Contrast-enhanced ultrasound for the differentiation of small atypical hepatocellular carcinomas from dysplastic nodules in cirrhosis

Shin, Seung Kak; Kim, Yun Soo; Choi, Seung Joon; Shim, Young Sup; Jung, Dong Hae; Kwon, Oh Sang; Choi, Duck Joo; Kim, Ju Hyun

doi:10.1016/j.dld.2015.05.001

Cited by 21 publications

(15 citation statements)

References 38 publications

(35 reference statements)

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“…Although not used widely in North America, multiphasic contrast‐enhanced US also can be used to diagnose HCC noninvasively, and further studies are needed . Prospective studies should include multiphasic CT, multiphasic MRI with an extracellular agent, and multiphasic MRI with gadoxetate disodium 8, and data on costs and patient preference should be collected.…”

Section: Methods Of Guideline Developmentmentioning

confidence: 99%

AASLD guidelines for the treatment of hepatocellular carcinoma

et al. 2017

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Section: Methods Of Guideline Developmentmentioning

confidence: 99%

AASLD guidelines for the treatment of hepatocellular carcinoma

et al. 2017

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“…[12] Recently, several studies have shown that detection of well-differentiated HCC with insufficient development of arterial vessels can be improved with alternative imaging modalities, such as diffusion-weighted imaging (DWI), computed tomography (CT) angiography, and contrast-enhanced ultrasound. [13–17] …”

Section: Introductionmentioning

confidence: 99%

Characterization of small (≤3 cm) hepatic lesions with atypical enhancement feature and hypointensity in hepatobiliary phase of gadoxetic acid-enhanced MRI in cirrhosis

Shin

Kim²,

Choi³

et al. 2017

Medicine

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It is difficult to characterize the nodular lesions in cirrhotic liver if typical enhancement pattern is not present on dynamic contrast-enhanced imagings. Although the signal intensity of the hepatobiliary phase in gadoxetic acid-enhanced magnetic resonance imaging (MRI) is helpful for characterization of the lesions, some dysplastic nodules may also exhibit low signal intensity in the hepatobiliary phase. We aimed to assess the usefulness of gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI including diffusion-weighted imaging (DWI) for differentiation between atypical small hepatocellular carcinomas (HCCs) and dysplastic nodules showing low signal intensity (SI) in the hepatobiliary phase, and to evaluate the MRI findings in determining the histological grade of atypical HCCs in patients with cirrhosis.A total of 43 cirrhotic patients with a small (≤3 cm) liver nodule (n = 25, HCC; n = 18, dysplastic nodule) who underwent Gd-EOB-DTPA-enhanced MRI and pathologic confirmation were retrospectively reviewed. Atypical HCC was defined as not showing arterial hyperenhancement and delayed washout on dynamic MRI.High SI on both T2WI and DWI (sensitivity 80.0%, specificity 100%, positive predictive value 100%, negative predictive value 78.3%) was the most specific feature to differentiate atypical HCCs from dysplastic nodules. High SI on both T2WI and DWI (100% vs 61.5%, P = .039) or low SI on pre-enhanced T1WI (83.3% vs 30.8%, P = .021) was more frequent observed in Edmonson grade II–III HCCs compared with those in grade I HCCs.The combination of DWI and T2WI is most useful for the differentiation of atypical small HCCs from dysplastic nodules showing low SI in the hepatobiliary phase. Combination of DWI and T2WI or pre-enhanced T1WI seems to be useful for predicting the histological grade of atypical HCCs.

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“…On visualization of tumor enhancement, immediate insertion of the RFA electrode is essential before hypervascularity becomes diminished. We used the arterial phase rather than the venous phase on the basis of the results of Shin et al (12) study, which demonstrated CEUS finding of small atypical HCCs in cirrhotic liver; 20.8% of small HCCs with atypical enhancement pattern on CT and MRI did not show hypoenhancement during the venous phase on CEUS.…”

Section: Discussionmentioning

confidence: 99%

“…Contrast-enhanced ultrasound (CEUS) with SonoVue showed improved diagnostic sensitivity and detectability for small and inconspicuous HCCs, compared with conventional B-mode US (10,11). Moreover, detection of hypervascularity in early HCC was significantly improved with CEUS compared with dynamic studies such as CT or MRI (12). To our knowledge, few studies have assessed the usefulness of CEUS-guided RFA electrode insertion into inconspicuous HCCs during the arterial phase of SonoVue (3,(13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Contrast-enhanced ultrasound-guided radiofrequency ablation in inconspicuous hepatocellular carcinoma on B-mode ultrasound

Kim¹,

Kim²,

Shin³

et al. 2017

Turk J Gastroenterol

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Recently, novel contrast agents for ultrasound have been developed to improve the diagnostic yield. SonoVue (Bracco, Milan, Italy) and Sonazoid (Daiichi-SanTurk J Gastroenterol 2017; 28: 446-52 Contrast-enhanced ultrasound-guided radiofrequency ablation in inconspicuous hepatocellular carcinoma on B-mode ultrasound Eui Joo Kim , Yun Soo Kim , Seung Kak Shin , Oh Sang Kwon , Duck Joo Choi , Ju LiverOriginal Article

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Contrast-enhanced ultrasound for the differentiation of small atypical hepatocellular carcinomas from dysplastic nodules in cirrhosis

Cited by 21 publications

References 38 publications

AASLD guidelines for the treatment of hepatocellular carcinoma

AASLD guidelines for the treatment of hepatocellular carcinoma

Characterization of small (≤3 cm) hepatic lesions with atypical enhancement feature and hypointensity in hepatobiliary phase of gadoxetic acid-enhanced MRI in cirrhosis

Contrast-enhanced ultrasound-guided radiofrequency ablation in inconspicuous hepatocellular carcinoma on B-mode ultrasound

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