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Menichelli C, Casamassima F, Aristei C, Ingrosso G, Borghesi S, Arcidiacono F, Lancellotta V, Franzese C, Arcangeli S. Stereotactic radiotherapy for liver oligometastases. Rep Pract Oncol Radiother 2022; 27:32-39. [PMID: 35402041 PMCID: PMC8989451 DOI: 10.5603/rpor.a2021.0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/14/2021] [Indexed: 11/25/2022] Open
Abstract
The liver is the first metastatic site in 15–25% of colorectal cancer patients and one of the first metastatic sites for lung and breast cancer patients. A computed tomography (CT ) scan with contrast medium is a standard procedure for assessing liver lesions but magnetic resonance imaging (MRI) characterizes small lesions better thanks to its high soft-tissue contrast. Positron emission tomography with computed tomography (PET-CT ) plays a complementary role in the diagnosis of liver metastases. Triphasic (arterial, venous and time-delayed) acquisition of contrast-medium CT images is the first step in treatment planning. Since the liver exhibits a relatively wide mobility due to respiratory movements and bowel filling, appropriate techniques are needed for target identification and motion management. Contouring requires precise recognition of target lesion edges. Information from contrast MRI and/or PET-CT is crucial as they best visualize metastatic disease in the parenchyma. Even though different fractionation schedules were reported, doses and fractionation schedules for liver stereotactic radiotherapy (SRT ) have not yet been established. The best local control rates were obtained with BED10 values over 100 Gy. Local control rates from most retrospective studies, which were limited by short follow-ups and included different primary tumors with intrinsic heterogeneity, ranged from 60% to 90% at 1 and 2 years. The most common SRT-related toxicities are increases in liver enzymes, hyperbilirubinemia and hypoalbuminemia. Overall, late toxicity is mild even in long-term follow-ups.
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Affiliation(s)
| | | | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | - Gianluca Ingrosso
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | - Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Italy
| | | | - Valentina Lancellotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italy
| | - Ciro Franzese
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital - IRCCS, Rozzano, Milan, Italy
| | - Stefano Arcangeli
- Department of Radiation Oncology, Policlinico S. Gerardo and University of Milan Bicocca, Milan, Italy
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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: 106] [Impact Index Per Article: 26.5] [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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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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Contrast-enhanced intra-operative ultrasound as a clinical decision making tool during surgery for colorectal liver metastases: The ULIIS study. Eur J Surg Oncol 2019; 45:1212-1218. [DOI: 10.1016/j.ejso.2019.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 02/07/2023] Open
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Hwang JA, Kim YK, Min JH, Song KD, Sohn I, Ahn HS. Non-contrast liver MRI as an alternative to gadoxetic acid-enhanced MRI for liver metastasis from colorectal cancer. Acta Radiol 2019; 60:441-450. [PMID: 30130970 DOI: 10.1177/0284185118788901] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Liver magnetic resonance imaging (MRI) provides reliable diagnostic performance for detecting liver metastasis but is costly and time-consuming. PURPOSE To compare the diagnostic performance of non-contrast liver MRI to whole MRI using gadoxetic acid for detecting liver metastasis in patients with colorectal cancer (CRC). MATERIAL AND METHODS We included 175 patients with histologically confirmed 401 liver metastases and 73 benign liver lesions. A non-contrast MRI (T1-weighted, T2-weighted, and diffusion-weighted images) with or without multidetector computed tomography (MDCT) and a whole MRI (gadoxetic acid-enhanced and non-contrast MRI) were analyzed independently by two observers to detect liver metastasis using receiver operating characteristic analysis. RESULTS We found no significant differences in Az value (range = 0.914-0.997), sensitivity (range = 95.2-99.6%), specificity (range = 77.3-100%), or positive (range = 92.9-100%) or negative predictive value (range = 87.5-95.7%) between the non-contrast MRI with or without MDCT and the whole MRI for both observers for all lesions as well as lesions ≤1.0 cm and lesions >1.0 cm in size ( P = 0.203-1.000). Combined MDCT and non-contrast MRI led to similar numbers of false-positive diagnosis to the whole MRI (eight for Observers 1 and 4 vs. 3 for Observer 2). CONCLUSION Non-contrast liver MRI may serve as an alternative to gadoxetic acid-enhanced MRI for detecting and characterizing liver metastasis from CRC, at least in patients with relatively high risk of liver metastasis who underwent MDCT. Non-contrast liver MRI could be beneficial especially for patients with lesions that are already documented as benign but require additional follow-up MRIs.
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Affiliation(s)
- Jeong Ah Hwang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan hospital, Cheonan, Republic of Korea
| | - Young Kon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Radiology, Chungnam National University Hospital, Chungnam National University of College of Medicine, Daejeon, Republic of Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Insuk Sohn
- Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyeon Seon Ahn
- Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea
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6
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Improved imaging of colorectal liver metastases using single-source, fast kVp-switching, dual-energy CT: preliminary results. Pol J Radiol 2019; 83:e643-e649. [PMID: 30800204 PMCID: PMC6384510 DOI: 10.5114/pjr.2018.80347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 11/05/2018] [Indexed: 12/03/2022] Open
Abstract
Purpose Computed tomography remains the first-choice modality for assessment of colorectal cancer liver metastases (CRLM). Dual-energy computed tomography (DECT) is a relatively new technique that is becoming increasingly available. One of the advantages of DECT is the ability to maximise iodine detection. Our aim was to test whether single-source, fast kVp-switching DECT can improve imaging quality of CRLM compared to conventional (polychromatic) CT. Material and methods Twenty consecutive patients were enrolled into a preliminary prospective study. The scanning protocol consisted of four phases: non-contrast with standard 120 kV tube voltage and three post-contrast phases with rapid voltage switching. As a result, three sets of images were reconstructed: pre- and postcontrast polychromatic (PR), monochromatic (MR), and iodine concentration map (IM). To compare the sensitivity of the tested reconstructions, the number of CRLMs and the maximum diameter of the largest lesion were calculated. Objective image quality was measured as signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). The radiation dose was expressed as CTDIvol. Results Imaging was successfully performed in all patients. The number of detected lesions was significantly lower on PR images than on IM and MR 50-70 keV (mean number: 4.20 and 4.45, respectively). IM and MR at 70 keV presented the highest quality. SNR was significantly higher for IM and 70 keV images than for other reconstructions. The mean radiation dose was 14.61 mGy for non-contrast 120 kV scan and 17.89 mGy for single DECT scan (p < 0.05). Conclusions DECT is a promising tool for CRLM imaging. IM and low-photon energy MR present the highest differences in contrast between metastases and the normal liver parenchyma.
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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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8
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Quaia E, Gennari AG. The Most Appropriate Time Delay after Microbubble Contrast Agent Intravenous Injection to Maximize Liver Metastasis Conspicuity on Contrast-Enhanced Ultrasound. J Med Ultrasound 2018; 26:128-133. [PMID: 30283198 PMCID: PMC6159328 DOI: 10.4103/jmu.jmu_12_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/09/2017] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To identify the most appropriate time delay after microbubble contrast agent injection to maximize liver metastasis conspicuity on contrast-enhanced ultrasound (CEUS). METHODS Twenty-five consecutive patients (12 male and 13 female; age: 50 ± 13 years) with a known primary tumor and evidence of liver metastases on unenhanced ultrasound (US) underwent CEUS. CEUS consisted of continuous liver parenchyma scanning during arterial (15-35 s after microbubble injection), portal venous (40-120 s), and late phase (from 120 s up to microbubble disappearance). Subjective conspicuity index (ranging from 1 to 5) and objective conspicuity index (Ilesion-Iliver/Iliver, I = signal intensity) were calculated on reference frames selected on arterial phase and every 20 s on portal venous and late phase. RESULTS A total number of 40 liver metastases were identified after microbubble injection. The highest liver metastasis conspicuity was observed on early portal venous phase (40-60 s after microbubble injection) both on visual (mean subjective conspicuity index ± standard deviation [SD] = 4.36 ± 0.75, reader 1; 4.25 ± 0.65, reader 2) and quantitative analysis (mean objective conspicuity index ± SD = -0.99 ± 0.001). CONCLUSION The early portal venous phase (40-60 s after microbubble injection) provides the best liver metastases' conspicuity after microbubble contrast agent injection.
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Affiliation(s)
- Emilio Quaia
- Department of Radiology, Edinburgh Imaging Facility Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK
- Address for correspondence: Dr. Emilio Quaia, Edinburgh Imaging Facility Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, Scotland, UK. E-mail:
| | - Antonio Giulio Gennari
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy
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9
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Wang Y, Nie F, Liu T, Yang D, Li Q, Li J, Song A. Revised Value of Contrast-Enhanced Ultrasound for Solid Hypo-Echoic Thyroid Nodules Graded with the Thyroid Imaging Reporting and Data System. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:930-940. [PMID: 29472113 DOI: 10.1016/j.ultrasmedbio.2017.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 10/26/2017] [Accepted: 12/21/2017] [Indexed: 06/08/2023]
Abstract
The use of ultrasound in differentiation of benign and malignant solid hypo-echoic thyroid nodules is a dilemma in clinical practice. The aim of this study was to investigate the revised value of contrast-enhanced ultrasound (CEUS) for differentiating solid hypo-echoic thyroid nodules using the Thyroid Imaging Reporting and Data System (TI-RADS).The study included 135 patients with 135 nodules confirmed by fine-needle aspiration and/or surgery. Every nodule underwent both conventional US and CEUS. Binary logistic regression analysis for conventional US features revealed that irregular shape, microcalcification and height greater than width were significant malignant predictive features. Binary logistic analysis for CEUS features indicated that hetero-enhancement, slow wash-in, an ill-defined enhancement border and fast wash-out were significantly associated with malignancy. The areas under the curve of the TI-RADS, CEUS and the combination were 0.806, 0.934 and 0.950, respectively. CEUS is a potentially useful tool in the differentiation of solid hypo-echoic thyroid nodules.
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Affiliation(s)
- YanFang Wang
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Fang Nie
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
| | - Ting Liu
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Dan Yang
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Qi Li
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Jing Li
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - AiLing Song
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China
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10
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Durot I, Wilson SR, Willmann JK. Contrast-enhanced ultrasound of malignant liver lesions. Abdom Radiol (NY) 2018; 43:819-847. [PMID: 29094174 DOI: 10.1007/s00261-017-1360-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) is a safe, relatively inexpensive, and widely available imaging technique using dedicated imaging ultrasound sequences and FDA-approved contrast microbubbles that allow detection and characterization of malignant focal liver lesions with high diagnostic accuracy. CEUS provides dynamic real-time imaging with high spatial and temporal capability, allowing for unique contributions to the already established protocols for diagnosing focal liver lesions using CT and MR imaging. In patients with lesions indeterminate on CT and MRI, CEUS is a helpful problem-solving complementary tool that improves patient management. Furthermore, CEUS assists guidance of liver biopsies and local treatment. Variations of CEUS such as DCE-US and ultrasound molecular imaging are emerging for quantitative monitoring of treatment effects and possible earlier detection of cancer. In this review, basic principles of CEUS techniques and ultrasound contrast agents along with a description of the enhancement patterns of malignant liver lesions are summarized. Also, a discussion of the role of CEUS for treatment guidance and monitoring, intraoperative CEUS, and an outlook on emerging applications is provided.
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11
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Kaur H, Hindman NM, Al-Refaie WB, Arif-Tiwari H, Cash BD, Chernyak V, Farrell J, Grajo JR, Horowitz JM, McNamara MM, Noto RB, Qayyum A, Lalani T, Kamel IR. ACR Appropriateness Criteria ® Suspected Liver Metastases. J Am Coll Radiol 2018; 14:S314-S325. [PMID: 28473088 DOI: 10.1016/j.jacr.2017.01.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 12/20/2022]
Abstract
Liver metastases are the most common malignant liver tumors. The accurate and early detection and characterization of liver lesions is the key to successful treatment strategies. Increasingly, surgical resection in combination with chemotherapy is effective in significantly improving survival if all metastases are successfully resected. MRI and multiphase CT are the primary imaging modalities in the assessment of liver metastasis, with the relative preference toward multiphase CT or MRI depending upon the clinical setting (ie, surveillance or presurgical planning). The optimization of imaging parameters is a vital factor in the success of either modality. PET/CT, intraoperative ultrasound are used to supplement CT and MRI. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Harmeet Kaur
- Principal Author, University of Texas, MD Anderson Cancer Center, Houston, Texas.
| | - Nicole M Hindman
- Co-author, New York University Medical Center, New York, New York
| | - Waddah B Al-Refaie
- Georgetown University Hospital, Washington, District of Columbia; American College of Surgeons
| | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | - Brooks D Cash
- University of South Alabama, Mobile, Alabama; American Gastroenterological Association
| | | | - James Farrell
- Interventional Endoscopy and Pancreatic Diseases, New Haven, Connecticut; American Gastroenterological Association
| | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, Florida
| | | | | | - Richard B Noto
- Brown University Rhode Island Hospital, Providence, Rhode Island
| | - Aliya Qayyum
- University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Tasneem Lalani
- Specialty Chair, Inland Imaging Associates and University of Washington, Seattle, Washington
| | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
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12
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Contrast-Enhanced Ultrasound of the Liver: Optimizing Technique and Clinical Applications. AJR Am J Roentgenol 2017; 210:320-332. [PMID: 29220210 DOI: 10.2214/ajr.17.17843] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of this article is to review the general principles, technique, and clinical applications of contrast-enhanced ultrasound of the liver. CONCLUSION Proper technique and optimization of contrast-enhanced ultrasound require a balance between maintaining the integrity of the microbubble contrast agent and preserving the ultrasound signal. Established and emerging applications in the liver include diagnosis of focal lesions, aiding ultrasound-guided intervention, monitoring of therapy, and aiding surgical management.
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13
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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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Ellebæk SB, Fristrup CW, Mortensen MB. Intraoperative Ultrasound as a Screening Modality for the Detection of Liver Metastases during Resection of Primary Colorectal Cancer - A Systematic Review. Ultrasound Int Open 2017; 3:E60-E68. [PMID: 28597000 DOI: 10.1055/s-0043-100503] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/15/2016] [Accepted: 12/18/2016] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common cancer diseases worldwide. One in 4 patients with CRC will have a disseminated disease at the time of diagnosis and often in the form of synchronous liver metastases. Studies suggest that up to 30% of patients have non-recognized hepatic metastases during primary surgery for CRC. Intraoperative ultrasonography examination (IOUS) of the liver to detect liver metastases was considered the gold standard during open CRC surgery. Today laparoscopic surgery is the standard procedure, but laparoscopic ultrasound examination (LUS) is not performed routinely. Aim To perform a systematic review of the test performance of IOUS and LUS regarding the detection of synchronous liver metastases in patients undergoing surgery for primary CRC. Method The literature was systematically reviewed using the search engines: PubMed, Cochrane, Embase and Google. 21 studies were included in the review and the key words: intraoperative ultrasound, laparoscopic ultrasound, staging colon and rectum cancer. Results Intraoperative ultrasound showed a higher sensitivity, specificity, positive predictive value and overall accuracy for the detection liver metastases during surgery for primary CRC, compared to preoperative imaging modalities (ultrasound, computed tomography (CT) and contrast-enhanced computed tomography (CE-CT)). LUS showed a higher detection rate for liver metastases compared to CT, CE-CT and magnetic resonance imaging (MRI). Conclusion This systematic review found that both IOUS and LUS had a higher detection rate regarding liver metastases during primary CRC surgery, especially liver metastases<10 mm in diameter, when compared to US, CT, CE-CT and MRI.
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15
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Yue WW, Wang S, Xu HX, Sun LP, Guo LH, Bo XW, Li XL, Zhao CK, Wang D, Liu BJ. Parametric imaging with contrast-enhanced ultrasound for differentiating hepatocellular carcinoma from metastatic liver cancer. Clin Hemorheol Microcirc 2016; 64:177-188. [PMID: 27258196 DOI: 10.3233/ch-162060] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Wen-Wen Yue
- Department of Medical Ultrasound, Tenth People’s Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Shuo Wang
- Department of Medical Ultrasound, Tenth People’s Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- Department of Ultrasound, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Tenth People’s Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
- State Key Laboratory of High Performance Ceramic and Superfine Microstructures, Shanghai Institute of Ceramics, Chinese Academy of Science, Shanghai, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Tenth People’s Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Tenth People’s Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Wan Bo
- Department of Medical Ultrasound, Tenth People’s Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Tenth People’s Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Tenth People’s Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Dan Wang
- Department of Medical Ultrasound, Tenth People’s Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Bo-Ji Liu
- Department of Medical Ultrasound, Tenth People’s Hospital of Tongji University, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
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Coimbra FJF, Ribeiro HSDC, Marques MC, Herman P, Chojniak R, Kalil AN, Wiermann EG, Cavallero SRDA, Coelho FF, Fernandes PHDS, Silvestrini AA, Almeida MFA, de Araújo ALE, Pitombo M, Teixeira HM, Waechter FL, Ferreira FG, Diniz AL, D'Ippolito G, D'Ippolito G, Begnami MDFDS, Prolla G, Balzan SMP, de Oliveira TB, Szultan LA, Lendoire J, Torres OJM. FIRST BRAZILIAN CONSENSUS ON MULTIMODAL TREATMENT OF COLORECTAL LIVER METASTASES. MODULE 1: PRE-TREATMENT EVALUATION. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 28:222-30. [PMID: 26734788 PMCID: PMC4755170 DOI: 10.1590/s0102-6720201500040002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/11/2015] [Indexed: 02/07/2023]
Abstract
Background : Liver metastases of colorectal cancer are frequent and potentially fatal event
in the evolution of patients with these tumors. Aim : In this module, was contextualized the clinical situations and parameterized
epidemiological data and results of the various treatment modalities established.
Method: Was realized deep discussion on detecting and staging metastatic colorectal
cancer, as well as employment of imaging methods in the evaluation of response to
instituted systemic therapy. Results : The next step was based on the definition of which patients would have their
metastases considered resectable and how to expand the amount of patients elegible
for modalities with curative intent. Conclusion : Were presented clinical, pathological and molecular prognostic factors,
validated to be taken into account in clinical practice.
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Affiliation(s)
| | | | | | - Paulo Herman
- American Hepato-Pancreato-Biliary Association, São Paulo, Brazil
| | - Rubens Chojniak
- American Hepato-Pancreato-Biliary Association, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Marcos Pitombo
- American Hepato-Pancreato-Biliary Association, São Paulo, Brazil
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Wendl C, Janke M, Jung W, Stroszczysnski C, Jung E. Contrast-enhanced ultrasound with perfusion analysis for the identification of malignant and benign tumours of the thyroid gland. Clin Hemorheol Microcirc 2016; 63:113-21. [DOI: 10.3233/ch-151966] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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18
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Preoperative detection of hepatic metastases from colorectal cancer: Prospective comparison of contrast-enhanced ultrasound and multidetector-row computed tomography (MDCT). Diagn Interv Imaging 2016; 97:851-5. [PMID: 27132590 DOI: 10.1016/j.diii.2015.11.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 10/30/2015] [Accepted: 11/05/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE The goal of this study was to prospectively compare the sensitivity of contrast-enhanced ultrasound (CEUS) with that of multiphase multidetector-row computed tomography (MDCT) in the preoperative detection of hepatic metastases. MATERIALS AND METHOD Forty-eight patients, with a mean age of 62years old (range: 43-85years) were prospectively included. All patients underwent CEUS following intravenous administration of 2.4mL of an ultrasound contrast agent (Sonovue(®), Bracco, Milan, Italy) and multiphase MDCT. Intraoperative ultrasound examination (IOUS) was used as the standard of reference. RESULTS A total of 158 liver metastases were identified by IOUS, 127 by preoperative MDCT (sensitivity; 80.4%) and 102 by CEUS (sensitivity, 64.5%). The 15.9% difference in sensitivity between CEUS and MDCT was statistically significant (P=0.002). There was a disagreement between IOUS and CEUS in 23 patients (47%) and in 13 patients (27%) between IOUS and MDCT. MDCT identified one or more additional metastases in 10 patients (20%) resulting in a change in the surgical strategy. CONCLUSION Based on an unselected patient cohort and using multiphase MDCT, CEUS is significantly inferior to MDCT for the preoperative detection of hepatic metastases of colorectal cancer.
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Current Status of Imaging to Evaluate Liver Metastases From Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2015. [DOI: 10.1007/s11888-015-0272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Mainenti PP, Romano F, Pizzuti L, Segreto S, Storto G, Mannelli L, Imbriaco M, Camera L, Maurea S. Non-invasive diagnostic imaging of colorectal liver metastases. World J Radiol 2015; 7:157-169. [PMID: 26217455 PMCID: PMC4506934 DOI: 10.4329/wjr.v7.i7.157] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/10/2015] [Accepted: 06/02/2015] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer is one of the few malignant tumors in which synchronous or metachronous liver metastases [colorectal liver metastases (CRLMs)] may be treated with surgery. It has been demonstrated that resection of CRLMs improves the long-term prognosis. On the other hand, patients with un-resectable CRLMs may benefit from chemotherapy alone or in addition to liver-directed therapies. The choice of the most appropriate therapeutic management of CRLMs depends mostly on the diagnostic imaging. Nowadays, multiple non-invasive imaging modalities are available and those have a pivotal role in the workup of patients with CRLMs. Although extensive research has been performed with regards to the diagnostic performance of ultrasonography, computed tomography, positron emission tomography and magnetic resonance for the detection of CRLMs, the optimal imaging strategies for staging and follow up are still to be established. This largely due to the progressive technological and pharmacological advances which are constantly improving the accuracy of each imaging modality. This review describes the non-invasive imaging approaches of CRLMs reporting the technical features, the clinical indications, the advantages and the potential limitations of each modality, as well as including some information on the development of new imaging modalities, the role of new contrast media and the feasibility of using parametric image analysis as diagnostic marker of presence of CRLMs.
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Meloni MF, Smolock A, Cantisani V, Bezzi M, D'Ambrosio F, Proiti M, Lee F, Aiani L, Calliada F, Ferraioli G. Contrast enhanced ultrasound in the evaluation and percutaneous treatment of hepatic and renal tumors. Eur J Radiol 2015; 84:1666-74. [PMID: 26094868 DOI: 10.1016/j.ejrad.2015.06.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 05/13/2015] [Accepted: 06/03/2015] [Indexed: 12/21/2022]
Abstract
Image-guided percutaneous ablation techniques are increasingly being used for the treatment of malignant tumors of the liver and kidney. Contrast enhanced ultrasound (CEUS) is a real-time dynamic imaging technique that plays an important role in the pre-, intra-, and post-procedural management of these patients. This review will focus on the role of CEUS in the evaluation of patients undergoing treatment with percutaneous ablation for hepatic or renal tumors.
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Affiliation(s)
| | - Amanda Smolock
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Vito Cantisani
- Department of Radiology, Oncology and Anatomo-Pathology "Sapienza" University of Rome, Rome, Italy
| | - Mario Bezzi
- Department of Radiology, Oncology and Anatomo-Pathology "Sapienza" University of Rome, Rome, Italy
| | - Ferdinando D'Ambrosio
- Department of Radiology, Oncology and Anatomo-Pathology "Sapienza" University of Rome, Rome, Italy
| | - Maria Proiti
- Department of Internal Medicine, Vittorio-Emanuele University Hospital, Catania, Italy
| | - Fred Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Luca Aiani
- Department of Radiology, Ospedale Valduce, Como, Italy
| | - Fabrizio Calliada
- Department of Radiology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giovanna Ferraioli
- Ultrasound Unit, Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Chung YE, Kim KW. Contrast-enhanced ultrasonography: advance and current status in abdominal imaging. Ultrasonography 2014; 34:3-18. [PMID: 25342120 PMCID: PMC4282229 DOI: 10.14366/usg.14034] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/10/2014] [Accepted: 09/12/2014] [Indexed: 12/12/2022] Open
Abstract
In the field of contrast-enhanced ultrasonography (US), contrast agents are classified as either first- or second-generation agents depending on the gas within the microbubbles. In the case of first-generation contrast agents, a high-mechanical-index technique is used and only intermittent scanning is possible due to the early destruction of the microbubbles during the scanning. The use of second-generation contrast agents in a low-mechanical-index technique enables continuous scanning. Besides the detection and characterization of focal liver lesions, contrastenhanced US is helpful in the monitoring of radiofrequency ablation therapy and in the targeting step of an US-guided biopsy. Recently, there has been a demand for new criteria to evaluate the treatment response obtained using anti-angiogenic agents because morphologic criteria alone may not reflect the treatment response of the tumor and contrast-enhanced US can provide quantitative markers of tissue perfusion. In spite of the concerns related to its cost-effectiveness, contrast-enhanced US has the potential to be more widely used as a complimentary tool or to substitute the current imaging modalities in some occasions.
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Affiliation(s)
- Yong Eun Chung
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Whang Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Cantisani V, Grazhdani H, Fioravanti C, Rosignuolo M, Calliada F, Messineo D, Bernieri MG, Redler A, Catalano C, D’Ambrosio F. Liver metastases: Contrast-enhanced ultrasound compared with computed tomography and magnetic resonance. World J Gastroenterol 2014; 20:9998-10007. [PMID: 25110428 PMCID: PMC4123379 DOI: 10.3748/wjg.v20.i29.9998] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 11/23/2013] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
The development of ultrasound contrast agents with excellent tolerance and safety profiles has notably improved liver evaluation with ultrasound (US) for several applications, especially for the detection of metastases. In particular, contrast enhanced ultrasonography (CEUS) allows the display of the parenchymal microvasculature, enabling the study and visualization of the enhancement patterns of liver lesions in real time and in a continuous manner in all vascular phases, which is similar to contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging. Clinical studies have reported that the use of a contrast agent enables the visualization of more metastases with significantly improved sensitivity and specificity compared to baseline-US. Furthermore, studies have shown that CEUS yields sensitivities comparable to CT. In this review, we describe the state of the art of CEUS for detecting colorectal liver metastases, the imaging features, the literature reports of metastases in CEUS as well as its technique, its clinical role and its potential applications. Additionally, the updated international consensus panel guidelines are reported in this review with the inherent limitations of this technique and best practice experiences.
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Zheng SG, Xu HX, Liu LN. Management of hepatocellular carcinoma: The role of contrast-enhanced ultrasound. World J Radiol 2014; 6:7-14. [PMID: 24578787 PMCID: PMC3936208 DOI: 10.4329/wjr.v6.i1.7] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 09/09/2013] [Accepted: 11/16/2013] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the sixth most common neoplasm and the third cause of cancer death worldwide. Contrast enhanced ultrasound (CEUS) has been applied for more than ten years and plays increasingly important roles in the management of HCC. On the basis of the Guideline and Good Clinical Practice Recommendations for CEUS in the liver-update 2012 and related literature about the management of HCC, we summarize the main roles and applications of CEUS in the management of HCC, including HCC surveillance, diagnosis, CEUS-guided treatment, treatment response evaluation and follow-up. The diagnostic algorithm for HCC is also suggested. Meanwhile, the comparisons between CEUS and contrast enhanced computed tomography/magnetic resonance imaging (CECT/CEMRI) in these areas are made. Although CEUS is subject to the same limitation as ordinary US and is inferior to CECT/CEMRI in some aspects, CEUS has proved to be of great value in the management of HCC with inherent advantages, such as sufficient high safety profile making it suitable for patients with renal failure or allergic to iodine, absence of radiation, easy reproducibility and high temporal resolution. The tremendous application of CEUS to the diagnosis and treatment of HCC provides more opportunities for patients with HCC diagnosed at different stages.
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Uchino K, Fujisawa M, Watanabe T, Endo Y, Nobuhisa T, Matsumoto Y, Kai K, Sato S, Notohara K, Matsukawa A. Oxaliplatin-induced liver injury mimicking metastatic tumor on images: a case report. Jpn J Clin Oncol 2013; 43:1034-8. [PMID: 23958518 DOI: 10.1093/jjco/hyt113] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Oxaliplatin-based chemotherapy is widely used for advanced colorectal cancer treatment, but it occasionally induces liver injury that is characterized histologically by sinusoidal dilatation, hepatic plate atrophy and/or venular obstruction. Most of the patients do not reveal apparent radiological abnormalities, however. Here, we report the case of a 47-year-old man with a radiologically detectable mass-forming oxaliplatin-induced sinusoidal injury that mimicked multiple liver tumors. These mass lesions were found on computed tomography images after the administration of six cycles of folinic acid, fluorouracil and oxaliplatin therapy as adjuvant chemotherapy for Stage III rectal cancer. The patient had to undergo liver resection because imaging studies could not exclude metastases. The histological examination revealed that a resected mass lesion was composed of severe sinusoidal dilatation. Milder dilatation was also seen in the surrounding parenchyma. We diagnosed the patient as having an oxaliplatin-induced sinusoidal injury with severe deviation. As oxaliplatin is a standard agent in colorectal cancer therapy today, all clinicians and pathologists should be aware of such non-neoplastic lesions as one of the rare differential diagnoses of metastatic liver tumor, to prevent overtreatment.
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Affiliation(s)
- Kaori Uchino
- *Department of Pathology, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji 670-8540, Japan.
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Adams RB, Aloia TA, Loyer E, Pawlik TM, Taouli B, Vauthey JN. Selection for hepatic resection of colorectal liver metastases: expert consensus statement. HPB (Oxford) 2013; 15:91-103. [PMID: 23297719 PMCID: PMC3719914 DOI: 10.1111/j.1477-2574.2012.00557.x] [Citation(s) in RCA: 216] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 07/29/2012] [Indexed: 02/06/2023]
Abstract
Hepatic resection offers a chance of a cure in selected patients with colorectal liver metastases (CLM). To achieve adequate patient selection and curative surgery, (i) precise assessment of the extent of disease, (ii) sensitive criteria for chemotherapy effect, (iii) adequate decision making in surgical indication and (iv) an optimal surgical approach for pre-treated tumours are required. For assessment of the extent of the disease, contrast-enhanced computed tomography (CT) and/or magnetic resonance imaging (MRI) with gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) is recommended depending on the local expertise and availability. Positron emission tomography (PET) and PET/CT may offer additive information in detecting extrahepatic disease. The RECIST criteria are a reasonable method to evaluate the effect of chemotherapy. However, they are imperfect in predicting a pathological response in the era of modern systemic therapy with biological agents. The assessment of radiographical morphological changes is a better surrogate of the pathological response and survival especially in the patients treated with bevacizumab. Resectability of CLM is dependent on both anatomic and oncological factors. To decrease the surgical risk, a sufficient volume of liver remnant with adequate blood perfusion and biliary drainage is required according to the degree of histopathological injury of the underlying liver. Portal vein embolization is sometimes required to decrease the surgical risk in a patient with small future liver remnant volume. As a complete radiological response does not signify a complete pathological response, liver resection should include all the site of a tumour detected prior to systemic treatment.
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Affiliation(s)
- Reid B Adams
- Division of General Surgery, University of Virginia School of MedicineCharlottesville, VA, USA
| | - Thomas A Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer CenterHouston, TX, USA
| | - Evelyne Loyer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer CenterHouston, TX, USA
| | - Timothy M Pawlik
- Department of Surgery, Johns Hopkins UniversityBaltimore, MD, USA
| | - Bachir Taouli
- Department of Radiology, Mount Sinai Medical CenterNew York, NY, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer CenterHouston, TX, USA
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Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, Nolsøe CP, Piscaglia F, Wilson SR, Barr RG, Chammas MC, Chaubal NG, Chen MH, Clevert DA, Correas JM, Ding H, Forsberg F, Fowlkes JB, Gibson RN, Goldberg BB, Lassau N, Leen ELS, Mattrey RF, Moriyasu F, Solbiati L, Weskott HP, Xu HX. Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver - update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:187-210. [PMID: 23137926 DOI: 10.1016/j.ultrasmedbio.2012.09.002] [Citation(s) in RCA: 480] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Initially, a set of guidelines for the use of ultrasound contrast agents was published in 2004 dealing only with liver applications. A second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some non-liver applications. Time has moved on, and the need for international guidelines on the use of CEUS in the liver has become apparent. The present document describes the third iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS) using contrast specific imaging techniques. This joint WFUMB-EFSUMB initiative has implicated experts from major leading ultrasound societies worldwide. These liver CEUS guidelines are simultaneously published in the official journals of both organizing federations (i.e., Ultrasound in Medicine and Biology for WFUMB and Ultraschall in der Medizin/European Journal of Ultrasound for EFSUMB). These guidelines and recommendations provide general advice on the use of all currently clinically available ultrasound contrast agents (UCA). They are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis and improve the management of patients worldwide.
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Affiliation(s)
- Michel Claudon
- Department of Pediatric Radiology, INSERM U947, Centre Hospitalier Universitaire de Nancy and Université de Lorraine, Vandoeuvre, France
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Krause J, Bergman A, Graf W, Nilsson A, Mahteme H. Ultrasonography findings and tumour quantification in patients with pseudomyxoma peritonei. Eur J Radiol 2012; 81:648-51. [DOI: 10.1016/j.ejrad.2011.01.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 01/04/2011] [Indexed: 12/27/2022]
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Abstract
Since the advent of second generation ultrasound (US) contrast agents, ultrasound has caught up with other imaging modalities for the detection and characterization of liver metastases and as a result of its high temporal and spatial resolution it can in some cases even be superior to computed tomography (CT) and magnetic resonance imaging (MRI). Many studies have demonstrated a sensitivity and specificity of over 90%. Due to its high temporal resolution contrast-enhanced US (CEUS) is capable of detecting even a very short duration of hyper-enhancement during the arterial phase. Radiation protection and lack of adverse effects on renal or thyroid function are additional arguments why CEUS should be recommended as the first imaging modality in the evaluation of hepatic metastases in cases of favorable scanning conditions.
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Affiliation(s)
- H-P Weskott
- Zentrale Sonographieabteilung, Klinikum Siloah, KRH, Roesebeckstr 15, 30559 Hannover.
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Hänle MM, Thiel R, Saur G, Mason RA, Pauls S, Kratzer W. Screening for liver metastases in women with mammary carcinoma: comparison of contrast-enhanced ultrasound and magnetic resonance imaging. Clin Imaging 2012; 35:366-70. [PMID: 21872126 DOI: 10.1016/j.clinimag.2010.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 09/02/2010] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of the present study was to compare conventional B-mode ultrasound (BMU), contrast-enhanced ultrasound (CEUS), and magnetic resonance imaging (MRI) in the detection of liver metastases at the primary staging and follow-up of women with histologically confirmed mammary carcinoma. PATIENTS AND METHODS Included in the study were 55 women (aged 57.5 ± 11.0 years, range 27-75 years; mean disease duration 57.5 months, range 5-168 months); of these, 17 women were examined as part of primary staging (staging group) and 38 women at follow-up (follow-up group). All patients underwent BMU (Philips HDI 5000), CEUS (Philips HDI 5000; 4.8 ml SonoVue), and MRI (Siemens Avanto 1.5 T) of the liver. RESULTS In the staging group (n = 17), a mass was detected by BMU in 24% (n = 4), by CEUS in 29% (n = 5), and by MRI in 47% (n = 8); masses suspicious for malignancy were identified in 6% of patients with BMU and in 12% each by CEUS and MRI. Malignancy was not confirmed in any case by cytology or surgery. In the follow-up group (n = 38), masses were identified by MRI in 53% of patients with suspicion of malignancy in 18%. Malignancy was confirmed in 16% of cases identified at MRI, in 13% of cases identified with CEUS, and in 11% of cases identified with BMU. The Pearson coefficients of correlation were r = .29 (P = .03) for MRI vs. BMU; r = .42 (P = .002) for MRI vs. CEUS; and r = .75 (P ≤ .001) for BMU vs. CEUS. With respect to malignancy, the Pearson coefficients of correlation were r = .40 (P = .099) for BMU vs. MRI and r = .71 (P = .0009) for CEUS vs. MRI. CONCLUSIONS Beginning in tumor stage III, the use of CEUS and MRI is associated with a significantly greater benefit in the detection of malignant tumors of the liver compared with conventional BMU. BMU appears to be adequate for primary staging and the follow-up of lower tumor stages.
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Affiliation(s)
- Martin Mark Hänle
- Department of Internal Medicine I, University Hospital Ulm, 89081 Ulm, Germany
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Abstract
In patients with known malignant disease, 51% of liver lesions less than 1.5 cm turn out to be benign. Whether the probability of malignancy is high or low, further investigations are often necessary to definitely exclude malignancy. Contrast-enhanced ultrasonography has a prominent role in lesion characterization with a diagnostic accuracy comparable with computed tomography and magnetic resonance imaging. Anti-angiogenic treatment is common in most oncological institutions and the response evaluation is a new challenge with a research focus on the change in tumour vasculature and perfusion. In planning biopsies, CEUS can identify necrotic and viable areas of tumours and improve the diagnostic accuracy.
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Affiliation(s)
- H H T Madsen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
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Anaye A, Perrenoud G, Rognin N, Arditi M, Mercier L, Frinking P, Ruffieux C, Peetrons P, Meuli R, Meuwly JY. Differentiation of focal liver lesions: usefulness of parametric imaging with contrast-enhanced US. Radiology 2011; 261:300-10. [PMID: 21746815 DOI: 10.1148/radiol.11101866] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate whether parametric imaging with contrast material-enhanced ultrasonography (US) is superior to visual assessment for the differential diagnosis of focal liver lesions (FLLs). MATERIALS AND METHODS This study had institutional review board approval, and verbal patient informed consent was obtained. Between August 2005 and October 2008, 146 FLLs in 145 patients (63 women, 82 men; mean age, 62.5 years; age range, 22-89 years) were imaged with real-time low-mechanical-index contrast-enhanced US after a bolus injection of 2.4 mL of a second-generation contrast agent. Clips showing contrast agent uptake kinetics (including arterial, portal, and late phases) were recorded and subsequently analyzed off-line with dedicated image processing software. Analysis of the dynamic vascular patterns (DVPs) of lesions with respect to adjacent parenchyma allowed mapping DVP signatures on a single parametric image. Cine loops of contrast-enhanced US and results from parametric imaging of DVP were assessed separately by three independent off-site readers who classified each lesion as benign, malignant, or indeterminate. Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated for both techniques. Interobserver agreement (κ statistics) was determined. RESULTS Sensitivities for visual interpretation of cine loops for the three readers were 85.0%, 77.9%, and 87.6%, which improved significantly to 96.5%, 97.3%, and 96.5% for parametric imaging, respectively (P < .05, McNemar test), while retaining high specificity (90.9% for all three readers). Accuracy scores of parametric imaging were higher than those of conventional contrast-enhanced US for all three readers (P < .001, McNemar test). Interobserver agreement increased with DVP parametric imaging compared with conventional contrast-enhanced US (change of κ from 0.54 to 0.99). CONCLUSION Parametric imaging of DVP improves diagnostic performance of contrast-enhanced US in the differentiation between malignant and benign FLLs; it also provides excellent interobserver agreement.
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Affiliation(s)
- Anass Anaye
- Department of Diagnostic and Interventional Radiology and Center for Clinical Epidemiology, Institute for Social and Preventive Medicine, University Hospital Lausanne, Switzerland.
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Zalinski S, Mariette C, Farges O. Management of patients with synchronous liver metastases of colorectal cancer. Clinical practice guidelines. Guidelines of the French society of gastrointestinal surgery (SFCD) and of the association of hepatobiliary surgery and liver transplantation (ACHBT). Short version. J Visc Surg 2011; 148:e171-82. [PMID: 21703959 DOI: 10.1016/j.jviscsurg.2011.05.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- S Zalinski
- Service de chirurgie hépatobiliaire, hôpital Saint-Antoine, 75012 Paris, France
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Kartalis N, Brismar TB, Mihocsa L, Isaksson B, Albiin N. The added value of contrast-enhanced ultrasound in patients with colorectal cancer undergoing preoperative evaluation with extensive gadobenate dimeglumine liver MRI. Eur Radiol 2011; 21:2067-73. [DOI: 10.1007/s00330-011-2156-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 04/05/2011] [Indexed: 12/14/2022]
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Rafaelsen SR, Jakobsen A. Contrast-enhanced ultrasound vs multidetector-computed tomography for detecting liver metastases in colorectal cancer: a prospective, blinded, patient-by-patient analysis. Colorectal Dis 2011; 13:420-5. [PMID: 20412096 DOI: 10.1111/j.1463-1318.2010.02288.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM This study compared the sensitivity and specificity of contrast-enhanced ultrasound (CEUS) and multidetector-computed tomography (MDCT) in the detection of liver metastases in patients with colorectal cancer. METHOD Between September 2004 and December 2008, 271 consecutive patients (146 men and 125 women; median age 68 years, range: 34-91 years) with primary colorectal cancer were evaluated. All underwent combined liver ultrasound and CEUS following intravenous injection of 2.4 ml of SonoVue(TM). The interval from injection to arrival time in the hepatic vein (ATHV) was noted. Contrast-enhanced MDCT in the portal phase was performed and interpreted blindly. In all patients, intra-operative ultrasound was used as the reference point. In addition, magnetic resonance imaging (MRI) or biopsy was performed on all suspicious lesions or if there was inconsistency in the results. RESULTS Liver metastases were detected in 21 (8%) patients. Both CEUS and MDCT had a sensitivity of 85.7%, with respective specificities of 97.6% and 95.6%, and positive predictive values of 75%vs 62%. The negative predictive value of both methods was 99%. In patients with and without liver metastases, ATHV was 18 and 22 s, respectively (P < 0.05). CONCLUSION CEUS has potential as a diagnostic alternative to MDCT in the detection of liver metastases. ATHV was shorter in patients with liver metastases.
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Affiliation(s)
- S R Rafaelsen
- Departments of Radiology Oncology, Danish Colorectal Cancer Group South, University of Southern Denmark and Vejle Hospital, Vejle, Denmark.
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Niekel MC, Bipat S, Stoker J. Diagnostic Imaging of Colorectal Liver Metastases with CT, MR Imaging, FDG PET, and/or FDG PET/CT: A Meta-Analysis of Prospective Studies Including Patients Who Have Not Previously Undergone Treatment. Radiology 2010; 257:674-84. [DOI: 10.1148/radiol.10100729] [Citation(s) in RCA: 420] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Cabassa P, Bipat S, Longaretti L, Morone M, Maroldi R. Liver metastases: Sulphur hexafluoride-enhanced ultrasonography for lesion detection: a systematic review. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:1561-1567. [PMID: 20800958 DOI: 10.1016/j.ultrasmedbio.2010.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Revised: 05/11/2010] [Accepted: 06/11/2010] [Indexed: 05/29/2023]
Abstract
This is a systematic review to evaluate the accuracy of contrast-enhanced ultrasonography (CEUS) performed with "SonoVue" (sulphur hexafluoride) in the detection of hepatic metastases. The MEDLINE, EMBASE and COCHRANE Databases were searched, regardless of language, for relevant articles published before December 2009. Two reviewers independently assessed study eligibility using a standardized form and methodological quality using the quality assessment of diagnostic accuracy studies (QUADAS) Checklist. Sensitivity estimates were calculated on a per-patient and/or per-lesion basis. The search for published articles yielded 718 potentially relevant abstracts. Of these, 14 papers were eligible but only three articles fulfilled the inclusion criteria, which comprised a total of 450 patients (patient sample number: range 12 to 365; cancer prevalence: 14.8 to 71.2%). Estimated per-patient sensitivity ranged from 79-100%. Although the quality assessment of diagnostic accuracy studies checklist showed the papers were of good quality, a meta-analysis was not applicable because of the lack of eligible studies. In conclusion, CEUS seems to be promising in the detection of liver metastases; however, there have not been enough studies to conduct meta-analysis. Further studies are required before this promising method can be widely used.
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Affiliation(s)
- Paolo Cabassa
- Department of Radiology, University of Brescia, Brescia, Italy.
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40
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Meacock LM, Sellars ME, Sidhu PS. Evaluation of gallbladder and biliary duct disease using microbubble contrast-enhanced ultrasound. Br J Radiol 2010; 83:615-27. [PMID: 20603412 DOI: 10.1259/bjr/60619911] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Ultrasound examination of the gallbladder is accepted as the primary imaging modality in the assessment of gallbladder disease, with inherent superiority in comparison to other imaging modalities. Contrast-enhanced ultrasound is established as a reliable tool in the detection and characterisation of focal liver lesions. It is less well recognised in gallbladder and biliary disease but can be a valuable complement to baseline ultrasound examination. Contrast-enhanced ultrasound provides the advantages of real-time, repeatable, multiplanar imaging without compromising patient safety or exposing patients to radiation. It can provide specific information as pathology often becomes more conspicuous following the administration of contrast, allowing detailed assessment of benign and malignant conditions arising in the gallbladder and biliary tree. This review illustrates the application of contrast-enhanced ultrasound in the evaluation of a variety of gallbladder and biliary duct diseases. The examination allows clearer delineation of the disease process and more confident diagnosis.
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Affiliation(s)
- L M Meacock
- Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, UK
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Floriani I, Torri V, Rulli E, Garavaglia D, Compagnoni A, Salvolini L, Giovagnoni A. Performance of imaging modalities in diagnosis of liver metastases from colorectal cancer: a systematic review and meta-analysis. J Magn Reson Imaging 2010; 31:19-31. [PMID: 20027569 DOI: 10.1002/jmri.22010] [Citation(s) in RCA: 173] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Surgery of liver metastases can be effective, and the appropriate selection of surgical candidates relies first on imaging. Different techniques are available, but information on their relative performance is unclear. The aim of this overview is to assess the imaging modality performance in the diagnosis of colorectal cancer (CRC) liver metastases. MEDLINE and EMBASE were searched for articles published from January 2000 to August 2008. Eligible trials had to be conducted on patients with diagnosis/suspicion of CRC liver metastases, comparing more than two modalities among MRI, computed tomography (CT), positron emission tomography using fluoro-18-deoxyglucose (FDG-PET), ultrasonography (US). Pooled estimates of sensitivity, specificity were calculated and pair-wise comparisons were performed. Of 6030 screened articles, 25 were eligible. Sensitivity and specificity on a per-patient basis for US, CT, MRI, and FDG-PET were 63.0% and 97.6%, 74.8% and 95.6%, 81.1% and 97.2, and 93.8% and 98.7%, respectively. On a per-lesion basis, sensitivity was 86.3%, 82.6%, 86.3%, and 86.0%, respectively. Specificity was reported in few studies. MRI showed a better sensitivity than CT in per-patient (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.47-0.99; P = 0.05) and in per-lesion analysis (OR: 0.66; 95% CI: 0.55-0.80; P < 0.0001). In per-lesion analysis, the difference was higher when liver-specific contrast agents were administered. Available evidence supports the MRI use for the detection of CRC liver metastases.
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Affiliation(s)
- Irene Floriani
- Department of Oncology, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
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Bellomi M, Travaini LL. Imaging as a surveillance tool in rectal cancer. Expert Rev Med Devices 2010; 7:99-112. [PMID: 20021242 DOI: 10.1586/erd.09.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Despite advances in diagnosis and treatment, half of patients with treated rectal cancer will die owing to recurrent disease. There is no evidence of benefit on survival from an intensive surveillance program, even if presymptomatic recurrent disease is detected. The aim of this article is to review the results described for the different imaging techniques in diagnosing rectal cancer recurrence in different sites and to discuss their relative clinical impact. The sensitivity of imaging techniques is related to the performance of the machines and the site being examined. Computed tomography is the most used technique owing to its availability, speed, panoramic images and ease of use, while MRI of the pelvis and the liver produces the highest resolution, sensitivity and specificity in these anatomical areas. Owing to its high cost, [(18)F] fluorodeoxyglucose-PET should be used as a third-level examination, a 'problem-solving' method when the site of recurrence is unknown or to rule out other possible sites of recurrence before a second surgery, and, finally, because it offers the possibility to investigate the whole body. The follow-up must be designed for individual patients, taking into account a number of factors. In the near future, whole-body imaging, probably by MRI, that is free from radiation will become the method of choice for screening for recurrent disease.
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Affiliation(s)
- Massimo Bellomi
- Department of Radiology and School of Medicine, University of Milano, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
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Sietses C, Meijerink MR, Meijer S, van den Tol MP. The impact of intraoperative ultrasonography on the surgical treatment of patients with colorectal liver metastases. Surg Endosc 2010; 24:1917-22. [PMID: 20112115 PMCID: PMC2895892 DOI: 10.1007/s00464-009-0874-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 12/19/2009] [Indexed: 12/15/2022]
Abstract
Introduction Intraoperative ultrasonography (IOUS) has been the standard in surgical decision making in oncologic liver surgery. Preoperative imaging techniques have improved substantially in resent years; therefore, the importance of IOUS might change. The current results of IOUS were compared with preoperative high-resolution helical CT scanning and the impact of IOUS on surgical decision making was evaluated. Methods A total of 100 consecutive patients who underwent open surgery for colorectal liver metastases within 4 weeks after preoperative imaging, performed with high-speed helical CT scanners, were included for this study. During surgery, IOUS was performed by a liver specialized radiologist. The findings on preoperative and intraoperative imaging and surgical exploration were compared regarding number, site, and size of the hepatic lesions. The preoperative surgical plan was compared with the final surgical treatment. Results One hundred patients with CRLM underwent 117 surgical treatments. In 38 patients IOUS differed from preoperative data. In 23 cases IOUS identified more metastatic lesions. In five patients, intraoperative findings identified smaller or less hepatic lesions. Additional information on the localization of the hepatic lesions was gathered by IOUS and changed the surgical treatment in ten cases. IOUS alone altered the surgical strategy 35 times during 117 procedures. In nearly all cases, discrepancy between the preoperative CT scan and IOUS resulted in a change of surgical treatment. Conclusions Despite improvement in preoperative imaging technology, the intraoperative use of ultrasonography remains of crucial importance. The detection of preoperatively unknown lesions remains high with great consequence on surgical therapy.
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Affiliation(s)
- C Sietses
- Department of Surgery, Vrije Universiteit Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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Larsen LPS. Role of contrast enhanced ultrasonography in the assessment of hepatic metastases: A review. World J Hepatol 2010; 2:8-15. [PMID: 21160951 PMCID: PMC2998950 DOI: 10.4254/wjh.v2.i1.8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 09/17/2009] [Accepted: 09/24/2009] [Indexed: 02/06/2023] Open
Abstract
Contrast enhanced ultrasonography (CEUS) has improved both the detection and characterization of focal liver lesions. It is now possible to evaluate in real time the perfusion of focal liver lesions in the arterial, portal and late contrast phases, and thus to characterize focal liver lesions with high diagnostic accuracy. As a result, CEUS has taken a central diagnostic role in the evaluation of focal liver lesions that are indeterminate upon computed tomography (CT) and magnetic resonance imaging. The combined use of second generation contrast agents and low mechanical index techniques is essential for the detection of liver metastases, and it now allows the examination of the entire liver in both the portal and late phases. Several studies have shown that using CEUS instead of conventional ultrasonography without contrast agents significantly improves sensitivity in detection of liver metastases. Furthermore, the detection rate with CEUS seems to be similar to that of CT. This review describes the clinical role of CEUS in detecting liver metastases, including details about examination techniques, features of metastases observed with CEUS, and clinical results and guidelines.
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Affiliation(s)
- Lars Peter Skovgaard Larsen
- Lars Peter Skovgaard Larsen, Department of Radiology, Aarhus University Hospital, Noerrebrogade 44, Aarhus 8000 C, Denmark
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Wong GLH, Xu HX, Xie XY. Detection Of Focal Liver Lesions In Cirrhotic Liver Using Contrast-Enhanced Ultrasound. World J Radiol 2009; 1:25-36. [PMID: 21160718 PMCID: PMC2998885 DOI: 10.4329/wjr.v1.i1.25] [Citation(s) in RCA: 10] [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: 11/11/2009] [Revised: 12/17/2009] [Accepted: 12/21/2009] [Indexed: 02/06/2023] Open
Abstract
Patients with liver cirrhosis are at increased risk of hepatocellular carcinoma (HCC). Conventional or baseline ultrasound (BUS) is often used as the first-line tool for HCC surveillance or detection, but the accuracy of BUS in HCC detection or differentiation from other focal liver lesions (FLLs) is limited. Contrast-enhanced ultrasound (CEUS) represents a recent revolution in the field of ultrasonography and it has become increasingly important in the detection and evaluation of FLLs. In CEUS, HCC typically exhibits arterial hyper-enhancement and portal-venous washout represented by hypo-enhanced lesions in the portal venous and late phases. The detection rate of HCC was significantly higher with CEUS compared with BUS. Even regenerative or some dysplastic nodules may exhibit arterial hyper-enhancement as they are differentiated from HCC by its iso-enhancing pattern in portal and late phases. The contrast-enhancement patterns of other different types of benign and malignant FLLs, as well as their detection rates with CEUS, were also discussed.
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Sandrasegaran K, Akisik FM, Lin C, Tahir B, Rajan J, Aisen AM. The value of diffusion-weighted imaging in characterizing focal liver masses. Acad Radiol 2009; 16:1208-14. [PMID: 19608435 DOI: 10.1016/j.acra.2009.05.013] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 05/01/2009] [Accepted: 05/03/2009] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES To determine if focal liver masses could be differentiated as benign or malignant on the basis of diffusion-weighted imaging (DWI). METHODS AND MATERIALS A total of 104 patients with focal liver masses were scanned using 1.5 T magnetic resonance imaging (MRI). DWI was performed with b values of 0, 50, and 400 s/mm(2). Of these, 76 patients had lesions larger than 2 cm diameter, radiologic or pathologic characterization of the lesion, and diagnostic quality DWI. The apparent diffusion coefficient (ADC) of the largest liver lesion was measured. The liver masses were diagnosed on histology or had characteristic computed tomography/MRI findings and follow up of more than 6 months. The analyzed lesions were hemangioma (n = 17), cysts (n = 5), hepatocellular cancer (HCC) (n = 41), adenoma (n = 3), focal nodular hyperplasia (FNH) (n = 6), and metastases (n = 4). RESULTS The mean (standard deviation) ADC values (10(-5) mm(2)/second) of hemangiomas, cysts, FNH, and HCC were 156.8 (54.1), 190.2 (43.0), 130.1 (81.9), and 107.6 (32.7). The ADC of cysts and hemangiomas were significantly higher than that of other lesions (P = .0003, t-test). There was no significant difference between ADC values of solid, benign liver lesions (FNH, adenoma) and malignant lesions (HCC, metastases) (P = .62). CONCLUSION Solid liver lesions have a lower ADC than cysts and hemangiomas. However, there is no significant difference in ADC between solid benign and malignant lesions. DWI appears to have only minimal additional value over currently used MRI sequences in characterizing liver masses.
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Hoeffel C, Job L, Ladam-Marcus V, Vitry F, Cadiot G, Marcus C. Detection of hepatic metastases from carcinoid tumor: prospective evaluation of contrast-enhanced ultrasonography. Dig Dis Sci 2009; 54:2040-6. [PMID: 19034651 DOI: 10.1007/s10620-008-0570-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 10/02/2008] [Indexed: 12/19/2022]
Abstract
The purpose of our study was to prospectively compare unenhanced ultrasonography (US) to contrast-enhanced US (CEUS) in the detection of hepatic metastases from carcinoid tumor. Thirty patients with carcinoid tumor prospectively underwent US, CEUS, and magnetic resonance imaging (MRI). Differences in sensitivity at US and CEUS were compared using a combination of the results of MR imaging, fine-needle biopsy, and follow-up imaging. Lesion conspicuity was assessed subjectively for US and CEUS. Seventeen patients had a total of 69 hepatic metastases. The addition of CEUS improved the detection of individual metastases from 47 (Se 68%; 95% CI: 57.0, 79.0) to 68 (Se 99%; 99% CI: 96.7, 100.0). Contrast enhancement improved the subjective conspicuity of metastases in 85% of patients. CEUS showed one more metastasis than did MRI in one patient, and MRI showed one more than did CEUS in one patient. CEUS is more sensitive than US in the detection of carcinoid liver metastases.
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Affiliation(s)
- Christine Hoeffel
- Service de Radiologie, Pôle d'Imagerie, Hôpital Robert Debré, CHU Reims, 51092 Reims, France.
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Mainenti PP, Mancini M, Mainolfi C, Camera L, Maurea S, Manchia A, Tanga M, Persico F, Addeo P, D'Antonio D, Speranza A, Bucci L, Persico G, Pace L, Salvatore M. Detection of colo-rectal liver metastases: prospective comparison of contrast enhanced US, multidetector CT, PET/CT, and 1.5 Tesla MR with extracellular and reticulo-endothelial cell specific contrast agents. ACTA ACUST UNITED AC 2009; 35:511-21. [PMID: 19562412 DOI: 10.1007/s00261-009-9555-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 06/11/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND To compare contrast-enhanced US (CE-US), multidetector-CT (MDCT), 1.5 Tesla MR with extra-cellular (Gd-enhanced) and intracellular (SPIO-enhanced) contrast agents and PET/CT, in the detection of hepatic metastases from colorectal cancer. MATERIALS AND METHODS A total of 34 patients with colo-rectal adenocarcinoma underwent preoperatively CE-US, MDCT, Gd- and SPIO-enhanced MR imaging (MRI), and PET/CT. Each set of images was reviewed independently by two blinded observers. The ROC method was used to analyze the results, which were correlated with surgical findings, intraoperative US, histopathology, and MDCT follow-up. RESULTS A total of 57 hepatic lesions were identified: 11 hemangiomas, 29 cysts, 1 focal fatty liver, 16 metastases (dimensional distribution: 5/16 < 5 mm; 3/16 between 5 mm and <10 mm; 8/16 ≥ 10 mm). Six of 34 patients were classified as positive for the presence of at least one metastasis. Considering all the metastases and those ≥ 10 mm, ROC areas showed no significant differences between Gd- and SPIO-enhanced MRI, which performed significantly better than the other modalities (P < 0.05). Considering the lesions <10 mm, ROC areas showed no significant differences between all modalities; however MRI presented a trend to perform better than the other techniques. Considering the patients, ROC areas showed no significant differences between all the modalities; however PET/CT seemed to perform better than the others. CONCLUSIONS Gd- and SPIO-enhanced MRI seem to be the most accurate modality in the identification of liver metastases from colo-rectal carcinoma. PET/CT shows a trend to perform better than the other modalities in the identification of patients with liver metastases.
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Advances in radiological imaging of gastrointestinal tumors. Crit Rev Oncol Hematol 2008; 69:153-67. [PMID: 18674926 DOI: 10.1016/j.critrevonc.2008.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 05/02/2008] [Accepted: 06/26/2008] [Indexed: 02/06/2023] Open
Abstract
This article summarizes the recent advances in radiological imaging in the hepatogastrointestinal field in terms of detection, characterization and staging of tumors. Introduction of multidetector row computed tomography technology has helped computed tomography to excel in its already established indications, and has expanded its capabilities by adding new clinical applications, such as computed tomography angiography, liver perfusion, computed tomography enterography or enteroclysis, and virtual colonoscopy. Contrast-enhanced ultrasound has dramatically changed the role of ultrasound in liver tumor characterization, detection, and other applications. Combining the advantages of unsurpassed soft tissue contrast and lack of ionizing radiation, magnetic resonance imaging of the gastrointestinal tract has become increasingly used clinically. Moreover, substantial progress in molecular and cellular magnetic resonance imaging has been achieved in the past few years. Particularly, the increasing number of available specific contrast agents dedicated to the evaluation of the liver and lymph nodes shows promises in the area of oncologic abdominal imaging.
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