Contrast-Enhanced Sonographic Appearance of Hepatocellular Carcinoma in Patients with Cirrhosis: Comparison with Contrast-Enhanced Helical CT Appearance

Giorgio, Antonio; Ferraioli, Giovanna; Tarantino, L.; Stefano, G. de; Scala, Vincenzo; Scarano, Ferdinando; Coppola, Carmine; Viscovo, Luca Del

doi:10.2214/ajr.183.5.1831319

Cited by 108 publications

(83 citation statements)

References 29 publications

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“…It should be stressed that preliminary studies reporting the sensitivity of the technique as around 95% [444][445][446][447] are irrelevant in this context, as they relate to characterisation (of known but unclassified nodules), rather than detection (of lesions that may or may not be present in a series of cirrhotic livers). One observational study has been published reporting the use of CEUS in a surveillance series; 448 however, the reference standard used to establish 'true' diagnoses (longterm follow-up, including biopsy and CT) was suboptimal.…”

Section: More Effective More Expensive Ultrasoundmentioning

confidence: 99%

Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis

Coon¹,

Rogers²,

Hewson³

et al. 2007

Health Technol Assess

148

108

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Section: More Effective More Expensive Ultrasoundmentioning

confidence: 99%

Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis

Coon¹,

Rogers²,

Hewson³

et al. 2007

Health Technol Assess

148

108

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“…The β-carboline alkaloids isolated from this plant are reported to possess antidepressant (6), hallucinogenic (7) and antileishmanial effect (8).The present study was undertaken to study the hypoglycemic effect of ethanolic extract of P. harmala seeds in normal and streptozotocin (STZ) induced diabetic rats…”

Section: Introductionmentioning

confidence: 99%

Preliminary studies on the hypoglycemic effect of Peganum harmala L. Seeds ethanol extract on normal and streptozotocin induced diabetic rats

Singh

Chaturvedi

Narender

et al. 2008

Indian J Clin Biochem

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“…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].…”

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confidence: 99%

“…1). The late phase, with or without hepato-specificity, was showed to be the most important for focal liver lesions characterization since benign lesions present prevalently a sustained enhancement with hyper or isovascular appearance to the adjacent liver while malignant lesions present prevalently microbubble washout with hypovascular appearance [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] (Fig. 2).…”

mentioning

confidence: 99%

“…Anyway, in routine clinical practice it is often not possible to predict a histological diagnosis by CEUS since many benign lesions appear hypervascular and even after microbubble injection are often indistinguishable; a small hypervascular haemangioma, an FNH, and a hepatocellular adenomas can all appear iso or hypervascular at portal-late phase; the only exception is the hepatocellular adenomas which may appear hypovascular on portal-late phase [22]. Malignant lesions may also not be differentiated since HCCs, cholangiocarcinomas and liver metastases prevalently appear hypervascular during the arterial phase and present washout of contrast agent with hypovascular appearance at portal-late phase, even though HCC may appear isovascular to the adjacent liver parenchyma in about 40% of cases [6][7][8][9]. In such HCCs the isovascular appearance during the portal-late phase may lead to the erroneous impression of a benign lesion, especially if the presence of liver cirrhosis is not known at the time of CEUS examination.…”

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confidence: 99%

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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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Contrast-Enhanced Sonographic Appearance of Hepatocellular Carcinoma in Patients with Cirrhosis: Comparison with Contrast-Enhanced Helical CT Appearance

Abstract: Contrast-enhanced sonography is similar to CT for detecting hepatocellular carcinoma hypervascularity. It could be complementary to conventional unenhanced sonography for evaluation of liver nodules.

Cited by 108 publications

References 29 publications

Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis

Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis

Preliminary studies on the hypoglycemic effect of Peganum harmala L. Seeds ethanol extract on normal and streptozotocin induced diabetic rats

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

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