Resistance index in differential diagnosis of liver lesions by color doppler ultrasonography

Contrast-enhanced ultrasound features of hepatic sarcomatoid carcinoma different from hepatocellular carcinoma

BACKGROUND

Hepatic sarcomatoid carcinoma (HSC) is a rare malignancy of the liver. The ultrasound and clinical features of HSC have not been determined.

OBJECTIVE

To investigate and compare the ultrasound and clinical features of HSC and hepatocellular carcinoma (HCC), and to reveal the valuable features of HSC.

METHODS

The ultrasound features and clinical data of pathologically proven HSC (n = 37) were compared with HCC (n = 92) in a matching ratio of 1:4 using the propensity score (age, gender and tumor size).

RESULTS

The HSC patients were more likely to accompany with clinical symptoms and vascular invasion than HCC patients (40.5% vs 17.4%, 24.3% vs 6.5%, P < 0.05). The size of HSCs was significantly larger than that of HCCs (P < 0.05). The proportion of patients with elevated alpha-fetoprotein was significantly lower in HSC (35.1% vs 54.3%, P < 0.05). On gray-scale ultrasound images, the HSCs were more likely to demonstrate as indistinct margin and irregular shape lesions compared to HCCs (78.4% vs 48.8%; 70.3% vs 23.9%, P < 0.05). Under color Doppler flow imaging (CDFI), the blood flow signals were more frequently detected in HSC lesions (75.7% vs 56.5%, P < 0.05). Resistance index (RI) was higher in HSCs than in HCCs [0.78 (0.70,0.82) vs 0.70 (0.62,0.76), P < 0.05]. On contrast-enhanced ultrasound (CEUS), HSCs mainly showed entirety heterogeneous hyper-enhancement (48.6%), entirety homogeneous enhancement (18.9%), peripheral and internal septal enhancement (18.9%). The incidence of non-enhanced areas inside HSC lesions was higher than that inside HCC lesions (56.8% vs 31.5%, P < 0.05). During the portal venous and late phases, most of the lesions revealed hypo-enhancement in both groups, whereas earlier washout was observed in HSCs [43.0 s (30.5,58.0) vs 60.0 s (46.3,100.0), P < 0.05].

CONCLUSIONS

CEUS features are useful in preoperative and non-invasive differentiation of hepatic sarcomatoid carcinoma and hepatocellular carcinoma.

The diagnostic value of Doppler Resistive Index in the differential diagnosis of focal liver lesions

Aim

To investigate the diagnostic value of resistance index (RI) in differentiating focal liver lesions.

Patients and methods

In this retrospective study, a total of 576 patients with histologically confirmed focal liver lesions were included. Each patient underwent B-mode ultrasound examination and color Doppler ultrasound examination. The RI values of different focal liver lesions were recorded and compared.

Results

The mean RI value of benign lesions was significantly lower than that of malignant lesions (0.54 ± 0.10 vs. 0.71 ± 0.12) (p <0.05). In malignant lesions, the RI value of intrahepatic cholangiocarcinoma was significantly lower than that of hepatocellular carcinoma lesions. Furthermore, in hepatocellular carcinoma lesions, the RI of large lesions (group 4: >10 cm) was significantly lower than that of small lesions (group 1: ≤2 cm, group 2: 2-5 cm) (p <0.05). Taken RI of 0.615 as a cutoff value to differentiate malignant and benign lesions, the sensitivity, specificity, positive predictive value and negative predictive value were 82.80%, 81.00%, 81.34% and 82.48%, respectively.

Conclusion

Color Doppler ultrasound examination is a valuable imaging method in detecting blood flow signal within liver lesions. The RI parameter should be helpful in differentiating malignant and benign liver tumors.

A comparative study of contrast enhanced ultrasound and contrast enhanced magnetic resonance imaging for the detection and characterization of hepatic hemangiomas

This study aims to compare contrast enhanced ultrasound (CEUS) and contrast enhanced magnetic resonance imaging (CEMRI) for the detection and characterization of hepatic hemangiomas. Included in this retrospective study were 83 histopathologically confirmed lesions of hemangioma in 66 hospitalized patients who underwent both CEUS and CEMRI and received surgery. The enhancement patterns on CEUS and CEMRI in each lesion were compared and analyzed. In addition, data obtained by the two modalities were then compared with the pathological findings to determine their value in differential diagnosis of hepatic hemangiomas. CEUS diagnosed 78 lesions of hemangioma against 80 by CEMRI. There were no statistical significant differences in the diagnostic value between CEUS and CEMRI in terms of sensitivity (88.0% vs. 92.8%), specificity (99.0% vs. 99.4%), accuracy (97.3% vs. 98.4%), positive predictive value (93.6% vs. 96.3%), and negative predictive value (98.0% vs. 98.8%) (p > 0.05, all). In the arterial phase, the main enhancement pattern on both CEUS and CEMRI was peripheral nodular enhancement (73 vs. 76), but lesions with diffuse enhancement on CEUS outnumbered those on CEMRI (3 vs. 1) and lesions with circular enhancement on CEMRI outnumbered those on CEUS (3 vs. 2). In the portal venous phase and delayed phase, the main enhancement pattern was hyperechoic change on CEUS and hyperintense on CEMRI (66 vs. 65), some lesions presented isoechoic change (12 vs. 15). These results suggested CEUS, an equivalent to CEMRI, may have an added diagnostic value in hemangiomas.

Effect of two sedative protocols and hepatosplenic disease on Doppler indices of splenic arteries in dogs: a preliminary study

Doppler flow indices (DFIs), such as the resistive index (RI) and the pulsatility index (PI), are commonly used to characterize blood flow. Parenchymal infiltration of an organ and administration of sedative and anaesthetic drugs can affect DFIs by altering resistance to blood flow. In this prospective study, the effect on DFIs of two sedative protocols (acepromazine or dexmedetomidine, each combined with butorphanol) and the presence or absence of hepatic and/or splenic disease, was investigated in the splenic arteries of 75 dogs. The RI and PI in splenic arteries of dogs sedated with dexmedetomidine and butorphanol were lower than those of dogs sedated with acepromazine and butorphanol. PI in splenic arteries was higher in animals with hepatosplenic disease than in healthy animals. Receiver Operating Characteristic (ROC) curves suggested that PI measured in canine splenic arteries could be useful in predicting the presence of hepatosplenic disease in the absence of other abdominal disease.