CEUS in Hepatocellular Carcinoma and Intrahepatic Cholangiocellular Carcinoma in 320 Patients – Early or Late Washout Matters: A Subanalysis of the DEGUM Multicenter Trial

Wildner, D; Bernatik, T.; Greis, Christian; Seitz, Karlheinz; Neurath, MF; Strobel, D

doi:10.1055/s-0034-1399147

Cited by 132 publications

(105 citation statements)

References 17 publications

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“…In the study of Chen et al CEUS showed the same accuracy as CECT [65]. In a subanalysis of the DEGUM study, CEUS managed a correct diagnosis for ICC in 95.2% of cases [66]. According to a Chinese study, most ICCs (87.9%) show "wash-out" in the first 60 seconds, and all of them 3 minutes after the contrast bolus [67] and, based on these criteria, CEUS had 78.8% sensitivity, 88% specificity and 84.3% accuracy for diagnosing ICC [68].…”

Section: Livermentioning

confidence: 88%

Romanian National Guidelines on Contrast Enhanced Ultrasound in clinical practice

et al. 2017

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Contrast-enhanced ultrasound (CEUS) allows a real-time assessment of the vascular pattern of different types of lesions, as it has no renal or liver toxicity, it lacks radiation exposure and it is also cheaper than other imaging methods, having a diagnostic capability that matches contrast-enhanced CT or MRI. In Romania CEUS is used more and more, especially by clinicians, and since some centres have extensive experience in this domain, we felt the need to disseminate our expertise in order to implement this method in as many centres as possible. These Guidelines present the clinical applications of CEUS in the liver, spleen, pancreas, kidney, testis, bowel, intra-cavitary and endoscopic ultrasound, as well as other applications.

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Section: Livermentioning

confidence: 88%

Romanian National Guidelines on Contrast Enhanced Ultrasound in clinical practice

et al. 2017

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“…Otherwise, further percutaneous biopsy or radiofrequency ablation (RFA) will always be guided by real-time BMUS. Short-term BMUS follow-up may be needed to further characterize the lesion [3]. Previous study showed the detection and characterization ability of BMUS is higher if the lesion detected with CT is >5 mm [3].…”

Section: Introductionmentioning

confidence: 99%

“…Short-term BMUS follow-up may be needed to further characterize the lesion [3]. Previous study showed the detection and characterization ability of BMUS is higher if the lesion detected with CT is >5 mm [3]. However, BMUS still shows low specificity and low accuracy for optimal characterization of small FLLs [4, 5].…”

Section: Introductionmentioning

confidence: 99%

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

Mao²,

Cao

et al. 2017

BioMed Research International

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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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“…In fact, rejecting CEUS as a diagnostic technique would lead to more biopsies including the respective risk and less benefit. In addition, ICCs are relatively rare in cirrhotic livers (1-2% of all new nodules) and CEUS can even show differences in the vascularization patterns between HCC and ICC [22]. HCC shows an arterial global hyperenhancement and delayed contrast wash-out in the late phase.…”

mentioning

confidence: 99%

“…In addition, since the evaluation of cirrhotic patients is performed by applying multimodality imaging strategy, CT and MRI have to be performed. As reported by D'Onofrio et al, the behavior of ICC at CEUS is different from the one in CT. During the late phase, ICC appears hypervascular at CT, because of desmoplastic reaction due to fibrotic component, while at CEUS it appears hypovascular [22]. In these cases CEUS should not be used as the sole imaging technique for conclusive hepatocellular carcinoma diagnosis and if the MRI does not display the diagnostic vascular pattern, a confirmatory biopsy is mandatory [20].…”

mentioning

confidence: 99%

Recall strategies for patients found to have a nodule in cirrhosis: is there still a role for CEUS?

et al. 2015

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Development of liver tumors and their evolution to hepatocellular carcinoma (HCC) is a multi-step process in which different HCC-etiologies induce continuous rounds of hepatocyte damage and regeneration. Over an extended time, this triggers cirrhosis which is a pathological state of the liver in which lesions can progress to become dysplastic nodules. Later, these nodules may evolve into HCC and occasionally generate metastatic events. To provide optimal care, patients with liver cancer should be managed using a multidisciplinary approach in specialized centers in which all the diagnostic and therapeutic resources are available. Among the different imaging modalities the introduction on contrast agents for ultrasound use has opened new further applications in different clinical settings. In fact, contrast enhanced ultrasound (CEUS) has been applied for more than ten years and plays increasingly important roles in the management of HCC. Since early 2000, international societies including the American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of the Liver (EASL), the Asian Pacific association for the Study of the Liver (APASL), the Japanese society of Hepatology (JSH), the Italian society for the study of the liver (AISF), the World Federation for Ultrasound in Medicine and Biology (WFUMB), and the European Federation of Societies for Ultrasound in Medicine and Biology (EFUSMB) have discussed the important role of CEUS in the diagnosis of HCC. In the present review an update of the literature and a detailed discussion of the present Guidelines regarding the role of CEUS in the evaluation of nodules in cirrhotic patients is offered.

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CEUS in Hepatocellular Carcinoma and Intrahepatic Cholangiocellular Carcinoma in 320 Patients – Early or Late Washout Matters: A Subanalysis of the DEGUM Multicenter Trial

Cited by 132 publications

References 17 publications

Romanian National Guidelines on Contrast Enhanced Ultrasound in clinical practice

Romanian National Guidelines on Contrast Enhanced Ultrasound in clinical practice

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

Recall strategies for patients found to have a nodule in cirrhosis: is there still a role for CEUS?

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