giglio Ct.da Pietrapollastra, Via Pisciotto, Cefalù, 90015 Palermo, Italy
- Unit of Nuclear Medicine, Fondazione Istituto Giuseppe Giglio Ct.da Pietrapollastra, Via Pisciotto, Cefalù, 90015 Palermo, Italy
- Correspondence:
| | - Adele Taibbi
- BiND Department: Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Del Vespro, 129, 90127 Palermo, Italy; (T.V.B.); (A.R.); (E.B.); (A.T.)
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Abstract
Contrast-enhanced ultrasound (CEUS) greatly improved the diagnostic accuracy of US in the detection and characterization of focal liver lesions (FLLs), and it is suggested and often included in many international guidelines as an important diagnostic tool in the imaging work-up of cirrhotic patients at risk for developing hepatocellular carcinoma (HCC). In particular, CEUS Liver Imaging Reporting and Data System (LI-RADS) provides standardized terminology, interpretation, and reporting for the diagnosis of HCC. The aim of this pictorial essay is to illustrate CEUS features of nodules discovered at US in cirrhotic liver according to LI-RADS categorization.
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Affiliation(s)
- Tommaso Vincenzo Bartolotta
- BiND Department: Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Del Vespro, 129 90127, Palermo, Italy. .,Department of Radiology, Fondazione Istituto Giuseppe Giglio Ct.da Pietrapollastra, Via Pisciotto, 90015, Cefalù (Palermo), Italy.
| | - Maria Chiara Terranova
- BiND Department: Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Del Vespro, 129 90127, Palermo, Italy
| | - Cesare Gagliardo
- BiND Department: Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Del Vespro, 129 90127, Palermo, Italy
| | - Adele Taibbi
- BiND Department: Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Del Vespro, 129 90127, Palermo, Italy
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Bartolotta TV, Taibbi A, Midiri M, Lagalla R. Contrast-enhanced ultrasound of hepatocellular carcinoma: where do we stand? Ultrasonography 2019; 38:200-214. [PMID: 31006227 PMCID: PMC6595127 DOI: 10.14366/usg.18060] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/25/2019] [Indexed: 12/12/2022] [Imported: 08/29/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) represents a significant breakthrough in ultrasonography (US), and it is being increasingly used for the evaluation of focal liver lesions (FLLs). CEUS is unique in that it allows non-invasive assessment of liver perfusion in real time throughout the vascular phase, which has led to dramatic improvements in the diagnostic accuracy of US in the detection and characterization of FLLs, the choice of therapeutic procedures, and the evaluation of response. Currently, CEUS is included as a part of the suggested diagnostic work-up of FLLs, including in cirrhotic patients with hepatocellular carcinoma, resulting in better patient management and cost-effective delivery of therapy.
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Affiliation(s)
| | - Adele Taibbi
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Roberto Lagalla
- Department of Radiology, University of Palermo, Palermo, Italy
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Bartolotta TV, Orlando A, Cantisani V, Matranga D, Ienzi R, Cirino A, Amato F, Di Vittorio ML, Midiri M, Lagalla R. Focal breast lesion characterization according to the BI-RADS US lexicon: role of a computer-aided decision-making support. Radiol Med 2018; 123:498-506. [PMID: 29569216 DOI: 10.1007/s11547-018-0874-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 03/13/2018] [Indexed: 01/10/2023] [Imported: 08/29/2023]
Affiliation(s)
- Tommaso Vincenzo Bartolotta
- Department of Radiology Di.Bi.MED, Policlinico P. Giaccone-University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy.
| | - Alessia Orlando
- Department of Radiology Di.Bi.MED, Policlinico P. Giaccone-University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Vito Cantisani
- Department of Radiology, Oncology, and Anatomy Pathology, Policlinico Umberto-University Sapienza, Rome, Italy
| | - Domenica Matranga
- Department of Sciences for Health Promotion and Mother, Child Care, Policlinico P. Giaccone-University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Raffele Ienzi
- Department of Radiology Di.Bi.MED, Policlinico P. Giaccone-University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Alessandra Cirino
- Department of Radiology Di.Bi.MED, Policlinico P. Giaccone-University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Francesco Amato
- Department of Radiology Di.Bi.MED, Policlinico P. Giaccone-University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Maria Laura Di Vittorio
- Department of Radiology Di.Bi.MED, Policlinico P. Giaccone-University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology Di.Bi.MED, Policlinico P. Giaccone-University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
| | - Roberto Lagalla
- Department of Radiology Di.Bi.MED, Policlinico P. Giaccone-University of Palermo, Via Del Vespro 129, 90127, Palermo, Italy
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Bartolotta TV, Vernuccio F, Taibbi A, Lagalla R. Contrast-Enhanced Ultrasound in Focal Liver Lesions: Where Do We Stand? Semin Ultrasound CT MR 2016; 37:573-586. [PMID: 27986175 DOI: 10.1053/j.sult.2016.10.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] [Imported: 08/29/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) represents a significant breakthrough in sonography, and it is being increasingly used for the evaluation of focal liver lesions (FLLs). Currently, CEUS is included as a part of the suggested diagnostic workup of FLLs, resulting in a better patient management and delivering cost-effective therapy. After a brief technical note, contrast-enhancement patterns of different types of benign and malignant FLLs, along with hepatic pseudolesions, are described and discussed based on our experience and literature data. At the same time, the most recent concepts and the use of CEUS in different clinical settings are presented.
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Affiliation(s)
| | - Federica Vernuccio
- Section of Radiology, DIBIMED, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Adele Taibbi
- Section of Radiology, DIBIMED, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Roberto Lagalla
- Section of Radiology, DIBIMED, University Hospital "Paolo Giaccone", Palermo, Italy
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