The main imagistic method for characterization of renal lesions is contrast enhanced computed tomography (CECT). Disadvantages of CECT are a contrast-induced nephropathy in patients with renal impairment, allergic reactions and high costs. Contrast-enhanced ultrasound (CEUS) evaluation of hepatic and non-hepatic lesions is a relatively new, but increasingly utilised, diagnostic method. In 2011 the European Federation of Societies of Ultrasound in Medicine and Biology (EFSUMB) updated the Guidelines and Recommendations on the Clinical Practice of CEUS and included in the recommendation the renal pathology. However, there are several possible new indications that have not been discussed (pyelocaliceal masses and renal vein thrombosis) and several issues that remain controversial such as the differentiation of benign and malignant tumours or the differentiation of lymphoma and metastasis.This study aims to review literature data, as well as reveal the latest findings in the field of renal CEUS.

Aims: To report on the long-term impact of tumor and non-tumor related parameters on local recurrence, distant recurrence and survival in patients with naïve or recurrent type hepatocellular carcinoma (HCC) treated by radiofrequency ablation (RFA).Methods: We performed 240 RFA sessions on 133 patients with 156 HCC nodules developed on a background of liver cirrhosis and analyzed the outcomes.Results: Contrast-enhanced ultrasound performed one month after RFA showed complete ablation in 119 out of 133 (89.65%) patients. With a median follow-up of 46 months, 3-, 5- and 7-year survival rates were 61.7%, 35.7%, and 22.6%, respectively. Previous ethanol injection and histological grade were significantly related to local tumor progression. Child-Pugh class, incomplete ablation, histological grade, previous ethanol injection, alpha-fetoprotein level before the treatment, and local recurrence were all significantly related to distant recurrence. Multivariate analysis demonstrated that age, Child-Pugh class, distant recurrence and multiple incomplete ablations were significantly related to survival.Conclusion: Radiofrequency ablation could be locally curative for HCC, resulting in a survival longer than 7 years. Previous ethanol injection and incomplete ablations were strongly associated with poor outcomes.

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Liver abscess is a potentially lethal condition that requires prompt recognition and adequate treatment for a good outcome. The aim of this study was to assess the value of contrast enhanced ultrasound (CEUS) in the management of liver abscesses in the clinical practice of a single centre. Material and methods: A retrospective analysis was performed including all patients diagnosed with liver abscesses during 5 years (2010-2014) in a tertiary Department of Gastroenterology and Hepatology. The demographic data, the presence of risk factors, the cause of liver abscess, the B-mode conventional US aspect, the CEUS appearance and the patient's outcome were documented and analyzed. Results: The study group included 41 patients diagnosed with liver abscesses (17 women and 24 men, mean age 63.3±13.2 years), 16/41 (39%) of them with diabetes mellitus. A single lesion was found in 28 (68.3%) patients, and 13 (31.7%) patients had multiple abscesses. The CEUS study was conclusive for the diagnosis of liver abscess in clinical context in 38/41 cases (92.7%). All conclusive cases presented rim enhancement in the arterial phase and no enhancement in the liquid areas. The honeycomb appearance with septa enhancement was present in 17/41 (41.5%) patients. Washout of the marginal rim was found in 22/41 (53.6%) lesions. Conclusion: In our group the most frequent CEUS features found were the rim enhancement in the arterial phase and the presence of no enhancement areas, followed by the honeycomb appearance. CEUS was able to be conclusive for the diagnosis of liver abscess in almost 93% of cases.

Aim: Percutaneous radiofrequency (RFA) and microwave ablation (MWA) are currently the best treatment options forpatients with liver metastases (LM) who cannot undergo a liver resection procedure. Presently, few studies have evaluated theefficacy of tumor ablation in beginner’s hands but none at all in hepatic metastasis. Our aim was to report the initial experiencewith ultrasound as a tool to guide tumor ablation in a low volume center with no experience in tumor ablation.Material and methods: We conducted a retrospective cohort study, on a series of 61 patients who had undergone percutaneous US-guided ablations for 82 LM between 2010 and 2015. Long term outcome predictors were assessed using univariate and multivariate analysis.Results: Complete ablation was achieved in 86.9% of cases (53/61). All MWA sessions (20/20) attained ablation margins >5mm, compared to 79% (49/62) for RFA sessions (p=0.031). Ablation time was significantly shorter for MWA, with a median duration of 10 minutes (range: 6-12) vs. 14 minutes (range: 10-19.5, p=0.003). There was no statistically significant difference in local tumor progression (LTP)-free survival rates between MWA and RFA (p=0.154). On univariate analysis, significant predictors for local recurrence were multiple metastases (p=0.013) and ablation margins <5 mm (p<.001), both retaining significance on multivariate analysis. Significant predictors for distant recurrence on both univariate and multivariate analysis were multiple metastases (p<0.001) and non-colorectal cancer metastases (p<0.05).Conclusion: A larger than 5 mm ablation size is critical for local tumor control. We favor the use of MWA due to its ability to achieve ablation in significantlyshorter times with less incomplete ablations.