scholarly journals Quantitative Analysis of the Time–Intensity Curve of Contrast-Enhanced Ultrasound of the Liver: Differentiation of Benign and Malignant Liver Lesions

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1244
Author(s):  
Sonja Schwarz ◽  
Dirk-André Clevert ◽  
Michael Ingrisch ◽  
Thomas Geyer ◽  
Vincent Schwarze ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Diagnostic Accuracy ◽  
Late Phase ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced ◽  
Malignant Lesions ◽  
Benign Liver ◽  
Benign Liver Lesions

Background: To evaluate the diagnostic accuracy of quantitative perfusion parameters in contrast-enhanced ultrasound to differentiate malignant from benign liver lesions. Methods: In this retrospective study 134 patients with a total of 139 focal liver lesions were included who underwent contrast enhanced ultrasound (CEUS) between 2008 and 2018. All examinations were performed by a single radiologist with more than 15 years of experience using a second-generation blood pool contrast agent. The standard of reference was histopathology (n = 60), MRI or CT (n = 75) or long-term CEUS follow up (n = 4). For post processing regions of interests were drawn both inside of target lesions and the liver background. Time–intensity curves were fitted to the CEUS DICOM dataset and the rise time (RT) of contrast enhancement until peak enhancement, and a late-phase ratio (LPR) of signal intensities within the lesion and the background tissue, were calculated and compared between malignant and benign liver lesion using Student’s t-test. Quantitative parameters were evaluated with respect to their diagnostic accuracy using receiver operator characteristic curves. Both features were then combined in a logistic regression model and the cumulated accuracy was assessed. Results: RT of benign lesions (14.8 ± 13.8 s, p = 0.005), and in a subgroup analysis, particular hemangiomas (23.4 ± 16.2 s, p < 0.001) differed significantly to malignant lesions (9.3 ± 3.8 s). The LPR was significantly different between benign (1.59 ± 1.59, p < 0.001) and malignant lesions (0.38 ± 0.23). Logistic regression analysis with RT and LPR combined showed a high diagnostic accuracy of quantitative CEUS parameters with areas under the curve of 0.923 (benign vs. malignant) and 0.929 (hemangioma vs. malignant. Conclusions: Quantified CEUS parameters are helpful to differentiate malignant from benign liver lesions, in particular in case of atypical hemangiomas.

Tips and Tricks in Contrast-Enhanced Ultrasound (CEUS) for the Characterization and Detection of Liver Malignancies

2019 ◽  
Vol 40 (04) ◽  
pp. 404-424 ◽  
Author(s):  
Barbara Schellhaas ◽  
Deike Strobel
Keyword(s):  
Liver Cirrhosis ◽  
Contrast Enhancement ◽  
Late Phase ◽  
Therapeutic Monitoring ◽  
Arterial Phase ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Liver Malignancies ◽  
Contrast Enhanced

AbstractContrast-enhanced ultrasound (CEUS) has a high diagnostic accuracy in the assessment of focal liver lesions. Clinical context (presence of liver cirrhosis, history of other malignancy versus incidental finding) is crucial for the correct interpretation of CEUS findings. CEUS has to be preceded by structured anamnesis and clinical examination as well as accurate B-mode sonography. Metastases are the most common malignant liver lesions in a non-cirrhotic liver. According to their contrast enhancement in the arterial phase, metastases are categorized as hyper- and hypo-vascular metastases. A common feature of all metastatic lesions is washout of the contrast agent in the portal venous or late phase. In the context of liver cirrhosis, > 95 % of focal liver lesions are hepatocellular carcinomas (HCCs). HCCs typically show arterial phase hyperenhancement, followed by mild and gradual contrast washout occurring very late in the late phase. For intrahepatic cholangiocellular carcinoma (ICC), the pattern of contrast enhancement in the arterial phase can vary. However, all ICCs typically show early and pronounced washout. Other liver malignancies like lymphoma, angiosarcoma, epithelioid hemangioendothelioma and others are very rare. Except for the contrast washout seen in all liver malignancies, they do not display pathognomonic enhancement patterns upon CEUS. Thus, biopsy is indispensable for definite diagnosis of the tumor entity. Furthermore, CEUS is used for the detection of metastases and therapeutic monitoring after local ablative procedures. The examination procedure differs slightly depending on the specific indication (characterization, detection).

Contrast-Enhanced Ultrasound of Benign Focal Liver Lesions

2018 ◽  
Vol 40 (01) ◽  
pp. 12-29 ◽  
Author(s):  
Christoph Dietrich
Keyword(s):  
Liver Tumors ◽  
Diagnostic Workup ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Contrast Enhanced Ultrasound ◽  
First Line ◽  
Benign Liver Tumors ◽  
Contrast Enhanced ◽  
Line Imaging ◽  
Benign Liver

AbstractThe diagnostic handling of benign focal liver lesions (FLLs) is a challenge and it is difficult to avoid over- and underdiagnosis. Conventional B-mode ultrasound and contrast-enhanced ultrasound (CEUS) are the first-line imaging methods to detect and characterize FLLs. This CME article discusses the diagnostic workup of benign liver tumors.

Contrast-enhanced ultrasound of benign liver lesions

2017 ◽  
Vol 43 (4) ◽  
pp. 848-860 ◽  
Author(s):  
Jessica G. Zarzour ◽  
Kristin K. Porter ◽  
Hisham Tchelepi ◽  
Michelle L. Robbin
Keyword(s):  
Liver Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced ◽  
Benign Liver ◽  
Benign Liver Lesions

Characterizing benign liver lesions and trauma with contrast-enhanced ultrasound

2014 ◽  
Vol 75 (2) ◽  
pp. 91-95 ◽  
Author(s):  
Mark Wills ◽  
Chris J Harvey ◽  
Siarhei Kuzmich ◽  
Asim Afaq ◽  
Adrian Lim ◽  
...  
Keyword(s):  
Liver Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced ◽  
Benign Liver ◽  
Benign Liver Lesions

scholarly journals Characterization of Focal Liver Lesions Indistinctive on B Mode Ultrasound: Benefits of Contrast-Enhanced Ultrasound

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Yi Dong ◽  
Feng Mao ◽  
Jiaying Cao ◽  
Peili Fan ◽  
Wen-Ping Wang
Keyword(s):  
Late Phase ◽  
Arterial Phase ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Mri Findings ◽  
Contrast Enhanced ◽  
Diagnostic Values ◽  
Additional Value

Aim. The aim of this prospective study was to evaluate the additional value of contrast-enhanced ultrasound (CEUS) in identifying and characterizing of focal liver lesions (FLLs) that are indistinctive on B mode ultrasound (BMUS). Methods. The study focused on 70 consecutive patients (male 46, female 24; mean age, 53.1 years ± 10). All lesions were detected by MRI but could not be clearly visualized by BMUS. CEUS was performed by injected SonoVue® (Bracco Imaging Spa, Milan, Italy) as a quick bolus into the antecubital vein. All lesions were proved by pathologic and MRI findings as primary or metastatic hepatic malignancies. Results. On CEUS, 45 (64.2%) FLLs displayed arterial hyperenhancement and 55 (78.5%) lesions showed hypoenhancement in portal venous and late phase (PVLP). Homogeneous and complete hyperenhancement pattern during the arterial phase is highly suspicious for HCC in liver cirrhosis (96.8%). Arterial isoenhancement and early washout during PVLP are characteristic for metastasis (73.3%). For recurrence lesions, arterial hyperenhancement and isoenhancement during PVLP are more common (60%). Conclusion. CEUS may provide added diagnostic values in FLLs appearing indistinctive on BMUS. Presence of early arterial enhancement and washout during PVLP may be helpful for detection of those lesions.

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