Contrast-Enhanced Ultrasound: a Simple and Effective Tool in Defining a Rapid Diagnostic Work-up for Small Nodules Detected in Cirrhotic Patients during Surveillance

2016 ◽  
Vol 25 (2) ◽  
pp. 205-211 ◽  
Author(s):  
Antonio Giorgio ◽  
Luca Montesarchio ◽  
Piero Gatti ◽  
Ferdinando Amendola ◽  
Paolo Matteucci ◽  
...  
Keyword(s):  
Predictive Value ◽  
Imaging Modality ◽  
Dynamic Imaging ◽  
Contrast Enhanced Ultrasound ◽  
Histologic Diagnosis ◽  
Therapeutic Work ◽  
Contrast Enhanced ◽  
Arterial Vascularization ◽  
Cirrhotic Patients ◽  
Work Up

  Background & Aims: Disappearance of portal blood flow and arterial vascularization is the hallmark of hepatocarcinogenesis. The capability of a dynamic imaging modality detecting arterial hypervascularization of small nodules is crucial to promote a rapid diagnostic and therapeutic work-up improving survival. We aimed to evaluate the capability of CEUS to detect arterial vascularization of ≤ 2 cm HCC nodules arising during surveillance so as to shorten the diagnostic and therapeutic work-up. Methods: From October 2009 to September 2014, among 1757 consecutive cirrhotic patients under surveillance with ultrasound (US), 243 patients had new single nodules 7-20 mm; 229/243 had a conclusive histologic diagnosis and comprised the study group. All patients underwent CEUS followed by enhanced MRI and US guided percutaneous 18G needle core biopsy of the nodules. Of the 229 nodules, 27 were hyperechoic, 171 hypoechoic and 31 isoechoic lesions. Results: The histology results revealed that 199/229 nodules were HCC and 30 were benign. Of 199 HCC, CEUS evidenced arterial hypervascularity in 190 nodules (95.5%) (sensitivity 94.48 %, specificity 100%, PPV 100%, NPV 76.92 %). Of the 39 CEUS arterial-unenhanced nodules, 30 were benign and 9 (23%) were well-differentiated HCC. eMRI showed arterial hypervascularity in 199 nodules (86,9%). Of these, only 193 (97%) were histologically HCCs while 6 were benign (sensitivity: 97%, specificity: 80%, PPV: 97%, NPV: 80%). Conclusions: CEUS has a great capability to detect arterial hypervascularity of small HCC. Because only 4.5% of new nodules escape the demonstration of arterial hyervascularity, CEUS must be performed immediately after conventional US to contrast the malignant fate of small lesions arising in a cirrhotic liver.. Abbreviations: CEUS: contrast-enhanced ultrasound; CT: computed tomography; HCC: hepatocellular carcinoma;MRI: magnetic resonance; NPV: negative predictive value; PPV: positive predictive value; US: ultrasonography.

scholarly journals Contrast-enhanced ultrasound performance in predicting blunt splenic injuries requiring only observation and monitoring

2019 ◽  
Vol 21 (1) ◽  
pp. 16 ◽  
Author(s):  
Corrado Tagliati ◽  
Giulio Argalia ◽  
Gian Marco Giuseppetti
Keyword(s):  
Predictive Value ◽  
Imaging Modality ◽  
Splenic Trauma ◽  
Trauma Patients ◽  
Contrast Enhanced Ultrasound ◽  
True Negative ◽  
Contrast Enhanced ◽  
Blunt Splenic Trauma ◽  
Conventional Ultrasound

Aims: To assess contrast enhanced ultrasound (CEUS) performance in the prediction of non-operatively managed blunt spleen injuries requiring only observation and monitoring during follow-up and to evaluate if CEUS accuracy was higher than conventional ultrasound (US) in this field.Material and methods: In 112 hemodynamic stable blunt spleen trauma patients, CEUS was performed for follow-up after computed tomography evaluation in the emergency department. CEUS and US performance were assessed considering as true negative cases patients that had not underwent interventional or surgical treatment during follow-up and were assessed as negative for splenic complications respectively by CEUS or US examinations.Results: CEUS showed sensitivity of 100%, specificity of 96.1%, positive predictive value of 69.2%, negative predictive value of 100.0% and accuracy of 96.4%. CEUS showed a significantly higher accuracy than conventional US (p=0.013).Conclusions: CEUS is a very useful imaging modality during follow-up of blunt splenic trauma non-operatively managed, allowing an efficientprediction of splenic injuries requiring only observation and monitoring during follow-up.

scholarly journals Real-life assessment of standardized contrast-enhanced ultrasound (CEUS) and CEUS algorithms (CEUS LI-RADS®/ESCULAP) in hepatic nodules in cirrhotic patients—a prospective multicenter study

2021 ◽  
Author(s):  
D. Strobel ◽  
E.-M. Jung ◽  
M. Ziesch ◽  
M. Praktiknjo ◽  
A. Link ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Real Life ◽  
Life Assessment ◽  
Arterial Phase ◽  
Contrast Enhanced Ultrasound ◽  
Non Invasive ◽  
Contrast Enhanced ◽  
Cirrhotic Patients

Abstract Objectives Hepatocellular carcinoma (HCC) can be diagnosed non-invasively with contrast-enhanced ultrasound (CEUS) in cirrhosis if the characteristic pattern of arterial phase hyperenhancement followed by hypoenhancement is present. Recent studies suggest that diagnosis based on this “hyper-hypo” pattern needs further refinement. This study compares the diagnostic accuracies of standardized CEUS for HCC according to the current guideline definition and following the newly developed CEUS algorithms (CEUS LI-RADS®, ESCULAP) in a prospective multicenter real-life setting. Methods Cirrhotic patients with liver lesions on B-mode ultrasound were recruited prospectively from 04/2018 to 04/2019, and clinical and imaging data were collected. The CEUS standard included an additional examination point after 4–6 min in case of no washout after 3 min. The diagnostic accuracies of CEUS following the guidelines (“hyper-hypo” pattern), based on the examiner’s subjective interpretation (“CEUS subjective”), and based on the CEUS algorithms ESCULAP and CEUS LI-RADS® were compared. Results In total, 470 cirrhotic patients were recruited in 43 centers. The final diagnosis was HCC in 378 cases (80.4%) according to the reference standard (histology 77.4%, MRI 16.4%, CT 6.2%). The “hyper-hypo” pattern yielded 74.3% sensitivity and 63% specificity. “CEUS subjective” showed a higher diagnostic accuracy (sensitivity, 91.5%; specificity, 67.4%; positive predictive value, 92%; negative predictive value, 66%). Sensitivity was higher for ESCULAP (95%) and “CEUS subjective” (91.5%) versus CEUS LI-RADS® (65.2%; p < 0.001). Specificity was highest for CEUS LI-RADS® (78.6%; p < 0.001). Conclusions CEUS has an excellent diagnostic accuracy for the non-invasive diagnosis of HCC in cirrhosis. CEUS algorithms may be a helpful refinement of the “hyper-hypo” pattern defined by current HCC guidelines. Key Points • Contrast-enhanced ultrasound (CEUS) has a high diagnostic accuracy for the non-invasive diagnosis of hepatocellular carcinoma (HCC) in cirrhosis. • The CEUS algorithm ESCULAP (Erlanger Synopsis for Contrast-enhanced Ultrasound for Liver lesion Assessment in Patients at risk) showed the highest sensitivity, whereas the CEUS LI-RADS® (Contrast-Enhanced UltraSound Liver Imaging Reporting and Data System) algorithm yielded the highest specificity. • A standardized CEUS examination procedure with an additional examination point in the late phase, after 4–6 min in lesions with no washout after 3 min, is vital.

A novel use of contrast-enhanced ultrasound in uterine artery embolization

2020 ◽  
Vol 4 ◽  
pp. 8
Author(s):  
Jemianne Bautista Jia ◽  
Eric Mastrolonardo ◽  
Mateen Soleman ◽  
Ilya Lekht
Keyword(s):  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Imaging Modality ◽  
Cost Effective ◽  
Contrast Enhanced Ultrasound ◽  
Artery Embolization ◽  
Non Invasive ◽  
Contrast Enhanced

Contrast-enhanced ultrasound (CEUS) is a cost-effective, quick, and non-invasive imaging modality that has yet to be incorporated in uterine artery embolization (UAE). We present two cases that demonstrate the utility of CEUS in UAE for the identification of uterine-ovarian collaterals which otherwise can result in ineffective fibroid treatment and non-target embolization.

Follow-Up Imaging in Patients with Blunt Splenic or Hepatic Injury Managed Nonoperatively

2018 ◽  
Vol 84 (2) ◽  
pp. 208-214 ◽  
Author(s):  
R. Viola Mebert ◽  
Beat SchnÜRiger ◽  
Daniel Candinas ◽  
Tobias Haltmeier
Keyword(s):  
Nonoperative Management ◽  
Imaging Modality ◽  
Ct Scans ◽  
Lower Grade ◽  
Contrast Enhanced Ultrasound ◽  
Promising Alternative ◽  
Contrast Enhanced ◽  
Pubmed Database ◽  
Hepatic Injuries

Nonoperative management of blunt splenic and hepatic injuries has become the standard of care for hemodynamically stable patients. However, nonoperative management may lead to delayed complications and appropriate follow-up is therefore crucial. The aim of this systematic literature review was to assess the role of different imaging modalities in the follow-up assessment of patients with blunt splenic or hepatic injuries using the PubMed database. Eighteen studies were found to be relevant to the topic. A total of 2725 patients were enrolled in the included studies. Both retrospective and prospective studies, but no randomized controlled trials were found. In these studies, CT, ultrasound, and contrast-enhanced ultrasound were discussed. CT was the most commonly used imaging modality. Taking into account all studies included, only one patient underwent intervention due to a complication diagnosed by follow-up CTscan in the absence of clinical signs and symptoms. This equates to a total of 920 CT scans performed to diagnose one clinically nonevident complication that required intervention. Based on the reviewed literature, routine imaging follow-up CT scans may not be indicated in asymptomatic patients with lower grade blunt splenic or hepatic injuries. Contrast-enhanced ultrasound is a promising alternative imaging modality for the follow-up of these patients.

scholarly journals Contrast-Enhanced Ultrasound (CEUS) for the Evaluation of Bosniak III Complex Renal Cystic Lesions—A 10-Year Specialized European Single-Center Experience with Histopathological Validation

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 692
Author(s):  
Vincent Schwarze ◽  
Johannes Rübenthaler ◽  
Saša Čečatka ◽  
Constantin Marschner ◽  
Matthias Frank Froelich ◽  
...  
Keyword(s):  
Imaging Modality ◽  
Color Doppler ◽  
Blood Pool ◽  
Histopathological Analysis ◽  
Cystic Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Single Center ◽  
Renal Lesions ◽  
Experienced Radiologist ◽  
Contrast Enhanced

Background and objectives: The aim of the present retrospective single-center study is to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for assessing Bosniak III complex renal cystic lesions with histopathological validation. Materials and Methods: 49 patients with CEUS-categorized Bosniak III renal cystic lesions were included in this retrospective study. All patients underwent native B-mode, Color Doppler, contrast-enhanced ultrasound (CEUS) between 2010–2020. Eight and five patients underwent computed tomography (CT) and magnetic resonance imaging (MRI), respectively. Twenty-nine underwent (partial) nephrectomy allowing for histopathological analysis. The applied contrast agent for CEUS was a second-generation blood pool agent. Ultrasonography examinations were performed and interpreted by a single experienced radiologist with more than 15 years of experience (EFSUMB Level 3). Results: CEUS examinations were successfully performed in all included patients without registering any adverse effects. The malignancy rate of CEUS-categorized Bosniak III renal lesions accounted for 66%. Initially, cystic complexity was visualized in native B-mode. In none of the renal lesions hypervascularization was detected in Color Doppler. CEUS allowed for detection of contrast enhancement patterns in all included Bosniak III renal lesions. Delayed wash-out could be detected in 6/29 renal lesions. In two cases of histopathologically confirmed clear-cell RCC, appropriate up-grading from Bosniak IIF to III was achieved by CEUS. Conclusions: CEUS depicts a promising imaging modality for the precise diagnostic workup and stratification of renal cystic lesions according to the Bosniak classification system, thereby helping guidance of adequate clinical management in the future.

scholarly journals Diagnostic value of contrast-enhanced ultrasound versus computed tomography for hepatocellular carcinoma: a retrospective, single-center evaluation of 234 patients

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052093015 ◽  
Author(s):  
Vincent Schwarze ◽  
Constantin Marschner ◽  
Wiebke Völckers ◽  
Sergio Grosu ◽  
Giovanna Negrão de Figueiredo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Hepatocellular Carcinoma ◽  
Predictive Value ◽  
Diagnostic Value ◽  
Ct Scans ◽  
Liver Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Single Center ◽  
Experienced Radiologist ◽  
Contrast Enhanced

Objective Hepatocellular carcinoma (HCC) is the most common cause of primary liver cancer. A major part of diagnostic HCC work-up is based on imaging findings from sonography, computed tomography (CT), or magnetic resonance imaging (MRI) scans. Contrast-enhanced ultrasound (CEUS) allows for the dynamic assessment of the microperfusion pattern of suspicious liver lesions. This study aimed to evaluate the diagnostic value of CEUS compared with CT scans for assessing HCC. Methods We performed a retrospective, single-center study between 2004 and 2018 on 234 patients with suspicious liver lesions who underwent CEUS and CT examinations. All patients underwent native B-mode, color Doppler and CEUS after providing informed consent. Every CEUS examination was performed and interpreted by a single experienced radiologist (European Federation of Societies for Ultrasound in Medicine and Biology level 3). Results CEUS was performed on all included patients without occurrence of any adverse effects. CEUS showed a sensitivity of 94%, a specificity of 70%, a positive predictive value of 93% and a negative predictive value of 72% for analyzing HCC compared with CT as the diagnostic gold standard. Conclusions CEUS has an excellent safety profile and shows a high diagnostic accuracy in assessing HCC compared with corresponding results from CT scans.

Negative Predictive Value of Contrast-Enhanced Ultrasound of Liver and Kidney Thermal Ablation Sites for Local Tumour Progression during Long-term Follow-up: A Retrospective Consecutive Study

2019 ◽  
Vol 70 (4) ◽  
pp. 434-440
Author(s):  
Mostafa Atri ◽  
Abdulmohsen Alrashed ◽  
Ahmad Hassan ◽  
Korosh Khalili ◽  
Tae Kyoung Kim ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Thermal Ablation ◽  
Tumour Progression ◽  
False Negative ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced ◽  
Local Tumour ◽  
Local Tumour Progression

Purpose To determine negative predictive value (NPV) of contrast-enhanced ultrasound (CEUS) to demonstrate local tumour progression (LTP) at thermal ablation (TA) sites. Methods Our institutional review board approved this retrospective study; acquisition of consent was waived. Consecutive CEUS examinations performed between 2004-2014 for TA site evaluation on patients who could not undergo enhanced computed tomography (CT) or magnetic resonance imaging (MRI), or had inconclusive CT or MRI, were retrospectively reviewed. Those reported as no abnormal enhancement in or surrounding TA site were included. CEUS examination was considered true-negative based on stability or lack of enhancement/washout on follow-up imaging for at least 1 year, and false-negative (FN), if there was an arterially enhancing focus with wash-out at or surrounding TA site on subsequent follow-up imaging. Results Study population included 56 tumours in 54 patients, 11 women, 43 men; mean age 71 years. Two patients had TA of two different hepatocellular carcinomas. Thirty-six examinations were for hepatic TA and twenty for renal TA. Lesion sizes ranged from 1 cm to 7 cm (mean 3.1 ± 1.2). Mean diameter of 7 recurrences was 13.8 mm. Overall FN rate was 12.5% (7/56). Corresponding numbers were 0% (0/20) for renal TA and 19.4% (7/36) for hepatic TA. Overall NPV of CEUS was 87.5% (49/56) (confidence interval [CI]: 78.8%–96.2%). NPV for renal TA was 100% (20/20) (CI: 100%–100%) and for hepatic TA 81.5% (29/36) (CI: 67.6 %–93.5%). Conclusion In this cohort, CEUS showed high NPV for exclusion of LTP at renal TA sites. NPV for hepatic TA sites was high but lower than renal TA.

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