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Focal Lesions in Fatty Liver: If Quantitative Analysis Facilitates the Differentiation of Atypical Benign from Malignant Lesions. Sci Rep 2016; 6:18640. [PMID: 26725923 PMCID: PMC4698663 DOI: 10.1038/srep18640] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 11/23/2015] [Indexed: 12/27/2022] Open
Abstract
To evaluate the diagnostic performance of quantitative analysis as an adjunctive diagnostic tool to contrast-enhanced ultrasound (US) for the differentiation of atypical benign focal liver lesions (FLLs) from malignancies in fatty liver. Twenty-seven benign FLLs and fifty-six malignant FLLs that appeared hyper-enhanced during the arterial phase with washout in the portal or late phase in fatty liver were analyzed. Chi-square tests and logistic regression were applied to identify the specific features. Three sets of criteria were assigned: 1) all FLLs subjected to routine contrast-enhanced US; 2) all FLLs subjected to quantification analysis and contrast-enhanced US; and 3) parts of FLLs that could not be diagnosed using contrast-enhanced US (n = 66, 75.9%) but instead were diagnosed using parametric features. The sensitivity, specificity, accuracy and area under the receiver operating characteristic curve (AUC) of the three sets of criteria were analyzed. The AUCs of the criterion set 2 were significantly higher than those of criterion set 1 (0.904 versus 0.792, P = 0.008). Criterion set 3 showed a relatively high sensitivity (90.2%) with a relatively high AUC (0.845). The quantification analysis offers improved diagnostic performance for the differential identification of atypical benign FLLs from malignancies in fatty liver.
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Onoue K, Miyamoto Y, Nishioka M, Nakata N, Sekiya T, Fukuda K. A case of focal nodular hyperplasia with a new characteristic finding on contrast-enhanced ultrasonography using Levovist. J Med Ultrason (2001) 2013; 40:47-50. [PMID: 27276924 DOI: 10.1007/s10396-012-0377-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 04/15/2012] [Indexed: 10/28/2022]
Abstract
We used contrast-enhanced ultrasound with Levovist, a microbubble contrast agent, to diagnose a case of hepatic focal nodular hyperplasia (FNH). A new characteristic finding of heartbeat-synchronized centrifugal enhancement was discovered. We call this enhancement pattern the "sonographic fireworks sign." It is expected to be useful for diagnosing FNH, especially when the lesions are small and it is difficult to depict a spoke-wheel pattern.
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Affiliation(s)
- Kaoru Onoue
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Yukio Miyamoto
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Makiko Nishioka
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Norio Nakata
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Toru Sekiya
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kunihiko Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Goertz RS, Bernatik T, Strobel D, Hahn EG, Haendl T. Software-based quantification of contrast-enhanced ultrasound in focal liver lesions—A feasibility study. Eur J Radiol 2010; 75:e22-6. [DOI: 10.1016/j.ejrad.2009.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 10/31/2009] [Accepted: 11/04/2009] [Indexed: 02/07/2023]
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Sugimoto K, Shiraishi J, Moriyasu F, Doi K. Computer-aided diagnosis for contrast-enhanced ultrasound in the liver. World J Radiol 2010; 2:215-23. [PMID: 21160633 PMCID: PMC2998841 DOI: 10.4329/wjr.v2.i6.215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 05/06/2010] [Accepted: 05/13/2010] [Indexed: 02/06/2023] Open
Abstract
Computer-aided diagnosis (CAD) has become one of the major research subjects in medical imaging and diagnostic radiology. The basic concept of CAD is to provide computer output as a second opinion to assist radiologists’ image interpretations by improving the accuracy and consistency of radiologic diagnosis and also by reducing the image-reading time. To date, research on CAD in ultrasound (US)-based diagnosis has been carried out mostly for breast lesions and has been limited in the fields of gastroenterology and hepatology, with most studies being conducted using B-mode US images. Two CAD schemes with contrast-enhanced US (CEUS) that are used in classifying focal liver lesions (FLLs) as liver metastasis, hemangioma, or three histologically differentiated types of hepatocellular carcinoma (HCC) are introduced in this article: one is based on physicians’ subjective pattern classifications (subjective analysis) and the other is a computerized scheme for classification of FLLs (quantitative analysis). Classification accuracies for FLLs for each CAD scheme were 84.8% and 88.5% for metastasis, 93.3% and 93.8% for hemangioma, and 98.6% and 86.9% for all HCCs, respectively. In addition, the classification accuracies for histologic differentiation of HCCs were 65.2% and 79.2% for well-differentiated HCCs, 41.7% and 50.0% for moderately differentiated HCCs, and 80.0% and 77.8% for poorly differentiated HCCs, respectively. There are a number of issues concerning the clinical application of CAD for CEUS, however, it is likely that CAD for CEUS of the liver will make great progress in the future.
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Watanabe M, Shiozawa K, Takahashi M, Wakui N, Otsuka Y, Kaneko H, Tanikawa K, Shibuya K, Kamiyama N, Sumino Y. Parametric imaging using contrast-enhanced ultrasound with Sonazoid for hepatocellular carcinoma. J Med Ultrason (2001) 2010; 37:81-6. [PMID: 27277718 DOI: 10.1007/s10396-009-0254-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 11/08/2009] [Indexed: 01/11/2023]
Abstract
PURPOSE To clarify the usefulness of parametric imaging using contrast-enhanced ultrasound (CE-US) with Sonazoid by comparing parametric images of hepatocellular carcinoma (HCC) with histopathological findings. METHODS Two patients with HCCs underwent CE-US with Sonazoid before surgical resection. A single focus point was set at the lower margin of the tumor, and a bolus intravenous injection of Sonazoid (0.5 ml) was administered. Images of the ideal scanning plane were displayed in real-time mode for the early vascular phase. We analyzed these images using prototype PC software. The software watches, pixel by pixel, the increase in the intensity due to the inflow of the microbubbles, and displays colors if the intensity becomes larger than a certain threshold. Parametric images were compared with histopathological findings. RESULTS The level of blood flow in the tumor could be visually evaluated using a single image by expressing the detailed hemodynamics of the tumor in terms of differences in color using a time axis appropriate for each case. CONCLUSIONS Parametric imaging is a very useful way of facilitating straightforward visualization of the level of blood flow within HCC and the distribution of histopathological findings in single static images.
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Affiliation(s)
- Manabu Watanabe
- Department of Gastroenterology and Hepatology, Toho University Medical Center, Omori Hospital, 6-11-1, Omorinishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Kazue Shiozawa
- Department of Gastroenterology and Hepatology, Toho University Medical Center, Omori Hospital, 6-11-1, Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Masayoshi Takahashi
- Department of Gastroenterology and Hepatology, Toho University Medical Center, Omori Hospital, 6-11-1, Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Noritaka Wakui
- Department of Gastroenterology and Hepatology, Toho University Medical Center, Omori Hospital, 6-11-1, Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Yuichiro Otsuka
- Department of Hepato-Biliary-Pancreatic Surgery, Toho University Medical Center, Omori Hospital, 6-11-1, Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Hironori Kaneko
- Department of Hepato-Biliary-Pancreatic Surgery, Toho University Medical Center, Omori Hospital, 6-11-1, Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Kayoko Tanikawa
- Department of Surgical Pathology, Toho University Medical Center, Omori Hospital, 6-11-1, Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Kazutoshi Shibuya
- Department of Surgical Pathology, Toho University Medical Center, Omori Hospital, 6-11-1, Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Naohisa Kamiyama
- The Ultrasound Systems Development Department, Toshiba Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Yasukiyo Sumino
- Department of Gastroenterology and Hepatology, Toho University Medical Center, Omori Hospital, 6-11-1, Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
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Testa AC, Timmerman D, Van Belle V, Fruscella E, Van Holsbeke C, Savelli L, Ferrazzi E, Leone FPG, Marret H, Tranquart F, Exacoustos C, Nazzaro G, Bokor D, Magri F, Van Huffel S, Ferrandina G, Valentin L. Intravenous contrast ultrasound examination using contrast-tuned imaging (CnTI) and the contrast medium SonoVue for discrimination between benign and malignant adnexal masses with solid components. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:699-710. [PMID: 19924735 DOI: 10.1002/uog.7464] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To determine whether intravenous contrast ultrasound examination is superior to gray-scale or power Doppler ultrasound for discrimination between benign and malignant adnexal masses with complex ultrasound morphology. METHODS In an international multicenter study, 134 patients with an ovarian mass with solid components or a multilocular cyst with more than 10 cyst locules, underwent a standardized transvaginal ultrasound examination followed by contrast examination using the contrast-tuned imaging technique and intravenous injection of the contrast medium SonoVue(R). Time intensity curves were constructed, and peak intensity, area under the intensity curve, time to peak, sharpness and half wash-out time were calculated. The sensitivity and specificity with regard to malignancy were calculated and receiver-operating characteristics (ROC) curves were drawn for gray-scale, power Doppler and contrast variables and for pattern recognition (subjective assignment of a certainly benign, probably benign, uncertain or malignant diagnosis, using gray-scale and power Doppler ultrasound findings). The gold standard was the histological diagnosis of the surgically removed tumors. RESULTS After exclusions (surgical removal of the mass > 3 months after the ultrasound examination, technical problems), 72 adnexal masses with solid components were used in our statistical analyses. The values for peak contrast signal intensity and area under the contrast signal intensity curve in malignant tumors were significantly higher than those in borderline tumors and benign tumors, while those for the benign and borderline tumors were similar. The area under the ROC curve of the best contrast variable with regard to diagnosing borderline or invasive malignancy (0.84) was larger than that of the best gray-scale (0.75) and power Doppler ultrasound variable (0.79) but smaller than that of pattern recognition (0.93). CONCLUSION Findings on ultrasound contrast examination differed between benign and malignant tumors but there was a substantial overlap in contrast findings between benign and borderline tumors. It appears that ultrasound contrast examination is not superior to conventional ultrasound techniques, which also have difficulty in distinguishing between benign and borderline tumors, but can easily differentiate invasive malignancies from other tumors.
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Affiliation(s)
- A C Testa
- Department of Obstetrics and Gynecology, Catholic University of Rome, Italy.
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Girszyn N, Héron F, Lahaxe L, Lévesque H, Marie I. [An isolated hepatic lesion]. Rev Med Interne 2007; 28:637-9. [PMID: 17321009 DOI: 10.1016/j.revmed.2007.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 01/23/2007] [Indexed: 11/21/2022]
Affiliation(s)
- N Girszyn
- Département de médecine interne, CHU de Rouen-Boisguillaume, 1, rue de Germont, 76031 Rouen cedex, France
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