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Mansour MGED, Kader MHA, Arafa HM, Ali SA. Characterization of focal liver lesions using sulphur hexafluoride (SF6) microbubble contrast-enhanced ultrasonography. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-020-00374-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Focal hepatic lesions incidentally detected during ultrasound usually need further step for proper characterization. The aim of this study was to highlight the efficacy of microbubble contrast-enhanced ultrasonography (CEUS) in characterization of focal liver lesions. This prospective study was conducted on 60 patients presented with hepatic focal lesions in the period from January 2019 to June 2020. CEUS studies were performed after a baseline conventional ultrasound with the same machine by the same operator. The ultrasound contrast agent used is second-generation US contrast agent. The enhancement patterns of the hepatic lesions were studied during the vascular phases up to 5 min and the data were correlated with histopathology, triphasic contrast-enhanced CT, and clinical follow-up.
Results
CEUS demonstrated a sensitivity of 94.2%, specificity of 88.9%, positive predictive value of 91%, negative predictive value of 94.1%, and accuracy of 92.3% for characterization of hepatic focal lesions, compared to a sensitivity of 100%, specificity of 81.8%, positive predictive value of 84%, negative predictive value of 100%, and accuracy of 90.7% for triphasic CT.
Conclusion
CEUS is an effective tool in characterization of HFLs and recommended as a second diagnostic step after conventional ultrasound to immediately establish the diagnosis especially in patients with contraindications to CECT.
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Ippolito D, Porta M, Maino C, Pecorelli A, Ragusi M, Giandola T, Querques G, Talei Franzesi C, Sironi S. Diagnostic approach in hepatic lymphoma: radiological imaging findings and literature review. J Cancer Res Clin Oncol 2020; 146:1545-1558. [PMID: 32296934 DOI: 10.1007/s00432-020-03205-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/30/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Imaging manifestations of hepatic lymphoma, both primary (PHL) and secondary (SHL), are extremely variable and non-specific, but some features are useful diagnostic clues in an appropriate clinical setting. Through a PubMed search, we found several published reviews focused on PHL and SHL diagnosis. However, to the best of our knowledge, few of them encompass a comprehensive analysis of all the diagnostic tools and relative radiological findings. The aim of this review is to provide a description of the radiological features of both PHL and SHL, by critically analyzing the available literature. MATERIALS AND METHODS An extensive review of published literature along with a description of personal case series of both PHL and SHL has been conducted. RESULTS SHL can be easily diagnosed with imaging techniques, as it is usually associated with node disease. On the contrary the diagnosis can be a challenge in PHL, often mimicking HCC or liver metastasis of adenocarcinoma. In this context, multiparametric MRI plays a fundamental role in the differential diagnosis. Both for PHL and SHL, liver involvement presents as solitary or multiple lesions or as diffuse infiltrative disease. CONCLUSION PHL and SHL may be correctly characterized using different radiological techniques. Both CT and MRI have showed a good correlation with histology, as they permit to distinguish between lymphomatous tissue, and necrotic and fibrotic areas.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Marco Porta
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Anna Pecorelli
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy.
- School of Medicine, University of Milano-Bicocca, Milan, Italy.
| | - Maria Ragusi
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Teresa Giandola
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Giulia Querques
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Cammillo Talei Franzesi
- Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Sandro Sironi
- Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
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Holmes JA, Yu ML, Chung RT. Hepatitis B reactivation during or after direct acting antiviral therapy - implication for susceptible individuals. Expert Opin Drug Saf 2017; 16:651-672. [PMID: 28471314 DOI: 10.1080/14740338.2017.1325869] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The FDA issued a warning following 24 cases of HBV reactivation during DAA therapy for HCV, including individuals with inactive, occult and past HBV infection. Clinical presentations ranged from asymptomatic fluctuations in HBV DNA to fulminant hepatic failure, liver transplantation and death. The mechanism is unknown. Areas covered: HCV/HBV coinfection is common, particularly in regions endemic for HBV. HCV and HBV utilize host factors to support replication; both viruses evade/impair host immunity. Clinical presentations of HBV reactivation during DAAs are summarized. Other causes of HBV reactivation are revisited and recent data regarding HBV reactivation are presented. Expert opinion: HBV reactivation during DAAs for HCV occurs, with life-threatening consequences in some individuals. The risk of HBV reactivation is observed in all HBV stages. The rapid removal of HCV likely alters and liberates host-viral ± viral-viral interactions that lead to increased HBV replication. As immune reconstitution occurs with HCV removal, host recognition of HBV DNA likely ensues followed by vigorous host immune responses leading to liver injury (HBV flare). These cases highlight the importance of HBV testing prior to initiating DAA therapy, the need for close monitoring of HBV during therapy and timely administration of anti-HBV therapy to prevent serious sequelae.
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Affiliation(s)
- Jacinta A Holmes
- a Gastrointestinal Unit , Massachusetts General Hospital , Boston , MA , USA.,b Department of Gastroenterology , St Vincent's Hospital, University of Melbourne , Fitzroy , Australia
| | - Ming-Lung Yu
- a Gastrointestinal Unit , Massachusetts General Hospital , Boston , MA , USA.,c Division of Hepatobiliary, Department of Internal Medicine and Hepatitis Center , Kaohsiung Medical University Hospital , Kaohsiung , Taiwan.,d Graduate Institute of Medicine, College of Medicine , Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Raymond T Chung
- a Gastrointestinal Unit , Massachusetts General Hospital , Boston , MA , USA.,e Department of Medicine , Harvard Medical School , Boston , MA , USA
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Abstract
OBJECTIVE The purpose of this article is to discuss the use of contrast-enhanced ultra-sound (CEUS) in focal liver lesions. CONCLUSION Focal liver lesions are usually detected incidentally during abdominal ultrasound. The injection of microbubble ultrasound contrast agents improves the characterization of focal liver lesions that are indeterminate on conventional ultrasound. The use of CEUS is recommended in official guidelines and suggested as a second diagnostic step after ultrasound detection of indeterminate focal liver lesions to immediately establish the diagnosis, especially for benign liver lesions, such as hemangiomas, avoiding further and more expensive examinations.
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Aviram R, Cohen I, Kornreich L, Braslavski D, Meizner I. Prenatal imaging of fetal hepatoblastoma. J Matern Fetal Neonatal Med 2009. [DOI: 10.1080/jmf.17.2.157.159] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rami Aviram
- Ultrasound Unit, Department of Obstetrics and Gynecology, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel
| | - Ian Cohen
- Department of Pediatric Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Liora Kornreich
- Department of Radiology, Rabin Medical Center, Petah-Tikva, Israel
| | - Diana Braslavski
- Department of Pathology, Rabin Medical Center, Petah-Tikva, Israel
| | - Israel Meizner
- Ultrasound Unit, Department of Obstetrics and Gynecology, Rabin Medical Center, Petah-Tikva, Israel
- Sackler School of Medicine, Aviv University, Ramat Aviv, Israel
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Wang Y, Wang WP, Ding H, Huang BJ, Mao F, Xu ZZ. Resistance index in differential diagnosis of liver lesions by color doppler ultrasonography. World J Gastroenterol 2004; 10:965-7. [PMID: 15052675 PMCID: PMC4717113 DOI: 10.3748/wjg.v10.i7.965] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To investigate the specific value of resistance index (RI) in color Doppler ultrasonography in the diagnosis of focal hepatic lesions.
METHODS: Eight hundred patients with 893 hepatic solid lesions were studied with color Doppler flow imaging (CDFI) and pulsed Doppler, including 644 malignant cases (596 primary malignant liver tumors, and 48 metastatic liver tumors), 156 benign cases. All were confirmed by operation and pathology.
RESULTS: The detection rate of arterial flow in malignant tumors was 92%, and 52% in benign lesions. Doppler spectrum analysis showed that the resistance index in primary malignant tumors was 0.75 ± 0.12, 0.73 ± 0.09 in metastatic tumors, and was below 0.6 in benign lesions. The difference was significant (P < 0.001). This difference was related with its histopathologic structure.
CONCLUSION: The arterial flow with RI ≥0.6 identified by CDFI within the liver lesion can be regarded as a criterion of malignant tumors, RI < 0.6 can be regarded as benign disorders. RI is useful in differential diagnosis of liver neoplasms.
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Affiliation(s)
- Yan Wang
- Department of Ultrasound, Ziongshan Hospital of Shanghai Fudan University, Shanghai 200032, China
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Flath B, Rickes S, Schweigert M, Lochs H, Possinger K, Wermke W. Differentiation of a pancreatic metastasis of a renal cell carcinoma from a primary pancreatic carcinoma by echo-enhanced power Doppler sonography. Pancreatology 2004; 3:349-51. [PMID: 12890999 DOI: 10.1159/000071775] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In a 70-year-old patient who had been treated for a renal cell carcinoma, a pancreatic mass was detected on CT scan. To differentiate a pancreatic metastasis of the renal cell carcinoma from a pancreatic carcinoma, an echo-enhanced power Doppler sonography was performed. The pancreatic mass demonstrated a strong echo enhancement, proving its hypervascularization. This behaviour favoured the diagnosis of a pancreatic metastasis of the renal cell carcinoma which was confirmed by histology. The principles and the role of echo-enhanced power Doppler sonography in the differential diagnosis between a primary pancreatic carcinoma and a metastasis of a renal carcinoma in the pancreas are discussed. We conclude that this technique can provide an important contribution to the diagnosis in this special instance. However, histology is the standard in the differential diagnosis of pancreatic tumours.
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Affiliation(s)
- B Flath
- Department of Oncology and Haematology, University Hospital Charité (Campus Mitte), Humboldt University, Berlin, Germany.
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Charnsangavei C, Loyer EM, Iyer RB, Choi H, Kaur H. Tumors of the liver, bile duct, and pancreas. Curr Probl Diagn Radiol 2000. [DOI: 10.1016/s0363-0188(00)90005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
The surgical and the radiological advances in liver tumors in last two decades have made some malignant tumors operable which were considered inoperable and have completely changed the expectations from radiology. However, accurate staging, that is performed by imaging modalities, has critical importance in the selection of patients who can benefit from resection. Radiologists and referring physicians, therefore, should be aware of the current concepts in imaging liver tumors. This report updates both the changing role of radiology in hepatic neoplasms and the appropriate use of radiological modalities in liver tumors.
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Affiliation(s)
- G Savci
- Department of Radiology, Uludag University Medical Faculty, Gorukle Campus, Bursa, Turkey.
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