Contrast-enhanced ultrasound approach to the diagnosis of focal liver lesions: the importance of washout

Contrast-enhanced ultrasound (CEUS) is a powerful technique for differentiating focal liver lesions (FLLs) without the risks of potential nephrotoxicity or ionizing radiation. In the diagnostic algorithm for FLLs on CEUS, washout is an important feature, as its presence is highly suggestive of malignancy and its characteristics are useful in distinguishing hepatocellular from non-hepatocellular malignancies. Interpreting washout on CEUS requires an understanding that microbubble contrast agents are strictly intravascular, unlike computed tomography or magnetic resonance imaging contrast agents. This review explains the definition and types of washout on CEUS in accordance with the 2017 version of the CEUS Liver Imaging Reporting and Data System and presents their applications to differential diagnosis with illustrative examples. Additionally, we propose potential mechanisms of rapid washout and describe the washout phenomenon in benign entities.

The safety of image-guided biopsy and its impact on patient care: the first Ethiopian experience

Background: The introduction of image-guided biopsy has revolutionized the quality of patient care by avoiding open and complications associated with it and the use anesthesia. Even though Ethiopian radiological training dates back to more than two decades, interventional radiology is a very recent introduction. This study reports the safety and significance of image guided biopsy on patient care.Patients and methods: This study was a prospective study carried out to assess the impact and safety of doing image-guided biopsy in a tertiary care teaching Hospital in Addis Ababa, Ethiopia.Results: A total of 117 patients, their age ranging from 3 to 80years and a mean age of 41 were evaluated; 6.8% of them were children below the age of 10. Around two-thirds of the cases had intra-abdominal indications for biopsy followed by mediastinal pathologies. Ultrasound was used as a guide in about 85% of the cases. Except for one case that developed massive hemoptysis following fine needle aspiration of a middle mediastinal mass and treated conservatively, there was no major complication. A few minor complications, like mild pain and minor hemorrhage, required only close observation.Conclusion: On the whole, our study indicates that image-guide biopsy improves the existing medical care.Moreover, institutions particularly those providing training in radiology should promote the establishment of interventional radiology for better patient diagnosis and improved planning of subsequent treatment

Local ablation therapy with contrast-enhanced ultrasonography for hepatocellular carcinoma: a practical review

A successful program for local ablation therapy for hepatocellular carcinoma (HCC) requires extensive imaging support for diagnosis and localization of HCC, imaging guidance for the ablation procedures, and post-treatment monitoring. Contrast-enhanced ultrasonography (CEUS) has several advantages over computed tomography/magnetic resonance imaging (CT/MRI), including real-time imaging capability, sensitive detection of arterial-phase hypervascularity and washout, no renal excretion, no ionizing radiation, repeatability, excellent patient compliance, and relatively low cost. CEUS is useful for image guidance for isoechoic lesions. While contrast-enhanced CT/MRI is the standard method for the diagnosis of HCC and post-ablation monitoring, CEUS is useful when CT/MRI findings are indeterminate or CT/MRI is contraindicated. This article provides a practical review of the role of CEUS in imaging algorithms for pre- and post-ablation therapy for HCC.