The value of preoperative computed tomography combined with ultrasound in the investigation of small indeterminate liver lesions in patients with colorectal cancer

2017 ◽  
Vol 58 (11) ◽  
pp. 1288-1293 ◽  
Author(s):  
Mirna Abraham-Nordling ◽  
Emma Öistämö ◽  
Thomas Josephson ◽  
Fredrik Hjern ◽  
Lennart Blomqvist
Keyword(s):  
Colorectal Cancer ◽  
Computed Tomography ◽  
Liver Metastases ◽  
Liver Lesion ◽  
Liver Cyst ◽  
Focal Liver Lesion ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Newly Diagnosed ◽  
Work Up

Background Computed tomography (CT) is used routinely for the preoperative detection of colorectal cancer (CRC) metastases. When small indeterminate focal liver lesions are detected that are too small to characterize (TSTC) on CT, additional imaging is usually needed, resulting in a potential delay in obtaining a complete diagnostic work-up. Purpose To determine the diagnostic accuracy of ultrasound (US) of the liver performed in direct conjunction to CT in the preoperative investigation among patients with newly diagnosed CRC when indeterminate liver lesions were found on CT. Material and Methods Preoperative investigations with CT and consecutive US where CT had shown at least one focal liver lesion in 74 patients diagnosed with CRC between June 2009 and February 2012 were retrospectively reviewed. Either histopathological findings or a combination of imaging and clinical follow-up one to three years after surgery was used as the reference. Results Liver metastases were diagnosed with CT/US in 13 out of 74 patients (17.6%). In one patient, a liver cyst was preoperatively regarded as liver metastasis by a combined CT/US. The sensitivity and specificity for the CT with consecutive US procedure was 100% (13/13) and 98.4% (60/61). Conclusion US performed in conjunction with CT in patients with indeterminate focal liver lesions on CT is an accurate work-up for detection of liver metastases in patients with newly diagnosed CRC. Although our results are promising, they cannot be considered safely generalizable to all hospitals.

Preoperative assessment of focal liver lesions: multidetector computed tomography challenges magnetic resonance imaging

2005 ◽  
Vol 46 (1) ◽  
pp. 9-15 ◽  
Author(s):  
K. Numminen ◽  
H. Isoniemi ◽  
J. Halavaara ◽  
P. Tervahartiala ◽  
H. Mäkisalo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Multidetector Computed Tomography ◽  
Intraoperative Ultrasound ◽  
Preoperative Assessment ◽  
Liver Lesion ◽  
Lesion Detection ◽  
Extrahepatic Disease ◽  
Focal Liver Lesions ◽  
Liver Lesions

Purpose: To investigate prospectively multidetector computed tomography (CT) (MDCT) and magnetic resonance (MR) imaging (MRI) in the preoperative assessment of focal liver lesions. Material and Methods: Multiphasic MDCT and conventional gadolinium‐enhanced MRI were performed on 31 consecutive patients prior to hepatic surgery. All images were blindly analyzed as consensus reading. Lesion counts and their relation to vascular structures and possible extrahepatic disease were determined. The data from the MDCT and MRI were compared with the results obtained by intraoperative ultrasound (IOUS) and palpation. Histopathologic verification was available. Results: At surgery, IOUS and palpation revealed 45 solid liver lesions. From these, preoperative MDCT detected 43 (96%) and MRI 35 (78%) deposits. MDCT performed statistically better than MRI in lesion detection ( P = 0.008). Assessment of lesion vascular proximity was correctly determined by MDCT in 98% of patients and by MRI in 87%. Statistical difference was found ( P = 0.002). IOUS and palpation changed the preoperative surgical plan as a result of extrahepatic disease in 8/31 (26%) cases. In MDCT as well in MRI extrahepatic involvement was suspected in two cases. Conclusion: MDCT was superior to MRI and nearly equal to IOUS in liver lesion detection and in the determination of lesion vascular proximity. However, both techniques fail to reliably detect extrahepatic disease.

The role of contrast-enhanced ultrasound in detection of liver metastases from colorectal cancer: A prospective monocentric study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15105-e15105
Author(s):  
C. Mucciarini ◽  
S. Bellentani ◽  
G. Razzini ◽  
I. Bernardini ◽  
F. Artioli ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Contrast Agent ◽  
Liver Metastases ◽  
Imaging Modalities ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Specificity And Sensitivity ◽  
Contrast Enhanced

e15105 Background: Up to 15–25% of patients with colorectal cancer (CRC) will develop metacronous liver metastases during the follow up. The management and prognosis of these patients depend heavily on the early detection of metastases. The most effective surveillance strategy has not yet being extablished. The introduction of second generation ultrasound contrast agents have improved the ability of contrast-enhanced ultrasound (CEUS) in detecting and characterizing liver lesions, showing that its accuracy is comparable to that of spiral CT and MRI with a liver contrast agent, with a cost and a time saving. We tested the sensitivity and specificity of CEUS in detecting liver metastases compared with the standard imaging modalities used in the follow up of CRC. Methods: We conducted a prospective study considering all patients with a diagnosis of CRC in high risk stage II, stage III or with a previous metastasectomy of the liver. In order to detect possible metastases, the patients were followed with a follow-up schedule including a six-monthly ultrasonography alternated to an annual CT, and a six-monthly CEUS with SonoVue contrast agent for the first 3 years. Results: From January 1st to December 2008 we executed 60 CEUS, identifying thirteen suspected liver lesions. 10/13 were confirmed metastases by CT, MRI or TC/PET. 2/13 resulted benign lesions. 1/13 resulted negative at the CT but positive with a MRI. Another additional case was missed by CEUS but detected by CT. CEUS improve specificity and sensitivity compared with baseline ultrasonography. We had an histological confirmation in all cases except one. The study is still recruiting patients. Conclusions: The clinical value of CEUS as a reliable alternative to CT or MRI in characterizing focal liver lesions has been expressed in various documents and guidelines. Our preliminary results confirm the similar diagnostic performance and confidence of CEUS compared to these imaging modalities in the follow up of CRC. Further clinical studies are still needed to strenghten the existing data. No significant financial relationships to disclose.

Characterization of Malignant Focal Liver Lesions with Contrast-Enhanced 40 MHz Ultrasound Imaging in Hepatitis B Virus X Transgenic Mice: A Feasibility Study

2008 ◽  
Vol 30 (4) ◽  
pp. 203-216 ◽  
Author(s):  
Ai-Ho Liao ◽  
Ya-Chien Cheng ◽  
Chien-Hsiu Weng ◽  
Ting-Fen Tsai ◽  
Wei-Hsiang Lin ◽  
...  
Keyword(s):  
Transgenic Mice ◽  
Liver Parenchyma ◽  
Liver Lesion ◽  
Focal Liver Lesion ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Preclinical Research ◽  
Post Contrast ◽  
Contrast Enhanced ◽  
B Virus

Contrast-enhanced ultrasound (CEUS) imaging has been a reliable clinical method of detecting three vascular contrast phases and characterizing focal liver lesions. Previous results were all from human (i.e., clinical studies). The main purpose of this study was to extend this to small animals and to investigate the feasibility of using CEUS in preclinical research. Specifically, high-frequency (40 MHz) ultrasound liver imaging with albumin-shelled microbubbles was employed to detect the three vascular contrast phases and characterize focal liver lesions that developed in thirteen Hepatitis B virus X (HBx) transgenic mice at around 14 to 16 months of age. Previous studies indicated that 90–100% incidence of hepatocellular carcinoma (HCC) was observed in HBx transgenic male mice. After injecting the contrast agent, the time-intensity curves (TICs) of focal liver lesions, vessels in focal liver lesions and surrounding liver parenchyma tissues were measured for 30 minutes. The peak of mean intensity relative to the baseline increased 7.36 dB (p<0.02). On the other hand, the mean contrast between the focal liver lesion and the liver parenchyma increased by 7.74 (p<0.05) dB, thus allowing clear detection of the lesion margin. Histopathology investigations confirmed the development of the lesion in these mice. In addition, guidelines of European Federation of Societies for Ultrasound in Medicine and Biology were followed as an attempt to characterize features of the TICs in mice. The arterial phase was defined as 2 to 60 seconds post contrast injection, and the parenchyma phase was defined as the time period from 10 to 30 minutes post contrast injection. Comparing the imaging with the pathology results, the sensitivity, specificity and accuracy of CEUS for the detection of malignant focal liver lesion in HBx transgenic mice were 91%, 100% and 92%. These results demonstrated that high-frequency CEUS imaging potentially can be used for detecting the three vascular contrast phases of malignant focal liver lesions and characterizing malignant focal liver lesions in mice. Thus can be a valuable tool in preclinical research.

scholarly journals Qualitative And Quantitative Magnetic Resonance Imaging Assessment Of Focal Liver Lesions: A Study To Evaluate The Role Of Different MRI Sequences.

2021 ◽  
Vol 9 (1) ◽  
pp. 27-27
Author(s):  
obaid ashraf ◽  
naseer choh ◽  
omair shah
Keyword(s):  
Tissue Characterization ◽  
Liver Lesion ◽  
Focal Liver Lesion ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Adc Value ◽  
Qualitative And Quantitative ◽  
Diffusion Weighted ◽  
Mri Sequences ◽  
Malignant Lesions

Background: Focal liver lesions have a broad differential diagnosis. MRI with its improved soft tissue characterization and newer sequences can significantly narrow the differentials especially when discriminating benign from malignant lesions. Methods: T1, T1 IN AND OUT OF PHASE, T2, LONG TE T2 AND Diffusion Weighted Imaging was done in 159 patients with USG documented focal liver lesion. Qualitative and quantitative assessment of ADC values and long TE images was done and a threshold for differentiating benign from malignant lesions was obtained. The MRI diagnosis was compared with final diagnosis obtained from histopathology in most cases or follow up and other tests (markers and RBC scan) were histopathology was not available. Sensitivity, specificity and accuracy of MRI sequences in differentiating various focal lesions were obtained. Results: T1 weighted images were useful for identifying fat, hemorrhage and iron within the lesions. T2 weighted imaging was able to correctly classify 82.0% lesions as malignant and 83.7% lesions as benign. Long TE T2 images were highly accurate in distinguishing haemangiomas and cysts from solid lesions. On diffusion-weighted (DW) imaging, 89.5% (i.e. 60 out of 67) lesions were correctly classified as malignant and 88.0% (i.e. 81 out of 92) lesions were correctly classified as benign. Threshold ADC value of 1.37 × 10-3 mm2/s is highly accurate for differentiating malignant from benign lesions. Conclusion: DWI is a sine qua non in liver lesion assessment allowing improved detection and characterization. Long TE T2 weighted imaging can accurately detect haemangiomas and cysts and rule out metastasis.

scholarly journals Contrast-enhanced ultrasound of benign and malignant liver lesions in children

2021 ◽  
Author(s):  
Cheng Fang ◽  
Sudha A. Anupindi ◽  
Susan J. Back ◽  
Doris Franke ◽  
Thomas G. Green ◽  
...  
Keyword(s):  
Liver Lesion ◽  
Focal Liver Lesion ◽  
Ultrasound Contrast Agents ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Cross Sectional ◽  
Pediatric Liver ◽  
Contrast Enhanced

AbstractContrast-enhanced ultrasound (CEUS) is increasingly being used in children. One of the most common referrals for CEUS performance is characterization of indeterminate focal liver lesions and follow-up of known liver lesions. In this setting, CEUS is performed with intravenous administration of ultrasound contrast agents (UCAs). When injected into a vein, UCA microbubbles remain confined within the vascular network until they dissipate. Therefore, visualization of UCA within the tissues and lesions corresponds to true blood flow. CEUS enables continuous, real-time observation of the enhancement pattern of a focal liver lesion, allowing in most cases for a definite diagnosis and obviating the need for further cross-sectional imaging or other interventional procedures. The recent approval of Lumason (Bracco Diagnostics, Monroe Township, NJ) for pediatric liver CEUS applications has spurred the widespread use of CEUS. In this review article we describe the role of CEUS in pediatric liver applications, focusing on the examination technique and interpretation of main imaging findings of the most commonly encountered benign and malignant focal liver lesions. We also compare the diagnostic performance of CEUS with other imaging modalities for accurate characterization of focal liver lesions.

scholarly journals Complications Following Irinotecan-Loaded Microsphere Chemoembolization of Colorectal Metastatic Liver Lesions Associated with Hepatic-Artery Branch Temporary Stasis

2021 ◽  
Vol 28 (3) ◽  
pp. 2296-2307
Author(s):  
Marcin Szemitko ◽  
Elzbieta Golubinska-Szemitko ◽  
Jerzy Sienko ◽  
Aleksander Falkowski
Keyword(s):  
Colorectal Cancer ◽  
Adverse Events ◽  
Liver Metastases ◽  
Hepatic Artery ◽  
Liver Lesions ◽  
Apparent Lack ◽  
Neoplastic Lesion ◽  
Hepatic Artery Branch ◽  
Artery Branch ◽  
Metastatic Liver

Chemoembolization with irinotecan-loaded microspheres has proven effective in the treatment of unresectable liver metastases in the course of colorectal cancer (CRC). Most researchers recommend slowly administering the embolizate at the level of the lobar arteries, without obtaining visible stasis. However, there are reports of a relationship between postoperative embolizate retention in metastatic lesions and the response to treatment. To retain residual embolizate throughout the entire neoplastic lesion requires a temporary flow stop (stasis) within all supply vessels, which may cause temporary stasis in subsegmental or even segmental vessels. Objective: To assess the risk of complications and post-embolization syndrome severity following chemoembolization of CRC metastatic liver lesions with microspheres loaded with Irinotecan, with regard to hepatic-artery branch level of temporary stasis. Patients and methods: The study included 52 patients (29 female, 23 male) with liver metastases from CRC, who underwent 202 chemoembolization treatments (mean: 3.88 per patient) with microspheres loaded with 100 mg irinotecan. Postembolization syndrome (PES) severity and complication occurrence were assessed with regard to the hepatic-artery branch level of temporary stasis. Adverse events were assessed according to Cancer Therapy Evaluation Program Common Terminology Criteria for Adverse Events. Results: Median survival from the start of chemoembolization was 13 months. From 202 chemoembolization sessions, 15 (7.4%) significant complications were found. The study found a significant relationship between the branch level of temporary stasis and the presence of complications (p < 0.001), with the highest number of complications observed with temporary stasis in segmental vessels. PES was diagnosed after 103 (51%) chemoembolization treatments. A significant association was found between PES severity and the branch level of temporary stasis (p < 0.001). Conclusions: The branch level of temporary stasis affected the severity of post-embolization syndrome. A significant association was found between the branch level of temporary stasis obtained in chemoembolization procedures and the presence of complications. The apparent lack of change in numbers of complications when stasis was applied at tumor supply vessels or subsegmental arteries may indicate the safe use of temporary stasis in some cases where colorectal cancer metastases are treated. Further research is needed to determine the most effective chemoembolization technique.

A clinical case of focal liver lesion in tuberculosis

2021 ◽  
pp. 67-70
Author(s):  
Igor Borisovich Kirichenko
Keyword(s):  
Computed Tomography ◽  
Clinical Practice ◽  
General Practitioner ◽  
Clinical Case ◽  
Liver Lesion ◽  
Focal Liver Lesion ◽  
Diagnostic Methods ◽  
Targeted Biopsy ◽  
Diagnostic Studies ◽  
Biochemical Studies

In the clinical practice of a general practitioner, there are many difficulties in the diagnosis of certain nosological forms, even in spite of various diagnostic studies. This is often due to the fact that in most cases, the used methods, especially ultrasound, as well as the results of many biochemical studies, make it possible to suspect pathology or reveal its indirect signs. Accurate diagnostic methods such as laparoscopy, biopsy, targeted biopsy, computed tomography and colonoscopy are rarely used. The clinical case presented below is one of the confirmations of the above [2; 3].

scholarly journals Hepatocellular Carcinoma Is the Most Frequent Final Diagnosis of Focal Liver Lesions Identified in a Cross-Sectional Evaluation of Patients with Chronic Liver Disease in Saudi Arabia

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Adnan Agha ◽  
Manuele Furnari ◽  
Rafaat Morched Chakik ◽  
Mamdouh M. Abdulhadi Ali ◽  
Dib Alsaudi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Odds Ratio ◽  
Final Diagnosis ◽  
Liver Lesion ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Benign Lesions ◽  
Cross Sectional

Background. Hepatocellular carcinoma (HCC) is a frequent diagnosis in patients with chronic liver disease (CLD) and a newly identified liver lesion, although benign diseases may also be responsible for this finding. Objective. To evaluate the characteristics of focal liver lesions in a population of patients with CLD not under surveillance for HCC in the Middle East. Methods. We performed a cross-sectional study evaluating 77 patients with CLD and a focal liver lesion identified during ultrasonography. Patients’ characteristics were analyzed on the basis of the final diagnosis (HCC versus benign lesions). Results. The most frequent diagnosis was HCC (64.9%). These patients were older (median age 64 versus 55 years, P=0.003) and cirrhotics (80.0% versus 51.9%, P=0.018), with multinodular lesions (58.0% versus 29.6%, P=0.031) and portal vein thrombosis (24.0% versus 0%, P=0.001) compared to patients with benign lesions. Prevalence of elevated alpha-fetoprotein (>10 ng/mL) was similar in both groups (80.0% versus 88.9%, P=0.198). Cirrhosis (odds ratio: 3.283) and multinodularity (odds ratio: 2.898) were independently associated with HCC. Conclusions. HCC is the most common diagnosis in Middle-Eastern patients with CLD and a liver lesion identified outside HCC surveillance programs, especially in cirrhotic patients. In these patients, elevated alpha-fetoprotein does not differentiate HCC from benign lesions.

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