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Safai Zadeh E, Prosch H, Ba-Ssalamah A, Findeisen H, Alhyari A, Raab N, Görg C. Contrast-enhanced ultrasound of the liver: basics and interpretation of common focal lesions. ROFO-FORTSCHR RONTG 2024; 196:807-818. [PMID: 38176437 DOI: 10.1055/a-2219-4726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
- Ehsan Safai Zadeh
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Wien, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Wien, Austria
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Wien, Austria
| | - Hajo Findeisen
- Department for Internal Medicine, Red Cross Hospital Bremen, Germany
| | - Amjad Alhyari
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Gießen and Marburg Campus Marburg, Germany
| | - Nils Raab
- Department for Internal Medicine, West Mecklenburg Hospital Helene von Bülow, Ludwigslust, Germany
| | - Christian Görg
- Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Gießen and Marburg Campus Marburg, Germany
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Liu JL, Bao D, Xu ZL, Zhuge XJ. Clinical value of contrast-enhanced computed tomography (CECT) combined with contrast-enhanced ultrasound (CEUS) for characterization and diagnosis of small nodular lesions in liver. Pak J Med Sci 2021; 37:1843-1848. [PMID: 34912405 PMCID: PMC8613047 DOI: 10.12669/pjms.37.7.4306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/14/2021] [Accepted: 07/03/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives To explore the clinical value of contrast-enhanced computed tomography (CECT) combined with contrast-enhanced ultrasound (CEUS) for characterization and diagnosis of small nodular lesions in the liver and investigate the association between such small nodular lesions and the degree of tumor differentiation. Methods Combined imaging modalities were performed on 120 patients who were admitted by Linyi Maternal and Child Health hospital from December 2018 to December 2020 and diagnosed with hepatic nodular lesions. The CT scans were interpreted by two senior imageologists while the ultrasound scans were analyzed by two senior sonographers. A comparative analysis was carried out on different scan modes and the postoperative or post-puncture pathological results using the t-test, the χ2 test, and the Pearson's correlation analysis. Results Compared to the pathological results, definite diagnoses of 55 malignant cases were made using CECT alone, with the coincidence rate of 78.6%; CECT combined with CEUS formed correct diagnoses in 64 cases, and the coincidence rate was up to 91.4%. The difference between the two scan modes was statistically significant (p= 0.03). Based on pathological diagnosis, seventy out of the 120 cases of small nodular lesions were identified as malignant, while the other 50 cases were benign. The single imaging modality diagnosed 63 malignant and 57 benign nodules, whereas the combined modalities identified 68 malignancies and 52 benign conditions. Compared to CECT as a single imaging modality, the combined modalities showed a higher degree of sensitivity and accuracy, and the difference was statistically significant (sensitivity: p= 0.03; accuracy: p= 0.02); in the malignant cases, the magnitudes of contrast enhancement of CT and ultrasound imaging decreased with an increase in the degree of differentiation, indicating a negative correlation between these factors. Conclusions CECT combined with CEUS has a higher coincidence rate, greater sensitivity, and better diagnostic accuracy when being used for characterization and diagnosis of small nodular lesions in the liver. A higher degree of tumor differentiation means a decreased magnitude of contrast enhancement and a blurrier boundary, which indicates that CECT and CEUS are complementary to each other in classifying malignant liver nodules. The use of the combined imaging modalities shows clinical value for characterizing small liver nodules and predicting the degree of malignancy.
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Affiliation(s)
- Jia-Lian Liu
- Jia-lian Liu, Department of Imaging, Linyi Central Hospital, Linyi, Shandong, 276400, P.R. China
| | - Dong Bao
- Dong Bao, Department of Imaging, Linyi Central Hospital, Linyi, Shandong, 276400, P.R. China
| | - Zong-Li Xu
- Zong-li Xu, Department of Imaging, Linyi Central Hospital, Linyi, Shandong, 276400, P.R. China
| | - Xiang-Ju Zhuge
- Xiang-ju Zhuge Department of Imaging, Linyi Maternal and Child Health Hospital, Linyi, Shandong, 276400, P.R. China
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Yu Z, Hu M, Li Z, Zhu L, Guo Y, Liu Q, Lan W, Jiang J, Wang L. Anti-G250 nanobody-functionalized nanobubbles targeting renal cell carcinoma cells for ultrasound molecular imaging. NANOTECHNOLOGY 2020; 31:205101. [PMID: 32107342 DOI: 10.1088/1361-6528/ab7040] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Traditional imaging examinations have difficulty in identifying benign and malignant changes in renal masses. This difficulty may be solved by ultrasound molecular imaging based on targeted nanobubbles, which could specifically enhance the ultrasound imaging of renal cell carcinomas (RCC) so as to discriminate benign and malignant renal masses. In this study, we aimed to prepare anti-G250 nanobody-functionalized targeted nanobubbles (anti-G250 NTNs) by coupling anti-G250 nanobodies to lipid nanobubbles and to verify their target specificity and binding ability to RCC cells that express G250 antigen and their capacity to enhance ultrasound imaging of RCC xenografts. Anti-G250 nanobodies were coupled to the lipid nanobubbles using the biotin-streptavidin bridge method. The average particle diameter of the prepared anti-G250 NTNs was 446 nm. Immunofluorescence confirmed that anti-G250 nanobodies were uniformly distributed on the surfaces of nanobubbles. In vitro experiments showed that the anti-G250 NTNs specifically bound to G250-positive 786-O cells and HeLa cells with affinities of 88.13% ± 4.37% and 71.8% ± 5.7%, respectively, and that they did not bind to G250-negative ACHN cells. The anti-G250 NTNs could significantly enhance the ultrasound imaging of xenograft tumors arising from 786-O cells and HeLa cells compared with blank nanobubbles, while the enhancement was not significant for xenograft tumors arising from ACHN cells. Immunofluorescence of tumor tissue slices confirmed that the anti-G250 NTNs could enter the tissue space through tumor blood vessels and bind to tumor cells specifically. In conclusion, anti-G250 nanobody-functionalized targeted nanobubbles could specifically bind to G250-positive RCC cells and enhance the ultrasound imaging of G250-positive RCC xenografts. This study has high-potential clinical application value for the diagnosis and differential diagnosis of renal tumors.
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Affiliation(s)
- Zhiping Yu
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
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Dietrich CF, Burmeister S, Hollerbach S, Arcidiacono PG, Braden B, Fusaroli P, Hocke M, Iglesias-Garcia J, Kitano M, Larghi A, Napoleon B, Oppong KW, Rimbas M, Saftoiu A, Sahai AV, Sun S, Dong Y, Carrara S, Hwang JH, Jenssen C. Do we need elastography for EUS? Endosc Ultrasound 2020; 9:284-290. [PMID: 32675464 PMCID: PMC7811716 DOI: 10.4103/eus.eus_25_20] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We recently introduced a series of papers “What should be known prior to performing EUS exams.” In Part I, the authors discussed which clinical information and whether other imaging modalities are needed before embarking EUS examinations. In Part II, technical controversies on how EUS is performed were discussed from different points of view. In this article, important practical issues regarding EUS elastography will be raised and controversially discussed from very different points of view.
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Affiliation(s)
- Christoph F Dietrich
- Department of Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland; Johann Wolfgang Goethe University Frankfurt, Germany; Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sean Burmeister
- Surgical Gastroenterology unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Stephan Hollerbach
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - Paolo Giorgio Arcidiacono
- Pancreatico/Biliary Endoscopy & Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Barbara Braden
- Johann Wolfgang Goethe University Frankfurt, Germany; Translational Gastroenterology Unit I John Radcliffe Hospital I Oxford OX3 9DU, UK
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna/Imola Hospital, Imola, Italy
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Germany
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Bertrand Napoleon
- Digestive Endoscopy Unit, Hopital Privé J Mermoz Ramsay Générale de Santé, Lyon, France
| | | | - Mihai Rimbas
- Gastroenterology Department, Colentina Clinical Hospital Internal Medicine Department, Carol Davila University of Medicine Bucharest, Romania
| | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Anand V Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Siyu Sun
- Endoscopy Center, ShengJing Hospital of China Medical University, Shenyang, Liaoning province, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Silvia Carrara
- Humanitas Clinical and Research Center- IRCCS- Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan, Italy
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA 94305, USA
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen; Brandenburg Institute of Clinical Ultrasound, Medical University Brandenburg, Neuruppin, Germany
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Kasper P, Holzapfel B, Whaba R, Suchan M, Drebber U, Goeser T, Michels G, Jaspers N. [Abdominal pain and unclear focal liver lesion in 46-year-old female patient]. Internist (Berl) 2019; 61:96-101. [PMID: 31705159 DOI: 10.1007/s00108-019-00698-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 46-year-old woman presented with recurrent right upper quadrant pain. Abdominal ultrasound revealed an inhomogeneous liver lesion (4 × 7 cm) with complex echotexture. Since further contrast-enhanced imaging tests were inconclusive and lesion integrity remained unclear, a left hemihepatectomy was performed. Histological examination revealed a hepatic epithelioid angiomyolipoma. Hepatic epithelioid angiomyolipoma is a rare, mostly benign, mesenchymal hepatic tumor, composed of smooth muscle cells, adipose tissue, and blood vessels of varying proportions, and its correct diagnosis remains a clinical challenge.
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Affiliation(s)
- P Kasper
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - B Holzapfel
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - R Whaba
- Klinik für Allgemein‑, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - M Suchan
- Klinik für Allgemein‑, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - U Drebber
- Institut für Pathologie, Universitätsklinikum Köln, Köln, Deutschland
| | - T Goeser
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - G Michels
- Klinik III für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - N Jaspers
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Dietrich CF, Tana C, Caraiani C, Dong Y. Contrast enhanced ultrasound (CEUS) imaging of solid benign focal liver lesions. Expert Rev Gastroenterol Hepatol 2018; 12:479-489. [PMID: 29658347 DOI: 10.1080/17474124.2018.1464389] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ultrasound is well accepted worldwide for imaging of the liver. Absences of radiation exposure, low cost and large diffusion are some of the advantages that make this technique the first to be used in the assessment of focal liver lesions (FLL). Areas covered: Contrast enhanced ultrasound (CEUS) has been introduced more than twenty years ago, and its detection rate is comparable to that of contrast enhanced magnetic resonance imaging (CEMRI) and contrast enhanced computed tomography (CECT). In this narrative review, we discuss the main CEUS features of benign liver lesions and controversies in published results including the gold standard chosen and the quality and knowledge of the preferred techniques. Expert commentary: CEUS is safe and allows an immediate evaluation of the nature of FLL. CEUS permits differentiation between malignant and benign FLL in healthy liver parenchyma by analysing the arterial, portal venous and late phases. CEMRI and CECT are reliable to characterize FLL but higher costs, radiation exposure, nephrotoxicity (in particular for CECT) and absence of real time imaging limit the appropriate evaluation of FLL. Therefore CEUS can be preferred in most clinical situations, and when results are unclear or suggestive for malignant FLL, biopsy and histological examination can be directly initiated avoiding unnecessary additional imaging.
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Affiliation(s)
- Christoph F Dietrich
- a Department of Internal Medicine 2 , Caritas Krankenhaus , Bad Mergentheim , Germany.,b Ultrasound Department , The First Affiliated Hospital of Zhengzhou University , Zhengzhou , China
| | - Claudio Tana
- c Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department , University-Hospital of Parma , Parma , Italy
| | - Cosmin Caraiani
- d Department of Radiology , University of Medicine and Pharmacy "Iuliu Hatieganu" , Cluj-Napoca , Romania
| | - Yi Dong
- e Department of Ultrasound , Zhongshan Hospital, Fudan University , Shanghai , China
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Dietrich CF, Dong Y, Froehlich E, Hocke M. Dynamic contrast-enhanced endoscopic ultrasound: A quantification method. Endosc Ultrasound 2017; 6:12-20. [PMID: 28218195 PMCID: PMC5331837 DOI: 10.4103/2303-9027.193595] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 06/05/2016] [Indexed: 12/12/2022] Open
Abstract
Dynamic contrast-enhanced ultrasound (DCE-US) has been recently standardized by guidelines and recommendations. The European Federation of Societies for US in Medicine and Biology position paper describes the use for DCE-US. Comparatively, little is known about the use of contrast-enhanced endoscopic US (CE-EUS). This current paper reviews and discusses the clinical use of CE-EUS and DCE-US. The most important clinical use of DCE-US is the prediction of tumor response to new drugs against vascular angioneogenesis.
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Affiliation(s)
- Christoph F. Dietrich
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Germany
| | - Yi Dong
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim, Academic Teaching Hospital of the University of Würzburg, Germany
| | | | - Michael Hocke
- Department of Internal Medicine 2, Helios Hospital Meiningen GmbH, Academic Teaching Hospital of the University of Jena, Germany
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Dong Y, Wang WP, Cantisani V, D’Onofrio M, Ignee A, Mulazzani L, Saftoiu A, Sparchez Z, Sporea I, Dietrich CF. Contrast-enhanced ultrasound of histologically proven hepatic epithelioid hemangioendothelioma. World J Gastroenterol 2016; 22:4741-4749. [PMID: 27217705 PMCID: PMC4870080 DOI: 10.3748/wjg.v22.i19.4741] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/15/2016] [Accepted: 04/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze contrast-enhanced ultrasound (CEUS) features of histologically proven hepatic epithelioid hemangioendothelioma (HEHE) in comparison to other multilocular benign focal liver lesions (FLL).
METHODS: Twenty-five patients with histologically proven HEHE and 45 patients with histologically proven multilocular benign FLL were retrospectively reviewed. Four radiologists assessed the CEUS enhancement pattern in consensus.
RESULTS: HEHE manifested as a single (n = 3) or multinodular (n = 22) FLL. On CEUS, HEHE showed rim-like (18/25, 72%) or heterogeneous hyperenhancement (7/25, 28%) in the arterial phase and hypoenhancement (25/25, 100%) in the portal venous and late phases (PVLP), a sign of malignancy. Eighteen patients showed central unenhanced areas (18/25, 72%); in seven patients (7/25, 28%), more lesions were detected in the PVLP. In contrast, all patients with hemangioma and focal nodular hyperplasia showed hyperenhancement as the most distinctive feature (P < 0.01).
CONCLUSION: CEUS allows for characterization of unequivocal FLL. By analyzing the hypoenhancement in the PVLP, CEUS can determine the malignant nature of HEHE.
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