Sonazoid-Enhanced Ultrasonography for Diagnosis of Hepatic Malignancies: Comparison with Contrast-Enhanced CT

Abstract

Objective: The purpose of this study was to assess the usefulness of Sonazoid-enhanced ultrasonography (US) in the diagnosis of hepatic malignancies in comparison with contrast-enhanced CT findings. Methods: A total of 74 patients with 113 hepatic tumors having or highly suspected of having malignancies were enrolled. These hepatic nodules were diagnosed by typical findings of imaging such as contrast-enhanced CT, dynamic MRI or Sonazoid-enhanced US, tumor markers and histological examinations after surgical resection or biopsy. Results: 108 nodules were diagnosed as malignant tumors (hepatocellular carcinoma: n = 90; metastasis: n = 16; intrahepatic cholangiocarcinoma: n = 2) and the remaining five tumors were diagnosed as benign tumors (dysplastic nodules: n = 5). Sonazoid-enhanced US correctly depicted the presence or absence of tumors in 74 patients, with a sensitivity of 95.4%, an accuracy of 94.7%, and a positive predictive rate of 99%. Contrast-enhanced CT depicted the malignancies with a sensitivity of 85.2%, an accuracy of 82.3%, and a positive predictive rate of 95.8%. There were significant differences between Sonazoid-enhanced US and contrast-enhanced CT for sensitivity and accuracy (both p < 0.05). Conclusion: Sonazoid-enhanced US has a higher sensitivity and accuracy for the diagnosis of hepatic malignancies than contrast-enhanced CT.

Clinical translation in the treatment of hepatocellular carcinoma following the introduction of contrast-enhanced ultrasonography with Sonazoid

“…Hatanaka et al found that this contrast agent has higher sensitivity and accuracy for the diagnosis of hepatic malignancy (7). We reported on the diagnostic efficacy of CEUS with sonazoid in cases of Hcc which were <2 cm (8).…”

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

“…The absence of Kupffer cells causes a defect in Sonazoid uptake in the postvascular phase. The diagnostic capability of CEUS with Sonazoid in the postvascular phase is similar to that of MRI with superparamagnetic iron oxide (SPIO) and has been endorsed in the Japanese guidelines for the management of HCC [10][11][12]37,38] . Furthermore, CEUS has an inherent advantage over CECT or CEMRI: its real-time imaging can not only dynamically display the vascular perfusion of HCC, but also carry on quantitative analysis for FLL on the basis of time intense curve, which indeed helps radiologists to read CEUS images accurately and to avoid misdiagnose due to some subjective biases [2,5,7,8,19] .…”

“…HCC always shows an enhancement defect in the postvascular phase due to the lack of Kupffer cells whereas benign lesions always show sustained enhancement. The advent of Sonazoid brings CEUS into the era of cell functional imaging or molecular US imaging [7,[10][11][12] . Here, on the basis of the Guideline and Good Clinical Practice Recommendations for CEUS in the liver -update 2012 [7] and other literature about the management of HCC, we summarize the main roles and applications of CEUS in the management of HCC.…”

Huge Pancreatic Acinar Cell Carcinoma with High Levels of AFP and Fucosylated AFP (AFP-L3)

“…Although it is a powerful modality for screening of metastasis, FDG-PET/CT has a limitation for the detection of small metastatic hepatic tumors (<1 cm) in the liver because of resolution limits (43). CEUS with Sonazoid has been reported as a useful modality for the detection for hepatic malignant tumors (44) and screening of hepatic metastasis (43). Using CEUS with Sonazoid, a small tumor was detected as a defect in the 5th segment of the liver in the Kupffer phase in the present case and enhanced uniformly by re-injection (45).…”