<i>RadioGraphics</i> Update: Contrast-enhanced US Approach                     to the Diagnosis of Focal Liver Masses

Burrowes, David P.; Kono, Yuko; Medellin, Alexandra; Wilson, Stephanie R.

doi:10.1148/rg.2020200109

Cited by 6 publications

(12 citation statements)

References 7 publications

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“…The ACR has created the LI-RADS criteria for noninvasive imaging diagnosis of HCC in patients at risk for its development. Recent articles have reviewed approaches to diagnosing HCC with CEUS [20,22,23]. Additional societies worldwide also have guidelines for noninvasive diagnosis of HCC, including European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), World Federation for Ultrasound in Medicine and Biology (WFUMB), and Erlanger Synopsis of Contrast-Enhanced Ultrasound for Liver Lesion Assessment in Patients at risk (ESCULAP), with studies comparing and contrasting them with LI-RADS.…”

Section: Discussionmentioning

confidence: 99%

“…CEUS can provide crucial information that can be used to differentiate HCC from intrahepatic cholangiocarcinoma (ICC), by demonstrating differences in their enhancement patterns [23]. As discussed, HCC classically shows arterial hyperenhancement and delayed, mild contrast washout in the late phase [22]. In contrast, ICC shows peripheral arterial contrast enhancement with early contrast washout of the vascularized parts of the lesion in the portal-venous and late phase [23,25].…”

Section: Discussionmentioning

confidence: 99%

“…While different subtypes of adenomas have differing transformation risks, differentiating imaging characteristics are not necessarily dependable, and biopsy may be required to determine the subtype and therefore the transformation risk, or if transformation has already occurred. On CEUS, there is significant overlap of adenoma with HCC in their enhancement patterns [15,22] but there may be differentiation by very early features in how the lesion enhances [15]. It is important to note that CEUS may show washout in adenomas, when MRI does not, which may be attributable to the contrast characteristics-CEUS contrast agents remain intravascular, whereas MRI agents diffuse into the interstitium [28].…”

Section: Discussionmentioning

confidence: 99%

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Contrast-Enhanced Ultrasonography for Screening and Diagnosis of Hepatocellular Carcinoma: A Case Series and Review of the Literature

et al. 2020

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Background: Contrast-enhanced ultrasound (CEUS) is a safe and noninvasive imaging technique that can characterize and evaluate liver lesions, and has been approved for this use in the Unites States since 2016. CEUS has been shown to be similar in accuracy to computed tomography (CT) and magnetic resonance imaging (MRI) for noninvasive diagnosis of hepatocellular carcinoma (HCC) and offers several advantages in certain patient populations who have contraindications for CT or MRI. However, CEUS has inherent limitations and has not been widely employed for evaluation of HCC. Methods: We present three retrospective cases of liver lesions in patients with cirrhosis, who underwent screening for HCC using concurrent, well-timed CT and CEUS. Results: In these cases, the liver lesions were better visualized and then diagnosed as malignancy via CEUS, whereas the lesions were best appreciated on CT only in retrospect. Conclusions: In some cirrhotic patients, a focal lesion may be more easily identifiable via CEUS than on CT and thus accurately characterized, suggesting an important and complementary role of CEUS with CT or MRI. Further studies are indicated to support the use of CEUS for the diagnosis and characterization of liver lesions in screening patients at risk for developing HCC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Contrast-Enhanced Ultrasonography for Screening and Diagnosis of Hepatocellular Carcinoma: A Case Series and Review of the Literature

et al. 2020

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“…LR-1 (definitely benign) observations include cysts, hemangiomas, focal hepatic fat deposition, focal hepatic fat sparing, and hypertrophic pseudo mass. The reader is referred to several excellent reviews for a thorough description of the imaging appearance of these entities [35][36][37][38][39] . An examination performed as a followup of observation could also be categorized as LR-1 if the observation spontaneously disappeared on followup.…”

Section: Description Of the Ceus Li-rads Algorithmmentioning

confidence: 99%

Contrast-enhanced ultrasound liver reporting and data system for hepatocellular carcinoma diagnosis

Vezeridis¹,

Kono²

2020

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Contrast-enhanced ultrasound (CEUS) is a powerful imaging modality for the diagnosis of focal liver lesions, including hepatocellular carcinoma (HCC). The American College of Radiology Contrast-Enhanced Ultrasound Liver Reporting and Data System (CEUS LI-RADS®) was created as a standardized reporting system to facilitate consistent and high-quality technique, interpretation, reporting, and data collection for CEUS diagnosis of HCC. This article describes the history and background of CEUS LI-RADS®, its major concepts and algorithm, and the differences between CEUS LI-RADS® and CT/MRI LI-RADS®.

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“…Contrast-enhanced ultrasound (CEUS) has a well-recognized role in the characterization of focal liver lesions in both asymptomatic and high-risk patients such as those with cirrhosis and cancer 1 2 3 . Benign and neoplastic lesions can be differentiated on the basis of the portal venous and late phase findings: marked washout with a punched-out appearance in the late arterial or portal venous phase (within 60 s of contrast injection) is considered typical of metastatic disease 3 4 5 and of some types of primary liver cancer, namely intrahepatic cholangiocarcinoma (ICC) 6 and poorly differentiated hepatocellular carcinoma (HCC) 7 . In contrast, benign lesions frequently show iso- or hyperenhancement in the portal venous and late phases.…”

Section: Introductionmentioning

confidence: 99%

Contrast-Enhanced Ultrasound Findings in Patients with Rare Solitary Necrotic Nodule of the Liver – a Multicenter Report

et al. 2021

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Purpose This multicenter retrospective study highlights the contrast-enhanced ultrasound (CEUS) findings in a series of histologically proven solitary necrotic nodules (SNN) of the liver, a poorly understood pathologic entity of uncertain origin that mimics malignancy. Materials and Methods 22 patients (M/F 13/9; mean age 59.4 years, SD ± 10.7, range 35–81) with histological diagnosis of SNN and CEUS were selected from clinical, imaging, and pathological archives of 7 US interventional centers, each of which provided 1 to 6 cases (mean 2.8). Pathological diagnosis was made on 20 US-guided biopsies and 2 surgical specimens. 2 patients had 2 SNNs with identical CEUS findings so that imaging analysis was carried out on 24 nodules. Results SNN was an incidental finding in healthy people in 10 cases (45.5 %), and it was discovered during follow-up for either known extrahepatic malignancies (9 cases = 41 %) or chronic liver disease (3 cases = 13.5 %). SNNs had a mean size of 19.3 mm (SD ± 6.5, range 9–40). On B-mode US, SNNs appeared hypoechoic in 14 cases (66.7 %), “target-like” in 7 cases (29.2 %), and homogeneously hyperechoic in 1 case (4.1 %). On CEUS, all lesions appeared devoid of contrast enhancement (“punched out” aspect) in the arterial, portal venous, and late phases after US contrast agent injection. A uniformly thin, hyperenhancing ring in the early arterial phase and isoenhanced with the surrounding parenchyma in the portal venous and late phases was found in 10 nodules (41.6 %). Clinical and imaging follow-up (mean duration 42.2 months, SD ± 34.9, range 2–108) was available in 15 patients with 16 SNNs: no changes in size and echostructure were seen. Conclusion CEUS can contribute to the diagnosis of SNN when a “punched out” appearance in all vascular phases with or without thin rim enhancement in the very early arterial phase is present in healthy subjects in whom a focal liver lesion is incidentally found. In patients with a history of chronic liver disease or malignancy, US-guided biopsy represents the unavoidable first-line diagnostic modality.

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RadioGraphics Update: Contrast-enhanced US Approach to the Diagnosis of Focal Liver Masses

Cited by 6 publications

References 7 publications

Contrast-Enhanced Ultrasonography for Screening and Diagnosis of Hepatocellular Carcinoma: A Case Series and Review of the Literature

Contrast-Enhanced Ultrasonography for Screening and Diagnosis of Hepatocellular Carcinoma: A Case Series and Review of the Literature

Contrast-enhanced ultrasound liver reporting and data system for hepatocellular carcinoma diagnosis

Contrast-Enhanced Ultrasound Findings in Patients with Rare Solitary Necrotic Nodule of the Liver – a Multicenter Report

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