Contrast-enhanced ultrasound in diagnosis and characterization of focal hepatic lesions

Abstract

The extensive use of imaging techniques in differential diagnosis of abdominal conditions and screening of hepatocellular carcinoma in patients with chronic hepatic diseases, has led to an important increase in identification of focal liver lesions. The development of contrastenhanced ultrasound (CEUS) opens a new window in the diagnosis and follow-up of these lesions. This technique offers obvious advantages over the computed tomography and magnetic resonance, without a decrease in its sensitivity and specificity. The new second generation contrast agents, due to their intravascular distribution, allow a continuous evaluation of the enhancement pattern, which is crucial in characterization of liver lesions. The dual blood supply in the liver shows three different phases, namely arterial, portal and late phases. The enhancement during portal and late phases can give important information about the lesion's behavior.Each liver lesion has a different enhancement pattern that makes possible an accurate approach to their diagnosis. The role of emerging techniques as a contrastenhanced three-dimensional US is also discussed. In this article, the advantages, indications and technique employed during CEUS and the different enhancement patterns of most benign and malignant focal liver lesions are discussed.

Activity-based cost analysis of contrast-enhanced ultrasonography (CEUS) related to the diagnostic impact in focal liver lesion characterisation

“…This is also evident from our results, as CEUS liver imaging, performed as a second-level examination, thanks to the reference diagnostic patterns reported in the literature [ 16 , 1 , 2 , 4 , 21 , 22 ], proved to be diagnostic in 83.1 % of the lesions investigated and allowed for lesion characterisation (without the need for further imaging confirmation or follow-up) in almost 90 % of these cases.…”

Potential role of contrast-enhanced ultrasound for the differentiation of malignant and benign gallbladder lesions in East Asia

“…The injected microbubble contrast agents can enhance the contrast between the blood and surrounding tissue. [ 9 ] Thus CEUS makes it possible to detect tumor blood flow clearly. Nowadays, CEUS is applied in the examination of several organs like breast, thyroid, kidney, liver, ovary, and especially in the identification of benign and malignant lesions.…”

Characteristics of hepatic solitary necrotic nodules on contrast-enhanced ultrasonography

“…Most patients showed no clinical symptoms, and were detected occasionally during physical examination, postmortem examination, or operation [ 7 ]. The pathological features of SNN include nodular coagulation necrosis, and presence of a complete fibrous capsule around the lesion, with the infiltration of inflammatory cells in the capsule (mainly eosinophil cells and lymphocytes), and no vascular tissue in the lesion [ 4 , 8 ].…”

“…However, in our study, 13 patients (13/24) showed peripheral thin rim-like enhancement in the arterial phase, which could easily be misdiagnosed as a malignant tumor such as metastatic hepatic carcinoma (MHC). However, the inner wall of the lesion’s enhancement ring was clear and sharp, and demonstrated iso-enhancement in the portal and delayed phases, which differed from the obviously decreased enhancement ring of the MHC lesion in the portal phase [ 2 , 8 ]. Peripheral thin rim-like enhancement in the arterial phase suggested micro-vessel distribution around the lesions of the SNN.…”