A novel method to determine hepatic segments using Sonazoid, an ultrasound contrast agent

Diagnostic Value of Contrast-Enhanced Ultrasound for Evaluation of Transjugular Intrahepatic Portosystemic Shunt Perfusion

BACKGROUND

In patients with liver cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) displays an effective method for treating portal hypertension. Main indications include refractory ascites and secondary prevention of esophageal bleeding. Color Doppler ultrasound (CDUS) plays a leading role in the follow-up management, whereas contrast-enhanced ultrasound (CEUS) is not routinely considered. We compared the efficacy of CEUS to CDUS and highlighted differences compared to findings of corresponding computed tomography (CT) and magnetic resonance imaging (MRI). (2) Methods: On a retrospective basis, 106 patients with CEUS examination after TIPS were included. The enrollment period was 12 years (between 2008 and 2020) and the age group ranged from 23.3 to 82.1 years. In addition, 92 CDUS, 43 CT and 58 MRI scans were evaluated for intermodal comparison. (3) Results: Intermodal analysis and comparison revealed a high level of concordance between CDUS, CT and MRI in the vast majority of cases. In comparison to CDUS, the correlation of the relevant findings was 92.5%, 95.3% for CT and 87.9% for MRI. In some cases, however, additional information was provided by CEUS (4) Conclusions: CEUS depicts a safe and effective imaging modality for follow-up after TIPS. In addition to CDUS, CEUS enables specific assessment of stent pathologies and stent dysfunction due to its capacity to dynamically visualize single microbubbles at high spatial and temporal resolution. Due to the low number of adverse events regarding the application of contrast agents, CEUS can be administered to a very broad patient population, thus avoiding additional radiation exposure compared to CT angiography in cases with divergent findings during follow-up.

Superb microvascular imaging technology of ultrasound examinations for the evaluation of tumor vascularity in hepatic hemangiomas

Purpose

This study aimed to investigate and categorize the diverse features of hepatic hemangiomas on superb microvascular imaging (SMI) in a relatively large prospective study.

Methods

In this prospective study, 70 patients with 92 hepatic hemangiomas were consecutively enrolled. All nodules were radiologically confirmed with the typical imaging features of hepatic hemangiomas on dynamic computed tomography (CT) or magnetic resonance imaging (MRI). Using SMI, all lesions were evaluated and categorized into subgroups according to the flow pattern on SMI. Differences in the frequencies of SMI patterns according to lesion size and enhancement patterns on dynamic CT or MRI were also compared.

Results

In 67.4% (62/92) of hemangiomas, tumor vascularity was detected using SMI, while 32.6% (30/92) did not show any signal on the SMI examination, and the absence of an SMI signal was not shown in rapidly enhancing hemangiomas (0% [0/30] vs. 100% [30/30], P=0.002) and was more frequent in lesions <2 cm than in lesions ≥2 cm (44.0% [22/50] vs. 2.7% [8/42], P=0.011). In hepatic hemangiomas in which vascularity was detected (n=62), the strip rim pattern was the most common SMI pattern of hepatic hemangiomas (48.4%, 30/62), followed by the nodular rim pattern involving spotty dot-like engorged vessels (37.1%, 23/62).

Conclusion

The evaluation of the inner vascularity of hepatic hemangiomas with SMI was feasible for most hemangiomas, especially in larger (≥2 cm) or rapidly enhancing hemangiomas. The most frequent SMI patterns of hepatic hemangiomas were the strip rim pattern and nodular rim pattern.

Clinical applications of Doppler ultrasonography for thyroid disease: consensus statement by the Korean Society of Thyroid Radiology

Doppler ultrasonography (US) is widely used for the differential diagnosis of thyroid nodules, metastatic cervical lymph nodes in patients with thyroid cancer, and diffuse parenchymal disease, as well as for guidance in various US-guided procedures, including biopsy and ablation. However, controversies remain regarding the appropriate use and interpretation of Doppler US. Therefore, the Korean Society of Thyroid Radiology organized a taskforce to develop a consensus statement on the clinical use of Doppler US for thyroid disease. The review and recommendations in this article are based on a comprehensive analysis of the current literature and the consensus of experts.