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de Sio I, D'Onofrio M, Mirk P, Bertolotto M, Priadko K, Schiavone C, Cantisani V, Iannetti G, Vallone G, Vidili G. SIUMB recommendations on the use of ultrasound in neoplastic lesions of the gallbladder and extrahepatic biliary tract. J Ultrasound 2023; 26:725-731. [PMID: 37147558 PMCID: PMC10469113 DOI: 10.1007/s40477-023-00788-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/31/2023] [Indexed: 05/07/2023] Open
Abstract
Extrahepatic biliary tract and gallbladder neoplastic lesions are relatively rare and hence are often underrepresented in the general clinical recommendations for the routine use of ultrasound (US). Dictated by the necessity of updated summarized review of current literature to guide clinicians, this paper represents an updated position of the Italian Society of Ultrasound in Medicine and Biology (SIUMB) on the use of US and contrast-enhanced ultrasound (CEUS) in extrahepatic biliary tract and gallbladder neoplastic lesions such as extrahepatic cholangiocarcinoma, gallbladder adenocarcinoma, gallbladder adenomyomatosis, dense bile with polypoid-like appearance and gallbladder polyps.
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Affiliation(s)
- Ilario de Sio
- Department of Hepatogastroenterology, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Mirko D'Onofrio
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Verona, Italy
| | - Paoletta Mirk
- Department of Radiology, Catholic University of the Sacred Heart-Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Kateryna Priadko
- Department of Hepatogastroenterology, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy.
| | - Cosima Schiavone
- Unit of Internistic Ultrasound, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Vito Cantisani
- Department of Radiological Sciences, Policlinico Umberto I, University La Sapienza, Rome, Italy
| | - Giovanni Iannetti
- Department of Internistic Ultrasound, Civil Hospital of Pescara, Pescara, Italy
| | - Gianfranco Vallone
- Department of Medicine and Health Sciences, "V. Tiberio" of the University of Molise, Molise, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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Wang S, Liu X, Zhao J, Liu Y, Liu S, Liu Y, Zhao J. Computer auxiliary diagnosis technique of detecting cholangiocarcinoma based on medical imaging: A review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 208:106265. [PMID: 34311415 DOI: 10.1016/j.cmpb.2021.106265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Cholangiocarcinoma (CCA) is one of the most aggressive human malignant tumors and is becoming one of the main factors of death and disability globally. Specifically, 60% to 70% of CCA patients were diagnosed with local invasion or distant metastasis and lost the chance of radical operation. The overall median survival time was less than 12 months. As a non-invasive diagnostic technology, medical imaging consisting of computed tomography (CT) imaging, magnetic resonance imaging (MRI), and ultrasound (US) imaging, is the most effectively and commonly used method to detect CCA. The computer auxiliary diagnosis (CAD) system based on medical imaging is helpful for rapid diagnosis and provides credible "second opinion" for specialists. The purpose of this review is to categorize and review the CAD technique of detecting CCA based on medical imaging. METHODS This work applies a four-level screening process to choose suitable publications. 125 research papers published in different academic research databases were selected and analyzed according to specific criteria. From the five steps of medical image acquisition, processing, analysis, understanding and verification of CAD combined with artificial intelligence algorithms, we obtain the most advanced insights related to CCA detection. RESULTS This work provides a comprehensive analysis and comparison analysis of the current CAD systems of detecting CCA. After careful investigation, we find that the main detection methods are traditional machine learning method and deep learning method. For the detection, the most commonly used method is semi-automatic segmentation algorithm combined with support vector machine classifier method, combination of which has good detection performance. The end-to-end training mode makes deep learning method more and more popular in CAD systems. However, due to the limited medical training data, the accuracy of deep learning method is unsatisfactory. CONCLUSIONS Based on analysis of artificial intelligence methods applied in CCA, this work is expected to be truly applied in clinical practice in the future to improve the level of clinical diagnosis and treatment of it. This work concludes by providing a prediction of future trends, which will be of great significance for researchers in the medical imaging of CCA and artificial intelligence.
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Affiliation(s)
- Shiyu Wang
- School of Electronic and Electric Engineering, Shanghai University of Engineering Science, Shanghai 201620, China
| | - Xiang Liu
- School of Electronic and Electric Engineering, Shanghai University of Engineering Science, Shanghai 201620, China.
| | - Jingwen Zhao
- School of Electronic and Electric Engineering, Shanghai University of Engineering Science, Shanghai 201620, China
| | - Yiwen Liu
- School of Electronic and Electric Engineering, Shanghai University of Engineering Science, Shanghai 201620, China
| | - Shuhong Liu
- Department of Pathology and Hepatology, The Fifth Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Yisi Liu
- Department of Pathology and Hepatology, The Fifth Medical Centre of Chinese PLA General Hospital, Beijing 100039, China
| | - Jingmin Zhao
- Department of Pathology and Hepatology, The Fifth Medical Centre of Chinese PLA General Hospital, Beijing 100039, China.
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Affiliation(s)
- John E Eaton
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN
| | | | - Gregory J Gores
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN
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Fontán FJP, Reboredo ÁR, Siso AR. Accuracy of Contrast-Enhanced Ultrasound in the Diagnosis of Bile Duct Obstruction. Ultrasound Int Open 2016; 1:E12-8. [PMID: 27689143 DOI: 10.1055/s-0035-1555880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To investigate the ability of contrast-enhanced ultrasound (CEUS) to differentiate benign from malignant lesions causing biliary duct obstruction. MATERIALS AND METHODS Between November 2006 and December 2013, 59 patients with bile duct obstruction of undetermined cause in baseline ultrasound underwent CEUS study. The enhancement and posterior washout were analyzed in real time all along the study duration (5'). The final diagnosis suggested by CEUS was compared with histologic diagnosis (47.5%) or with radiologic follow-up with TC, RM or ERCP. RESULTS Final diagnoses included 42 malignant lesions (cholangiocarcinoma n=22, metastases n=6, pancreatic carcinoma n=6, hepatocarcinoma n=4, gallbladder carcinoma n=2, ampullary carcinoma n=1 and lymphoma n=1) and 17 benign lesions (lithiasis or biliary sludge n=15, xanthogranulomatous cholecystitis n=1 and indeterminate n=1). CEUS accuracy compared with final diagnoses based on combined reference standard was 86.4%. CEUS correctly identified 36 of 42 malignant lesions (sensibility 85.7%) and 15 of 17 benign lesions (specificity 88.2%). The positive predictive value of CEUS for malignancy was 94.7%, while the negative predictive value was 71.4%. CONCLUSION CEUS is useful to differentiate between benign and malignant causes of obstructive jaundice. This technique improves the detection of bile duct invasion in hepatic neoplasms and permits better evaluation of intra- and extraductal extension of hilar hepatobiliary tumors.
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Affiliation(s)
- F J P Fontán
- Radiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Á R Reboredo
- Radiology, Complejo Hospitalario Universitario Arquitecto Marcide, A Coruña, Spain
| | - A R Siso
- Radiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
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Guo HL, Chen LD, Wang Z, Huang Y, Liu JY, Shan QY, Xie XY, Lu MD, Wang W. Hilar biliary neurofibroma without neurofibromatosis: case report with contrast-enhanced ultrasound findings. J Med Ultrason (2001) 2016; 43:537-43. [PMID: 27443917 DOI: 10.1007/s10396-016-0732-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/30/2016] [Indexed: 11/24/2022]
Abstract
Solitary neurofibroma located in the hilum of the liver is extremely rare, particularly without neurofibromatosis. We herein report a case of hilar biliary neurofibroma without signs of von Recklinghausen's disease. A 36-year-old man was admitted to our department with progressive jaundice. The case was diagnosed as hilar cholangiocarcinoma based on preoperative imaging. The patient consequently received a Roux-en-Y hepaticojejunostomy and was confirmed with neurofibroma pathologically. This is the first reported imaging finding of hilar biliary neurofibroma using contrast-enhanced ultrasound, emphasizing the differential diagnosis of biliary tumors.
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Affiliation(s)
- Huan-Ling Guo
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Li-da Chen
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Zhu Wang
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Yang Huang
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Jin-Ya Liu
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Quan-Yuan Shan
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Ming-de Lu
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Wei Wang
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-Sen University, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China.
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Wu W, Cong Y, Zhang Z, Yang W, Yin S, Fan Z, Dai Y, Yan K, Chen M. Application of Contrast-Enhanced Sonography for Diagnosis of Space-Occupying Lesions in the Extrahepatic Bile Duct: Comparison With Conventional Sonography and Contrast-Enhanced Computed Tomography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:29-35. [PMID: 26614793 DOI: 10.7863/ultra.14.10078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 04/08/2015] [Indexed: 05/23/2023]
Abstract
OBJECTIVES To investigate the application of contrast-enhanced sonography compared with conventional sonography and contrast-enhanced computed tomography (CT) for diagnosis of space-occupying lesions in the extrahepatic bile duct. METHODS Seventy-two patients with pathologic diagnoses of space-occupying lesions in the extrahepatic bile duct were retrospectively recruited. All patients underwent conventional sonography, contrast-enhanced sonography, and contrast-enhanced CT. The sensitivity, specificity, and diagnostic accuracy were compared. RESULTS Among the 72 patients, 11 cases were benign, and 61 were malignant. The diagnostic accuracy rates for conventional sonography, contrast-enhanced sonography, and contrast-enhanced CT were 66.67% (48 of 72), 90.28% (65 of 72), and 88.89% (64 of 72), respectively. The Youden index showed that contrast-enhanced sonography (0.811) was comparable with contrast-enhanced CT (0.720) and better than conventional sonography (0.159). There were significant differences in accuracy between conventional and contrast-enhanced sonography (P= .001) and conventional sonography and contrast-enhanced CT (P = .001); however, there was no significant difference between contrast-enhanced sonography and contrast-enhanced CT (P = .785). There were significant differences in sensitivity between conventional and contrast-enhanced sonography (P= .006) and conventional sonography and contrast-enhanced CT (P = .006) but no significant difference between contrast-enhanced sonography and contrast-enhanced CT (P > .99). There were no significant differences in specificity among the techniques (P > .05). There was a significant difference in the number of lesions with clear boundaries displayed: 16 on conventional sonography and 56 on contrast-enhanced sonography (P = .006). CONCLUSIONS Contrast-enhanced sonography can show the dynamic blood supply in space-occupying pathologic regions of the extrahepatic bile duct. The diagnostic accuracy of contrast-enhanced sonography in the extrahepatic bile duct was higher than that of conventional sonography and comparable with that of contrast-enhanced CT. Therefore, contrast-enhanced sonography may be a promising imaging technique for diagnosis of space-occupying lesions in the extrahepatic bile duct.
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Affiliation(s)
- Wei Wu
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yue Cong
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhongyi Zhang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Wei Yang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Shanshan Yin
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhihui Fan
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Ying Dai
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
| | - Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China.
| | - Minhua Chen
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Ultrasound, Peking University Cancer Hospital and Institute, Beijing, China
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Madhusudhan KS, Gamanagatti S, Gupta AK. Imaging and interventions in hilar cholangiocarcinoma: A review. World J Radiol 2015; 7:28-44. [PMID: 25729485 PMCID: PMC4326732 DOI: 10.4329/wjr.v7.i2.28] [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: 10/08/2014] [Revised: 11/14/2014] [Accepted: 12/16/2014] [Indexed: 02/06/2023] Open
Abstract
Hilar cholangiocarcinoma is a common malignant tumor of the biliary tree. It has poor prognosis with very low 5-year survival rates. Various imaging modalities are available for detection and staging of the hilar cholangiocarcinoma. Although ultrasonography is the initial investigation of choice, imaging with contrast enhanced computed tomography scan or magnetic resonance imaging is needed prior to management. Surgery is curative wherever possible. Radiological interventions play a role in operable patients in the form of biliary drainage and/or portal vein embolization. In inoperable cases, palliative interventions include biliary drainage, biliary stenting and intra-biliary palliative treatment techniques. Complete knowledge of application of various imaging modalities available and about the possible radiological interventions is important for a radiologist to play a critical role in appropriate management of such patients.We review the various imaging techniques and appearances of hilar cholangiocarcinoma and the possible radiological interventions.
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Soares KC, Kamel I, Cosgrove DP, Herman JM, Pawlik TM. Hilar cholangiocarcinoma: diagnosis, treatment options, and management. Hepatobiliary Surg Nutr 2014; 3:18-34. [PMID: 24696835 DOI: 10.3978/j.issn.2304-3881.2014.02.05] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 12/30/2013] [Indexed: 12/16/2022]
Abstract
Hilar cholangiocarcinoma (HC) is a rare disease with a poor prognosis which typically presents in the 6(th) decade of life. Of the 3,000 cases seen annually in the United States, less than one half of these tumors are resectable. A variety of risk factors have been associated with HC, most notably primary sclerosing cholangitis (PSC), biliary stone disease and parasitic liver disease. Patients typically present with abdominal pain, pruritis, weight loss, and jaundice. Computed topography (CT), magnetic resonance imaging (MRI), and ultrasound (US) are used to characterize biliary lesions. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) assess local ductal extent of the tumor while allowing for therapeutic biliary drainage. MRCP has demonstrated similar efficacies to PTC and ERCP in identifying anatomic extension of tumors with less complications. Treatment consists of surgery, radiation, chemotherapy and photodynamic therapy. Biliary drainage of the future liver remnant should be performed to decrease bilirubin levels thereby facilitating future liver hypertrophy. Standard therapy consists of surgical margin-negative (R0) resection with extrahepatic bile duct resection, hepatectomy and en bloc lymphadenectomy. Local resection should not be undertaken. Lymph node invasion, tumor grade and negative margins are important prognostic indicators. In instances where curative resection is not possible, liver transplantation has demonstrated acceptable outcomes in highly selected patients. Despite the limited data, chemotherapy is indicated for patients with unresectable tumors and adequate functional status. Five-year survival after surgical resection of HC ranges from 10% to 40% however, recurrence can be as high as 50-70% even after R0 resection. Due to the complexity of this disease, a multi-disciplinary approach with multimodal treatment is recommended for this complex disease.
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Affiliation(s)
- Kevin C Soares
- 1 Department of Surgery, Division of Surgical Oncology, 2 Department of Radiology, 3 Department of Oncology, 4 Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ihab Kamel
- 1 Department of Surgery, Division of Surgical Oncology, 2 Department of Radiology, 3 Department of Oncology, 4 Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David P Cosgrove
- 1 Department of Surgery, Division of Surgical Oncology, 2 Department of Radiology, 3 Department of Oncology, 4 Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph M Herman
- 1 Department of Surgery, Division of Surgical Oncology, 2 Department of Radiology, 3 Department of Oncology, 4 Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M Pawlik
- 1 Department of Surgery, Division of Surgical Oncology, 2 Department of Radiology, 3 Department of Oncology, 4 Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Zheng SG, Xu HX, Lu MD, Xie XY, Xu ZF, Liu GJ, Liu LN. Role of contrast-enhanced ultrasound in follow-up assessment after ablation for hepatocellular carcinoma. World J Gastroenterol 2013; 19:855-865. [PMID: 23430451 PMCID: PMC3574882 DOI: 10.3748/wjg.v19.i6.855] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 12/03/2012] [Accepted: 12/25/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the usefulness of contrast-enhanced ultrasound (CEUS) during follow-up after percutaneous ablation therapy for hepatocellular carcinoma (HCC).
METHODS: A total of 141 patients with HCCs who received percutaneous ablation therapy were assessed by paired follow-up CEUS and contrast-enhanced computed tomography (CECT). The follow-up scheme was designed prospectively and the intervals between CEUS and CECT examinations were less than 14 d. Both images of follow-up CEUS and CECT were reviewed by radiologists. The ablated lesions were evaluated and classified as local tumor progression (LTP) and LTP-free. LTP was defined as regrowth of tumor inside or adjacent to the successfully treated nodule. The detected new intrahepatic recurrences were also evaluated and defined as presence of intrahepatic new foci. On CEUS and CECT, LTP and new intrahepatic recurrence both were displayed as typical enhancement pattern of HCC (i.e., hyper-enhancing during the arterial phase and washout in the late phase). With CECT as the reference standard, the ability of CEUS in detecting LTP or new intrahepatic recurrence during follow-up was evaluated.
RESULTS: During a follow-up period of 1-31 mo (median, 4 mo), 169 paired CEUS and CECT examinations were carried out for the 141 patients. For a total of 221 ablated lesions, 266 comparisons between CEUS and CECT findings were performed. Thirty-three LTPs were detected on CEUS whereas 40 LTPs were detected on CECT, there was significant difference (P < 0.001). In comparison with CECT, the numbers of false positive and false negative LTPs detected on CEUS were 6 and 13, respectively; the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of CEUS in detecting LTPs were 67.5%, 97.4%, 81.8%, 94.4% and 92.3%, respectively. Meanwhile, 131 new intrahepatic recurrent foci were detected on CEUS whereas 183 were detected on CECT, there was also significant difference (P < 0.05). In comparison with CECT, the numbers of false positive and false negative intrahepatic recurrences detected on CEUS were 13 and 65, respectively; the sensitivity, specificity, PPV, NPV and overall accuracy of CEUS in detecting new intrahepatic recurrent foci were 77.7%, 92.0%, 92.4%, 76.7% and 84.0%, respectively.
CONCLUSION: The sensitivity of CEUS in detecting LTP and new intrahepatic recurrence after percutaneous ablation therapy is relatively low in comparison with CECT.
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Li C, Wang W, Ding H, Huang B, Cao J, Mao F, Ji Z. Value of contrast-enhanced sonography in the diagnosis of peripheral intrahepatic cholangiocarcinoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:447-453. [PMID: 21626512 DOI: 10.1002/jcu.20797] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 01/06/2011] [Indexed: 05/30/2023]
Abstract
BACKGROUND To illustrate contrast-enhanced harmonic ultrasonography (CEUS) findings of peripheral intrahepatic cholangiocarcinoma (PICC) and to assess the usefulness of CEUS in the diagnosis of this disease. METHODS This study is a retrospective analysis of 46 patients (20 men, 26 women) with PICC who underwent both preoperative CEUS and pathologic examination. Sonographic examinations were performed with sonographic instruments equipped with low mechanical index contrast imaging software. The contrast agent SonoVue was used. The wash-in and wash-out features of the lesions were documented and the enhancement patterns were analyzed by visual inspection of the real-time cine loops. RESULTS During the hepatic arterial phase of CEUS, the majority of PICC lesions (43/46, 93.5%) showed hypervascularity compared with the liver parenchyma, whereas three lesions (3/46, 6.5%) showed hypovascularity. In the portal phases, all lesions were either isoechoic or hypoechoic, while they were all hypoechoic in the late phase. Of all the hypervascular lesions, 48.8% (21/43) showed diffuse enhancement and 51.2% (22/43) showed rim-like or thick, rim-like enhancement. In 62.8% (27/43) of cases, progressive dendritic and centripetal fill-in of the contrast agent was observed. There were 83.7% (36/43) of hypervascular nodules showing heterogeneous enhancement during peak contrast enhancement of the lesions. CEUS provided clearer visualization of lesion margins than did conventional sonography. CONCLUSIONS CEUS examination yields some specific findings that are useful in the diagnosis of PICC.
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Affiliation(s)
- Chaolun Li
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Xu HX. Era of diagnostic and interventional ultrasound. World J Radiol 2011; 3:141-6. [PMID: 21666820 PMCID: PMC3110916 DOI: 10.4329/wjr.v3.i5.141] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 03/19/2011] [Accepted: 03/25/2011] [Indexed: 02/06/2023] Open
Abstract
It is an era of diagnostic and interventional ultrasound (US). Various new techniques such as three-dimensional US (3D US), interventional US, and contrast-enhanced US (CEUS) have been introduced into clinical practice. Dr. Xu and his colleagues have taken advantage of these techniques and carried out a series of relevant studies. Their use of 3D US in the liver, gallbladder, liver tumor volumetry, guidance for ablation, and 3D CEUS has widened the application of 3D US in the clinic. They found that prognosis in patients with hepatocellular carcinoma (HCC) after thermal ablation with curative intent was determined by treatment response to ablation, pretreatment serum AFP, and liver function reserve. Tumor response to treatment was the most predictive factor for long-term survival. They compared the use of percutaneous microwave ablation and radiofrequency ablation for the treatment of HCC and found that both are effective methods in treating HCCs. The local tumor control, complications related to treatment, and long-term survival were equivalent for the two modalities. They first compared the enhancement patterns of HCC and intrahepatic cholangiocarcinoma (ICC) and proposed the diagnostic clues for ICC, liver angiomyolipoma (AML), gallbladder cancer, renal carcinoma, and renal AML, which have greatly enhanced the role of CEUS in the clinic. They also evaluated the diagnostic performance of CEUS in characterizing complex cystic focal liver lesions and the agreement between two investigators with different experience levels; and found that CEUS is especially useful for the young investigator. They assessed the effect of anti-angiogenic gene therapy for HCC treated by microbubble-enhanced US exposure and concluded that gene therapy mediated by US exposure enhanced by a microbubble contrast agent may become a new treatment option for HCC.
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A case report of follicular lymphoma arising from the extrahepatic bile duct: interesting contrast-enhanced ultrasonographic findings. Clin J Gastroenterol 2011; 4:129-34. [PMID: 26190720 DOI: 10.1007/s12328-011-0207-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 01/16/2011] [Indexed: 10/18/2022]
Abstract
We report a case of follicular lymphoma of the extrahepatic bile duct and the associated characteristic findings of contrast-enhanced ultrasonography (CEUS). A 60-year-old man with jaundice was scheduled to undergo surgical treatment because of a suspected diagnosis of biliary adenocarcinoma. CEUS in the high-resolution power Doppler mode showed early pulsatile enhancement of the inner layer of the thickened bile duct wall. Thereafter, gradual weak enhancement was detected in the outer layer. Extrahepatic bile duct resection was performed, and the resected specimen was diagnosed as a follicular lymphoma. On microscopic examination, the fibromuscular and deeper layers of the specimen were found to be infiltrated by follicle-forming tumor cells. The mucosal epithelium of the bile duct was almost normal. Although this is the fourth report of this condition in the English-language literature, it is the first to discuss the possibility of a preoperative diagnosis by CEUS.
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13
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The current status of contrast-enhanced ultrasound in China. J Med Ultrason (2001) 2010; 37:97-106. [DOI: 10.1007/s10396-010-0264-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 03/04/2010] [Indexed: 12/11/2022]
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Xu HX. Contrast-enhanced ultrasound: The evolving applications. World J Radiol 2009; 1:15-24. [PMID: 21160717 PMCID: PMC2999308 DOI: 10.4329/wjr.v1.i1.15] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 12/17/2009] [Accepted: 12/21/2009] [Indexed: 02/07/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is a major breakthrough for ultrasound imaging in recent years. By using a microbubble contrast agent and contrast-specific imaging software, CEUS is able to depict the micro- and macro-circulation of the targeted organ, which in turn leads to improved performance in diagnosis. Due to the special dual blood supply system in the liver, CEUS is particularly suitable for liver imaging. It is evident that CEUS facilitates improvement for characterization of focal liver lesions (FLLs), detection of liver malignancy, guidance for interventional procedures, and evaluation of treatment response after local therapies. CEUS has been demonstrated to be equal to contrast-enhanced computed tomography or magnetic resonance imaging for the characterization of FLLs. In addition, the applicability of CEUS has expanded to non-liver structures such as gallbladder, bile duct, pancreas, kidney, spleen, breast, thyroid, and prostate. The usefulness of CEUS in these applications is confirmed by extensive literature production. Novel applications include detecting bleeding sites and hematomas in patients with abdominal trauma, guiding percutaneous injection therapy and therefore achieving the goal of using interventional ultrasonography in managing splenic trauma, assessing the activity of Crohn’s disease, and detecting suspected endoleaks after endovascular abdominal aneurysm repair. Contrast-enhanced intraoperative ultrasound (US) and intracavitary use of CEUS have been developed and clinically studied. The potential use of CEUS involves sentinel lymph node detection, drug or gene delivery, and molecular imaging. In conclusion, the advent of CEUS has greatly enhanced the usefulness of US and even changed the status of US in clinical practice. The application of CEUS in the clinic is continuously evolving and it is expected that its use will be expanded further in the future.
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Xu HX. Contrast-enhanced ultrasound in the biliary system: Potential uses and indications. World J Radiol 2009; 1:37-44. [PMID: 21160719 PMCID: PMC2999303 DOI: 10.4329/wjr.v1.i1.37] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Revised: 12/11/2009] [Accepted: 12/21/2009] [Indexed: 02/06/2023] Open
Abstract
Conventional ultrasound (US) is the first-line imaging investigation for biliary diseases. However, it is lack of the ability to depict the microcirculation of some lesions which may lead to failure in diagnosis for some biliary diseases. The use of contrast-enhanced US (CEUS) has reached the field of bile duct disease in recent years and promising results have been achieved. In this review, the methodology, image interpretation, enhancement pattern, clinical usefulness, and indications for CEUS in the biliary system are summarized. CEUS may be indicated in the biliary system under the following circumstances: (1) Where there is a need to make a characterization of intrahepatic cholangiocarcinoma (ICC); (2) For differentiation diagnosis between ICC and other tumors (i.e. hepatocellular carcinoma or liver metastasis) or infectious diseases; (3) For differentiation diagnosis between biliary cystadenoma and biliary cystadenocarcinoma; (4) To detect malignant change in Caroli’s disease; (5) To depict the extent of Klatskin’s tumor with greater clarity; (6) To make a distinction between gallbladder cholesterol polyp, adenoma and polypoid cancer; (7) To make a distinction between chronic cholecystitis with thickened wall and gallbladder cancer; (8) For differentiation diagnosis between motionless sludge and gallbladder cancer; (9) For differentiation diagnosis between common bile duct cancer and sludge or stone without acoustic shadowing; and (10) In patients who are suspected of having a drop of their percutaneous transhepatic cholangiodrainage tube, US contrast agent can be administered to through the tube detect the site of the tube.
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