Enhancement pattern of hilar cholangiocarcinoma: Contrast-enhanced ultrasound versus contrast-enhanced computed tomography

Objective

To compare the enhancement pattern of hilar cholangiocarcinoma on contrast-enhanced ultrasound (CEUS) with that on contrast-enhanced computed tomography (CECT).

Methods

Thirty-two consecutive patients with pathologically proven hilar cholangiocarcinomas were evaluated by both low mechanical index CEUS and CECT. The enhancement feature of the tumor, portal vein infiltration, and lesion conspicuity on them was investigated.

Results

In the arterial phase, the numbers of the lesions showing hyperenhancement, isoenhancement, and hypoenhancement, were 14 (43.8%), 14 (43.8%), and 4 (12.6%), on CEUS, and 12 (37.5%), 9 (28.1%), and 11 (34.4%), on CECT (P = 0.162). In portal phase, the numbers of the lesions showing hypoenhancement, isoenhancement, and hyperenhancement were 30 (93.8%), 1 (3.1%), and 1 (3.1%), on CEUS, and 23 (71.9%), 8 (25.0%), and 1 (3.1%), on CECT (P = 0.046). The detection rates for portal vein infiltration were 84.2% (16/19) for baseline ultrasound, 89.5% (17/19) for CEUS, and 78.9% (15/19) for CECT (all P > 0.05 between every two groups). CEUS significantly improved the lesion conspicuity in comparison with CECT. CEUS and CECT made correct diagnoses in 30 (93.8%) and 25 (78.1%) lesions prior to pathological examination (P = 0.125).

Conclusion

The enhancement pattern of hilar cholangiocarcinoma on CEUS was similar with that on CECT in arterial phase, whereas in portal phase hilar cholangiocarcinoma shows hypoenhancement more likely on CEUS. CEUS and CECT lead to similar results in evaluating portal vein infiltration and diagnosis of this entity.     

Enhancement pattern of hepatocellular carcinoma: comparison of real-time contrast-enhanced ultrasound and contrast-enhanced computed tomography

We compared the enhancement pattern of 98 hepatocellular carcinoma nodules in 92 patients on contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT). Contrast-enhanced ultrasound was performed with SonoVue and a low mechanical index method. In arterial phase, 98 nodules were hyperenhancing on CEUS and 94 on CECT. In portal phase, 82 nodules were hypoenhancing on CEUS and 83 on CECT. Peripheral thin-rim-like enhancement was exhibited in 30 nodules on CEUS and 31 on CECT. Intratumoral vessels were visualized in 94 nodules on CEUS and 36 on CECT.     

Intrahepatic cholangiocarcinoma and hepatocellular carcinoma: differential diagnosis with contrast-enhanced ultrasound

Objective

We assessed the usefulness of contrast-enhanced ultrasound (CEUS) in the differentiation of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC).

Methods

The CEUS enhancement patterns of 50 ICCs were retrospectively analysed and compared with 50 HCCs. Two readers independently reviewed the baseline ultrasound (BUS) and CEUS images and the diagnostic performances were evaluated by receiver operating characteristic (ROC) analysis. Time–intensity curves (TIC) were plotted for quantification analysis.

Results

In the arterial phase, peripheral rim-like hyperenhancement, heterogeneous hyperenhancement, homogeneous hyperenhancement and heterogeneous hypoenhancement were found in 25, 10, 3 and 12 of the ICCs versus 2, 29, 19 and 0 of the HCCs (P?<?0.001), respectively. The diagnostic performance of both readers in terms of the area under the ROC curve (0.745 vs. 0.933 for reader 1, and 0.803 vs. 0.911 for reader 2), sensitivity (28% vs. 90%, and 44% vs. 82%) and accuracy (64% vs. 90%, and 71% vs. 90%) improved significantly after CEUS (all P?<?0.05). The interobserver agreement increased from κ?=?0.575 at BUS to κ?=?0.720 after CEUS. TICs demonstrated that the intensities of the peripheral and central portions of the ICCs were lower than those of HCCs (both P?<?0.05).

Conclusion

CEUS improves the diagnostic performance significantly in the differentiation between ICC and HCC.     

Imaging features of hepatic angiomyolipomas on real-time contrast-enhanced ultrasound

The aim of this study was to evaluate the imaging features of hepatic angiomyolipoma (AML) on contrast-enhanced ultrasound (CEUS). The imaging features of 12 pathologically proven hepatic AML lesions in 10 patients who had undergone baseline ultrasound (BUS) and CEUS examinations were evaluated retrospectively. The enhancement extent, pattern and dynamic change, along with the enhancement process, on CEUS were analysed. The diagnostic results of BUS and CEUS before pathological examination were also recorded. The results showed that 75% (9/12) of the AML lesions exhibited mixed echogenicity on BUS and most showed remarkable hyperechogenicity in combination with a hypoechoic or anechoic portion. Arterial flow signals were detected in 75% (9/12) of the lesions on colour Doppler imaging. On CEUS, 66.7% (n = 8) of the 12 lesions exhibited hyperenhancement in the arterial phase, slight hyperenhancement (n = 2) or isoenhancement (n = 6) in the portal phase, and slight hyperenhancement (n = 1) or isoenhancement (n = 7) in the late phase. Three (25%) lesions exhibited hyperenhancement in the arterial phase and hypoenhancement in both portal and late phases. One (8.3%) lesion exhibited hypoenhancement throughout the CEUS process. Before pathological examination with BUS, only 3 (25%) lesions were correctly diagnosed as hepatic AML. Conversely, on CEUS, correct diagnoses were made for 66.8% (8/12) of hepatic AMLs. Therefore, arterial hyperenhancement and subsequent sustained enhancement on CEUS were found in the majority of hepatic AMLs. The combination of BUS and CEUS leads to the correct diagnosis in the majority of hepatic AMLs, and is higher than the success rate achieved by BUS alone.Hepatic angiomyolipoma (AML) is generally considered a rare benign mesenchymal tumour of the liver [1]. With the increasing clinical application of imaging, more and more hepatic AMLs are being detected [2, 3]. Baseline ultrasound (BUS) is the first-line imaging modality for liver use owing to its relatively low cost, non-invasiveness, easy manipulation and ready availability; however, its ability to characterise focal liver lesions (FLLs) cannot meet the requirement in the clinical setting [4]. The advent of the second-generation ultrasound contrast agents and contrast-specific ultrasound techniques allows depiction of the micro- and macro-circulation of FLLs, which has facilitated a great improvement in the characterisation of FLLs [5, 6]. However, until now, few reports in the literature have described the use of contrast-enhanced ultrasound (CEUS) in hepatic AML [7–11]. Herein we analyse retrospectively the imaging features of 12 hepatic AMLs on CEUS; the diagnostic results of BUS and CEUS before pathological examination are also recorded.     

乏血供肝转移瘤超声造影与CT增强扫描的对比研究

目的:探讨乏血供肝转移瘤超声造影(CEUS)血流灌注特点及其与CT增强扫描的差异。方法:选择CT增强扫描提示为乏血供肝转移瘤的12例(20个病灶)行常规超声及造影检查。二维超声观察病灶的部位、大小、边界、内部回声;CEUS观察病灶各期的强化模式、强化水平,重点观察动脉期(0～25s),并与CT增强扫描进行比较。结果:12例共20个病灶,CT增强扫描动脉期:1个病灶轻度增强(5%),11个环形强化(55%),2个不均匀强化(10%),6个无强化(30%)。CEUS动脉期:11个病灶弥漫性均匀强化(55%),7个环形强化(35%),2个不均匀强化(10%)。结论:CEUS显示乏血供肝转移瘤动脉期血供情况优于CT增强扫描;对于CT增强扫描怀疑为乏血供肝转移瘤患者,尤其是单发转移瘤,CEUS检查对临床诊断和治疗有很大帮助。     

Real-time contrast-enhanced ultrasound in diagnosing of focal spleen lesions

Objective

To investigate the features of focal spleen lesions (FSLs) on contrast-enhanced ultrasound (CEUS) imaging.

Materials and methods

CEUS with a blot injection of SonoVue was performed in 48 patients with 75 FSLs (median diameter 2.6 cm) and their perfusion characteristics were analyzed by using contrast pulse sequences (CPS) technique.

Results

Among 19 malignant lesions (10 metastases, 7 lymphoma, 1 hemangiosarcoma, 1 epithelioid hemangioendothelioma) and 56 benign lesion (23 hemangiomas, 14 cysts, 8 infarctions, 4 splenic ruptures, 3 tuberculosis, 2 abscess, 1 pseudoaneurysm, 1 lymphangioma), 25 benign lesions were demonstrated nonenhancement. For malignancy, 50.0% (5/10) metastases and 57.1% (4/7) lymphomas were showed hypoenhancement in the arterial phase, and 18 (94.7%) of malignant lesions were hypo-enhancement in the parenchymal phase. Among 31 benign lesions with enhancement, 27 (87.1%) were showed isoenhancement or hyperenhancement in the arterial phase and 22 (71.0%) lesions were isoenhancement or hyperenhancement in the parenchymal phase. The sensitivity, specificity and accuracy of diagnosis for FSLs were 91.1%, 95.0% and 92.0% for CEUS and 75.0%, 84.2% and 77.3% respectively, for the conventional baseline ultrasound (BUS).

Conclusion

Real-time CEUS can provide valuable information for the diagnosis and differential diagnosis of FSLs.     

Real-time contrast-enhanced ultrasound imaging of focal liver lesions in fatty liver

PurposeThe objective of this study was to investigate the contrast-enhanced ultrasound (CEUS) imaging features of focal liver lesions (FLLs) in fatty liver.MethodOne hundred FLLs in 98 patients with fatty liver were evaluated with real-time CEUS.ResultsAll malignant FLLs showed hyperenhancement in arterial phase and contrast washout in portal and late phases. Among the FLLs, 3.3% of hemangiomas, 12.5% of focal nodular hyperplasias (FNHs), and 2.5% of focal fatty sparing lesions showed contrast washout in the late phase. The sensitivity and specificity for the characterization of hepatocellular carcinoma, metastasis, hemangioma, FNH, and focal fatty sparing lesions were 100% and 95.6%, 60% and 100%, 93.3% and 98.6%, 87.5% and 97.8%, and 92.6% and 100%, respectively.ConclusionsCorrect characterization of FLLs in fatty liver by CEUS is possible based on their typical enhancement patterns.     

超声造影与增强CT对肾癌的诊断分析

目的:本研究旨在比较超声造影(CEUS)和增强CT(CECT)在肾癌病灶中的诊断价值,探讨超声造影在肾癌的诊断价值。方法:对54例患者临床诊断为肾脏内占位性病灶进行CEUS和CECT检查,通过分析病灶CEUS和CECT的特点,比较两种方法的诊断效能。结果:54个病灶中34个为肾脏恶性肿瘤,20个为肾脏良性病灶,CEUS和CECT诊断敏感性、特异性、准确性、阳性预测值、阴性预测值分别为97.05%、85.0%、92.59%、91.67%、94.44%与91.18%、80.00%、87.04%、88.57%、84.21%。两种方法诊断差异无统计学意义(P>0.05)。结论:分析比较CEUS和CECT在诊断肾癌过程中,两种方法诊断效能无明显差异,均能为临床诊断提供重要依据,但CEUS对微循环灌注方面及假包膜的观察优于CECT;CEUS定量评价肾肿瘤血管现处于动物实验阶段,临床上特异指标的找寻仍有待于进一步研究。     

Correlation between enhancement pattern of hepatocellular carcinoma on real-time contrast-enhanced ultrasound and tumour cellular differentiation on histopathology

The objective of this study was to evaluate the correlation between the enhancement pattern of hepatocellular carcinoma (HCC) on contrast-enhanced ultrasound (CEUS) and tumour cellular differentiation on histopathology. 189 HCC lesions in 189 patients were retrospectively evaluated with CEUS and histopathological examination. CEUS was performed with SonoVue and contrast pulse sequencing. Histopathological diagnoses were made according to the Edmonson grading system. Significant differences were shown between the time that the HCC became hypoenhancing or remained echogenic in late phase and tumour cellular differentiation (p = 0.006; p = 0.036), but not with the time of commencement of hyperenhancing or commencement of isoenhancing in arterial phase and portal phase (p = 0.164, p = 0.113; p = 0.186, p = 0.070). The timing of HCC becoming hypoenhancing on CEUS is correlated with tumour cellular differentiation; well differentiated tumours wash out more slowly than poorly differentiated ones.     

Evaluating the perfusion of occupying lesions of kidney and bladder with contrast-enhanced ultrasound

PurposeTo evaluate the clinical diagnostic value of contrast-enhanced ultrasound (CEUS) for occupying lesions of kidney and bladder.Materials and MethodsCEUS was performed for a total of 50 kidney and bladder occupying lesions in 47 cases, and CEUS manifestations of these lesions were observed and analyzed. Patterns of dynamic changes in perfusion phases of CEUS were summarized and compared with results of postoperative pathology, enhanced computed tomography (CT), magnetic resonance imaging (MRI), and follow-ups.ResultsCEUS results showed that there were 22 cases of malignant renal tumors, 11 cases of benign lesions, two cases of renal column hypertrophy, and 12 cases of malignant bladder tumors (15 lesions). Renal cell carcinoma exhibited various CEUS manifestation, with the majority showing fast filling and hyper-enhancement. CEUS manifestation of renal hamartoma was characterized by slow filling and slow outflow. Renal cystic lesions always exhibited no enhancement within the cysts. Renal column hypertrophy exhibited the same enhancement pattern as the renal cortex. CEUS manifestation of bladder carcinoma was mainly characterized by quick filling, quick outflow, and hyperenhancement.ConclusionsCEUS offers real-time observation of perfusion in occupying lesions of kidney and bladder, but the enhancement pattern of kidney occupying lesions was complex; therefore, combination of enhanced CT, MRI, and CEUS may be necessary.     

Characterization of focal liver lesions with a new ultrasound contrast agent using continuous low acoustic power imaging: comparison with contrast enhanced spiral CT

PURPOSE: To evaluate the concordance of the enhancement patterns of a new ultrasound contrast agent (SonoVue) with those obtained with dual-phase contrast-enhanced spiral CT (CE-CT) in the characterization of focal liver lesions (FLLs). MATERIALS AND METHODS: Sixty-two patients with focal liver lesions discovered at ultrasound and also studied with CECT underwent contrast-enhanced ultrasound using continuous low acoustic power imaging after receiving a 2.4 ml bolus of the new US contrast agent SonoVue, consisting of a dispersion of sulphur hexafluoride microbubbles. The examinations were made using ATL HDI-5000, Acuson SEQUOIA and Aloka 5500 Prosound ultrasound systems with 5.2 MHz curved-array probes. The concordance between US and CE-CT images was evaluated on site by two radiologists blinded to CT RESULTS: The FLLs were assessed in the arterial (20 s after CM injection), portal (after 45-60 s) and late (after 120 s) phases for: 1) presence/absence of enhancement 2) distribution of enhancement (homogenous or target distribution, centripetal or centrifugal flow, and other), 3) qualitative enhancement pattern (hyperechoic, hypoechoic, or isoechoic) versus normal liver parenchyma. RESULTS: The concordance between SonoVue-enhanced US and CE-CT was 85%. Moreover during portal venous phase with CEUS it was possible to differentiate between malignancy or benignity of 91% of lesions. CONCLUSIONS: The preliminary data obtained in this study suggest that continuous low acoustic power imaging and contrast-enhanced US show similar results to CT in contrast distribution and contrast enhancement patterns.     

Application of contrast-enhanced ultrasound in the diagnosis of solid pancreatic lesions—A comparison of conventional ultrasound and contrast-enhanced CT

Objective

To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) by comparison with conventional ultrasound (US) and contrast-enhanced CT (CECT) in solid pancreatic lesions.

Method

Ninety patients with solid pancreatic focal lesions were enrolled, including 36 cases of pancreatic carcinoma, 28 cases of pancreatitis, 6 cases of pancreatic neuroendocrine tumor, 12 cases of solid pseudopapillary tumor of the pancreas, 6 cases of pancreatic metastases, 1 case of cavernous hemolymphangioma and 1 case of lymphoma. US and CEUS were applied respectively for the diagnosis of a total of 90 cases of solid pancreatic lesions. The diagnostic results were scored on a 5-point scale. Results of CEUS were compared with CECT.

Results

(1) 3-score cases (undetermined) diagnosed by CEUS were obviously fewer than that of US, while the number of 1-score (definitely benign) and 5-score (definitely malignant) cases diagnosed by CEUS was significantly more than that of US. There was a significant difference in the distribution of final scores using the two methods (p < 0.001). The overall diagnostic accuracies of the 90 cases for CEUS and US were 83.33% and 44.44%, respectively, which indicated an obvious advantage for CEUS (p < 0.001). (2) The diagnostic consistency among three ultrasound doctors: the kappa values calculated for US were 0.537, 0.444 and 0.525, compared with 0.748, 0.645 and 0.795 for CEUS. The interobserver agreement for CEUS was higher than that for US. (3) The sensitivity, specificity and accuracy of the diagnosis of pancreatic carcinoma with CEUS and CECT were 91.7% and 97.2%, 87.0% and 88.9%, and 88.9% and 92.2%, respectively, while for the diagnosis of pancreatitis, the corresponding indices were 82.1% and 67.9%, 91.9% and 100%, and 88.9% and 90%, respectively, showing no significant differences (p > 0.05).

Conclusion

CEUS has obvious superiority over conventional US in the general diagnostic accuracy of solid pancreatic lesions and in the diagnostic consistency among doctors. The performances of CEUS are similar to that of CECT in the diagnosis of pancreatic carcinoma and focal pancreatitis.     

Contrast-enhanced ultrasound of intrahepatic cholangiocarcinoma: correlation with pathological examination

Objective

To investigate the correlation between enhancement patterns of intrahepatic cholangiocarcinoma (ICC) on contrast-enhanced ultrasound (CEUS) and pathological findings.

Methods

The CEUS enhancement patterns of 40 pathologically proven ICC lesions were retrospectively analysed. Pathologically, the degree of tumour cell and fibrosis distribution in the lesion was semi-quantitatively evaluated.

Results

4 enhancement patterns were observed in the arterial phase for 32 mass-forming ICCs: peripheral rim-like hyperenhancement (n=19); heterogeneous hyperenhancement (n=6); homogeneous hyperenhancement (n=3); and heterogeneous hypo-enhancement (n=4). Among the four enhancement patterns, the differences in tumour cell distribution were statistically significant (p<0.05). The hyperenhancing area on CEUS corresponded to more tumour cells for mass-forming ICCs. Heterogeneous hyperenhancement (n=2) and heterogeneous hypo-enhancement (n=2) were observed in the arterial phase for four periductal infiltrating ICCs. In this subtype, fibrosis was more commonly found in the lesions. Heterogeneous hyperenhancement (n=1) and homogeneous hyperenhancement (n=3) were observed in the arterial phase for four intraductal growing ICCs. This subtype tended to have abundant tumour cells.

Conclusion

The CEUS findings of ICC relate to the degree of carcinoma cell proliferation at pathological examination. Hyperenhancing areas in the tumour always indicated increased density of cancer cells.Intrahepatic cholangiocarcinoma (ICC) originates in the small bile duct and is grouped according to the International Classification of Diseases code, with hepatocellular carcinoma (HCC) being the primary liver tumour. It is the second most common primary liver tumour and is highly malignant. Although ICC is a relatively rare tumour, interest in this disease is rising because incidence and mortality rates for ICC are increasing steadily worldwide [1-5].ICC is notoriously difficult to diagnose and is usually fatal, owing to its late clinical presentation and the lack of effective non-surgical therapeutic modalities. It tends to present with non-specific symptoms such as malaise, weight loss and abdominal pain. Most patients have unresectable disease at presentation and die within 12 months from the effects of cancer cachexia and a subsequent rapid decline in performance status.According to growth characteristics, ICC is subcategorised into mass-forming, periductal infiltrating or intraductal-growing types by the Liver Cancer Study Group of Japan [6]. These subtypes show different biological behaviours and have different clinical outcomes. Mass-forming ICC spreads between hepatocyte plates and expands via the hepatic sinusoidal spaces. It often invades the adjacent peripheral branches of the portal vein. Periductal-infiltrating ICC tends to spread along the bile duct wall via the nerve and perineural tissue of Glisson''s capsule towards the porta hepatis. Intraductal-growing ICCs are usually small or polypoid and do not invade deeply into the submucosal layer, often spreading superficially along the mucosa surface. Characterisation of the tumours in terms of their growth pattern is necessary for optimal treatment planning and prognosis assessing. The prognosis for mass-forming and periductal-infiltrating cholangiocarcinoma is generally unfavourable, but is much better for the intraductal-growing type after surgical resection, and long-term patient survival can be expected [7,8].Contrast-enhanced ultrasound (CEUS) has been increasingly applied in liver imaging. By administration of ultrasound contrast agents, CEUS can display dynamic blood flow perfusion and microcirculation of liver lesions [9], similar to CT and MRI. In previous studies, CEUS had a similar diagnostic accuracy for ICC to CT and was suggested as an alternative diagnostic option when CT examination was not available for patients with iodine allergy or impaired renal function [10]. It was confirmed that CT and/or MRI findings of ICC were correlated with pathological findings; that is, the hyperenhancing areas always indicated a large number of tumour cells and the areas of delayed enhancement corresponded to fibrotic stroma at pathological examination. In addition, different morphological subtypes tended to exhibit distinct enhancement characteristics on CT [7,8,11-13]. On CEUS, besides the specific feature of peripheral rim-like hyperenhancement, diverse imaging findings of ICC were reported [9,10,14-17]. These different CEUS appearances may reflect the differences in pathological subtypes or components of ICC. The aim of this study was to investigate the correlation between the enhancement pattern of ICC on CEUS and pathological findings. This information may be useful for diagnosis, treatment planning and prognostic evaluation of ICC.     

Analysis of comparative performance of CEUS and CECT/MR LI-RADS classification: Can CEUS dichotomize LI-RADS indeterminate lesions on CT or MRI?

PurposeTo study the comparative performance of contrast-enhanced ultrasound (CEUS) and contrast-enhanced CT or MRI (CECT/MR) in evaluating liver lesions using the LI-RADS guidelines.MethodsRetrospective analysis of radiology database from July 2010 to April 2017 revealed 228 patients who had CECT/MR and CEUS. Patients at risk of hepatocellular carcinoma (HCC), had contemporaneous CEUS and CECT/CEMR studies within 3 months and adequate follow up were included; reviewed (2 reviewers) and graded according to the 2017 CEUS and 2018 CECT/MR LI-RADS guidelines. Reference standard was multidisciplinary clinical decisions, histology or follow-up imaging.ResultsThe study cohort consisted of 45 patients with 46 lesions. HCC were significantly larger than non-malignant (mean sizes of 2.5 and 1.4 cm, respectively, p<0.001). Intraclass correlation coefficient for CEUS review (0.941) was higher than of CECT/MR review (0.643). Mean area-under-ROC curve (AUC) for CEUS (0.994) was significantly higher than of CECT/MR (0.760) for all lesions (p=0.01). For lesions scored LR-3 by CECT/MR, the AUC was significantly higher for CEUS (0.978) than CECT/MR (0.500) (p<0.001). Twenty-one (of 27) lesions, classified LR-3 or LR-4 by CECT/MR were upgraded by CEUS and 20 were found to be HCC. Six lesions that were LR-3 on both CECT/MR and CEUS were found to be non-malignant. There was good concordance for LR-5 lesions between both techniques.ConclusionCEUS is useful for reassessment of lesions with intermediate probability (LR-3) or probable for HCC (LR-4) on CECT/MR. Lesions upgraded by CEUS tend to be HCC. Lesions that remain LR-3 on CEUS tend to be non-malignant.     

Evaluation of hepatocellular carcinoma using SonoVue,a second generation ultrasound contrast agent: correlation with cellular differentiation

The appearance of hepatocellular carcinoma (HCC) with contrast-enhanced ultrasound (CEUS) in the vascular phase is described and evaluated as to whether the enhancement pattern correlates with the degree of cellular differentiation. One hundred four HCCs were prospectively evaluated with CEUS using coherent-contrast imaging (CCI) and SonoVue with a low mechanical index (<0.2). The enhancement of HCCs in the vascular phase was analyzed according to the degree of pathological differentiation obtained by fine-needle biopsy. In the arterial phase, all HCCs except for four well differentiated ones (96.2%) showed enhancement (P<0.05). Histological differentiation of hypoechoic lesions in the early portal phase (7 HCCs; 16%) significantly differed from hyperechoic (1 HCC; 1%) or isoechoic lesions (87 HCCs; 83.6%) (P<0.05), with a significant probability of a worse differentiation in hypoechoic lesions. Histological differentiation of isoechoic lesions in the late phase (30 HCCs; 28.8%) significantly differed from hypoechoic lesions (74 HCCs; 71.2%) (P<0.05), with a significant probability of a better differentiation in isoechoic lesions. CEUS using CCI and SonoVue revealed enhancement in the arterial phase in >95% of HCCs, with a few well-differentiated cases not being diagnosed due to the absence of enhancement. Echogenicity in the portal and late phases correlated with cellular differentiation.     

Focal liver masses: enhancement patterns on contrast-enhanced images--concordance of US scans with CT scans and MR images

PURPOSE: To assess prospectively the concordance of enhancement patterns of focal liver masses on contrast material-enhanced ultrasonographic (US) scans with patterns on contrast-enhanced computed tomographic (CT) scans or magnetic resonance (MR) images. MATERIALS AND METHODS: This study was approved by the institutional review board; patients gave informed consent. Contrast-enhanced US and contrast-enhanced CT or MR imaging were performed in 135 patients (62 men, 73 women; mean age, 51 years) with 144 confirmed liver masses. Masses included 49 hepatocellular carcinomas, 13 metastases, 30 hemangiomas, 41 lesions of focal nodular hyperplasia, and 11 others. Randomized image sets from each modality were shown independently to three blinded readers, who answered identical questions about enhancement of the lesion and liver in the arterial and portal venous phases and changes with time. Concordance for modalities was calculated from answers of readers and consensus answers between readers, with 95% confidence intervals (CIs). The kappa values were calculated for interreader agreement. RESULTS: Features of arterial phase enhancement showed concordance of more than 76% for modalities. The highest concordance of 92% (132 of 144), with 95% CI of 86% and 95% (kappa>0.84), was for the presence of peripheral pools and centripetal progression. Concordance in the portal venous phase was lower, with agreement for predominant enhancement of the lesion in 61% (86 of 142), with 95% CI of 52% and 68% (kappa>0.83). Portal venous phase washout occurred in 75% (106 of 142), with 95% CI of 67% and 81% (kappa>0.81). The majority of discordances were for malignancies for which only US depicted no sustained enhancement in the portal venous phase. CONCLUSION: US shows high concordance with CT or MR imaging, especially for the arterial phase. Discordance in the portal venous phase may reflect the tendency of CT and MR contrast agents, unlike microbubbles, to diffuse into interstitium.     

超声造影在肝癌病灶诊断及引导射频消融治疗中的应用价值

目的探讨超声造影（CEUS）在肝恶性肿瘤病灶诊断及引导射频消融（RFA）治疗中的应用价值。方法对经病理确诊并经RFA治疗的56例肝癌患者资料进行回顾性分析,术前比较增强cT、普通彩色多普勒超声（二维＋多普勒）和超声造影对肝癌（原发及转移）的检出率,观察二维及超声造影病灶图像差异及特点。对普通彩色多普勒超声引导组（62个病灶）和超声造影引导组（so个病灶）在术中引导RFA的消融效果进行对比并利用超声造影观察射频消融术后疗效。结果56例肝癌患者,112个病灶（原发灶36个,转移灶76个）。超声造影对肝癌病灶检出率为94．6％（106／112）,增强CT对肝癌病灶检出率为96．4％（108／112）,两者检出率比较差异无统计学意义0（x^2=0．42,P〉O．05）。普通彩色多普勒超声对肝癌病灶检出率为74．1％（83／112）,其与超声造影的检出率差异有统计学意义0（2=16,P〈0．05）。在普通彩色多普勒超声引导下进行RFA完全消融率为69％（43／62）,超声造影引导下完全消融率为84％（42／50）,两者的完全消融率差异无统计学意义舒=1．6,P〉0．05）。结论超声造影在RFA术前对肝脏肿瘤的诊断,术中对病灶的准确定位及实时引导穿刺,术后对手术疗效的随访观察都具有重要的应用价值。     

肝脏局灶性结节性增生超声造影的典型特征和病灶大小的相关性研究

目的:探讨肝脏局灶性结节性增生(FNH)超声造影的典型特征与病灶大小的联系。方法:本组采用新型超声对比剂SonoVue和对比脉冲序列成像技术,对33例FNH患者共35个病灶行超声造影检查(CEUS),观察病灶的增强模式和其它声像图特征,分析轮幅状的增强模式和中央疤痕的发生率;其中26例由CT、MRI证实,其余7例经手术或穿刺病理证实。结果:24个直径>3cm的病灶22个(22/24,91.7%)动脉相早期呈轮幅状增强,而11个直径<3cm的病灶4个(4/11,36.4%)为轮幅状增强,本组共计26个(26/35,74.3%)病灶呈轮幅状增强。本组22个(22/35,62.9%)病灶可见中央疤痕,其中19个(19/24,79.2%)直径>3cm的病灶和3个(3/11,27.3%)直径<3cm的病灶可见上述特征。结论:多数直径>3cm的FNH超声造影动脉相表现为典型的轮幅状增强模式,延迟相可见中央疤痕,如果无轮幅状增强和中央疤痕等声像图特征,则超声造影难以鉴别诊断FNH与其它富血供的肿瘤。     

超声增强造影与肝酶水平在肝损伤分级中的意义

目的探讨超声增强造影和血清肝酶在肝损伤检查和分级中的价值和意义。方法 20只健康新西兰大白兔,雌雄不限,体重为(2.15±0.23)kg。随机制作不同级别的肝损伤模型。建模前后抽取静脉血进行血清肝酶检查,建模后分别使用通用16排螺旋CT和Philip公司IU22临床超声仪对实验动物进行增强CT和超声增强造影检查,然后根据美国创伤外科协会(AAST)分级标准对肝脏损伤进行分级,最后将超声造影的分级结果与增强CT分级结果进行Spearman相关性分析,将血清肝酶的结果与CT分级结果进行Pearson相关性分析。结果按照AAST诊断标准,超声增强造影和增强CT检查对肝损伤等级的分类具有很高的一致性,Spearman相关系数为0.888(P0.0001),Kappa值为0.71;天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、乳酸脱氨酶(LDH)、AST/ALT比值与肝损伤的等级呈正相关,Pearson相关系数分别为0.664(P=0.0014)、0.704(P=0.0005)、0.503(P=0.024),γ-谷氨酰基转移酶(GGT)水平与肝损伤等级呈负相关(r=-0.467,P=0.038)。结论超声增强造影和血清肝酶检查在对肝损伤的检查与分级上与增强CT检查的结果有较好的一致性,可作为肝损伤诊断及治疗中监测手段。     

超声造影与增强CT在胆囊疾病诊断中的对比分析

目的:比较超声造影(contrast-enhanced ultrasound,CEUS)和CT增强(contrast-enhanced helicalcomputedtomography,CECT)检查在胆囊占位性病变诊断中血流灌注过程中的的特点,探讨其在胆囊占位性病变诊断中的价值。方法:对比分析78例胆囊占位性病变的超声造影和增强CT在不同时相的增强及灌注特征。结果:超声造影和增强CT具有相似的表现。但对于小于5 mm的病变,超声造影的检出率高于增强CT,78例胆囊占位性病变中,胆囊癌35例,胆囊息肉29例,局限性胆囊腺肌增生症14例,增强CT准确率分别为84.35%,89.63%和80.13%,超声造影准确率分别为83.12%,93.79%和79.72%。结论:增强CT和超声造影检查均有助于胆囊疾病诊断,两者结合可提高胆囊疾病的诊断符合率。