Diagnostic Value of High Frame Rate Contrast-enhanced Ultrasonography and Post-processing Contrast Vector Imaging for Evaluation of Focal Liver Lesions: A Feasibility Study

Diagnostic value of high-frame-rate contrast-enhanced ultrasound and contrast vector imaging for superficial lymph node lesions

PURPOSE

To explore the diagnostic performance and feasibility of high-frame-rate contrast-enhanced ultrasound (HFR CEUS) combined with contrast vector imaging (CVI) in detecting benign and malignant superficial lymph nodes (SLNs).

MATERIALS AND METHODS

In this single-center prospective study conducted between October 2023 and February 2024, 38 consecutive patients with suspected SLN lesions underwent B-mode US, HFR CEUS examination, and post-processing CVI analysis. Their diagnosis was confirmed using fine-needle aspiration cytologic or histopathologic examination. The diagnostic efficacy of HFR CEUS alone and the combination of HFR CEUS with CVI for benign and malignant LN diagnosis was compared and the significance of other CVI parameters was evaluated.

RESULTS

The final data set included 38 participants (mean age, 56 ± 16 years) with 42 SLN lesions. Both HFR CEUS alone and HFR CEUS combined with CVI examination showed differences in the contrast patterns of benign and malignant SLNs (all P < 0.001). The contrast pattern of benign LNs was predominantly centrifugal, while that of malignant LNs was primarily centripetal and hybrid and they were more likely to exhibit perfusion defects. The comparison between CVI combined with HFR CEUS examination and pathological results for the diagnosis of benign and malignant LNs showed a high level of consistency with a kappa value of 0.81. Comparison with HFR CEUS alone resulted in a kappa value of 0.66.

CONCLUSION

HFR CEUS combined with CVI examination demonstrated a good performance in distinguishing benign and malignant SLNs.

Feeding artery: a valuable feature for differentiation of regenerative nodule, dysplastic nodules and small hepatocellular carcinoma in CEUS LI-RADS

OBJECTIVE

To investigate whether the feeding artery (FA) feature can aid in discriminating small hepatocellular carcinoma (HCC) using the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) from precancerous lesions.

METHODS

Between June 2017 and May 2021, a total of 347 patients with 351 precancerous liver lesions or small HCCs who underwent CEUS were enrolled. Two independent radiologists assigned LI-RADS categories to all lesions and assessed the presence of the FA feature, which was used as an ancillary feature to either upgrade or downgrade the LI-RADS category. The diagnostic performance of CEUS LI-RADS, both with and without the FA feature, was evaluated based on accuracy, sensitivity, specificity, positive predictive value, and negative predictive value.

RESULTS

The FA feature was found to be more prevalent in HCC (85.54%, p < 0.001) than in regenerative nodules (RNs, 29.73%), low-grade dysplastic nodules (LGDNs, 33.33%), and high-grade dysplastic nodules (HGDNs, 55.26%). Furthermore, the presence of arterial phase hyperenhancement (APHE), washout (WO), and FA in liver nodules was associated with a higher expression of GPC-3 and Ki-67 compared to the group without these features (p < 0.001). After adjusting, the sensitivity and accuracy of LR-5 for HCC improved from 68.67% (95%CI: 62.46%, 74.30%) to 77.51% (95%CI: 71.72%, 82.44%) and from 69.23% (95%CI: 64.11%, 74.02%) to 73.79% (95%CI: 68.86%, 78.31%), respectively.

CONCLUSION

The FA feature is a valuable feature for distinguishing small HCC and precancerous lesions and could be added as a possible ancillary feature in CEUS LI-RADS which was backed up by biomarkers.

CLINICAL RELEVANCE STATEMENT

The presence of a feeding artery is a valuable imaging feature in the differentiation of HCC and precancerous lesions. Incorporating this characteristic in the CEUS LI-RADS can enhance the diagnostic ability.

KEY POINTS

• Feeding artery is more frequent in HCC than in regenerative nodules, low-grade dysplastic nodules, and high-grade dysplastic nodules. • Feeding artery feature is a valuable ancillary feature for CEUS LI-RADS to differentiate regenerative nodules, low-grade dysplastic nodules, high-grade dysplastic nodules, and HCC. • The existence of feeding artery, arterial phase hyperenhancement, and washout is associated with more GPC-3 positive expression and higher Ki-67 expression than the group without these features.

Added Value of Ultrasound-Based Multimodal Imaging to Diagnose Hepatic Sclerosed Hemangioma before Biopsy and Resection

Imaging methods have the overwhelming advantage of being non-invasive in the diagnosis of hepatic lesions and, thanks to technical developments in the field of ultrasound (US), radiation exposure can also be avoided in many clinical situations. In particular, contrast-enhanced US (CEUS) outperforms other radiological methods in regard to real-time images, repeatability, and prompt reporting and demonstrates relatively few contraindications and adverse reactions. In this study, we reported in detail a rare benign tumor: hepatic sclerosed hemangioma (HSH). We described US-based multimodal imaging (B-flow imaging, US elastography, and Sonazoid CEUS) features of this HSH case. Furthermore, by summarizing the recently published literature on the imaging diagnosis of HSH, we offered readers comprehensive knowledge of conventional imaging methods (CT, MRI) and CEUS in the diagnosis of HSH and preliminarily discussed their mechanism of pathology-based diagnosis. Our multimodal imaging approach may provide a diagnostic strategy for HSH, thus avoiding unnecessary biopsy or resection.