Hepatic parenchymal hemodynamics of cholangitis with portal trunk thrombus using contrast-enhanced ultrasonography with Sonazoid: delineation of so-called central and peripheral zonal differentiation by arrival-time parametric imaging

Current Developments and Role of Intestinal Ultrasound including the Advent of AI

Intestinal ultrasound is a non-invasive, safe, and cost-effective technique to study the small and large intestines. In addition to conventional B-mode and color doppler imaging, new US tools have been developed in more recent years that provide auxiliary data on many GI conditions, improving the diagnosis and assessment of relevant outcomes. We have reviewed the more recent literature (from 2010 onwards) on auxiliary tools in bowel ultrasound such as elastography techniques, CEUS, SICUS, and the potential contribution by artificial intelligence (AI) to overcome current intestinal ultrasound limitations. For this scoping review, we performed an extensive literature search on PubMed and EMBASE to identify studies published until December 2023 and investigating the application of elastography techniques, CEUS, SICUS, and AI in the ultrasonographic assessment of the small and large intestines. Multiparametric intestinal ultrasound shows promising capabilities in Crohn's disease, while less is known about the role in ulcerative colitis. Despite some evidence, the CEUS role as a point-of-care examination tool for rare conditions such as intestinal GvHD and ischemic small bowel disease seems promising, possibly avoiding the need to perform further cross-sectional imaging. The use of AI in intestinal ultrasound is still anecdotical and limited to acute appendicitis.

Differentiation of atypical hepatic hemangioma from liver metastases: Diagnostic performance of a novel type of color contrast enhanced ultrasound

BACKGROUND

In clinical practice, the diagnosis is sometimes difficult with contrast-enhanced ultrasound (CEUS) when the case has an atypical perfusion pattern. Color parametric imaging (CPI) is an analysis software for CEUS with better detection of temporal differences in CEUS imaging using arbitrary colors. It measures the differences in arrival time of the contrast agent in lesions so that the perfusion features of atypical hemangioma and colorectal cancer (CRC) liver metastasis can be distinguished.

AIM

To evaluate the role of a novel type of CPI of CEUS in the differential diagnosis of atypical hemangioma from liver metastases in patients with a history of CRC.

METHODS

From January 2016 to July 2018, 42 patients including 20 cases of atypical hemangioma and 22 cases of liver metastases from CRC were enrolled. These patients had a mean age of 60.5 ± 9.3 years (range: 39-75 years). All patients received ultrasound, CEUS and CPI examinations. Resident and staff radiologists independently and retrospectively reviewed CEUS and CPI images. Two sets of criteria were assigned: (1) Routine CEUS alone; and (2) CEUS and CPI. The diagnostic sensitivity, specificity, accuracy and receiver operating characteristic (ROC) curve of resident and staff radiologists were analyzed.

RESULTS

The following CPI features were significantly different between liver hemangioma and liver metastases analyzed by staff and resident radiologists: Peripheral nodular enhancement (65%-70.0% vs 4.5%-13.6%, P < 0.001, P = 0.001), mosaic/chaotic enhancement (5%-10% vs 68.2%-63.6%, P < 0.001, P < 0.001) and feeding artery (20% vs 59.1%-54.5%, P = 0.010, P = 0.021). CPI imaging offered significant improvements in detection rates compared with routine CEUS in both resident and staff groups. By resident radiologists, the specificity and accuracy of CEUS+CPI were significantly increased compared with that of CEUS (77.3% vs 45.5%, P = 0.030; 78.6% vs 50.0%, P = 0.006). In addition, the area under the curve (AUC) of CEUS+CPI was significantly higher than that of CEUS (0.803 vs 0.757, P = 0.036). By staff radiologists, accuracy was improved in CEUS+CPI (81.0% vs 54.8%, P = 0.010), whereas no significant differences in specificity and sensitivity were found (P = 0.144, P = 0.112). The AUC of CEUS+CPI was significantly higher than that of CEUS (0.890 vs 0.825, P = 0.013) by staff radiologists.

CONCLUSION

Compared with routine CEUS, CPI could provide specific information on the hemodynamic features of liver lesions and help to differentiate atypical hemangioma from liver metastases in patients with CRC, even for senior radiologists.