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Zhou J, Qin S, Cui R, Chen Y, Wang Y, Liu G. Outcomes of ultrasound-guided percutaneous ablation of >5 versus ≤ 5 colorectal liver metastases: a propensity score matching study. Int J Hyperthermia 2025; 42:2488128. [PMID: 40255153 DOI: 10.1080/02656736.2025.2488128] [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: 07/04/2024] [Revised: 03/28/2025] [Accepted: 03/30/2025] [Indexed: 04/22/2025] Open
Abstract
OBJECTIVES To investigate the effectiveness and safety of microwave ablation (MWA) in patients with 1-5 colorectal liver metastases (CRLM) versus those with 6-9 CRLM. METHODS Data from patients with 1-9 CRLM, who underwent ultrasound (US)-guided percutaneous MWA between January 2018 and May 2023, were retrospectively analyzed. Propensity score matching (PSM) at a ratio of 1:2 was used to balance potential bias between the groups. RESULTS Data from 264 patients were included in the analysis. After PSM, there were 43 and 75 patients in the CRLM >5 and ≤5 groups, respectively. Even with higher tumor burden and technical difficulty, there was no statistical difference in the local tumor progression (LTP)-free survival (LTPFS) between the groups (p > 0.05). Patients with an ablation margin (AM) ≤5 mm exhibited a significantly higher rate of LTP than those with AM >5 mm in both groups(p < 0.05). Patients with 6-9 CRLM experienced a higher incidence of intrahepatic recurrence (iHR) (p = 0.041) and shorter progression-free survival (PFS) at any site (p < 0.05). CRLM > 5 is an independent risk factor for poor PFS (p = 0.008). The minor complication rate was lower in the CRLM ≤ 5 group (p < 0.05) and the major complication rate showed no difference (p > 0.05). CONCLUSIONS When the number of CRLM was limited to 9, single-session MWA was feasible and safe for radical local treatment. An AM >5 mm was critical for local tumor control. Compared with patients with 1-5 CRLM, those with 6-9 CRLM experienced inferior PFS at any site, which mainly lies in more iHR.
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Affiliation(s)
- Jingwen Zhou
- Department of Medical Ultrasonics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Si Qin
- Department of Medical Ultrasonics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Cui
- Department of Medical Ultrasonics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yao Chen
- Department of Medical Ultrasonics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yimin Wang
- Department of Medical Ultrasonics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guangjian Liu
- Department of Medical Ultrasonics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Li L, Burgio MD, Fetzer DT, Ferraioli G, Lyshchik A, Meloni MF, Rafailidis V, Sidhu PS, Vilgrain V, Wilson SR, Zhou J. Contrast-Enhanced Ultrasound for Hepatocellular Carcinoma Diagnosis- AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2025. [PMID: 40434167 DOI: 10.2214/ajr.25.32813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2025]
Abstract
Despite growing clinical use of contrast-enhanced ultrasound (CEUS), inconsistency remains in the modality's role in clinical pathways for hepatocellular carcinoma (HCC) diagnosis and management. This AJR Expert Panel Narrative Review provides practical insights on the use of CEUS for the diagnosis of HCC across populations, including individuals at high risk for HCC, individuals with metabolic dysfunction-associated steatotic liver disease, and remaining individuals not at high risk for HCC. Considerations addressed with respect to high-risk patients include CEUS diagnostic criteria for HCC, use of CEUS for differentiating HCC from non-HCC malignancy, use of CEUS for small (≤2 cm) lesions, use of CEUS for characterizing occult lesions on B-mode ultrasound, and use of CEUS for indeterminate lesions on CT or MRI. Representative literature addressing the use of CEUS for HCC diagnosis as well as gaps in knowledge requiring further investigation are highlighted. Throughout these discussions, the article distinguishes two broad types of ultrasound contrast agents used for liver imaging: pure blood-pool agents and a combined blood-pool and Kupffer-cell agent. Additional topics include the use of CEUS for treatment response assessment after nonradiation therapies and implications of artificial intelligence technologies. The article concludes with a series of consensus statements from the author panel.
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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, Guangzhou, Guangdong 510060, China
| | - Marco Dioguardi Burgio
- Université Paris Cité, Inserm, Centre de recherche sur l'inflammation, F-75018 Paris, France
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 100 Boulevard du Général Leclerc, 92110 Clichy, France
| | - David T Fetzer
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, E6-230-BF, Dallas, TX 75390-9316, USA
| | - Giovanna Ferraioli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Campus della Salute c/o Policlinico San Matteo, Viale Golgi 19, Pavia, Italy
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Maria Franca Meloni
- Casa di Cura Villa Igea, Department of Interventional Ultrasound, Casa di Cura Igea, Milan, Italy
| | - Vasileios Rafailidis
- Department of Radiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul S Sidhu
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London UK; Department of Radiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London UK
| | - Valerie Vilgrain
- Université Paris Cité, Inserm, Centre de recherche sur l'inflammation, F-75018 Paris, France
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 100 Boulevard du Général Leclerc, 92110 Clichy, France
| | | | - 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, Guangzhou, Guangdong 510060, China
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Dong Y, Cheng J, Huang YL, Qiu YJ, Cao JY, Lu XY, Wang WP, Möller K, Dietrich CF. Characterization of non-alcoholic fatty liver disease-related hepatocellular carcinoma on contrast-enhanced ultrasound with Sonazoid. Ultrasonography 2025; 44:232-242. [PMID: 40200415 PMCID: PMC12081131 DOI: 10.14366/usg.24205] [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: 11/15/2024] [Revised: 03/05/2025] [Accepted: 03/13/2025] [Indexed: 04/10/2025] Open
Abstract
PURPOSE This study aimed to evaluate the contrast-enhanced ultrasound with Sonazoid (Sonazoid-CEUS) features of hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD). METHODS In this retrospective study, patients who underwent surgical resection and were histopathologically diagnosed with NAFLD or cirrhosis-related HCC were included. All patients received Sonazoid-CEUS examinations within 1 week prior to hepatic surgery. The enhancement patterns of HCC lesions were evaluated and compared between the two groups according to the current World Federation for Ultrasound in Medicine and Biology guidelines. Multivariate logistic regression analysis was used to assess the correlations between Sonazoid-CEUS enhancement patterns and clinicopathologic characteristics. RESULTS From March 2022 to April 2023, a total of 151 patients with HCC were included, comprising 72 with NAFLD-related HCC and 79 with hepatitis B virus (HBV) cirrhosis-related HCC. On Sonazoid-CEUS, more than half of the NAFLD-related HCCs exhibited relatively early and mild washout within 60 seconds (54.2%, 39/72), whereas most HBV cirrhosis-related HCCs displayed washout between 60 and 120 seconds (46.8%, 37/79) or after 120 seconds (39.2%, 31/79) (P<0.001). In the patients with NAFLD-related HCC, multivariate analysis revealed that international normalized ratio (odds ratio [OR], 0.002; 95% confidence interval [CI], 0.000 to 0.899; P=0.046) and poor tumor differentiation (OR, 21.930; 95% CI, 1.960 to 245.319; P=0.012) were significantly associated with washout occurring within 60 seconds. CONCLUSION Characteristic Sonazoid-CEUS features are useful for diagnosing HCC in patients with NAFLD.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juan Cheng
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun-Lin Huang
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Jie Qiu
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia-Ying Cao
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiu-Yun Lu
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kathleen Möller
- Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany
| | - Christoph F. Dietrich
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem and Permanence, Bern, Switzerland
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Möller K, Görg C, Krix M, Jenssen C, Dong Y, Cui XW, Dietrich CF. Washout on Contrast-Enhanced Ultrasound of Benign Focal Liver Lesions-A Review on Its Frequency and Possible Causes. Diagnostics (Basel) 2025; 15:998. [PMID: 40310346 PMCID: PMC12025567 DOI: 10.3390/diagnostics15080998] [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: 03/03/2025] [Revised: 04/07/2025] [Accepted: 04/10/2025] [Indexed: 05/02/2025] Open
Abstract
In all imaging methods, including contrast-enhanced ultrasound (CEUS), enhancement in the late phase (LP) is an important criterion for differentiating between benign and malignant focal liver lesions (FLLs). In general, malignant liver lesions are characterized by hypoenhancement and washout in the LP. A lesion with LP hyperenhancement or isoenhancement in the non-cirrhotic liver is usually benign. However, LP hypoenhancement in benign lesions is not so rare, and is even normal and the standard for some lesions, and there are exceptions for each tumor entity that can represent a diagnostic challenge. Knowing these contrast patterns and exceptions is key for correct diagnosis and patient management. The following narrative review describes the contrast behaviors and the frequency of washout and LP hypoenhancement for common as well as rare benign liver lesions and analyzes its causes.
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Affiliation(s)
- Kathleen Möller
- Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, 10365 Berlin, Germany;
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35037 Marburg, Germany;
| | - Martin Krix
- Global Medical & Regulatory Affairs, Bracco Imaging, 78467 Konstanz, Germany;
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland, 15344 Strausberg, Germany;
- Brandenburg Institute for Clinical Ultrasound (BICUS) at Brandenburg Medical University, 16816 Neuruppin, Germany
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200082, China;
| | - Xin-Wu Cui
- Medical Ultrasound, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China;
| | - Christoph F. Dietrich
- Department General Internal Medicine (DAIM), Hospitals Hirslanden Bern Beau Site, Salem and Permanence, 3013 Bern, Switzerland
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Elgenidy A, Saad K, Ibrahim R, Sherif A, Elmozugi T, Darwish MY, Abbas M, Othman YA, Elshimy A, Sheir AM, Khattab DH, Helal AA, Tawadros MM, Abuel-naga O, Abdel-Rahman HI, Gamal DA, Elhoufey A, Dailah HG, Metwally RA, ElBazzar N, Serhan HA. Diagnostic Accuracy of Sonazoid-Enhanced Ultrasonography for Detection of Liver Metastasis. Med Sci (Basel) 2025; 13:42. [PMID: 40265389 PMCID: PMC12015772 DOI: 10.3390/medsci13020042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Revised: 03/28/2025] [Accepted: 04/02/2025] [Indexed: 04/24/2025] Open
Abstract
PURPOSE To evaluate the potential clinical role and reliability of Sonazoid-enhanced ultrasound (SEUS) as a diagnostic tool for liver metastatic lesions. METHODS An extensive literature search was conducted across five electronic databases, PubMed, Scopus, Embase, Cochrane Library, and Web of Science, from their inception up to January 2024 to identify all studies evaluating the use of Sonazoid-enhanced ultrasonography for detecting hepatic metastases. A meta-analysis was performed to assess diagnostic accuracy using the Meta-DiSc 2.0 software. RESULTS A total of 31 studies were included, 16 of which were eligible for meta-analysis and diagnostic test accuracy evaluation. A total of 13 studies in the meta-analysis evaluated the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) for 1347 metastatic and 1565 non-metastatic liver lesions. The pooled sensitivity and specificity for CEUS were 0.88 (95% CI: 0.82-0.92) and 0.92 (95% CI: 0.84-0.96), respectively. The combined positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 11.89 (95% CI: 5.42-26.09), 0.12 (95% CI:0.08-0.19), and 91.99 (95% CI: 32.15-263.17), respectively. Additionally, four studies of the meta-analysis assessed the diagnostic performance of contrast-enhanced intraoperative sonography (CE-IOUS) in detecting 664 metastatic and 246 non-metastatic liver lesions. The pooled sensitivity and specificity for CE-IOUS were 0.93 (95% CI: 0.82-0.97) and 0.84 (95% CI: 0.65-0.93), respectively. The aggregated positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated as 5.95 (95% CI: 2.32-15.25), 0.07 (95% CI: 0.02-0.24), and 77.68 (95% CI: 10.33-583.86), respectively. CONCLUSIONS CE-IOUS and CEUS are reliable approaches for diagnosing liver metastatic lesions. CE-IOUS, in particular, exhibits higher accuracy in identifying liver metastatic lesions, indicating its potential effectiveness in clinical practice.
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Affiliation(s)
- Anas Elgenidy
- Faculty of Medicine, Cairo University, Cairo 12613, Egypt
| | - Khaled Saad
- Pediatric Department, Faculty of Medicine, Assiut University, Assiut 71516, Egypt
| | - Reda Ibrahim
- Faculty of Medicine, Cairo University, Cairo 12613, Egypt
| | - Aya Sherif
- Faculty of Medicine, Beni Suef University, Beni Suef 62511, Egypt
| | - Taher Elmozugi
- Faculty of Medicine, Benghazi University, Benghazi 18251, Libya
| | | | - Mahmoud Abbas
- Department of Radiology, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA
| | | | | | - Alyaa M. Sheir
- Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | | | | | | | - Osama Abuel-naga
- Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Hazem I. Abdel-Rahman
- Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
| | - Doaa Ali Gamal
- Clinical Oncology Department, Faculty of Medicine, Assiut University, Assiut 71516, Egypt
| | - Amira Elhoufey
- Department of Community Health Nursing, Alddrab University College, Jazan University, Jazan 45142, Saudi Arabia
- Department of Community Health Nursing, Faculty of Nursing, Assiut University, Assiut 71111, Egypt
| | - Hamad Ghaleb Dailah
- Research and Scientific Studies Unit, College of Nursing, Jazan University, Jazan 45142, Saudi Arabia
| | - Rami A. Metwally
- Department of Internal Medicine, Benha University, Benha 13511, Egypt
| | - Noran ElBazzar
- Department of Internal Medicine, Benha University, Benha 13511, Egypt
| | - Hashem Abu Serhan
- Department of Ophthalmology, Hamad Medical Corporation, Doha 3050, Qatar
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Lin C, Yang XH, Zhai HY, Zhu XY, Zhou GM. LI-RADS for diagnosing hepatocellular carcinoma by contrast-enhanced US with SonoVue and Sonazoid-a single center prospective study. Abdom Radiol (NY) 2025:10.1007/s00261-025-04881-4. [PMID: 40116886 DOI: 10.1007/s00261-025-04881-4] [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: 12/11/2024] [Revised: 02/28/2025] [Accepted: 03/03/2025] [Indexed: 03/23/2025]
Abstract
PURPOSE To compare the diagnostic performance of two algorithms for HCC diagnosis: SonoVue-CEUS based on CEUS LI-RADS version 2017 and a modified algorithm incorporating Kupffer-phase findings for Sonazoid-CEUS. METHODS This single center prospective study enrolled high-risk patients for HCC. Each participant underwent SonoVue-CEUS and Sonazoid-CEUS. Each liver observation was assigned two LI-RADS categories according to each algorithm: SonoVue-CEUS LI-RADS and modified Sonazoid-CEUS LI-RADS. For the latter method, observations at least 10 mm with non-rim 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. RESULTS Overall, 66 patients (mean age, 61.2 years ± 10.9; 54 male patients, 12 female patients) with 66 observations (mean size, 31 mm ± 16) were eventually enrolled. The results of Sonazoid-CEUS LI-RADS showed significant changes in sensitivity (82% vs. 65%, p < 0.001), accuracy (85% vs. 71%, p < 0.001) compared with the SonoVue-CEUS LI-RADS. There was no significant difference in specificity (93% vs. 87%, p = 0.26). CONCLUSION When incorporating Kupffer-phase findings, Sonazoid-CEUS LI-RADS had higher sensitivity without loss of specificity compared with SonoVue-CEUS LI-RADS.
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Affiliation(s)
- Chen Lin
- Tianjin Medical University General Hospital, Tianjin, China
| | - Xiao-Huan Yang
- Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Hong-Yan Zhai
- Tianjin Medical University General Hospital, Tianjin, China
| | - Xin-Yuan Zhu
- Tianjin Medical University General Hospital, Tianjin, China.
| | - Gui-Ming Zhou
- Tianjin Medical University General Hospital, Tianjin, China.
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Hawley J, Tang Y, Sjöström A, Fuentes-Alburo A, Tranquart F. The Clinical Utility of Liver-Specific Ultrasound Contrast Agents During Hepatocellular Carcinoma Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2025; 51:415-427. [PMID: 39674715 DOI: 10.1016/j.ultrasmedbio.2024.10.011] [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: 06/12/2024] [Revised: 10/17/2024] [Accepted: 10/21/2024] [Indexed: 12/16/2024]
Abstract
Hepatocellular carcinoma (HCC) is the most common form of hepatic malignancy, with high mortality rates recorded globally. Early detection through clinical biomarkers, medical imaging and histological assessment followed by rapid intervention are integral for positive patient outcomes. Although contrast-enhanced computed tomography scans and magnetic resonance imaging are recognised as the reference standard for the diagnosis and staging of HCC in international guidelines, ultrasound (US) examination is recommended as a screening tool for patients at risk. Contrast-enhanced US (CEUS) elevates the standard of an US examination using US contrast agents (UCAs), capable of diagnosing focal liver lesions with high efficacy. Most UCAs are purely intravascular, offering clinicians a dynamic representation of a lesions' arterial phase vascular kinetics, which is seldom seen in such detail during computed tomography or magnetic resonance imaging assessments. Despite its benefits, there is incongruity between international societies on the role of CEUS in the HCC clinical pathway. The transient nature of pure blood-pool agents is suggested to be insufficient to justify CEUS as a primary modality due to the inability to consistently perform whole liver imaging, alongside disputes regarding its capabilities to differentiate HCC from intrahepatic cholangiocarcinoma. A sinusoidal phase UCA affords clinicians the opportunity to perform whole liver imaging through Kupffer cell uptake in addition to visualising lesion vascular kinetics in the arterial and portal venous phases. Therefore, the purpose of this review was to examine the role of CEUS in the HCC clinical pathway in its current practice and observe how a Kupffer cell sinusoidal phase UCA may supplement contemporary diagnostic techniques through a multi-modality, multi-agent approach.
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Affiliation(s)
- Joshua Hawley
- GE HealthCare Pharmaceutical Diagnostics, Chalfont St. Giles, UK; Chesterfield Royal Hospital Foundation NHS Trust, Chesterfield, UK.
| | - Yongqing Tang
- GE HealthCare Pharmaceutical Diagnostics, Chalfont St. Giles, UK
| | - Anders Sjöström
- GE HealthCare Pharmaceutical Diagnostics, Chalfont St. Giles, UK
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Snipstad S, Einen C, Kastellet AB, Fernandez JL, Mühlenpfordt M, Kurbatskaya A, Årseth C, Berg S, Bjørkøy A, Davies CDL. Ultrasound and Microbubble-Induced Reduction of Functional Vasculature Depends on the Microbubble, Tumor Type and Time After Treatment. ULTRASOUND IN MEDICINE & BIOLOGY 2025; 51:33-42. [PMID: 39389855 DOI: 10.1016/j.ultrasmedbio.2024.09.003] [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: 05/14/2024] [Revised: 08/15/2024] [Accepted: 09/05/2024] [Indexed: 10/12/2024]
Abstract
OBJECTIVE Ultrasound in combination with microbubbles can enhance accumulation and improve the distribution of various therapeutic agents in tumor tissue, leading to improved efficacy. Understanding the impact of treatment on the tumor microenvironment, concurrently with how microenvironment attributes affect treatment outcome, will be important for selecting appropriate patient cohorts in future clinical trials. The main aim of this work was to investigate the influence of ultrasound and microbubbles on the functional vasculature of cancer tissue. METHODS Four different tumor models in mice (bone, pancreatic, breast and colon cancer) were characterized with respect to vascular parameters using contrast-enhanced ultrasound imaging. The effect of treatment with microbubbles and ultrasound was then investigated using immunohistochemistry and confocal microscopy, quantifying the total amount of vasculature and fraction of functional vessels. Two different microbubbles were used, the clinical contrast agent SonoVue and the large bubbles generated by Acoustic Cluster Therapy (ACT), tailored for therapeutic purposes. RESULTS The colon cancer model displayed slower flow but a higher vascular volume than the other models. The pancreatic model showed the fastest flow but also the lowest vascular volume. Ultrasound and SonoVue transiently reduced the amount of functional vasculature in breast and colon tumors immediately after treatment. No reduction was observed for ACT, likely due to shorter ultrasound pulses and lower pressures applied. CONCLUSION Variation between tumor models due to tissue characteristics emphasizes the importance of evaluating treatment suitability in the specific tissue of interest, as altered perfusion could have a large impact on drug delivery and therapeutic outcome.
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Affiliation(s)
- Sofie Snipstad
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway; Cancer Clinic, St. Olav's Hospital, Trondheim, Norway.
| | - Caroline Einen
- Porelab and Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andrea Berge Kastellet
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jessica Lage Fernandez
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Melina Mühlenpfordt
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna Kurbatskaya
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Charlotte Årseth
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigrid Berg
- Department of Health Research, SINTEF Digital, Trondheim, Norway
| | - Astrid Bjørkøy
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
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Li X, Huang Y, Jiang T, Luo H, Dong X, Zhuo T, Cheng W, Zhang X, Che Y, Zhang B, Jiang X, Liu R, Zhang J, Liang P. The ability of contrast-enhanced ultrasound with Sonazoid to differentiate endometrial carcinoma from benign endometrial lesions: A preliminary, prospective, and multicenter clinical study. J Cancer Res Ther 2024; 20:2066-2073. [PMID: 39792417 DOI: 10.4103/jcrt.jcrt_203_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 10/15/2024] [Indexed: 01/12/2025]
Abstract
OBJECTIVE To examine the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) with Sonazoid (Sonazoid-CEUS) for endometrial lesions. METHODS In this prospective and multicenter study, data were collected from 84 patients with endometrial lesions from 11 hospitals in China. All the patients received a conventional US and Sonazoid-CEUS examination. The lesion characteristics based on US and Sonazoid-CEUS imaging were collected from the case report forms. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were determined using histopathologic diagnosis as the gold standard. RESULTS Of the 79 patients included, 29 were diagnosed with benign lesions and 50 with endometrial carcinoma (EC). The accuracy, sensitivity, specificity, PPV, and NPV for Sonazoid-CEUS and US at differentiating EC from benign endometrial lesions were 82.2%, 94%, 62.1%, 81.0%, and 85.7%, and 79.7%, 96%, 51.7%, 92.3%, and 88.2%, respectively, with no significant differences observed for any of the values. For Sonazoid-CEUS, the best delineators of EC versus benign lesions were early enhancement and hyperenhancement (74% vs 53.3%, P = 0.029, 68% vs 45%, P < 0.001), and lesion size enlargement (76% vs 48%, P = 0.001). Despite finding no significant difference in the enhancement patterns (P = .367), a faster wash-in pattern with the contrast agent entering before the surrounding myometrium was more common in the EC vs benign cases (92% vs 48.3%). CONCLUSIONS Sonazoid-CEUS has higher accuracy, specificity, and comparable sensitivity for differentiating EC from benign endometrial lesions compared with conventional US. It provides complementary hemodynamics information reflective of tissue vascularization, which may improve the overall diagnostic efficiency.
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Affiliation(s)
- Xin Li
- Department of Interventional Ultrasound, Fifth Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ying Huang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Tianan Jiang
- Department of Ultrasound Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hong Luo
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Sichuan, China
| | - Xuejuan Dong
- Department of Interventional Ultrasound, Fifth Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Tao Zhuo
- Department of Intervention, Yulin First people's Hospital, Yulin, Guangxi, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xinling Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ying Che
- Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Yinchuan, Ningxia, China
| | - Bingsong Zhang
- Department of Ultrasound, Eighth Medical Centre of Chinese People's Liberation Army General Hospital, Yinchuan, Ningxia, China
| | - Xue Jiang
- Department of Ultrasound, Fourth Medical Center of Chinese People's Liberation Army General Hospital, Yinchuan, Ningxia, China
| | - Rui Liu
- Department of Ultrasound, Eighth Medical Centre of Chinese People's Liberation Army General Hospital, Yinchuan, Ningxia, China
| | - Jing Zhang
- Department of Interventional Ultrasound, Fifth Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Fifth Center of Chinese People's Liberation Army General Hospital, Beijing, China
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Luo Y, Huang Q, Wen D, Yan J, Liu F, Qiao L. Review of Clinical Applications of Sonazoid Ultrasound Contrast for Liver Evaluation. Ultrasound Q 2024; 40:e00692. [PMID: 39293387 DOI: 10.1097/ruq.0000000000000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Abstract
ABSTRACT Sonazoid is a new ultrasound contrast agent with unique Kupffer phase imaging advantages and high mechanical index stability. This paper introduces the basic theories and advantages of Sonazoid ultrasound. Then, the application and latest advances of Sonazoid in the diagnosis and treatment of liver diseases are reviewed in detail. In addition, the advantages and disadvantages of Sonazoid ultrasound and its future directions are discussed. Sonazoid is expected to become an important tool for clinical ultrasound diagnosis and treatment.
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Affiliation(s)
| | | | - Danlin Wen
- Department of Ultrasound, Sichuan Integrative Medicine Hospital, Chengdu, China
| | - Jiaojun Yan
- Department of Ultrasound, Sichuan Integrative Medicine Hospital, Chengdu, China
| | - Fangqin Liu
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Kim H, Kim JH, Lee JM. A Comparative Study of SonoVue and Sonazoid for Contrast-Enhanced Ultrasound CT/MRI Fusion Guidance During Radiofrequency Ablation of Poorly Visualized Hepatic Malignancies: A Prospective Intra-Individual Analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1879-1884. [PMID: 39306481 DOI: 10.1016/j.ultrasmedbio.2024.08.014] [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: 06/25/2024] [Revised: 07/31/2024] [Accepted: 08/17/2024] [Indexed: 10/21/2024]
Abstract
PURPOSE This study aimed to evaluate the effectiveness of two contrast agents, SonoVue (SV) and Sonazoid (SZ), by comparing them intra-individually in contrast-enhanced ultrasound (CEUS)-CT/MRI fusion imaging (FI) to improve the visibility of inconspicuous liver malignancies on B-mode sonography for guiding percutaneous radiofrequency ablation (RFA). Additionally, the radiologists' preference between SonoVue- CT/MRI FI (SV-FI) and Sonazoid-CT/MRI FI (SZ-FI) was determined. METHODS This prospective study enrolled 23 patients with inconspicuous hepatic malignancies (≤ 3 cm) on B-mode US who underwent both SV-FI and SZ-FI for RFA guidance. The patients underwent real-time CEUS FI with CT/MRI on the same day, utilizing both SV and SZ with at least 15-min intervals. Tumor visibility and radiologists' preferences were assessed and graded using a 4-point scale during the dynamic phases of both SV-FI and SZ-FI and the Kupffer phase of SZ-FI. RESULTS The tumor visibility scores obtained from CEUS-CT/MRI FI were significantly better than those obtained from US-FI. Indeed, SV-FI and SZ-FI demonstrated comparable visibility scores when corresponding phases were compared (p > 0.05). However, the Kupffer phase images of SZ-FI displayed superior visibility scores (3.70 ± 0.56 vs. 2.96 ± 0.88; p = 0.002) than the late vascular phase images of SV-FI. The radiologists favored SZ-FI in many cases, exhibiting moderate inter-observer agreement (Kappa value = 0.587; 95% CI, 0.403-0.772). CONCLUSION Although CEUS-CT/MRI FI with either SV or SZ substantially improved the visibility of inconspicuous tumors on US-CT/MRI FI, radiologists preferred SZ to SV to guide the RFA procedure.
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Affiliation(s)
- HeeSoo Kim
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Jongno-gu, Seoul, Republic of Korea.
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12
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Lu YB, Huang YN, Weng YC, Chiang TY, Fang TK, Chen WT, Lee JC. Contrast-enhanced ultrasonography guidance avoids US-CT/MR fusion error for percutaneous radiofrequency ablation of hepatocellular carcinoma. BMC Med Imaging 2024; 24:323. [PMID: 39609743 PMCID: PMC11605966 DOI: 10.1186/s12880-024-01508-w] [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: 07/21/2024] [Accepted: 11/20/2024] [Indexed: 11/30/2024] Open
Abstract
BACKGROUND This study evaluated the impact of contrast-enhanced ultrasonography (CEUS) combined with CT or MRI fusion imaging on percutaneous radiofrequency ablation (RFA) outcomes for hepatocellular carcinoma (HCC) inconspicuous on conventional ultrasonography (US). METHODS Patients were categorized into US-inconspicuous (USI) and US-conspicuous (USC) groups based on US imaging. The parameters of viable HCCs ⎯ including diameter, location, and RFA efficacy ⎯ were compared between USI and USC groups. Moreover, the breathing fusion imaging errors were measured. The differences in technical success, technical efficacy, local tumor progression, new tumor occurrence, and overall survival rate between USI and USC groups were analyzed. RESULTS Sixty-five patients with 106 lesions were included. CEUS showed high consistency with CT/MRI but revealed larger diameters (p < 0.001) and more feeding arteries (p = 0.019) than CT/MRI. Breathing fusion imaging errors averaged 17 ± 4 mm, significantly affecting lesions in segments II, III, V, and VI (p < 0.001). The USI group had more lesions ablated per patient in a single RFA procedure (p = 0.001) than the USC group. No significant differences were observed in technical success rate, technical efficacy rate, local tumor progression rate, and overall survival rate between the two groups. CONCLUSIONS CEUS combined with fusion imaging provides detailed information on viable HCCs and their feeding arteries. CEUS-guided RFA avoids fusion imaging errors and achieves comparable efficacy in both US-conspicuous and US-inconspicuous HCCs.
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Affiliation(s)
- Yang-Bor Lu
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
| | - Yung-Ning Huang
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
| | - Yu-Chieh Weng
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
| | - Tung-Ying Chiang
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
| | - Ta-Kai Fang
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
| | - Wei-Ting Chen
- Department of Digestive Disease, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China
- Department of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jung-Chieh Lee
- Department of Ultrasound, Xiamen Chang Gung Hospital Hua Qiao University, Xiamen, China.
- Xiamen Chang Gung Hospital, No. 123 Xiafei Road, Haicang District, Xiamen, Fujian, 361028, China.
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Huang Z, Zhu RH, Li SS, Luo HC, Li KY. Diagnostic performance of Sonazoid-enhanced CEUS in identifying definitive hepatocellular carcinoma in cirrhotic patients according to KLCA-NCC 2022 and APASL 2017 guidelines. Insights Imaging 2024; 15:263. [PMID: 39480596 PMCID: PMC11528081 DOI: 10.1186/s13244-024-01838-x] [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: 05/15/2024] [Accepted: 10/05/2024] [Indexed: 11/02/2024] Open
Abstract
OBJECTIVE This study aims to assess the diagnostic performance of Sonazoid-contrast-enhanced ultrasound (CEUS) in identifying definitive HCC within hepatic nodules in cirrhotic patients, comparing the KLCA-NCC 2022 and APASL 2017 diagnostic guidelines. MATERIALS AND METHODS This retrospective study analyzed cirrhotic patients who underwent Sonazoid-CEUS for liver lesion evaluation between October 2019 and October 2023. HCC diagnosis was based on the KLCA-NCC 2022 and APASL 2017 guidelines. Inter-reader agreement on CEUS imaging features and the diagnostic accuracy of the guidelines were evaluated. Sensitivity and specificity comparisons were made using McNemar's test. RESULTS Among 400 patients with 432 lesions, CEUS showed excellent inter-reader consistency in detecting arterial phase hyperenhancement and Kupffer defects. The KLCA-NCC 2022 criteria notably enhanced sensitivity to 96.2%, with specificity and accuracy of 93.8% and 95.8%, respectively. APASL 2017 achieved the highest sensitivity at 97.8%, although specificity dropped to 46.9%, resulting in an accuracy of 90.3%. The KLCA-NCC 2022 guidelines demonstrated significantly higher specificity than APASL 2017 (p < 0.001), while APASL 2017 exhibited the highest sensitivity at 97.8%. Notably, the KLCA-NCC 2022 guidelines also demonstrated an impressive positive predictive value of 98.9%. CONCLUSION Sonazoid-enhanced CEUS, particularly when applied using the KLCA-NCC 2022 guidelines, is an effective diagnostic tool for HCC. CRITICAL RELEVANCE STATEMENT Perfluorobutane CEUS, particularly in accordance with the KLCA-NCC 2022 guidelines, emerges as a valuable adjunct for diagnosing HCC in cirrhotic patients. It demonstrates superior positive predictive value and specificity compared to APASL 2017, underscoring its potential as an effective diagnostic tool. KEY POINTS Contrast-enhanced (CE)US using Sonazoid with KLCA-NCC 2022 guidelines is highly effective for HCC diagnosis. KLCA-NCC 2022 criteria showed high accuracy, 96.2% sensitivity, and 98.9% PPV. CEUS demonstrated excellent inter-reader consistency in detecting arterial phase hyperenhancement and Kupffer defects.
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Affiliation(s)
- Zhe Huang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Rong-Hua Zhu
- Institute of Hepato-Pancreato-Biliary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, China
| | - Shan-Shan Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hong-Chang Luo
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Kai-Yan Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Shen Q, Wu W, Wang R, Zhang J, Liu L. A non-invasive predictive model based on multimodality ultrasonography images to differentiate malignant from benign focal liver lesions. Sci Rep 2024; 14:23996. [PMID: 39402127 PMCID: PMC11473797 DOI: 10.1038/s41598-024-74740-7] [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: 07/11/2024] [Accepted: 09/30/2024] [Indexed: 10/17/2024] Open
Abstract
We have developed a non-invasive predictive nomogram model that combines image features from Sonazoid contrast-enhanced ultrasound (SCEUS) and Sound touch elastography (STE) with clinical features for accurate differentiation of malignant from benign focal liver lesions (FLLs). This study ultimately encompassed 262 patients with FLLs from the First Hospital of Shanxi Medical University, covering the period from March 2020 to April 2023, and divided them into training set (n = 183) and test set (n = 79). Logistic regression analysis was used to identify independent indicators and develop a predictive model based on image features from SCEUS, STE, and clinical features. The area under the receiver operating characteristic (AUC) curve was determined to estimate the diagnostic performance of the nomogram with CEUS LI-RADS, and STE values. The C-index, calibration curve, and decision curve analysis (DCA) were further used for validation. Multivariate and LASSO logistic regression analyses identified that age, ALT, arterial phase hyperenhancement (APHE), enhancement level in the Kupffer phase, and Emean by STE were valuable predictors to distinguish malignant from benign lesions. The nomogram achieved AUCs of 0.988 and 0.978 in the training and test sets, respectively, outperforming the CEUS LI-RADS (0.754 and 0.824) and STE (0.909 and 0.923) alone. The C-index and calibration curve demonstrated that the nomogram offers high diagnostic accuracy with predicted values consistent with actual values. DCA indicated that the nomogram could increase the net benefit for patients. The predictive nomogram innovatively combining SCEUS, STE, and clinical features can effectively improve the diagnostic performance for focal liver lesions, which may help with individualized diagnosis and treatment in clinical practice.
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Affiliation(s)
- Qianqian Shen
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, 030001, China
- Department of Ultrasound Intervention, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Wei Wu
- Department of Anorectal Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, 030001, China
| | - Ruining Wang
- Department of Ultrasound Intervention, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Jiaqi Zhang
- Department of Ultrasound Intervention, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030001, China
| | - Liping Liu
- Department of Ultrasound Intervention, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030001, China.
- Department of Ultrasound Intervention, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030001, China.
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Ito T, Manabe H, Kubota M, Komoike Y. Current status and future perspectives of contrast-enhanced ultrasound diagnosis of breast lesions. J Med Ultrason (2001) 2024; 51:611-625. [PMID: 39174799 PMCID: PMC11499542 DOI: 10.1007/s10396-024-01486-0] [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: 03/27/2024] [Accepted: 06/28/2024] [Indexed: 08/24/2024]
Abstract
Advances in various imaging modalities for breast lesions have improved diagnostic capabilities not only for tumors but also for non-tumorous lesions. Contrast-enhanced ultrasound (CEUS) plays a crucial role not only in the differential diagnosis of breast lesions, identification of sentinel lymph nodes, and diagnosis of lymph node metastasis but also in assessing the therapeutic effects of neoadjuvant chemotherapy (NAC). In CEUS, two image interpretation approaches, i.e., qualitative analysis and quantitative analysis, are employed and applied in various clinical settings. In this paper, we review CEUS for breast lesions, including its various applications.
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Affiliation(s)
- Toshikazu Ito
- Division of Breast and Endocrine Surgery and Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan.
| | - Hironobu Manabe
- Division of Breast and Endocrine Surgery and Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Michiyo Kubota
- Division of Breast and Endocrine Surgery and Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yoshifumi Komoike
- Division of Breast and Endocrine Surgery and Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
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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; 49:3427-3437. [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] [MESH Headings] [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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Han S, Sung PS, Park SY, Kim JW, Hong HP, Yoon JH, Chung DJ, Kwon JH, Lim S, Kim JH, Shin SK, Kim TH, Lee DH, Choi JY, Association RCOTKLC. Local Ablation for Hepatocellular Carcinoma: 2024 Expert Consensus-Based Practical Recommendations of the Korean Liver Cancer Association. Gut Liver 2024; 18:789-802. [PMID: 39223081 PMCID: PMC11391139 DOI: 10.5009/gnl240350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
Local ablation for hepatocellular carcinoma, a non-surgical option that directly targets and destroys tumor cells, has advanced significantly since the 1990s. Therapies with different energy sources, such as radiofrequency ablation, microwave ablation, and cryoablation, employ different mechanisms to induce tumor necrosis. The precision, safety, and effectiveness of these therapies have increased with advances in guiding technologies and device improvements. Consequently, local ablation has become the first-line treatment for early-stage hepatocellular carcinoma. The lack of organized evidence and expert opinions regarding patient selection, preprocedure preparation, procedural methods, swift post-treatment evaluation, and follow-up has resulted in clinicians following varied practices. Therefore, an expert consensus-based practical recommendation for local ablation was developed by a group of experts in radiology and hepatology from the Research Committee of the Korean Liver Cancer Association in collaboration with the Korean Society of Image-Guided Tumor Ablation to provide useful information and guidance for performing local ablation and for the pre- and post-treatment management of patients.
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Affiliation(s)
- Seungchul Han
- Department of Radiology, Samsung Medical Center, Seoul, Korea
| | - Pil Soo Sung
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Young Park
- Department of Internal Medicine, Kyungpook National University Hospital, College of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Woong Kim
- Department of Radiology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Hee Yoon
- Department of Radiology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong Jin Chung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Ho Kwon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sanghyeok Lim
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Kak Shin
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Tae Hyung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Young Choi
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Han J, Lin M, Lin Q, Guo R, Liao Y, Wu Z, Ye Y, Guo Z, Yao K, Li L, Zhou J. Development and Validation of a Contrast-Enhanced US VI-RADS for Evaluating Muscle Invasion in Bladder Cancer. Radiology 2024; 312:e232815. [PMID: 39254448 DOI: 10.1148/radiol.232815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Background Contrast-enhanced US (CEUS) can be used preoperatively for evaluating muscle invasion in bladder cancer, which is important for determining appropriate treatment. However, diagnostic criteria for assessing this at CEUS have not been standardized. Purpose To develop and validate a CEUS Vesical Imaging Reporting and Data System (VI-RADS) for evaluating muscle invasion in bladder cancer. Materials and Methods This single-center prospective study consecutively enrolled patients with suspected bladder cancer. Participants underwent transabdominal or intracavity CEUS between July 2021 and May 2023. Participants were divided into a training set and a validation set at a 2:1 ratio based on the chronologic order of enrollment. The training set was used to identify major imaging features to include in CEUS VI-RADS, and the likelihood of muscle invasion per category was determined using a pathologic reference standard. The optimal VI-RADS category cutoff for muscle invasion was determined with use of the maximum Youden index. The validation set was assessed by novice and expert readers and used to validate the diagnostic performance and interreader agreement of the developed system. Results Overall, 126 participants (median age, 64 years [IQR, 57-71 years]; 107 male) and 67 participants (median age, 64 years [IQR, 56-69 years]; 49 male) were included in the training and validation set, respectively. In the training set, the optimal CEUS VI-RADS category cutoff for muscle invasion was VI-RADS 4 or higher (Youden index, 0.77). In the validation set, CEUS VI-RADS achieved good performance for both novice and expert readers (area under the receiver operating characteristic curve, 0.80 [95% CI: 0.70, 0.90] vs 0.88 [95% CI: 0.80, 0.97]; P = .09). The interreader agreement regarding the evaluation of CEUS VI-RADS category was 0.77 (95% CI: 0.65, 0.85) for novice readers, 0.87 (95% CI: 0.79, 0.92) for expert readers, and 0.78 (95% CI: 0.70, 0.84) for all readers. Conclusion The developed CEUS VI-RADS showed good performance and interreader agreement for the assessment of muscle invasion in bladder cancer. Chinese Clinical Trial Registry no. ChiCTR2100049435 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Morrell in this issue.
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Affiliation(s)
- Jing Han
- From the Departments of Ultrasound (J.H., M.L., Q.L., R.G., Y.L., Z.G., L.L., J.Z.) and Urology (Z.W., Y.Y., K.Y.), Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, No. 651 Dongfeng Rd East, Guangzhou 510060, People's Republic of China
| | - Min Lin
- From the Departments of Ultrasound (J.H., M.L., Q.L., R.G., Y.L., Z.G., L.L., J.Z.) and Urology (Z.W., Y.Y., K.Y.), Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, No. 651 Dongfeng Rd East, Guangzhou 510060, People's Republic of China
| | - Qingguang Lin
- From the Departments of Ultrasound (J.H., M.L., Q.L., R.G., Y.L., Z.G., L.L., J.Z.) and Urology (Z.W., Y.Y., K.Y.), Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, No. 651 Dongfeng Rd East, Guangzhou 510060, People's Republic of China
| | - Ruohan Guo
- From the Departments of Ultrasound (J.H., M.L., Q.L., R.G., Y.L., Z.G., L.L., J.Z.) and Urology (Z.W., Y.Y., K.Y.), Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, No. 651 Dongfeng Rd East, Guangzhou 510060, People's Republic of China
| | - Ying Liao
- From the Departments of Ultrasound (J.H., M.L., Q.L., R.G., Y.L., Z.G., L.L., J.Z.) and Urology (Z.W., Y.Y., K.Y.), Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, No. 651 Dongfeng Rd East, Guangzhou 510060, People's Republic of China
| | - Zhiming Wu
- From the Departments of Ultrasound (J.H., M.L., Q.L., R.G., Y.L., Z.G., L.L., J.Z.) and Urology (Z.W., Y.Y., K.Y.), Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, No. 651 Dongfeng Rd East, Guangzhou 510060, People's Republic of China
| | - Yunlin Ye
- From the Departments of Ultrasound (J.H., M.L., Q.L., R.G., Y.L., Z.G., L.L., J.Z.) and Urology (Z.W., Y.Y., K.Y.), Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, No. 651 Dongfeng Rd East, Guangzhou 510060, People's Republic of China
| | - Zhixing Guo
- From the Departments of Ultrasound (J.H., M.L., Q.L., R.G., Y.L., Z.G., L.L., J.Z.) and Urology (Z.W., Y.Y., K.Y.), Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, No. 651 Dongfeng Rd East, Guangzhou 510060, People's Republic of China
| | - Kai Yao
- From the Departments of Ultrasound (J.H., M.L., Q.L., R.G., Y.L., Z.G., L.L., J.Z.) and Urology (Z.W., Y.Y., K.Y.), Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, No. 651 Dongfeng Rd East, Guangzhou 510060, People's Republic of China
| | - Lingling Li
- From the Departments of Ultrasound (J.H., M.L., Q.L., R.G., Y.L., Z.G., L.L., J.Z.) and Urology (Z.W., Y.Y., K.Y.), Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, No. 651 Dongfeng Rd East, Guangzhou 510060, People's Republic of China
| | - Jianhua Zhou
- From the Departments of Ultrasound (J.H., M.L., Q.L., R.G., Y.L., Z.G., L.L., J.Z.) and Urology (Z.W., Y.Y., K.Y.), Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, No. 651 Dongfeng Rd East, Guangzhou 510060, People's Republic of China
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19
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Han S, Sung PS, Park SY, Kim JW, Hong HP, Yoon JH, Chung DJ, Kwon JH, Lim S, Kim JH, Shin SK, Kim TH, Lee DH, Choi JY. Local Ablation for Hepatocellular Carcinoma: 2024 Expert Consensus-Based Practical Recommendations of the Korean Liver Cancer Association. Korean J Radiol 2024; 25:773-787. [PMID: 39197823 PMCID: PMC11361797 DOI: 10.3348/kjr.2024.0550] [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: 06/10/2024] [Accepted: 06/15/2024] [Indexed: 09/01/2024] Open
Abstract
Local ablation for hepatocellular carcinoma (HCC), a non-surgical option that directly targets and destroys tumor cells, has advanced significantly since the 1990s. Therapies with different energy sources, such as radiofrequency ablation, microwave ablation, and cryoablation, employ different mechanisms to induce tumor necrosis. The precision, safety, and effectiveness of these therapies have increased with advances in guiding technologies and device improvements. Consequently, local ablation has become the first-line treatment for early-stage HCC. The lack of organized evidence and expert opinions regarding patient selection, pre-procedure preparation, procedural methods, swift post-treatment evaluation, and follow-up has resulted in clinicians following varied practices. Therefore, an expert consensus-based practical recommendation for local ablation was developed by a group of experts in radiology and hepatology from the Research Committee of the Korean Liver Cancer Association in collaboration with the Korean Society of Image-guided Tumor Ablation to provide useful information and guidance for performing local ablation and for the pre- and post-treatment management of patients.
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Affiliation(s)
- Seungchul Han
- Department of Radiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Pil Soo Sung
- Department of Internal Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Young Park
- Department of Internal Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jin Woong Kim
- Department of Radiology, Chosun University Hospital and Chosun University College of Medicine, Gwangju, Republic of Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung-Hee Yoon
- Department of Radiology, Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Dong Jin Chung
- Department of Radiology, Yeouido St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon Ho Kwon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sanghyeok Lim
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University, Seoul, Republic of Korea
| | - Seung Kak Shin
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Tae Hyung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University, Seoul, Republic of Korea.
| | - Jong Young Choi
- Department of Internal Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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20
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Han S, Sung PS, Park SY, Kim JW, Hong HP, Yoon JH, Chung DJ, Kwon JH, Lim S, Kim JH, Shin SK, Kim TH, Lee DH, Choi JY, Research Committee of the Korean Liver Cancer Association. Local ablation for hepatocellular carcinoma: 2024 expert consensus-based practical recommendation of the Korean Liver Cancer Association. JOURNAL OF LIVER CANCER 2024; 24:131-144. [PMID: 39210668 PMCID: PMC11449576 DOI: 10.17998/jlc.2024.08.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 08/04/2024] [Indexed: 09/04/2024]
Abstract
Local ablation for hepatocellular carcinoma (HCC), a non-surgical option that directly targets and destroys tumor cells, has advanced significantly since the 1990s. Therapies with different energy sources, such as radiofrequency ablation, microwave ablation, and cryoablation, employ different mechanisms to induce tumor necrosis. The precision, safety, and effectiveness of these therapies have increased with advances in guiding technologies and device improvements. Consequently, local ablation has become the firstline treatment for early-stage HCC. The lack of organized evidence and expert opinions regarding patient selection, pre-procedure preparation, procedural methods, swift post-treatment evaluation, and follow-up has resulted in clinicians following varied practices. Therefore, an expert consensus-based practical recommendation for local ablation was developed by a group of experts in radiology and hepatology from the Research Committee of the Korean Liver Cancer Association in collaboration with the Korean Society of Image-guided Tumor Ablation to provide useful information and guidance for performing local ablation and for the pre- and posttreatment management of patients.
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Affiliation(s)
- Seungchul Han
- Department of Radiology, Samsung Medical Center, Seoul, Korea
| | - Pil Soo Sung
- Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Soo Young Park
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jin Woong Kim
- Department of Radiology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Hee Yoon
- Department of Radiology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong Jin Chung
- Department of Radiology, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Joon Ho Kwon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sanghyeok Lim
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Kak Shin
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Tae Hyung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Young Choi
- Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Research Committee of the Korean Liver Cancer Association
- Department of Radiology, Samsung Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Radiology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Radiology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
- Department of Radiology, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Korea
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
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21
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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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22
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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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23
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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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24
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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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25
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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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26
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Sultan LR, Venkatakrishna SSB, Morgan TA, Gabbert ML, Machado P, Wessner C, Mayer H, Forsberg F, Anupindi S. Liver microvascular flow evaluation by texture analysis and quantitative contrast-enhanced ultrasound in pediatric chronic liver disease. IEEE SOUTH ASIAN ULTRASONICS SYMPOSIUM 2024; 2024:10.1109/SAUS61785.2024.10563258. [PMID: 39525688 PMCID: PMC11545312 DOI: 10.1109/saus61785.2024.10563258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
The liver's intricate vascular network is pivotal to its function, requiring a comprehensive understanding for improved diagnostic and treatment strategies in liver diseases. In this pilot study we explore the efficacy of contrast-enhanced ultrasound in identifying microvascular flow in pediatric chronic liver disease (CLD), highlighting the need for objective tools to gain deeper insights. We focused on two novel methods: microvasculature texture analysis and quantitative microvascular flow analysis. CEUS liver images were acquired from 8 patients with CLD related to different etiologies. These images underwent texture analysis, incorporating techniques like first-order histogram analysis, gray-level co-occurrence matrices, and run-length matrix analysis. We also employed a delta projection method to assess microvascular perfusion dynamics. For comparative purposes, liver CEUS images from four healthy individuals were also analyzed. Our texture analysis showed distinct vessel arrangement, and heterogeneity patterns with different liver diseases. For example, patients with primary sclerosing cholangitis exhibited average heterogeneity values of 1411.9. In contrast, those with biliary atresia had different echogenicity heterogeneity (1149.3). The delta projection technique further differentiated microvascular perfusion patterns across liver diseases, with each condition displaying unique perfusion index (PI) and peak enhancement (PE) values. Patients with primary sclerosing cholangitis exhibited comparable perfusion index (PI) values (3.2-3.5) and peak enhancement (PE) values (49.8-53.5). Biliary atresia cases perfusion values were (Pl of 1.3-1.7 and a PE of 40-45.4). Microvasculature texture analysis use is feasible, and with quantitative CEUS analysis, can provide valuable insights into microvascular patterns, enhancing diagnostic precision for pediatric CLD.
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Affiliation(s)
- Laith R Sultan
- Children's Hospital of Philadelphia, Division of Body Imaging, Department of Radiology
| | | | - Trudy A Morgan
- Children's Hospital of Philadelphia, Division of Body Imaging, Department of Radiology
| | - Morgan L Gabbert
- Children's Hospital of Philadelphia, Division of Body Imaging, Department of Radiology
| | | | | | - Hailee Mayer
- Thomas Jefferson University, Department of Radiology
| | | | - Sudha Anupindi
- Children's Hospital of Philadelphia, Division of Body Imaging, Department of Radiology
- Perelman School of Medicine, University of Pennsylvania
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27
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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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28
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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: 1] [Impact Index Per Article: 1.0] [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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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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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: 0.5] [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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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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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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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: 11] [Impact Index Per Article: 5.5] [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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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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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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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: 16] [Impact Index Per Article: 8.0] [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: 20] [Impact Index Per Article: 10.0] [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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Li L, Mao S, Wang J, Zheng W, Shen J, Clevert DA, Zhou J. 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: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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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
| | - Siyue Mao
- Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 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
| | - 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
| | - Jingxian Shen
- Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Dirk-André Clevert
- Department of Radiology, Interdisciplinary Ultrasound Center, University of Munich Grosshadern Campus, Munich, Germany
| | - 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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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: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/01/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVES To compare the diagnostic efficacy of SonoVue-enhanced and Sonazoid-enhanced ultrasound (US) for hepatocellular carcinoma (HCC) in patients at high risk. METHODS Between 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. RESULTS In 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]. CONCLUSIONS Sonazoid-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
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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: 1] [Impact Index Per Article: 0.3] [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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Hwang JA, Jeong WK, Kang HJ, Lee ES, Park HJ, Lee JM. 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: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Affiliation(s)
- Jeong Ah Hwang
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Hyo-Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, Republic of Korea.
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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: 17] [Impact Index Per Article: 5.7] [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: 0.7] [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: 12] [Impact Index Per Article: 4.0] [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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50
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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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