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Fergadi MP, Magouliotis DE, Vlychou M, Rountas C, Athanasiou T, Zacharoulis D. A meta-analysis evaluating contrast-enhanced intraoperative ultrasound (CE-IOUS) in the context of surgery for colorectal liver metastases. Abdom Radiol (NY) 2021; 46:4178-4188. [PMID: 33969446 DOI: 10.1007/s00261-021-03096-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/09/2021] [Accepted: 04/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aimed to assess the outcomes of contrast-enhanced intraoperative ultrasound (CE-IOUS) for patients with colorectal liver metastases (CRLMs) undergoing surgery. METHOD A thorough literature search was performed in PubMed, Scopus, and Cochrane databases, in accordance with the PRISMA guidelines. The Odds Ratio, Weighted Mean Difference, and 95% Confidence Interval were evaluated, by means of Random-Effects model. RESULTS Eleven articles met the inclusion criteria and incorporated 497 patients. The present study shows that CE-IOUS is associated with higher sensitivity and accuracy compared with multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), and intraoperative ultrasound (IOUS) in identifying CRLMs (p < 0.05). The positive predictive value was similar among the different modalities. Furthermore, new CRLMs were identified by CE-IOUS, thus affecting the surgical plan in 128 patients (51.8% of the patients with new CRLMs). Moreover, 91 patients (71%) underwent a more extensive hepatectomy and 15 patients (11.7%) were considered non-operable. Two alternative contrast agents, Sonazoid and Sonovue, were employed with similar sensitivity (p > 0.05). CONCLUSION These outcomes suggest the superiority of the CE-IOUS over MDCT, MRI, and IOUS for the staging of patients with CRLMs undergoing surgery. However, they should be treated with caution given the small number of the included studies.
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Affiliation(s)
- Maria P Fergadi
- Department of Radiology, University of Thessaly, Biopolis, 41110, Larissa, Greece
| | - Dimitrios E Magouliotis
- Division of Surgery and Interventional Science, Faculty of Medical Sciences, UCL, London, UK
- Department of Surgery, University of Thessaly, Biopolis, 41110, Larissa, Greece
| | - Marianna Vlychou
- Department of Radiology, University of Thessaly, Biopolis, Larissa, Greece
| | - Christos Rountas
- Department of Radiology, University of Thessaly, Biopolis, Larissa, Greece
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, W2 1NY, UK
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Liu W, Zhang ZY, Yin SS, Yan K, Xing BC. Contrast-Enhanced Intraoperative Ultrasound Improved Sensitivity and Positive Predictive Value in Colorectal Liver Metastasis: a Systematic Review and Meta-Analysis. Ann Surg Oncol 2020; 28:3763-3773. [PMID: 33247361 DOI: 10.1245/s10434-020-09365-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The diagnostic accuracy of imaging modalities in colorectal cancer liver metastases (CRLM) has improved in recent years, therefore the role of current imaging techniques needs to be defined. OBJECTIVE The aim of this study was to assess the diagnostic performance of magnetic resonance imaging, preoperative imaging (magnetic resonance imaging or computed tomography), intraoperative ultrasound, and contrast-enhanced intraoperative ultrasound in the detection of CRLM. MATERIALS AND METHODS Eligible trials published before 30 March 2020 were identified from the EMBASE, PubMed, Web of Science, and Cochrane Library databases, and descriptive and quantitative data were extracted. Study quality was evaluated for the identified studies and a random-effects model was used to determine the integrated diagnosis estimation. Meta-regression was implemented to explore the possible contributors to heterogeneity. RESULTS Overall, 13 studies were included for analysis, comprising 682 patients with a total of 2303 liver lesions. The pooled sensitivity, specificity, and diagnostic odds ratio of contrast-enhanced intraoperative ultrasound were 0.94 (95% confidence interval [CI] 0.89-0.97), 0.83 (95% CI 0.67-0.92), and 79 (95% CI 32-196), respectively. The overall weighted area under the curve was 0.96 (95% CI 0.94-0.97). In univariate meta-regression analysis, disappearing liver metastasis, contrast agent, and Kupffer phase were the potent sources of heterogeneity; however, in multivariate meta-regression, no definite variable was the source of the study heterogeneity. CONCLUSION Contrast-enhanced intraoperative ultrasound demonstrated a high sensitivity and specificity for screening CRLM.
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Affiliation(s)
- Wei Liu
- Key Laboratory of Carcinogenesis and Translational Research, Hepatopancreatobiliary Surgery Department I, School of Oncology, Beijing Cancer Hospital and Institute, Peking University, Ministry of Education, Beijing, People's Republic of China
| | - Zhong-Yi Zhang
- Key Laboratory of Carcinogenesis and Translational Research, Department of Ultrasonography, School of Oncology, Beijing Cancer Hospital and Institute, Peking University, Ministry of Education, Beijing, People's Republic of China
| | - Shan-Shan Yin
- Key Laboratory of Carcinogenesis and Translational Research, Department of Ultrasonography, School of Oncology, Beijing Cancer Hospital and Institute, Peking University, Ministry of Education, Beijing, People's Republic of China
| | - Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research, Department of Ultrasonography, School of Oncology, Beijing Cancer Hospital and Institute, Peking University, Ministry of Education, Beijing, People's Republic of China.
| | - Bao-Cai Xing
- Key Laboratory of Carcinogenesis and Translational Research, Hepatopancreatobiliary Surgery Department I, School of Oncology, Beijing Cancer Hospital and Institute, Peking University, Ministry of Education, Beijing, People's Republic of China.
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Patil PG, Reddy P, Rawat S, Ananthasivan R, Sinha R. Multimodality Approach in Detection and Characterization of Hepatic Metastases. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2020. [DOI: 10.1055/s-0039-3402100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
AbstractEarly detection of liver metastases is important in patients with known primary malignancies. This plays an important role in treatment planning and impacts on further management of certain primary malignancies.Magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography-computed tomography scans are reported to have high accuracy in the diagnosis of intrahepatic lesions. MRI in particular has the advantages of its high tissue sensitivity and its multiparametric approach.Hepatic metastatic lesions have considerable overlap in their radiological appearance, and in this article the imaging appearance of various hepatic metastasis and approach is described.
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Affiliation(s)
- Pooja G. Patil
- Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
| | - Pramesh Reddy
- Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
| | - Sudarshan Rawat
- Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
| | - Rupa Ananthasivan
- Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
| | - Rakesh Sinha
- Department of Radiology, South Warwickshire NHS Foundation Trust, Warwick, United Kingdom
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Mao Y, Chen B, Wang H, Zhang Y, Yi X, Liao W, Zhao L. Diagnostic performance of magnetic resonance imaging for colorectal liver metastasis: A systematic review and meta-analysis. Sci Rep 2020; 10:1969. [PMID: 32029809 PMCID: PMC7005325 DOI: 10.1038/s41598-020-58855-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 01/21/2020] [Indexed: 12/12/2022] Open
Abstract
The prognosis of colorectal cancer (CRC) is largely dependent on the early detection of hepatic metastases. With the advantages of nonradioactivity and the availability of multiple scanning sequences, the efficacy of magnetic resonance imaging (MRI) in the detection of colorectal liver metastases (CRLM) is not yet clear. We performed this meta-analysis to address this issue. PubMed, Embase, and the Cochrane Library were searched for studies reporting diagnostic performance of MRI for CRLM. Descriptive and quantitative data were extracted. The study quality was evaluated for the identified studies and a random effects model was used to determine the integrated diagnosis estimation. Meta-regression and subgroup analyses were implemented to investigate the potential contributors to heterogeneity. As a result, seventeen studies were included for analysis (from the year 1996 to 2018), comprising 1121 patients with a total of 3279 liver lesions. The pooled sensitivity, specificity, and diagnostic odds ratio were 0.90 (95% confidence intervals (CI): 0.81-0.95), 0.88 (0.80-0.92), and 62.19 (23.71-163.13), respectively. The overall weighted area under the curve was 0.94 (0.92-0.96). Using two or more imaging planes and a quantitative/semiquantitative interpretation method showed higher diagnostic performance, although only the latter demonstrated statistical significance (P < 0.05). Advanced scanning sequences with DWI and liver-specific contrast media tended to increase the sensitivity for CRLM detection. We therefore concluded that contemporary MRI has high sensitivity and specificity for screening CRLM, especially for those with advanced scanning sequences. Using two or more imaging planes and adopting a quantitative/semiquantitative imaging interpretation may further improve diagnosis. However, the MRI results should be interpreted with caution because of substantial heterogeneity among studies.
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Affiliation(s)
- Yitao Mao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Bin Chen
- Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Haofan Wang
- Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510630, China
| | - Youming Zhang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Xiaoping Yi
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
| | - Luqing Zhao
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
- Department of Pathology, School of Basic Medical Science, Xiangya School of Medicine, Central South University, Changsha, Hunan, 410013, China.
- Department of Pathology and State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China.
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Engstrand J, Strömberg C, Nilsson H, Freedman J, Jonas E. Synchronous and metachronous liver metastases in patients with colorectal cancer-towards a clinically relevant definition. World J Surg Oncol 2019; 17:228. [PMID: 31878952 PMCID: PMC6933908 DOI: 10.1186/s12957-019-1771-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/16/2019] [Indexed: 12/17/2022] Open
Abstract
Background Approximately 25% of patients with colorectal cancer (CRC) will have liver metastases classified as synchronous or metachronous. There is no consensus on the defining time point for synchronous/metachronous, and the prognostic implications thereof remain unclear. The aim of the study was to assess the prognostic value of differential detection at various defining time points in a population-based patient cohort and conduct a literature review of the topic. Methods All patients diagnosed with CRC in the counties of Stockholm and Gotland, Sweden, during 2008 were included in the study and followed for 5 years or until death to identify patients diagnosed with liver metastases. Patients with liver metastases were followed from time of diagnosis of liver metastases for at least 5 years or until death. Different time points defining synchronous/metachronous detection, as reported in the literature and identified in a literature search of databases (PubMed, Embase, Cochrane library), were applied to the cohort, and overall survival was calculated using Kaplan-Meier curves and compared with log-rank test. The influence of synchronously or metachronously detected liver metastases on disease-free and overall survival as reported in articles forthcoming from the literature search was also assessed. Results Liver metastases were diagnosed in 272/1026 patients with CRC (26.5%). No statistically significant difference in overall survival for synchronous vs. metachronous detection at any of the defining time points (CRC diagnosis/surgery and 3, 6 and 12 months post-diagnosis/surgery) was demonstrated for operated or non-operated patients. In the literature search, 41 publications met the inclusion criteria. No clear pattern emerged regarding the prognostic significance of synchronous vs. metachronous detection. Conclusion Synchronous vs. metachronous detection of CRC liver metastases lacks prognostic value. Using primary tumour diagnosis/operation as standardized cut-off point to define synchronous/metachronous detection is semantically correct. In synchronous detection, it defines a clinically relevant group of patients where individualized multimodality treatment protocols will apply.
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Affiliation(s)
- Jennie Engstrand
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, 182 88, Stockholm, Sweden.
| | - Cecilia Strömberg
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Nilsson
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, 182 88, Stockholm, Sweden
| | - Jacob Freedman
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, 182 88, Stockholm, Sweden
| | - Eduard Jonas
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Surgical Gastroenterology Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town Health Sciences Faculty, Cape Town, South Africa
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Zhang L, Zhang L, Wang H, Chen L, Sui G. Diagnostic performance of contrast-enhanced ultrasound and magnetic resonance imaging for detecting colorectal liver metastases: A systematic review and meta-analysis. Dig Liver Dis 2019; 51:1241-1248. [PMID: 31262616 DOI: 10.1016/j.dld.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine the diagnostic performance of contrast-enhanced ultrasound, diffusion-weighted magnetic resonance imaging and contrast-enhanced magnetic resonance imaging for detecting colorectal liver metastases. METHODS We performed comprehensive searches of the MEDLINE, EMBASE, and Cochrane Library databases to identify studies reporting the per-lesion diagnostic accuracy of contrast-enhanced ultrasound, diffusion-weighted magnetic resonance imaging, and contrast-enhanced magnetic resonance imaging for detecting colorectal liver metastases. Studies published between January 2003 and December 2018 with reference standards, including histopathology and intraoperative observation, and/or follow-up, were included. Sources of bias were assessed using the QUADAS-2 tool. A linear mixed-effects regression model was used to determine sensitivity estimates. RESULTS Overall, 47 articles were included. The sensitivity estimates for contrast-enhanced ultrasound, diffusion-weighted magnetic resonance imaging, and contrast-enhanced magnetic resonance imaging for detecting colorectal liver metastases were 85.3%, 83.0%, and 90.1%, respectively. For lesions ≥10 mm in diameter, the sensitivities were 93.1%, 92.9%, and 94.5%, respectively. In 21 articles using histopathology as the only reference standard, the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for contrast-enhanced ultrasound/contrast-enhanced magnetic resonance imaging were 86%/91%, 91%/95%, 9.2/16.6, 0.15/0.10, and 61/170, respectively. CONCLUSIONS CEUS showed a diagnostic ability comparable to that of DWI and CEMRI, particularly for lesions ≥10 mm in diameter.
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Affiliation(s)
- Luni Zhang
- Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Li Zhang
- Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hui Wang
- Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Libo Chen
- Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun, China.
| | - Guoqing Sui
- Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun, China.
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Ludwig DR, Mintz AJ, Sanders VR, Fowler KJ. Liver Imaging for Colorectal Cancer Metastases. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kobayashi K, Maruyama H, Kiyono S, Yokosuka O, Ohtsuka M, Miyazaki M, Matsushima J, Kishimoto T, Nakatani Y. Histology-Based Assessment of Sonazoid-Enhanced Ultrasonography for the Diagnosis of Liver Metastasis. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2151-2158. [PMID: 28755791 DOI: 10.1016/j.ultrasmedbio.2017.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 06/10/2017] [Accepted: 06/15/2017] [Indexed: 06/07/2023]
Abstract
This retrospective study aimed to assess the diagnostic performance of contrast-enhanced ultrasound with Sonazoid (S-CEUS) for liver metastasis. We enrolled in this study 98 patients with 148 histologically proven liver lesions, with 121 metastases and 27 non-metastases. The S-CEUS technique showed sensitivity in 95.0% (115 of 121), specificity in 44.4% (12 of 27) and accuracy in 85.8% (127 of 148) for the diagnosis of metastasis. Higher body mass index had a negative influence on the positive predictive value and accuracy, and a greater depth of the lesion had a negative influence on the accuracy. The management was changed in 8 patients (8.2%) because of S-CEUS findings. In conclusion, the addition of S-CEUS may offer a great benefit by improvement of the quality of diagnosis and management for patients with cancer who have a tentative diagnosis of liver metastasis by contrast-enhanced computed tomography.
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Affiliation(s)
- Kazufumi Kobayashi
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan
| | - Hitoshi Maruyama
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan.
| | - Soichiro Kiyono
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan
| | - Osamu Yokosuka
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan
| | - Masaru Miyazaki
- Department of General Surgery, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan
| | - Jun Matsushima
- Department of Diagnostic Pathology, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan
| | - Takashi Kishimoto
- Department of Molecular Pathology, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan
| | - Yukio Nakatani
- Department of Diagnostic Pathology, Chiba University Graduate School of Medicine, Chuo-ku, Chiba, Japan
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Routine Preoperative Liver-specific Magnetic Resonance Imaging Does Not Exclude the Necessity of Contrast-enhanced Intraoperative Ultrasound in Hepatic Resection for Colorectal Liver Metastasis. Ann Surg 2016; 262:1086-91. [PMID: 26010441 DOI: 10.1097/sla.0000000000001085] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To assess the usefulness of contrast-enhanced intraoperative ultrasound (CE-IOUS) during surgery for colorectal liver metastases (CRLM) when gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) is performed as a part of preoperative imaging work-up. BACKGROUND EOB-MRI is expected to supersede CE-IOUS, which is reportedly indispensable in surgery for CRLM. METHODS One hundred consecutive patients underwent EOB-MRI, contrast-enhanced computed tomography (CE-CT), and contrast-enhanced ultrasound within 1 month before surgery for CRLM. Conventional IOUS and subsequent CE-IOUS using perflubutane were performed after the laparotomy. All the nodules identified in any of the preoperative or intraoperative examinations were resected and were submitted for histological examination, in principle. RESULTS Preoperative imaging examinations identified 242 nodules; 25 additional nodules were newly identified using IOUS, 22 additional nodules were newly identified during CE-IOUS, and a histological examination further identified 4 nodules. Among the 25 nodules newly identified using IOUS, all 21 histologically proven CRLMs and 3 of the 4 benign nodules were correctly diagnosed using CE-IOUS. Among the 22 nodules newly identified using CE-IOUS, 17 nodules in 16 patients were histologically diagnosed as CRLMs. The planned surgical procedure was modified on the basis of IOUS and CE-IOUS findings in 12 and 14 patients, respectively. The sensitivity, positive-predictive value, and accuracy of CE-IOUS were 99%, 98%, and 97%, respectively. Those values of EOB-MRI (82%, 99%, 83%, respectively) were similar to CE-CT (81%, 99%, 81%, respectively). CONCLUSIONS CE-IOUS is useful in hepatic resection for CRLM, even if EOB-MRI and CE-CT are performed.
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Joo I. The role of intraoperative ultrasonography in the diagnosis and management of focal hepatic lesions. Ultrasonography 2015; 34:246-57. [PMID: 25971896 PMCID: PMC4603208 DOI: 10.14366/usg.15014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 04/06/2015] [Accepted: 04/06/2015] [Indexed: 12/12/2022] Open
Abstract
Intraoperative ultrasonography (IOUS) has been widely utilized in hepatic surgery both as a diagnostic technique and in the course of treatment. Since IOUS involves direct-contact imaging of the target organ, it can provide high spatial resolution without interference from the surrounding structures. Therefore, IOUS may improve the detection, characterization, localization, and local staging of hepatic tumors. IOUS is also a real-time imaging modality capable of providing interactive information and valuable guidance in a range of procedures. Recently, contrast-enhanced IOUS, IOUS elastography, and IOUS-guided hepatic surgery have attracted increasing interest and are expected to lead to the broader implementation of IOUS. Herein, we review the various applications of IOUS in the diagnosis and management of focal hepatic lesions.
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Affiliation(s)
- Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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