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Ren J, Lu Q, Fei X, Dong Y, D Onofrio M, Sidhu PS, Dietrich CF. Assessment of arterial-phase hyperenhancement and late-phase washout of hepatocellular carcinoma-a meta-analysis of contrast-enhanced ultrasound (CEUS) with SonoVue® and Sonazoid®. Eur Radiol 2024; 34:3795-3812. [PMID: 37989916 DOI: 10.1007/s00330-023-10371-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES The recognition of arterial phase hyperenhancement (APHE) and washout during the late phase is key for correct diagnosis of hepatocellular carcinoma (HCC) with contrast-enhanced ultrasound (CEUS). This meta-analysis was conducted to compare SonoVue®-enhanced and Sonazoid®-enhanced ultrasound in the assessment of HCC enhancement and diagnosis. METHODS Studies were included in the analysis if they reported data for HCC enhancement in the arterial phase and late phase for SonoVue® or in the arterial phase and Kupffer phase (KP) for Sonazoid®. Forty-two studies (7502 patients) with use of SonoVue® and 30 studies (2391 patients) with use of Sonazoid® were identified. In a pooled analysis, the comparison between SonoVue® and Sonazoid® CEUS was performed using chi-square test. An inverse variance weighted random-effect model was used to estimate proportion, sensitivity, and specificity along with 95% confidence interval (CI). RESULTS In the meta-analysis, the proportion of HCC showing APHE with SonoVue®, 93% (95% CI 91-95%), was significantly higher than the proportion of HCC showing APHE with Sonazoid®, 77% (71-83%) (p < 0.0001); similarly, the proportion of HCC showing washout at late phase/KP was significantly higher with SonoVue®, 86% (83-89%), than with Sonazoid®, 76% (70-82%) (p < 0.0001). The sensitivity and specificity for the detection of APHE plus late-phase/KP washout detection in HCC were also higher with SonoVue® than with Sonazoid® (sensitivity 80% vs 52%; specificity 80% vs 73% in studies within unselected patient populations). CONCLUSION APHE and late washout in HCC are more frequently observed with SonoVue® than with Sonazoid®. This may affect the diagnostic performance of CEUS in the diagnosis of HCCs. CLINICAL RELEVANCE STATEMENT Meta-analysis data show the presence of key enhancement features for diagnosis of hepatocellular carcinoma is different between ultrasound contrast agents, and arterial hyperenhancement and late washout are more frequently observed at contrast-enhanced ultrasound with SonoVue® than with Sonazoid®. KEY POINTS • Dynamic enhancement features are key for imaging-based diagnosis of HCC. • Arterial hyperenhancement and late washout are more often observed in HCCs using SonoVue®-enhanced US than with Sonazoid®. • The existing evidence for contrast-enhanced US may need to be considered being specific to the individual contrast agent.
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Affiliation(s)
- Jie Ren
- Department of Medical Ultrasound, Laboratory of Novel Optoacoustic (Ultrasonic) Imaging, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qiang Lu
- Department of Ultrasound, Laboratory of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Xiang Fei
- Department of Ultrasound, the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | | - Paul S Sidhu
- King's College London, Radiology, London, United Kingdom
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem and Permancence, Bern, Switzerland.
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Wang S, Yao J, Li K, Yang H, Lu S, He G, Wu W, Cheng W, Jiang T, Ding H, Jing X, Yan Y, Liu F, Yu J, Han Z, Cheng Z, Tan S, Li X, Dou J, Li Y, Qi E, Zhang Y, Liang P, Yu X. Nomogram based on Sonazoid contrast-enhanced ultrasound to differentiate intrahepatic cholangiocarcinoma and poorly differentiated hepatocellular carcinoma: a prospective multicenter study. Abdom Radiol (NY) 2023; 48:3101-3113. [PMID: 37436451 DOI: 10.1007/s00261-023-03993-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/17/2023] [Accepted: 06/18/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES The aim of this study was to develop a predictive model based on Sonazoid contrast-enhanced ultrasound (SCEUS) and clinical features to discriminate poorly differentiated hepatocellular carcinoma (P-HCC) from intrahepatic cholangiocarcinoma (ICC). PATIENTS AND METHOD Forty-one ICC and forty-nine P-HCC patients were enrolled in this study. The CEUS LI-RADS category was assigned according to CEUS LI-RADS version 2017. Based on SCEUS and clinical features, a predicated model was established. Multivariate logistic regression analysis and LASSO logistic regression were used to identify the most valuable features, 400 times repeated 3-fold cross-validation was performed on the nomogram model and the model performance was determined by its discrimination, calibration, and clinical usefulness. RESULTS Multivariate logistic regression and LASSO logistic regression indicated that age (> 51 y), viral hepatitis (No), AFP level (≤ 20 µg/L), washout time (≤ 45 s), and enhancement level in the Kupffer phase (Defect) were valuable predictors related to ICC. The area under the receiver operating characteristic (AUC) of the nomogram was 0.930 (95% CI: 0.856-0.973), much higher than the subjective assessment by the sonographers and CEUS LI-RADS categories. The calibration curve showed that the predicted incidence was more consistent with the actual incidence of ICC, and 400 times repeated 3-fold cross-validation revealed good discrimination with a mean AUC of 0.851. Decision curve analysis showed that the nomogram could increase the net benefit for patients. CONCLUSIONS The nomogram based on SCEUS and clinical features can effectively differentiate P-HCC from ICC.
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Affiliation(s)
- Shuo Wang
- Department of Interventional Ultrasound, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
- Chinese PLA Medical School, Beijing, 100853, China
| | - Jundong Yao
- Department of Interventional Ultrasound, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
- Department of Ultrasound, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, 471000, China
| | - Kaiyan Li
- Department of Ultrasound, Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hong Yang
- Department of Ultrasound, The First Affiliated Hospital of Guangxi medical University, Nanning, 530021, China
| | - Shichun Lu
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Guangzhi He
- Department of Ultrasound, University of Chinese Academy of Sciences Shenzhen Hospital, Guangming District, Shenzhen, 518000, China
| | - Wei Wu
- Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Wen Cheng
- Department of Ultrasonography, Harbin Medical University Cancer Hospital, Harbin, 150000, China
| | - Tianan Jiang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, China
| | - Hong Ding
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Yuanyuan Yan
- Department of Ultrasound, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Henan, 450007, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Fifth Medical Center of ChinesePLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Jie Yu
- Department of Interventional Ultrasound, Fifth Medical Center of ChinesePLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Fifth Medical Center of ChinesePLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Fifth Medical Center of ChinesePLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Shuilian Tan
- Department of Interventional Ultrasound, Fifth Medical Center of ChinesePLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Xin Li
- Department of Interventional Ultrasound, Fifth Medical Center of ChinesePLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Jianping Dou
- Department of Interventional Ultrasound, Fifth Medical Center of ChinesePLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Yunlin Li
- Department of Interventional Ultrasound, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Erpeng Qi
- Department of Interventional Ultrasound, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Yiqiong Zhang
- Department of Interventional Ultrasound, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Ping Liang
- Department of Interventional Ultrasound, Fifth Medical Center of ChinesePLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China.
| | - Xiaoling Yu
- Department of Interventional Ultrasound, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China.
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Bae JS, Lee JY, Suh KS, Hong SK, Yoon JH, Kim YJ, Yu SJ, Lee JH, Cho EJ, Lee YB, Han JK. Characterization of hepatobiliary phase hypointense nodules without arterial phase hyperenhancement on gadoxetic acid-enhanced MRI via contrast-enhanced ultrasound using perfluorobutane. Abdom Radiol (NY) 2023; 48:2321-2330. [PMID: 37097451 DOI: 10.1007/s00261-023-03901-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) on gadoxetic acid-enhanced MRI (GA-MRI) may be nonmalignant cirrhosis-associated nodules or hepatocellular carcinomas (HCCs). We aimed to characterize HBP hypointense nodules without APHE on GA-MRI by performing contrast-enhanced ultrasound using perfluorobutane (PFB-CEUS). METHODS In this prospective, single-center study, participants at high-risk of HCC having HBP hypointense nodules without APHE at GA-MRI were enrolled. All participants underwent PFB-CEUS; if APHE and late, mild washout or washout in the Kupffer phase were present, the diagnosis of HCC was established according to the v2022 Korean guidelines. The reference standard consisted of histopathology or imaging. The sensitivity, specificity, and positive/negative predictive values of PFB-CEUS for detecting HCC were calculated. Associations between clinical/imaging features and the diagnosis of HCC were evaluated with logistic regression analyses. RESULTS In total, 67 participants (age, 67.0 years ± 8.4; 56 men) with 67 HBP hypointense nodules without APHE (median size, 1.5 cm [range, 1.0-3.0 cm]) were included. The prevalence of HCC was 11.9% (8/67). The sensitivity, specificity, and positive and negative predictive values of PFB-CEUS for detecting HCC were 12.5%(1/8), 96.6%(57/59), 33.3%(1/3) and 89.1%(57/64), respectively. Mild-moderate T2 hyperintensity on GA-MRI (odds ratio, 5.756; P = 0.042) and washout in the Kupffer phase on PFB-CEUS (odds ratio, 5.828; P = 0.048) were independently associated with HCC. CONCLUSION Among HBP hypointense nodules without APHE, PFB-CEUS was specific for detecting HCC, which had a low prevalence. Mild-moderate T2 hyperintensity on GA-MRI and washout in the Kupffer phase on PFB-CEUS may be useful to detect HCC in those nodules.
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Affiliation(s)
- Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Su Jong Yu
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Eun Ju Cho
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Yun Bin Lee
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
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Kupffer Phase Radiomics Signature in Sonazoid-Enhanced Ultrasound is an Independent and Effective Predictor of the Pathologic Grade of Hepatocellular Carcinoma. JOURNAL OF ONCOLOGY 2022; 2022:6123242. [PMID: 35794982 PMCID: PMC9252702 DOI: 10.1155/2022/6123242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/18/2022]
Abstract
We conduct this study to investigate the value of Kupffer phase radiomics signature of Sonazoid-enhanced ultrasound images (SEUS) for the preoperative prediction of hepatocellular carcinoma (HCC) grade. From November 2019 to October 2021, 68 pathologically confirmed HCC nodules from 54 patients were included. Quantitative radiomic features were extracted from grayscale images and arterial and Kupffer phases of SEUS of HCC lesions. Univariate logistic regression and the maximum relevance minimum redundancy (MRMR) method were applied to select radiomic features best corresponding to pathological results. Prediction radiomic signature was calculated using each of the image types. A predictive model was validated using internal leave-one-out cross validation (LOOCV). For discrimination between poorly differentiated HCC (p-HCC) and well-differentiated HCC/moderately differentiated HCC (w/m-HCC), the Kupffer phase radiomic score (KPRS) achieved an excellent area under the curve (AUC = 0.937), significantly higher than the other two radiomic signatures. KPRS was the best radiomic score based on the highest AUC (AUC = 0.878), which is prior to gray and arterial RS for differentiation between w-HCC and m/p-HCC. Univariate and multivariate analysis incorporating all radiomic signatures and serological variables showed that KPRS was the only independent predictor in both predictions of HCC lesions (p-HCC vs. w/m-HCC, log OR 15.869, P < 0.001, m/p-HCC vs. w-HCC, log OR 12.520, P < 0.05). We conclude that radiomics signature based on the Kupffer phase imaging may be useful for identifying the histological grade of HCC. The Kupffer phase radiomic signature may be an independent and effective predictor in discriminating w-HCC and p-HCC.
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Kim YY, Min JH, Hwang JA, Jeong WK, Sinn DH, Lim HK. Second-line Sonazoid-enhanced ultrasonography for Liver Imaging Reporting and Data System category 3 and 4 on gadoxetate-enhanced magnetic resonance imaging. Ultrasonography 2022; 41:519-529. [PMID: 35439873 PMCID: PMC9262668 DOI: 10.14366/usg.21198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/28/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose This study investigated the utility of second-line contrast-enhanced ultrasonography (CEUS) using Sonazoid in Liver Imaging Reporting and Data System category 3 (LR-3) and 4 (LR-4) observations on gadoxetate-enhanced magnetic resonance imaging (MRI). Methods This retrospective study included LR-3 or LR-4 observations on gadoxetate-enhanced MRI subsequently evaluated with CEUS from 2013 to 2017. The presence of MRI features, CEUS-arterial phase hyperenhancement (CEUS-APHE), and Kupffer phase defect (KPD) was evaluated. Multivariable logistic regression analysis was performed to identify significant imaging features associated with the diagnosis of hepatocellular carcinoma (HCC). The optimal diagnostic criteria were investigated using the McNemar test. Results In total, 104 patients with 104 observations (63 HCCs) were included. The presence of both CEUS-APHE and KPD on CEUS enabled the additional detection of 42.3% (11/26) of LR-3 HCCs and 78.4% (29/37) of LR-4 HCCs. Transitional phase (TP) hypointensity (adjusted odds ratio [OR], 10.59; P<0.001), restricted diffusion (adjusted OR, 7.55; P=0.004), and KPD (adjusted OR, 7.16; P=0.003) were significant imaging features for HCC diagnosis. The presence of at least two significant imaging features was optimal for HCC diagnosis (sensitivity, specificity, and accuracy: 88.9%, 78.1%, and 84.6%, respectively), with significantly higher sensitivity than the presence of both CEUS-APHE and KPD (sensitivity, specificity, and accuracy: 63.5% [P=0.001], 92.7% [P=0.077], and 75.0% [P=0.089], respectively). Conclusion The combined interpretation of gadoxetate-enhanced MRI and second-line CEUS using Sonazoid, focusing on TP hypointensity, restricted diffusion, and KPD, may be optimal for further characterizing LR-3 and LR-4 observations.
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Affiliation(s)
- Yeun-Yoon Kim
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Ah Hwang
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Keun Lim
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Takahashi H, Sugimoto K, Kamiyama N, Sakamaki K, Kakegawa T, Wada T, Tomita Y, Abe M, Yoshimasu Y, Takeuchi H, Itoi T. Noninvasive Diagnosis of Hepatocellular Carcinoma on Sonazoid-Enhanced US: Value of the Kupffer Phase. Diagnostics (Basel) 2022; 12:diagnostics12010141. [PMID: 35054309 PMCID: PMC8774743 DOI: 10.3390/diagnostics12010141] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to compare the diagnostic performance of Contrast-Enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) version 2017, which includes portal- and late-phase washout as a major imaging feature, with that of modified CEUS LI-RADS, which includes Kupffer-phase findings as a major imaging feature. Participants at risk of hepatocellular carcinoma (HCC) with treatment-naïve hepatic lesions (≥1 cm) were recruited and underwent Sonazoid-enhanced US. Arterial phase hyperenhancement (APHE), washout time, and echogenicity in the Kupffer phase were evaluated using both criteria. The diagnostic performance of both criteria was analyzed using the McNemar test. The evaluation was performed on 102 participants with 102 lesions (HCCs (n = 52), non-HCC malignancies (n = 36), and benign (n = 14)). Among 52 HCCs, non-rim APHE was observed in 92.3% (48 of 52). By 5 min, 73.1% (38 of 52) of HCCs showed mild washout, while by 10 min or in the Kupffer phase, 90.4% (47 of 52) of HCCs showed hypoenhancement. The sensitivity (67.3%; 35 of 52; 95% CI: 52.9%, 79.7%) of modified CEUS LI-RADS criteria was higher than that of CEUS LI-RADS criteria (51.9%; 27 of 52; 95% CI: 37.6%, 66.0%) (p = 0.0047). In conclusion, non-rim APHE with hypoenhancement in the Kupffer phase on Sonazoid-enhanced US is a feasible criterion for diagnosing HCC.
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Affiliation(s)
- Hiroshi Takahashi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
- Correspondence:
| | - Naohisa Kamiyama
- Ultrasound General Imaging, GE Healthcare, Hino-shi 191-0065, Japan;
| | - Kentaro Sakamaki
- Center for Data Science, Yokohama City University, Yokohama 236-0027, Japan;
| | - Tatsuya Kakegawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
| | - Takuya Wada
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
| | - Yusuke Tomita
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
| | - Masakazu Abe
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
| | - Yu Yoshimasu
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
| | - Hirohito Takeuchi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
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Dong Y, Zuo D, Qiu YJ, Cao JY, Wang HZ, Yu LY, Wang WP. Preoperative prediction of microvascular invasion (MVI) in hepatocellular carcinoma based on kupffer phase radiomic features of sonazoid contrast-enhanced ultrasound (SCEUS): A prospective study. Clin Hemorheol Microcirc 2022; 81:97-107. [PMID: 35001883 DOI: 10.3233/ch-211363] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To establish and evaluate a machine learning radiomics model based on grayscale and Sonazoid contrast enhanced ultrasound images for the preoperative prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients. METHODS 100 cases of histopathological confirmed HCC lesions were prospectively included. Regions of interest were segmented on both grayscale and Kupffer phase of Sonazoid contrast enhanced (CEUS) images. Radiomic features were extracted from tumor region and region containing 5 mm of peritumoral liver tissues. Maximum relevance minimum redundancy (MRMR) and Least Absolute Shrinkage and Selection Operator (LASSO) were used for feature selection and Support Vector Machine (SVM) classifier was trained for radiomic signature calculation. Radiomic signatures were incorporated with clinical variables using univariate-multivariate logistic regression for the final prediction of MVI. Receiver operating characteristic curves, calibration curves and decision curve analysis were used to evaluate model's predictive performance of MVI. RESULTS Age were the only clinical variable significantly associated with MVI. Radiomic signature derived from Kupffer phase images of peritumoral liver tissues (kupfferPT) displayed a significantly better performance with an area under the receiver operating characteristic curve (AUROC) of 0.800 (95% confidence interval: 0.667, 0.834), the final prediction model using Age and kupfferPT achieved an AUROC of 0.804 (95% CI: 0.723, 0.878), accuracy of 75.0%, sensitivity of 87.5% and specificity of 69.1%. CONCLUSIONS Radiomic model based on Kupffer phase ultrasound images of tissue adjacent to HCC lesions showed an observable better predictive value compared to grayscale images and has potential value to facilitate preoperative identification of HCC patients at higher risk of MVI.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032, Shanghai, China
| | - Dan Zuo
- Precision Health Institute, GE Healthcare China, Shanghai, China
| | - Yi-Jie Qiu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032, Shanghai, China
| | - Jia-Ying Cao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032, Shanghai, China
| | - Han-Zhang Wang
- Precision Health Institute, GE Healthcare China, Shanghai, China
| | - Ling-Yun Yu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032, Shanghai, China
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Dong Y, Teufel A, Wang WP, Dietrich CF. Current Opinion about Hepatocellular Carcinoma <10 mm. Digestion 2021; 102:335-341. [PMID: 32516767 DOI: 10.1159/000507923] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 04/14/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Early detection of hepatocellular carcinoma (HCC) is important. Advances in liver imaging techniques have facilitated the detection of HCC at an early stage. However, there is a controversial discussion on how to diagnose very small HCC by imaging. The aim of the current review is to present current published data on HCC ≤10 mm and discuss on how to best diagnose and treat such lesions. SUMMARY It is still challenging, however, to accurately characterize HCC <10 mm. The accuracy of contrast-enhanced ultrasound may be critical for early treatment decisions for cancer patients, particularly when CECT and/or CEMRI are inconclusive. Key Messages: The characterization of focal liver lesions <10 mm is frequently delayed until a follow-up imaging procedure demonstrates growth or stability. A repetition of ultrasound examination after 3 months for new nodules <1 cm should be recommended.
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Affiliation(s)
- Yi Dong
- Ultrasound Department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Andreas Teufel
- Division of Hepatology, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wen-Ping Wang
- Ultrasound Department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland,
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9
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Funaoka A, Numata K, Takeda A, Saigusa Y, Tsurugai Y, Nihonmatsu H, Chuma M, Fukuda H, Okada M, Nakano M, Maeda S. Use of Contrast-Enhanced Ultrasound with Sonazoid for Evaluating the Radiotherapy Efficacy for Hepatocellular Carcinoma. Diagnostics (Basel) 2021; 11:diagnostics11030486. [PMID: 33803373 PMCID: PMC7998355 DOI: 10.3390/diagnostics11030486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 01/05/2023] Open
Abstract
Radiotherapy is one of the available curative therapies for hepatocellular carcinoma (HCC). We investigate the use of contrast-enhanced ultrasound using Sonazoid (SCEUS) in evaluating the efficacy of radiotherapy for HCC. We enrolled 59 patients with 59 HCCs in this retrospective study. Tumor size and tumor vascularity were evaluated using SCEUS before and 1, 3, 7, 10, and 13 months after radiotherapy. The median follow-up period was 44.5 months (range: 16–82 months). Of the HCCs, 95% (56/59) had no local recurrence, while 5% (3/59) did. At 13 months after radiotherapy, in cases with no local recurrence, SCEUS showed a reduction in tumor vascularity in all cases, while tumor size reduction (>30% reduction, compared with pre-radiotherapy) was observed in 82.1% (46/56). In all three cases of local recurrence, vascularity and tumor size reduction were not observed during the follow-up period and residual HCCs were demonstrated pathologically. Compared with cases with local recurrence, tumor size reduction and reduction in tumor vascularity (p < 0.001) were significantly greater in cases with no local recurrence at 13 months after radiotherapy. SCEUS may be useful in evaluating radiotherapy efficacy for HCC.
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Affiliation(s)
- Akihiro Funaoka
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Kanagawa 232-0024, Japan; (A.F.); (H.N.); (M.C.); (H.F.)
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan;
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Kanagawa 232-0024, Japan; (A.F.); (H.N.); (M.C.); (H.F.)
- Correspondence: ; Tel.: +81-45-261-5656
| | - Atsuya Takeda
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa 247-0056, Japan; (A.T.); (Y.T.)
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan;
| | - Yuichirou Tsurugai
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa 247-0056, Japan; (A.T.); (Y.T.)
| | - Hiromi Nihonmatsu
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Kanagawa 232-0024, Japan; (A.F.); (H.N.); (M.C.); (H.F.)
| | - Makoto Chuma
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Kanagawa 232-0024, Japan; (A.F.); (H.N.); (M.C.); (H.F.)
| | - Hiroyuki Fukuda
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Kanagawa 232-0024, Japan; (A.F.); (H.N.); (M.C.); (H.F.)
| | - Masahiro Okada
- Department of Radiology, Nihon University School of Medicine, Tokyo 173-8610, Japan;
| | - Masayuki Nakano
- Tokyo Central Pathology Laboratory, Hachioji, Tokyo 192-0024, Japan;
| | - Shin Maeda
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa 236-0004, Japan;
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10
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Cruz M, Ferreira AA, Papanikolaou N, Banerjee R, Alves FC. New boundaries of liver imaging: from morphology to function. Eur J Intern Med 2020; 79:12-22. [PMID: 32571581 DOI: 10.1016/j.ejim.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/20/2020] [Accepted: 06/04/2020] [Indexed: 12/12/2022]
Abstract
From an invisible organ to one of the most explored non-invasively, the liver is, today, one of the cornerstones for current cross-sectional imaging techniques and minimally invasive procedures. After the achievements of US, CT and, most recently, MRI in providing highly accurate morphological and structural information about the organ, a significant scientific development has gained momentum for the last decades, coupling morphology to liver function and contributing far most to what we know today as precision medicine. In fact, dedicated tailor-made investigations are now possible in order to detect and, most of all, quantify physiopathological processes with unprecedented certitude. It is the intention of this review to provide a better insight to the reader of several functional imaging techniques applied to liver imaging. Contrast enhanced imaging, diffusion weighted imaging, elastography, spectral computed tomography and fat and iron assessment techniques are commonly performed clinically. Diffusion kurtosis imaging, magnetic resonance spectroscopy, T1 relaxometry and radiomics remain largely limited to advanced clinical research. Each of them has its own value and place on the diagnostic armamentarium and provide unique qualitative and quantitative information regarding the pathophysiology of diseases, contributing at a large scale to model therapeutic decisions and patient follow-up. Therefore, state-of-the-art liver imaging acts today as a non-invasive surrogate biomarker of many focal and diffuse liver diseases.
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Affiliation(s)
- Manuel Cruz
- Department of Radiology, Faculty of Medicine, University Hospital Coimbra and CIBIT/ICNAS research center, University of Coimbra, Coimbra, Portugal.
| | - Ana Aguiar Ferreira
- Department of Radiology, Faculty of Medicine, University Hospital Coimbra and CIBIT/ICNAS research center, University of Coimbra, Coimbra, Portugal
| | - Nikolaos Papanikolaou
- Computational Clinical Imaging Group, Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal
| | - Rajarshi Banerjee
- Department of Acute Medicine, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Filipe Caseiro Alves
- Department of Radiology, Faculty of Medicine, University Hospital Coimbra and CIBIT/ICNAS research center, University of Coimbra, Coimbra, Portugal
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11
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Lee JY, Minami Y, Choi BI, Lee WJ, Chou YH, Jeong WK, Park MS, Kudo N, Lee MW, Kamata K, Iijima H, Kim SY, Numata K, Sugimoto K, Maruyama H, Sumino Y, Ogawa C, Kitano M, Joo I, Arita J, Liang JD, Lin HM, Nolsoe C, Gilja OH, Kudo M. The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid. Ultrasonography 2020; 39:191-220. [PMID: 32447876 PMCID: PMC7315291 DOI: 10.14366/usg.20057] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 12/11/2022] Open
Abstract
The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The 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 nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.
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Affiliation(s)
- Jae Young Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
| | - Byung Ihn Choi
- Department of Radiology, Chung Ang University Hospital, Seoul, Korea
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yi-Hong Chou
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan.,Department of Radiology, National Yang Ming University, Taipei, Taiwan
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi-Suk Park
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nobuki Kudo
- Laboratory of Biomedical Engineering, Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
| | - Hiroko Iijima
- Department of Ultrasound, Hepatobiliary and Pancreatic Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - So Yeon Kim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Maruyama
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Yasukiyo Sumino
- Department of Gastroenterology and Hepatology, Toho University Medical Center, Tokyo, Japan
| | - Chikara Ogawa
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Masayuki Kitano
- Department of Gastroenterology and Hepatology, Wakayama Medical University Hospital, Wakayama, Japan
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ja-Der Liang
- Department of Gastroenterology and Hepatology, National Taiwan University, Taipei, Taiwan
| | - Hsi-Ming Lin
- Department of Gastroenterology and Hepatology, Chang Gung University, Taipei, Taiwan
| | - Christian Nolsoe
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Copenhagen, Denmark
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
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12
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Lee JY, Minami Y, Choi BI, Lee WJ, Chou YH, Jeong WK, Park MS, Kudo N, Lee MW, Kamata K, Iijima H, Kim SY, Numata K, Sugimoto K, Maruyama H, Sumino Y, Ogawa C, Kitano M, Joo I, Arita J, Liang JD, Lin HM, Nolsoe C, Gilja OH, Kudo M. The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid. J Med Ultrasound 2020; 28:59-82. [PMID: 32874864 PMCID: PMC7446696 DOI: 10.4103/jmu.jmu_124_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/09/2020] [Accepted: 02/17/2020] [Indexed: 12/13/2022] Open
Abstract
The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The 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 nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.
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Affiliation(s)
- Jae Young Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
| | - Byung Ihn Choi
- Department of Radiology, Chung Ang University Hospital, Seoul, Korea
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yi-Hong Chou
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan
- Department of Radiology, National Yang Ming University, Taipei, Taiwan
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi-Suk Park
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nobuki Kudo
- Laboratory of Biomedical Engineering, Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
| | - Hiroko Iijima
- Department of Ultrasound, Hepatobiliary and Pancreatic Disease, Hyogo College of Medicine, Nishinomiya, Japan
| | - So Yeon Kim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Maruyama
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Yasukiyo Sumino
- Department of Gastroenterology and Hepatology, Toho University Medical Center, Tokyo, Japan
| | - Chikara Ogawa
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Masayuki Kitano
- Department of Gastroenterology and Hepatology, Wakayama Medical University Hospital, Wakayama, Japan
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ja-Der Liang
- Department of Gastroenterology and Hepatology, National Taiwan University, Taipei, Taiwan
| | - Hsi-Ming Lin
- Department of Gastroenterology and Hepatology, Chang Gung University, Taipei, Taiwan
| | - Christian Nolsoe
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Copenhagen, Denmark
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Higashi-Osaka, Japan
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13
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Watanabe Y, Ogawa M, Kumagawa M, Hirayama M, Miura T, Matsumoto N, Nakagawara H, Yamamoto T, Moriyama M. Utility of Contrast-Enhanced Ultrasound for Early Therapeutic Evaluation of Hepatocellular Carcinoma After Transcatheter Arterial Chemoembolization. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:431-440. [PMID: 31436341 DOI: 10.1002/jum.15118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We aimed to investigate whether contrast-enhanced ultrasound (CEUS) could be useful for early evaluation of the treatment response to transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). METHODS This study retrospectively selected HCCs in which homogeneous retention of iodized oil was confirmed on non-contrast-enhanced computed tomography performed immediately after TACE. Therapeutic responses of HCCs were evaluated by CEUS 1 to 2 days after TACE and by contrast-enhanced computed tomography (CECT) approximately 4 weeks after TACE. We investigated the noninferiority of CEUS 1 to 2 days after TACE to CECT approximately 4 weeks after TACE in terms of the diagnostic accuracy of the therapeutic response to TACE on HCC. RESULTS Eighty-nine HCCs were enrolled in this study between April 2014 and June 2016. A complete response was observed in 57 of 89 nodules (64.0%), and an incomplete response was observed in the remaining 32 nodules (36.0%). The accuracy rates for CEUS 1 to 2 days after TACE and CECT approximately 4 weeks after TACE in the therapeutic effect of TACE on HCCs were 83.1% (95% confidence interval, 73.7%-90.2%) and 83.1% (95% confidence interval, 73.7%-90.2%), respectively. The difference in diagnostic accuracy between methods was 0%, which was below the predetermined noninferiority limit of 15%, and CEUS 1 to 2 days after TACE was noninferior to CECT approximately 4 weeks after TACE. CONCLUSIONS Our results suggest that CEUS is a useful modality for early therapeutic evaluation of TACE for HCC, and we can thus plan the next treatment strategies for HCC within a few days after TACE.
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Affiliation(s)
- Yukinobu Watanabe
- Department of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Masahiro Ogawa
- Department of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Mariko Kumagawa
- Department of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Midori Hirayama
- Department of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Takao Miura
- Department of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Naoki Matsumoto
- Department of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroshi Nakagawara
- Department of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiki Yamamoto
- Department of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Mitsuhiko Moriyama
- Department of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
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14
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Duisyenbi Z, Numata K, Nihonmatsu H, Fukuda H, Chuma M, Kondo M, Nozaki A, Tanaka K, Maeda S. Comparison Between Low Mechanical Index and High Mechanical Index Contrast Modes of Contrast-Enhanced Ultrasonography: Evaluation of Perfusion Defects of Hypervascular Hepatocellular Carcinomas During the Post-Vascular Phase. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2329-2338. [PMID: 30653696 DOI: 10.1002/jum.14926] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/26/2018] [Accepted: 12/15/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES We evaluated the detection rates for perfusion defects in hypervascular hepatocellular carcinomas comparing the low mechanical index (MI) and high MI contrast modes during the post-vascular phase (PVP) of contrast-enhanced ultrasonography. METHODS Seventy-eight patients with 84 hypervascular hepatocellular carcinomas (mean diameter, 23.4 ± 11.2 mm) were selected for this retrospective study. All the patients underwent whole-liver scanning using conventional ultrasonography before injection of a perflubutane-based contrast agent (Sonazoid), and all the detected nodules were classified as either hypoechoic or hyperechoic nodules. Next, hypoechoic and hyperechoic nodules were evaluated using contrast-enhanced ultrasonography, and the presence of a perfusion defect was assessed for each nodule using both the low MI (0.2-0.3) and the high MI (0.7-1.2) contrast modes during the PVP (10 minutes after injection). The data were analyzed using the McNemar test. RESULTS Forty-four nodules were classified as hypoechoic nodules, and the remaining 40 nodules were classified as hyperechoic nodules using conventional ultrasonography. The detection rate for perfusion defects determined using the high MI contrast mode was higher than that determined using the low MI contrast mode in hyperechoic nodules during the PVP (low MI, 58% [23 of 40]; high MI, 90% [36 of 40]; P < .0001). However, no significant difference was observed between the low MI and the high MI contrast modes in hypoechoic nodules (low MI, 80% [35 of 44]; high MI, 89% [39 of 44]; P = .125). CONCLUSION Compared with the low MI contrast mode, the high MI contrast mode was more sensitive for detecting perfusion defects in hypervascular hepatocellular carcinomas in patients with hyperechoic nodules during the PVP.
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Affiliation(s)
- Zaya Duisyenbi
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Radiology, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiromi Nihonmatsu
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroyuki Fukuda
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Makoto Chuma
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Masaaki Kondo
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Akito Nozaki
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsuaki Tanaka
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Maeda
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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15
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Tamura M, Nakamura K, Osuga T, Shimbo G, Sasaki N, Morishita K, Ohta H, Takiguchi M. Findings of contrast-enhanced ultrasonography with Sonazoid for cholangiocellular adenoma in three dogs. J Vet Med Sci 2019; 81:1104-1108. [PMID: 31243194 PMCID: PMC6715911 DOI: 10.1292/jvms.19-0116] [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] [Indexed: 01/08/2023] Open
Abstract
Contrast-enhanced ultrasonography (CEUS) is useful to distinguish benign and malignant
focal liver lesions in dogs. Cholangiocellular adenoma is an extremely rare benign tumor
in dogs and has not been examined using CEUS with Sonazoid. The aim of this study was to
describe findings of CEUS with Sonazoid in three dogs with cholangiocellular adenoma. All
three dogs showed contrast defects in the Kupffer phase and these findings mimicked
malignant neoplasia during the Kupffer phase. Moreover, all dogs showed early washout and
hypoechoic lesions relative to the surrounding normal liver parenchyma in the portal
phase. To our knowledge, this is the first study to report that CEUS findings of
cholangiocellular adenoma with Sonazoid mimicked malignancy in three dogs.
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Affiliation(s)
- Masahiro Tamura
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan
| | - Kensuke Nakamura
- Organization for Promotion of Tenure Track, University of Miyazaki, Miyazaki 889-2192, Japan
| | - Tatsuyuki Osuga
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido 060-0819, Japan
| | - Genya Shimbo
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido 060-0819, Japan
| | - Noboru Sasaki
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan
| | - Keitaro Morishita
- Veterinary Teaching Hospital, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido 060-0819, Japan
| | - Hiroshi Ohta
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan
| | - Mitsuyoshi Takiguchi
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan
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16
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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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17
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Yang WY, Park HS, Kim YJ, Yu MH, Jung SI, Jeon HJ. Visibility of focal liver lesions: Comparison between kupffer phase of CEUS with sonazoid and hepatobiliary phase of gadoxetic acid-enhanced MRI. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:542-550. [PMID: 28547764 DOI: 10.1002/jcu.22499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND To investigate the agreement between Kupffer phase of Sonazoid contrast-enhanced sonography (CEUS) and hepatobiliary phase of gadoxetic acid-enhanced MRI in the evaluation of focal liver lesions (FLLs). METHODS One hundred fifty-four FLLs in 154 patients who underwent both Sonazoid CEUS and gadoxetic acid-enhanced liver MRI were included in this retrospective study. FLL visibility on the Kupffer-phase images was graded as one (invisible or isoenhancing), two (vaguely visible or vaguely hypoenhancing), or three (clearly visible or clearly hypoenhancing), and that on the hepatobiliary-phase images of MRI was graded as one (invisible or hyper/isointense), two (vaguely visible or weakly hypointense), or three (clearly visible or strongly hypointense). Pairwise comparison of lesion visibility between the two modalities was performed, and intermodality agreement was assessed. RESULTS On Kupffer-phase CEUS, 31 (20.1%) lesions were invisible, 17 (11.1%) were vaguely visible, and 106 (68.9%) were clearly visible. On the hepatobiliary-phase MRI, 9 (5.9%) lesions were invisible, 45 (29.2%) were vaguely visible, and 100 (64.9%) were clearly visible. Overall, lesion visibility scores were not significantly different between the two modalities (p = 0.121), but the visibility was significantly better on MRI in smaller lesions. Twenty-eight lesions (18.2%) showed discrepancy in the visibility on CEUS and MRI, and most of the cases (89.7%) were lesions that were invisible on CEUS but visible on MRI. CONCLUSIONS The overall visibility of FLLs was comparable between the Kupffer phase of Sonazoid-CEUS and the hepatobiliary-phase images of gadoxetic acid-enhanced MRI, with a discrepancy between the two modalities in 18% of the cases. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:542-550, 2017.
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Affiliation(s)
- Woo Young Yang
- Department of Radiology, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, Korea
| | - Mi Hye Yu
- Department of Radiology, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, Korea
| | - Hae Jeong Jeon
- Department of Radiology, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, Korea
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18
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Lee S, Kim JH, Lee JH, Zen Y, Han JK. Imaging Monitoring of Kupffer Cell Function and Hepatic Oxygen Saturation in Preneoplastic Changes During Cholangiocarcinogenesis. Sci Rep 2017; 7:14203. [PMID: 29079853 PMCID: PMC5660185 DOI: 10.1038/s41598-017-14218-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 10/05/2017] [Indexed: 12/13/2022] Open
Abstract
We investigated serial changes of the Kupffer cell (KC) function and hepatic oxygen saturation (sO2) using contrast-enhanced ultrasound imaging (CEUS) and photoacoustic imaging (PAI) in preneoplastic changes during cholangiocarcinogenesis induced by obstructive cholangitis and N-nitrosodimethylamine in a mouse model. The CEUS and PAI were performed to assess Sonazoid contrast agent uptake by KC and changes in the sO2 of liver parenchyma. An extensive bile ductular reaction, cystic dilatation, and epithelial hyperplasia with dysplastic changes were noted in the experimental group. During the preneoplastic changes, the parenchymal echogenicity on the Kupffer-phase of CEUS was continuously decreased in the experimental group, and which means that the Sonazoid phagocytosis by KC was decreased. The number of KCs was increased in the CD68 analysis, indicating functionally impaired KCs. There was a simultaneous serial decrease in sO2 on PAI measurement of the experimental group during the preneoplastic changes. The experimental group also showed significantly higher expression of hypoxia-inducible factor-1α and vascular endothelial growth factor protein. Our study demonstrated that KC dysfunction and hypoxic environmental changes were the factors influencing preneoplastic change during cholangiocarcinogenesis, and we could non-invasively monitor these changes using CEUS and PAI.
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Affiliation(s)
- Seunghyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea. .,Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Jeong Hwa Lee
- Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yoh Zen
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea
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19
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Murata K, Saito A, Katagiri S, Ariizumi S, Nakano M, Yamamoto M. Association of des-γ-carboxy prothrombin production and Sonazoid-enhanced ultrasound findings in hepatocellular carcinomas of different histologic grades. J Med Ultrason (2001) 2017; 45:223-229. [PMID: 28828695 DOI: 10.1007/s10396-017-0816-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/19/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE We previously reported that hepatocellular carcinoma (HCC) changes to a phenotype producing des-γ-carboxy prothrombin (DCP) during epithelial mesenchymal transition (EMT) in vitro. To confirm this change in vivo, we evaluated the association between DCP production and HCC hemodynamics in patients undergoing resection as EMT and hemodynamic changes are closely associated with each other. METHODS We evaluated HCC hemodynamics by employing Sonazoid-enhanced ultrasound (SEUS) before surgical resection, and sought associations with histological grade and immunohistochemical staining of DCP in 19 areas from 11 patients. RESULTS In 10 HCC areas showing early washout (3 min ≥) using SEUS, three areas corresponded to poorly differentiated HCC and the remaining seven areas corresponded to moderately differentiated HCC, and positive DCP staining was observed in only two of the seven moderately differentiated HCC areas, whereas no staining was observed in poorly differentiated HCC areas. Six HCC areas showing intermediate washout (3-10 min) using SEUS were moderately differentiated, of which five demonstrated positive DCP staining (83.3%, 5/6). However, all HCC areas without enhancement in the arterial phase were well-differentiated and did not show DCP staining. CONCLUSION Our preliminary findings suggest that HCC hemodynamics evaluated by SEUS are associated with histological grade and/or DCP production.
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Affiliation(s)
- Kazumoto Murata
- The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, Japan.,Department of Gastroenterology, Graduate School of Medical Sciences, International University of Health and Welfare, Nasushiobara, Japan
| | - Akiko Saito
- Gastroenterology and Hepatology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
| | - Satoshi Katagiri
- Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shunichi Ariizumi
- Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayuki Nakano
- Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masakazu Yamamoto
- Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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20
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Kondo S, Takagi K, Nishida M, Iwai T, Kudo Y, Ogawa K, Kamiyama T, Shibuya H, Kahata K, Shimizu C. Computer-Aided Diagnosis of Focal Liver Lesions Using Contrast-Enhanced Ultrasonography With Perflubutane Microbubbles. IEEE TRANSACTIONS ON MEDICAL IMAGING 2017; 36:1427-1437. [PMID: 28141517 DOI: 10.1109/tmi.2017.2659734] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This paper proposes an automatic classification method based on machine learning in contrast-enhanced ultrasonography (CEUS) of focal liver lesions using the contrast agent Sonazoid. This method yields spatial and temporal features in the arterial phase, portal phase, and post-vascular phase, as well as max-hold images. The lesions are classified as benign or malignant and again as benign, hepatocellular carcinoma (HCC), or metastatic liver tumor using support vector machines (SVM) with a combination of selected optimal features. Experimental results using 98 subjects indicated that the benign and malignant classification has 94.0% sensitivity, 87.1% specificity, and 91.8% accuracy, and the accuracy of the benign, HCC, and metastatic liver tumor classifications are 84.4%, 87.7%, and 85.7%, respectively. The selected features in the SVM indicate that combining features from the three phases are important for classifying FLLs, especially, for the benign and malignant classifications. The experimental results are consistent with CEUS guidelines for diagnosing FLLs. This research can be considered to be a validation study, that confirms the importance of using features from these phases of the examination in a quantitative manner. In addition, the experimental results indicate that for the benign and malignant classifications, the specificity without the post-vascular phase features is significantly lower than the specificity with the post-vascular phase features. We also conducted an experiment on the operator dependency of setting regions of interest and observed that the intra-operator and inter-operator kappa coefficients were 0.45 and 0.77, respectively.
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21
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Park HJ, Choi BI, Lee ES, Park SB, Lee JB. How to Differentiate Borderline Hepatic Nodules in Hepatocarcinogenesis: Emphasis on Imaging Diagnosis. Liver Cancer 2017; 6. [PMID: 28626731 PMCID: PMC5473078 DOI: 10.1159/000455949] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Rapid advances in liver imaging have improved the evaluation of hepatocarcinogenesis and early diagnosis and treatment of hepatocellular carcinoma (HCC). In this situation, detection of early-stage HCC in its development is important for the improvement of patient survival and optimal treatment strategies. Because early HCCs are considered precursors of progressed HCC, precise differentiation between a dysplastic nodule (DN), especially a high-grade DN, and early HCC is important. In clinical practice, these nodules are frequently called "borderline hepatic nodules." SUMMARY This article discusses radiological and pathological characteristics of these borderline hepatic nodules and offers an understanding of multistep hepatocarcinogenesis by focusing on the descriptions of the imaging changes in the progression of DN and early HCC. Detection and accurate diagnosis of borderline hepatic nodules are still a challenge with contrast enhanced ultrasonography, CT, and MRI with extracellular contrast agents. However, gadoxetic acid-enhanced MRI may be useful for improving the diagnosis of these borderline nodules. KEY MESSAGES Since there is a net effect of incomplete neoangiogenesis and decreased portal venous flow in the early stage of hepatocarcinogenesis, borderline hepatic nodules commonly show iso- or hypovascularity. Therefore, precise differentiation of these nodules remains a challenging issue. In MRI using hepatobiliary contrast agents, signal intensity of HCCs on hepatobiliary phase (HBP) is regarded as a potential imaging biomarker. Borderline hepatic nodules are seen as nonhypervascular and hypointense nodules on the HBP, which is important for predicting tumor behavior and determining appropriate therapeutic strategies.
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Affiliation(s)
| | - Byung Ihn Choi
- *Byung Ihn Choi, MD, Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul 06973 (Republic of Korea), E-Mail
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22
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Terzi E, Salvatore V, Negrini G, Piscaglia F. Ongoing challenges in the diagnosis of hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol 2016; 10:451-63. [PMID: 26603785 DOI: 10.1586/17474124.2016.1124758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In 2001, the European Association for the Study of the Liver (EASL) endorsed the possibility of achieving a non-invasive diagnosis of Hepatocellular Carcinoma (HCC) for the first time. Since then, various refinements of the criteria and techniques capable of achieving this diagnosis and the role of plasma and tissue oncomarkers have been reported in the literature and have been accepted to different extents in various geographical areas. Such tools can also potentially imply prognostic significance. The present article critically discusses some of the most relevant and debated challenges which have emerged in this field, including the role of contrast-enhanced ultrasound, and of hepatocyte-specific magnetic resonance contrast agents, the pitfall of transient hepatic attenuation differences, the reliability of biopsy and the status of biomarkers.
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Affiliation(s)
- Eleonora Terzi
- a Division of Internal Medicine, Department of Digestive Disease and Internal Medicine, Sant'Orsola-Malpighi Hospital , University of Bologna , Bologna , Italy
| | - Veronica Salvatore
- a Division of Internal Medicine, Department of Digestive Disease and Internal Medicine, Sant'Orsola-Malpighi Hospital , University of Bologna , Bologna , Italy
| | - Giulia Negrini
- a Division of Internal Medicine, Department of Digestive Disease and Internal Medicine, Sant'Orsola-Malpighi Hospital , University of Bologna , Bologna , Italy
| | - Fabio Piscaglia
- a Division of Internal Medicine, Department of Digestive Disease and Internal Medicine, Sant'Orsola-Malpighi Hospital , University of Bologna , Bologna , Italy
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23
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Malone CD, Mattrey RF, Fetzer DT. Contrast-Enhanced Ultrasound (CEUS) for the Diagnosis and Management of Hepatocellular Carcinoma: Current Status and Future Trends. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s11901-016-0324-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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24
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Sugimoto K, Shiraishi J, Tanaka H, Tsuchiya K, Aso K, Kobayashi Y, Iijima H, Moriyasu F. Computer-aided diagnosis for estimating the malignancy grade of hepatocellular carcinoma using contrast-enhanced ultrasound: an ROC observer study. Liver Int 2016; 36:1026-32. [PMID: 26681659 DOI: 10.1111/liv.13043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 12/07/2015] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS We are developing a computer-aided diagnosis (CAD) system for estimating the malignancy grade of hepatocellular carcinoma (HCC) using contrast-enhanced ultrasound (CEUS). In this study, observers estimated the malignancy grade of HCC with and without the cues provided by CAD. MATERIALS AND METHODS Institutional review board approval was obtained and informed consent was waived. A total of 232 histologically confirmed HCCs were studied: 76 well-differentiated HCC (w-HCC), 133 moderately differentiated HCC (m-HCC), and 23 poorly differentiated HCC (p-HCC). In this observer study, CEUS vascular images acquired using the maximum intensity projection technique were displayed together with static B-mode and Kupffer-phase (defined as 10 min after injection) images. Five hepatologists independently assigned confidence ratings for the malignancy grade of each HCC. Each hepatologist first read each case without CAD and then immediately afterwards with CAD. The observers' rating data were evaluated by multireader multicase receiver operating characteristic (ROC) analysis. RESULTS The overall sensitivity of our CAD system for discrimination between three histological differentiation grades of HCC was 87.5% (203/232). For discrimination between w-HCC and m/p-HCC, the mean area under the ROC curve (AUC) for the five observers was significantly improved from 0.779 ± 0.074 to 0.872 ± 0.090 with CAD (P = 0.0069). For discrimination between m-HCC and p-HCC, the mean AUC was also significantly improved from 0.713 ± 0.107 to 0.863 ± 0.101 with CAD (P = 0.0321). CONCLUSION The use of our CAD system can significantly improve the diagnostic performance of hepatologists in discriminating between three histological differentiation grades of HCC using CEUS.
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Affiliation(s)
- Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Junji Shiraishi
- School of Health Sciences, Kumamoto University, Kumamoto, Japan
| | - Hironori Tanaka
- Ultrasound Imaging Center, Hyogo College of Medicine, Hyogo, Japan.,Department of Gastroenterology and Hepatology, Takarazuka City Hospital, Osaka, Japan
| | - Kaoru Tsuchiya
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Kazunobu Aso
- Division of Metabolism and Biosystemic Science, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Yoshiyuki Kobayashi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hiroko Iijima
- Ultrasound Imaging Center, Hyogo College of Medicine, Hyogo, Japan
| | - Fuminori Moriyasu
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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25
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Maruyama H, Sekimoto T, Yokosuka O. Role of contrast-enhanced ultrasonography with Sonazoid for hepatocellular carcinoma: evidence from a 10-year experience. J Gastroenterol 2016; 51:421-33. [PMID: 26694825 DOI: 10.1007/s00535-015-1151-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/25/2015] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC) represents primary liver cancer. Because the development of HCC limits the prognosis as well as the quality of life of the patients, its management should be properly conducted based on an accurate diagnosis. The liver is the major target organ of ultrasound (US), which is the simple, non-invasive, and real-time imaging method available worldwide. Microbubble-based contrast agents are safe and reliable and have become popular, which has resulted in the improvement of diagnostic performances of US due to the increased detectability of the peripheral blood flow. Sonazoid (GE Healthcare, Waukesha, WI, USA), a second-generation contrast agent, shows the unique property of accumulation in the liver and spleen. Contrast-enhanced US with Sonazoid is now one of the most frequently used modalities in the practical management of liver tumors, including the detection and characterization of the nodule, evaluation of the effects of non-surgical treatment, intraoperative support, and post-treatment surveillance. This article reviews the 10-year evidence for contrast-enhanced US with Sonazoid in the practical management of HCC.
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Affiliation(s)
- Hitoshi Maruyama
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba, 260-8670, Japan.
| | - Tadashi Sekimoto
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba, 260-8670, Japan
| | - Osamu Yokosuka
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba, 260-8670, Japan
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26
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Inoue T, Hyodo T, Korenaga K, Murakami T, Imai Y, Higaki A, Suda T, Takano T, Miyoshi K, Koda M, Tanaka H, Iijima H, Ochi H, Hirooka M, Numata K, Kudo M. Kupffer phase image of Sonazoid-enhanced US is useful in predicting a hypervascularization of non-hypervascular hypointense hepatic lesions detected on Gd-EOB-DTPA-enhanced MRI: a multicenter retrospective study. J Gastroenterol 2016; 51:144-52. [PMID: 26373860 DOI: 10.1007/s00535-015-1094-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 06/06/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND It remains unknown whether Kupffer-phase images in Sonazoid-enhanced ultrasonography (US) can be used to predict hypervascularization of borderline lesions. Therefore, we aimed to clarify whether Kupffer-phase images in Sonazoid-enhanced ultrasonography can predict subsequent hypervascularization in hypovascular borderline lesions detected on hepatobiliary-phase gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging. METHODS From January 2008 to March 2012, 616 low-intensity hypovascular nodules were detected in hepatobiliary-phase images of Gd-EOB-DTPA-enhanced MRI at nine institutions. Among these, 167 nodules, which were confirmed as hypovascular by Gd-EOB-DTPA-enhanced MRI and Sonazoid-enhanced US, were evaluated in this study. Potential hypervascularization factors were selected based on their clinical significance and the results of previous reports. The Kaplan-Meier model and log-rank test were used for univariate analysis and the Cox regression model was used for multivariate analysis. RESULTS The cumulative incidence of hypervascularization of borderline lesions was 18, 37, and 43 % at 1, 2, and 3 years, respectively. Univariate analyses showed that tumor size (p = 0.0012) and hypoperfusion on Kupffer-phase images in Sonazoid-enhanced US (p = 0.004) were associated with hypervascularization of the tumor. Multivariate analysis showed that tumor size [HR: 1.086, 95 % confidence interval = 1.027-1.148, p = 0.004] and hypo perfusion on Kupffer-phase images [HR: 3.684, 95 % confidence interval = 1.798-7.546, p = 0.0004] were significantly different. CONCLUSIONS Kupffer-phase images in Sonazoid-enhanced US and tumor diameter can predict hypervascularization of hypointense borderline lesions detected on hepatobiliary-phase Gd-EOB-DTPA-enhanced MRI.
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Affiliation(s)
- Tatsuo Inoue
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, 589-8511, Osaka, Japan.
| | - Tomoko Hyodo
- Department of Diagnostic Radiology, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, 589-8511, Osaka, Japan
| | - Keiko Korenaga
- Department of Hepatology and Pancreatology, Kawasaki Medical School, Kurashiki, Japan
- Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Takamichi Murakami
- Department of Diagnostic Radiology, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, 589-8511, Osaka, Japan
| | - Yasuharu Imai
- Department of Gastroenterology, Ikeda Municipal Hospital, Osaka, Japan
| | - Atsushi Higaki
- Department of Hepatology and Pancreatology, Kawasaki Medical School, Kurashiki, Japan
| | - Takeshi Suda
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Toru Takano
- Division of Radiation Oncology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Kennichi Miyoshi
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University, Tottori, Japan
| | - Masahiko Koda
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University, Tottori, Japan
| | - Hironori Tanaka
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Japan
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroko Iijima
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hironori Ochi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, 589-8511, Osaka, Japan.
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27
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Diagnosing Borderline Hepatic Nodules in Hepatocarcinogenesis: Imaging Performance. AJR Am J Roentgenol 2015; 205:10-21. [PMID: 26102378 DOI: 10.2214/ajr.14.12655] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purposes of this article are to describe the pathologic and radiologic features of small nodular lesions and to offer insight into the multistep process of hepatocarcinogenesis by describing the progression of imaging changes that link dysplastic nodules and early hepatocellular carcinoma, (HCC) to small HCC that has progressed. CONCLUSION Nodules larger than 1 cm found during ultrasound surveillance of a cirrhotic liver should be investigated further with diagnostic imaging. Contrast-enhanced CT and dynamic MRI are the primary diagnostic studies for the diagnosis of HCC; contrast-enhanced ultrasound can be used as an alternative test. If a nodule has the typical hallmark of hypervascularity in the hepatic arterial phase with washout in the portal venous or delayed phase, a definitive diagnosis of HCC can be made. Nodules found during ultrasound surveillance that are smaller than 1 cm can be followed with ultrasound examinations at intervals of 3-6 months.
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28
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Ohno N, Miyati T, Yamashita M, Narikawa M. Quantitative Assessment of Tissue Perfusion in Hepatocellular Carcinoma Using Perflubutane Dynamic Contrast-Enhanced Ultrasonography: A Preliminary Study. Diagnostics (Basel) 2015; 5:210-8. [PMID: 26854150 PMCID: PMC4665596 DOI: 10.3390/diagnostics5020210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/28/2015] [Accepted: 05/14/2015] [Indexed: 12/21/2022] Open
Abstract
Our purpose in this study was to assess the relationship between contrast signal intensity (CI) and concentration of perflubutane microbubbles in a phantom experiment, and to examine the feasibility of this technique for quantitative analysis of vascularity in hepatocellular carcinoma (HCC). Microbubble solutions of the perflubutane contrast agent were prepared by mixing with purified water. We examined the relationship between CI in dB units and the concentration. Moreover, seven HCC patients were examined using real-time dynamic contrast imaging. The perfusion index was calculated from time-intensity curves generated for both HCC and surrounding liver parenchyma. We observed a linear relationship between the CIdB and the concentration in the phantom study and a higher perfusion index in the HCC lesions relative to the surrounding liver parenchyma. Dynamic contrast-enhanced ultrasonography with perflubutane microbubbles, which exhibit linear and temporally stable characteristics under continuous ultrasound exposure, allows the collection of quantitative hemodynamic information regarding HCC.
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Affiliation(s)
- Naoki Ohno
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80, Kodatsuno, Kanazawa, Ishikawa 9200942, Japan.
| | - Tosiaki Miyati
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80, Kodatsuno, Kanazawa, Ishikawa 9200942, Japan.
| | - Makiko Yamashita
- Department of Radiology, Tonami General Hospital, 16-1, Shintomicho, Tonami, Toyama 9391395, Japan.
| | - Mayu Narikawa
- Department of Radiology, Tonami General Hospital, 16-1, Shintomicho, Tonami, Toyama 9391395, Japan.
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Nishigaki Y, Hayashi H, Tomita E, Suzuki Y, Watanabe N, Watanabe S, Watanabe C, Takagi Y, Kato T, Naiki T. Usefulness of contrast-enhanced ultrasonography using Sonazoid for the assessment of therapeutic response to percutaneous radiofrequency ablation for hepatocellular carcinoma. Hepatol Res 2015; 45:432-40. [PMID: 24917381 DOI: 10.1111/hepr.12370] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 06/01/2014] [Accepted: 06/05/2014] [Indexed: 02/08/2023]
Abstract
AIM Accurate assessment of the coagulated area is imperative to achieve an excellent outcome from percutaneous radiofrequency ablation (PRFA) for the treatment of hepatocellular carcinoma (HCC). We evaluated the efficacy of contrast-enhanced ultrasonography (CEUS) with the contrast-enhancing agent Sonazoid for precisely assessing the therapeutic effect of PRFA for HCC. METHODS We enrolled 87 consecutive patients with solitary naïve HCC of less than 3 cm in diameter. PRFA treatment was performed with a 17-G cool-tip needle, and CEUS was performed to assess the ablative margin 3 h after the procedure, when the coagulated tumor outline was easiest to discern. The treatment was repeated until an ablative margin greater than 5 mm was confirmed. After CEUS assessment of the therapeutic response, the patients were followed to investigate local tumor recurrence. RESULTS In 78 patients (89.7%), the outline of the coagulated tumors could be recognized by ultrasonography, and CEUS assessment of the ablative margin was successful. The remaining nine patients were assessed by computed tomography. The 5-year cumulative survival rate after the assessment of the treatment response with CEUS was 58.4%, and the 4-year cumulative total recurrence rate was 72.3%. The 5-year cumulative local tumor recurrence rate was very low (2.3%). CONCLUSION The assessment with CEUS at 3 h after the PRFA procedure was successful in the majority of the patients, and it yielded a very low rate of local recurrence.
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Affiliation(s)
- Yoichi Nishigaki
- Department of Gastroenterology and Hepatology, Gifu Municipal Hospital, Gifu, Japan
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Park HS, Kim YJ, Yu MH, Jung SI, Jeon HJ. Real-time contrast-enhanced sonographically guided biopsy or radiofrequency ablation of focal liver lesions using perflurobutane microbubbles (sonazoid): value of Kupffer-phase imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:411-421. [PMID: 25715362 DOI: 10.7863/ultra.34.3.411] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To evaluate the utility of Kupffer-phase imaging by real-time contrast-enhanced sonography using the perflurobutane microbubble contrast agent Sonazoid (GE Healthcare, Oslo, Norway) in guiding biopsy or radiofrequency (RF) ablation of focal liver lesions. METHODS A total of 75 patients (mean age, 59.7 years) who were referred for percutaneous biopsy (n = 42) or RF ablation (n = 33) were included in the study. Grayscale sonography and contrast-enhanced sonography using Sonazoid were performed in all patients before the procedure. The conspicuity of each targeted liver lesion on grayscale sonography, vascular-phase contrast-enhanced sonography, and Kupffer-phase contrast-enhanced sonography was graded using a 5-point scale. Lesion detection rates were calculated, and the conspicuity of the lesions among the imaging modalities was compared. The technical success of the procedures was also assessed. RESULTS The procedures were conducted in 66 patients (biopsy in 41 and RF ablation in 25) under real-time guidance by Kupffer-phase contrast-enhanced sonography. Lesion detection rates were 77.3% (58 of 75), 84.0% (63 of 75), and 92.0% (69 of 75) on grayscale sonography, vascular-phase contrast-enhanced sonography, and Kupffer-phase contrast-enhanced sonography, respectively, and were significantly different among the 3 modalities (P= .034). Overall, lesion conspicuity was significantly increased on vascular-phase and Kupffer-phase contrast-enhanced sonography compared to grayscale sonography (P < .001). Technical success rates for the procedures were 95.2% (40 of 42) for biopsy and 69.7% (23 of 33) for RF ablation. CONCLUSIONS Kupffer-phase imaging by contrast-enhanced sonography using Sonazoid increases the conspicuity of the liver lesions compared to grayscale sonography, and it is useful for real-time guidance of percutaneous biopsy or RF ablation of focal liver lesions.
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Affiliation(s)
- Hee Sun Park
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea.
| | - Mi Hye Yu
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Hae Jeong Jeon
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
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Kudo M, Matsui O, Izumi N, Iijima H, Kadoya M, Imai Y, Okusaka T, Miyayama S, Tsuchiya K, Ueshima K, Hiraoka A, Ikeda M, Ogasawara S, Yamashita T, Minami T, Yamakado K. JSH Consensus-Based Clinical Practice Guidelines for the Management of Hepatocellular Carcinoma: 2014 Update by the Liver Cancer Study Group of Japan. Liver Cancer 2014; 3:458-68. [PMID: 26280007 PMCID: PMC4531423 DOI: 10.1159/000343875] [Citation(s) in RCA: 461] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The Clinical Practice Guidelines for the Management of Hepatocellular Carcinoma proposed by the Japan Society of Hepatology was updated in June 2014 at a consensus meeting of the Liver Cancer Study Group of Japan. Three important items have been updated: the surveillance and diagnostic algorithm, the treatment algorithm, and the definition of transarterial chemoembolization (TACE) failure/refractoriness. The most important update to the diagnostic algorithm is the inclusion of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging as a first line surveillance/diagnostic tool. Another significant update concerns removal of the term "lipiodol" from the definition of TACE failure/refractoriness.
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Affiliation(s)
- Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan,*Masatoshi Kudo, MD, PhD, Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Ohno-Higashi, Osaka-Sayama, Osaka 589-8511 (Japan), Tel. +81 72 366 0221, E-Mail
| | - Osamu Matsui
- Department of Radiology, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Hiroko Iijima
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Masumi Kadoya
- Department of Radiology, Shinshu University School of Medicine, Nagano, Japan
| | - Yasuharu Imai
- Department of Gastroenterology, Ikeda Municipal Hospital, Osaka, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shiro Miyayama
- Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan
| | - Kaoru Tsuchiya
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Kazuomi Ueshima
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan
| | - Atsushi Hiraoka
- Department of Gastroenterology, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tatsuya Yamashita
- Department of Gastroenterology, Kanazawa University Hospital, Ishikawa, Japan
| | - Tetsuya Minami
- Department of Radiology, Kanazawa University Hospital, Ishikawa, Japan
| | - Koichiro Yamakado
- Department of Interventional Radiology, Mie University School of Medicine, Mie, Japan
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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: 110] [Impact Index Per Article: 11.0] [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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Images of Sonazoid-enhanced ultrasonography in multistep hepatocarcinogenesis: comparison with Gd-EOB-DTPA-enhanced MRI. J Gastroenterol 2014; 49:1081-93. [PMID: 23903870 DOI: 10.1007/s00535-013-0859-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 07/04/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Little is known about the difference in enhancement patterns of hepatocellular carcinoma (HCC) during multistep hepatocarcinogenesis between the post-vascular phase of Sonazoid-enhanced ultrasonography (SEUS) and hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine (Gd-EOB-DTPA)-enhanced MRI, as well as uptakes of Sonazoid and Gd-EOB-DTPA by HCC. METHODS Seventy patients with 73 histologically proven HCCs (33 hypovascular well-differentiated HCCs and 40 progressed HCCs) and 9 dysplastic nodules (DNs) were enrolled. Enhancement patterns of the lesions on the post-vascular phase of SEUS and hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were evaluated. Uptakes of Sonazoid and Gd-EOB-DTPA were assessed by Sonazoid enhancement index and EOB enhancement ratio in relation to immunohistochemistry of CD68 and organic anion transporting polypeptide 8 (OATP8), respectively. RESULTS On the post-vascular phase of SEUS, none of the 9 DNs and 3 of 33 hypovascular well-differentiated HCCs (9 %) were hypoechoic, whereas 3 of 9 DNs (33 %) and 31 of 33 hypovascular well-differentiated HCCs (94 %) showed hypointensity on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI. Of 31 progressed HCCs, 95 and 93 % were hypoechoic and hypointense on the post-vascular phase of SEUS and hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI, respectively. Sonazoid enhancement indexes decreased in progressed HCCs, correlating with lower Kupffer cell numbers (P < 0.001). EOB enhancement ratios decreased in hypovascular well-differentiated and progressed HCCs, as OATP8 expression declined (P < 0.001). CONCLUSIONS In stepwise hepatocarcinogenesis, uptake of Sonazoid starts decreasing later than that of Gd-EOB-DTPA. Although signal reductions on the post-vascular phase of SEUS or hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI suggest HCC, hypoechoic appearance on the post-vascular phase of SEUS might be HCC-specific, particularly progressed HCC.
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Kagen A, Fowler K, Sirlin CB. Insight into hepatocellular carcinoma biology with gadoxetate disodium-enhanced MRI. Hepat Oncol 2014; 1:95-105. [PMID: 30190944 PMCID: PMC6114011 DOI: 10.2217/hep.13.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The current algorithm for the imaging diagnosis of hepatocellular carcinoma accurately detects large, progressed tumors displaying the classical imaging features of arterial hyperenhancement with 'washout' and/or 'capsule' appearance. Liver MRI with the relatively newer hepatobiliary agent, gadoxetate disodium, provides information on hepatocellular function in addition to vascularity, facilitates detection of small progressed tumors, as well as early/vaguely nodular tumors, and shows promise for characterizing hepatocellular carcinoma biology. Prediction of tumor grade, presence of biliary and stem cell markers, microvascular invasion, future hypervascularization and post-treatment recurrence have all been studied with gadoxetate disodium-enhanced MRI with encouraging results. Incorporation of gadoxetate disodium-enhanced MRI into standard diagnostic and management algorithms will likely unfold in the future.
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Affiliation(s)
- Alexander Kagen
- Beth Israel Medical Center, Department of Radiology, 2nd Floor, First Avenue at 16th Street, New York, NY 11231, USA
| | - Kathryn Fowler
- Washington University School of Medicine, 510 S. Kings Highway Boulevard, St Louis, MO 63110, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California, San Diego, 408 Dickinson Street, San Diego, CA 92013-8226, USA
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Klibanov AL. Ultrasound contrast materials in cardiovascular medicine: from perfusion assessment to molecular imaging. J Cardiovasc Transl Res 2013; 6:729-39. [PMID: 23913363 DOI: 10.1007/s12265-013-9501-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 07/08/2013] [Indexed: 11/26/2022]
Abstract
Ultrasound imaging is widely used in cardiovascular diagnostics. Contrast agents expand the range of tasks that ultrasound can perform. In the clinic in the USA, endocardial border delineation and left ventricle opacification have been an approved indication for more than a decade. However, myocardial perfusion contrast ultrasound studies are still at the clinical trials stage. Blood pool contrast and perfusion in other tissues might be an easier indication to achieve: general blood pool ultrasound contrast is in wider use in Europe, Canada, Japan, and China. Targeted (molecular) contrast microbubbles will be the next generation of ultrasound imaging probes, capable of specific delineation of the areas of disease by adherence to molecular targets. The shell of targeted microbubbles (currently in the preclinical research and early stage clinical trials) is decorated with the ligands (antibodies, peptides or mimetics, hormones, and carbohydrates) that ensure firm binding to the molecular markers of disease.
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Affiliation(s)
- Alexander L Klibanov
- Division of Cardiovascular Medicine and Cardiovascular Research Center, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA,
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Abstract
Based on recent clinical practice guidelines, imaging is largely replacing pathology as the preferred diagnostic method for determination of hepatocellular carcinoma (HCC). A variety of imaging modalities, including ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, and angiography, are currently used to examine patients with chronic liver disease and suspected HCC. Advancements in imaging techniques such as perfusion imaging, diffusion imaging, and elastography along with the development of new contrast media will further improve the ability to detect and characterize HCC. Early diagnosis of HCC is essential for prompt treatment, which may in turn improve prognosis. Considering the process of hepatocarcinogenesis, it is important to evaluate sequential changes via imaging which would help to differentiate HCC from premalignant or benign lesions. Recent innovations including multiphasic examinations, high-resolution imaging, and the increased functional capabilities available with contrast-enhanced US, multidetector row CT, and MRI have raised the standards for HCC diagnosis. Although hemodynamic features of nodules in the cirrhotic liver remain the main diagnostic criterion, newly developed cellspecific contrast agents have shown great possibilities for improved HCC diagnosis and may overcome the diagnostic dilemma associated with small or borderline hepatocellular lesions. In the 20th century paradigm of medical imaging, radiological diagnosis was based on morphological characteristics, but in the 21st century, a paradigm shift to include biomedical, physiological, functional, and genetic imaging is needed. A multidisciplinary team approach is necessary to foster an integrated approach to HCC imaging. By developing and combining new imaging modalities, all phases of HCC patient care, including screening, diagnosis, treatment, and therapy, can be dramatically improved.
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Affiliation(s)
| | - Byung Ihn Choi
- *Byung Ihn Choi, MD, Department of Radiology, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul 110-744 (Korea), Tel. +82 2 2072 2515, E-Mail
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Shindoh J, Seyama Y, Umekita N. Three-dimensional staining of liver segments with an ultrasound contrast agent as an aid to anatomic liver resection. J Am Coll Surg 2012; 215:e5-10. [PMID: 22683072 DOI: 10.1016/j.jamcollsurg.2012.05.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 05/16/2012] [Accepted: 05/16/2012] [Indexed: 12/16/2022]
Affiliation(s)
- Junichi Shindoh
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
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