Era of diagnostic and interventional ultrasound

Abstract

It is an era of diagnostic and interventional ultrasound (US). Various new techniques such as three-dimensional US (3D US), interventional US, and contrastenhanced US (CEUS) have been introduced into clinical practice. Dr. Xu and his colleagues have taken advantage of these techniques and carried out a series of relevant studies. Their use of 3D US in the liver, gallbladder, liver tumor volumetry, guidance for ablation, and 3D CEUS has widened the application of 3D US in the clinic. They found that prognosis in patients with hepatocellular carcinoma (HCC) after thermal ablation with curative intent was determined by treatment response to ablation, pretreatment serum AFP, and liver function reserve. Tumor response to treatment was the most predictive factor for long-term survival. They compared the use of percutaneous microwave ablation and radiofrequency ablation for the treatment of HCC and found that both are effective methods in treating HCCs. The local tumor control, complications related to treatment, and long-term survival were equivalent for the two modalities. They first compared the enhancement patterns of HCC and intrahepatic cholangiocarcinoma (ICC) and proposed the diagnostic clues for ICC, liver angiomyolipoma (AML), gallbladder cancer, renal carcinoma, and renal AML, which have greatly enhanced the role of CEUS in the clinic. They also evaluated the diagnostic performance of CEUS in characterizing complex cystic focal liver lesions and the agreement between two investigators with different experience levels; and found that CEUS is especially useful for the young investigator. They assessed the effect of anti-angiogenic gene therapy for HCC treated by microbubble-enhanced US exposure and concluded that gene therapy mediated by US exposure enhanced by a microbubble contrast agent may become a new treatment option for HCC.

Management of hepatocellular carcinoma: The role of contrast-enhanced ultrasound

“…CEUS can not only accurately tell the location of HCC but also guide real-time puncture during the arterial phase, or its sufficient long portal-venous and late phases. Moreover, UCA can be administrated repeatedly to guide percutaneous therapy at multiple sites or for multi-lesions [7,8,47] .…”

“…CEUS can Zheng SG et al . CEUS for management of HCC sponse, currently, the use of contrast enhanced imaging to detect the viable tumor or recurrent HCC is widely accepted [8,[47][48][49] . Previously, CECT or CEMRI has been regarded as the reference standard for treatment response evaluation after local therapies.…”

Contrast enhanced ultrasound in the evaluation and percutaneous treatment of hepatic and renal tumors

“…After the first year, follow-up was performed every 4 months with CEUS, and CECT or CEMRI every 8 months to reduce costs and the effects of iodinated contrast agents [39]. The reported sensitivity and specificity of CEUS for the evaluation of residual or recurrent RCC are 82.2-100%, and 96.6-100% [39,40,43,44], respectively, with an accuracy of 90.5-98.1% [39,40,43]. The concordance of CEUS with CECT or CEMRI ranges between 80 and 100% [38][39][40][41][42].…”

Gadoxetic Acid–enhanced Magnetic Resonance Imaging and Contrast-enhanced Ultrasonography in the Diagnosis of Hepatocellular Carcinoma

“…For multiple lesions, ultrasound contrast agents can be administered repeatedly to guide percutaneous therapy at multiple sites. 128,141 Fusion imaging with conventional ultrasonography and CECT or CEMRI can be used for guiding biopsy or ablation of inconspicuous lesions. About 83% of HCCs that are inconspicuous on fusion imaging with conventional ultrasonography are well visualised on CEUS.…”