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Shivgulam ME, Liu H, Kivell MJ, MacLeod JR, O'Brien MW. Effectiveness of contrast-enhanced duplex ultrasound for detecting renal artery stenosis: A systematic review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:763-772. [PMID: 38660883 DOI: 10.1002/jcu.23684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/26/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Contrast-enhanced duplex ultrasound (CEUS) might be a useful tool to diagnosing renal artery stenosis (RAS). We amalgamated and reviewed the evidence assessing the diagnostic accuracy of CEUS on detecting RAS compared to angiography. METHODS This preregistered systematic review included studies that compared the presence of RAS via CEUS with angiography. Sources were searched in November 2022 and included Scopus, EMBASE, MEDLINE, CINAHL, and Academic Search Premier (n = 1717). The Quality Assessment of Diagnostic Studies 2 tool assessed study quality. Results are presented narratively. RESULTS The studies included (n = 11) had a total of 447 unique participants (193 females) and average age of 56 ± 9 years. Five of eleven studies investigated CEUS using SonoVue contrast agent and reported an average accuracy (91% ± 2%), sensitivity (91% ± 3%), specificity (90% ± 5%), negative predictive value (86% ± 6%), and positive predictive value (94% ± 1%) with all values >80%. The accuracy of CEUS using other types of contrast agent (n = 6), including Levovsit (n = 3/6), Definity (n = 1/6), perfienapent emulsion (n = 1/6), and perfluorocarbon-exposed sonicated dextrose albumin (n = 1/6) was mixed. These studies detected an average accuracy of 91 ± 11% (n = 2/3% > 80%), sensitivity of 98% ± 4%, (n = 3/3% > 80%), and specificity of 86% ± 10% (n = 2/3% > 80%). Included studies had generally low risk of bias and applicability concerns except for unclear flow and timing (n = 7/11) and applicability of patient selection (n = 4/11). CONCLUSION Despite being limited by the heterogeneity of included studies, our review indicates a high overall diagnostic accuracy for CEUS to detect RAS compared to angiography, with the largest evidence-base for SonoVue contrast. Radiologists and hospital decision makers should consider CEUS as an acceptable alternative to angiography.
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Affiliation(s)
| | - Haoxuan Liu
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew J Kivell
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jessica R MacLeod
- Diagnostic Medical Ultrasound, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Myles W O'Brien
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Centre de Formation Médicale Du Nouveau-Brunswick, Université de Sherbrooke, Moncton, New Brunswick, Canada
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2
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Qin Z, Zhou Y, Zhang X, Ding J, Zhou H, Wang Y, Zhao L, Chen C, Jing X. The comparison of contrast-enhanced ultrasound and gadoxetate disodium-enhanced MRI LI-RADS for nodules ≤2 cm in patients at high risk for HCC: a prospective study. Front Oncol 2024; 14:1345981. [PMID: 38774417 PMCID: PMC11106436 DOI: 10.3389/fonc.2024.1345981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/12/2024] [Indexed: 05/24/2024] Open
Abstract
Objectives To investigate the consistency of LI-RADS of CEUS and EOB-MRI in the categorization of liver nodules ≤2cm in patients at high risk for HCC. Methods Patients at high risk for HCC with nodules ≤2cm who underwent CEUS and EOB-MRI in our hospital were prospectively enrolled. The CEUS images and EOB-MRI imaging of each liver nodule were observed to evaluate inter-observer consistency and category according to CEUS LI-RADS V2017 and CT/MRI LI-RADS V2017 criteria double blinded. Pathology and/or follow-up were used as reference standard. Results A total of 127 nodules in 119 patients met the inclusion criteria. The inter-observer agreement was good on CEUS and EOB-MRI LI-RADS (kappa = 0.76, 0.76 p < 0.001). The inter-modality agreement was fair (kappa=0.21, p < 0.001). There was no statistical difference in PPV and specificity between CEUS and EOB-MRI LR-5 for HCC, while the difference in AUC was statistically significant. We used new criteria (CEUS LR-5 and EOB-MRI LR-4/5 or CEUS LR-4/5 and EOB-MRI LR-5) to diagnose HCC. The sensitivity, specificity, and AUC of this criteria was 63.4%, 95.6%, and 0.80. Conclusions CEUS and EOB-MRI showed fair inter-modality agreement in LI-RADS categorization of nodules ≤2 cm. The inter-observer agreement of CEUS and EOB-MRI LI-RADS were substantial. CEUS and EOB-MRI LR-5 have equally good positive predictive value and specificity for HCC ≤ 2cm, and combining these two modalities may better diagnose HCC ≤ 2 cm. Clinical Trial Registration https://clinicaltrials.gov/, identifier NCT04212286.
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Affiliation(s)
- Zhengyi Qin
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, China
| | - Yan Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
| | - Xiang Zhang
- Department of Radiology, Tianjin Nankai Hospital, Tianjin, China
| | - Jianmin Ding
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, China
| | - Hongyu Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, China
| | - Yandong Wang
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, China
| | - Lin Zhao
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, China
| | - Chen Chen
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, China
- Department of Radiology, Tianjin Third Central Hospital, Tianjin, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, China
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Russell G, Strnad BS, Ludwig DR, Middleton WD, Itani M, Khot R, Mellnick V, Malone C. Contrast-Enhanced Ultrasound for Image-Guided Procedures. Tech Vasc Interv Radiol 2023; 26:100913. [PMID: 38071027 DOI: 10.1016/j.tvir.2023.100913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) uses intravenously injected gas microbubbles as a pure blood pool contrast agent to demonstrate blood flow and tissue perfusion at a much higher sensitivity than color Doppler and power Doppler ultrasound. CEUS has gained traction in abdominal diagnostic imaging for improved lesion detection and characterization and a complementary problem-solving tool to CT and MRI. In addition to its diagnostic applications, CEUS has also proven useful for pre-procedure planning, procedure guidance, and post-procedure evaluation. This review provides a practical overview and guides to the application of CEUS in percutaneous, ultrasound-guided, needle-driven procedures, focusing on 2 common procedures, which illustrate the many benefits of CEUS- core needle biopsy (CNB) and percutaneous hepatic lesion ablation.
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Affiliation(s)
- Gentry Russell
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital/Washington University School of Medicine, St Louis, MO
| | - Benjamin S Strnad
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital/Washington University School of Medicine, St Louis, MO
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital/Washington University School of Medicine, St Louis, MO
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital/Washington University School of Medicine, St Louis, MO
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital/Washington University School of Medicine, St Louis, MO
| | - Rachita Khot
- Department of Radiology, University of Virginia Medical Center/University of Virginia School of Medicine, Charlottesville, VA
| | - Vincent Mellnick
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital/Washington University School of Medicine, St Louis, MO
| | - Christopher Malone
- Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital/Washington University School of Medicine, St Louis, MO.
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Wu Q, Liu Y, Sun D, Wang Y, Wei X, Li J, Liu B, Wang S, Zhou Y, Hu H, Zhang R, Jiao Q, Li Y, Ying T. Protocol of Kupffer phase whole liver scan for metastases: A single-center prospective study. Front Med (Lausanne) 2022; 9:911807. [PMID: 36017002 PMCID: PMC9396128 DOI: 10.3389/fmed.2022.911807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/28/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction As the presence of hepatic metastases is very important to cancer patients' clinical stage which would directly affect the selection and application of anti-cancer treatments. Although conventional ultrasound is commonly performed as a screening tool, most of the examinations have relatively poor sensitivity and specificity for detecting liver metastases. Contrast-enhanced ultrasound (CEUS) with Sonazoid has been reported to have the advantage of the diagnosis and therapeutic support of focal hepatic lesions and its specific Kupffer phase whole liver scan (KPWLS) is believed to be sensitive to detect liver metastases. And the purpose of this study is to determine the number, size, location and diagnosis of metastatic lesions, and to compare the results with conventional ultrasound and contrast-enhanced computed tomography (CECT), thus to clarify the application value, indications of Sonazoid-CEUS in screening liver metastasis. Methods and analysis Kupffer phase whole liver scan for metastases (KPWLSM) is a self-control, blind map-reading, single-center, prospective superiority trial. Approved by the institutional review committee, the study period is planned to be from 1 January 2022 to 31 December 2025. Our study will include 330 patients with history of malignant tumors that cling to metastasize to liver. All patients will undergo the examinations of conventional ultrasound, Sonazoid-CEUS, and contrast-enhanced magnetic resonance imaging (CEMRI), and 65 of them should have additional CECT scans. The primary endpoint is the comparative analysis of the numbers of detected liver metastatic lesions among Sonazoid-CEUS, conventional ultrasound and CECT in screening liver metastases. Subjective conditions of patient after injection of Sonazoid will be followed up 3 and 30 days after KPWLSM, and any short-term and long-term adverse events are to be recorded with telephone interviews. Ethics and dissemination This study has been granted by the Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People's Hospital (Approval No: 2021-197). When the KPWLSM is completed, we will publish it in an appropriate journal to promote further widespread use. Registration Trial Registration Number and Date of Registration: Chinese Clinical Trial Registry, ChiCTR2100054385, December 16, 2021.
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Affiliation(s)
- Qiong Wu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Yilun Liu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Di Sun
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Yan Wang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Xiaoer Wei
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jing Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Beibei Liu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shuhao Wang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yan Zhou
- Oncology Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haiyan Hu
- Oncology Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Rui Zhang
- Obstetrics and Gynecology Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qiong Jiao
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yi Li
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
- *Correspondence: Yi Li
| | - Tao Ying
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
- Tao Ying
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Zhang Y, Numata K, Du Y, Maeda S. Contrast Agents for Hepatocellular Carcinoma Imaging: Value and Progression. Front Oncol 2022; 12:921667. [PMID: 35720001 PMCID: PMC9200965 DOI: 10.3389/fonc.2022.921667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022] Open
Abstract
Hepatocellular carcinoma (HCC) has the third-highest incidence in cancers and has become one of the leading threats to cancer death. With the research on the etiological reasons for cirrhosis and HCC, early diagnosis has been placed great hope to form a favorable prognosis. Non-invasive medical imaging, including the associated contrast media (CM)-based enhancement scan, is taking charge of early diagnosis as mainstream. Meanwhile, it is notable that various CM with different advantages are playing an important role in the different imaging modalities, or even combined modalities. For both physicians and radiologists, it is necessary to know more about the proper imaging approach, along with the characteristic CM, for HCC diagnosis and treatment. Therefore, a summarized navigating map of CM commonly used in the clinic, along with ongoing work of agent research and potential seeded agents in the future, could be a needed practicable aid for HCC diagnosis and prognosis.
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Affiliation(s)
- Ying Zhang
- Department of Medical Ultrasound, Ningbo Medical Centre Li Huili Hospital, Ningbo, China.,Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.,Department of Gastroenterology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuewu Du
- Department of Medical Ultrasound, Ningbo Medical Centre Li Huili Hospital, Ningbo, China
| | - Shin Maeda
- Department of Gastroenterology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Fei X, Han P, Jiang B, Zhu L, Tian W, Sang M, Zhang X, Zhu Y, Luo Y. High Frame Rate Contrast-enhanced Ultrasound Helps Differentiate Malignant and Benign Focal Liver Lesions. J Clin Transl Hepatol 2022; 10:26-33. [PMID: 35233370 PMCID: PMC8845153 DOI: 10.14218/jcth.2020.00172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/24/2021] [Accepted: 05/11/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS This study aimed to evaluate the diagnostic performance of high frame rate contrast-enhanced ultrasound (H-CEUS) of focal liver lesions (FLLs). METHODS From July 2017 to June 2019, conventional contrast-enhanced ultrasound (C-CEUS) and H-CEUS were performed in 78 patients with 78 nodules. The characteristics of C-CEUS and H-CEUS in malignant and benign groups and the differences between different lesion sizes (1-3 cm, 3-5 cm, or >5 cm) of C-CEUS and H-CEUS were examined. The diagnostic performance of C-CEUS and H-CEUS was analyzed. The chi-square test or Fisher's exact test was used to assess inter-group differences. The receiver operating characteristic curve was plotted to determine the diagnostic performance of C-CEUS and H-CEUS. RESULTS There were significant differences in the enhancement area, fill-in direction and vascular architecture between C-CEUS and H-CEUS for both benign and malignant lesions (all p=0.000-0.008), but there were no significant differences in washout results (p=0.566 and p=0.684, respectively). For lesions 1-3 cm in size, the enhancement area, fill-in direction, and vascular architecture on C-CEUS and H-CEUS were significantly different (all p=0.000), unlike for lesions 3-5 cm or >5 cm in size. For differentiation of malignant from benign FLLs in the 1-3 cm group, H-CEUS showed sensitivity, specificity, accuracy, and positive and negative predictive values of 92.86%, 95.0%, 96.3%, 90.48% and 93.75%, respectively, which were higher than those for C-CEUS (75.0%, 70.0%, 77.78%, 66.67% and 72.91%, respectively). CONCLUSIONS H-CEUS provided more vascular information which could help differentiate malignant from benign FLLs, especially for lesions 1-3 cm in size.
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Affiliation(s)
- Xiang Fei
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Peng Han
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Bo Jiang
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Lianhua Zhu
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Wenshuo Tian
- Clinical Research Division of Ultrasound Imaging System, Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, Guangdong, China
| | - Maodong Sang
- R&D Division of Ultrasound Imaging System, Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, Guangdong, China
| | - Xirui Zhang
- R&D Division of Ultrasound Imaging System, Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, Guangdong, China
| | - Yaqiong Zhu
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
- Correspondence to: Yukun Luo, Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, NO. 28 Fu Xing Road, Beijing 100853, China. Tel: +86-10-66936848, E-mail:
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Moga TV, David C, Popescu A, Lupusoru R, Heredea D, Ghiuchici AM, Foncea C, Burdan A, Sirli R, Danilă M, Ratiu I, Bizerea-Moga T, Sporea I. Multiparametric Ultrasound Approach Using a Tree-Based Decision Classifier for Inconclusive Focal Liver Lesions Evaluated by Contrast Enhanced Ultrasound. J Pers Med 2021; 11:jpm11121388. [PMID: 34945860 PMCID: PMC8709328 DOI: 10.3390/jpm11121388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Multiparametric ultrasound (MPUS) is a concept whereby the examiner is encouraged to use the latest features of an ultrasound machine. The aim of this study was to reanalyze inconclusive focal liver lesions (FLLs) that had been analyzed via contrast enhanced ultrasound (CEUS) using the MPUS approach with the help of a tree-based decision classifier. MATERIALS AND METHODS We retrospectively analyzed FLLs that were inconclusive upon CEUS examination in our department, focusing our attention on samples taken over a period of two years (2017-2018). MPUS reanalysis followed a three-step algorithm, taking into account the liver stiffness measurement (LSM), time-intensity curve analysis (TIC), and parametric imaging (PI). After processing all steps of the algorithm, a binary decision tree classifier (BDTC) was used to achieve a software-assisted decision. RESULTS Area was the only TIC-CEUS parameter that showed a significant difference between malign and benign lesions with a cutoff of >-19.3 dB for washout phenomena (AUROC = 0.58, Se = 74.0%, Sp = 45.7%). Using the binary decision tree classifier (BDTC) algorithm, we correctly classified 71 out of 91 lesions according to their malignant or benignant status, with an accuracy of 78.0% (sensitivity = 62%, specificity = 45%, and precision = 80%). CONCLUSIONS By reevaluating inconclusive FLLs that had been analyzed via CEUS using MPUS, we managed to determine that 78% of the lesions were malignant and, in 28% of them, we established the lesion type.
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Affiliation(s)
- Tudor Voicu Moga
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timişoara, Romania; (T.V.M.); (A.P.); (D.H.); (A.M.G.); (C.F.); (A.B.); (R.S.); (M.D.); (I.R.); (I.S.)
| | - Ciprian David
- Electronics and Telecommunications Faculty, “Politehnica” University of Timișoara, 300006 Timișoara, Romania;
| | - Alina Popescu
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timişoara, Romania; (T.V.M.); (A.P.); (D.H.); (A.M.G.); (C.F.); (A.B.); (R.S.); (M.D.); (I.R.); (I.S.)
| | - Raluca Lupusoru
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timişoara, Romania; (T.V.M.); (A.P.); (D.H.); (A.M.G.); (C.F.); (A.B.); (R.S.); (M.D.); (I.R.); (I.S.)
- Center for Modeling Biological Systems and Data Analysis, Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence: ; Tel.: +40-733912028
| | - Darius Heredea
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timişoara, Romania; (T.V.M.); (A.P.); (D.H.); (A.M.G.); (C.F.); (A.B.); (R.S.); (M.D.); (I.R.); (I.S.)
| | - Ana M. Ghiuchici
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timişoara, Romania; (T.V.M.); (A.P.); (D.H.); (A.M.G.); (C.F.); (A.B.); (R.S.); (M.D.); (I.R.); (I.S.)
| | - Camelia Foncea
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timişoara, Romania; (T.V.M.); (A.P.); (D.H.); (A.M.G.); (C.F.); (A.B.); (R.S.); (M.D.); (I.R.); (I.S.)
| | - Adrian Burdan
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timişoara, Romania; (T.V.M.); (A.P.); (D.H.); (A.M.G.); (C.F.); (A.B.); (R.S.); (M.D.); (I.R.); (I.S.)
| | - Roxana Sirli
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timişoara, Romania; (T.V.M.); (A.P.); (D.H.); (A.M.G.); (C.F.); (A.B.); (R.S.); (M.D.); (I.R.); (I.S.)
| | - Mirela Danilă
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timişoara, Romania; (T.V.M.); (A.P.); (D.H.); (A.M.G.); (C.F.); (A.B.); (R.S.); (M.D.); (I.R.); (I.S.)
| | - Iulia Ratiu
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timişoara, Romania; (T.V.M.); (A.P.); (D.H.); (A.M.G.); (C.F.); (A.B.); (R.S.); (M.D.); (I.R.); (I.S.)
| | - Teofana Bizerea-Moga
- Department of Pediatrics—1st Pediatric Discipline, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Ioan Sporea
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timişoara, Romania; (T.V.M.); (A.P.); (D.H.); (A.M.G.); (C.F.); (A.B.); (R.S.); (M.D.); (I.R.); (I.S.)
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Chammas MC, Bordini AL. Contrast-enhanced ultrasonography for the evaluation of malignant focal liver lesions. Ultrasonography 2021; 41:4-24. [PMID: 34724777 PMCID: PMC8696138 DOI: 10.14366/usg.21001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022] Open
Abstract
In this review, the authors address the analysis of different types of malignant focal liver lesions (FLLs) using contrast-enhanced ultrasonography (CEUS). The specific enhancing patterns of hepatocellular carcinoma, cholangiocarcinoma, and metastases are discussed and exemplified with images. In addition, the use of CEUS in malignant portal vein thrombosis is discussed. The advantages and limitations of CEUS for the analysis of malignant FLLs are also discussed.
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Affiliation(s)
- Maria Cristina Chammas
- Department of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - André Leopoldino Bordini
- Department of Radiology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
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Bartolotta TV, Taibbi A, Randazzo A, Gagliardo C. New frontiers in liver ultrasound: From mono to multi parametricity. World J Gastrointest Oncol 2021; 13:1302-1316. [PMID: 34721768 PMCID: PMC8529919 DOI: 10.4251/wjgo.v13.i10.1302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/17/2021] [Accepted: 08/24/2021] [Indexed: 02/06/2023] Open
Abstract
Modern liver ultrasonography (US) has become a “one-stop shop” able to provide not only anatomic and morphologic but also functional information about vascularity, stiffness and other various liver tissue properties. Modern US techniques allow a quantitative assessment of various liver diseases. US scanning is no more limited to the visualized plane, but three-dimensional, volumetric acquisition and consequent post-processing are also possible. Further, US scan can be consistently merged and visualized in real time with Computed Tomography and Magnetic Resonance Imaging examinations. Effective and safe microbubble-based contrast agents allow a real time, dynamic study of contrast kinetic for the detection and characterization of focal liver lesions. Ultrasound can be used to guide loco-regional treatment of liver malignancies and to assess tumoral response either to interventional procedures or medical therapies. Microbubbles may also carry and deliver drugs under ultrasound exposure. US plays a crucial role in diagnosing, treating and monitoring focal and diffuse liver disease. On the basis of personal experience and literature data, this paper is aimed to review the main topics involving recent advances in the field of liver ultrasound.
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Affiliation(s)
- Tommaso Vincenzo Bartolotta
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
- Radiology Department, Fondazione Istituto G. Giglio Hospital, Cefalù 90015, Italy
| | - Adele Taibbi
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
| | - Angelo Randazzo
- Department of Radiology, University Hospital "Paolo Giaccone", Palermo 90127, Italy
| | - Cesare Gagliardo
- Department of Biopathology and Medical and Forensic Biotechnologies, University of Palermo, Palermo 90127, Italy
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10
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Barr RG, Wilson SR, Lyshchik A, McCarville B, Darge K, Grant E, Robbin M, Wilmann JK, Chong WK, Fleischer A, Paltiel HJ. Contrast -Enhanced Ultrasound: State of the Art in North America. Ultrasound Q 2021; 36:206-217. [PMID: 32890323 DOI: 10.1097/ruq.0000000000000514] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Society of Radiologists in Ultrasound convened a panel of specialists in contrast-enhanced ultrasound (CEUS) to produce a white paper on noncardiac CEUS in North America. The panel met in Chicago, Illinois, on October 24 and 25, 2017. The recommendations are based on analysis of current literature and common practice strategies and are thought to represent a reasonable approach to introduce the advantages of this safe and noninvasive technique for the benefit of our patients. Characterization of liver nodules, and pediatric vascular and intravesicular applications comprise the approved indications for CEUS in the United States. They, along with the very successful off-label use of CEUS for the kidney, are included in this publication.Other off-label uses are presented with emphasis on their value and literature support in the online version.
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Affiliation(s)
| | | | | | | | - Kassa Darge
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Edward Grant
- University of Southern California, Los Angeles, CA
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11
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Li I, Ye X, He S. Letter to the Editor: Imaging Monitoring of Patients With Primary Sclerosing Cholangitis. Hepatology 2021; 74:534-535. [PMID: 33427311 DOI: 10.1002/hep.31709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Iangfa Li
- Division of Hepatobiliary Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaofei Ye
- Division of Hepatobiliary Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Songqing He
- Division of Hepatobiliary Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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12
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Malone CD, Fetzer DT, Monsky WL, Itani M, Mellnick VM, Velez PA, Middleton WD, Averkiou MA, Ramaswamy RS. Contrast-enhanced US for the Interventional Radiologist: Current and Emerging Applications. Radiographics 2021; 40:562-588. [PMID: 32125955 DOI: 10.1148/rg.2020190183] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
US is a powerful and nearly ubiquitous tool in the practice of interventional radiology. Use of contrast-enhanced US (CEUS) has gained traction in diagnostic imaging given the recent approval by the U.S. Food and Drug Administration (FDA) of microbubble contrast agents for use in the liver, such as sulfur hexafluoride lipid-type A microspheres. Adoption of CEUS by interventional radiologists can enhance not only procedure guidance but also preprocedure patient evaluation and assessment of treatment response across a wide spectrum of oncologic, vascular, and nonvascular procedures. In addition, the unique physical properties of microbubble contrast agents make them amenable as therapeutic vehicles in themselves, which can lay a foundation for future therapeutic innovations in the field in drug delivery, thrombolysis, and vascular flow augmentation. The purpose of this article is to provide an introduction to and overview of CEUS aimed at the interventional radiologist, highlighting its role before, during, and after frequently practiced oncologic and vascular interventions such as biopsy, ablation, transarterial chemoembolization, detection and control of hemorrhage, evaluation of transjugular intrahepatic portosystemic shunts (TIPS), detection of aortic endograft endoleak, thrombus detection and evaluation, evaluation of vascular malformations, lymphangiography, and percutaneous drain placement. Basic physical principles of CEUS, injection and scanning protocols, and logistics for practice implementation are also discussed. Early adoption of CEUS by the interventional radiology community will ensure rapid innovation of the field and development of future novel procedures. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Christopher D Malone
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - David T Fetzer
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Wayne L Monsky
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Philip A Velez
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - William D Middleton
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Michalakis A Averkiou
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Raja S Ramaswamy
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
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13
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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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14
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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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15
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Shin J, Lee S, Bae H, Chung YE, Choi JY, Huh YM, Park MS. Contrast-enhanced ultrasound liver imaging reporting and data system for diagnosing hepatocellular carcinoma: A meta-analysis. Liver Int 2020; 40:2345-2352. [PMID: 32722894 DOI: 10.1111/liv.14617] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) is a comprehensive system for standardizing CEUS at high risk for hepatocellular carcinoma (HCC). We performed a meta-analysis to determine the diagnostic performance of the CEUS LR-5 for HCC and the pooled proportions of HCCs in each CEUS LI-RADS category. METHODS We searched multiple databases for studies reporting the diagnostic accuracy of the CEUS LI-RADS. Random-effects model was used to determine summary estimates of the diagnostic performance of CEUS LR-5 and the pooled proportions of HCCs in each CEUS LI-RADS category. Risk of bias and concerns regarding applicability were evaluated with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. RESULTS Eleven studies were included in the final analysis, which consisted of 5535 observations with 3983 HCCs. The pooled per-observation sensitivity and specificity of the CEUS LR-5 for diagnosing HCC were 69% (95% confidence interval [CI], 64%-73%) and 92% (95% CI, 83%-96%) respectively. The pooled proportions of HCCs were 0% (95% CI, 0-0%) for LR-1, 1% (95% CI, 0%-4%) for CEUS LR-2, 26% (95% CI, 14%-39%) for CEUS LR-3, 77% (95% CI, 68%-86%) for CEUS LR-4, 97% (95% CI, 95%-98%) for CEUS LR-5, 57% (95% CI, 44%-69%) for CEUS LR-M and 100% (95% CI, 93%-100%) for CEUS LR-5V or TIV. CONCLUSIONS The CEUS LR-5 category showed moderate sensitivity and high specificity for diagnosing HCC. The proportion of HCCs was higher in the higher CEUS LI-RADS categories.
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Affiliation(s)
| | - Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Heejin Bae
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Eun Chung
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Min Huh
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Yonsei Biomedical Research Institute, Yonsei University Health System, Seoul, Korea
| | - Mi-Suk Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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16
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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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Ding J, Long L, Zhang X, Chen C, Zhou H, Zhou Y, Wang Y, Jing X, Ye Z, Wang F. Contrast-enhanced ultrasound LI-RADS 2017: comparison with CT/MRI LI-RADS. Eur Radiol 2020; 31:847-854. [PMID: 32803416 DOI: 10.1007/s00330-020-07159-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/14/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare the classification based on contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) with that of contrast-enhanced CT and MRI (CECT/MRI) LI-RADS for liver nodules in patients at high risk of hepatocellular carcinoma. METHODS Two hundred thirty-nine patients with 273 nodules were enrolled in this retrospective study. Each nodule was categorized according to the CEUS LI-RADS version 2017 and CECT/MRI LI-RADS version 2017. The diagnostic performance of CEUS and CECT/MRI was compared. The reference standard was histopathology diagnosis. Inter-modality agreement was assessed with Cohen's kappa. RESULTS The inter-modality agreement for CEUS LI-RADS and CECT/MRI LI-RADS was fair with a kappa value of 0.319 (p < 0.001). The positive predictive values (PPVs) of hepatocellular carcinoma (HCC) in LR-5, LR-4, and LR-3 were 98.3%, 60.0%, and 25.0% in CEUS, and 95.9%, 65.7%, and 48.1% in CECT/MRI, respectively. The sensitivities and specificities of LR-5 for diagnosing HCC were 75.6% and 93.8% in CEUS, and 83.6% and 83.3% in CECT/MRI, respectively. The positive predictive values of non-HCC malignancy in CEUS LR-M and CECT/MRI LR-M were 33.9% and 93.3%, respectively. The sensitivity, specificity, and accuracy for diagnosing non-HCC malignancy were 90.9%, 84.5%, and 85.0% in CEUS LR-M and 63.6%, 99.6%, and 96.7% in CECT/MRI LR-M, respectively. CONCLUSIONS The inter-modality agreement of the LI-RADS category between CEUS and CECT/MRI is fair. The positive predictive values of HCCs in LR-5 of the CEUS and CECT/MRI LI-RADS are comparable. CECT/MRI LR-M has better diagnostic performance for non-HCC malignancy than CEUS LR-M. KEY POINTS • The inter-modality agreement for the final LI-RADS category between CEUS and CECT/MRI is fair. • The LR-5 of CEUS and CECT/MRI LI-RADS corresponds to comparable positive predictive values (PPVs) of HCC. For LR-3 and LR-4 nodules categorized by CECT/MRI, CEUS examination should be performed, at least if they can be detected on plain ultrasound. • CECT/MRI LR-M has better diagnostic performance for non-HCC malignancy than CEUS LR-M. For LR-M nodules categorized by CEUS, re-evaluation by CECT/MRI is necessary.
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Affiliation(s)
- Jianmin Ding
- Department of Radiology, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Lei Long
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Xiang Zhang
- Department of Radiology, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Chen Chen
- Department of Radiology, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Hongyu Zhou
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Yan Zhou
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Yandong Wang
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China.
| | - Zhaoxiang Ye
- Department of Radiology, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
| | - Fengmei Wang
- Department of Gastroenterology and Hepatology, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
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Current Imaging Standards for Nonmetastatic Benign and Malignant Liver Tumors. Surg Oncol Clin N Am 2019; 28:539-572. [PMID: 31472905 DOI: 10.1016/j.soc.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The accurate diagnosis of a liver mass can usually be established with a thorough history, examination, laboratory inquiry, and imaging. The necessity of a liver biopsy to determine the nature of a liver mass is rarely necessary. Contrast-enhanced computed tomography and magnetic resonance are the standard of care for diagnosing liver lesions and high-quality imaging should be performed before performing a biopsy. This article discusses current consensus guidelines for imaging of liver masses, as well as masses found on surveillance imaging. The ability to accurately characterize lesions requires proper use and understanding of the technology and expert interpretation.
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Zhai HY, Liang P, Yu J, Cao F, Kuang M, Liu FY, Liu FY, Zhu XY. Comparison of Sonazoid and SonoVue in the Diagnosis of Focal Liver Lesions: A Preliminary Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2417-2425. [PMID: 30680779 DOI: 10.1002/jum.14940] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/10/2018] [Accepted: 12/30/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study aimed to compare the efficacy of Sonazoid and SonoVue in subjects with focal liver lesions. METHODS The patients who had untreated focal solid liver lesions confirmed by B-mode ultrasonography were eligible for the study. The target lesion and whole liver were scanned by gray scale ultrasonography; then, contrast-enhanced ultrasonography was performed, and the results were evaluated blindly. The main end point was accuracy improvement with postcontrast versus precontrast ultrasound examination for diagnosis of the target lesion of interest as malignant or benign against the reference standard. RESULTS There were 65 patients with 65 hepatic tumors enrolled in the study. The improvement of diagnostic accuracy was 0.30 in the Sonazoid group and 0.16 in the SonoVue group (95% confidence interval, -0.828-0.168; P = .24). Using 20% as the noninferiority margin, the upper limit of the 95% confidence interval (0.168) was less than 0.20. The number of lesions detected during the whole-liver scanning in the Sonazoid group was significantly more than that detected in the SonoVue group (P = .024). CONCLUSION The diagnosis value of Sonazoid is noninferior to SonoVue, and this new contrast agent can improves the whole-liver image quality.
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Affiliation(s)
- Hong-Yan Zhai
- Department of Interventional Ultrasound, The General Hospital of Chinese People's Liberation Army, Beijing, China
- Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China
| | - Ping Liang
- Department of Interventional Ultrasound, The General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, The General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Feng Cao
- Department of Cardiovascular, The General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Ming Kuang
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Feng-Yong Liu
- Department of Interventional Radiology, The General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, The General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Xin-Yuan Zhu
- Department of Cardiovascular Surgery, Tianjin Medical University General Hospital, Tianjin, China
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Navin PJ, Venkatesh SK. Hepatocellular Carcinoma: State of the Art Imaging and Recent Advances. J Clin Transl Hepatol 2019; 7:72-85. [PMID: 30944823 PMCID: PMC6441649 DOI: 10.14218/jcth.2018.00032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 12/31/2018] [Accepted: 01/04/2019] [Indexed: 02/07/2023] Open
Abstract
The incidence of hepatocellular carcinoma (HCC) is increasing, with this trend expected to continue to the year 2030. Hepatocarcinogenesis follows a predictable course, which makes adequate identification and surveillance of at-risk individuals central to a successful outcome. Moreover, imaging is central to this surveillance, and ultimately to diagnosis and management. Many liver study groups throughout Asia, North America and Europe advocate a surveillance program for at-risk individuals to allow early identification of HCC. Ultrasound is the most commonly utilized imaging modality. Many societies offer guidelines on how to diagnose HCC. The Liver Image Reporting and Data System (LIRADS) was introduced to standardize the acquisition, interpretation, reporting and data collection of HCC cases. The LIRADS advocates diagnosis using multiphase computed tomography or magnetic resonance imaging (MRI) imaging. The 2017 version also introduces contrast-enhanced ultrasound as a novel approach to diagnosis. Indeed, imaging techniques have evolved to improve diagnostic accuracy and characterization of HCC lesions. Newer techniques, such as T1 mapping, intravoxel incoherent motion analysis and textural analysis, assess specific characteristics that may help grade the tumor and guide management, allowing for a more personalized approach to patient care. This review aims to analyze the utility of imaging in the surveillance and diagnosis of HCC and to assess novel techniques which may increase the accuracy of imaging and determine optimal treatment strategies.
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Affiliation(s)
| | - Sudhakar K. Venkatesh
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- *Correspondence to: Sudhakar K. Venkatesh, Mayo Clinic, Rochester, 200 1 Street, Rochester MN 55905, USA. Tel: +1-507-284-1728, Fax: +1-507-284-2405, E-mail:
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Huang R, Jiang L, Xu Y, Gong Y, Ran H, Wang Z, Sun Y. Comparative Diagnostic Accuracy of Contrast-Enhanced Ultrasound and Shear Wave Elastography in Differentiating Benign and Malignant Lesions: A Network Meta-Analysis. Front Oncol 2019; 9:102. [PMID: 30891425 PMCID: PMC6412152 DOI: 10.3389/fonc.2019.00102] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 02/04/2019] [Indexed: 12/12/2022] Open
Abstract
Background: We performed a network meta-analysis to compare the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) and shear wave elastography (SWE) in differentiating benign and malignant lesions in different body sites. Methods: A computerized literature search of Medline, Embase, SCOPUS, and Web of Science was performed using relevant keywords. Following data extraction, we calculated sensitivity, specificity, positive likelihood ratio (LR), negative LR, and diagnostic odds ratio (DOR) for CEUS, and SWE compared to histopathology as a reference standard. Statistical analyses were conducted by MetaDiSc (version 1.4) and R software (version 3.4.3). Results: One hundred and fourteen studies (15,926 patients) were pooled in the final analyses. Network meta-analysis showed that CEUS had significantly higher DOR than SWE (DOR = 27.14, 95%CI [2.30, 51.97]) in breast cancer detection. However, there were no significant differences between CEUS and SWE in hepatic (DOR = −6.67, 95%CI [−15.08, 1.74]) and thyroid cancer detection (DOR = 3.79, 95%CI [−3.10, 10.68]). Interestingly, ranking analysis showed that CEUS achieved higher DOR in detecting breast and thyroid cancer, while SWE achieved higher DOR in detecting hepatic cancer. The overall DOR for CEUS in detecting renal cancer was 53.44, 95%CI [29.89, 95.56] with an AUROC of 0.95, while the overall DOR for SWE in detecting prostate cancer was 25.35, 95%CI [7.15, 89.89] with an AUROC of 0.89. Conclusion: Both diagnostic tests showed relatively high sensitivity and specificity in detecting malignant tumors in different organs. Network meta-analysis showed that CEUS had higher diagnostic accuracy than SWE in detecting breast and thyroid cancer, while SWE had higher accuracy in detecting hepatic cancer. However, the results were not statistically significant in hepatic and thyroid malignancies. Further head-to-head comparisons are needed to confirm the optimal imaging technique to differentiate each cancer type.
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Affiliation(s)
- Rongzhong Huang
- The First People's Hospital of Yunnan Province, Kunming, China
| | - Lihong Jiang
- The First People's Hospital of Yunnan Province, Kunming, China
| | - Yu Xu
- Chuangxu Institute of Life Science, Chongqing, China
| | - Yuping Gong
- Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haitao Ran
- Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhigang Wang
- Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Sun
- Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Lorentzen T, Nolsoe CP. The Role of US Contrast Agents in US-Guided Biopsy of Focal Liver Lesions: A Pictorial Review. Ultrasound Int Open 2019; 5:E11-E19. [PMID: 30599041 PMCID: PMC6251788 DOI: 10.1055/a-0770-4237] [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] [Received: 06/14/2018] [Revised: 08/15/2018] [Accepted: 09/28/2018] [Indexed: 02/08/2023] Open
Abstract
US-guided percutaneous biopsy of focal liver lesions (FLL) is a classic interventional procedure performed by almost all radiology units. Typically, an incidental focal finding on US or a focal indeterminate lesion diagnosed on CT, MRI or PET/CT is referred for US-guided biopsy for final diagnosis. The introduction of microbubble US contrast agents has overcome some of the limitations of standard US in diagnosing FLLs by displaying the microvasculature together with the US morphology, which has increased both the sensitivity and the specificity. The combination of CEUS and intervention is facilitated by newer US equipment providing split-screen mode, which displays the CEUS mode alongside the standard US mode simultaneously on a single monitor. The puncture line is displayed in both modes as well as on the monitor. The interventional device (i. e., biopsy needle) is typically best visualized in the standard US mode, while the characteristic tissue pattern in an FLL is typically best visualized in CEUS mode. There are 3 main categories in which CEUS has an impact on US-guided biopsy of FLLs: • CEUS improves the visualization of FLLs • CEUS improves the quality of the biopsy specimen from an FLL • CEUS reduces the need for US-guided biopsy of an FLL In the two first categories, CEUS is utilized simultaneously with US-guided biopsy to ensure correct needle targeting. In the last category, US-guided biopsy of the FLL becomes superfluous as a result of the CEUS examination.
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Affiliation(s)
- Torben Lorentzen
- Ultrasound Section, Division of Surgery, Dep of Gastroenterology, Herlev Hospital, University of Copenhagen, Denmark
| | - Christian Pallson Nolsoe
- Ultrasound Section, Division of Surgery, Dep of Gastroenterology, Herlev Hospital, Copenhagen Academy for Medical Education and Simulation University of Copenhagen, Denmark
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Gupta M, Gabriel H, Miller FH. Role of Imaging in Surveillance and Diagnosis of Hepatocellular Carcinoma. Gastroenterol Clin North Am 2018; 47:585-602. [PMID: 30115439 DOI: 10.1016/j.gtc.2018.04.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The prognosis for hepatocellular carcinoma (HCC) is dependent on tumor stage at diagnosis, with curative treatment options more available to early-detected HCCs. Professional organizations have produced HCC screening guidelines in at-risk groups, with ultrasound the most commonly used screening tool and increased interest in MRI in specific populations. HCC may be diagnosed by imaging features alone and have been universally incorporated into management guidelines. The radiology community has standardized imaging criteria for HCC with the development of the Liver Imaging Reporting and Data System, which has expanded to incorporate computed tomography, MR, and contrast-enhanced ultrasound for diagnostic purposes.
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Affiliation(s)
- Mohit Gupta
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
| | - Helena Gabriel
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
| | - Frank H Miller
- Body Imaging Section and Fellowship Program, MRI, Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA.
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Nolsøe CP, Nolsøe AB, Klubien J, Pommergaard HC, Rosenberg J, Meloni MF, Lorentzen T. Use of Ultrasound Contrast Agents in Relation to Percutaneous Interventional Procedures: A Systematic Review and Pictorial Essay. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1305-1324. [PMID: 29230842 DOI: 10.1002/jum.14498] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/28/2017] [Accepted: 09/08/2017] [Indexed: 06/07/2023]
Abstract
The aim of this article is to provide an inventory of the use of contrast-enhanced ultrasound (CEUS) in relation to percutaneous interventional procedures. The article is structured into a systematic literature review followed by a clinical part relating to percutaneous CEUS-guided procedures. A literature search identified 3109 records. After abstract screening, 55 articles were analyzed and supplemented with pictorial material to explain the techniques. In conclusion, the best-evidenced indications for CEUS-guided interventions are biopsy and ablation of inconspicuous or B-mode-invisible tumors, intraprocedural ablation control and follow-up, as well as percutaneous transhepatic cholangiography and drainage procedures.
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Affiliation(s)
- Christian Pállson Nolsøe
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, and Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Herlev, Denmark
| | - Alexander Bjørneboe Nolsøe
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, and Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Herlev, Denmark
| | - Jeanett Klubien
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, and Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Herlev, Denmark
| | - Hans-Christian Pommergaard
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, and Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Herlev, Denmark
| | - Maria Franca Meloni
- Interventional Ultrasound Section, Department of Radiology, Institute of Care Igea, Milan, Italy
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Torben Lorentzen
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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Abstract
With the recent FDA approval for characterization of focal liver lesions (FLL) in both pediatric and adult patients using Lumason (sulfur hexafluoride microbubbles), increased use of ultrasound contrast for routine clinical use is expected. This agent has been available for many years in Europe and Asia, and a large body of literature is available regarding the sensitivity and specificity of this agent. In addition, a few studies have directly compared CEUS to CECT and CEMRI for the characterization of focal liver lesions. This paper reviews the literature to provide a background to investigators in the United States as to the accuracy of CEUS in the characterization of FLL. This paper reviews the literature regarding sulfur hexafluoride microbubbles (Lumason in the USA and Sonovue in the rest of the world) since it is the only FDA approved agent in the USA for characterization of FLL. The results of other ultrasound contrast agents which are not FDA approved for abdominal indications (approval for cardiac indications) most likely will have similar results.
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28
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Song Y, Cheng J, Zhang R. Contribution of 3-Dimensional Contrast-Enhanced Ultrasonography (CEUS) Compared With 2-Dimensional CEUS in the Analysis of Liver Tumors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1117-1128. [PMID: 29064112 DOI: 10.1002/jum.14458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/13/2017] [Accepted: 07/31/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES In this study, we investigated the vascular characteristics of liver tumors on 3-dimensional (3D) and 2-dimensional (2D) contrast-enhanced ultrasonography (CEUS). The clinical value of these CEUS methods in the diagnosis of benign and malignant liver tumors was evaluated and compared. METHODS A total of 126 liver tumors were examined by conventional ultrasonography (US), 2D CEUS, and dynamic 3D CEUS (frequency range, 1-6 MHz; focusing ability, 2-25 cm in depth; mechanical index, 0.09). Dynamic 3D CEUS images were postprocessed with high-resolution intelligent tomographic technology. The sensitivity and specificity of the CEUS methods in differentiating benign and malignant liver tumors were compared, as were the vascular characteristics (including the number and spatial relationships of the tumor vessels, such as origin and continuity) of the tumors in the arterial phase. RESULTS The imaging methods did not significantly differ in their sensitivity and specificity for differentiating benign and malignant liver tumors (P > .05). Dynamic 3D CEUS was significantly better than 2D CEUS in revealing the vascular characteristics of the tumors (P < .05). The vascular morphologic characteristics of benign and malignant hepatic tumors in the arterial phase of dynamic 3D CEUS using intelligent tomographic technology differed significantly (P < .05). CONCLUSIONS Dynamic 3D CEUS of liver tumors provides a more intuitive and comprehensive view of the spatial relationships of their blood vessels, including their peripheral and internal distribution. The volume information obtained with dynamic 3D CEUS combined with intelligent tomographic technology can improve the US-based diagnosis of liver tumors and thus guide their treatment.
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Affiliation(s)
- Yi Song
- Departments of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Departments of Magnetic Resonance Imaging, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruifang Zhang
- Departments of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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29
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Wilson SR, Lyshchik A, Piscaglia F, Cosgrove D, Jang HJ, Sirlin C, Dietrich CF, Kim TK, Willmann JK, Kono Y. CEUS LI-RADS: algorithm, implementation, and key differences from CT/MRI. Abdom Radiol (NY) 2018; 43:127-142. [PMID: 28819825 DOI: 10.1007/s00261-017-1250-0] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) is a specialized form of ultrasound (US) performed with an intravenous injection of microbubble contrast agents. It has been successfully used for a variety of applications including characterization of liver tumors. In April 2014, the American College of Radiology (ACR) convened a working group of international experts to develop ACR CEUS Liver Imaging Reporting and Data System (CEUS LI-RADS). An initial version of CEUS LI-RADS was published in August 2016. Although the CEUS LI-RADS concept and principles for liver lesion characterization, using dynamic contrast enhancement features, are similar to those for CT or MRI, there are significant differences between CT/MRI and CEUS LI-RADS. Therefore, CEUS LI-RADS has different diagnostic features and a unique characterization algorithm. The size of a lesion, the type and degree of arterial phase enhancement, the presence of washout, and the timing and degree of washout are the major features used for categorization. This paper describes key differences between CT/MRI and CEUS, and provides a diagnostic algorithm of CEUS LI-RADS with detailed, step-by-step instructions and imaging examples of CEUS LI-RADS categories.
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Affiliation(s)
- Stephanie R Wilson
- Department of Radiology, University of Calgary, 1403 29 Street NW, Calgary, T2N 2T9, Canada
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, 132 S. 10th Street, 763G Main Bldg, Philadelphia, PA, 19107, USA
| | - Fabio Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - David Cosgrove
- Hammersmith hospital, London, UK
- King's College Hospital, London, UK
| | - Hyun-Jung Jang
- Department of Medical Imaging, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
| | - Claude Sirlin
- Department of Radiology, University of California, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
| | - Christoph F Dietrich
- Caritas Krankenhaus Bad Mergentheim, Uhlandstraße 7, 97980, Bad Mergentheim, Germany
| | | | | | - Yuko Kono
- Division of Gastroenterology & Hepatology, University of California, 200 West Arbor Dr, San Diego, CA, 92103, USA.
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Contrast-enhanced US for characterization of focal liver lesions: a comprehensive meta-analysis. Eur Radiol 2017; 28:2077-2088. [PMID: 29189932 DOI: 10.1007/s00330-017-5152-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/17/2017] [Accepted: 10/19/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This meta-analysis was performed to evaluate the accuracy of contrast-enhanced ultrasound (CEUS) in differentiating malignant from benign focal liver lesions (FLLs). METHODS Cochrane Library, PubMed and Web of Science databases were systematically searched and checked for studies using CEUS in characterization of FLLs. Data necessary to construct 2×2 contingency tables were extracted from included studies. The QUADAS tool was utilized to assess the methodologic quality of the studies. Meta-analysis included data pooling, subgroup analyses, meta-regression and investigation of publication bias was comprehensively performed. RESULTS Fifty-seven studies were included in this meta-analysis and the overall diagnostic accuracy in characterization of FLLs was as follows: pooled sensitivity, 0.92 (95%CI: 0.91-0.93); pooled specificity, 0.87 (95%CI: 0.86-0.88); diagnostic odds ratio, 104.20 (95%CI: 70.42-154.16). Subgroup analysis indicated higher diagnostic accuracy of the second-generation contrast agents (CAs) than the first-generation CA (Levovist; DOR: 118.27 vs. 62.78). Furthermore, Sonazoid demonstrated the highest diagnostic accuracy among three major CAs (SonoVue, Levovist and Sonazoid; DOR: 118.82 vs. 62.78 vs. 227.39). No potential publication bias was observed of the included studies. CONCLUSION CEUS is an accurate tool to stratify the risk of malignancy in FLLs. The second-generation CAs, especially Sonazoid may greatly improve diagnostic performance. KEY POINTS • CEUS shows excellent diagnostic accuracy in differentiating malignant from benign FLLs. • The second-generation CAs have higher diagnostic accuracy than first-generation CAs. • Sonazoid demonstrates the highest diagnostic accuracy among three major CAs.
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Liver investigations: Updating on US technique and contrast-enhanced ultrasound (CEUS). Eur J Radiol 2017; 96:65-73. [PMID: 29103478 DOI: 10.1016/j.ejrad.2017.08.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/15/2017] [Accepted: 08/28/2017] [Indexed: 12/15/2022]
Abstract
Over the past few years, the cross sectional imaging techniques (Computed Tomography - CT and Magnetic Resonance - MR) have improved, allowing a more efficient study of focal and diffuse liver diseases. Many papers had been published about the results of a routinely clinical use of the dual source/dual energy CT techniques and the use of hepatobiliary contrast agents in MR liver studies. As a consequence, these new improvements have diverted the attention away from the Ultrasound technique and its technical and conceptual evolutions. In these years of disinterest, US and especially Contrast Enhanced Ultrasound (CEUS) have consolidated and grown in their application in clinical routine for liver pathologies. In particular, thanks to the introduction of new, dedicated software packages, CEUS has allowed not only qualitative, but also quantitative analysis of lesion microcirculation, thus opening a new era in the evaluation of lesion characterization and response to therapy. Moreover, the renewed interest in liver elastography, a baseline ultrasound-based imaging modality, has led to the development of a competitive technique to assess liver stiffness and then for the evaluation of the progression towards cirrhosis, and characterization of focal liver lesions, opening the way to avoid, in selected cases, liver biopsy. The aim of this review is to offer an up-to-date overview on the state of the art of clinical applications of US and CEUS in the study of focal and diffuse liver pathologies. Besides, it aims to highlight the emerging role of perfusion techniques in the assessment of local and systemic treatment response and to show how the liver evolution from steatosis to fibrosis can be revealed by elastography.
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Ferraioli G, Meloni MF. Contrast-enhanced ultrasonography of the liver using SonoVue. Ultrasonography 2017; 37:25-35. [PMID: 28830058 PMCID: PMC5769944 DOI: 10.14366/usg.17037] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/19/2017] [Accepted: 07/12/2017] [Indexed: 12/12/2022] Open
Abstract
This review focuses on the use of contrast-enhanced ultrasonography (CEUS) with SonoVue (Bracco Imaging) for the diagnosis of focal liver lesions (FLLs), guidance during ablative treatment, and follow-up of liver tumors. Multicenter trials have shown that the performance of CEUS for the characterization of FLLs is similar to that of contrast-enhanced computed tomography or contrast-enhanced magnetic resonance imaging. CEUS with SonoVue has been effectively used for guiding the percutaneous treatment of malignant liver tumors that are invisible or poorly visualized in traditional gray-scale ultrasonography. Postprocedural CEUS may be used to detect and retreat residual viable tissue in the same ablative session. The use of CEUS for the assessment of diffuse liver disease is also discussed.
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Affiliation(s)
- Giovanna Ferraioli
- Ultrasound Unit, Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Gatos I, Tsantis S, Karamesini M, Spiliopoulos S, Karnabatidis D, Hazle JD, Kagadis GC. Focal liver lesions segmentation and classification in nonenhanced T2-weighted MRI. Med Phys 2017; 44:3695-3705. [PMID: 28432822 DOI: 10.1002/mp.12291] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 04/11/2017] [Accepted: 04/14/2017] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To automatically segment and classify focal liver lesions (FLLs) on nonenhanced T2-weighted magnetic resonance imaging (MRI) scans using a computer-aided diagnosis (CAD) algorithm. METHODS 71 FLLs (30 benign lesions, 19 hepatocellular carcinomas, and 22 metastases) on T2-weighted MRI scans were delineated by the proposed CAD scheme. The FLL segmentation procedure involved wavelet multiscale analysis to extract accurate edge information and mean intensity values for consecutive edges computed using horizontal and vertical analysis that were fed into the subsequent fuzzy C-means algorithm for final FLL border extraction. Texture information for each extracted lesion was derived using 42 first- and second-order textural features from grayscale value histogram, co-occurrence, and run-length matrices. Twelve morphological features were also extracted to capture any shape differentiation between classes. Feature selection was performed with stepwise multilinear regression analysis that led to a reduced feature subset. A multiclass Probabilistic Neural Network (PNN) classifier was then designed and used for lesion classification. PNN model evaluation was performed using the leave-one-out (LOO) method and receiver operating characteristic (ROC) curve analysis. RESULTS The mean overlap between the automatically segmented FLLs and the manual segmentations performed by radiologists was 0.91 ± 0.12. The highest classification accuracies in the PNN model for the benign, hepatocellular carcinoma, and metastatic FLLs were 94.1%, 91.4%, and 94.1%, respectively, with sensitivity/specificity values of 90%/97.3%, 89.5%/92.2%, and 90.9%/95.6% respectively. The overall classification accuracy for the proposed system was 90.1%. CONCLUSIONS Our diagnostic system using sophisticated FLL segmentation and classification algorithms is a powerful tool for routine clinical MRI-based liver evaluation and can be a supplement to contrast-enhanced MRI to prevent unnecessary invasive procedures.
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Affiliation(s)
- Ilias Gatos
- Department of Medical Physics, School of Medicine, University of Patras, Rion, GR, 26504, Greece
| | - Stavros Tsantis
- Department of Medical Physics, School of Medicine, University of Patras, Rion, GR, 26504, Greece
| | - Maria Karamesini
- Department of Radiology, Magnitiki Patron Diagnostic Center, 105 Othonos-Amalias st, Patras, GR, 26222, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, University of Athens, Athens, GR, 12461, Greece
| | - Dimitris Karnabatidis
- Department of Radiology, School of Medicine, University of Patras, Rion, GR, 26504, Greece
| | - John D Hazle
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - George C Kagadis
- Department of Medical Physics, School of Medicine, University of Patras, Rion, GR, 26504, Greece
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
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Hocke M, Ignee A, Dietrich C. Role of contrast-enhanced endoscopic ultrasound in lymph nodes. Endosc Ultrasound 2017; 6:4-11. [PMID: 28218194 PMCID: PMC5331842 DOI: 10.4103/2303-9027.190929] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 04/25/2016] [Indexed: 12/11/2022] Open
Abstract
Diagnosing unclear lymph node (LN) enlargements in the mediastinum and abdomen is the most important indication of endoscopic ultrasound (EUS)-fine needle aspiration (FNA) after the diagnosis and treatment of pancreatic diseases. Investigating LNs in these areas can happen in different clinical settings. Mostly, it is the first modality in general LN diseases without any peripheral LN enlargements. On the other hand, it can be the question of LN involvement in a known or suspected primary tumor. Due to EUS-FNA cytology, those questions can be answered highly, accurately. However, a primary discrimination of LNs might be helpful to increase the diagnostic value of the FNA cytology, especially in cases with multiple LN enlargements and hard to reach enlarged LNs for example by vessel interposition. Because of the unreliability of B-mode criteria, further diagnostic improvements such as elastography and contrast-enhanced EUS are investigated to increase the accuracy of the initial diagnosis.
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Affiliation(s)
- Michael Hocke
- Medical Department, Helios Klinikum Meiningen, D-98617 Meiningen, Germany
| | - Andre Ignee
- Medical Department, Caritas-Krankenhaus, D-97980 Bad Mergentheim, Germany
| | - Christoph Dietrich
- Medical Department, Caritas-Krankenhaus, D-97980 Bad Mergentheim, Germany
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Malone CD, Mattrey RF, Fetzer DT. Contrast-Enhanced Ultrasound (CEUS) for the Diagnosis and Management of Hepatocellular Carcinoma: Current Status and Future Trends. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s11901-016-0324-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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36
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Knieling F, Waldner MJ. Light and sound - emerging imaging techniques for inflammatory bowel disease. World J Gastroenterol 2016; 22:5642-5654. [PMID: 27433080 PMCID: PMC4932202 DOI: 10.3748/wjg.v22.i25.5642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/02/2016] [Accepted: 05/23/2016] [Indexed: 02/06/2023] Open
Abstract
Patients with inflammatory bowel disease are known to have a high demand of recurrent evaluation for therapy and disease activity. Further, the risk of developing cancer during the disease progression is increasing from year to year. New, mostly non-radiant, quick to perform and quantitative methods are challenging, conventional endoscopy with biopsy as gold standard. Especially, new physical imaging approaches utilizing light and sound waves have facilitated the development of advanced functional and molecular modalities. Besides these advantages they hold the promise to predict personalized therapeutic responses and to spare frequent invasive procedures. Within this article we highlight their potential for initial diagnosis, assessment of disease activity and surveillance of cancer development in established techniques and recent advances such as wide-view full-spectrum endoscopy, chromoendoscopy, autofluorescence endoscopy, endocytoscopy, confocal laser endoscopy, multiphoton endoscopy, molecular imaging endoscopy, B-mode and Doppler ultrasound, contrast-enhanced ultrasound, ultrasound molecular imaging, and elastography.
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Chiorean L, Caraiani C, Radziņa M, Jedrzejczyk M, Schreiber-Dietrich D, Dietrich CF. Vascular phases in imaging and their role in focal liver lesions assessment. Clin Hemorheol Microcirc 2016; 62:299-326. [PMID: 26444602 DOI: 10.3233/ch-151971] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Liliana Chiorean
- Med. Klinik 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
- Département d’Imagerie Médicale, Clinique des Cévennes Annonay, France
| | - Cosmin Caraiani
- Department of Radiology and Computed Tomography, “Octavian Fodor” Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania; “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maija Radziņa
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - Maciej Jedrzejczyk
- Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland
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Chiorean L, Tana C, Braden B, Caraiani C, Sparchez Z, Cui XW, Baum U, Dietrich CF. Advantages and Limitations of Focal Liver Lesion Assessment with Ultrasound Contrast Agents: Comments on the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines. Med Princ Pract 2016; 25:399-407. [PMID: 27318740 PMCID: PMC5588445 DOI: 10.1159/000447670] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 06/16/2016] [Indexed: 12/17/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) represents a significant breakthrough in sonography. Due to US contrast agents (UCAs) and contrast-specific techniques, sonography offers the potential to show enhancement of liver lesions in a similar way as contrast-enhanced cross-sectional imaging techniques. The real-time assessment of liver perfusion throughout the vascular phases, without any risk of nephrotoxicity, represents one of the major advantages that this technique offers. CEUS has led to a dramatic improvement in the diagnostic accuracy of US and subsequently has been included in current guidelines as an important step in the diagnostic workup of focal liver lesions (FLLs), resulting in a better patient management and cost-effective therapy. The purpose of this review was to provide a detailed description of contrast agents used in different cross-sectional imaging procedures for the study of FLLs, focusing on characteristics, indications and advantages of UCAs in clinical practice.
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Affiliation(s)
- Liliana Chiorean
- Department of Internal Medicine, Wuhan, China
- Department of Medical Imaging, des Cévennes Clinic, Annonay, France
| | - Claudio Tana
- Department of Internal Medicine Unit, Guastalla Hospital, AUSL Reggio Emilia, Guastalla, Italy
| | - Barbara Braden
- Department of Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | - Cosmin Caraiani
- Department of Radiology and Computed Tomography, Wuhan, China
| | - Zeno Sparchez
- Department of Gastroenterology, ‘Octavian Fodor’ Institute of Gastroenterology and Hepatology and ‘Iuliu Haţieganu’ University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Xin-Wu Cui
- Department of Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ulrich Baum
- Department of Radiology, Caritas Hospital, Bad Mergentheim, Germany
| | - Christoph F. Dietrich
- Department of Internal Medicine, Wuhan, China
- *Prof. Dr. med. Christoph F. Dietrich, Innere Medizin 2, Caritas Krankenhaus, Uhlandstrasse 7, DE—97980 Bad Mergentheim (Germany), E-Mail
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Nolsøe CP, Lorentzen T. International guidelines for contrast-enhanced ultrasonography: ultrasound imaging in the new millennium. Ultrasonography 2015; 35:89-103. [PMID: 26867761 PMCID: PMC4825210 DOI: 10.14366/usg.15057] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 12/12/2022] Open
Abstract
The intent of this review is to discuss and comment on common clinical scenarios in which contrast-enhanced ultrasonography (CEUS) may play a decisive role and to illustrate important points with typical cases. With the advent of CEUS, the scope of indications for ultrasonography has been dramatically extended, and now includes functional imaging and tissue characterization, which in many cases enable tumor diagnosis without a biopsy. It is virtually impossible to imagine the practice of modern medicine as we know it in high-income countries without the use of imaging, and yet, an estimated two thirds of the global population may receive no such care. Ultrasound imaging with CEUS has the potential to correct this inequity.
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Affiliation(s)
- Christian Pállson Nolsøe
- Ultrasound Section, Department of Gastric Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Torben Lorentzen
- Ultrasound Section, Department of Gastric Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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Chiorean L, Cantisani V, Jenssen C, Sidhu P, Baum U, Dietrich C. Focal masses in a non-cirrhotic liver: The additional benefit of CEUS over baseline imaging. Eur J Radiol 2015; 84:1636-43. [PMID: 26049958 DOI: 10.1016/j.ejrad.2015.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/16/2015] [Accepted: 05/02/2015] [Indexed: 02/07/2023]
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Skoczylas K, Pawełas A. Ultrasound imaging of the liver and bile ducts - expectations of a clinician. J Ultrason 2015; 15:292-306. [PMID: 26673784 PMCID: PMC4657394 DOI: 10.15557/jou.2015.0026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/25/2015] [Accepted: 08/03/2015] [Indexed: 12/12/2022] Open
Abstract
Since diseases of the liver and bile ducts are common, a clinician is faced by the need to implement an appropriate diagnostic process. It is necessary to apply diagnostic methods that enable appropriate assessment of the most common pathologies of the liver, i.e. fibrosis, steatosis and focal lesions, as well as initial assessment of the bile ducts. These goals can be achieved using ultrasound methods based on conventional sonography, contrast-enhanced sonography and elastography. The assessment of fatty liver and bile duct dilatation using ultrasound reaches satisfactory levels of sensitivity and specificity. The usage of contrast agents enables unambiguous differentiation between benign and malignant focal lesions, frequently allowing them to be identified accurately without the assistance of other imaging modalities. Elastography has enabled reliable assessment of liver fibrosis. Its results are comparable to those of the standard method, i.e. liver biopsy.
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Affiliation(s)
- Krzysztof Skoczylas
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Institute of Oncology, Warsaw, Poland
| | - Andrzej Pawełas
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Institute of Oncology, Warsaw, Poland
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Shen ZY, Xia GL, Wu MF, Shi MX, Qiang FL, Shen E, Hu B. The effects of low-frequency ultrasound and microbubbles on rabbit hepatic tumors. Exp Biol Med (Maywood) 2015; 239:747-57. [PMID: 24719377 DOI: 10.1177/1535370214525320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
High-intensity focused ultrasound in combination with microbubbles (MBs) is able to inhibit the growth of VX2 rabbit liver tumors in vivo and prolong the survival time of the animals. In this study, we attempt to investigate the feasibility of VX2 tumor growth inhibition using low-frequency ultrasound (US)-mediated MB disruption. Forty-eight New Zealand rabbits with hepatic VX2 tumors were divided into four groups: control, MBs group, low-frequency US group, and US + MB group. The parameters of the US were 20 kHz, 2 W/cm², 40% duty cycle, 5 min, and once every other day for 2 weeks. At the end of the therapy experiment, 24 rabbits were euthanized, and the cancers were collected and cut into five sections for histological examination, immunohistochemistry, laser confocal microscopy, western blotting assays, and transmission electron microscopy (TEM). Another 24 rabbits were saved, and overall survival time was recorded. The tumor volumes in control, MB, US, and US + MB groups were 6.36 ± 0.58, 5.68 ± 0.42, 5.29 ± 0.26, and 2.04 ± 0.14 cm³, respectively (US + MB versus the other three groups, P < 0.01). Tumor cells manifested coagulation necrosis with internal calcification. Hematoxylin and eosin (H–E) staining revealed interstitial hemorrhage and intravascular thrombosis. The intensity of cyclooxygenase-2 (COX-2), and vascular endothelial growth factor (VEGF) in the US + MB group in the immunohistochemical staining, laser confocal microscopy, and western blotting assays was lower than that of the other three groups (P < 0.05). TEM of the US + MB group revealed vascular endothelial cell wall rupture, widened endothelial cell gaps, interstitial erythrocyte leakage, and microvascular thrombosis, while intact vascular endothelial cells and normal erythrocytes in the tumor vessels were observed in control, MB, and US groups. Rabbits treated with US + MB had a significantly longer overall survival than those in the other three groups (χ2 = 9.328, P = 0.0242). VX2 tumor growth could be inhibited by cavitation induced using low-frequency US and MB.
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Chou R, Cuevas C, Fu R, Devine B, Wasson N, Ginsburg A, Zakher B, Pappas M, Graham E, Sullivan SD. Imaging Techniques for the Diagnosis of Hepatocellular Carcinoma: A Systematic Review and Meta-analysis. Ann Intern Med 2015; 162:697-711. [PMID: 25984845 DOI: 10.7326/m14-2509] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Several imaging modalities are available for diagnosis of hepatocellular carcinoma (HCC). PURPOSE To evaluate the test performance of imaging modalities for HCC. DATA SOURCES MEDLINE (1998 to December 2014), the Cochrane Library Database, Scopus, and reference lists. STUDY SELECTION Studies on test performance of ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI). DATA EXTRACTION One investigator abstracted data, and a second investigator confirmed them; 2 investigators independently assessed study quality and strength of evidence. DATA SYNTHESIS Few studies have evaluated imaging for HCC in surveillance settings. In nonsurveillance settings, sensitivity for detection of HCC lesions was lower for ultrasonography without contrast than for CT or MRI (pooled difference based on direct comparisons, 0.11 to 0.22), and MRI was associated with higher sensitivity than CT (pooled difference, 0.09 [95% CI, 0.07 to 12]). For evaluation of focal liver lesions, there were no clear differences in sensitivity among ultrasonography with contrast, CT, and MRI. Specificity was generally 0.85 or higher across imaging modalities, but this item was not reported in many studies. Factors associated with lower sensitivity included use of an explanted liver reference standard, and smaller or more well-differentiated HCC lesions. For MRI, sensitivity was slightly higher for hepatic-specific than nonspecific contrast agents. LIMITATIONS Only English-language articles were included, there was statistical heterogeneity in pooled analyses, and costs were not assessed. Most studies were conducted in Asia and had methodological limitations. CONCLUSION CT and MRI are associated with higher sensitivity than ultrasonography without contrast for detection of HCC; sensitivity was higher for MRI than CT. For evaluation of focal liver lesions, the sensitivities of ultrasonography with contrast, CT, and MRI for HCC are similar. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality. ( PROSPERO CRD42014007016).
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Affiliation(s)
- Roger Chou
- From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon; University of Washington Centers for Comparative and Health Systems Effectiveness (CHASE) Alliance, Seattle, Washington; and Mayo Medical School, Rochester, Minnesota
| | - Carlos Cuevas
- From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon; University of Washington Centers for Comparative and Health Systems Effectiveness (CHASE) Alliance, Seattle, Washington; and Mayo Medical School, Rochester, Minnesota
| | - Rongwei Fu
- From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon; University of Washington Centers for Comparative and Health Systems Effectiveness (CHASE) Alliance, Seattle, Washington; and Mayo Medical School, Rochester, Minnesota
| | - Beth Devine
- From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon; University of Washington Centers for Comparative and Health Systems Effectiveness (CHASE) Alliance, Seattle, Washington; and Mayo Medical School, Rochester, Minnesota
| | - Ngoc Wasson
- From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon; University of Washington Centers for Comparative and Health Systems Effectiveness (CHASE) Alliance, Seattle, Washington; and Mayo Medical School, Rochester, Minnesota
| | - Alexander Ginsburg
- From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon; University of Washington Centers for Comparative and Health Systems Effectiveness (CHASE) Alliance, Seattle, Washington; and Mayo Medical School, Rochester, Minnesota
| | - Bernadette Zakher
- From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon; University of Washington Centers for Comparative and Health Systems Effectiveness (CHASE) Alliance, Seattle, Washington; and Mayo Medical School, Rochester, Minnesota
| | - Miranda Pappas
- From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon; University of Washington Centers for Comparative and Health Systems Effectiveness (CHASE) Alliance, Seattle, Washington; and Mayo Medical School, Rochester, Minnesota
| | - Elaine Graham
- From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon; University of Washington Centers for Comparative and Health Systems Effectiveness (CHASE) Alliance, Seattle, Washington; and Mayo Medical School, Rochester, Minnesota
| | - Sean D. Sullivan
- From Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon; University of Washington Centers for Comparative and Health Systems Effectiveness (CHASE) Alliance, Seattle, Washington; and Mayo Medical School, Rochester, Minnesota
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Shi JH, Line PD. Effect of liver regeneration on malignant hepatic tumors. World J Gastroenterol 2014; 20:16167-16177. [PMID: 25473170 PMCID: PMC4239504 DOI: 10.3748/wjg.v20.i43.16167] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/05/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023] Open
Abstract
Liver regeneration after major surgery may activate occult micrometastases and facilitate tumor growth, leading to liver tumor recurrence. Molecular changes during liver regeneration can provide a microenvironment that stimulates intrahepatic tumor propagation through alterations in cellular signaling pathways, where activation and proliferation of mature hepatocytes, hepatic progenitor cells, non-parenchymal liver cells might favor both liver regeneration and tumor growth. This review highlights recent advances of tumor growth and development in the regenerating liver, possible mechanisms and clinical implications.
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Hepatosplenic sarcoidosis: contrast-enhanced ultrasound findings and implications for clinical practice. BIOMED RESEARCH INTERNATIONAL 2014; 2014:926203. [PMID: 25215299 PMCID: PMC4151864 DOI: 10.1155/2014/926203] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 07/17/2014] [Indexed: 12/14/2022]
Abstract
Sarcoidosis is a complex granulomatous disease that affects virtually every organ and tissue, with a prevalence that varies significantly among the sites involved. The role of conventional imaging, such as computed tomography and magnetic resonance imaging, in the assessment of hepatosplenic sarcoidosis is well established by revealing organ enlargement, multiple discrete nodules, and lymphadenopathy. In this review, we aim to describe contrast-enhanced ultrasound (CEUS) findings in liver and spleen involvement by sarcoidosis, reporting evidence from the literature and cases from our experience, after a brief update on safety profile, cost-effectiveness, and clinical indications of this novel technique. Furthermore, we highlight potential advantages of CEUS in assessing hepatosplenic sarcoidosis that may be useful in the clinical practice.
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Alunni-Fabbroni M, Müller V, Fehm T, Janni W, Rack B. Monitoring in metastatic breast cancer: is imaging outdated in the era of circulating tumor cells? ACTA ACUST UNITED AC 2014; 9:16-21. [PMID: 24803882 DOI: 10.1159/000360438] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In clinical practice imaging technologies such as computed tomography (CT), positron emission tomography (PET)/CT and magnetic resonance imaging (MRI) are well-established methods for monitoring metastatic breast cancer (MBC) patients and for assessing therapeutic efficacy. However, several weeks of treatment are required before these technologies can offer any reliable information on effective disease regression, and, in the meanwhile, the patients are exposed to potentially unnecessary therapy. Circulating tumor cells (CTCs) have been shown to be powerful prognostic and predictive markers and provide clinicians with valuable information. However, in one clinical trial, an early change of chemotherapy based on CTC detection did not result in improved survival. Currently, CTC detection outside clinical trials should be limited to selected clinical situations, i.e. increased treatment toxicity or as risk estimation.
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Affiliation(s)
| | - Volkmar Müller
- Clinic for Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Germany
| | - Tanja Fehm
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Wolfgang Janni
- Clinic for Gynecology and Obstetrics, University Hospital Ulm, Germany
| | - Brigitte Rack
- Clinic for Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Germany
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Zhang P, Zhou P, Tian SM, Qian Y, Li JL, Li RZ. Diagnostic performance of contrast-enhanced sonography and acoustic radiation force impulse imaging in solid liver lesions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:205-214. [PMID: 24449722 DOI: 10.7863/ultra.33.2.205] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the diagnostic performance of contrast-enhanced sonography and acoustic radiation force impulse imaging (ARFI) in differential diagnosis of benign and malignant liver lesions. METHODS A total of 156 patients with liver lesions were included in the study. The images from conventional sonography and contrast-enhanced sonography and the shear wave velocity values of the liver lesions were obtained. The diagnostic performance of conventional sonography, contrast-enhanced sonography, and ARFI was assessed by using pathologic examination (needle biopsy or surgery) or clinical imaging inspection as the reference standard. RESULTS The sensitivity and specificity of conventional sonography for malignant liver lesions were 57.1% and 43.1%, respectively, and the sensitivity and specificity of ARFI were 81.3% and 74.1%. When using contrast-enhanced sonography for the diagnosis of malignant liver lesions, the sensitivity and specificity were 92.9% and 89.7%. The sensitivity and specificity of contrast-enhanced sonography were significantly higher than those of ARFI and conventional sonography (P < .05). CONCLUSIONS The differential diagnostic performance of contrast-enhanced sonography is most predictive of malignant liver lesions. Contrast-enhanced sonography and ARFI have complementary effects in the differential diagnosis of benign and malignant liver lesions.
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Affiliation(s)
- Ping Zhang
- Department of Ultrasound, Third Xiangya Hospital, Central South University, 410013 Changsha, Hunan, China.
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Dietrich CF, Sharma M, Gibson RN, Schreiber-Dietrich D, Jenssen C. Fortuitously discovered liver lesions. World J Gastroenterol 2013; 19:3173-3188. [PMID: 23745019 PMCID: PMC3671069 DOI: 10.3748/wjg.v19.i21.3173] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/28/2013] [Indexed: 02/06/2023] Open
Abstract
The fortuitously discovered liver lesion is a common problem. Consensus might be expected in terms of its work-up, and yet there is none. This stems in part from the fact that there is no preventive campaign involving the early detection of liver tumors other than for patients with known liver cirrhosis and oncological patients. The work-up (detection and differential diagnosis) of liver tumors comprises theoretical considerations, history, physical examination, laboratory tests, standard ultrasound, Doppler ultrasound techniques, contrast-enhanced ultrasound (CEUS), computed tomography and magnetic resonance imaging, as well as image-guided biopsy. CEUS techniques have proved to be the most pertinent method; these techniques became part of the clinical routine about 10 years ago in Europe and Asia and are used for a variety of indications in daily clinical practice. CEUS is in many cases the first and also decisive technical intervention for detecting and characterizing liver tumors. This development is reflected in many CEUS guidelines, e.g., in the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines 2004, 2008 and 2012 as well as the recently published World Federation for Ultrasound in Medicine and Biology-EFSUMB guidelines 2012. This article sets out considerations for making a structured work-up of incidental liver tumors feasible.
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Wang W, Chen LD, Lu MD, Liu GJ, Shen SL, Xu ZF, Xie XY, Wang Y, Zhou LY. Contrast-enhanced ultrasound features of histologically proven focal nodular hyperplasia: diagnostic performance compared with contrast-enhanced CT. Eur Radiol 2013; 23:2546-54. [PMID: 23624595 DOI: 10.1007/s00330-013-2849-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 02/18/2013] [Accepted: 03/01/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To investigate and compare contrast-enhanced ultrasound (CEUS) in the characterisation of histologically proven focal nodular hyperplasia (FNH) with contrast-enhanced computed tomography (CECT). METHODS CEUS was performed in 85 patients with 85 histologically proven FNHs. Enhancement, centrifugal filling, spoke-wheel arteries, feeding artery and central scarring were reviewed and correlated with lesion size or liver background. Independent factors for predicting FNH from other focal liver lesions (FLLs) were evaluated. Forty-seven FLLs with CECT were randomly selected for comparison of diagnostic performance with CEUS. RESULTS Centrifugal filling was more common (P = 0.002) and the significant predictor (P = 0.003) in FNHs ≤3 cm. Lesion size or liver background has no significant influence on the detection rate of the spoke-wheel arteries and feeding artery (P > 0.05). Central scarring was found in 42.6 % of FNHs ≥3 cm (P = 0.000). The area under the ROC curve, sensitivity and specificity showed no significant differences between CEUS and CECT (P > 0.05), except that the sensitivity of CEUS was better for reader 1 (P = 0.041). CONCLUSION CEUS is valuable in characterising centrifugal filling signs or spoke wheels in small FNHs and should be employed as the first-line imaging technique for diagnosis of FNH. KEY POINTS • The confident diagnosis of focal nodular hyperplasia is important in liver imaging. • The centrifugal filling sign is useful for diagnosis of FNHs ≤3 cm. • Contrast-enhanced ultrasound and contrast-enhanced CT have similar diagnostic performance for FNH. • CEUS should be the first-line imaging technique for the diagnosis of FNH.
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Affiliation(s)
- Wei Wang
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, NO.58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
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Vascularisation pattern of chronic pancreatitis compared with pancreatic carcinoma: results from contrast-enhanced endoscopic ultrasound. Int J Inflam 2012; 2012:420787. [PMID: 22844642 PMCID: PMC3400364 DOI: 10.1155/2012/420787] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 04/14/2012] [Accepted: 05/22/2012] [Indexed: 12/14/2022] Open
Abstract
Discriminating between focal chronic pancreatitis and pancreatic cancer is always a challenge in clinical medicine. Contrast-enhanced endoscopic ultrasound using Doppler techniques can uniquely reveal different vascularisation patterns in pancreatic tissue alterated by chronic inflammatory processes and even allows a discrimination from pancreatic cancer. This paper will describe the basics of contrast-enhanced high mechanical index endoscopic ultrasound (CEHMI EUS) and contrast enhanced low mechanical index endoscopic ultrasound (CELMI EUS) and explain the pathophysiological differences of the vascularisation of chronic pancreatitis and pancreatic carcinoma. Furthermore it will discuss how to use these techniques in daily clinical practice.
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