Color flow Doppler characterization of focal hepatic lesions.

Nino-Murcia, Matilde; Ralls, Philip W.; Jeffrey, R. Brooke; Johnson, M B

doi:10.2214/ajr.159.6.1332456

Cited by 82 publications

(59 citation statements)

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“…Furtehrmore, in a more complex clinical setting, US may identify doubtful focal liver lesions during pre-surgical tumour staging or during post-surgical follow-up, or may detect hepatocellular nodules during surveillance for liver cirrhosis. Unenhanced grey-scale US and colour Doppler US present clear limitations in differentiating malignant from benign liver lesions because of the similar US appearance and vascular architecture of malignant and benign lesions, especially in a background of liver cirrhosis, and are effective in characterizing incidental focal liver lesions as benign or malignant in the normal liver only in 40-50% of the cases provided that a typical pattern is identified, as in haemangiomas appearing homogeneously hyperechoic or in liver metastases presenting a peripheral hypoechoic halo or also in FNHs presenting a spoke wheel -shaped central vascular pattern at colour Doppler US [17,18]. This is mainly due to the well known limitations of Colour Doppler US including colour signal saturation, motion and blooming artefacts, and insensitivity to the slow flow of capillary vessels due to wall filter.…”

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confidence: 99%

The real capabilities of contrast-enhanced ultrasound in the characterization of solid focal liver lesions

Quaia

2010

Eur Radiol

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Contrast-enhanced US (CEUS) using intravenous agents is a rapidly evolving field even though the main clinically recognized application is the characterization of focal liver lesions. Several reports have described the improvement provided by CEUS in the characterization of focal liver lesions in comparison to unenhanced US. CEUS with low transmit power insonation allows the real-time assessment of focal liver lesion contrast enhancement and vascularity during the different dynamic phases after injection of an intravenous contrast agent. CEUS allows the accurate characterization of focal liver lesions as benign or malignant based on the lesion contrast enhancement pattern during the arterial phase and lesion vascularity during portal-late phase in comparison to the adjacent liver parenchyma. During the portal-late phase, benign lesions present prevalently a sustained contrast enhancement with hyper or isovascular appearance to the adjacent liver while malignant lesions present prevalently microbubble washout with hypovascular appearance. On the other hand, the histology of focal liver lesions can only be confidently predicted in selected cases by CEUS, as in liver haemangiomas presenting typical nodular peripheral enhancement with subsequent centripetal fill-in and focal nodular hyperplasia with central spoke wheelshaped contrast enhancement.Grey-scale ultrasound (US) is the most widespread imaging procedure for investigating the liver parenchyma due to its relative low cost, availability, safety, and high patient acceptance. However conventional unenhanced gray-scale US is somewhat limited in characterizing focal liver lesions, and several papers have described the general capabilities of contrast-enhanced US (CEUS) in improving focal liver lesion characterization [1][2][3][4][5][6][7][8][9][10][11].Recently, European Radiology has published several papers regarding the capabilities of CEUS in focal liver lesion characterization [12][13][14][15][16]. Soussan et al. [16] presented an interesting study evaluating the role of CEUS in the characterization of solid focal liver lesions in comparison to contrast-enhanced MR imaging. In this study authors analysed a series of 47 patients with 50 incidental focal liver lesions-24 focal nodular hyperplasias (FNHs), 11 hepatocellar adenomas, 10 haemangiomas, 1 focal fatty changes, and 4 malignancies including 2 hepatocellular adenomas with malignant foci, 1 hepatocellular carcinoma (HCC), and 1 epithelioid haemangioendotheliomadetected by US and scheduled for contrast-enhanced MR imaging. All patients underwent CEUS after intravenous injection of an US contrast agent consisting of sulphur hexafluoride-filled microbubbles (SonoVue, Bracco, Italy). The MR images and CEUS cine-clips of each lesion were randomly assigned to two blinded readers, with 17 and 22 years of experience in MR imaging and 8 years of experience in CEUS, who independently reviewed all the examinations and were asked to provide the most likely histological diagnosis for each focal liver lesion a...

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confidence: 99%

The real capabilities of contrast-enhanced ultrasound in the characterization of solid focal liver lesions

Quaia

2010

Eur Radiol

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“…Our study showed that the presence of both intra-and peritumoral arterial flow was strongly suggestive of malignancy, whereas the presence of intratumoral venous flow was remarkably suggestive of benignancy [4][5][6][7] . Intratumoral and peritumoral arterial flow signals were obtained in 92% of malignant tumors, but only in 52% of benign lesions.…”

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confidence: 99%

Resistance index in differential diagnosis of liver lesions by color doppler ultrasonography

Wang¹,

Wang²,

Ding³

et al. 2004

WJG

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AIM:To investigate the specific value of resistance index (RI) in color Doppler ultrasonography in the diagnosis of focal hepatic lesions. METHODS:Eight hundred patients with 893 hepatic solid lesions were studied with color Doppler flow imaging (CDFI) and pulsed Doppler, including 644 malignant cases (596 primary malignant liver tumors, and 48 metastatic liver tumors), 156 benign cases. All were confirmed by operation and pathology. RESULTS:The detection rate of arterial flow in malignant tumors was 92%, and 52% in benign lesions. Doppler spectrum analysis showed that the resistance index in primary malignant tumors was 0.75±0.12, 0.73±0.09 in metastatic tumors, and was below 0.6 in benign lesions. The difference was significant (P<0.001). This difference was related with its histopathologic structure. CONCLUSION:The arterial flow with RI 0.6 identified by CDFI within the liver lesion can be regarded as a criterion of malignant tumors, RI<0.6 can be regarded as benign disorders. RI is useful in differential diagnosis of liver neoplasms.

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“…However, there is no report on the use of color Doppler sonography in the diagnosis of intestinal venous malformation. In liver hemangiomas, Tanaka et al 12 reported that color Doppler imaging revealed a characteristic spot pattern of internal vascularity in up to 50% of cases, but Nino-Murcia et al 13 and Choi et al 14 reported that color Doppler imaging showed no internal vascularity in most lesions. Cavernous venous malformations in the liver are histologically heterogeneous, and their imaging appearances vary depending on the size of vascular channels and the intervening septa of connective tissue.…”

Section: Mmentioning

confidence: 99%

Usefulness of color doppler sonography and ^99mTc‐RBC scintigraphy for preoperative diagnosis of a venous malformation of the small intestine in a 2‐year‐old child

Sugito

Kusafuka

Hoshino

et al. 2007

J of Clinical Ultrasound

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Color flow Doppler characterization of focal hepatic lesions.

Cited by 82 publications

References 3 publications

The real capabilities of contrast-enhanced ultrasound in the characterization of solid focal liver lesions

The real capabilities of contrast-enhanced ultrasound in the characterization of solid focal liver lesions

Resistance index in differential diagnosis of liver lesions by color doppler ultrasonography

Usefulness of color doppler sonography and ^99mTc‐RBC scintigraphy for preoperative diagnosis of a venous malformation of the small intestine in a 2‐year‐old child

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Color flow Doppler characterization of focal hepatic lesions.

Cited by 82 publications

References 3 publications

The real capabilities of contrast-enhanced ultrasound in the characterization of solid focal liver lesions

The real capabilities of contrast-enhanced ultrasound in the characterization of solid focal liver lesions

Resistance index in differential diagnosis of liver lesions by color doppler ultrasonography

Usefulness of color doppler sonography and 99mTc‐RBC scintigraphy for preoperative diagnosis of a venous malformation of the small intestine in a 2‐year‐old child

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Usefulness of color doppler sonography and ^99mTc‐RBC scintigraphy for preoperative diagnosis of a venous malformation of the small intestine in a 2‐year‐old child