Peliosis hepatis: a rare differential diagnosis of focal liver lesions – Peliosis hepatis: eine seltene Differenzialdiagnose fokaler Leberläsionen

Zusammenfassung Hintergrund: Evaluierung der diagnostischen Treffsicherheit der Kontrastmittelsonografie in der Differenzialdiagnose kleiner Leberläsionen. Material und Methoden: 1349 Patienten mit im B-Bild und Power Doppler unklarem Lebertumor wurden prospektiv mittels KM-Sono multizentrisch mit standardisiertem Protokoll (mechanischer Index < 0,4, Phase/Puls-Inversion-Technik, Sonovue-Bolus-Injektion) untersucht. Die Differenzialdiagnose im KM-Sono basierte auf tumortypischen Vaskularisationsmustern in der arteriellen, portalvenösen Phase und Spätphase (EFSUMB-Leitlinie). 335 Patienten mit fokalen Leberläsionen (FLLs) ≤ 20 mm wurden analysiert. Die Tumorklassifizierung nach KM-Sono wurde mit der Histologie (73,2 %) oder in einigen Fällen mit CT und/oder MRT verglichen. Ergebnisse: Eine definitive Tumordiagnose war in 329 FLLs möglich. Die Enddiagnose der ≤ 20 mm FLLs mit histologischer Sicherung (n = 241) beinhaltete 87 benigne und 154 maligne Tumore. Die diagnostische Treffsicherheit des KM-Sono bei ≤ 20 mm histologisch gesicherten FLLs war 83,8 %. Die KM-Sono identifizierte 144 /154 maligne FLLs (Sensitivität 93,5 %) und 58 /87 benigne FLLs (Spezifität 66,7 %). 24 /241 FLLs blieben nach der KM-Sono unklar (9,9 %). Die KM-Sono klassifizierte 15 /241 FLLs (6,2 %) falsch (12 benigne und 3 maligne FLLs). Die positive Voraussagekraft der KM-Sono bei malignen FLLs war 92,3 %, die negative Voraussagekraft 95,1 %. Von 241 histologisch gesicherten FLLs waren 62 FLLs ≤ 10 mm (diagnostische Treffsicherheit KM-Sono 80,6 %) und 179 FLLs > 10 mm ≤ 20 mm (diagnostische Treffsicherheit KM-Sono 80,6 %). Schlussfolgerung: Die KM-Sonografie hat eine hohe diagnostische Treffsicherheit in der Differenzierung kleiner und kleinster (≤ 1 cm) FLL im klinischen Alltag.

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Differential Diagnosis of Focal Liver Lesions in Signal-Enhanced Ultrasound Using BR 1, a Second-Generation Ultrasound Signal Enhancer

Digestive Diseases ◽

10.1159/000078738 ◽

2004 ◽

Vol 22 (1) ◽

pp. 73-80 ◽

Cited By ~ 6

Author(s):

R. Peschl ◽

A. Werle ◽

G. Mathis

Keyword(s):

Differential Diagnosis ◽

Second Generation ◽

Focal Liver Lesions ◽

Liver Lesions ◽

Ultrasound Signal

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Value of Contrast-Enhanced Ultrasound in Differential Diagnosis of Focal Liver Lesions

Medical Visualization ◽

10.24835/1607-0763-2017-2-36-52 ◽

2017 ◽

pp. 36-52

Author(s):

E. I. Peniaeva ◽

J. R. Kamalov ◽

A. N. Sencha ◽

U. N. Patrunov ◽

E. A. Sencha

Keyword(s):

Differential Diagnosis ◽

Contrast Enhancement ◽

Complex Analysis ◽

Final Diagnosis ◽

Arterial Phase ◽

Focal Liver Lesions ◽

Diagnostic Feature ◽

Liver Lesions ◽

Contrast Enhanced ◽

Venous Phase

Purpose:to evaluate the diagnostic value of contrastenhanced ultrasound (CEUS) with SonoVue in differential diagnosis of focal liver lesions (FLL) in a multidisciplinary clinic in Russian Federation.Materials and methods. Bolus intravenous administration of 1.2 ml of SonoVue (Bracco Swiss CA, Switzerland) followed with 5ml saline flush was used for liver CEUS. We utilized the scanners Mindray DC-8 (Mindrаy, China), Logiq S8 (GE, USA), Philips Epiq 7 (Philips, Holland), SonoScape S9 (SonoScape, China), Hitachi Ascendus (Hitachi, Japan) with 3.0–5.0 MHz convex probes in specialized “contrast” mode with low mechanic index (MI 0.08–0.1). The study conferred 73 patients in the age between 18 and 84 years (mean age 49 years) with FLL. CEUS was performed in 22 patients with previously verified diagnosis, while the rest of patients underwent CEUS before the final diagnosis. Contrast-enhanced liver CT was performed in all patients. In 49 (67.12%) of 73 cases, a pathology was performed after a targeted core-needle biopsy or autopsy. Qualitative features of US contrast enhancement of FLL were evaluated.Results. Qualitative aspects of CEUS for differentiation of FLL were defined. The principal sign for diagnosis between benign and malignant masses with CEUS was hypoenhancement of malignant lesions in comparison to surrounding normal parenchyma in portal and late venous phase (p ≤ 0.01). Alternatively, hyper- or isoenhancement throughout late venous phase was characteristic for benign FLL. Diffuse heterogeneous contrast enhancement was indicative of malignant FLL, and homogeneous – for benign. Additional diagnostic feature (p ≤ 0.05) was the type of contrast enhancement in the arterial phase. Heterogeneous diffuse contrast enhancement was observed in malignant FLL, while homogeneous – in benign FLL. Peripheral nodular contrast enhancement with centripetal filling was characteristic for liver hemangioma, centrifugal filling with “spoke-wheel” vascular pattern – for FNH, and peripheral rim-like hyperenhancement with rapid achievement of hypoenhancement at the beginning of the portal phase – for liver metastasis.Conclusion.Complex analysis of qualitative characteristics of CEUS with SonoVue is a promising option for differential diagnosis of FLL (sensitivity 92.85%, specificity 91.3%, diagnostic accuracy 92.15%) and can be utilized in daily practice.

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Aim: To investigate the value of ElastPQ measurement for differential diagnosis of benign and malignant focal liver lesions (FLLs) by using histologic results as a reference standard. Material and methods: A total of 154 patients were included. ElastPQ measurement was performed for each lesion in which the shear wave speed (SWS) was measured. The difference in SWS and SWS ratio of FLL to surrounding liver were evaluated, and the cut off value was investigated. Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance. Histology as a gold standard was obtained by surgery in all patients. Results: A total of 154 lesions including 129 (83.7 %) malignant FLLs and 25 (16.3 %) benign ones were analysed. The SWS of malignant and benign FLLs was significantly different, 2.77±0.68 m/s and 1.57±0.55 m/s (p<0.05). The SWS ratio of each FLL to surrounding liver parenchyma was 2.23±0.49 for malignant and 1.14±0.36 for benign FLLs (p<0.05). The cut off value for differential diagnosis was 2.06 m/s for SWS and 1.67 for SWS ratio. Conclusions: ElastPQ measurement provides reliable quantitative stiffness information of FLLs and may be helpful in the differential diagnosis between malignant and benign FLLs.

Medical Ultrasonography ◽

10.11152/mu-1142 ◽

2017 ◽

Vol 19 (3) ◽

pp. 259 ◽

Cited By ~ 5

Author(s):

Yi Dong ◽

Wen-Ping Wang ◽

Yadan Xu ◽

Jiaying Cao ◽

Feng Mao ◽

...

Keyword(s):

Differential Diagnosis ◽

Gold Standard ◽

Diagnostic Performance ◽

Wave Speed ◽

Operating Characteristic ◽

Liver Parenchyma ◽

Focal Liver Lesions ◽

Liver Lesions ◽

Shear Wave Speed ◽

The Difference

Aim: To investigate the value of ElastPQ measurement for differential diagnosis of benign and malignant focal liver lesions (FLLs) by using histologic results as a reference standard.Material and methods: A total of 154 patients were included. ElastPQ measurement was performed for each lesion in which the shear wave speed (SWS) was measured. The difference in SWS and SWS ratio of FLL to surrounding liver were evaluated, and the cut off value was investigated. Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance. Histology as a gold standard was obtained by surgery in all patients.Results: A total of 154 lesions including 129 (83.7 %) malignant FLLs and 25 (16.3 %) benign ones were analysed. The SWS of malignant and benign FLLs was significantly different, 2.77±0.68 m/s and 1.57±0.55 m/s (p<0.05). The SWS ratio of each FLL to surrounding liver parenchyma was 2.23±0.49 for malignant and 1.14±0.36 for benign FLLs (p<0.05). The cut off value for differential diagnosis was 2.06 m/s for SWS and 1.67 for SWS ratio.Conclusions: ElastPQ measurement provides reliable quantitative stiffness information of FLLs and may be helpful in the differential diagnosis between malignant and benign FLLs.

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Hyperenhancing focal liver lesions: differential diagnosis with helical CT.

American Journal of Roentgenology ◽

10.2214/ajr.173.3.10470887 ◽

1999 ◽

Vol 173 (3) ◽

pp. 605-611 ◽

Cited By ~ 9

Author(s):

C Valls ◽

E Andía ◽

A Sanchez ◽

A Gumà ◽

T Serrano

Keyword(s):

Differential Diagnosis ◽

Helical Ct ◽

Focal Liver Lesions ◽

Liver Lesions

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Diagnosis and Differential Diagnosis of Focal Liver Lesions - CME Reply Form

Radiologie up2date ◽

10.1055/s-2004-825821 ◽

2004 ◽

Vol 4 (2) ◽

pp. 127-146

Author(s):

D. Högemann Savellano ◽

T. Kirchhoff ◽

M. Galanski

Keyword(s):

Differential Diagnosis ◽

Focal Liver Lesions ◽

Liver Lesions

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Evaluation of Nine Commercial Serological Tests for the Diagnosis of Human Hepatic Cyst Echinococcosis and the Differential Diagnosis with Other Focal Liver Lesions: A Diagnostic Accuracy Study

Diagnostics ◽

10.3390/diagnostics11020167 ◽

2021 ◽

Vol 11 (2) ◽

pp. 167

Author(s):

Francesca Tamarozzi ◽

Silvia Stefania Longoni ◽

Ambra Vola ◽

Monica Degani ◽

Stefano Tais ◽

...

Keyword(s):

Differential Diagnosis ◽

Diagnostic Accuracy ◽

Diagnostic Algorithm ◽

Solid Content ◽

Focal Liver Lesions ◽

Liver Lesions ◽

Diagnostic Accuracy Study ◽

Liquid Content ◽

Serological Tests ◽

Accuracy Study

The differential diagnosis of hepatic cystic echinococcosis (CE) may be challenging. When imaging is insufficient, serology can be applied, but no consensus diagnostic algorithm exists. We evaluated the performances of nine serological tests commercialized in Europe for the diagnosis of “echinococcosis”. We performed a diagnostic accuracy study using a panel of sera from patients with hepatic CE (n = 45 “liquid” content stages, n = 25 “solid” content stages) and non-CE focal liver lesions (n = 54 with “liquid” content, n = 11 with “solid” content). The diagnosis and staging of CE were based on ultrasound (gold standard). Nine commercial seroassays (5 ELISA, 2 WB, 1 Chemiluminescence Immunoassay [CLIA] and 1 Immunochromatographic test [ICT]) were the index tests. Sensitivity (Se) ranged from 43 to 94% and from 31 to 87%, and specificity (Sp) from 68 to 100% and from 94 to 100%, when borderline results were considered positive or negative, respectively. Three seroassays (2 ELISA, 1 WB) were excluded from further analyses due to poor performances. When tests were combined, Sp was 98–100%. The best results were obtained using the WB-LDBIO alone (Se 83%) or as a third test after two non-WB tests (Se 67–86%). A validated WB or two non-WB tests, read with stringent criteria (borderline = negative and considered positive only if concordant positive), possibly confirmed by the WB, appear sensible approaches.

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