Contrast-Enhanced Ultrasound: a Simple and Effective Tool in Defining a Rapid Diagnostic Work-up for Small Nodules Detected in Cirrhotic Patients during Surveillance

Giorgio, Antonio; Montesarchio, Luca; Gatti, Pietro; Amendola, F.; Matteucci, Paolo; Santoro, B.; Merola, Maria Gabriella; Merola, Francesca Reduzzi; Coppola, Carmine; Giorgio, Valentina

doi:10.15403/jgld.2014.1121.252.chu

Cited by 34 publications

(23 citation statements)

References 16 publications

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“…Moreover, the application of contrast agents has gained more and more attention. Compared to other imaging modalities, contrast enhanced ultrasound (CEUS) can be performed immediately after conventional ultrasound (US), providing a simple, easy-to-perform and immediately available dynamic imaging tool[ 1 ]. The use of CEUS might therefore shorten the diagnostic and therapeutic work-up of hepatocellular carcinoma (HCC) patients.…”

Section: Introductionmentioning

confidence: 99%

Contemporary role of liver biopsy in hepatocellular carcinoma

Spârchez¹,

Mocan²

2018

WJH

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A correct diagnosis of hepatocellular carcinoma (HCC) in cirrhotic patients with focal liver lesions is one of the most important issues nowadays. Probably one of the oldest debates in the hepatology community is whether to perform liver biopsy (LB) in all cirrhotic patients with focal liver lesions. We now face a time when oncology is moving towards personalized medicine. According to the current European Association for the study of Liver diseases HCC guidelines, LB has only a minor role in the management of HCC. However, the current recommendations were made more than five years ago. As time has passed, the development of high-throughput molecular technologies has helped reveal the main molecular mechanism involved in HCC development and progression. Several subtypes of HCC, with both molecular and histological characterization, have been described. Importantly, some of these subtypes have prognostic impact. In the context of personalized treatment, the role of LB will be carefully reconsidered. Until then, it is mandatory to know the various techniques of LB, their performances, complications and limitations. The balance of risk and benefit defines many of the decisions that we make as providers of medical care. In this review, we discuss not only the risks associated with LB, but also the benefits of biopsy in various clinical scenarios. Not long from now, the role of LB will be reconsidered. It is possible that we will go back in time and once again use biopsy for HCC diagnosis. Then again, we may move back to the future to try to improve the use of liquid biopsy in the follow-up of HCC patients after various treatment modalities.

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Section: Introductionmentioning

confidence: 99%

Contemporary role of liver biopsy in hepatocellular carcinoma

Spârchez¹,

Mocan²

2018

WJH

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“…1 B) 2nd bolus for characterisaƟon of the ablaƟon defect (procedure as in Fig. 1 A with focus on the arterial phase) However, as particularly well-differentiated HCCs can lack contrast washout in the late phase, it is controversial whether arterial phase hyperenhancement alone might be sufficient for the noninvasive diagnosis of HCC in the cirrhotic liver [7,17]. ▶ Fig.…”

Section: Primary Liver Malignanciesmentioning

confidence: 99%

Tips and Tricks in Contrast-Enhanced Ultrasound (CEUS) for the Characterization and Detection of Liver Malignancies

Schellhaas

Strobel

2019

Ultraschall in Med

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Contrast-enhanced ultrasound (CEUS) has a high diagnostic accuracy in the assessment of focal liver lesions. Clinical context (presence of liver cirrhosis, history of other malignancy versus incidental finding) is crucial for the correct interpretation of CEUS findings. CEUS has to be preceded by structured anamnesis and clinical examination as well as accurate B-mode sonography. Metastases are the most common malignant liver lesions in a non-cirrhotic liver. According to their contrast enhancement in the arterial phase, metastases are categorized as hyper- and hypo-vascular metastases. A common feature of all metastatic lesions is washout of the contrast agent in the portal venous or late phase. In the context of liver cirrhosis, > 95 % of focal liver lesions are hepatocellular carcinomas (HCCs). HCCs typically show arterial phase hyperenhancement, followed by mild and gradual contrast washout occurring very late in the late phase. For intrahepatic cholangiocellular carcinoma (ICC), the pattern of contrast enhancement in the arterial phase can vary. However, all ICCs typically show early and pronounced washout. Other liver malignancies like lymphoma, angiosarcoma, epithelioid hemangioendothelioma and others are very rare. Except for the contrast washout seen in all liver malignancies, they do not display pathognomonic enhancement patterns upon CEUS. Thus, biopsy is indispensable for definite diagnosis of the tumor entity. Furthermore, CEUS is used for the detection of metastases and therapeutic monitoring after local ablative procedures. The examination procedure differs slightly depending on the specific indication (characterization, detection).

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“…Aktuell wird kontrovers diskutiert, ob auch ein alleiniges arterielles Hyperenhancement ohne nachfolgendes Auswaschen für die Diagnosestellung eines HCC bei Patienten mit Leberzirrhose ausreichend ist. Neueren Arbeiten zufolge kann nämlich insbesondere bei gut differenzierten HCC auch häufig ein KM-Auswaschen fehlen [4,10,12].…”

Section: Hepatozelluläres Karzinomunclassified

Blickdiagnose mit Mikrobläschen-Kontrastmittelsonografie fokaler Leberläsionen

Schellhaas¹,

Strobel²

2019

Gastroenterologie up2date

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Contrast-Enhanced Ultrasound: a Simple and Effective Tool in Defining a Rapid Diagnostic Work-up for Small Nodules Detected in Cirrhotic Patients during Surveillance

Cited by 34 publications

References 16 publications

Contemporary role of liver biopsy in hepatocellular carcinoma

Contemporary role of liver biopsy in hepatocellular carcinoma

Tips and Tricks in Contrast-Enhanced Ultrasound (CEUS) for the Characterization and Detection of Liver Malignancies

Blickdiagnose mit Mikrobläschen-Kontrastmittelsonografie fokaler Leberläsionen

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