Contrast-Enhanced Ultrasound Algorithms (CEUS-LIRADS/ESCULAP) for the Noninvasive Diagnosis of Hepatocellular Carcinoma – A Prospective Multicenter DEGUM Study
“…Hence, the CEUS LI-RADS (Liver Imaging Reporting and Data System) classification was established. This classification was adjusted to MRI and CT as reference imaging [ 7 ]. Fig.…”
Section: Hepatocellular Carcinomamentioning
confidence: 99%
“…It is important to keep in mind that the differentiation of regenerative or dysplastic nodules or early stages of HCC in small hypervascularized lesions with a diameter of a maximum of 10 mm might be difficult or even impossible to safely detect when using SonoVue®, because this is a strictly intravascular contrast medium. Even though these contrast media have not yet been approved, in vivo tumor-specific contrast media like BR 55® or even liver-specific ultrasound contrast media (analogously to MRI) are in trials [ 3 , 7 , 14 – 16 ].…”
Section: Hepatocellular Carcinomamentioning
confidence: 99%
“…When using CEUS perfusion the amount of wash-out kinetics can be assessed in a more detailed way. A fast wash-out, for example, is more likely to be a cholangiocellular carcinoma, whereas a hepatocellular carcinoma shows prolonged wash-out kinetics until the late phase (up to 4–5 min after the injection; [ 7 ]). For follow-up of chemotherapy, evaluation of the wash-out is also important.…”
In multimodal radiologic imaging, contrast-enhanced ultrasound (CEUS) is increasingly used. One of the advantages of CEUS is the possibility of repeated application of contrast media without decreasing renal function or affecting the thyroid gland. Small solid liver lesions can be diagnosed and detected with high accuracy. Moreover, solid lesions in other abdominal organs can also be characterized. Frequent applications for solid lesions in the near field concern thyroid tumors and lymph nodes. For prostate diagnostics, CEUS can be used with an endorectal probe and perfusion imaging. This review explains how the additional (semi-)quantitative perfusion analysis, especially time–intensity curve (TIC) analyses, and wash-in/wash-out kinetics of integrated or external perfusion software programs facilitate new options in dynamic assessment of microvascularization during tumor follow-up care and even minimally invasive tumor therapy.
“…Hence, the CEUS LI-RADS (Liver Imaging Reporting and Data System) classification was established. This classification was adjusted to MRI and CT as reference imaging [ 7 ]. Fig.…”
Section: Hepatocellular Carcinomamentioning
confidence: 99%
“…It is important to keep in mind that the differentiation of regenerative or dysplastic nodules or early stages of HCC in small hypervascularized lesions with a diameter of a maximum of 10 mm might be difficult or even impossible to safely detect when using SonoVue®, because this is a strictly intravascular contrast medium. Even though these contrast media have not yet been approved, in vivo tumor-specific contrast media like BR 55® or even liver-specific ultrasound contrast media (analogously to MRI) are in trials [ 3 , 7 , 14 – 16 ].…”
Section: Hepatocellular Carcinomamentioning
confidence: 99%
“…When using CEUS perfusion the amount of wash-out kinetics can be assessed in a more detailed way. A fast wash-out, for example, is more likely to be a cholangiocellular carcinoma, whereas a hepatocellular carcinoma shows prolonged wash-out kinetics until the late phase (up to 4–5 min after the injection; [ 7 ]). For follow-up of chemotherapy, evaluation of the wash-out is also important.…”
In multimodal radiologic imaging, contrast-enhanced ultrasound (CEUS) is increasingly used. One of the advantages of CEUS is the possibility of repeated application of contrast media without decreasing renal function or affecting the thyroid gland. Small solid liver lesions can be diagnosed and detected with high accuracy. Moreover, solid lesions in other abdominal organs can also be characterized. Frequent applications for solid lesions in the near field concern thyroid tumors and lymph nodes. For prostate diagnostics, CEUS can be used with an endorectal probe and perfusion imaging. This review explains how the additional (semi-)quantitative perfusion analysis, especially time–intensity curve (TIC) analyses, and wash-in/wash-out kinetics of integrated or external perfusion software programs facilitate new options in dynamic assessment of microvascularization during tumor follow-up care and even minimally invasive tumor therapy.
“…In fact, it seems that CEUS is better than CT to identify M lesions, most likely because the target nodule was already depicted on grayscale US [83]. Although the characteristics of arterial phase can differentiate between HCC and ICC [84], both malignancies are hypo-enhanced in the venous and late phase.…”
Section: Defining Classes Of Risk and Developing Imaging Strategies According To The Riskmentioning
Hepatocellular carcinoma (HCC) is probably the epitome of a screening target, with a well-defined high-risk population, accessible screening methods, and multiple curative-intent treatments available for early disease. Per major societies guideline consensus, biannual ultrasound (US) surveillance of the at-risk patients is the current standard of care worldwide. Yet, despite its documented success in the past decades, this standard is far from perfect. While the whole community is working to further tighten the knots, a worrying number of cases still slip through this safety net. Consequently, these patients lose their chance to a curative solution which leads to a high disease burden with disproportionate mortality. While US will probably remain the fundamental staple in the screening strategy, key questions are seeking better answers. How can its caveats be addressed, and the technique be improved? When are further steps needed? How to increase accuracy without giving up on accessibility? This narrative review discusses the place of US surveillance in the bigger HCC picture, trying to navigate through its strengths and limits based on the most recent available evidence.
“…Hilfreich in der Beurteilung sind die Kriterien des Liver Imaging Reporting and Data System (LI-RADS) für CEUS und die radiologischen Verfahren. Die Diagnosestellung des HCC erfolgt in erster Linie durch die kontrastverstärkte Bildgebung [54,55,56,57,58,59,60,61,62,63,64].…”
ZusammenfassungDie histologische Sicherung von Tumoren ist zusammen mit einem adäquaten Staging die Voraussetzung für eine stadiengerechte und personalisierte Therapie. Beschrieben werden Indikationen, technische Möglichkeiten und Einschränkungen sowie potenzielle Komplikationen der bildgebend geführten Nadelbiopsie mittels Ultraschalls (US), Computertomografie (CT) und Endosonografie (EUS). Welches Verfahren für welches Organ und welche Läsion?
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