Characterization of Indeterminate Liver Lesions on CT and MRI With Contrast-Enhanced Ultrasound: What Is the Evidence?

Wang, David C.; Jang, Hyun‐Jung; Kim, Tae Kyoung

doi:10.2214/ajr.19.21498

Cited by 31 publications

(21 citation statements)

References 74 publications

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“…Sonazoid consists of perfluorobutane (C 4 F 10 ) gas stabilized by a monomolecular membrane of hydrogenated egg phosphatidylserine; SonoVue is composed of sulfurhexfluoride gas encapsulated by a phospholipid shell. Both agents have been used for more than a decade in clinical applications for CEUS of FLLs, leading to their increased use in routine practice across the world [6,[10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Prospective assessment of diagnostic efficacy and safety of SonazoidTM and SonoVue® ultrasound contrast agents in patients with focal liver lesions

Zhai

Jiang

et al. 2021

Abdom Radiol

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Objectives To assess the respective diagnostic value of Sonazoid™ and SonoVue® for characterizing FLLs as benign or malignant and the corresponding safety. Methods This prospective Phase 3 study was conducted at 17 centres in China and Korea (May 2014 to April 2015); 424 patients (20 to 80 years) with at least 1 untreated focal liver lesion (FLL) (< 10 cm in diameter) underwent a contrast-enhanced ultrasound (CEUS) examination (218 received Sonazoid of 0.12 μL microbubbles/kg; 206 received SonoVue of 2.4 mL). Three independent blinded readers evaluated pre- and post-contrast images characterising the FLLs as benign or malignant. Results Sonazoid-enhanced and SonoVue-enhanced ultrasound provided a statistically significant improvement in specificity for all 3 readers comparing to unenhanced ultrasound (for Sonazoid: p = 0.0093, < 0.0001, 0.0011; for SonoVue: p = 0.002, 0.03, 0.12, respectively). Difference in accuracy improvement between the 2 groups was within the pre-specified non-inferiority margin of 20% for all 3 readers (6.1%, 95% CI: − 5.0 to 17.2; − 7.5%, 95% CI: − 18.4 to 3.5; − 0.3%, 95% CI: − 11.3 to 10.7). The diagnostic confidence level for all 3 readers increased with post-contrast images relative to pre-contrast images. Both contrast agents were well tolerated. Conclusion Results showed a similar efficacy for Sonazoid™ and SonoVue® in diagnosing FLLs as benign or malignant, and underlined the benefit of CEUS imaging over unenhanced ultrasound imaging in reaching a confident diagnosis without having to refer patients for additional imaging exams.

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Section: Introductionmentioning

confidence: 99%

Prospective assessment of diagnostic efficacy and safety of SonazoidTM and SonoVue® ultrasound contrast agents in patients with focal liver lesions

Zhai

Jiang

et al. 2021

Abdom Radiol

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“…As discussed, HCC classically shows arterial hyperenhancement and delayed, mild contrast washout in the late phase [22]. In contrast, ICC shows peripheral arterial contrast enhancement with early contrast washout of the vascularized parts of the lesion in the portal-venous and late phase [23,25]. This may allow for key differentiation between two malignancies and further argues for the usefulness of CEUS as a diagnostic modality.…”

Section: Discussionmentioning

confidence: 95%

“…The ACR has created the LI-RADS criteria for noninvasive imaging diagnosis of HCC in patients at risk for its development. Recent articles have reviewed approaches to diagnosing HCC with CEUS [20,22,23]. Additional societies worldwide also have guidelines for noninvasive diagnosis of HCC, including European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), World Federation for Ultrasound in Medicine and Biology (WFUMB), and Erlanger Synopsis of Contrast-Enhanced Ultrasound for Liver Lesion Assessment in Patients at risk (ESCULAP), with studies comparing and contrasting them with LI-RADS.…”

Section: Discussionmentioning

confidence: 99%

“…Negative predictive value of LIRADS was inferior, with positive predictive value similarly high among all three diagnostic categories [24] Within LI-RADS guidance, there is an additional category for malignant lesion that is not specific for HCC-LI-RADS M [18,19]. CEUS can provide crucial information that can be used to differentiate HCC from intrahepatic cholangiocarcinoma (ICC), by demonstrating differences in their enhancement patterns [23]. As discussed, HCC classically shows arterial hyperenhancement and delayed, mild contrast washout in the late phase [22].…”

Section: Discussionmentioning

confidence: 99%

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Contrast-Enhanced Ultrasonography for Screening and Diagnosis of Hepatocellular Carcinoma: A Case Series and Review of the Literature

et al. 2020

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Background: Contrast-enhanced ultrasound (CEUS) is a safe and noninvasive imaging technique that can characterize and evaluate liver lesions, and has been approved for this use in the Unites States since 2016. CEUS has been shown to be similar in accuracy to computed tomography (CT) and magnetic resonance imaging (MRI) for noninvasive diagnosis of hepatocellular carcinoma (HCC) and offers several advantages in certain patient populations who have contraindications for CT or MRI. However, CEUS has inherent limitations and has not been widely employed for evaluation of HCC. Methods: We present three retrospective cases of liver lesions in patients with cirrhosis, who underwent screening for HCC using concurrent, well-timed CT and CEUS. Results: In these cases, the liver lesions were better visualized and then diagnosed as malignancy via CEUS, whereas the lesions were best appreciated on CT only in retrospect. Conclusions: In some cirrhotic patients, a focal lesion may be more easily identifiable via CEUS than on CT and thus accurately characterized, suggesting an important and complementary role of CEUS with CT or MRI. Further studies are indicated to support the use of CEUS for the diagnosis and characterization of liver lesions in screening patients at risk for developing HCC.

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“…CEUS may be used to accurately characterize many FLLs, 2‐5 with the most common discussed later. CEUS is particularly helpful in the setting of an incidental lesion seen by grayscale US, or an inconclusive CT or MRI 6,7 …”

Section: Fllsmentioning

confidence: 99%

Using Contrast‐Enhanced Ultrasound to Characterize Focal Liver Lesions

Fetzer

Kono

Rodgers

2021

Clinical Liver Disease

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Characterization of Indeterminate Liver Lesions on CT and MRI With Contrast-Enhanced Ultrasound: What Is the Evidence?

Cited by 31 publications

References 74 publications

Prospective assessment of diagnostic efficacy and safety of SonazoidTM and SonoVue® ultrasound contrast agents in patients with focal liver lesions

Prospective assessment of diagnostic efficacy and safety of SonazoidTM and SonoVue® ultrasound contrast agents in patients with focal liver lesions

Contrast-Enhanced Ultrasonography for Screening and Diagnosis of Hepatocellular Carcinoma: A Case Series and Review of the Literature

Using Contrast‐Enhanced Ultrasound to Characterize Focal Liver Lesions

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