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Consul N, Sirlin CB, Chernyak V, Fetzer DT, Masch WR, Arora SS, Do RKG, Marks RM, Fowler KJ, Borhani AA, Elsayes KM. Imaging Features at the Periphery: Hemodynamics, Pathophysiology, and Effect on LI-RADS Categorization. Radiographics 2021; 41:1657-1675. [PMID: 34559586 DOI: 10.1148/rg.2021210019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Liver lesions have different enhancement patterns at dynamic contrast-enhanced imaging. The Liver Imaging Reporting and Data System (LI-RADS) applies the enhancement kinetic of liver observations in its algorithms for imaging-based diagnosis of hepatocellular carcinoma (HCC) in at-risk populations. Therefore, careful analysis of the spatial and temporal features of these enhancement patterns is necessary to increase the accuracy of liver mass characterization. The authors focus on enhancement patterns that are found at or around the margins of liver observations-many of which are recognized and defined by LI-RADS, such as targetoid appearance, rim arterial phase hyperenhancement, peripheral washout, peripheral discontinuous nodular enhancement, enhancing capsule appearance, nonenhancing capsule appearance, corona enhancement, and periobservational arterioportal shunts-as well as peripheral and periobservational enhancement in the setting of posttreatment changes. Many of these are considered major or ancillary features of HCC, ancillary features of malignancy in general, features of non-HCC malignancy, features associated with benign entities, or features related to treatment response. Distinction between these different patterns of enhancement can help with achieving a more specific diagnosis of HCC and better assessment of response to local-regional therapy. ©RSNA, 2021.
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Affiliation(s)
- Nikita Consul
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Claude B Sirlin
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Victoria Chernyak
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - David T Fetzer
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - William R Masch
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Sandeep S Arora
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Richard K G Do
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Robert M Marks
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Kathryn J Fowler
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Amir A Borhani
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Khaled M Elsayes
- From the Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 (N.C.); University of California San Diego Health, San Diego, Calif (C.B.S., K.J.F.); Montefiore Medical Center, Bronx, NY (V.C.); University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); University of Michigan Medical School, Ann Arbor, Mich (W.R.M.); Yale School of Medicine, New Haven, Conn (S.S.A.); Memorial Sloan Kettering Cancer Center, New York, NY (R.K.G.D.); Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Northwestern University, Chicago, Ill (A.A.B.); and University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.)
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Zhou Y, Wang Y, Wang F, Zhang X, Ding J, Zhou H, Jing X. Additional Diagnostic Value of Fusion Imaging of CEUS and First CEUS of Invisible Hepatic Lesions ≤2 cm. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1173-1181. [PMID: 32941666 DOI: 10.1002/jum.15498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/12/2020] [Accepted: 08/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To explore the clinical value of image fusion of contrast-enhanced ultrasonography (CEUS) and contrast-enhanced computed tomography (CECT) in the diagnosis of invisible lesions with a size ≤2 cm on conventional ultrasound imaging, and compare it with the clinical value of "first CEUS" . METHODS A total of 132 patients with 147 lesions with abnormal blood supply with a size ≤2 cm on CECT were included in this study. "first CEUS" was performed for these lesions. Then "fusion CEUS," that is, CEUS administered after fusion of US and CECT images, was carried out. The detection rates of the "first CEUS" and "fusion CEUS" were compared. How "fusion CEUS" corrects the misdiagnosis of liver lesions on CECT was analyzed. RESULTS One hundred nine lesions considered as HCC and 38 lesions considered as benign lesions on CECT were included. The detection rates for the lesions of "first CEUS" and "fusion CEUS" were 71.4% and 96.6%, respectively (P < 0.001). Among the 147 lesions, 68 were with a diameter ≤ 1 cm. The detection rate of "first CEUS" and "fusion CEUS" were 55.9% and 95.6%, respectively (P < 0.001) for the lesions with a size ≤1 cm. "Fusion CEUS" and "first CEUS" corrected the misdiagnosis in 2 lesions on CECT. CONCLUSION The "first CEUS" and "fusion CEUS" can improve the lesion conspicuity. Compared with "first CEUS," "fusion CEUS" has a higher diagnostic ability and hence can detect most of the invisible lesions on the former.
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Affiliation(s)
- Yan Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Yandong Wang
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Fengmei Wang
- Department of Hepatology, Tianjin Second People's Hospital, Tianjin, 300192, China
| | - Xiang Zhang
- Department of Radiology, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Jianmin Ding
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Hongyu Zhou
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, 300170, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Third Central Hospital, Tianjin, 300170, China
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Malone CD, Fetzer DT, Monsky WL, Itani M, Mellnick VM, Velez PA, Middleton WD, Averkiou MA, Ramaswamy RS. Contrast-enhanced US for the Interventional Radiologist: Current and Emerging Applications. Radiographics 2021; 40:562-588. [PMID: 32125955 DOI: 10.1148/rg.2020190183] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
US is a powerful and nearly ubiquitous tool in the practice of interventional radiology. Use of contrast-enhanced US (CEUS) has gained traction in diagnostic imaging given the recent approval by the U.S. Food and Drug Administration (FDA) of microbubble contrast agents for use in the liver, such as sulfur hexafluoride lipid-type A microspheres. Adoption of CEUS by interventional radiologists can enhance not only procedure guidance but also preprocedure patient evaluation and assessment of treatment response across a wide spectrum of oncologic, vascular, and nonvascular procedures. In addition, the unique physical properties of microbubble contrast agents make them amenable as therapeutic vehicles in themselves, which can lay a foundation for future therapeutic innovations in the field in drug delivery, thrombolysis, and vascular flow augmentation. The purpose of this article is to provide an introduction to and overview of CEUS aimed at the interventional radiologist, highlighting its role before, during, and after frequently practiced oncologic and vascular interventions such as biopsy, ablation, transarterial chemoembolization, detection and control of hemorrhage, evaluation of transjugular intrahepatic portosystemic shunts (TIPS), detection of aortic endograft endoleak, thrombus detection and evaluation, evaluation of vascular malformations, lymphangiography, and percutaneous drain placement. Basic physical principles of CEUS, injection and scanning protocols, and logistics for practice implementation are also discussed. Early adoption of CEUS by the interventional radiology community will ensure rapid innovation of the field and development of future novel procedures. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Christopher D Malone
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - David T Fetzer
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Wayne L Monsky
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Philip A Velez
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - William D Middleton
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Michalakis A Averkiou
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
| | - Raja S Ramaswamy
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110 (C.D.M., M.I., V.M.M., P.A.V., W.D.M., R.S.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (W.L.M.); and Department of Bioengineering, University of Washington, Seattle, Wash (M.A.A.)
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