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Fu Y, Cui LG, Ma JY, Fang M, Lin YX, Li N. Development of a Novel Contrast-Enhanced Ultrasound-Based Nomogram for Superficial Lymphadenopathy Differentiation: Postvascular Phase Value. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:852-859. [PMID: 38448315 DOI: 10.1016/j.ultrasmedbio.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/23/2024] [Accepted: 02/14/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE The aim of this study was to develop and prospectively validate a prediction model for superficial lymphadenopathy differentiation using Sonazoid contrast-enhanced ultrasound (CEUS) combined with ultrasound (US) and clinical data. METHODS The training cohort comprised 260 retrospectively enrolled patients with 260 pathological lymph nodes imaged between January and December 2020. Two clinical US-CEUS models were created using multivariable logistic regression analysis and compared using receiver operating characteristic curve analysis: Model 1 included clinical and US characteristics; Model 2 included all confirmed predictors, including CEUS characteristics. Feature contributions were evaluated using the SHapley Additive exPlanations (SHAP) algorithm. Data from 172 patients were prospectively collected between January and May 2021 for model validation. RESULTS Age, tumor history, long-axis diameter of lymph node, blood flow distribution, echogenic hilus, and the mean postvascular phase intensity (MPI) were identified as independent predictors for malignant lymphadenopathy. The area under the curve (AUC), sensitivity, specificity, and accuracy of MPI alone was 0.858 (95% confidence interval [CI], 0.817-0.891), 86.47%, 74.55%, and 81.2%, respectively. Model 2 had an AUC of 0.919 (95% CI, 0.879-0.949) and good calibration in training and validation cohorts. The incorporation of MPI significantly enhanced diagnostic capability (p < 0.0001 and p = 0.002 for training and validation cohorts, respectively). Decision curve analysis indicated Model 2 as the superior diagnostic tool. SHAP analysis highlighted MPI as the most pivotal feature in the diagnostic process. CONCLUSION The employment of our straightforward prediction model has the potential to enhance clinical decision-making and mitigate the need for unwarranted biopsies.
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Affiliation(s)
- Ying Fu
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, China.
| | - Jiu-Yi Ma
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Mei Fang
- Department of Pathology, Peking University Third Hospital, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Yu-Xuan Lin
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
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2
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Ban JY, Kang TW, Jeong WK, Lee MW, Park B, Song KD. Value of Sonazoid-enhanced ultrasonography in characterizing indeterminate focal liver lesions on gadoxetic acid-enhanced liver MRI in patients without risk factors for hepatocellular carcinoma. PLoS One 2024; 19:e0304352. [PMID: 38787832 PMCID: PMC11125474 DOI: 10.1371/journal.pone.0304352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
PURPOSE To evaluate the added value of contrast-enhanced ultrasonography (CEUS) using Sonazoid in characterizing focal liver lesions (FLLs) with indeterminate findings on gadoxetic acid-enhanced liver MRI in patients without risk factors for hepatocellular carcinoma (HCC). METHODS Patients who underwent CEUS using Sonazoid for characterizing indeterminate FLLs on gadoxetic acid-enhanced liver MRI were. The indeterminate FLLs were classified according to the degree of malignancy on a 5-point scale on MRI and combined MRI and CEUS. The final diagnosis was made either pathologically or based on more than one-year follow-up. The diagnostic performance was assessed using a receiver operating characteristic (ROC) curve analysis, and the net reclassification improvement (NRI) was calculated. RESULTS A total of 97 patients (mean age, 49 years ± 16, 41 men, 80 benign and 17 malignant lesions) were included. When CEUS was added to MRI, the area under the ROC curve increased, but the difference was not statistically significant (0.87 [95% confidence interval {CI}, 0.77-0.98] for MRI vs 0.93 [95% CI, 0.87-0.99] for CEUS added to MRI, P = 0.296). The overall NRI was 0.473 (95% CI, 0.100-0.845; P = 0.013): 33.8% (27/80) of benign lesions and 41.2% (7/17) of malignant lesions were appropriately reclassified, whereas 10.0% (8/80) of benign lesions and 17.6% (3/17) of malignant lesions were incorrectly reclassified. CONCLUSIONS Although performing CEUS with Sonazoid did not significantly improve the overall diagnostic performance in characterizing indeterminate FLLs on gadoxetic acid-enhanced liver MRI in patients without risk factors for HCC, it may increase radiologist's confidence in classifying FLLs.
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Affiliation(s)
- Ji Yoon Ban
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Tae Wook Kang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Boram Park
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
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3
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Wang Z, Yao J, Jing X, Li K, Lu S, Yang H, Ding H, Li K, Cheng W, He G, Jiang T, Liu F, Yu J, Han Z, Cheng Z, Tan S, Wang Z, Qi E, Wang S, Zhang Y, Li L, Dong X, Liang P, Yu X. A combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound in the Kupffer phase for the diagnosis of well-differentiated hepatocellular carcinoma and atypical focal liver lesions: a prospective, multicenter study. Abdom Radiol (NY) 2024:10.1007/s00261-024-04253-4. [PMID: 38744698 DOI: 10.1007/s00261-024-04253-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/04/2024] [Accepted: 02/08/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The objective of this study was to develop a combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound (CEUS) during the Kupffer phase and to evaluate its value in differentiating well-differentiated hepatocellular carcinoma (w-HCC) from atypical benign focal liver lesions (FLLs). METHODS A total of 116 patients with preoperatively Sonazoid-CEUS confirmed w-HCC or benign FLL were selected from a prospective multiple study on the clinical application of Sonazoid in FLLs conducted from August 2020 to March 2021. According to the randomization principle, the patients were divided into a training cohort and a test cohort in a 7:3 ratio. Seventy-nine patients were used for establishing and training the radiomics model and combined model. In comparison, 37 patients were used for validating and comparing the performance of the models. The diagnostic efficacy of the models for w-HCC and atypical benign FLLs was evaluated using ROCs curves and decision curves. A combined model nomogram was created to assess its value in reducing unnecessary biopsies. RESULTS Among the patients, there were 55 cases of w-HCC and 61 cases of atypical benign FLLs, including 28 cases of early liver abscess, 16 cases of atypical hepatic hemangioma, 8 cases of hepatocellular dysplastic nodules (DN), and 9 cases of focal nodular hyperplasia (FNH). The radiomics model and combined model we established had AUCs of 0.905 and 0.951, respectively, in the training cohort, and the AUCs of the two models in the test cohort were 0.826 and 0.912, respectively. The combined model outperformed the radiomics feature model significantly. Decision curve analysis demonstrated that the combined model achieved a higher net benefit within a specific threshold probability range (0.25 to 1.00). A nomogram of the combined model was developed. CONCLUSION The combined model based on the radiomics features of Sonazoid-CEUS in the Kupffer phase showed satisfactory performance in diagnosing w-HCC and atypical benign FLLs. It can assist clinicians in timely detecting malignant FLLs and reducing unnecessary biopsies for benign diseases.
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Affiliation(s)
- Zhen Wang
- Medical School of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Jundong Yao
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
- Department of Ultrasound, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, 471000, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, China
| | - Kaiyan Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - ShiChun Lu
- Department of Hepatobiliary Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Hong Yang
- Department of Medical Ultrasonics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hong Ding
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Kai Li
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wen Cheng
- Department of Ultrasonography, Harbin Medical University Cancer Hospital, Harbin, China
| | - Guangzhi He
- Department of Ultrasound, University of Chinese Academy of Sciences Shenzhen Hospital, Guangming District, Shenzhen, China
| | - Tianan Jiang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Jie Yu
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Shuilian Tan
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Zhen Wang
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Erpeng Qi
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China
| | - Shuo Wang
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - YiQiong Zhang
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Lu Li
- Medical School of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Xiaocong Dong
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Ping Liang
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese, PLA General Hospital, Beijing, China.
| | - Xiaoling Yu
- Department of Interventional Ultrasound, First Medical Center of Chinese, PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China.
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Lyshchik A, Fetzer DT, Kono Y, Wilson SR, Dietrich CF, Clevert DA, Meloni MF, Jang HJ, Kim TK, Lee JM, Minami Y, Kudo M, Piscaglia F, Atzen S. Liver Imaging Reporting and Data System Contrast-Enhanced US Nonradiation Treatment Response Assessment Version 2024. Radiology 2024; 311:e232369. [PMID: 38805727 PMCID: PMC11140523 DOI: 10.1148/radiol.232369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/07/2023] [Accepted: 01/05/2024] [Indexed: 05/30/2024]
Abstract
The American College of Radiology Liver Imaging Reporting and Data System (LI-RADS) standardizes the imaging technique, reporting lexicon, disease categorization, and management for patients with or at risk for hepatocellular carcinoma (HCC). LI-RADS encompasses HCC surveillance with US; HCC diagnosis with CT, MRI, or contrast-enhanced US (CEUS); and treatment response assessment (TRA) with CT or MRI. LI-RADS was recently expanded to include CEUS TRA after nonradiation locoregional therapy or surgical resection. This report provides an overview of LI-RADS CEUS Nonradiation TRA v2024, including a lexicon of imaging findings, techniques, and imaging criteria for posttreatment tumor viability assessment. LI-RADS CEUS Nonradiation TRA v2024 takes into consideration differences in the CEUS appearance of viable tumor and posttreatment changes within and in close proximity to a treated lesion. Due to the high sensitivity of CEUS to vascular flow, posttreatment reactive changes commonly manifest as areas of abnormal perilesional enhancement without washout, especially in the first 3 months after treatment. To improve the accuracy of CEUS for nonradiation TRA, different diagnostic criteria are used to evaluate tumor viability within and outside of the treated lesion margin. Broader criteria for intralesional enhancement increase sensitivity for tumor viability detection. Stricter criteria for perilesional enhancement limit miscategorization of posttreatment reactive changes as viable tumor. Finally, the TRA algorithm reconciles intralesional and perilesional tumor viability assessment and assigns a single LI-RADS treatment response (LR-TR) category: LR-TR nonviable, LR-TR equivocal, or LR-TR viable.
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Affiliation(s)
- Andrej Lyshchik
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - David T. Fetzer
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Yuko Kono
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Stephanie R. Wilson
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Christoph F. Dietrich
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Dirk A. Clevert
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Maria Franca Meloni
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Hyun-Jung Jang
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Tae Kyoung Kim
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Jeong Min Lee
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Yasunori Minami
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Masatoshi Kudo
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Fabio Piscaglia
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
| | - Sarah Atzen
- From the Department of Radiology, Thomas Jefferson University
Hospital, 132 S 10th St, 763G Main Bldg, Philadelphia, PA 19107 (A.L.);
Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (D.T.F.);
Departments of Medicine and Radiology, University of California, San Diego, San
Diego, Calif (Y.K.); Department of Diagnostic Imaging, University of Calgary,
Calgary, Alberta, Canada (S.R.W.); Department of General Internal Medicine,
Hirslanden Klinik Beau-Site, Hirslanden Salem-Spital, and Hirslanden Klinik
Permanence, Bern, Switzerland (C.F.D.); Interdisciplinary Ultrasound Center,
Department of Radiology, LMU University Hospital, Ludwig Maximilian University
of Munich, Munich, Germany (D.A.C.); Department of Interventional Ultrasound,
Casa di Cura Igea, Milan, Italy (M.F.M.); Joint Department of Medical Imaging,
University of Toronto, Toronto, Ontario, Canada (H.J.J., T.K.K.); Department of
Radiology and Institute of Radiation Medicine, Seoul National University
Hospital, Seoul, Korea (J.M.L.); Department of Radiology, Seoul National
University College of Medicine, Seoul, Korea (J.M.L.); Department of
Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka,
Japan (Y.M., M.K.); Hepatobiliary and Immunoallergic Diseases, Division of
Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna,
Italy (F.P.); and Department of Medical and Surgical Sciences, University of
Bologna, Bologna, Italy (F.P.)
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5
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Guo D, Wan W, Bai X, Wen R, Peng J, Lin P, Liao W, Huang W, Liu D, Peng Y, Kang T, Yang H, He Y. Intra-individual comparison of Sonazoid contrast-enhanced ultrasound and SonoVue contrast-enhanced ultrasound in diagnosing hepatocellular carcinoma. Abdom Radiol (NY) 2024; 49:1432-1443. [PMID: 38584190 DOI: 10.1007/s00261-024-04250-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE To assess whether the diagnostic performance of Sonazoid contrast-enhanced ultrasound (SZUS) is non-inferior to that of SonoVue contrast-enhanced ultrasound (SVUS) in diagnosing hepatocellular carcinoma (HCC) in individuals with high risk. MATERIALS AND METHODS This prospective study was conducted from October 2020 to May 2022 and included participants with a high risk of HCC who underwent SZUS and SVUS. All lesions were confirmed by clinical or pathological diagnosis. Each nodule was classified according to the Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System version 2017 (CEUS LI-RADS v2017) for SVUS and SZUS and the modified CEUS LI-RADS (using Kupffer phase defect instead of late and mild washout) for SZUS. The diagnostic performance of both two modalities for all observations was compared. Analysis of the vascular phase and Kupffer phase imaging characteristics of CEUS was performed. RESULTS One hundred and fifteen focal liver lesions from 113 patients (94 HCCs, 12 non-HCC malignancies, and 9 benign lesions) were analysed. According to CEUS LI-RADS (v2017), SVUS and SZUS showed similar sensitivity (71.3% vs. 72.3%) and specificity (85.7% vs. 81.0%) in HCC diagnosis. However, the modified CEUS LI-RADS did not significantly improve the diagnostic efficacy of Sonazoid compared to CEUS LI-RADS v2017, having equivalent sensitivity (73.4% vs. 72.3%) and specificity (81.0% vs. 81.0%). The agreement between SVUS and SZUS for all observations was 0.610 (95% CI 0.475, 0.745), while for HCCs it was 0.452 (95% CI 0.257, 0.647). CONCLUSION Using LI-RADS v2017, SZUS and SVUS showed non-inferior efficacy in evaluating HCC lesions. In addition, adding Kupffer phase defects to SZUS does not notably improve its diagnostic efficacy.
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Affiliation(s)
- Danxia Guo
- Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Weijun Wan
- Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Xiumei Bai
- Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Rong Wen
- Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Jinbo Peng
- Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Peng Lin
- Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Wei Liao
- Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Weiche Huang
- Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Dun Liu
- Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Yuye Peng
- Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Tong Kang
- Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Hong Yang
- Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Yun He
- Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, 530021, China.
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6
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Liu Q, Liu T, Liu X, Zhang F, Yang J, Cheng Y, Yang Q. The efficacy of modified contrast-enhanced ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) using Sonazoid in diagnosis of hepatocellular carcinoma: a systematic review and meta-analysis. Quant Imaging Med Surg 2024; 14:2927-2937. [PMID: 38617149 PMCID: PMC11007533 DOI: 10.21037/qims-23-1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/23/2024] [Indexed: 04/16/2024]
Abstract
Background The contrast-enhanced ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) is an algorithm for the diagnosis of hepatocellular carcinoma (HCC) in high-risk populations. Previous studies have shown the algorithm to have high specificity and moderate sensitivity. Nevertheless, it is designated for utilization solely with blood pool contrast agents. Sonazoid, a contrast agent that combines blood pools and Kupffer cells properties, has recently gained approval for marketing in an increased number of countries. Enhanced sensitivity in diagnosing HCC may be achieved through the distinctive Kupffer phase (KP) exhibited by Sonazoid. Certain academics have suggested the modified CEUS LI-RADS using Sonazoid. The main criteria of mild and late (≥60 seconds) washout in CEUS LI-RADS LR-5 were replaced by KP (>10 minutes) defects as the primary criteria. The purpose of this research was to evaluate the effectiveness of the modified CEUS LI-RADS using Sonazoid in diagnosing HCC. Methods Original studies on Sonazoid and CEUS LI-RADS were searched in the PubMed, Embase, Cochrane Library, and Web of Science databases until 13 July 2023, with no restrictions on language. We enrolled studies that applied Sonazoid for CEUS in patients at high risk of HCC and modified CEUS LI-RADS for the diagnosis of intrahepatic nodules. Meta-analyses, evaluations, case studies, correspondences, remarks, and summaries of conferences were excluded. Additionally, studies that fell outside the scope of this study and contained data on the same patients were also excluded. We evaluated the quality of research by employing the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. A bivariate mixed effects model was utilized to conduct a meta-analysis, summarizing the sensitivity and specificity in the diagnosis of HCC. The investigation of potential factors contributing to study heterogeneity was conducted using meta-regression analysis. Results Out of the 103 studies screened, 6 studies (835 lesions) were included in the final results. Modified CEUS LR-5 exhibited a sensitivity of 0.77 [95% confidence interval (CI): 0.70-0.82; I2=71.98%; P=0.00] and a specificity of 0.88 (95% CI: 0.83-0.92; I2=0.00; P=0.47) for HCC diagnosis, with heterogeneity in sensitivity. The presence of heterogeneity in the study was found to have a significant association with factors such as the study design, the number of image reviewers, the proportion of cirrhosis, the proportion of other non-HCC malignancies (OM) cases, and the type of reference standard (P≤0.05). Conclusions The modified CEUS LI-RADS LR-5 categorization demonstrates a reasonable level of sensitivity 0.77, but an insufficient level of specificity 0.88 when diagnosing HCC. KP defects cannot be used as a primary feature in the diagnosis of HCC by CEUS LI-RADS, perhaps as an ancillary feature.
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Affiliation(s)
- Qianyu Liu
- Department of Ultrasound, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ting Liu
- Department of Ultrasound, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiang Liu
- Department of Ultrasound, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Feng Zhang
- Department of Ultrasound, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinyu Yang
- Department of Ultrasound, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanan Cheng
- Department of Ultrasound, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qing Yang
- Department of Ultrasound, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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7
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Zhang R, Li D, Chen Y, Xu W, Zhou W, Lin M, Xie X, Xu M. Development and Comparison of Prediction Models Based on Sonovue- and Sonazoid-Enhanced Ultrasound for Pathologic Grade and Microvascular Invasion in Hepatocellular Carcinoma. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:414-424. [PMID: 38155069 DOI: 10.1016/j.ultrasmedbio.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/31/2023] [Accepted: 12/01/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE This study was aimed at developing and comparing prediction models based on Sonovue and Sonazoid contrast-enhanced ultrasound (CEUS) in predicting pathologic grade and microvascular invasion (MVI) of hepatocellular carcinoma (HCC). Also investigated was whether Kupffer phase images have additional predictive value for the above pathologic features. METHODS Ninety patients diagnosed with primary HCC who had undergone curative hepatectomy were prospectively enrolled. All patients underwent conventional ultrasound (CUS), Sonovue-CEUS and Sonazoid-CEUS examinations pre-operatively. Clinical, radiologic and pathologic features including pathologic grade, MVI and CD68 expression were collected. We developed prediction models comprising clinical, CUS and CEUS (Sonovue and Sonazoid, respectively) features for pathologic grade and MVI with both the logistic regression and machine learning (ML) methods. RESULTS Forty-one patients (45.6%) had poorly differentiated HCC (p-HCC) and 37 (41.1%) were MVI positive. For pathologic grade, the logistic model based on Sonazoid-CEUS had significantly better performance than that based on Sonovue-CEUS (area under the curve [AUC], 0.929 vs. 0.848, p = 0.035), whereas for MVI, these two models had similar accuracy (AUC, 0.810 vs. 0.786, p = 0.068). Meanwhile, we found that well-differentiated HCC tended to have a higher enhancement ratio in 6-12 min during the Kupffer phase of Sonazoid-CEUS, as well as higher CD68 expression compared with p-HCC. In addition, all of these models can effectively predict the risk of recurrence (p < 0.05). CONCLUSION Sonovue-CEUS and Sonazoid-CEUS were comparably excellent in predicting MVI, while Sonazoid-CEUS was superior to Sonovue-CEUS in predicting pathologic grade because of the Kupffer phase. The enhancement ratio in the Kupffer phase has additional predictive value for pathologic grade prediction.
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Affiliation(s)
- Rui Zhang
- Department of Medical Ultrasound, Division of Interventional Ultrasound, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Di Li
- Department of Medical Ultrasound, Division of Interventional Ultrasound, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanlin Chen
- Department of Medical Ultrasound, Division of Interventional Ultrasound, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenxin Xu
- Department of Medical Ultrasound, Division of Interventional Ultrasound, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenwen Zhou
- Department of Medical Ultrasound, Division of Interventional Ultrasound, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Manxia Lin
- Department of Medical Ultrasound, Division of Interventional Ultrasound, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasound, Division of Interventional Ultrasound, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming Xu
- Department of Medical Ultrasound, Division of Interventional Ultrasound, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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8
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Kang HJ, Lee JM, Yoon JH, Yoo J, Kim JH, Park J. Contrast-Enhanced Ultrasound With Perfluorobutane for Hepatocellular Carcinoma Diagnosis: Comparison of Imaging Phases and Diagnostic Criteria. AJR Am J Roentgenol 2024; 222:e2330156. [PMID: 37991335 DOI: 10.2214/ajr.23.30156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND. Contrast-enhanced ultrasound (CEUS) with perfluorobutane has used varying protocols and diagnostic criteria for hepatocellular carcinoma (HCC). OBJECTIVE. The purpose of this article was to assess diagnostic performance for HCC of CEUS with perfluorobutane in high-risk patients using various criteria. METHODS. This retrospective post hoc study evaluating individual patient data from three earlier prospective studies from one hospital included 204 patients (136 men, 68 women; mean age, 63 ± 11 [SD] years) at high risk of HCC with 213 liver observations. Patients underwent CEUS using perfluorobutane from March 2019 to June 2022. Three radiologists (the examination's operator and two subsequent reviewers) independently interpreted examinations, assessing arterial, portal venous (arterial phase completion through 2 minutes), transitional (2-5 minutes after injection), and Kupffer (≥ 10 minutes after injection) phase findings. Six criteria for HCC were tested: 1, any arterial phase hyperenhancement (APHE) with Kupffer phase hypoenhancement; 2, nonrim APHE with Kupffer phase hypoenhancement; 3, nonrim APHE with portal venous washout; 4, nonrim APHE with portal venous washout and/or Kupffer phase hypoenhancement; 5, nonrim APHE with portal venous and/or transitional washout; 6, nonrim APHE with any of portal venous washout, transitional washout, or Kupffer phase hypoenhancement. Depending on the criteria, observations were instead deemed to be a non-HCC malignancy if showing rim APHE, early washout (at < 1 minute), or marked washout (at 2 minutes). Reference was pathology for malignant observations and pathology or imaging follow-up for benign observations. Diagnostic performance was assessed, pooling readers' data. RESULTS. Criterion 1 (no recognized features of non-HCC malignancy) had highest sensitivity (86.9%) but lowest specificity (43.2%) for HCC. Compared with nonrim APHE and portal venous washout (criterion 3), the addition of Kupffer phase hypoenhancement (criterion 4), transitional washout (criterion 5), or either feature (criterion 6) significantly increased sensitivity (34.4% vs 62.6-64.2%) and accuracy (61.8% vs 75.1-76.5%), but significantly decreased specificity (98.5% vs 91.9-94.1%). Criteria 2, 4, 5, and 6 (all incorporating transitional washout and/or Kupffer phase hypoenhancement) showed no significant differences in sensitivity (62.6-64.2%), specificity (91.9-94.1%), or accuracy (75.1-76.5%). CONCLUSION. Recognition of features of non-HCC malignancy improved specificity for HCC. Incorporation of the findings of transitional washout and/or Kupffer phase hypoenhancement improved sensitivity and accuracy, albeit lowered specificity, versus arterial and portal venous findings alone, without further performance variation among criteria incorporating those two findings. CLINICAL IMPACT. Kupffer phase acquisition may be optional for observations classified as HCC or non-HCC malignancy by arterial, portal venous, and transitional phases.
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Affiliation(s)
- Hyo-Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea
| | - Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Jiwon Park
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
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9
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Lee Y, Yoon JH, Han S, Joo I, Lee JM. Contrast-enhanced ultrasonography-CT/MRI fusion guidance for percutaneous ablation of inconspicuous, small liver tumors: improving feasibility and therapeutic outcome. Cancer Imaging 2024; 24:4. [PMID: 38172949 PMCID: PMC10762814 DOI: 10.1186/s40644-023-00650-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Percutaneous radiofrequency ablation (RFA) is pivotal for treating small malignant liver tumors, but tumors often remain inconspicuous on B-mode ultrasound (US). This study evaluates the potential of CEUS-CT/MRI fusion imaging (FI) to improve tumor visibility and the associated RFA outcomes for small (≤ 3 cm) malignant liver tumors that were inconspicuous on US. METHODS Between January 2019 and April 2021, a prospective study enrolled 248 patients with liver malignancies (≤ 3 cm) that were poorly visible on B-mode US. Tumor visibility and ablation feasibility were assessed using B-mode US, US-CT/MRI FI, and CEUS-CT/MRI FI, and graded on a 4-point scale. CEUS was employed post-registration of US and CT/MRI images, utilizing either SonoVue or Sonazoid. Comparisons between US-based and CEUS-based fusion visibility and feasibility scores were undertaken using the Friedman test. Moreover, rates of technical success, technique efficacy, local tumor progression (LTP), and major complications were assessed. RESULTS The cohort included 223 hepatocellular carcinomas (HCCs) (89.9%) and 23 metastases (9.3%), with an average tumor size of 1.6 cm. CEUS-CT/MRI FI demonstrated a significant advantage in tumor visibility (3.4 ± 0.7 vs. 1.9 ± 0.6, P < 0.001) and technical feasibility (3.6 ± 0.6 vs. 2.9 ± 0.8, P < 0.001) compared to US-FI. In 85.5% of patients, CEUS addition to US-FI ameliorated tumor visibility. Technical success was achieved in 99.6% of cases. No severe complications were reported. One and two-year post CEUS-CT/MRI FI-guided RFA estimates for LTP were 9.3% and 10.9%, respectively. CONCLUSIONS CEUS-CT/MRI FI significantly improves the visualization of tumors not discernible on B-mode US, thus augmenting percutaneous RFA success and delivering improved therapeutic outcomes. TRIAL REGISTRATION ClinicalTrials.gov, NCT05445973. Registered 17 June 2022 - Retrospectively registered, http://clinicaltrials.gov/study/NCT05445973?id=NCT05445973&rank=1 .
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Affiliation(s)
- Yuna Lee
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Seungchul Han
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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10
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Qin S, Zhou J, Cui R, Chen Y, Wang Y, Liu G. Percutaneous ablation of colorectal liver metastases: a comparison between the outcomes of grayscale US guidance and Sonazoid CEUS Kupffer phase guidance using propensity score matching. Int J Hyperthermia 2023; 40:2260573. [PMID: 37788806 DOI: 10.1080/02656736.2023.2260573] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/13/2023] [Indexed: 10/05/2023] Open
Abstract
PURPOSE To assess the utility of Sonazoid contrast-enhanced ultrasound (CEUS) for guiding percutaneous microwave ablation (MWA) for colorectal liver metastases (CRLMs). MATERIALS AND METHODS The medical records of patients who had undergone ultrasound (US)-guided percutaneous MWA between July 2020 and June 2022, were reviewed. Propensity score matching (PSM) with a ratio of 1:1 was used to balance the potential bias between the grayscale US-guided and Sonazoid CEUS-guided groups. Local tumor progression (LTP), intrahepatic recurrence (IR), and complication rates were compared between the two groups. RESULTS Of 252 patients enrolled, 247 achieved complete ablation, and the technical effectiveness was 98.0% (247/252). Of these 247 patients, 158 were in the grayscale US-guided group and 89 in the Sonazoid CEUS-guided group. The median follow-up period was 14.6 months. After PSM, there were no significant differences in LTP, IR, or complication rates between the two groups (p = 0.100, p = 0.511, p > 0.99, respectively). Multivariate analysis identified tumor size ≥ 3 cm (hazard ratio [HR], 7.945; 95% CI, 2.591-24.370; p < 0.001), perivascular (HR, 2.331; 95% CI, 1.068-5.087; p = 0.034), and tumor depth > 8 cm (HR, 3.194; 95% CI, 1.439-7.091; p = 0.004) as significant factors associated with LTP. For tumors with poor vision on grayscale US, Sonazoid CEUS-guided ablation achieved a better LTP rate than grayscale US-guided ablation (3.7% vs.14.8%, p = 0.032). CONCLUSION For tumors with poor vision on grayscale US, Sonazoid CEUS guidance is recommended for better local tumor control.
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Affiliation(s)
- Si Qin
- Department of Medical Ultrasonics, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Jingwen Zhou
- Department of Medical Ultrasonics, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Rui Cui
- Department of Medical Ultrasonics, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Yao Chen
- Department of Medical Ultrasonics, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Yimin Wang
- Department of Medical Ultrasonics, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
| | - Guangjian Liu
- Department of Medical Ultrasonics, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
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11
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Wang S, Yao J, Li K, Yang H, Lu S, He G, Wu W, Cheng W, Jiang T, Ding H, Jing X, Yan Y, Liu F, Yu J, Han Z, Cheng Z, Tan S, Li X, Dou J, Li Y, Qi E, Zhang Y, Liang P, Yu X. Nomogram based on Sonazoid contrast-enhanced ultrasound to differentiate intrahepatic cholangiocarcinoma and poorly differentiated hepatocellular carcinoma: a prospective multicenter study. Abdom Radiol (NY) 2023; 48:3101-3113. [PMID: 37436451 DOI: 10.1007/s00261-023-03993-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/17/2023] [Accepted: 06/18/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES The aim of this study was to develop a predictive model based on Sonazoid contrast-enhanced ultrasound (SCEUS) and clinical features to discriminate poorly differentiated hepatocellular carcinoma (P-HCC) from intrahepatic cholangiocarcinoma (ICC). PATIENTS AND METHOD Forty-one ICC and forty-nine P-HCC patients were enrolled in this study. The CEUS LI-RADS category was assigned according to CEUS LI-RADS version 2017. Based on SCEUS and clinical features, a predicated model was established. Multivariate logistic regression analysis and LASSO logistic regression were used to identify the most valuable features, 400 times repeated 3-fold cross-validation was performed on the nomogram model and the model performance was determined by its discrimination, calibration, and clinical usefulness. RESULTS Multivariate logistic regression and LASSO logistic regression indicated that age (> 51 y), viral hepatitis (No), AFP level (≤ 20 µg/L), washout time (≤ 45 s), and enhancement level in the Kupffer phase (Defect) were valuable predictors related to ICC. The area under the receiver operating characteristic (AUC) of the nomogram was 0.930 (95% CI: 0.856-0.973), much higher than the subjective assessment by the sonographers and CEUS LI-RADS categories. The calibration curve showed that the predicted incidence was more consistent with the actual incidence of ICC, and 400 times repeated 3-fold cross-validation revealed good discrimination with a mean AUC of 0.851. Decision curve analysis showed that the nomogram could increase the net benefit for patients. CONCLUSIONS The nomogram based on SCEUS and clinical features can effectively differentiate P-HCC from ICC.
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Affiliation(s)
- Shuo Wang
- Department of Interventional Ultrasound, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
- Chinese PLA Medical School, Beijing, 100853, China
| | - Jundong Yao
- Department of Interventional Ultrasound, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
- Department of Ultrasound, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, 471000, China
| | - Kaiyan Li
- Department of Ultrasound, Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hong Yang
- Department of Ultrasound, The First Affiliated Hospital of Guangxi medical University, Nanning, 530021, China
| | - Shichun Lu
- Department of Hepatobiliary Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Guangzhi He
- Department of Ultrasound, University of Chinese Academy of Sciences Shenzhen Hospital, Guangming District, Shenzhen, 518000, China
| | - Wei Wu
- Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Wen Cheng
- Department of Ultrasonography, Harbin Medical University Cancer Hospital, Harbin, 150000, China
| | - Tianan Jiang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, China
| | - Hong Ding
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xiang Jing
- Department of Ultrasound, Tianjin Third Central Hospital, Tianjin, 300170, China
| | - Yuanyuan Yan
- Department of Ultrasound, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Henan, 450007, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Fifth Medical Center of ChinesePLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Jie Yu
- Department of Interventional Ultrasound, Fifth Medical Center of ChinesePLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Fifth Medical Center of ChinesePLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Fifth Medical Center of ChinesePLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Shuilian Tan
- Department of Interventional Ultrasound, Fifth Medical Center of ChinesePLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Xin Li
- Department of Interventional Ultrasound, Fifth Medical Center of ChinesePLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Jianping Dou
- Department of Interventional Ultrasound, Fifth Medical Center of ChinesePLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Yunlin Li
- Department of Interventional Ultrasound, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Erpeng Qi
- Department of Interventional Ultrasound, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Yiqiong Zhang
- Department of Interventional Ultrasound, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Ping Liang
- Department of Interventional Ultrasound, Fifth Medical Center of ChinesePLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China.
| | - Xiaoling Yu
- Department of Interventional Ultrasound, First Medical Center of Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China.
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12
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Zhang Q, Liang X, Zhang Y, Nie H, Chen Z. A review of contrast-enhanced ultrasound using SonoVue® and Sonazoid™ in non-hepatic organs. Eur J Radiol 2023; 167:111060. [PMID: 37657380 DOI: 10.1016/j.ejrad.2023.111060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/08/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) is a dependable modality for the diagnosis of various clinical conditions. A judicious selection of ultrasound contrast agent (UCA) is imperative for optimizing imaging and improving diagnosis. Approved UCAs for imaging the majority of organs include SonoVue, a pure blood agent, and Sonazoid, which exhibits an additional Kupffer phase. Despite the fact that the two UCAs are increasingly being employed, there is a lack of comparative reviews between the two agents in different organs diseases. This review represents the first attempt to compare the two UCAs in non-hepatic organs, primarily including breast, thyroid, pancreas, and spleen diseases. Through comparative analysis, this review provides a comprehensive and objective evaluation of the performance characteristics of SonoVue and Sonazoid, with the aim of offering valuable guidance for the clinical application of CEUS. Overall, further clinical evidences are required to compare and contrast the dissimilarities between the two UCAs in non-hepatic organs, enabling clinicians to make an appropriate selection based on actual clinical applications.
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Affiliation(s)
- Qing Zhang
- Institution of Medical Imaging, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China; Institution of Medical Imaging, University of South China, Hengyang, China; The Seventh Affiliated Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Xiaowen Liang
- Institution of Medical Imaging, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China; Institution of Medical Imaging, University of South China, Hengyang, China
| | - Yanfen Zhang
- Department of Ultrasound, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Hongjun Nie
- Department of Ultrasound, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Zhiyi Chen
- Institution of Medical Imaging, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China; Institution of Medical Imaging, University of South China, Hengyang, China.
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13
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Kang HJ, Lee JM, Kim SW. Sonazoid-enhanced ultrasonography for noninvasive imaging diagnosis of hepatocellular carcinoma: special emphasis on the 2022 KLCA-NCC guideline. Ultrasonography 2023; 42:479-489. [PMID: 37423603 PMCID: PMC10555687 DOI: 10.14366/usg.23051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 07/11/2023] Open
Abstract
Contrast-enhanced ultrasonography (CEUS) is a noninvasive imaging modality used to diagnose hepatocellular carcinoma (HCC) based on specific imaging features, without the need for pathologic confirmation. Two types of ultrasound contrast agents are commercially available: pure intravascular agents (such as SonoVue) and Kupffer agents (such as Sonazoid). Major guidelines recognize CEUS as a reliable imaging method for HCC diagnosis, although they differ depending on the contrast agents used. The Korean Liver Cancer Association-National Cancer Center guideline includes CEUS with either SonoVue or Sonazoid as a second-line diagnostic technique. However, Sonazoid-enhanced ultrasound is associated with several unresolved issues. This review provides a comparative overview of these contrast agents regarding pharmacokinetic features, examination protocols, diagnostic criteria for HCC, and potential applications in the HCC diagnostic algorithm.
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Affiliation(s)
- Hyo-Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Se Woo Kim
- Department of Radiology, Armed Forces Daejeon Hospital, Daejeon, Korea
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14
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Huang PY, Tsai MY, Huang JS, Lin PY, Chou CP. Contrast-enhanced ultrasound-guided biopsy of suspicious breast lesions on contrast-enhanced mammography and contrast-enhanced MRI: a case series. J Med Ultrason (2001) 2023; 50:521-529. [PMID: 37493921 DOI: 10.1007/s10396-023-01345-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/25/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE To assess the effectiveness of contrast-enhanced ultrasound (CEUS) in guiding biopsies of breast lesions that were detected on contrast-enhanced mammography (CEM) or contrast-enhanced breast MRI (CE-MRI) but were not clearly visible on B-mode ultrasound (B-US). METHODS In this study, 23 lesions in 16 patients were selected for CEUS-guided biopsy due to poor visualization on B-US despite being detected on CEM (n = 20) or CE-MRI (n = 3). B-US, color Doppler ultrasound (CDUS), and CEUS were used to visualize the suspicious lesions, followed by a CEUS-guided core needle biopsy using Sonazoid as the contrast agent. The accuracy of the biopsy was assessed based on pathology-radiology concordance and 12-month imaging follow-up. The conspicuity scores for lesion visualization were evaluated using a 5-point conspicuity scale agreed upon by two breast radiologists. RESULTS The enhancing lesions detected on CEM/CE-MRI had an average size of 1.6 ± 1.3 cm and appeared as mass-enhancing (61%) or non-mass-enhancing (39%). The lesions had mean conspicuity scores of 2.30 on B-US, 2.78 on CDUS, and 4.61 on CEUS, with 96% of the lesions showing contrast enhancement on CEUS. CEUS-guided biopsy showed increased visibility in 96% and 91% of the lesions compared to B-US and CDUS, respectively. The overall accuracy of CEUS-guided biopsy was 100% based on concordance with histology and 12-month follow-up. CONCLUSIONS CEUS enhances the visibility of suspicious CEM/CE-MRI lesions that are poorly visible on B-US during biopsy procedures.
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Affiliation(s)
- Pi-Yi Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Rd, Kaohsiung, 813, Taiwan, ROC
| | - Meng-Yuan Tsai
- Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Rd, Kaohsiung, 813, Taiwan, ROC
| | - Jer-Shyung Huang
- Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Rd, Kaohsiung, 813, Taiwan, ROC
| | - Pei-Ying Lin
- Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Rd, Kaohsiung, 813, Taiwan, ROC
| | - Chen-Pin Chou
- Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Rd, Kaohsiung, 813, Taiwan, ROC.
- Department of Medical Laboratory Sciences and Biotechnology, Fooyin University, Kaohsiung, Taiwan, ROC.
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15
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Han S, Kim SW, Park S, Yoon JH, Kang HJ, Yoo J, Joo I, Bae JS, Lee JM. Perfluorobutane-Enhanced Ultrasound for Characterization of Hepatocellular Carcinoma From Non-hepatocellular Malignancies or Benignancy: Comparison of Imaging Acquisition Methods. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2256-2263. [PMID: 37495497 DOI: 10.1016/j.ultrasmedbio.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/20/2023] [Accepted: 07/02/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE The aim of the work described here was to evaluate the diagnostic performance of perfluorobutane (PFB)-enhanced ultrasound in differentiating hepatocellular carcinoma (HCC) from non-HCC malignancies and other benign lesions using different acquisition methods. METHODS This prospective study included 69 patients with solid liver lesions larger than 1 cm who were scheduled for biopsy or radiofrequency ablation between September 2020 and March 2021. Lesion diagnosis was designated by three blinded radiologists after reviewing three different sets of acquired images selected according to the following presumed acquisition methods: (i) method A, acquisition up to 5 min after contrast injection; (ii) method B, acquisition up to 1 min after contrast injection with additional Kupffer phase; and (iii) method C, acquisition up to 5 min after contrast injection with additional Kupffer phase. RESULTS After excluding 7 technical failures, 62 patients with liver lesions (mean size: 24.2 ± 14.8 mm), which consisted of 7 benign lesions, 37 non-HCC malignancies and 18 HCCs. For the HCC diagnosis, method C had the highest sensitivity (75.9%), followed by method B (72.2%) and method A (68.5%), but failed to exhibit statistical significance (p = 0.12). There was no significant difference with respect to the pooled specificity between the three methods (p = 0.28). Diagnostic accuracy was the highest with method C (87.1%) but failed to exhibit statistical significance (p = 0.24). CONCLUSION Image acquisition up to 5 min after contrast injection with additional Kupffer phase could potentially result in high accuracy and sensitivity without loss of specificity in diagnosing HCC with PFB-enhanced ultrasound.
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Affiliation(s)
- Seungchul Han
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Se Woo Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sungeun Park
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyo-Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
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Jeong WK. Diagnosis of hepatocellular carcinoma using Sonazoid: a comprehensive review. JOURNAL OF LIVER CANCER 2023; 23:272-283. [PMID: 37723641 PMCID: PMC10565540 DOI: 10.17998/jlc.2023.08.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/20/2023]
Abstract
Sonazoid contrast-enhanced ultrasonography (CEUS) is a promising technique for the detection and diagnosis of focal liver lesions, particularly hepatocellular carcinoma (HCC). Recently, a collaborative effort between the Korean Society of Radiology and Korean Society of Abdominal Radiology resulted in the publication of guidelines for diagnosing HCC using Sonazoid CEUS. These guidelines propose specific criteria for identifying HCC based on the imaging characteristics observed during Sonazoid CEUS. The suggested diagnostic criteria include nonrim arterial phase hyperenhancement, and the presence of late and mild washout, or Kupffer phase washout under the premise that the early or marked washout should not occur during the portal venous phase. These criteria aim to improve the accuracy of HCC diagnosis using Sonazoid CEUS. This review offers a comprehensive overview of Sonazoid CEUS in the context of HCC diagnosis. It covers the fundamental principles of Sonazoid CEUS and its clinical applications, and introduces the recently published guidelines. By providing a summary of this emerging technique, this review contributes to a better understanding of the potential role of Sonazoid CEUS for diagnosing HCC.
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Affiliation(s)
- Woo Kyoung Jeong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lee SW, Kang MK, Zhang X. Sonazoid contrast-enhanced ultrasonography for the diagnosis of hepatocellular carcinoma: strengths and shortcomings. JOURNAL OF LIVER CANCER 2023; 23:238-240. [PMID: 37726895 PMCID: PMC10565547 DOI: 10.17998/jlc.2023.09.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Sung Won Lee
- Department of Gastroenterology and Hepatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
- The Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea
| | - Min Kyu Kang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Xiang Zhang
- State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, China
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18
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Li L, Zou X, Zheng W, Li Y, Xu X, Li K, Su Z, Han J, Li Q, Zuo Y, Xie S, Wen H, Wang J, Guo Z, Zou R, Zhou J. Contrast-enhanced US with Sulfur Hexafluoride and Perfluorobutane: LI-RADS for Diagnosing Hepatocellular Carcinoma. Radiology 2023; 308:e230150. [PMID: 37642573 DOI: 10.1148/radiol.230150] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Liver Imaging Reporting and Data System (LI-RADS) was designed for contrast-enhanced US (CEUS) with pure blood pool agents to diagnose hepatocellularfcarcinoma (HCC), such as sulfur hexafluoride (SHF), but Kupffer-cell agents, such as perfluorobutane (PFB), allow additional lesion characterization in the Kupffer phase yet remain unaddressed. Purpose To compare the diagnostic performance of three algorithms for HCC diagnosis: two algorithms based on CEUS LI-RADS version 2017 for both SHF and PFB and a modified algorithm incorporating Kupffer-phase findings for PFB. Materials and Methods This multicenter prospective study enrolled high-risk patients for HCC from June 2021 to December 2021. Each participant underwent same-day SHF-enhanced US followed by PFB-enhanced US. Each liver observation was assigned three LI-RADS categories according to each algorithm: LI-RADS SHF, LI-RADS PFB, and modified PFB. For modified PFB, observations at least 10 mm with nonrim arterial phase hyperenhancement were upgraded LR-4 to LR-5 if there was no washout with a Kupffer defect and were reassigned LR-M to LR-5 if there was early washout with mild Kupffer defect. The reference standard was pathologic confirmation or composite (typical CT or MRI features, or 1-year size stability and/or reduction). Diagnostic metrics of LR-5 for HCC using the three algorithms were calculated and compared using the McNemar test. Results Overall, 375 patients (mean age, 56 years ± 11 [SD]; 318 male patients, 57 female patients) with 424 observations (345 HCCs, 40 non-HCC malignancies, 39 benign lesions) were enrolled. PFB and SHF both using LI-RADS showed no significant difference in sensitivity (60% vs 58%; P = .41) and specificity (96% vs 95%; P > .99). The modified algorithm with PFB had increased sensitivity (80% vs 58%; P < .001) and a nonsignificant decrease in specificity (92% vs 95%; P = .73) compared with LI-RADS SHF. Conclusion Based on CEUS LI-RADS version 2017, both SHF and PFB achieved high specificity and relatively low sensitivity for HCC diagnosis. When incorporating Kupffer-phase findings, PFB had higher sensitivity without loss of specificity. Chinese Clinical Trial Registry no. ChiCTR2100047035 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Kim in this issue.
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Affiliation(s)
- Lingling Li
- From the Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China (L.L., X.Z., W.Z., Y.L., J.H., Q.L., J.W., Z.G., R.Z., J.Z.); Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China (Y.L.); Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China (X.X.); Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K.L.); Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (Z.S.); Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China (Y.Z.); Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China (S.X.); and Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.)
| | - Xuebin Zou
- From the Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China (L.L., X.Z., W.Z., Y.L., J.H., Q.L., J.W., Z.G., R.Z., J.Z.); Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China (Y.L.); Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China (X.X.); Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K.L.); Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (Z.S.); Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China (Y.Z.); Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China (S.X.); and Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.)
| | - Wei Zheng
- From the Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China (L.L., X.Z., W.Z., Y.L., J.H., Q.L., J.W., Z.G., R.Z., J.Z.); Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China (Y.L.); Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China (X.X.); Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K.L.); Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (Z.S.); Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China (Y.Z.); Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China (S.X.); and Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.)
| | - Yu Li
- From the Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China (L.L., X.Z., W.Z., Y.L., J.H., Q.L., J.W., Z.G., R.Z., J.Z.); Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China (Y.L.); Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China (X.X.); Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K.L.); Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (Z.S.); Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China (Y.Z.); Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China (S.X.); and Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.)
| | - Xiaohong Xu
- From the Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China (L.L., X.Z., W.Z., Y.L., J.H., Q.L., J.W., Z.G., R.Z., J.Z.); Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China (Y.L.); Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China (X.X.); Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K.L.); Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (Z.S.); Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China (Y.Z.); Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China (S.X.); and Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.)
| | - Kai Li
- From the Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China (L.L., X.Z., W.Z., Y.L., J.H., Q.L., J.W., Z.G., R.Z., J.Z.); Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China (Y.L.); Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China (X.X.); Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K.L.); Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (Z.S.); Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China (Y.Z.); Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China (S.X.); and Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.)
| | - Zhongzhen Su
- From the Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China (L.L., X.Z., W.Z., Y.L., J.H., Q.L., J.W., Z.G., R.Z., J.Z.); Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China (Y.L.); Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China (X.X.); Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K.L.); Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (Z.S.); Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China (Y.Z.); Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China (S.X.); and Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.)
| | - Jing Han
- From the Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China (L.L., X.Z., W.Z., Y.L., J.H., Q.L., J.W., Z.G., R.Z., J.Z.); Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China (Y.L.); Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China (X.X.); Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K.L.); Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (Z.S.); Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China (Y.Z.); Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China (S.X.); and Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.)
| | - Qing Li
- From the Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China (L.L., X.Z., W.Z., Y.L., J.H., Q.L., J.W., Z.G., R.Z., J.Z.); Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China (Y.L.); Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China (X.X.); Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K.L.); Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (Z.S.); Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China (Y.Z.); Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China (S.X.); and Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.)
| | - Yanling Zuo
- From the Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China (L.L., X.Z., W.Z., Y.L., J.H., Q.L., J.W., Z.G., R.Z., J.Z.); Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China (Y.L.); Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China (X.X.); Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K.L.); Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (Z.S.); Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China (Y.Z.); Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China (S.X.); and Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.)
| | - Shousong Xie
- From the Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China (L.L., X.Z., W.Z., Y.L., J.H., Q.L., J.W., Z.G., R.Z., J.Z.); Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China (Y.L.); Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China (X.X.); Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K.L.); Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (Z.S.); Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China (Y.Z.); Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China (S.X.); and Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.)
| | - Hong Wen
- From the Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China (L.L., X.Z., W.Z., Y.L., J.H., Q.L., J.W., Z.G., R.Z., J.Z.); Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China (Y.L.); Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China (X.X.); Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K.L.); Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (Z.S.); Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China (Y.Z.); Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China (S.X.); and Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.)
| | - Jianwei Wang
- From the Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China (L.L., X.Z., W.Z., Y.L., J.H., Q.L., J.W., Z.G., R.Z., J.Z.); Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China (Y.L.); Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China (X.X.); Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K.L.); Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (Z.S.); Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China (Y.Z.); Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China (S.X.); and Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.)
| | - Zhixing Guo
- From the Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China (L.L., X.Z., W.Z., Y.L., J.H., Q.L., J.W., Z.G., R.Z., J.Z.); Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China (Y.L.); Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China (X.X.); Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K.L.); Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (Z.S.); Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China (Y.Z.); Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China (S.X.); and Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.)
| | - Ruhai Zou
- From the Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China (L.L., X.Z., W.Z., Y.L., J.H., Q.L., J.W., Z.G., R.Z., J.Z.); Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China (Y.L.); Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China (X.X.); Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K.L.); Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (Z.S.); Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China (Y.Z.); Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China (S.X.); and Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.)
| | - Jianhua Zhou
- From the Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China (L.L., X.Z., W.Z., Y.L., J.H., Q.L., J.W., Z.G., R.Z., J.Z.); Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China (Y.L.); Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China (X.X.); Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K.L.); Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (Z.S.); Department of Ultrasound Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China (Y.Z.); Department of Ultrasound, The First People's Hospital of Foshan, Foshan, China (S.X.); and Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.)
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Bo J, Xiang F, XiaoWei F, LianHua Z, ShiChun L, YuKun L. A Nomogram Based on Contrast-Enhanced Ultrasound to Predict the Microvascular Invasion in Hepatocellular Carcinoma. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1561-1568. [PMID: 37003955 DOI: 10.1016/j.ultrasmedbio.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/13/2023] [Accepted: 02/27/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE The aim of this study was to establish and validate a contrast-enhanced ultrasound (CEUS) nomogram for pre-operative microvascular invasion (MVI) prediction in hepatocellular carcinoma (HCC), and compare it with the nomogram based on gadopentetate dimeglumine-enhanced magnetic resonance imaging (Gd-MRI). METHODS A total of 251 patients with a single HCC were enrolled in this prospective study, including 176 patients in the training cohort and 75 patients in the validation cohort. Contrast-enhanced ultrasound (CEUS) with Sonazoid and Gd-MRI was performed pre-operatively. Post-operative histopathology was the gold standard for MVI. Univariate and multivariate logistic regression was performed to determine independent risk factors for MVI. Nomograms based on CEUS and Gd-MRI were established, and their discrimination, calibration and decision curve analysis were evaluated and compared. RESULTS Multivariate logistic regression revealed that arterial circular enhancement, non-enhancing area and thick ring-like enhancement in the post-vascular phase were independent risk factors for MVI. The areas under the receiver operating characteristic curve of the nomogram were 0.841 (0.779-0.892) and 0.914 (0.827-0.966) in the training and validation cohorts, with no significant difference compared with the Gd-MRI nomogram (p = 0.294, 0.321). The C-indexes were 0.821 and 0.870 in the training and validation cohorts. Decision curve analysis revealed that the CEUS nomogram had better clinical applicability than the Gd-MRI nomogram when the threshold probability was between 0.35 and 0.95. CONCLUSION The CEUS-based nomogram was available for predicting MVI in HCC, and its predictive performance was not inferior to that of Gd-MRI.
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Affiliation(s)
- Jiang Bo
- Department of Ultrasound, First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Fei Xiang
- Department of Ultrasound, First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Fan XiaoWei
- Department of Pathology, First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Zhu LianHua
- Department of Ultrasound, First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Lu ShiChun
- Department of Hepatobiliary Surgery, First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Luo YuKun
- Department of Ultrasound, First Medical Centre, Chinese PLA General Hospital, Beijing, China.
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Jeong WK, Kang HJ, Choi SH, Park MS, Yu MH, Kim B, You MW, Lim S, Cho YS, Lee MW, Hwang JA, Lee JY, Kim JH, Joo I, Bae JS, Kim SY, Chung YE, Kim DH, Lee JM. Diagnosing Hepatocellular Carcinoma Using Sonazoid Contrast-Enhanced Ultrasonography: 2023 Guidelines From the Korean Society of Radiology and the Korean Society of Abdominal Radiology. Korean J Radiol 2023; 24:482-497. [PMID: 37271203 DOI: 10.3348/kjr.2023.0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 06/06/2023] Open
Abstract
Sonazoid, a second-generation ultrasound contrast agent, was introduced for the diagnosis of hepatic nodules. To clarify the issues with Sonazoid contrast-enhanced ultrasonography for the diagnosis of hepatocellular carcinoma (HCC), the Korean Society of Radiology and Korean Society of Abdominal Radiology collaborated on the guidelines. The guidelines are de novo, evidence-based, and selected using an electronic voting system for consensus. These include imaging protocols, diagnostic criteria for HCC, diagnostic value for lesions that are inconclusive on other imaging results, differentiation from non-HCC malignancies, surveillance of HCC, and treatment response after locoregional and systemic treatment for HCC.
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Affiliation(s)
- Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo-Jin Kang
- Department of Radiology and Research Institute of Radiological Science, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi-Suk Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Hye Yu
- Department of Radiology, Konkuk University Hospital, Konkuk University College of Medicine, Seoul, Korea
| | - Bohyun Kim
- Department of Radiology, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung-Won You
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sanghyeok Lim
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Young Seo Cho
- Department of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Ah Hwang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Young Lee
- Department of Radiology and Research Institute of Radiological Science, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hoon Kim
- Department of Radiology and Research Institute of Radiological Science, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ijin Joo
- Department of Radiology and Research Institute of Radiological Science, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Seok Bae
- Department of Radiology and Research Institute of Radiological Science, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Eun Chung
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hwan Kim
- Department of Radiology, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology and Research Institute of Radiological Science, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Tranquart F. Contrast-Enhanced Ultrasound With Sonazoid for the Imaging and Diagnosis of Colorectal Liver Metastasis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1371-1374. [PMID: 36478442 DOI: 10.1002/jum.16146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 05/18/2023]
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Huang J, Gao L, Li J, Yang R, Jiang Z, Liao M, Luo Y, Lu Q. Head-to-head comparison of Sonazoid and SonoVue in the diagnosis of hepatocellular carcinoma for patients at high risk. Front Oncol 2023; 13:1140277. [PMID: 37007159 PMCID: PMC10050587 DOI: 10.3389/fonc.2023.1140277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/01/2023] [Indexed: 03/17/2023] Open
Abstract
ObjectivesTo compare the diagnostic efficacy of SonoVue-enhanced and Sonazoid-enhanced ultrasound (US) for hepatocellular carcinoma (HCC) in patients at high risk.MethodsBetween August 2021 and February 2022, participants at high risk for HCC with focal liver lesions were enrolled and underwent both SonoVue- and Sonazoid-enhanced US. Vascular-phase and Kupffer phase (KP) imaging features of contrast-enhanced US (CEUS) were analyzed. The diagnostic performance of both contrast agent-enhanced US according to the CEUS liver imaging reporting and data system (LI-RADS) and the modified criteria (using KP defect instead of late and mild washout) were compared. Histopathology and contrast-enhanced MRI/CT were used as reference standards.ResultsIn total, 62 nodules, namely, 55 HCCs, 3 non-HCC malignancies and 4 hemangiomas, from 59 participants were included. SonoVue-enhanced US had comparable sensitivity to Sonazoid-enhanced US for diagnosing HCC [80% (95% confidential interval (CI): 67%, 89.6%) versus 74.6% (95% CI: 61%, 85.3%), p = 0.25]. Both SonoVue and Sonazoid-enhanced US achieved a specificity of 100%. Compared with CEUS LI-RADS, the modified criteria with Sonazoid did not improve sensitivity for HCC diagnosis [74.6% (95% CI: 61%, 85.3%) versus 76.4% (95% CI: 63%, 86.8%), p = 0.99].ConclusionsSonazoid-enhanced US had comparable diagnostic performance to SonoVue-enhanced US for patients with HCC risk. KP did not considerably improve the diagnostic efficacy, whereas KP defects in atypical hemangioma may be pitfalls in diagnosing HCC. Further studies with larger sample sizes are needed to further validate the conclusions in the present study.
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Affiliation(s)
- Jiayan Huang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Ling Gao
- Department of Ultrasound, Chengdu BOE Hospital, Chengdu, China
| | - Jiawu Li
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Rui Yang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Zhenpeng Jiang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Min Liao
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Luo
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Qiang Lu
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Qiang Lu,
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Intraindividual Comparison of Contrast-Enhanced Ultrasound Using Perfluorobutane With Modified Criteria Versus CT/MRI LI-RADS Version 2018 for Diagnosing HCC in High-Risk Patients. AJR Am J Roentgenol 2023; 220:682-691. [PMID: 36382914 DOI: 10.2214/ajr.22.28420] [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: 11/17/2022]
Abstract
BACKGROUND. Previously proposed modifications to LI-RADS criteria for contrast-enhanced ultrasound (CEUS) performed using perfluorobutane contrast agent yielded increased sensitivity for hepatocellular carcinoma (HCC) without a significant decrease in specificity. OBJECTIVE. The purpose of our study was to compare the diagnostic performance of CEUS with perfluorobutane using modified LI-RADS criteria versus contrast-enhanced CT or MRI using LI-RADS version 2018 (v2018) for characterizing lesions as HCC in high-risk patients. METHODS. This retrospective study included 171 patients (140 men, 31 women; mean age, 54 ± 12 [SD] years) at high-risk for HCC with a pathologically confirmed liver observation evaluated by both CEUS using perfluorobutane and contrast-enhanced CT or MRI between March 2020 and May 2021. A matching algorithm was used to select two patients with HCC for each patient with a non-HCC lesion. Two readers evaluated observations using previously proposed modifications to CEUS LI-RADS version 2017 that classify certain observations as LR-5 rather than as LR-4 or LR-M on the basis of the presence of Kupffer phase defect after perfluorobutane administration; two different readers evaluated observations using CT/MRI LI-RADS v2018. Each reader pair reached consensus. Diagnostic performance was evaluated. RESULTS. A total of 114 patients had HCC, 43 had a non-HCC malignancy, and 14 had a benign lesion. Modified CEUS criteria using perfluorobutane and CT/MRI LI-RADS v2018 showed no significant difference (p > .05) in sensitivity (92.1% vs 89.5%), specificity (87.7% vs 84.2%), or accuracy (90.6% vs 87.7%) of LR-5 for diagnosis of HCC. Of six observations assessed as LR-4 only by CT/MRI LI-RADS v2018, modified CEUS criteria using perfluorobutane assessed one as LR-3 (benign lesion) and five as LR-5 (all HCC). Of seven observations assessed as LR-M only by CT/MRI LI-RADS v2018, modified CEUS criteria using perfluorobutane assessed one as LR-3 (non-HCC malignancy) and six as LR-5 (all HCC). Eight of 12 observations assessed as LR-5 only by CT/MRI LI-RADS v2018 and 11 of 13 observations assessed as LR-5 only by modified CEUS criteria using perfluorobutane were HCC. CONCLUSION. The diagnostic performance of LR-5 for HCC diagnosis was not significantly different between modified CEUS criteria using perfluorobutane and CT/MRI LI-RADS v2018. CLINICAL IMPACT. The findings support the application of modified CEUS criteria using perfluorobutane for diagnosing HCC in high-risk patients.
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HCC treated with immune checkpoint inhibitors: a hyper-enhanced rim on Sonazoid-CEUS Kupffer phase images is a predictor of tumor response. Eur Radiol 2022; 33:4389-4400. [PMID: 36547674 DOI: 10.1007/s00330-022-09339-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/20/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES We aimed to evaluate the efficacy of anti-programmed cell death 1 (PD-1)/programmed death-ligand 1 (PD-L1) antibody therapy by assessing the hyper-enhanced rim phenomenon of hepatocellular carcinoma (HCC) on Sonazoid-contrast-enhanced ultrasound (CEUS) Kupffer phase images. METHODS This retrospective study included 61 patients with HCC who received anti-PD-1/PD-L1 antibody therapy from August 1, 2020, to January 31, 2022. We compared the progression-free survival (PFS) of patients with hyper-enhanced rim+ and hyper-enhanced rim-nodules and the time to nodule progression (TTnP) of hyper-enhanced rim+ and hyper-enhanced rim- nodules. RESULTS Thirty-nine patients received postoperative therapy, and 22 patients had unresectable HCC. The mean PFS was 11.8 months (95% confidence interval [CI]: 8.7-14.9) for patients with hyper-enhanced rim+ HCC nodules and 16.5 months (95% CI: 14.9-18.1) for patients with hyper-enhanced rim- HCC nodules in the surgery group (p = 0.017). The mean PFS was 9.2 months (95% CI: 3.6-14.8) for patients with hyper-enhanced rim+ HCC nodules and 17.8 months (95% CI: 14.9-20.6) for patients with hyper-enhanced rim- HCC nodules in the non-surgery group (p = 0.015). For hyper-enhanced rim+ HCC nodules, TTnP for each nodule exceeding the specified threshold was 10.1 months, whereas that for hyper-enhanced rim- HCC nodules was 17.6 months (p = 0 .018). The disease control rate was 42.9% (3/7) for hyper-enhanced rim+ HCC nodules and 85.7% (21/24) for hyper-enhanced rim- HCC nodules (p = 0.013). CONCLUSIONS The presence of hyper-enhanced rim on the Kupffer phase images obtained via the non-invasive Sonazoid-CEUS is a promising imaging biomarker for predicting unfavorable response with anti-PD-1/PD-L1 therapy in patients with HCC. KEY POINTS • The mean progression-free survival was 11.8 months for patients with hyper-enhanced rim+ HCC nodules and 16.5 months for patients with hyper-enhanced rim- HCC nodules in the surgery group. • The mean progression-free survival was 9.2 months for patients with hyper-enhanced rim+ HCC nodules and 17.8 months for patients with hyper-enhanced rim- HCC nodules in the non-surgery group. • The disease control rate was 42.9% for hyper-enhanced rim+ HCC nodules and 85.7% for hyper-enhanced rim- HCC nodules (p = 0.013).
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Maruyama H, Tobari M, Nagamatsu H, Shiina S, Yamaguchi T. Contrast-enhanced ultrasonography for the management of portal hypertension in cirrhosis. Front Med (Lausanne) 2022; 9:1057045. [PMID: 36590972 PMCID: PMC9794740 DOI: 10.3389/fmed.2022.1057045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
Portal hypertension is a major pathophysiological condition in patients with cirrhosis. This accounts for the occurrence and severity of the various manifestations. The degree is determined by the portal pressure or hepatic venous pressure gradients, both of which are obtained by invasive interventional radiological procedures. Ultrasound (US) is a simple and minimally invasive imaging modality for the diagnosis of liver diseases. Owing to the availability of microbubble-based contrast agents and the development of imaging modes corresponding to contrast effects, contrast-enhanced US (CEUS) has become popular worldwide for the detailed evaluation of hepatic hemodynamics, diffuse liver disease, and focal hepatic lesions. Recent advancements in digital technology have enabled contrast-based demonstrations with improved resolution, leading to a wider range of applications. This review article describes the current role, benefits, and limitations of CEUS in the management of portal hypertension.
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Affiliation(s)
- Hitoshi Maruyama
- Department of Gastroenterology, Juntendo University, Tokyo, Japan,*Correspondence: Hitoshi Maruyama
| | - Maki Tobari
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | | | - Suichiro Shiina
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Tadashi Yamaguchi
- Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
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Kang HJ, Lee JM, Yoon JH, Yoo J, Choi Y, Joo I, Han JK. Sonazoid™ versus SonoVue ® for Diagnosing Hepatocellular Carcinoma Using Contrast-Enhanced Ultrasound in At-Risk Individuals: A Prospective, Single-Center, Intraindividual, Noninferiority Study. Korean J Radiol 2022; 23:1067-1077. [PMID: 36196767 PMCID: PMC9614293 DOI: 10.3348/kjr.2022.0388] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To determine whether Sonazoid-enhanced ultrasound (SZUS) was noninferior to SonoVue-enhanced ultrasound (SVUS) in diagnosing hepatocellular carcinoma (HCC) using the same diagnostic criteria. MATERIALS AND METHODS This prospective, single-center, noninferiority study (NCT04847726) enrolled 105 at-risk participants (71 male; mean age ± standard deviation, 63 ± 11 years; range, 26-86 years) with treatment-naïve solid hepatic nodules (≥ 1 cm). All participants underwent same-day SZUS (experimental method) and SVUS (control method) for one representative nodule per participant. Images were interpreted by three readers (the operator and two independent readers). All malignancies were diagnosed histopathologically, while the benignity of other lesions was confirmed by follow-up stability or pathology. The primary endpoint was per-lesion diagnostic accuracy for HCC pooled across three readers using the conventional contrast-enhanced ultrasound diagnostic criteria, including arterial phase hyperenhancement followed by mild (assessed within 2 minutes after contrast injection) and late (≥ 60 seconds with a delay of 5 minutes) washout. The noninferiority delta was -10%p. Furthermore, different time delays were compared as washout criteria in SZUS, including delays of 2, 5, and > 10 minutes. RESULTS A total of 105 lesions (HCCs [n = 61], non-HCC malignancies [n = 19], and benign [n = 25]) were evaluated. Using the 5-minutes washout criterion, per-lesion accuracy of SZUS pooled across the three readers (72.4%; 95% confidence interval [CI], 64.1%-79.3%) was noninferior to that of SVUS (71.4%; 95% CI, 63.1%-78.6%), meeting the statistical criterion for non-inferiority (difference of 0.95%p; 95% CI, -3.8%p-5.7%p). The arterial phase hyperenhancement combined with the 5-minutes washout criterion showed the same sensitivity as that of the > 10-minutes criterion (59.0% vs. 59.0%, p = 0.989), and the specificities were not significantly different (90.9% vs. 86.4%, p = 0.072). CONCLUSION SZUS was noninferior to SVUS for diagnosing HCC in at-risk patients using the same diagnostic criteria. No significant improvement in HCC diagnosis was observed by extending the washout time delay from 5 to 10 minutes.
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Affiliation(s)
- Hyo-Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Zheng Z, Xie W, Tian J, Wu J, Luo B, Xu X. Utility of Sonazoid-Enhanced Ultrasound for the Macroscopic Classification of Hepatocellular Carcinoma: A Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2165-2173. [PMID: 36030130 DOI: 10.1016/j.ultrasmedbio.2022.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
We assessed the diagnostic value of Sonazoid-enhanced ultrasound (SEUS) in determining the macroscopic classification of hepatocellular carcinoma (HCC) because of its strong relevance to the poor prognosis of the non-simple nodular (non-SN) type. The PubMed, EMBASE, Web of Science and Cochrane Library databases were searched for studies investigating patients who underwent surgery for HCC after undergoing SEUS pre-operatively. Five studies involving a total of 334 patients met the inclusion criteria. The summary sensitivity and specificity were 0.74 (95% confidence interval [CI]: 0.63-0.83) and 0.92 (95% CI: 0.82-0.97), respectively. The positive and negative likelihood ratios of SEUS for determining the macroscopic classification of HCC in Kupffer phase were 9.21 (95% CI: 4.02-21.13) and 0.28 (95% CI: 0.19-0.41), respectively. The diagnostic odds ratio of SEUS for determining the macroscopic classification of HCC was 34.2 (95% CI: 11.64-100.51), and the area under the summary receiver operating characteristic curve was 0.87 (95% CI: 0.84-0.90). Subgroup analysis suggested that small HCCs (≤30 mm) and studies including fewer than 70 patients may be associated with a higher diagnostic odds ratio than the corresponding subsets. SEUS had moderate diagnostic value for determining the macroscopic classification of HCC in the Kupffer phase.
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Affiliation(s)
- Zijie Zheng
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei Xie
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jing Tian
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiayi Wu
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Baoming Luo
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaolin Xu
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China.
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Li L, Zheng W, Wang J, Han J, Guo Z, Hu Y, Li X, Zhou J. Contrast-Enhanced Ultrasound Using Perfluorobutane: Impact of Proposed Modified LI-RADS Criteria on Hepatocellular Carcinoma Detection. AJR Am J Roentgenol 2022; 219:434-443. [PMID: 35441534 DOI: 10.2214/ajr.22.27521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND. Contrast-enhanced ultrasound (CEUS) LI-RADS version 2017 (v2017) applies only to CEUS examinations performed using pure blood pool agents, noting that future versions will address combined blood pool and Kupffer cell agents such as perfluorobutane. Such agents may improve hepatocellular carcinoma (HCC) detection by visualization of a defect in the Kupffer phase (obtained ≥ 10 minutes after injection). OBJECTIVE. The purpose of our study was to compare the diagnostic performance of the LR-5 category for HCC detection in at-risk patients between CEUS LI-RADS v2017 and proposed modified criteria for CEUS examinations performed using perfluorobutane. METHODS. This retrospective study included 293 patients at risk for HCC (259 men, 34 women; mean age, 55 ± 12 [SD] years) who underwent CEUS using perfluorobutane from March 1, 2020, to October 30, 2020, showing a total of 304 observations (274 HCC, 14 non-HCC malignancy, and 16 benign lesions). Two readers independently assessed examinations and assigned categories using both CEUS LI-RADS v2017 and the proposed modified criteria. In the modified criteria, observations 10 mm or greater with not rim arterial phase hyperenhancement (APHE), no washout, and a Kupffer defect were upgraded from LR-4 to LR-5, and observations 10 mm or greater with not rim APHE, early washout, and a mild Kupffer defect were reassigned from LR-M to LR-5. Interreader agreement was assessed, and consensus interpretations were reached. Diagnostic performance was evaluated. RESULTS. Interreader agreement for LI-RADS category assignments, expressed using kappa coefficients, was 0.839 for CEUS LI-RADS v2017 and 0.854 for the modified criteria. Modified criteria upgraded 35 observations from LR-4 to LR-5 on the basis of a Kupffer defect, of which 34 were HCC and one was benign. Modified criteria reassigned 22 observations from LR-M to LR-5 on the basis of a mild Kupffer defect, of which all were HCC. LR-5 using modified criteria, compared with CEUS LI-RADS v2017, had significantly increased sensitivity (89% vs 69%, p < .001), a nonsignificant decrease in specificity (83% vs 87%, p > .99), and significantly increased accuracy (89% vs 71%, p < .001) for HCC. CONCLUSION. When using perfluorobutane for CEUS in at-risk patients, modified criteria incorporating Kupffer defects significantly improve sensitivity without significant loss of specificity in HCC detection. CLINICAL IMPACT. Future CEUS LI-RADS updates seeking to address the use of combined blood pool and Kupffer cell agents should consider adoption of the explored criteria.
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Affiliation(s)
- Lingling Li
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd E, Guangzhou 510060, China
| | - Wei Zheng
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd E, Guangzhou 510060, China
| | - Jianwei Wang
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd E, Guangzhou 510060, China
| | - Jing Han
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd E, Guangzhou 510060, China
| | - Zhixing Guo
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd E, Guangzhou 510060, China
| | - Yixin Hu
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd E, Guangzhou 510060, China
| | - Xiaoxian Li
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd E, Guangzhou 510060, China
| | - Jianhua Zhou
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd E, Guangzhou 510060, China
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Wu Q, Liu Y, Sun D, Wang Y, Wei X, Li J, Liu B, Wang S, Zhou Y, Hu H, Zhang R, Jiao Q, Li Y, Ying T. Protocol of Kupffer phase whole liver scan for metastases: A single-center prospective study. Front Med (Lausanne) 2022; 9:911807. [PMID: 36017002 PMCID: PMC9396128 DOI: 10.3389/fmed.2022.911807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/28/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction As the presence of hepatic metastases is very important to cancer patients' clinical stage which would directly affect the selection and application of anti-cancer treatments. Although conventional ultrasound is commonly performed as a screening tool, most of the examinations have relatively poor sensitivity and specificity for detecting liver metastases. Contrast-enhanced ultrasound (CEUS) with Sonazoid has been reported to have the advantage of the diagnosis and therapeutic support of focal hepatic lesions and its specific Kupffer phase whole liver scan (KPWLS) is believed to be sensitive to detect liver metastases. And the purpose of this study is to determine the number, size, location and diagnosis of metastatic lesions, and to compare the results with conventional ultrasound and contrast-enhanced computed tomography (CECT), thus to clarify the application value, indications of Sonazoid-CEUS in screening liver metastasis. Methods and analysis Kupffer phase whole liver scan for metastases (KPWLSM) is a self-control, blind map-reading, single-center, prospective superiority trial. Approved by the institutional review committee, the study period is planned to be from 1 January 2022 to 31 December 2025. Our study will include 330 patients with history of malignant tumors that cling to metastasize to liver. All patients will undergo the examinations of conventional ultrasound, Sonazoid-CEUS, and contrast-enhanced magnetic resonance imaging (CEMRI), and 65 of them should have additional CECT scans. The primary endpoint is the comparative analysis of the numbers of detected liver metastatic lesions among Sonazoid-CEUS, conventional ultrasound and CECT in screening liver metastases. Subjective conditions of patient after injection of Sonazoid will be followed up 3 and 30 days after KPWLSM, and any short-term and long-term adverse events are to be recorded with telephone interviews. Ethics and dissemination This study has been granted by the Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People's Hospital (Approval No: 2021-197). When the KPWLSM is completed, we will publish it in an appropriate journal to promote further widespread use. Registration Trial Registration Number and Date of Registration: Chinese Clinical Trial Registry, ChiCTR2100054385, December 16, 2021.
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Affiliation(s)
- Qiong Wu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Yilun Liu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Di Sun
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Yan Wang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Xiaoer Wei
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jing Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Beibei Liu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shuhao Wang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yan Zhou
- Oncology Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haiyan Hu
- Oncology Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Rui Zhang
- Obstetrics and Gynecology Department, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qiong Jiao
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yi Li
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
- *Correspondence: Yi Li
| | - Tao Ying
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
- Tao Ying
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Huang JX, Shi CG, Xu YF, Fu J, Zhong Y, Liu LZ, Pei XQ. The benefit of contrast-enhanced ultrasound in biopsies for focal liver lesions: a retrospective study of 820 cases. Eur Radiol 2022; 32:6830-6839. [PMID: 35881185 DOI: 10.1007/s00330-022-08988-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/15/2022] [Accepted: 06/27/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study compared the performance between ultrasound (US)- and contrast-enhanced US (CEUS)-guided liver biopsies and evaluated the benefit of CEUS in percutaneous biopsy for focal liver lesions (FLLs). METHODS We performed a retrospective study of 820 patients with FLLs, who underwent percutaneous liver biopsy in our center between 2017 and 2019. The patients were divided into two groups based on whether US (n = 362) or CEUS (n = 458) used before a biopsy. The two groups were compared based on specimen adequacy for pathological diagnosis and diagnostic accuracy of liver biopsy. Stratification analysis was performed based on lesion and protocol characteristics to provide detailed information for selecting the imaging guidance for biopsy. RESULTS Compared with the US group, the CEUS group yielded more acceptable samples (97.6% vs. 99.4%, p < 0.05) and improved diagnostic accuracy (92.6% vs. 96.4%, p < 0.05), and achieved better sensitivity (92.5% vs. 96.2%, p < 0.05) for liver biopsies, especially in FLLs ≥ 5 cm, heterogeneous hypoechoic FLLs, or FLLs with an obscure boundary. The CEUS group showed significantly higher accuracy compared with the US group pertaining to single-puncture biopsies (100% vs. 92.7%, p < 0.05) or biopsies with punctures ≤ 2 (97.6% vs. 94.3%, p < 0.05). CONCLUSION CEUS achieved an enhanced success rate for sampling and diagnostic accuracy of liver biopsies, especially in FLLs ≥ 5 cm, heterogeneous hypoechoic FLLs, or FLLs with an obscure boundary. CEUS can be used to decrease the number of punctures needed, which might increase the safety of liver biopsy. KEY POINTS • CEUS can help confirm an adequate biopsy site, increasing the sampling success rate and diagnostic accuracy of the liver biopsy. • CEUS can be used to decrease the number of punctures needed to improve the safety of liver biopsy. • It is recommended to use CEUS guidance for liver biopsies, especially with FLLs ≥ 5 cm, heterogeneous hypoechoic FLLs, or FLLs with an obscure boundary.
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Affiliation(s)
- Jia-Xin Huang
- Department of Medical Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510000, Guangdong Province, China
| | - Cai-Gou Shi
- Department of Medical Ultrasound, Liuzhou People's Hospital, Liuzhou, 545000, China
| | - Yan-Fen Xu
- Department of Medical Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510000, Guangdong Province, China
| | - Juan Fu
- Department of Medical Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510000, Guangdong Province, China
| | - Yuan Zhong
- Department of Medical Ultrasound, Foshan First People's Hospital, Foshan, 528000, China
| | - Long-Zhong Liu
- Department of Medical Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510000, Guangdong Province, China
| | - Xiao-Qing Pei
- Department of Medical Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510000, Guangdong Province, China.
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Perfluorobutane-enhanced ultrasonography with a Kupffer phase: improved diagnostic sensitivity for hepatocellular carcinoma. Eur Radiol 2022; 32:8507-8517. [PMID: 35705829 DOI: 10.1007/s00330-022-08900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/21/2022] [Accepted: 05/19/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of perfluorobutane contrast-enhanced ultrasonography (CEUS) for hepatocellular carcinoma (HCC) and to explore how accuracy can be improved compared to conventional diagnostic criteria in at-risk patients. METHODS A total of 123 hepatic nodules (≥ 1 cm) from 123 at-risk patients who underwent perfluorobutane CEUS between 2013 and 2020 at three institutions were retrospectively analyzed. Ninety-three percent of subjects had pathological results, except benign lesions stable in follow-up images. We evaluated presence of arterial phase hyperenhancement (APHE), washout time and degree, and Kupffer phase (KP) defects. KP defects are defined as hypoenhancing lesions relative to the liver in KP. HCC was diagnosed in two ways: (1) Liver Imaging Reporting and Data System (LI-RADS) criteria defined as APHE and late (≥ 60 s)/mild washout, and (2) APHE and Kupffer (AK) criteria defined as APHE and KP defect. We explored grayscale features that cause misdiagnosis of HCC and reflected in the adjustment. Diagnostic performance was compared using McNemar's test. RESULTS There were 77 HCCs, 15 non-HCC malignancies, and 31 benign lesions. An ill-defined margin without hypoechoic halo on grayscale applied as a finding that did not suggest HCC. Regarding diagnosis of HCC, sensitivity of AK criteria (83.1%; 95% confidence interval [CI]: 72.9-90.7%) was higher than that of LI-RADS criteria (75.3%; 95% CI: 64.2-84.4%; p = 0.041). Specificity was 91.3% (95% CI: 79.2-97.6%) in both groups. CONCLUSION On perfluorobutane CEUS, diagnostic criteria for HCC using KP defect with adjustment by grayscale findings had higher diagnostic performance than conventional criteria without losing specificity. KEY POINTS • Applying Kupffer phase defect instead of late/mild washout and adjusting with grayscale findings can improve the diagnostic performance of perfluorobutane-enhanced US for HCC. • Adjustment with ill-defined margins without a hypoechoic halo for features unlikely to be HCC decreases false positives for HCC diagnosis using the perfluorobutane-enhanced US. • After adjustment with grayscale findings, the sensitivity and accuracy of the APHE and Kupffer criteria were higher than those of the LI-RADS criteria; specificity was 91.3% for both.
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Kyung Jeon S, Young Lee J, Kang HJ, Koo Han J. Additional value of superb microvascular imaging of ultrasound examinations to evaluate focal liver lesions. Eur J Radiol 2022; 152:110332. [DOI: 10.1016/j.ejrad.2022.110332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/17/2022] [Accepted: 04/23/2022] [Indexed: 11/17/2022]
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Li X, Han X, Li L, Su C, Sun J, Zhan C, Feng D, Cheng W. Dynamic Contrast-Enhanced Ultrasonography with Sonazoid for Diagnosis of Microvascular Invasion in Hepatocellular Carcinoma. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:575-581. [PMID: 34933756 DOI: 10.1016/j.ultrasmedbio.2021.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/30/2021] [Accepted: 11/08/2021] [Indexed: 06/14/2023]
Abstract
The aim of the present study was to investigate the imaging features observed in pre-operative Sonazoid contrast-enhanced ultrasound (SZ-CEUS) and the correlations with the presence of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients. In this single-center retrospective study, 31 patients with surgically and histopathologically confirmed HCC lesions were included. Patients were classified according to the presence of MVI into the MVI-positive group (n = 15) and MVI-negative group (n = 16). The CEUS examinations were performed within 2 or 3 d before surgery. Features, including tumor necrosis and ultrasound contrast agent (UCA) distribution characteristics in the arterial phase (AP), tumor types (single nodular [SN] or non-single nodular [non-SN]) in the post-vascular phase (PVP), wash-in time, wash-in slope, time to peak (TTP) and peak intensity (PI), were assessed. Univariate analysis revealed statistically significant differences between the two groups with respect to tumor necrosis (p = 0.002), inhomogeneous distribution of contrast agent in the AP (p = 0.001) and non-SN type in the PVP (p < 0.001). There was no significant difference in the quantitative parameters. Multivariate analysis revealed that non-SN type in the PVP was a significant independent risk factor for MVI of HCC (odds ratio = 30.51, 95% confidence interval [CI]: 2.335-398.731, p = 0.009). The area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 0.873, 93.3%, 81.3%, 82.4% and 92.9%, respectively. Thus, SZ-CEUS can provide useful information for the diagnosis of MVI in HCC.
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Affiliation(s)
- Xintong Li
- Department of Ultrasound, Hepatology, and Pathology, Harbin Medical University Cancer Hospital, Nangang District, Harbin, PR China
| | - Xue Han
- Department of Ultrasound, Hepatology, and Pathology, Harbin Medical University Cancer Hospital, Nangang District, Harbin, PR China
| | - Lei Li
- Department of Ultrasound, Hepatology, and Pathology, Harbin Medical University Cancer Hospital, Nangang District, Harbin, PR China
| | - Chang Su
- Department of Ultrasound, Hepatology, and Pathology, Harbin Medical University Cancer Hospital, Nangang District, Harbin, PR China
| | - Jianmin Sun
- Department of Ultrasound, Hepatology, and Pathology, Harbin Medical University Cancer Hospital, Nangang District, Harbin, PR China
| | - Chao Zhan
- Department of Ultrasound, Hepatology, and Pathology, Harbin Medical University Cancer Hospital, Nangang District, Harbin, PR China
| | - Di Feng
- Department of Ultrasound, Hepatology, and Pathology, Harbin Medical University Cancer Hospital, Nangang District, Harbin, PR China
| | - Wen Cheng
- Department of Ultrasound, Hepatology, and Pathology, Harbin Medical University Cancer Hospital, Nangang District, Harbin, PR China.
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Wang J, Zhao R, Cheng J. Diagnostic accuracy of contrast-enhanced ultrasound to differentiate benign and malignant breast lesions: A systematic review and meta-analysis. Eur J Radiol 2022; 149:110219. [DOI: 10.1016/j.ejrad.2022.110219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/28/2022] [Accepted: 02/10/2022] [Indexed: 12/24/2022]
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Kim YY, Min JH, Hwang JA, Jeong WK, Sinn DH, Lim HK. Second-line Sonazoid-enhanced ultrasonography for Liver Imaging Reporting and Data System category 3 and 4 on gadoxetate-enhanced magnetic resonance imaging. Ultrasonography 2022; 41:519-529. [PMID: 35439873 PMCID: PMC9262668 DOI: 10.14366/usg.21198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/28/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose This study investigated the utility of second-line contrast-enhanced ultrasonography (CEUS) using Sonazoid in Liver Imaging Reporting and Data System category 3 (LR-3) and 4 (LR-4) observations on gadoxetate-enhanced magnetic resonance imaging (MRI). Methods This retrospective study included LR-3 or LR-4 observations on gadoxetate-enhanced MRI subsequently evaluated with CEUS from 2013 to 2017. The presence of MRI features, CEUS-arterial phase hyperenhancement (CEUS-APHE), and Kupffer phase defect (KPD) was evaluated. Multivariable logistic regression analysis was performed to identify significant imaging features associated with the diagnosis of hepatocellular carcinoma (HCC). The optimal diagnostic criteria were investigated using the McNemar test. Results In total, 104 patients with 104 observations (63 HCCs) were included. The presence of both CEUS-APHE and KPD on CEUS enabled the additional detection of 42.3% (11/26) of LR-3 HCCs and 78.4% (29/37) of LR-4 HCCs. Transitional phase (TP) hypointensity (adjusted odds ratio [OR], 10.59; P<0.001), restricted diffusion (adjusted OR, 7.55; P=0.004), and KPD (adjusted OR, 7.16; P=0.003) were significant imaging features for HCC diagnosis. The presence of at least two significant imaging features was optimal for HCC diagnosis (sensitivity, specificity, and accuracy: 88.9%, 78.1%, and 84.6%, respectively), with significantly higher sensitivity than the presence of both CEUS-APHE and KPD (sensitivity, specificity, and accuracy: 63.5% [P=0.001], 92.7% [P=0.077], and 75.0% [P=0.089], respectively). Conclusion The combined interpretation of gadoxetate-enhanced MRI and second-line CEUS using Sonazoid, focusing on TP hypointensity, restricted diffusion, and KPD, may be optimal for further characterizing LR-3 and LR-4 observations.
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Affiliation(s)
- Yeun-Yoon Kim
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Ah Hwang
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Keun Lim
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Takahashi H, Sugimoto K, Kamiyama N, Sakamaki K, Kakegawa T, Wada T, Tomita Y, Abe M, Yoshimasu Y, Takeuchi H, Itoi T. Noninvasive Diagnosis of Hepatocellular Carcinoma on Sonazoid-Enhanced US: Value of the Kupffer Phase. Diagnostics (Basel) 2022; 12:diagnostics12010141. [PMID: 35054309 PMCID: PMC8774743 DOI: 10.3390/diagnostics12010141] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to compare the diagnostic performance of Contrast-Enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) version 2017, which includes portal- and late-phase washout as a major imaging feature, with that of modified CEUS LI-RADS, which includes Kupffer-phase findings as a major imaging feature. Participants at risk of hepatocellular carcinoma (HCC) with treatment-naïve hepatic lesions (≥1 cm) were recruited and underwent Sonazoid-enhanced US. Arterial phase hyperenhancement (APHE), washout time, and echogenicity in the Kupffer phase were evaluated using both criteria. The diagnostic performance of both criteria was analyzed using the McNemar test. The evaluation was performed on 102 participants with 102 lesions (HCCs (n = 52), non-HCC malignancies (n = 36), and benign (n = 14)). Among 52 HCCs, non-rim APHE was observed in 92.3% (48 of 52). By 5 min, 73.1% (38 of 52) of HCCs showed mild washout, while by 10 min or in the Kupffer phase, 90.4% (47 of 52) of HCCs showed hypoenhancement. The sensitivity (67.3%; 35 of 52; 95% CI: 52.9%, 79.7%) of modified CEUS LI-RADS criteria was higher than that of CEUS LI-RADS criteria (51.9%; 27 of 52; 95% CI: 37.6%, 66.0%) (p = 0.0047). In conclusion, non-rim APHE with hypoenhancement in the Kupffer phase on Sonazoid-enhanced US is a feasible criterion for diagnosing HCC.
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Affiliation(s)
- Hiroshi Takahashi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
- Correspondence:
| | - Naohisa Kamiyama
- Ultrasound General Imaging, GE Healthcare, Hino-shi 191-0065, Japan;
| | - Kentaro Sakamaki
- Center for Data Science, Yokohama City University, Yokohama 236-0027, Japan;
| | - Tatsuya Kakegawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
| | - Takuya Wada
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
| | - Yusuke Tomita
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
| | - Masakazu Abe
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
| | - Yu Yoshimasu
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
| | - Hirohito Takeuchi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.T.); (T.K.); (T.W.); (Y.T.); (M.A.); (Y.Y.); (H.T.); (T.I.)
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Sandulescu LD, Urhut CM, Sandulescu SM, Ciurea AM, Cazacu SM, Iordache S. One stop shop approach for the diagnosis of liver hemangioma. World J Hepatol 2021; 13:1892-1908. [PMID: 35069996 PMCID: PMC8727199 DOI: 10.4254/wjh.v13.i12.1892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/25/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour. The typical ultrasound appearance of hemangioma is easily recognizable and quickly guides the diagnosis without the need for further investigation. But there is also an entire spectrum of atypical and uncommon ultrasound features and our review comes to detail these particular aspects. An atypical aspect in standard ultrasound leads to the continuation of explorations with an imaging investigation with contrast substance [ultrasound/ computed tomography/or magnetic resonance imaging (MRI)]. For a clinician who practices ultrasound and has an ultrasound system in the room, the easiest, fastest, non-invasive and cost-effective method is contrast enhanced ultrasound (CEUS). Approximately 85% of patients are correctly diagnosed with this method and the patient has the correct diagnosis in about 30 min without fear of malignancy and without waiting for a computer tomography (CT)/MRI appointment. In less than 15% of patients CEUS does not provide a conclusive appearance; thus, CT scan or MRI becomes mandatory and liver biopsy is rarely required. The aim of this updated review is to synthesize the typical and atypical ultrasound aspects of hepatic hemangioma in the adult patient and to propose a fast, non-invasive and cost-effective clinical-ultrasound algorithm for the diagnosis of hepatic hemangioma.
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Affiliation(s)
- Larisa Daniela Sandulescu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | | | - Sarmis Marian Sandulescu
- Department of Surgery, Emergency County Hospital of Craiova, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Ana-Maria Ciurea
- Department of Oncology, Emergency County Hospital of Craiova, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Sergiu Marian Cazacu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Sevastita Iordache
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
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Park J, Lee JM, Kim TH, Yoon JH. Imaging Diagnosis of HCC: Future directions with special emphasis on hepatobiliary MRI and contrast-enhanced ultrasound. Clin Mol Hepatol 2021; 28:362-379. [PMID: 34955003 PMCID: PMC9293611 DOI: 10.3350/cmh.2021.0361] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a unique cancer entity that can be noninvasively diagnosed using imaging modalities without pathologic confirmation. In 2018, several major guidelines for HCC were updated to include hepatobiliary contrast agent magnetic resonance imaging (HBA-MRI) and contrast-enhanced ultrasound (CEUS) as major imaging modalities for HCC diagnosis. HBA-MRI enables the achievement of high sensitivity in HCC detection using the hepatobiliary phase (HBP). CEUS is another imaging modality with real-time imaging capability, and it is reported to be useful as a second-line modality to increase sensitivity without losing specificity for HCC diagnosis. However, until now, there is an unsolved discrepancy among guidelines on whether to accept “HBP hypointensity” as a definite diagnostic criterion for HCC or include CEUS in the diagnostic algorithm for HCC diagnosis. Furthermore, there is variability in terminology and inconsistencies in the definition of imaging findings among guidelines; therefore, there is an unmet need for the development of a standardized lexicon. In this article, we review the performance and limitations of HBA-MRI and CEUS after guideline updates in 2018 and briefly introduce some future aspects of imaging-based HCC diagnosis.
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Affiliation(s)
- Junghoan Park
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Tae-Hyung Kim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Kang HJ, Kim JH, Yoo J, Han JK. Diagnostic criteria of perfluorobutane-enhanced ultrasonography for diagnosing hepatocellular carcinoma in high-risk individuals: how is late washout determined? Ultrasonography 2021; 41:530-542. [PMID: 35144328 PMCID: PMC9262666 DOI: 10.14366/usg.21172] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the optimal washout criteria of perfluorobutane-enhanced ultrasonography (PFB-US) for the diagnosis of hepatocellular carcinoma (HCC) in high-risk individuals. METHODS Participants at risk of HCC with treatment-naïve solid hepatic observations (≥1 cm) who underwent PFB-US from March 2019 to September 2020 were prospectively recruited. Arterial phase hyperenhancement (APHE), washout time, and washout degree were evaluated. The diagnosis of HCC was made by non-rim APHE with late and mild washout. The per-lesion diagnostic performance for diagnosing HCC using different cutoffs for late washout (50, 55, 60, 65, and 70 seconds postcontrast) and the different time windows for determining washout (until 2, 3, 4, 5, 6, 7, 8, 9, and 10 minutes postcontrast) were compared using the McNemar test. RESULTS In total, 101 participants with 113 observations (mean size, 33.5±2.8 mm; HCCs [n=82], non-HCC malignancies [n=16], benign [n=15]) were evaluated. Non-rim APHE was observed in 86.6% (71/82) of HCCs. As the cutoff time for late washout increased, the specificity increased to 100% (95% confidence interval [CI], 88.8% to 100%) at the 60-second cutoff with 62.2% sensitivity (95% CI, 50.8% to 72.7%). When the time window for determining washout became wider, the sensitivity and accuracy increased until 6 minutes, with 100% specificity at all times. CONCLUSION Determining washout within 6 minutes after contrast injection with a 60-second cutoff for late washout showed the highest sensitivity without losing specificity for diagnosing HCC using PFB-US in individuals at high risk.
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Affiliation(s)
- Hyo-Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Marschner CA, Geyer T, Froelich MF, Rübenthaler J, Schwarze V, Clevert DA. Diagnostic Value of Contrast-Enhanced Ultrasound for Evaluation of Transjugular Intrahepatic Portosystemic Shunt Perfusion. Diagnostics (Basel) 2021; 11:1593. [PMID: 34573935 PMCID: PMC8472159 DOI: 10.3390/diagnostics11091593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/11/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In patients with liver cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) displays an effective method for treating portal hypertension. Main indications include refractory ascites and secondary prevention of esophageal bleeding. Color Doppler ultrasound (CDUS) plays a leading role in the follow-up management, whereas contrast-enhanced ultrasound (CEUS) is not routinely considered. We compared the efficacy of CEUS to CDUS and highlighted differences compared to findings of corresponding computed tomography (CT) and magnetic resonance imaging (MRI). (2) Methods: On a retrospective basis, 106 patients with CEUS examination after TIPS were included. The enrollment period was 12 years (between 2008 and 2020) and the age group ranged from 23.3 to 82.1 years. In addition, 92 CDUS, 43 CT and 58 MRI scans were evaluated for intermodal comparison. (3) Results: Intermodal analysis and comparison revealed a high level of concordance between CDUS, CT and MRI in the vast majority of cases. In comparison to CDUS, the correlation of the relevant findings was 92.5%, 95.3% for CT and 87.9% for MRI. In some cases, however, additional information was provided by CEUS (4) Conclusions: CEUS depicts a safe and effective imaging modality for follow-up after TIPS. In addition to CDUS, CEUS enables specific assessment of stent pathologies and stent dysfunction due to its capacity to dynamically visualize single microbubbles at high spatial and temporal resolution. Due to the low number of adverse events regarding the application of contrast agents, CEUS can be administered to a very broad patient population, thus avoiding additional radiation exposure compared to CT angiography in cases with divergent findings during follow-up.
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Affiliation(s)
- Constantin A. Marschner
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (T.G.); (J.R.); (V.S.); (D.-A.C.)
| | - Thomas Geyer
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (T.G.); (J.R.); (V.S.); (D.-A.C.)
| | - Matthias F. Froelich
- Department of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, 68167 Mannheim, Germany;
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (T.G.); (J.R.); (V.S.); (D.-A.C.)
| | - Vincent Schwarze
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (T.G.); (J.R.); (V.S.); (D.-A.C.)
| | - Dirk-André Clevert
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (T.G.); (J.R.); (V.S.); (D.-A.C.)
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Wang F, Numata K, Nihonmatsu H, Chuma M, Moriya S, Nozaki A, Ogushi K, Fukuda H, Ruan L, Okada M, Luo W, Koizumi N, Nakano M, Otani M, Inayama Y, Maeda S. Intraprocedurally EOB-MRI/US fusion imaging focusing on hepatobiliary phase findings can help to reduce the recurrence of hepatocellular carcinoma after radiofrequency ablation. Int J Hyperthermia 2021; 37:1149-1158. [PMID: 32996799 DOI: 10.1080/02656736.2020.1825837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND & AIMS To explore the ability of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid magnetic resonance imaging (EOB-MRI)/ultrasound (US) fusion imaging (FI) to improve the prognosis of radiofrequency ablation (RFA) by ablating the characteristic findings of hepatocellular carcinoma (HCC) in hepatobiliary phase (HBP) imaging. METHODS We retrospectively recruited 115 solitary HCC lesions with size of (15.9 ± 4.6) mm. They were all treated by RFA and preoperative EOB-MRI. According to the modalities guiding RFA performance, the lesions were grouped into contrast enhanced US (CEUS)/US guidance group and EOB-MRI/US FI guidance group. For the latter group, the ablation scope was set to cover the HBP findings (peritumoral hypointensity and irregular protruding margin). The presence of HBP findings, the modalities guided RFA, the recurrence rate were observed. RESULTS After an average follow-up of 377 days, local tumor progression (LTP) and intrahepatic distant recurrence (IDR) were 14.8% and 38.4%, respectively. The lesions having HBP findings exhibited a higher recurrence rate (73.7%) than the lesions without HBP findings (42.9%) (p = 0.002) and a low overall recurrence-free curve using the Kaplan-Meier method (p = 0.038). Using EOB-MRI/US FI as guidance, there was no difference in the recurrence rate between the groups with and without HBP findings (p = 0.799). In lesions with HBP findings, RFA guided by EOB-MRI/US FI (53.8%) produced a lower recurrence rate than CEUS/US (84.0%) (p = 0.045). CONCLUSIONS The intraprocedurally application of EOB-MRI/US FI to determine ablation scope according to HBP findings is feasible and beneficial for prognosis of RFA.
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Affiliation(s)
- Feiqian Wang
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.,Ultrasound Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiromi Nihonmatsu
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Makoto Chuma
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Satoshi Moriya
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Akito Nozaki
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsuaki Ogushi
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroyuki Fukuda
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Litao Ruan
- Ultrasound Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Masahiro Okada
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Wen Luo
- Department of Ultrasound, Xijing Hospital, Air Force Military Medical University, Xi'an, P.R. China
| | - Norihiro Koizumi
- Department of Mechanical and Intelligent Systems Engineering, Graduate School of Informatics and Engineering, The University of Electro-Communications, Choufu, Japan
| | | | - Masako Otani
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshiaki Inayama
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Maeda
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Sun Y, Cui L, Wang S, Shi T, Hao Y, Lei Y. Comparative study of two contrast agents for intraoperative identification of sentinel lymph nodes in patients with early breast cancer. Gland Surg 2021; 10:1638-1645. [PMID: 34164308 DOI: 10.21037/gs-21-87] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The use of contrast-enhanced ultrasound (CEUS) to locate sentinel lymph nodes (SLNs) in breast cancer has been studied more and more in recent years. This prospective study aimed to compare periareolar injection of two different contrast agents, SonoVue® (SNV) and Sonazoid® (SNZ), followed by CEUS to identify SLNs in breast cancer patients with clinically negative nodes. Methods A total of 205 patients with T1-2N0M0 breast cancer were divided into the SNV group and SNZ group. All were administered a periareolar injection of SNV or SNZ and underwent US to identify contrast-enhanced SLNs. Each contrast-enhanced SLN underwent a biopsy with blue dye and examined again by CEUS in vitro. Results In all cases, contrast-enhanced lymphatic vessels were clearly visualized using US soon after the periareolar injection of SNZ, and the SLNs were easily identified. The SLN identification rates were 75.27% (210/279) for SNV and 93.58% (102/109) for SNZ. Although the accuracy of detecting SLN metastasis was slightly different between the two groups, there was no statistically significant difference between those groups (P=0.615). Moreover, it was possible to identify SLNs in vitro in the SNZ group, and these could be compared with the lymph nodes (LNs) located using SNZ during the preoperative stage and with blue dye during the procedure. This helped in determining the resection requirements. Conclusions When comparing the subdermal use of SNV and SNZ, no significant differences in the number of detected SLNs and the diagnosis of metastatic LNs were observed. Because SLNs can be detected for a longer time in living tissues with SNZ, this contrast agent may provide more intraoperative information for complete resection of all preoperative localization of SLN.
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Affiliation(s)
- Yan Sun
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Shunmin Wang
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Tan Shi
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Yunxia Hao
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Yutao Lei
- Department of General Surgery, Peking University Third Hospital, Beijing, China
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Advanced Techniques in the Percutaneous Ablation of Liver Tumours. Diagnostics (Basel) 2021; 11:diagnostics11040585. [PMID: 33805107 PMCID: PMC8064108 DOI: 10.3390/diagnostics11040585] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/20/2021] [Accepted: 03/21/2021] [Indexed: 02/07/2023] Open
Abstract
Percutaneous ablation is an accepted treatment modality for primary hepatocellular carcinoma (HCC) and liver metastases. The goal of curative ablation is to cause the necrosis of all tumour cells with an adequate margin, akin to surgical resection, while minimising local damage to non-target tissue. Aside from the ablative modality, the proceduralist must decide the most appropriate imaging modality for visualising the tumour and monitoring the ablation zone. The proceduralist may also employ protective measures to minimise injury to non-target organs. This review article discusses the important considerations an interventionalist needs to consider when performing the percutaneous ablation of liver tumours. It covers the different ablative modalities, image guidance, and protective techniques, with an emphasis on new and advanced ablative modalities and adjunctive techniques to optimise results and achieve satisfactory ablation margins.
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Minami Y, Minami T, Ueshima K, Yagyu Y, Tsurusaki M, Okada T, Hori M, Kudo M, Murakami T. Three-Dimensional Radiological Assessment of Ablative Margins in Hepatocellular Carcinoma: Pilot Study of Overlay Fused CT/MRI Imaging with Automatic Registration. Cancers (Basel) 2021; 13:cancers13061460. [PMID: 33806751 PMCID: PMC8004695 DOI: 10.3390/cancers13061460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/06/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We investigate the feasibility of image fusion application for ablative margin assessment in radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and possible causes for a wrong initial evaluation of technical success through a side-by-side comparison. METHODS A total of 467 patients with 1100 HCCs who underwent RFA were reviewed retrospectively. Seventeen patients developed local tumor progressions (LTPs) (median size, 1.0 cm) despite initial judgments of successful ablation referring to contrast-enhanced images obtained in the 24 h after ablation. The ablative margins were reevaluated radiologically by overlaying fused images pre- and post-ablation. RESULTS The initial categorizations of the 17 LTPs had been grade A (absolutely curative) (n = 5) and grade B (relatively curative) (n = 12); however, the reevaluation altered the response categories to eight grade C (margin-zero ablation) and nine grade D (existence of residual HCC). LTP occurred in eight patients re-graded as C within 4 to 30.3 months (median, 14.3) and in nine patients re-graded as D within 2.4 to 6.7 months (median, 4.2) (p = 0.006). Periablational hyperemia enhancements concealed all nine HCCs reevaluated as grade D. CONCLUSION Side-by-side comparisons carry a risk of misleading diagnoses for LTP of HCC. Overlay fused imaging technology can be used to evaluate HCC ablative margin with high accuracy.
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Affiliation(s)
- Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (T.M.); (K.U.); (M.K.)
- Correspondence: ; Tel.: +81-72-366-0221 (ext. 3149); Fax: +81-72-367-2880
| | - Tomohiro Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (T.M.); (K.U.); (M.K.)
| | - Kazuomi Ueshima
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (T.M.); (K.U.); (M.K.)
| | - Yukinobu Yagyu
- Department of Radiology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (Y.Y.); (M.T.)
| | - Masakatsu Tsurusaki
- Department of Radiology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (Y.Y.); (M.T.)
| | - Takuya Okada
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan; (T.O.); (M.H.); (T.M.)
| | - Masatoshi Hori
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan; (T.O.); (M.H.); (T.M.)
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (T.M.); (K.U.); (M.K.)
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan; (T.O.); (M.H.); (T.M.)
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Minami Y, Kudo M. Image Guidance in Ablation for Hepatocellular Carcinoma: Contrast-Enhanced Ultrasound and Fusion Imaging. Front Oncol 2021; 11:593636. [PMID: 33747913 PMCID: PMC7973273 DOI: 10.3389/fonc.2021.593636] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022] Open
Abstract
The ultrasound (US) imaging technology, including contrast-enhanced US (CEUS) and fusion imaging, has experienced radical improvement, and advancement in technology thus overcoming the problem of poor conspicuous hepatocellular carcinoma (HCC). On CEUS, the presence or absence of enhancement distinguishes the viable portion from the ablative necrotic portion. Using volume data of computed tomography (CT) or magnetic resonance imaging (MRI), fusion imaging enhances the three-dimensional relationship between the liver vasculature and HCC. Therefore, CT/MR-US fusion imaging provides synchronous images of CT/MRI with real-time US, and US-US fusion imaging provides synchronous US images before and after ablation. Moreover, US-US overlay fusion can visualize the ablative margin because it focuses the tumor image onto the ablation zone. Consequently, CEUS and fusion imaging are helpful to identify HCC with little conspicuity, and with more confidence, we can perform ablation therapy. CEUS/fusion imaging guidance has improved the clinical effectiveness of ablation therapy in patients with poor conspicuous HCCs. Therefore; this manuscript reviews the status of CEUS/fusion imaging guidance in ablation therapy of poor conspicuous HCC.
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Affiliation(s)
- Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
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Jeon SK, Lee JY, Han JK. Superb microvascular imaging technology of ultrasound examinations for the evaluation of tumor vascularity in hepatic hemangiomas. Ultrasonography 2021; 40:538-545. [PMID: 33866773 PMCID: PMC8446495 DOI: 10.14366/usg.20177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/14/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose This study aimed to investigate and categorize the diverse features of hepatic hemangiomas on superb microvascular imaging (SMI) in a relatively large prospective study. Methods In this prospective study, 70 patients with 92 hepatic hemangiomas were consecutively enrolled. All nodules were radiologically confirmed with the typical imaging features of hepatic hemangiomas on dynamic computed tomography (CT) or magnetic resonance imaging (MRI). Using SMI, all lesions were evaluated and categorized into subgroups according to the flow pattern on SMI. Differences in the frequencies of SMI patterns according to lesion size and enhancement patterns on dynamic CT or MRI were also compared. Results In 67.4% (62/92) of hemangiomas, tumor vascularity was detected using SMI, while 32.6% (30/92) did not show any signal on the SMI examination, and the absence of an SMI signal was not shown in rapidly enhancing hemangiomas (0% [0/30] vs. 100% [30/30], P=0.002) and was more frequent in lesions <2 cm than in lesions ≥2 cm (44.0% [22/50] vs. 2.7% [8/42], P=0.011). In hepatic hemangiomas in which vascularity was detected (n=62), the strip rim pattern was the most common SMI pattern of hepatic hemangiomas (48.4%, 30/62), followed by the nodular rim pattern involving spotty dot-like engorged vessels (37.1%, 23/62). Conclusion The evaluation of the inner vascularity of hepatic hemangiomas with SMI was feasible for most hemangiomas, especially in larger (≥2 cm) or rapidly enhancing hemangiomas. The most frequent SMI patterns of hepatic hemangiomas were the strip rim pattern and nodular rim pattern.
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Affiliation(s)
- Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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Maruyama H, Yamaguchi T, Nagamatsu H, Shiina S. AI-Based Radiological Imaging for HCC: Current Status and Future of Ultrasound. Diagnostics (Basel) 2021; 11:diagnostics11020292. [PMID: 33673229 PMCID: PMC7918339 DOI: 10.3390/diagnostics11020292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a common cancer worldwide. Recent international guidelines request an identification of the stage and patient background/condition for an appropriate decision for the management direction. Radiomics is a technology based on the quantitative extraction of image characteristics from radiological imaging modalities. Artificial intelligence (AI) algorithms are the principal axis of the radiomics procedure and may provide various results from large data sets beyond conventional techniques. This review article focused on the application of the radiomics-related diagnosis of HCC using radiological imaging (computed tomography, magnetic resonance imaging, and ultrasound (B-mode, contrast-enhanced ultrasound, and elastography)), and discussed the current role, limitation and future of ultrasound. Although the evidence has shown the positive effect of AI-based ultrasound in the prediction of tumor characteristics and malignant potential, posttreatment response and prognosis, there are still a number of issues in the practical management of patients with HCC. It is highly expected that the wide range of applications of AI for ultrasound will support the further improvement of the diagnostic ability of HCC and provide a great benefit to the patients.
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Affiliation(s)
- Hitoshi Maruyama
- Department of Gastroenterology, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (H.N.); (S.S.)
- Correspondence: ; Tel.: +81-3-38133111; Fax: +81-3-56845960
| | - Tadashi Yamaguchi
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoicho, Inage, Chiba 263-8522, Japan;
| | - Hiroaki Nagamatsu
- Department of Gastroenterology, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (H.N.); (S.S.)
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; (H.N.); (S.S.)
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Hwang JA, Jeong WK, Min JH, Kim YY, Heo NH, Lim HK. Sonazoid-enhanced ultrasonography: comparison with CT/MRI Liver Imaging Reporting and Data System in patients with suspected hepatocellular carcinoma. Ultrasonography 2021; 40:486-498. [PMID: 33745266 PMCID: PMC8446493 DOI: 10.14366/usg.20120] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/15/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose The aim of this study was to evaluate the association of contrast-enhanced ultrasound (CEUS) features using Sonazoid for liver nodules with Liver Imaging Reporting and Data System (LI-RADS) categories and to identify the usefulness of Kupffer-phase images. Methods This retrospective study was conducted in 203 patients at high risk of hepatocellular carcinoma (HCC) who underwent CEUS with Sonazoid from 2013 to 2016. Nodule enhancement in the arterial, portal venous, late, and Kupffer phases; CEUS LI-RADS major features; and Kupffer-phase defects were evaluated. According to the computed tomography/magnetic resonance imaging (CT/MRI) LI-RADS v2018, all nodules were assigned an LR category (n=4/33/99/67 for LR-M/3/4/5) and comparisons across LR categories were made. We defined modified CEUS LI-RADS as using Kupffer-phase defects as an alternative to late and mild washout in CEUS LI-RADS and compared the diagnostic performance for HCC. Results On CEUS of 203 nodules, 89.6% of CT/MRI LR-5 and 85.9% of LR-4 nodules showed hyperenhancement in the arterial phase, while 57.6% of LR-3 nodules showed hyperenhancement. Among the CT/MRI LR-5 nodules that showed arterial phase hyperenhancement or isoenhancement, 59.7% showed hypoenhancing changes from the portal venous phase, 23.9% from the late phase, and 13.4% additionally in the Kupffer phase. The modified CEUS LI-RADS showed higher sensitivity than CEUS LI-RADS (83.2% vs. 74.2%, P=0.008) without compromising specificity (63.6% vs. 69.7%, P=0.500). Conclusion The Kupffer phase best shows hypoenhancing changes in LR-5 lesions and is expected to improve the sensitivity for HCC in high-risk patients.
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Affiliation(s)
- Jeong Ah Hwang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeun-Yoon Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Hun Heo
- Clinical Trial Center, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hyo Keun Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Marschner CA, Rübenthaler J, Froelich MF, Schwarze V, Clevert DA. Benefits of contrast-enhanced ultrasonography for interventional procedures. Ultrasonography 2020; 40:207-216. [PMID: 33530676 PMCID: PMC7994736 DOI: 10.14366/usg.20083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/19/2020] [Indexed: 12/14/2022] Open
Abstract
For evaluating unclear tumorous lesions, contrast-enhanced ultrasonography (CEUS) is an important imaging modality in addition to contrast-enhanced computed tomography and magnetic resonance imaging, and may provide valuable insights into the microvascularization of tumors in dynamic examinations. In interventional procedures, CEUS can make a valuable contribution in pre-, peri-, and post-interventional settings, reduce radiation exposure and, under certain circumstances, decrease the number of interventions needed for patients.
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Affiliation(s)
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - Matthias Frank Froelich
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Mannheim, Germany
| | - Vincent Schwarze
- Department of Radiology, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - Dirk-André Clevert
- Department of Radiology, University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
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Saito A, Yamamoto M, Katagiri S, Yamashita S, Nakano M, Morizane T. Early hemodynamics of hepatocellular carcinoma using contrast-enhanced ultrasound with Sonazoid: focus on the pure arterial and early portal phases. Glob Health Med 2020; 2:319-327. [PMID: 33330827 DOI: 10.35772/ghm.2020.01092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 12/13/2022]
Abstract
To clarify the early hemodynamics of hepatocellular carcinoma (HCC), we defined the early portal phase of contrast-enhanced ultrasound (CEUS) and examined the reliability of this modality for determining HCC differentiation. Starting in 2007, we performed Sonazoid CEUS in 146 pathologically confirmed hepatic nodules; 118 HCC (8 poorly [Pd], 73 moderately [Md] and 37 well-differentiated [Wd]) and 28 benign nodules. We focused on the pure arterial and early portal phases up to 45 seconds after Sonazoid injection, and then the subsequent phase up to 30 minutes. We calculated covariance-adjusted sensitivities for nodule enhancement combinations of these three phases. Nodule enhancements were divided into hypo, iso and hyper. A positive predictive value of 100% was obtained for the following patterns: iso-iso-hypo, hypo-iso-iso, and hypo-hypo-hypo for Wd, hyper-iso-hypo and hyper-hypo-hypo for Md, hypo-hyper-hypo for Pd, and hyper-hyper-hyper for benign nodules. In Wd HCC (early HCC), there were seven enhancement patterns, thought to be characterized by various hemodynamic changes from early to advanced HCC. Two patterns allowing a diagnosis of Wd HCC were hypo in the pure arterial phase. Subsequent iso-enhancement in the early portal phase indicated a portal blood supply. Decreased enhancement in the early portal phase allows a diagnosis of Md HCC. However, gradual enhancement observed from the pure arterial to the early portal phase allows a diagnosis of Pd HCC. Therefore, even in the early portal phase, hemodynamic changes were visible not only in Wd but also in Md and Pd HCC. In conclusion, with division of the early phase hemodynamics into pure arterial and early portal phases, CEUS can provide information useful for determining the likely degree of HCC differentiation and for distinguishing early stage HCC from benign nodules.
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Affiliation(s)
- Akiko Saito
- Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoshi Katagiri
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shingo Yamashita
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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