51
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TAMSEL İ. Karaciğer kitlelerinin ayırıcı tanısında renkli doppler ultrasonografi ve eko kontrast madde kullanımının etkinliği. EGE TIP DERGISI 2020. [DOI: 10.19161/etd.833695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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52
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Abstract
With the increasing use of cross-sectional imaging, the detection of incidental liver lesions has become more common. Accurate and reliable characterisation of these is vital for optimal patient care. Owing to the great improvements in medical imaging technology in recent years, particularly magnetic resonance imaging, it is now possible to characterise a significant proportion of these non-invasively. This is of paramount importance in improving patient safety and reducing costs by avoiding unnecessary biopsies. This article gives a synopsis of the different imaging modalities for liver. It depicts the salient imaging features of the common benign and malignant focal liver lesions on different imaging modalities, with emphasis on magnetic resonance imaging. It demonstrates the pseudolesions, variants, mimics and pitfalls that occur in liver imaging. The tailored magnetic resonance imaging protocols including abbreviated ones, the contrast agents and the pathway for managing incidental liver lesions in the author's institution are covered.
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Affiliation(s)
- Anitha James
- Imaging Department, University Hospital of North Midlands, Stoke-on-Trent, UK
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53
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Contrast-enhanced ultrasound imaging of the liver: a review of the clinical evidence for SonoVue and Sonazoid. Abdom Radiol (NY) 2020; 45:3779-3788. [PMID: 32424608 DOI: 10.1007/s00261-020-02573-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) has become an established modality in various clinical indications for liver diseases. SonoVue®, a pure blood pure agent, and Sonazoid®, which exhibits an additional Kupffer phase, are contrast agents approved for liver imaging. This review discusses and compares the current clinical evidence for these two ultrasound contrast agents in the characterization and detection of focal liver lesions in the non-cirrhotic and cirrhotic liver, as well as for the use in interventional procedures such as liver biopsy guidance, and local ablation treatment monitoring. Reference is made to clinical studies which evaluated the accuracy of CEUS using a standard of reference, its safety, or to comparative studies of these two agents.
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54
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Chernyak V, Horowitz JM, Kamel IR, Arif-Tiwari H, Bashir MR, Cash BD, Farrell J, Goldstein A, Grajo JR, Gupta S, Hindman NM, Kamaya A, McNamara MM, Porter KK, Solnes LB, Srivastava PK, Zaheer A, Carucci LR. ACR Appropriateness Criteria® Liver Lesion-Initial Characterization. J Am Coll Radiol 2020; 17:S429-S446. [PMID: 33153555 DOI: 10.1016/j.jacr.2020.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 02/08/2023]
Abstract
Incidental liver masses are commonly identified on imaging performed for other indications. Since the prevalence of benign focal liver lesions in adults is high, even in patients with primary malignancy, accurate characterization of incidentally detected lesions is of paramount clinical importance. This document reviews utilization of various imaging modalities for characterization of incidentally detected liver lesions, discussed in the context of several clinical scenarios. For each clinical scenario, a summary of current evidence supporting the use of a given diagnostic modality is reported. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | | | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - James Farrell
- Interventional Endoscopy and Pancreatic Diseases, New Haven, Connecticut; American Gastroenterological Association
| | | | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, Florida
| | - Samir Gupta
- Rush University Medical Center, Chicago, Illinois; American College of Surgeons
| | | | - Aya Kamaya
- Stanford University Medical Center, Stanford, California
| | | | | | | | - Pavan K Srivastava
- University of Illinois College of Medicine, Chicago, Illinois; American College of Physicians
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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55
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Kang TW, Jeong WK, Kim YY, Min JH, Kim YK, Kim SH, Sinn DH, Kim K. Comparison of Super-Resolution US and Contrast Material-enhanced US in Detection of the Spoke Wheel Sign in Patients with Focal Nodular Hyperplasia. Radiology 2020; 298:82-90. [PMID: 33107798 DOI: 10.1148/radiol.2020200885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Diagnosis of focal nodular hyperplasia (FNH) with US generally requires the use of contrast material. The effect of the super-resolution US technique on the diagnosis of FNH is unknown. Purpose To investigate the equivalence between super-resolution US and contrast material-enhanced US in the detection of spoke wheel sign in patients with FNH by comparing patterns of tumor vascularity. Materials and Methods This is a secondary analysis of a prospective trial (NCT02737865) that enrolled participants diagnosed with FNH between May 2016 and March 2019. These patients underwent super-resolution US and subsequent contrast-enhanced US with perfluorobutane microbubbles on the same day. The primary outcome was the confidence score of detecting spoke wheel sign in patients with FNH at US. Two radiologists used a four-point scale to score their confidence in the presence of the spoke wheel sign based on super-resolution US and contrast-enhanced US findings. Two one-sided tests were used to test the equivalence between super-resolution US and contrast-enhanced US in terms of the score for the confidence level of the spoke wheel sign. Interobserver agreement for both techniques between the two radiologists, using the recorded images, was analyzed by using an intraclass correlation coefficient. Results In 62 patients (mean age, 37 years; range, 20-69 years; 41 women) with FNH, the majority of patients showed a spoke wheel sign at super-resolution US and contrast-enhanced US (63% [39 of 62] and 71% [44 of 62], respectively; P = .36). There was no significant difference between the super-resolution US and contrast-enhanced US techniques regarding the confidence score for the spoke wheel sign (mean score, 1.8 vs 2.0; P = .03 for equivalence test). The intraclass correlation coefficients of super-resolution US and contrast-enhanced US regarding the presence of the spoke wheel sign were 0.82 (95% confidence interval: 0.73, 0.96) and 0.58 (95% confidence interval: 0.41, 0.73), respectively. Conclusion In comparison with contrast-enhanced US, super-resolution US provided a reliable rate of detection of the spoke wheel sign in patients with focal nodular hyperplasia. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Fetzer in this issue.
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Affiliation(s)
- Tae Wook Kang
- From the Department of Radiology and Center for Imaging Science (T.W.K., W.K.J., Y.Y.K., J.H.M., Y.K.K., S.H.K.) and Department of Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea; and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (K.K.)
| | - Woo Kyoung Jeong
- From the Department of Radiology and Center for Imaging Science (T.W.K., W.K.J., Y.Y.K., J.H.M., Y.K.K., S.H.K.) and Department of Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea; and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (K.K.)
| | - Yeun-Yoon Kim
- From the Department of Radiology and Center for Imaging Science (T.W.K., W.K.J., Y.Y.K., J.H.M., Y.K.K., S.H.K.) and Department of Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea; and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (K.K.)
| | - Ji Hye Min
- From the Department of Radiology and Center for Imaging Science (T.W.K., W.K.J., Y.Y.K., J.H.M., Y.K.K., S.H.K.) and Department of Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea; and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (K.K.)
| | - Young Kon Kim
- From the Department of Radiology and Center for Imaging Science (T.W.K., W.K.J., Y.Y.K., J.H.M., Y.K.K., S.H.K.) and Department of Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea; and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (K.K.)
| | - Seong Hyun Kim
- From the Department of Radiology and Center for Imaging Science (T.W.K., W.K.J., Y.Y.K., J.H.M., Y.K.K., S.H.K.) and Department of Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea; and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (K.K.)
| | - Dong Hyun Sinn
- From the Department of Radiology and Center for Imaging Science (T.W.K., W.K.J., Y.Y.K., J.H.M., Y.K.K., S.H.K.) and Department of Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea; and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (K.K.)
| | - Kyunga Kim
- From the Department of Radiology and Center for Imaging Science (T.W.K., W.K.J., Y.Y.K., J.H.M., Y.K.K., S.H.K.) and Department of Medicine (D.H.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Republic of Korea; and Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea (K.K.)
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56
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Dietrich CF, Nolsøe CP, Barr RG, Berzigotti A, Burns PN, Cantisani V, Chammas MC, Chaubal N, Choi BI, Clevert DA, Cui X, Dong Y, D'Onofrio M, Fowlkes JB, Gilja OH, Huang P, Ignee A, Jenssen C, Kono Y, Kudo M, Lassau N, Lee WJ, Lee JY, Liang P, Lim A, Lyshchik A, Meloni MF, Correas JM, Minami Y, Moriyasu F, Nicolau C, Piscaglia F, Saftoiu A, Sidhu PS, Sporea I, Torzilli G, Xie X, Zheng R. Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver - Update 2020 - WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:562-585. [PMID: 32707595 DOI: 10.1055/a-1177-0530] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS), first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications.The 2012 guideline requires updating as previously the differences of the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including the United States Food and Drug Administration (FDA) approval as well as the extensive Asian experience, to produce a truly international perspective.These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCA) and are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis to improve the management of patients.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
- Johann Wolfgang Goethe Universitätsklinik Frankfurt, Germany
| | - Christian Pállson Nolsøe
- Center for Surgical Ultrasound, Dep of Surgery, Zealand University Hospital, Køge. Copenhagen Academy for Medical Education and Simulation (CAMES). University of Copenhagen, Denmark
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA and Southwoods Imaging, Youngstown, Ohio, USA
| | - Annalisa Berzigotti
- Hepatology, University Clinic for Visceral Surgery and Medicine, DBMR, Inselspital, University of Bern, Switzerland
| | - Peter N Burns
- Dept Medical Biophysics, University of Toronto, Imaging Research, Sunnybrook Research Institute, Toronto
| | - Vito Cantisani
- Uos Ecografia Internistico-chirurgica, Dipartimento di Scienze Radiologiche, Oncologiche, Anatomo-Patologiche, Policlinico Umberto I, Univ. Sapienza, Rome, Italy
| | - Maria Cristina Chammas
- Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Dirk-André Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mirko D'Onofrio
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - J Brian Fowlkes
- Basic Radiological Sciences Division, Department of Radiology, University of Michigan Health System, Ann Arbor, MI, United States
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Pintong Huang
- Department of Ultrasound in Medicine, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Andre Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland, Department of Internal Medicine, Strausberg/Wriezen, Germany
| | - Yuko Kono
- Departments of Medicine and Radiology, University of California, San Diego, USA
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Nathalie Lassau
- Imaging Department. Gustave Roussy and BIOMAPS. Université Paris-Saclay, Villejuif, France
| | - Won Jae Lee
- Department of Radiology and Center For Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Departments of Health and Science and Technology and Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London United Kingdom
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | | | - Jean Michel Correas
- Service de Radiologie Adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Fuminori Moriyasu
- Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Carlos Nicolau
- Radiology Department, Hospital Clinic. University of Barcelona, Barcelona, Spain
| | - Fabio Piscaglia
- Unit of Internal Medicine, Dept of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Adrian Saftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, King's College London, London
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary & General Surgery, Humanitas University & Research Hospital, Rozzano, Milano, Italy
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, The 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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57
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Dietrich CF, Nolsøe CP, Barr RG, Berzigotti A, Burns PN, Cantisani V, Chammas MC, Chaubal N, Choi BI, Clevert DA, Cui X, Dong Y, D'Onofrio M, Fowlkes JB, Gilja OH, Huang P, Ignee A, Jenssen C, Kono Y, Kudo M, Lassau N, Lee WJ, Lee JY, Liang P, Lim A, Lyshchik A, Meloni MF, Correas JM, Minami Y, Moriyasu F, Nicolau C, Piscaglia F, Saftoiu A, Sidhu PS, Sporea I, Torzilli G, Xie X, Zheng R. Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the Liver-Update 2020 WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2579-2604. [PMID: 32713788 DOI: 10.1016/j.ultrasmedbio.2020.04.030] [Citation(s) in RCA: 211] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/16/2020] [Accepted: 04/24/2020] [Indexed: 05/14/2023]
Abstract
The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast-enhanced ultrasound, first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology. The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications. The 2012 guideline requires updating as, previously, the differences in the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including U.S. Food and Drug Administration approval and the extensive Asian experience, to produce a truly international perspective. These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCAs) and are intended to create standard protocols for the use and administration of UCAs in liver applications on an international basis to improve the management of patients.
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Affiliation(s)
- Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland; Johann Wolfgang Goethe Universitätsklinik, Frankfurt, Germany.
| | - Christian Pállson Nolsøe
- Center for Surgical Ultrasound, Dep of Surgery, Zealand University Hospital, Køge. Copenhagen Academy for Medical Education and Simulation (CAMES). University of Copenhagen, Denmark
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA; Southwoods Imaging, Youngstown, Ohio, USA
| | - Annalisa Berzigotti
- Hepatology, University Clinic for Visceral Surgery and Medicine, DBMR, Inselspital, University of Bern, Switzerland
| | - Peter N Burns
- Department of Medical Biophysics, University of Toronto, Imaging Research, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Vito Cantisani
- Uos Ecografia Internistico-chirurgica, Dipartimento di Scienze Radiologiche, Oncologiche, Anatomo-Patologiche, Policlinico Umberto I, Univ. Sapienza, Rome, Italy
| | - Maria Cristina Chammas
- Institute of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, Brazil
| | - Nitin Chaubal
- Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai, India
| | - Byung Ihn Choi
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Dirk-André Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mirko D'Onofrio
- Department of Radiology, G. B. Rossi University Hospital, University of Verona, Verona, Italy
| | - J Brian Fowlkes
- Basic Radiological Sciences Division, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway
| | - Pintong Huang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Andre Ignee
- Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland, Department of Internal Medicine, Strausberg/Wriezen, Germany
| | - Yuko Kono
- Departments of Medicine and Radiology, University of California, San Diego, California, USA
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Nathalie Lassau
- Imaging Department, Gustave Roussy and BIOMAPS, Université Paris-Saclay, Villejuif, France
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Departments of Health and Science and Technology and Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London, United Kingdom
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Jean Michel Correas
- Service de Radiologie Adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Fuminori Moriyasu
- Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Carlos Nicolau
- Radiology Department, Hospital Clinic. University of Barcelona, Barcelona, Spain
| | - Fabio Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Adrian Saftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Romania
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, King's College London, London, United Kingdom
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary & General Surgery, Humanitas University & Research Hospital, Rozzano, Milan, Italy
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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58
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The Echogenic Liver: Steatosis and Beyond. Ultrasound Q 2020; 37:308-314. [PMID: 32956242 DOI: 10.1097/ruq.0000000000000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ABSTRACT Ultrasound is the most common modality used to evaluate the liver. An echogenic liver is defined as increased echogenicity of the liver parenchyma compared with the renal cortex. The prevalence of echogenic liver is approximately 13% to 20%. In most clinical settings, increased liver echogenicity is simply attributed to hepatic steatosis. It is important to recognize other hepatic and systemic diseases including cirrhosis, viral hepatitis, glycogen storage disease, and hemochromatosis that may also cause an echogenic liver and to identify the associated findings to distinguish them from hepatic steatosis.
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59
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Contrast-Enhanced Ultrasound for Focal Hepatic Lesions: When to Use and How to Differentiate Lesions? Ultrasound Q 2020; 36:224-234. [PMID: 32890325 DOI: 10.1097/ruq.0000000000000475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Contrast-enhanced ultrasound can be used effectively to evaluate focal hepatic lesions and offers unique advantages over computed tomography and magnetic resonance imaging. Serial vascular filling patterns of focal hepatic lesions during arterial, portal, and late phases can provide unique information on lesion characterization and differentiation. Sensitive depiction of arterial hypervascularity and analysis of washout pattern are clues for differentiation of several indeterminate hepatic nodules on conventional ultrasound and computed tomography/magnetic resonance. In this report, we present cases demonstrating clinical applications of contrast-enhanced ultrasound in the diagnosis and management of focal hepatic lesions.
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60
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Yoo J, Lee JM. Diagnostic Value of High Frame Rate Contrast-enhanced Ultrasonography and Post-processing Contrast Vector Imaging for Evaluation of Focal Liver Lesions: A Feasibility Study. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2254-2264. [PMID: 32546409 DOI: 10.1016/j.ultrasmedbio.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/25/2020] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
This study evaluated the feasibility of contrast vector imaging (CVI) to characterize focal liver lesions. From July to October 2019, we prospectively enrolled 30 patients with focal liver lesions (hepatocellular carcinoma [HCC] [n = 19], metastasis [n = 8], combined HCC-cholangiocarcinoma [CC] [n = 1], intra-hepatic CC [n = 1] and sclerosed hemangioma [n = 1]). Contrast-enhanced ultrasound (CEUS) was performed with high frame rate contrast harmonic imaging technique by one radiologist, and post-processing CVI was obtained and analyzed by two radiologists. On combined CVI with CEUS, the staining pattern was significantly predominant in HCCs (9/11, 81.8%), while peripheral rim was frequent in non-HCCs (5/8, 62.5%) (p = 0.020). HCCs exhibited feeding arteries (8/11, 45.5%) and high velocity variance (10/11, 90.9 %), whereas non-HCCs showed detour pattern (4/8, 50.0%) with either a high or low velocity variance (4/8, 50.0%, both), with no significant inter-group differences (p = 0.052 and 0.080, respectively). In conclusion, CVI was feasible and provided quantitative and multi-parametric information of different types of hepatic tumors.
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Affiliation(s)
- Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea; Seoul National University College of Medicine and Institute of Radiation Medicine, Seoul, Korea.
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An Update on Hepatobiliary Ultrasound. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00357-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mann R, Kristenson S, Kitley C, Thoren K. Nested stromal epithelial tumor of the liver: A multidisciplinary approach to the treatment of an extremely rare malignancy. Radiol Case Rep 2020; 15:1216-1220. [PMID: 32566067 PMCID: PMC7299906 DOI: 10.1016/j.radcr.2020.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/29/2022] Open
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Tu H, Chen L, Lin J, Wang J. Liver Cancer Confirmation by Contrast-Enhanced Ultrasound Coupled With Magnetic Resonance Imaging: Case Report of Liver Inflammation Misdiagnosed as Atypical Liver Cancer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1453-1457. [PMID: 32003868 DOI: 10.1002/jum.15233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 01/02/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Haibin Tu
- Ultrasonography Laboratory, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Lihong Chen
- Ultrasonography Laboratory, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Jianling Lin
- Ultrasonography Laboratory, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Jian Wang
- Imaging Department, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
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Kang HJ, Lee JM, Jeon SK, Ryu H, Yoo J, Lee JK, Han JK. Microvascular Flow Imaging of Residual or Recurrent Hepatocellular Carcinoma after Transarterial Chemoembolization: Comparison with Color/Power Doppler Imaging. Korean J Radiol 2020; 20:1114-1123. [PMID: 31270975 PMCID: PMC6609430 DOI: 10.3348/kjr.2018.0932] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/07/2019] [Indexed: 02/07/2023] Open
Abstract
Objective To determine the feasibility of microvascular flow imaging (MVFI) in comparison with color/power Doppler imaging (CDI/PDI) for detection of intratumoral vascularity in suspected post-transarterial chemoembolization (TACE) residual or recurrent hepatocellular carcinomas (HCCs) by using contrast-enhanced ultrasonography (CEUS) or hepatic angiography (HA) findings as the reference standard. Materials and Methods One hundred HCCs (mean size, 2.2 cm) in 100 patients treated with TACE were included in this prospective study. CDI, PDI, and MVFI were performed in tandem for evaluating intratumoral vascularity of the lesions by using an RS85 ultrasound scanner (Samsung Medison Co., Ltd.). Intratumoral vascularity in each technique was assessed by two radiologists in consensus by using a 5-point scale. Then, one of the two radiologists and another radiologist performed additional image review in the reverse order (MVFI-PDI-CDI) for evaluation of intra- and interobserver agreements. Results were then compared with those of either HA or CEUS as the reference. The McNemar test, logistic regression analysis, and intraclass correlation coefficient (ICC) were used. Results CEUS or HA revealed intratumoral vascularity in 87% (87/100) of the tumors. Sensitivity (79.3%, 69/87) and accuracy (80.0%, 80/100) of MVFI were significantly higher than those of CDI (sensitivity, 27.6% [24/87]; accuracy, 37.0% [37/100]) or PDI (sensitivity, 36.8% [32/87]; accuracy, 44.0% [44/100]) (all p < 0.05). CDI, PDI, and MVFI presented excellent intraobserver (ICCs > 0.9) and good interobserver agreements (ICCs > 0.6). Conclusion MVFI demonstrated significantly higher sensitivity and accuracy than did CDI and PDI for the detection of intratumoral vascularity in suspected residual or recurrent HCCs after TACE.
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Affiliation(s)
- Hyo Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
| | - Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Hwaseong Ryu
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | | | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Negrão de Figueiredo G, Mueller-Peltzer K, Schwarze V, Marschner C, Zhang L, Rübenthaler J, Siepmann T, Illigens B, Clevert D. Long-term study analysis of contrast-enhanced ultrasound in the diagnosis of focal nodular hyperplasia. Clin Hemorheol Microcirc 2020; 74:441-452. [DOI: 10.3233/ch-190710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- G. Negrão de Figueiredo
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - K. Mueller-Peltzer
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - V. Schwarze
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
| | - C. Marschner
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
| | - L. Zhang
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
| | - J. Rübenthaler
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
| | - T. Siepmann
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - B.W. Illigens
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - D.A. Clevert
- Department of Radiology, Interdisciplinary Ultrasound-Center Ludwig-Maximilians-University of Munich – Grosshadern Campus, Munich, Germany
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Characterization of Indeterminate Liver Lesions on CT and MRI With Contrast-Enhanced Ultrasound: What Is the Evidence? AJR Am J Roentgenol 2020; 214:1295-1304. [DOI: 10.2214/ajr.19.21498] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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67
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Ippolito D, Porta M, Maino C, Pecorelli A, Ragusi M, Giandola T, Querques G, Talei Franzesi C, Sironi S. Diagnostic approach in hepatic lymphoma: radiological imaging findings and literature review. J Cancer Res Clin Oncol 2020; 146:1545-1558. [PMID: 32296934 DOI: 10.1007/s00432-020-03205-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/30/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Imaging manifestations of hepatic lymphoma, both primary (PHL) and secondary (SHL), are extremely variable and non-specific, but some features are useful diagnostic clues in an appropriate clinical setting. Through a PubMed search, we found several published reviews focused on PHL and SHL diagnosis. However, to the best of our knowledge, few of them encompass a comprehensive analysis of all the diagnostic tools and relative radiological findings. The aim of this review is to provide a description of the radiological features of both PHL and SHL, by critically analyzing the available literature. MATERIALS AND METHODS An extensive review of published literature along with a description of personal case series of both PHL and SHL has been conducted. RESULTS SHL can be easily diagnosed with imaging techniques, as it is usually associated with node disease. On the contrary the diagnosis can be a challenge in PHL, often mimicking HCC or liver metastasis of adenocarcinoma. In this context, multiparametric MRI plays a fundamental role in the differential diagnosis. Both for PHL and SHL, liver involvement presents as solitary or multiple lesions or as diffuse infiltrative disease. CONCLUSION PHL and SHL may be correctly characterized using different radiological techniques. Both CT and MRI have showed a good correlation with histology, as they permit to distinguish between lymphomatous tissue, and necrotic and fibrotic areas.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Marco Porta
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Anna Pecorelli
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy.
- School of Medicine, University of Milano-Bicocca, Milan, Italy.
| | - Maria Ragusi
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Teresa Giandola
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Giulia Querques
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Cammillo Talei Franzesi
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Sandro Sironi
- Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
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Lund M, Nadarevic T, Bjerre TA, Grønbaek H, Mortensen F, Kragh Andersen P. Contrast-enhanced ultrasound compared with computed tomography, magnetic resonance imaging, and positron emission tomography-computed tomography for diagnosing liver metastases in people with newly diagnosed colorectal cancer. Hippokratia 2020. [DOI: 10.1002/14651858.cd012388.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Martin Lund
- Department of Radiology; Randers Regional Hospital; Randers Denmark
| | - Tin Nadarevic
- Department of Radiology; Clinical Hospital Centre Rijeka; Rijeka Croatia
| | | | - Henning Grønbaek
- Medical Department V; Aarhus University Hospital; Aarhus Denmark
| | - Frank Mortensen
- Department of Surgery L; Aarhus University Hospital; Aarhus Denmark
| | - Per Kragh Andersen
- Department of Biostatistics; University of Copenhagen, Faculty of Health Sciences, Institute of Public Health; Copenhagen K Denmark
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Yu Z, Hu M, Li Z, Zhu L, Guo Y, Liu Q, Lan W, Jiang J, Wang L. Anti-G250 nanobody-functionalized nanobubbles targeting renal cell carcinoma cells for ultrasound molecular imaging. NANOTECHNOLOGY 2020; 31:205101. [PMID: 32107342 DOI: 10.1088/1361-6528/ab7040] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Traditional imaging examinations have difficulty in identifying benign and malignant changes in renal masses. This difficulty may be solved by ultrasound molecular imaging based on targeted nanobubbles, which could specifically enhance the ultrasound imaging of renal cell carcinomas (RCC) so as to discriminate benign and malignant renal masses. In this study, we aimed to prepare anti-G250 nanobody-functionalized targeted nanobubbles (anti-G250 NTNs) by coupling anti-G250 nanobodies to lipid nanobubbles and to verify their target specificity and binding ability to RCC cells that express G250 antigen and their capacity to enhance ultrasound imaging of RCC xenografts. Anti-G250 nanobodies were coupled to the lipid nanobubbles using the biotin-streptavidin bridge method. The average particle diameter of the prepared anti-G250 NTNs was 446 nm. Immunofluorescence confirmed that anti-G250 nanobodies were uniformly distributed on the surfaces of nanobubbles. In vitro experiments showed that the anti-G250 NTNs specifically bound to G250-positive 786-O cells and HeLa cells with affinities of 88.13% ± 4.37% and 71.8% ± 5.7%, respectively, and that they did not bind to G250-negative ACHN cells. The anti-G250 NTNs could significantly enhance the ultrasound imaging of xenograft tumors arising from 786-O cells and HeLa cells compared with blank nanobubbles, while the enhancement was not significant for xenograft tumors arising from ACHN cells. Immunofluorescence of tumor tissue slices confirmed that the anti-G250 NTNs could enter the tissue space through tumor blood vessels and bind to tumor cells specifically. In conclusion, anti-G250 nanobody-functionalized targeted nanobubbles could specifically bind to G250-positive RCC cells and enhance the ultrasound imaging of G250-positive RCC xenografts. This study has high-potential clinical application value for the diagnosis and differential diagnosis of renal tumors.
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Affiliation(s)
- Zhiping Yu
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
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Benjamin JL, Dennis R, White S, Munson D, Anupindi SA, Piskunowicz M, Darge K, Gokli A, Hwang M. Improved Diagnostic Sensitivity of Bowel Disease of Prematurity on Contrast-Enhanced Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1031-1036. [PMID: 31705672 DOI: 10.1002/jum.15168] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/30/2019] [Accepted: 10/11/2019] [Indexed: 06/10/2023]
Abstract
Bowel diseases of prematurity, including necrotizing enterocolitis, are dreaded ailments of neonates. Early diagnosis is difficult, with clinical and radiographic findings often inconclusive. We present a novel use of contrast-enhanced ultrasound in detection of pediatric bowel disease. Early identification of compromised blood flow or an at-risk bowel can be quantitatively detected and monitored. This ability has implications for guidance of emerging therapies, allowing targeting of inflammation. These findings represent an advancement in detection of bowel disease in neonates.
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Affiliation(s)
- Jamaal L Benjamin
- Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rebecca Dennis
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Stacy White
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David Munson
- Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sudha A Anupindi
- Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Maciej Piskunowicz
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Kassa Darge
- Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ami Gokli
- Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Misun Hwang
- Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Quarato CMI, De Cosmo S, D'Agostino F, Gaudiuso G, Sperandeo M. Commentary: Ultrasound-Guided Biopsy of Pleural-Based Pulmonary Lesions by Injection of Contrast-Enhancing Drugs. Front Pharmacol 2020; 11:365. [PMID: 32346365 PMCID: PMC7171447 DOI: 10.3389/fphar.2020.00365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 03/10/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy
| | - Salvatore De Cosmo
- Department of Internal Medicine, IRCCS Fondazione "Casa Sollievo Della Sofferenza", Foggia, Italy
| | - Federica D'Agostino
- Department of Internal Medicine, IRCCS Fondazione "Casa Sollievo Della Sofferenza", Foggia, Italy
| | - Giulia Gaudiuso
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Bari, Bary, Italy
| | - Marco Sperandeo
- Department of Internal Medicine, Unit of Interventional and Diagnostic Ultrasound, IRCCS Fondazione "Casa Sollievo Della Sofferenza", Foggia, Italy
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Contrast-enhanced ultrasound features of malignant focal liver masses in dogs. Sci Rep 2020; 10:6076. [PMID: 32269300 PMCID: PMC7142119 DOI: 10.1038/s41598-020-63220-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/26/2020] [Indexed: 12/13/2022] Open
Abstract
A total of 185 cases (150 retrospectively and 35 prospectively) of malignant liver masses were collected. In the retrospectively collected cases hyperenhancement during wash-in was the most common feature in HCCs but there was a high percentage of cases showing no enhancement or hypo/isoenhancement. ICCs displayed a large variety of contrast enhancement patterns and, although statically significant differences between ICCs and HCCs were evident, no clear distinction between these two pathologies was possible based only on their CEUS appearance. Sarcomas displayed all the possible degrees of wash-in enhancement with non-enhancing being the most common appearance. Metastases displayed all the possible contrast-enhancement patterns, with the most common being hyperenhancement in the wash-in phase followed by hypoenhancement in the wash-out phase. A decision tree was developed based on the features of the retrospectively selected cases. Based on the developed decision tree 27/35 prospectively collected cases were correctly classified. Even if some significant differences among groups were evident, all the histotypes displayed all the possible patterns of contrast enhancement, and, therefore, the differentiation of liver masses in dogs based only on their CEUS features is not feasible and, therefore, cytology or histopathology is required.
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Denis de Senneville B, Frulio N, Laumonier H, Salut C, Lafitte L, Trillaud H. Liver contrast-enhanced sonography: computer-assisted differentiation between focal nodular hyperplasia and inflammatory hepatocellular adenoma by reference to microbubble transport patterns. Eur Radiol 2020; 30:2995-3003. [PMID: 32002637 DOI: 10.1007/s00330-019-06566-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/21/2019] [Accepted: 10/30/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE A new computer tool is proposed to distinguish between focal nodular hyperplasia (FNH) and an inflammatory hepatocellular adenoma (I-HCA) using contrast-enhanced ultrasound (CEUS). The new method was compared with the usual qualitative analysis. METHODS The proposed tool embeds an "optical flow" algorithm, designed to mimic the human visual perception of object transport in image series, to quantitatively analyse apparent microbubble transport parameters visible on CEUS. Qualitative (visual) and quantitative (computer-assisted) CEUS data were compared in a cohort of adult patients with either FNH or I-HCA based on pathological and radiological results. For quantitative analysis, several computer-assisted classification models were tested and subjected to cross-validation. The accuracies, area under the receiver-operating characteristic curve (AUROC), sensitivity and specificity, positive predictive values (PPVs), negative predictive values (NPVs), false predictive rate (FPRs) and false negative rate (FNRs) were recorded. RESULTS Forty-six patients with FNH (n = 29) or I-HCA (n = 17) with 47 tumours (one patient with 2 I-HCA) were analysed. The qualitative diagnostic parameters were accuracy = 93.6%, AUROC = 0.94, sensitivity = 94.4%, specificity = 93.1%, PPV = 89.5%, NPV = 96.4%, FPR = 6.9% and FNR = 5.6%. The quantitative diagnostic parameters were accuracy = 95.9%, AUROC = 0.97, sensitivity = 93.4%, specificity = 97.6%, PPV = 95.3%, NPV = 96.7%, FPR = 2.4% and FNR = 6.6%. CONCLUSIONS Microbubble transport patterns evident on CEUS are valuable diagnostic indicators. Machine-learning algorithms analysing such data facilitate the diagnosis of FNH and I-HCA tumours. KEY POINTS • Distinguishing between focal nodular hyperplasia and an inflammatory hepatocellular adenoma using dynamic contrast-enhanced ultrasound is sometimes difficult. • Microbubble transport patterns evident on contrast-enhanced sonography are valuable diagnostic indicators. • Machine-learning algorithms analysing microbubble transport patterns facilitate the diagnosis of FNH and I-HCA.
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Affiliation(s)
- Baudouin Denis de Senneville
- Institut de Mathématiques de Bordeaux (IMB), UMR 5251 CNRS/Université de Bordeaux, 351 cours de la Libération, F-33405, Talence, France.
| | - Nora Frulio
- CHU de Bordeaux, Service d'imagerie diagnostique et Interventionnelle Magellan/Saint André, F-33000, Bordeaux, France
| | - Hervé Laumonier
- CHU de Bordeaux, Service d'imagerie diagnostique et Interventionnelle Magellan/Saint André, F-33000, Bordeaux, France
| | - Cécile Salut
- CHU de Bordeaux, Service d'imagerie diagnostique et Interventionnelle Magellan/Saint André, F-33000, Bordeaux, France
| | - Luc Lafitte
- Institut de Mathématiques de Bordeaux (IMB), UMR 5251 CNRS/Université de Bordeaux, 351 cours de la Libération, F-33405, Talence, France
| | - Hervé Trillaud
- CHU de Bordeaux, Service d'imagerie diagnostique et Interventionnelle Magellan/Saint André, F-33000, Bordeaux, France.,EA IMOTION (Imagerie moléculaire et thérapies innovantes en oncologie), Université de Bordeaux, F-33000, Bordeaux, France
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Erlichman DB, Weiss A, Koenigsberg M, Stein MW. Contrast enhanced ultrasound: A review of radiology applications. Clin Imaging 2019; 60:209-215. [PMID: 31927496 DOI: 10.1016/j.clinimag.2019.12.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/08/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022]
Abstract
Ultrasound contrast agents have been used for decades in Europe and Asia for cardiac and abdominal imaging and are now being more commonly utilized in the United States for radiology applications. Our article reviews the basics of contrast-enhanced ultrasound including how the contrast agent works, advantages and disadvantages, as well as pearls and pitfalls to help the radiologist efficiently integrate this technology into day-to-day clinical practice. We also discuss the diagnosis of focal hepatic lesions as well as off-label applications such as evaluation of renal masses.
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Affiliation(s)
- David B Erlichman
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, United States of America.
| | - Amanda Weiss
- Northwell Health System, Zucker School of Medicine at Hofstra/Northwell, United States of America
| | - Mordecai Koenigsberg
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, United States of America
| | - Marjorie W Stein
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, United States of America
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The interreader agreement and validation of contrast-enhanced ultrasound liver imaging reporting and data system. Eur J Radiol 2019; 120:108685. [PMID: 31606712 DOI: 10.1016/j.ejrad.2019.108685] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/04/2019] [Accepted: 09/18/2019] [Indexed: 02/07/2023]
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76
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Campos S, Poley JW, van Driel L, Bruno MJ. The role of EUS in diagnosis and treatment of liver disorders. Endosc Int Open 2019; 7:E1262-E1275. [PMID: 31579708 PMCID: PMC6773586 DOI: 10.1055/a-0958-2183] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/07/2019] [Indexed: 02/06/2023] Open
Abstract
Background and aim Transabdominal ultrasound (US), computed tomographic scanning (CT) and magnetic resonance imaging (MRI) are established diagnostic tools for liver diseases. Percutaneous transhepatic cholangiography is used to perform hepatic interventional procedures including biopsy, biliary drainage procedures, and radiofrequency ablation. Despite their widespread use, these techniques have limitations. Endoscopic ultrasound (EUS), a tool that has proven useful for evaluating the mediastinum, esophagus, stomach, pancreas, and biliary tract, has an expanding role in the field of hepatology complementing the traditional investigational modalities. This review aimed to assess the current scientific evidence regarding diagnostic and therapeutic applications of EUS for hepatic diseases.
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Affiliation(s)
- Sara Campos
- Department of Gastroenterology, Hospital Garcia da Orta, Portugal
- Department of Gastroenterology and Hepatology, Erasmus MC, The Netherlands
| | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus MC, The Netherlands
| | - Lydi van Driel
- Department of Gastroenterology and Hepatology, Erasmus MC, The Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC, The Netherlands
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Kessner R, Nakamoto DA, Kondray V, Partovi S, Ahmed Y, Azar N. Contrast-Enhanced Ultrasound Guidance for Interventional Procedures. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2541-2557. [PMID: 30714653 DOI: 10.1002/jum.14955] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/03/2019] [Indexed: 06/09/2023]
Abstract
Since its introduction, contrast-enhanced ultrasound (CEUS) has gained an important role in the diagnosis and management of abdominal and pelvic diseases. Contrast-enhanced ultrasound can improve lesion detection rates as well as success rates of interventional procedures when compared to conventional ultrasound alone. Additionally, CEUS enables the interventionalist to assess the dynamic enhancement of different tissues and lesions, without the adverse effects of contrast-enhanced computed tomography, such as exposure to ionizing radiation and nephrotoxicity from iodinated contrast material. This review article describes the various applications and advantages of the use of CEUS to enhance performance of ultrasound-guided interventions in the abdomen and pelvis.
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Affiliation(s)
- Rivka Kessner
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Dean A Nakamoto
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Victor Kondray
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sasan Partovi
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yasmine Ahmed
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nami Azar
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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A case of primary clear cell hepatocellular carcinoma comprised mostly of clear cells. Radiol Case Rep 2019; 14:1377-1381. [PMID: 31695824 PMCID: PMC6823767 DOI: 10.1016/j.radcr.2019.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 01/26/2023] Open
Abstract
Clear cell hepatocellular carcinoma (CHCC) is defined as a tumor which contains more than 50% of clear cells. However, CHCC with more than 90% of clear cells are extremely rare. We report a case of a 65-year-old woman who was found to have a solitary mass, which was histologically diagnosed as clear cell hepatocellular carcinoma composed of 90% or more clear cells. The tumor presented rim arterial phase hyperenhancement in computed tomography, magnetic resonance imaging, and computed tomography during hepatic arteriography, and was classified as LR-M category according to The Liver Imaging Reporting and Data System version 2018(LI-RADS v2018). This tumor may mimic other tumors with similar radiographic features, such as intrahepatic cholangiocellular carcinoma and metastatic tumor.
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79
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Hsiao CY, Chen PD, Huang KW. A Prospective Assessment of the Diagnostic Value of Contrast-Enhanced Ultrasound, Dynamic Computed Tomography and Magnetic Resonance Imaging for Patients with Small Liver Tumors. J Clin Med 2019; 8:E1353. [PMID: 31480576 PMCID: PMC6780634 DOI: 10.3390/jcm8091353] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 08/25/2019] [Accepted: 08/29/2019] [Indexed: 12/27/2022] Open
Abstract
AIM This prospective study assessed the diagnostic value of contrast-enhanced ultrasound (CEUS) using long Kupffer phase enhancement for adults with liver tumor size of less than 3 cm. Performance comparisons were also conducted with dynamic computed tomography (CT) and magnetic resonance imaging (MRI). BACKGROUND CEUS has emerged as a reliable image modality, since the development of second-generation contrast medium with long Kupffer phase enhancement. Nonetheless, dynamic CT and MRI are currently the standard imaging tools for the diagnosis of liver cancers, and the diagnostic value of CEUS for liver cancer has yet to be universally accepted. METHODS Sixty-six adult patients suspected of having liver tumors smaller than 3 cm underwent CEUS, dynamic CT, and MRI examinations independently. Subsequent tumor biopsies were used to verify the diagnostic performance of the three imaging modalities. RESULTS The diagnostic odds ratio (DOR, 95% CI) for hepatocellular carcinoma were as follows: CEUS (52.8, 11.4-243), CT (29.29, 7.36-116), and MRI (19.43, 5.44-69.4); for metastasis: CEUS (200, 19.1-2095), CT (24, 5.05-114), and MRI (32, 6.56-156); and all liver malignancy: CEUS (260, 12.7-5310), CT (2.57, 0.55-12.1), and MRI (5.22, 1.25-21.8). CEUS achieved the best differentiation performance. CONCLUSIONS CEUS outperformed dynamic CT and MRI in terms of diagnostic performance when dealing with small liver tumors (<3 cm).
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Affiliation(s)
- Chih-Yang Hsiao
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei 10048, Taiwan
- Department of Surgery, National Taiwan University Hospital, Taipei 10002, Taiwan
- Department of Traumatology, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Po-Da Chen
- Department of Surgery, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Kai-Wen Huang
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei 10048, Taiwan.
- Department of Surgery, National Taiwan University Hospital, Taipei 10002, Taiwan.
- Hepatitis Research Center, National Taiwan University Hospital, Taipei 10048, Taiwan.
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80
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Lee SC, Tchelepi H, Grant E, Desai B, Luo C, Groshen S, Hovanessian-Larsen L. Contrast-Enhanced Ultrasound Imaging of Breast Masses: Adjunct Tool to Decrease the Number of False-Positive Biopsy Results. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2259-2273. [PMID: 30597640 PMCID: PMC7735954 DOI: 10.1002/jum.14917] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/20/2018] [Accepted: 11/28/2018] [Indexed: 05/09/2023]
Abstract
OBJECTIVES This pilot study evaluated use of contrast-enhanced ultrasound (CEUS) to reduce the number of benign breast masses recommended for biopsy. METHODS This prospective study included 131 consenting women, from October 2016 to June 2017, with American College of Radiology Breast Imaging Reporting and Data System category 4a, 4b, and 4c masses detected by mammography, conventional ultrasound (US), or both. Contrast-enhanced US examinations (using intravenous injection of perflutren lipid microspheres or sulfur hexafluoride lipid-type A microspheres) were performed before biopsy. Qualitative and quantitative CEUS parameters were compared with reference standard histopathologic results from biopsy of 131 masses. RESULTS There were 109 benign, 6 high-risk, and 16 malignant masses, with a median size of 12 mm (range, 4 to 48 mm) on conventional US imaging. Of 131 masses, 93 (71%) enhanced on CEUS imaging, including 73 of 109 (67%) benign, 6 of 6 (100%) high-risk, and 14 of 16 (87.5%) malignant. Thirty-eight lesions did not enhance, including 36 of 109 (33%) benign and 2 of 16 (12.5%) malignant. Prediction models using recursive petitioning revealed that CEUS may reduce 31% (95% confidence interval, 23%, 40%) of benign biopsies for masses that are: nonenhancing with circumscribed margins or enhancing with an oval shape and homogeneous enhancement. Quantitative parameters indicated that benign masses had the longest time to peak (P = .078), highest time-to-peak ratio of mass to background (P = .036), lowest peak intensity (P = .021), and smallest difference in peak intensity between the mass and background (P = .079) compared to high-risk and malignant lesions. CONCLUSIONS Contrast-enhanced US may be a valuable modality that can be used to predict benign pathologic results of breast masses, thereby reducing the number of biopsies.
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Affiliation(s)
- Sandy C. Lee
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Hisham Tchelepi
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Edward Grant
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Bhushan Desai
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Chunqiao Luo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Susan Groshen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Linda Hovanessian-Larsen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
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Abstract
CLINICAL/METHODICAL ISSUE Cross-sectional modalities or conventional ultrasound are not always able to sufficiently identify and characterize malignant liver lesions. STANDARD RADIOLOGICAL METHODS The evaluation of malignant liver lesions in conventional ultrasound relies on echostructure, shape and borders, but often warrants additional contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) studies. METHODICAL INNOVATIONS Contrast-enhanced ultrasound (CEUS) is a relatively safe imaging technique used for the detection and characterization of malignant liver lesions. The use of a second-generation contrast agent in dynamic real-time imaging allows the visualization of vascularization in any kind of liver lesion as well as liver perfusion during the arterial, portal venous and late phase. PERFORMANCE Due to the different enhancement patterns, it is possible to differentiate a liver lesion with high diagnostic accuracy (over 90%). ACHIEVEMENTS CEUS is a helpful complementary technique to cross-sectional imaging for the evaluation of unclear liver lesions and may frequently obviate additional contrast-enhanced MRI or CT studies. PRACTICAL RECOMMENDATIONS CEUS enables the detection and characterization of liver lesions in real time.
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82
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Zamir MA, Hakim W, Yusuf S, Thomas R. Imaging of Pancreatic-Neuroendocrine Tumours: An Outline of Conventional Radiological Techniques. Curr Radiopharm 2019; 12:135-155. [DOI: 10.2174/1874471012666190214165845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 09/19/2018] [Accepted: 10/30/2018] [Indexed: 01/18/2023]
Abstract
IIntroduction:
Pancreatic Neuroendocrine Tumours (p-NETs) are an important disease entity
and comprise of peptide-secreting tumours often with a functional syndrome.
:
Accounting for a small percentage of all pancreatic tumours, they have a good overall survival rate
when diagnosed early, with surgery being curative. The role of nuclear medicine in the diagnosis and
treatment of these tumours is evident. However, the vast majority of patients will require extensive imaging
in the form of conventional radiological techniques. It is important for clinicians to have a fundamental
understanding of the p-NET appearances to aid prompt identification and to help direct management
through neoplastic staging.
Methods:
This article will review the advantages and disadvantages of conventional radiological techniques
in the context of p-NETs and highlight features that these tumours exhibit.
Conclusion:
Pancreatic neuroendocrine tumours are a unique collection of neoplasms that have markedly
disparate clinical features but similar imaging characteristics. Most p-NETs are small and welldefined
with homogenous enhancement following contrast administration, although larger and less welldifferentiated
tumours can demonstrate areas of necrosis and cystic architecture with heterogeneous
enhancement characteristics.
:
Prognosis is generally favourable for these tumours with various treatment options available. However,
conventional radiological techniques will remain the foundation for the initial diagnosis and staging of
these tumours, and a grasp of these modalities is extremely important for physicians.
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Affiliation(s)
- Muhammad Affan Zamir
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, United Kingdom
| | - Wasim Hakim
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, United Kingdom
| | - Siraj Yusuf
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, United Kingdom
| | - Robert Thomas
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, United Kingdom
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83
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Miller DL, Lu X, Fabiilli M, Dou C. Hepatocyte Injury Induced by Contrast-Enhanced Diagnostic Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1855-1864. [PMID: 30548874 DOI: 10.1002/jum.14883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/05/2018] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Contrast-enhanced diagnostic ultrasound (US) has a potential to induce localized biological effects. The potential for contrast-enhanced diagnostic US bioeffects in liver were researched, with guidance from a report by Yang et al (Ultrasonics 2012; 52:1065-1071). METHODS Contact and standoff scanning was performed for 10 minutes with a diagnostic US phased array at 1.6 MHz during bolus injection or infusion of a contrast agent at a high dose. The impact of the imaging on rat liver was investigated by measuring enzyme release, microvascular leakage, and staining of injured hepatocytes. RESULTS The results showed liver enzyme release at 30 minutes, indicating liver injury, and elevated extraction of Evans blue dye, indicating microvascular leakage. In addition, Evans blue and trypan blue vital-staining methods revealed scattered stained cells within the US scan plane. For the Evans blue method, fluorescent cell counts in frozen sections were greatest for standoff exposure with contrast infusion. The count decreased strongly with depth for bolus injection, which was probably reflective of the high attenuation noted for this agent delivery method. CONCLUSIONS The results qualitatively confirmed the report by Yang et al and additionally showed hepatocyte vital staining. Research is needed to determine the threshold for the effects and the contrast agent dose response.
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Affiliation(s)
- Douglas L Miller
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Xiaofang Lu
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Mario Fabiilli
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Chunyan Dou
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
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Tamura M, Nakamura K, Osuga T, Shimbo G, Sasaki N, Morishita K, Ohta H, Takiguchi M. Findings of contrast-enhanced ultrasonography with Sonazoid for cholangiocellular adenoma in three dogs. J Vet Med Sci 2019; 81:1104-1108. [PMID: 31243194 PMCID: PMC6715911 DOI: 10.1292/jvms.19-0116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Contrast-enhanced ultrasonography (CEUS) is useful to distinguish benign and malignant
focal liver lesions in dogs. Cholangiocellular adenoma is an extremely rare benign tumor
in dogs and has not been examined using CEUS with Sonazoid. The aim of this study was to
describe findings of CEUS with Sonazoid in three dogs with cholangiocellular adenoma. All
three dogs showed contrast defects in the Kupffer phase and these findings mimicked
malignant neoplasia during the Kupffer phase. Moreover, all dogs showed early washout and
hypoechoic lesions relative to the surrounding normal liver parenchyma in the portal
phase. To our knowledge, this is the first study to report that CEUS findings of
cholangiocellular adenoma with Sonazoid mimicked malignancy in three dogs.
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Affiliation(s)
- Masahiro Tamura
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan
| | - Kensuke Nakamura
- Organization for Promotion of Tenure Track, University of Miyazaki, Miyazaki 889-2192, Japan
| | - Tatsuyuki Osuga
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido 060-0819, Japan
| | - Genya Shimbo
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido 060-0819, Japan
| | - Noboru Sasaki
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan
| | - Keitaro Morishita
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido 060-0819, Japan
| | - Hiroshi Ohta
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan
| | - Mitsuyoshi Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan
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Corvino A, Sandomenico F, Setola SV, Corvino F, Tafuri D, Catalano O. Morphological and dynamic evaluation of complex cystic focal liver lesions by contrast-enhanced ultrasound: current state of the art. J Ultrasound 2019; 22:251-259. [PMID: 31087277 DOI: 10.1007/s40477-019-00385-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/02/2019] [Indexed: 12/14/2022] Open
Abstract
Complex cystic and cystic-like focal liver lesions (FLLs) encompass a spectrum of disorders ranging from non-neoplastic conditions to benign and malignant tumors. In this prospective, the possibility of non-invasive differentiation of these lesions is extremely important, because the clinical implications and therapeutic strategies vary considerably. Because of its advantageous cost/benefit ratio, widespread availability and easy execution, ultrasound (US) is the first-line imaging modality in most countries for the initial liver survey and represents the imaging technique that usually detects a complex liver cyst. However, US showed poor efficacy in the differential diagnosis of complex cystic FLLs. Thus, for years, computed tomography (CT) and magnetic resonance (MR) imaging have been used for further assessment of these lesions. Recently, the development of low mechanical index real-time contrast-enhanced ultrasound (CEUS) technique performed with the second generation of US contrast agents has led to an accurate depiction of macrovasculature and microvasculature. The technique yields information about contrast enhancement of the liver and FLLs almost as CT and MRI do, but in real time and without the use of ionizing radiation. To date, there is only a small amount of evidence about the role of CEUS in the less common setting of complex liver cysts. The aim of this review is to offer an up-to-date overview on the state of the art of CEUS in the study of the most common complex cystic focal liver lesions. To our knowledge, there are no literature comprehensive reviews on this topic.
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Affiliation(s)
- Antonio Corvino
- Motor Science and Wellness Department, University of Naples "Parthenope", VIA F. Acton 38, 80133, Naples, Italy.
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), Via S. Pansini 5, 80131, Naples, Italy.
- , via Croce no. 82, 81033, Casal di Principe, CE, Italy.
| | - Fabio Sandomenico
- Radiology Department, National Cancer Institute Pascale Foundation, Via M. Semmola 53, 80131, Naples, Italy
| | - Sergio Venanzio Setola
- Radiology Department, National Cancer Institute Pascale Foundation, Via M. Semmola 53, 80131, Naples, Italy
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Domenico Tafuri
- Motor Science and Wellness Department, University of Naples "Parthenope", VIA F. Acton 38, 80133, Naples, Italy
| | - Orlando Catalano
- Radiology Unit, Istituto Diagnostico Varelli, Via Cornelia Dei Gracchi 65, 80126, Naples, Italy
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86
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Schelker RC, Andorfer K, Putz F, Herr W, Jung EM. Identification of two distinct hereditary hemorrhagic telangiectasia patient subsets with different hepatic perfusion properties by combination of contrast-enhanced ultrasound (CEUS) with perfusion imaging quantification. PLoS One 2019; 14:e0215178. [PMID: 30973932 PMCID: PMC6459476 DOI: 10.1371/journal.pone.0215178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/27/2019] [Indexed: 12/27/2022] Open
Abstract
Background Hereditary hemorrhagic telangiectasia (HHT) is marked by arteriovenous fusion comprising hepatic vascular malformations (HVaMs) with the chance of bleeding. Aims We investigated HVaMs in HHT patients by combination of contrast-enhanced ultrasound (CEUS) with perfusion imaging quantification to be able to sub-classify a high risk cohort of asymptomatic HHT patients. Methods The imaging characteristics on CEUS in 34 patients (aged 21–84 years; mean 58.9) with HHT were retrospectively evaluated. Real-time contrast harmonic imaging, sulfur hexafluoride-filled microbubbles and motion adjustment were utilized. Cine loops of the liver were digital stored, perfusion was quantified using a software reading DICOM data`s. Results HVaMs were diagnosed in 31 out of 34 patients. Significant uppermost peak enhancement (PE), wash-in area under the curve (WiAUC) and wash-in perfusion index (WiPI) were identified in the shunt region (100%), next in the hilar region (PE 32.6%; WiAUC 33.9%; WiPI 34.1%), and the lowest in the hepatic parenchyma (PE 10.2%; WiAUC 12.0%; WiPI 9.5%). The perfusion parameters in the shunt region compared to the other regions were significantly increased in one subgroup of patients. Consistent with this, the intrahepatic portal vein diameter and Buscarini grading was significantly higher, while portal vein peak velocity was significantly lower in this patient subset. By statistical analysis, we could correlate PE and WiPI to these clinical parameters, while WiAUC showed no clinical association. Conclusions For the first time we combined CEUS findings with motion adjustment software to quantitative determine perfusion parameters of a cohort of HHT patients. Hereby, we could identify a subset of HHT patients with two markedly increased parameter values in the shunt region compared to the hilus/hepatic parenchyma. This could contribute to sub-classify a high-risk group of HHT patients with therapeutic indication.
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Affiliation(s)
- Roland C. Schelker
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Regensburg, Germany
- * E-mail:
| | - Kornelia Andorfer
- Department of Ear-Nose-Throat, University Hospital of Regensburg, Regensburg, Germany
| | - Franz Putz
- Department of Nephrology, University Hospital of Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, Hematology & Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - Ernst-Michael Jung
- Department of Radiology, University Hospital of Regensburg, Regensburg, Germany
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87
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Yang HK, Burns PN, Jang HJ, Kono Y, Khalili K, Wilson SR, Kim TK. Contrast-enhanced ultrasound approach to the diagnosis of focal liver lesions: the importance of washout. Ultrasonography 2019; 38:289-301. [PMID: 31311068 PMCID: PMC6769186 DOI: 10.14366/usg.19006] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/17/2019] [Indexed: 12/12/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is a powerful technique for differentiating focal liver lesions (FLLs) without the risks of potential nephrotoxicity or ionizing radiation. In the diagnostic algorithm for FLLs on CEUS, washout is an important feature, as its presence is highly suggestive of malignancy and its characteristics are useful in distinguishing hepatocellular from nonhepatocellular malignancies. Interpreting washout on CEUS requires an understanding that microbubble contrast agents are strictly intravascular, unlike computed tomography or magnetic resonance imaging contrast agents. This review explains the definition and types of washout on CEUS in accordance with the 2017 version of the CEUS Liver Imaging Reporting and Data System and presents their applications to differential diagnosis with illustrative examples. Additionally, we propose potential mechanisms of rapid washout and describe the washout phenomenon in benign entities.
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Affiliation(s)
- Hyun Kyung Yang
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Peter N Burns
- Department of Medical Biophysics, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Hyun-Jung Jang
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Yuko Kono
- Departments of Medicine and Radiology, University of California, San Diego, CA, USA
| | - Korosh Khalili
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Stephanie R Wilson
- Diagnostic Imaging, Department of Radiology, University of Calgary, Calgary, Canada
| | - Tae Kyoung Kim
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
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Vidili G, De Sio I, D'Onofrio M, Mirk P, Bertolotto M, Schiavone C. SIUMB guidelines and recommendations for the correct use of ultrasound in the management of patients with focal liver disease. J Ultrasound 2019; 22:41-51. [PMID: 30580390 PMCID: PMC6430299 DOI: 10.1007/s40477-018-0343-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/26/2018] [Indexed: 12/11/2022] Open
Abstract
The present document describes the SIUMB (Italian Society of Ultrasound in Medicine and Biology) guidelines for the use of ultrasound in the management of focal liver disease. The aim of the paper is to provide a clinical practice guideline for Italian physicians who are approaching the ultrasound study of a focal liver lesion. In particular, these guidelines provide simple indications, recommendations and general practice advices for the correct use of contrast-enhanced ultrasound (CEUS) in this scenario. They represent the SIUMB position of the ultrasound role in the diagnostic flow charts of the principal focal liver lesions, and are in agreement with other, previously published national and international guidelines.
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Affiliation(s)
- Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43b, 07100, Sassari, Italy.
| | - Ilario De Sio
- Department of Hepatogastroenterology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Mirko D'Onofrio
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Paoletta Mirk
- Department of Radiology, Catholic University of the Sacred Heart- Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Cosima Schiavone
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University of Chieti, Chieti, Italy
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Han H, Ding H, Ji Z, Zhang W, Wang Q, Wang W. Primary Application of Micro-Flow Imaging Technology in the Diagnosis of Hepatic Tumors. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:395-401. [PMID: 30409471 DOI: 10.1016/j.ultrasmedbio.2018.09.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/13/2018] [Accepted: 09/27/2018] [Indexed: 06/08/2023]
Abstract
The purpose of the study was to evaluate the vascular architecture of focal liver lesions with the newly released non-contrast micro-flow imaging (MFI) technique. Eighty patients with 80 hepatic tumors were enrolled in this study. The richness of displayed blood flow was first compared with color Doppler flow imaging using grades according to Adler's method. The results indicated that MFI outperformed color Doppler flow imaging with a statistically significant difference (p <0.0001). With the enhanced position in arterial phase of contrast-enhanced ultrasound imaging as the ground truth, the displayed blood flow distribution within tumors in MFI was further evaluated. The coincidence rate between MFI and contrast-enhanced ultrasound was 73.75% (59/80), which was higher than that of color Doppler flow imaging (52.5%, 42/80) (p < 0.0001). Moreover, for the five cases of focal nodular hyperplasia, MFI clearly revealed the spoke-wheel or radiating intra-tumoral vasculature, a finding specific to the diagnosis of focal nodular hyperplasia.
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Affiliation(s)
- Hong Han
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Hong Ding
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Zhengbiao Ji
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Weibin Zhang
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Qun Wang
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Wenping Wang
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China.
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Namikawa T, Tsuda S, Fujisawa K, Munekage E, Iwabu J, Munekage M, Uemura S, Tsujii S, Maeda H, Kitagawa H, Iguchi M, Murakami I, Kobayashi M, Hanazaki K. Intrahepatic bile duct adenoma in a patient with gastric cancer. Int Cancer Conf J 2019; 8:7-11. [PMID: 31149539 PMCID: PMC6498292 DOI: 10.1007/s13691-018-0345-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/10/2018] [Indexed: 12/14/2022] Open
Abstract
We report a case of intrahepatic bile duct adenoma (BDA) detected during laparoscopic distal gastrectomy for gastric cancer. A 70-year-old man was referred to our hospital for the treatment of gastric cancer. Esophagogastroduodenoscopy revealed an irregular, nodular, and elevated lesion on the greater curvature side of the middle third of the stomach. Abdominal contrast-enhanced computed tomography showed wall thickening with homogeneous enhancement in the middle part of the stomach, and no lesions in the liver. The patient underwent laparoscopic distal gastrectomy with regional lymphadenectomy, and during the operation a small whitish nodule was observed on the lateral segment of the liver surface. The lesion was excised by partial resection of the liver for the purpose of both histological diagnosis and treatment. Pathological examination of the liver lesion revealed no structural or cellular atypia, no stromal invasion, and immunohistochemical positivity for CK7 and CK19, but negativity for p53. The final diagnosis was well-differentiated adenocarcinoma invading the gastric serosal layer without lymph node metastasis, and intrahepatic BDA measuring 0.4 × 0.3 cm. Following surgery, the patient remained symptom-free without evidence of recurrence for 5 months. To the best of our knowledge, this is the first case of BDA with gastric cancer. Because it is difficult to distinguish BDA from other liver tumors including metastatic cancer due to its characteristically small size and lack of specific morphological features on standard imaging, surgical resection should be considered as the most suitable approach for both accurate diagnosis and treatment.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505 Japan
| | - Sachi Tsuda
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505 Japan
| | - Kazune Fujisawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505 Japan
| | - Eri Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505 Japan
| | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505 Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505 Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505 Japan
| | - Shigehiro Tsujii
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505 Japan
| | - Hiromichi Maeda
- Cancer Treatment Center, Kochi Medical School Hospital, Kochi, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505 Japan
| | - Mitsuko Iguchi
- Department of Pathology, Kochi Medical School, Kochi, Japan
| | | | - Michiya Kobayashi
- Cancer Treatment Center, Kochi Medical School Hospital, Kochi, Japan
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505 Japan
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91
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Marchegiani G, Landoni L, Andrianello S, Masini G, Cingarlini S, D'Onofrio M, De Robertis R, Davì M, Capelli P, Manfrin E, Amodio A, Paiella S, Malleo G, Damoli I, Miotto M, Bianchi B, Nessi C, Vivani E, Scarpa A, Salvia R, Bassi C. Patterns of Recurrence after Resection for Pancreatic Neuroendocrine Tumors: Who, When, and Where? Neuroendocrinology 2019; 108:161-171. [PMID: 30481765 DOI: 10.1159/000495774] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 11/25/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Pancreatic neuroendocrine tumors (pan-NENs) represent an increasingly common indication for pancreatic resection, but there are few data regarding possible recurrence after surgery. The aim of the study was to describe the frequency, timing, and patterns of recurrence after resection for pan-NENs with consequent implications for postoperative follow-up. METHODS We performed a retrospective analysis of pan-NENs resected between 1990 and 2015 at The Pancreas Institute, University of Verona Hospital Trust. Predictors of recurrence were assessed. Survival analysis was conducted using the Kaplan-Meier and conditional survival (CS) methods. RESULTS The cohort consisted of 487 patients with a median follow-up of 71 months. Recurrence developed in 12.3%: 54 (11.1%) liver metastases, 11 (2.3%) local recurrence, 10 (2.1%) nodal recurrence, and 8 (1.6%) metastases in other organs. Thirty-one (6.4%) died due to disease recurrence. Size > 21 mm, G3 grade, nodal metastasis, and vascular infiltration were independent predictors of overall recurrence. Recurrence occurred either during the first year of follow-up (n = 9), or after 10 years (n = 4). CS analysis revealed that nonfunctioning G1 pan-NEN ≤20 mm without nodal metastasis or vascular invasion had a negligible risk of developing recurrence. In the present series, after 5 years of follow-up without developing recurrence, tumor recurrence occurred only in the form of liver metastases. CONCLUSIONS Recurrence of pan-NENs is rare and is predicted by tumor size, nodal metastasis, grading, and vascular invasion. Patients with G1 pan-NEN without nodal metastasis and vascular invasion may be considered cured by surgery. After 5 years without recurrence, follow-up should focus on excluding the development of liver metastases.
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Affiliation(s)
- Giovanni Marchegiani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Luca Landoni
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Stefano Andrianello
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Gaia Masini
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Sara Cingarlini
- Department of Oncology, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Riccardo De Robertis
- Department of Radiology, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Mariavittoria Davì
- Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | - Paola Capelli
- Pathology, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Erminia Manfrin
- Pathology, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Antonio Amodio
- Department of Gastroenterology, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Salvatore Paiella
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Giuseppe Malleo
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Isacco Damoli
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Marco Miotto
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Beatrice Bianchi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Chiara Nessi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Elena Vivani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Aldo Scarpa
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy,
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
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92
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Miller DL, Lu X, Fabiilli M, Dou C. Influence of Microbubble Size and Pulse Amplitude on Hepatocyte Injury Induced by Contrast-Enhanced Diagnostic Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:170-176. [PMID: 30366606 PMCID: PMC6289861 DOI: 10.1016/j.ultrasmedbio.2018.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/07/2018] [Accepted: 09/12/2018] [Indexed: 05/08/2023]
Abstract
Recent research has found that contrast-enhanced diagnostic ultrasound (CEDUS) has the potential to induce localized injury in the liver, with clearly observable effects for contrast agent doses higher than the recommended dose and maximal mechanical index values. This study was undertaken to assess effects with intermittent exposure at lower contrast doses of infusion and at reduced output to determine thresholds. In addition, microbubble (MB) suspensions with enhanced content of larger MBs were tested. Exposure from a phased array probe (GE Vivid 7 Dimension, GE Vingmed Ultrasound, Horten, Norway) was applied at 1.6 MHz and 1-s intermittent frame trigger for 10 min with infusion of MB suspension with normal (1.8 µm), medium (3.1 µm) and large (5.3 µm) mean MB diameters. The bio-effect endpoint was the count of hepatocytes stained with Evans blue dye in frozen sections. For the normal MBs, the count increased for clinically relevant infusion dosages, but leveled off above 20 µL/kg/min. The evidence of injury declined with time from 30 min to 4 h and was lacking at 24 h. The exposure thresholds in terms of peak rarefactional pressure amplitude, divided by the square root of frequency (in situ mechanical index) were 1.7, 1.3 and 1.2 for the normal-, medium- and large-sized MB suspensions. The enhanced efficacy for larger MBs lends support to the two-criterion model for cavitational microvascular injury during CEDUS. Overall, CEDUS in liver appears to have markedly less potential for induction of tissue injury than has been reported in other tissues, which indicates a satisfactory safety profile for CEDUS using recommended parameters in normal liver.
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Affiliation(s)
- Douglas L Miller
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
| | - Xiaofang Lu
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Mario Fabiilli
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Chunyan Dou
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
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93
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Xu Y, Qi X, Zhao X, Ren W, Ding W. Clinical diagnostic value of contrast-enhanced ultrasound and TI-RADS classification for benign and malignant thyroid tumors: One comparative cohort study. Medicine (Baltimore) 2019; 98:e14051. [PMID: 30681562 PMCID: PMC6358332 DOI: 10.1097/md.0000000000014051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/21/2018] [Accepted: 12/14/2018] [Indexed: 02/06/2023] Open
Abstract
To evaluate the diagnostic efficacy and clinical value of contrast-enhanced ultrasonography (CEUS) plus TI-RADS classification in benign and malignant thyroid tumors compared with either method alone.The informed consent was signed all patients. A total of 370 patients with thyroid tumors of TI-RADS category 3 and 4 were recruited, with 432 thyroid nodules. They respectively received routine ultrasonography and CEUS. The nodules were reclassified according to CEUS scoring, and a combined diagnosis was made. The pathological results were taken as the gold standard. The sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and area under the ROC curve were calculated for the 3 diagnostic methods. The diagnostic efficacy was compared by using Student t test, Pearson chi-square (χ) test, McNemar chi-square (χ) test or Z test. Student t test and logistic regression were employed for comparing different imaging features of benign and malignant thyroid tumors on CEUS and risk analysis.Of 432 thyroid nodules, there were 258 malignant nodules (59.72%) and 174 benign ones (40.28%). By logistic regression, 6 suspicious features on CEUS were considered significant for differentiating malignant from benign tumors: slow entry of contrast agents during enhancement stage (OR = 15.610, P = .001), slow time to peak (OR = 7.416, P = .002), non-uniform enhancement (OR = 10.076, P = .023), enhancement pattern (irregular) (OR = 36.233, P = .002), enhancement boundary (unclear) (OR = 25.300, P = .012), and no ring-like enhancement (OR = 25.297, P = .004). CEUS plus TI-RADS classification showed a higher diagnostic efficacy for differentiating between benign and malignant thyroid tumors. The Se was 85.66% (0.806-0.896), Sp 83.33% (0.768-0.884), PPV 88.40% (0.836-0.919), NPV 79.67% (0.729-0.851), and AUC 0.867 ± 0.019 (0.815-0.889). The above indicators were of statistical significance as compared with TI-RADS classification or CEUS alone (P <.05).CEUS can more clearly visualize microvascular distribution of the nodules and offers a new approach to diagnose benign and malignant thyroid tumors. TI-RADS classification plus CEUS is more accurate than TI-RADS classification alone. This combined approach is worthy of clinical popularization.
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94
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Uncommon Finding of a Gastrointestinal Stromal Tumor in a Patient with Hyperechoic Liver Lesions - Case Report. ACTA MEDICA MARISIENSIS 2018. [DOI: 10.2478/amma-2018-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: Hyperechoic liver lesions identified by conventional ultrasonography are diverse in underlying pathology and most of the time require further investigations. Gastrointestinal stromal tumors (GIST) are rare neoplasms of the gastrointestinal tract which are uncommonly found in metastatic stages at first presentation.
Case report: We present the case of a 51 years old woman with nonspecific symptoms in which conventional ultrasonography showed hyperechoic lesions in the right lobe of the liver with a diameter up to 40 mm. Esophagogastroduodenoscopy revealed a submucosal tumor on the small curvature of the stomach, on the anterior wall, with central ulceration, with normal narrow band imaging (NBI) mucosal pattern and negative gastric biopsy. Contrast enhanced ultrasonography was performed, describing multiple lesions with inhomogeneous enhancement in the arterial phase and rapid washout at the end of arterial phase. Endoscopic ultrasound with fine needle aspiration (EUS-FNA) biopsy examination was definitive for the final diagnosis of epithelioid gastric gastrointestinal stromal tumor. The patient was diagnosed with T2N0M1 epithelioid gastric GIST, stage IV, and is currently under treatment with tyrosine kinase inhibitors.
Conclusions: GIST represent a diagnostic challenge in medical practice because of its size, unusual location in the submucosal layer and lack of symptoms. The role of EUS-FNA is of paramount importance in increasing the accuracy of diagnosis in the case of GIST. The particularity in our case consists of the unusual presentation with the lack of specific symptoms and signs associated with the presence of metastatic lesions at the moment of the diagnosis of GIST.
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95
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Outcome of liver lesions indeterminate for malignancy on ultrasound: the role of patient age, risk status, and lesion echogenicity. Abdom Radiol (NY) 2018; 43:2970-2979. [PMID: 29594466 DOI: 10.1007/s00261-018-1571-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the relationship between final outcome of lesions indeterminate for malignancy on ultrasound (US) and patient and imaging characteristics. METHODS We identified all patients with indeterminate liver lesions on US between 9/1/2013 and 12/31/2014 using institutional codes based on radiologist opinion. Miscoded lesions (n = 30) and patients with no imaging, pathology, or clinical follow-up at our health system (n = 6) were excluded. Final diagnostic category of malignant, benign, pseudolesion, or indeterminate was assigned using imaging, pathology, and clinical follow-up. Differences in diagnostic categories were compared by patient (age, gender, race, known malignancy. or liver disease) and imaging characteristics (lesion size, echogenicity. and number). Independent likelihood of a benign final diagnostic category was adjusted for significant variables on univariate analysis. RESULTS Indeterminate liver lesions on US were found in 153/6813 patients (2%). Final diagnostic categories were malignant (11/153, 7%), benign (94/153, 61%), pseudolesion (42/153, 27%). and indeterminate (6/153, 4%). Nearly one-third of hypoechoic masses in patients with known malignancy or liver disease (i.e., high-risk status) ≥ 46 years of age were malignant (9/28, 32%). On multivariate analysis, patients of age ≥ 61 years and high-risk status were associated with decreased likelihood of benign diagnostic category (OR .19 (95% CI .07-.51) and OR .40 (95% CI .18-.88), p values .001 and .022, respectively). CONCLUSIONS 2% of patients undergoing abdominal US have sonographically indeterminate liver lesions, of which 7% are malignant. Older, high-risk patients with hypoechoic lesions should receive short-term follow-up as one-third will have malignant lesions. Younger, low-risk patients should receive conservative follow-up, regardless of US imaging features.
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96
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Li X, Staub D, Rafailidis V, Al-Natour M, Kalva S, Partovi S. Contrast-enhanced ultrasound of the abdominal aorta - current status and future perspectives. VASA 2018; 48:115-125. [PMID: 30324867 DOI: 10.1024/0301-1526/a000749] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ultrasound has been established as an important diagnostic tool in assessing vascular abnormalities. Standard B-mode and Doppler techniques have inherent limitations with regards to detection of slow flow and small vasculature. Contrast-enhanced ultrasound (CEUS) is a complementary tool and is useful in assessing both the macro- and microvascular anatomy of the aorta. CEUS can also provide valuable physiological information in real-time scanning sessions due to the physical and safety profiles of the administered microbubbles. From a macrovascular perspective, CEUS has been used to characterize aortic aneurysm rupture, dissection and endoleaks post-EVAR repair. With regard to microvasculature CEUS enables imaging of adventitial vasa vasorum thereby assessing aortic inflammation processes, such as monitoring treatment response in chronic periaortitis. CEUS may have additional clinical utility since adventitial vasa vasorum has important implications in the pathogenesis of aortic diseases. In recent years, there have been an increasing number of studies comparing CEUS to cross-sectional imaging for aortic applications. For endoleak surveillance CEUS has been shown to be equal or in certain cases superior in comparison to CT angiography. The recent advancement of CEUS software along with the ongoing development of drug-eluting contrast microbubbles has allowed improved targeted detection and real-time ultrasound guided therapy for aortic vasa vasorum inflammation and neovascularization in animal models. Therefore, CEUS is uniquely suited to comprehensively assess and potentially treat aortic vascular diseases in the future.
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Affiliation(s)
- Xin Li
- 1 Department of Radiology, University Hospital Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Daniel Staub
- 2 Angiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Vasileios Rafailidis
- 3 AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mohammed Al-Natour
- 1 Department of Radiology, University Hospital Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sanjeeva Kalva
- 4 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sasan Partovi
- 5 Section of Interventional Radiology, Department of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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97
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Microvascular Invasion in HCC: The Molecular Imaging Perspective. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:9487938. [PMID: 30402046 PMCID: PMC6193341 DOI: 10.1155/2018/9487938] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/20/2018] [Indexed: 12/11/2022]
Abstract
Hepatocellular carcinoma represents the most frequent primary liver tumor; curative options are only surgical resection and liver transplantation. From 1996, Milan Criteria are applied in consideration of patients with cirrhosis and hepatocellular for liver transplantation; nonetheless, more recently, Milan Criteria have been criticized because they appear over conservative. Apart from number and size of lesions and biomarker levels, which already have been associated with poorer prognosis, overall survival and recurrence rates after transplantation are affected also by the presence of vascular invasion. Microvascular invasion suggests a poor prognosis but it is often hard to detect before transplant. Diagnostic imaging and tumor markers may play an important role and become the main tools to define microvascular invasion. In particular, a possible role could be found for computed tomography, magnetic resonance imaging, and positron emission tomography. In this paper, we analyze the possible role of positron emission tomography as a preoperative imaging biomarker capable of predicting microvascular invasion in patients with hepatocellular carcinoma and thus selecting optimal candidates for liver transplantation.
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98
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McNamara MM, Thomas JV, Alexander LF, Little MD, Bolus DN, Li YE, Morgan DE. Diffusion-weighted MRI as a screening tool for hepatocellular carcinoma in cirrhotic livers: correlation with explant data-a pilot study. Abdom Radiol (NY) 2018; 43:2686-2692. [PMID: 29500648 DOI: 10.1007/s00261-018-1535-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the sensitivity and specificity of diffusion-weighted liver MRI alone with complete, multiphasic gadoteridol-enhanced MRI for the detection of hepatocellular carcinoma in cirrhotic patients before liver transplant. MATERIALS AND METHODS This single institution retrospective study was performed after IRB approval and was HIPAA compliant. MRI scans of 37 patients who underwent liver transplant were evaluated and findings correlated with liver explant (36) or biopsy (1). All MRI scans were obtained within six months of explant. MRI from 17 patients with liver lesions by report at imaging subsequently proven to be HCC at pathology and 20 controls without liver lesions by imaging and pathology were reviewed in random order on the radiology PACS by three independent readers blinded to the MRI reports and pathology reports in two separate sittings. First, only the diffusion-weighted images (DWI) were interpreted. Second, the complete multiphasic MRI exam with DWI was reviewed. A consensus read was obtained by two separate radiologists who had access to the patients' explant data in order to map lesions. Reader-specific and pooled classification was assessed using sensitivity, specificity, positive predictive value, and negative predictive values and corresponding 95% confidence intervals (CI) for both DWI and complete MRI examination readings compared to pathology. McNemar's test and Kappa coefficient were used to assess differences (agreement) in DWI and complete examination readings. RESULTS A total of 37 patients have been studied (25M 12F age range 21-70). Averaged results of the three independent readers demonstrated a sensitivity of 78% (95% CI 65-89%) and specificity of 88% (95% CI 77-95%) for DWI alone for detection of liver lesions, with a positive predictive value of 85% (95% CI 72-94%) and a negative predictive value of 83% (95% CI 71-91%). Review of the complete MRI exam showed a sensitivity of 90% (95% CI 76-97%) and a specificity of 82% (95% CI 66-92%) with a positive predictive value of 83% (95% CI 69-93%) and a negative predictive value of 89% (95% CI 74-97%). McNemar's agreement test revealed no significant difference between the DWI and complete multiphasic interpretations (p = 0.3458), with simple Kappa coefficient of 0.6716 (95% CI 0.5332-0.8110). Lesions identified on DWI ranged in size from 1.5 to 5 cm. Detection of lesions was decreased in the presence of artifact from motion, large ascites, and technical issues. CONCLUSION Diffusion-weighted MRI has NPV and PPV comparable to complete multiphasic MRI examination for liver lesion detection in cirrhotic patients and may have a role in screening.
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Affiliation(s)
- M M McNamara
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - J V Thomas
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - L F Alexander
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - M D Little
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D N Bolus
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yufeng E Li
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D E Morgan
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Thimm MA, Rhee D, Takemoto CM, Karnsakul W, Cuffari C, Guerrerio AL, Garcia A, Gearhart J, Huisman TAGM, Hwang M. Diagnosis of congenital and acquired focal lesions in the neck, abdomen, and pelvis with contrast-enhanced ultrasound: a pictorial essay. Eur J Pediatr 2018; 177:1459-1470. [PMID: 29971555 DOI: 10.1007/s00431-018-3197-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 05/30/2018] [Accepted: 06/19/2018] [Indexed: 01/17/2023]
Abstract
UNLABELLED Contrast-enhanced ultrasound (CEUS) is a versatile imaging modality that improves the diagnostic potential of conventional ultrasound. It allows for portable imaging at the bedside. In this paper, we illustrate how CEUS can be used in evaluating several focal lesions in the pediatric population, including liver hemangioma, telangiectasias, splenic hamartomas, and bladder lesions. We describe the ultrasound findings and contrast enhancement patterns associated with these lesions. Findings are correlated with MRI, CT, and/or pathology when available. This paper demonstrates the value of CEUS in improving characterization of many focal lesions in the pediatric population. CONCLUSION CEUS is a valuable bedside technique for use in the pediatric population to evaluate focal lesions in various organs, and will allow for safe, more efficient diagnostic imaging. What is Known: • CEUS offers many advantages over CT and MRI and is underutilized in the United States. • It is only FDA approved for vesicoureteral reflux and liver in the pediatric population. However, off label uses are well described. What is New: • This pictorial essay describes ultrasound findings and contrast enhancement patterns associated with liver hemangioma, liver telangiectasia, splenic hamartoma, hemorrhagic ovarian cyst, urachal remnant, spinning top urethras, and kaposiform hemangioendothelioma. • We demonstrate the utility of CEUS in expanding the diagnostic potential of conventional ultrasound.
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Affiliation(s)
- Matthew A Thimm
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Rhee
- Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Clifford M Takemoto
- Division of Pediatric Hematology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Wikrom Karnsakul
- Division of Pediatric Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Carmen Cuffari
- Division of Pediatric Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Anthony L Guerrerio
- Division of Pediatric Gastroenterology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Alejandro Garcia
- Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - John Gearhart
- Division of Pediatric Urology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Thierry A G M Huisman
- Division of Pediatric Radiology and Pediatric Neuroradiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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Ashrafi AN, Nassiri N, Gill IS, Gulati M, Park D, de Castro Abreu AL. Contrast-Enhanced Transrectal Ultrasound in Focal Therapy for Prostate Cancer. Curr Urol Rep 2018; 19:87. [PMID: 30155585 PMCID: PMC9084632 DOI: 10.1007/s11934-018-0836-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Contrast-enhanced transrectal ultrasound (CeTRUS) is an emerging imaging technique in prostate cancer (PCa) diagnosis and treatment. We review the utility and implications of CeTRUS in PCa focal therapy (FT). RECENT FINDINGS CeTRUS utilizes intravenous injection of ultrasound-enhancing agents followed by high-resolution ultrasound to evaluate tissue microvasculature and differentiate between benign tissue and PCa, with the latter demonstrating increased enhancement. The potential utility of CeTRUS in FT for PCa extends to pre-, intra- and post-operative settings. CeTRUS may detect PCa, facilitate targeted biopsy and aid surgical planning prior to FT. During FT, the treated area can be visualized as a well-demarcated non-enhancing zone and continuous real-time assessment allows immediate re-treatment if necessary. Following FT, the changes on CeTRUS are immediate and consistent, thus facilitating repeat imaging for comparison during follow-up. Areas suspicious for recurrence may be detected and target-biopsied. Enhancement can be quantified using time-intensity curves allowing objective assessment and comparison. Based on encouraging early outcomes, CeTRUS may become an alternative imaging modality in prostate cancer FT. Further study with larger cohorts and longer follow-up are needed.
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Affiliation(s)
- Akbar N Ashrafi
- USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Nima Nassiri
- USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Inderbir S Gill
- USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Mittul Gulati
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Daniel Park
- USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA
| | - Andre L de Castro Abreu
- USC Institute of Urology, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90089, USA.
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