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Objective:To compare the diagnostic efficacies of Sonazoid contrast-enhanced ultrasound (CEUS) and contrast-enhanced magnetic resonance imaging (CE-MRI) in the diagnosis of focal liver lesions (FLLs), and to evaluate the clinical value of Sonazoid.Methods:A total of 58 FLLs in 50 patients who underwent Sonazoid-CEUS and CE-MRI examinations from July 2019 to January 2021 in the First Affiliated Hospital of Zhejiang University School of Medicine were enrolled in this study according to the inclusion criteria. The final diagnostic reference standard was decided by surgical pathology or ultrasound-guided biopsy pathology. Sonazoid-CEUS and CE-MRI features of benign and malignant FLLs were analyzed, and the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic coincidence rate of the two tests were calculated respectively.Results:There was a statistically significant difference between benign and malignant FLLs in the imaging pattern of homogeneous or heterogeneous intratumoral enhancement in the artery-dominant phase and washout images in the late phase( P<0.001).9.8%(4/41) of the malignant lesions did not decrease until the late phase but decreased in the post-vascular phase. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic coincidence rate of the two tests were 97.6%, 52.9%, 83.3%, 90.0%, 84.5%(Sonazoid-CEUS) and 85.4%, 64.7%, 85.4%, 64.7%, 79.3%(CE-MRI), the differences of sensitivity and specificity were not statistically significant ( P=0.125, P=0.687). Conclusions:The vascular phase in Sonazoid-CEUS is still an important diagnostic sign of FLLs, and the unique Kupffer phase can provide additional information for the diagnosis. Sonazoid-CEUS has the same important value as CE-MRI in the diagnosis of FLLs.
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Objective To compare the difference in diagnostic value between conventional ultrasound and contrast-enhanced ultrasound (CEUS) for focal liver lesions and observe the application value of CEUS in the diagnosis and differential diagnosis of focal liver lesions. Methods Eighty-three patients who carried out conventional examination were diagnosed as focal liver lesions admitted to the Department of Ultrasound in Tianjin Medical University Cancer Hospital from May 2012 to July 2016, and totally 93 lesions were found. The types of lesions were determined by conventional ultrasonography, CEUS and pathology, and the effectiveness of conventional ultrasound and CEUS in the diagnosis of focal lesion types was compared, the time-intensity curve was used to record the beginning time of enhancement, peak time of enhancement, washout time and peak strength in different types of focal liver lesion, that may provide certain characteristics for differentiation of benign from malignant lesions, and the patterns of CEUS in different types of liver focal lesion were observed. Results Pathological examination confirmed the types of lesions:there were 57 malignant focal lesions in 93 lesions (including 34 hepatocellular carcinoma, 11 cholangiocarcinoma, 11 metastatic tumors and 1 lymphoma in liver), there were 36 benign lesions in 93 lesions [including 16 liver abscesses, 5 liver focal nodular hyperplasia (FNH), 5 hepatic adenomas, 4 hemangiomas, 3 uneven fatty liver, 2 hepatic cysts, and 1 hepatic perivascular cytoma]. By conventional ultrasound 51 focal liver lesions and by CEUS 80 focal liver lesions were correctly diagnosed. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CEUS in diagnosing focal liver lesions were significantly higher than those of conventional ultrasound: 91.23% vs. 68.42%, 77.78% vs. 33.33%, 86.67% vs. 61.90%, 84.85% vs. 40%, 86.02% vs. 54.84%, respectively, the differences being statistically significant (all P < 0.01). All of malignant lesions including the arrival time (seconds: 11.17±2.15 vs. 15.92±2.90), the enhancement peak time (seconds: 21.13±3.06 vs. 40.93±11.71), the washout time (seconds:37.16±6.84 vs. 73.51±11.80) were earlier than those of benign lesions, and peak strength of malignant lesion was higher than that of benign lesions (dB: -46.64±3.60 vs. -63.36±15.38), the difference being statistically significant (all P < 0.01). Under CEUS pattern, different liver focal lesions revealed different types of enhancement, but in part of the focal lesions the types of enhancement had manifestations crossed. Conclusions CEUS improves the diagnostic efficacy for focal liver lesions which has great value for differential diagnosis of benign from malignant liver lesions.
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Objective To compare the difference in diagnostic value between conventional ultrasound and contrast-enhanced ultrasound (CEUS) for focal liver lesions and observe the application value of CEUS in the diagnosis and differential diagnosis of focal liver lesions. Methods Eighty-three patients who carried out conventional examination were diagnosed as focal liver lesions admitted to the Department of Ultrasound in Tianjin Medical University Cancer Hospital from May 2012 to July 2016, and totally 93 lesions were found. The types of lesions were determined by conventional ultrasonography, CEUS and pathology, and the effectiveness of conventional ultrasound and CEUS in the diagnosis of focal lesion types was compared, the time-intensity curve was used to record the beginning time of enhancement, peak time of enhancement, washout time and peak strength in different types of focal liver lesion, that may provide certain characteristics for differentiation of benign from malignant lesions, and the patterns of CEUS in different types of liver focal lesion were observed. Results Pathological examination confirmed the types of lesions:there were 57 malignant focal lesions in 93 lesions (including 34 hepatocellular carcinoma, 11 cholangiocarcinoma, 11 metastatic tumors and 1 lymphoma in liver), there were 36 benign lesions in 93 lesions [including 16 liver abscesses, 5 liver focal nodular hyperplasia (FNH), 5 hepatic adenomas, 4 hemangiomas, 3 uneven fatty liver, 2 hepatic cysts, and 1 hepatic perivascular cytoma]. By conventional ultrasound 51 focal liver lesions and by CEUS 80 focal liver lesions were correctly diagnosed. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CEUS in diagnosing focal liver lesions were significantly higher than those of conventional ultrasound: 91.23% vs. 68.42%, 77.78% vs. 33.33%, 86.67% vs. 61.90%, 84.85% vs. 40%, 86.02% vs. 54.84%, respectively, the differences being statistically significant (all P < 0.01). All of malignant lesions including the arrival time (seconds: 11.17±2.15 vs. 15.92±2.90), the enhancement peak time (seconds: 21.13±3.06 vs. 40.93±11.71), the washout time (seconds:37.16±6.84 vs. 73.51±11.80) were earlier than those of benign lesions, and peak strength of malignant lesion was higher than that of benign lesions (dB: -46.64±3.60 vs. -63.36±15.38), the difference being statistically significant (all P < 0.01). Under CEUS pattern, different liver focal lesions revealed different types of enhancement, but in part of the focal lesions the types of enhancement had manifestations crossed. Conclusions CEUS improves the diagnostic efficacy for focal liver lesions which has great value for differential diagnosis of benign from malignant liver lesions.
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Objective To assess the ability of three-dimensional contrast-enhanced ultrasonography (3D-CEUS) and quantitative analysis in differential diagnosis of focal liver lesions ( FLL) . Methods The quantitative analysis technique was used to deal with the dynamic 3D-CEUS raw data of FLL ,which were confirmed by clinical or pathological diagnosis . The corresponding time-intensity curve and parameters were obtained . The parameters were compared to confirm whether there existed any difference in the parameters between benign and malignant FLL . Results Seventy-three FLL were enrolled including 59 malignant and 14 benign lesions . The differences of the parameters between benign and malignant groups were statistically significant ,including area under the curve ( A) ( 169 .58 ± 95 .46 vs 71 .26 ± 64 .13) ,area under the curve of wash-in(AWI)(22.84±18.37vs9.96±10.01) ,andareaunderthecurveofwash-out(AWO)(146.73± 82 .03 vs 61 .29 ± 55 .06) (all P <0 .05) . The other quantitative parameters showed no significant difference (all P > 0 .05) .Conclusions The quantitative analysis can be used to identify benign and malignant FLLs on 3D-CEUS .
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Background: Magnetic resonance signal intensity of focal liver lesions is affected by numerous pathologic factors. Lesion histologic features, such as cellularity, vascularity, stromal component, and intratumoral necrosis or hemorrhage, strongly affect T1 and T2 relaxation times. Aim: Our study is done to assess the lesion characterization potential of MRI by evaluating unenhanced and dynamic gadolinium enhanced sequences. Materials and methods: A total of 50 consecutive patients who were diagnosed by sonography as having focal liver lesions for period of 2 years were included in the study. Results: Most of the patients are of 30 - 60 years. The mean age for malignant lesions is 51 years. Of 50 patients 32 are males and 18 are males. Male: female ratio 2:1. 65% of the lesions are located in right lobe of the liver. The most common benign lesion encountered was liver abscess followed by haemangiomas and most common malignant lesion was metastases. Abscess and hemangiomas were predominant in benign whereas metastases and hepatocellular carcinomas were predominant in malignant lesions. The difference in mean ADC values in both the groups was significant. Conclusions: MR imaging is a powerful tool for the evaluation of focal liver lesions. Pre contrast T1 weighted gradient echo images, T2 weighted images, inphase and out phase imaging, EPI - DWI and gadolinium enhanced T1 weighted images provide accurate characterization of the lesions.
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Objective To evaluate the value of quantized diffusion-weighted imaging (DWI)in diagnosis of focal liver lesions. Methods A retrospective analysis was performed in 120 patients with focal liver lesions and in 12 healthy controls who underwent DWI and routine non-enhanced MRI at 3.0T.In 120 patients,there were 1 79 focal liver lesions including 53 hepatocellular carcinomas (HCC),61 metastatic tumors,32 hemangiomas and 33 cysts.The DWI and apparent diffusion coefficient (ADC)maps and ADC val-ues of the lesions and the normal liver were analyzed and measured with a b value of 800 s/mm2 ,and the statistical differences be-tween two groups were compared.Results DWI showed 33 hepatic cysts with low signal,and 5 1 hepatocellular carcinomas,61 he-patic metastases and 32 hepatic hemangiomas with high signal,thus the signal difference between hepatic cyst and other lesions was significant (P 0.05).In addit-on,the ratios of the ADC values of lesion to background liver between hepatocellular carcinoma and metastases were significantly dif-ferent (P <0.05).Conclusion DWI and ADC maps,and ADC value can provide importantly additional information for the diagnosis and differential diagnosis of focal liver lesions.
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Objective To evaluate the value of contrast enhanced MR imaging (CEMRI)for the diagnosis of focal liver lesions with Meta analysis.Methods Relevant English and Chinese language studies were searched on the Pubmed,EMBASE,EBSCO,OV-ID,CNKI,CBM,VIP,WANFANG databases,respectively.Data were calculated with software of STATA 1 1.0 and Meta Disc 1.4. Results 1 7 of 2836 retrieved studies were included,the pooled sensitivity and specificity for CEMRI with 95% confidence interval (95%CI)were 0.85(0.84-0.87)and 0.86(0.84-0.88),respectively,the AUC of SROC was 0.91 6 8.Conclusion CEMRI can be used as one of the primary examination modalities for focal liver lesions with moderate sensitivity and specificity.
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Las lesiones focales del hígado comprenden un grupo heterogéneo de entidades como tumores benignos y malignos, sólidos o quistes, vasculares, masas inflamatorias y metástasis, entre otras. Reportar lesiones focales hepáticas en niños, características clínicas, estudios por imágenes y conducta terapéutica. Estudio descriptivo, retrospectivo, basado en la revisión de 16 historias clínicas de niños con lesiones focales hepáticas en el periodo comprendido entre enero 2007 a enero 2012. Se excluyeron los abscesos hepáticos. El 68,75%11 eran del sexo masculino y 31,25%5 del sexo femenino; con edad promedio de 9,5 años (rango: 10 días - 14 años). Las lesiones focales benignas fueron: hemangioma 4/16 (25%), hematoma hepático 4/16 (25%), quiste hepático 3/16 (18,75%), hiperplasia nodular focal 1/16 (6,25%) adenoma 1/16 (6,25%) y las malignas: hepatocarcinoma 2/16 (12,50%) y hepatoblastoma 1/16 (6,25%). La mayoría de los pacientes (56,25%) se encontraban asintomáticos, 3/16 (18,75%) presentaron dolor abdominal, 3/16 (18,75%) masa palpable y 2/16 (12,5%) ictericia. La lesión fue identificada por ultrasonido abdominal en todos los pacientes y sólo el 56,25% (9/16) ameritaron tomografía con contraste. Al 43,75% (7/16) se les realizó marcadores tumorales y de estos el 42,85% (3/7) reportaron neoplasias. El funcionalismo hepático reportó normal en el 75% de los casos. El ultrasonido abdominal es el método de elección para el diagnóstico y seguimiento de las lesiones focales hepáticas, mientras el origen de las mismas, guía la conducta terapéutica
Focal liver lesions comprise a heterogeneous group of entities such as benign and malignant, solid or cysts, vascular, inflammatory masses and metastasis among others. To report focal liver lesions in children, clinical features, imaging and therapeutic behavior. A descriptive, retrospective study based on a review of 16 case histories of children with focal liver lesions in the period from January 2007 to January 2012. Liver abscesses were excluded. 68.75%11 were male and 31.25%5 females, mean age 9.5 years (range: 10 days - 14 years). Focal lesions were benign: Hemangioma 4/16 (25%), liver hematoma 4/16 (25%), hepatic cyst 3/16 (18.75%), nodular focal hyperplasia 1/16 (6.25%) and adenomas 1/16 (6.25%) and malignant: Hepatocellular carcinoma 2/16 (12.50%) and hepatoblastoma 1/16 (6.25%). Most patients (56.25%) were asymptomatic, 3/16 (18.75%) had abdominal pain, 3/16 (18.75%) and palpable mass 2/16 (12.5%) jaundice. The lesion was identified by abdominal ultrasound in all patients and only 56.25% (9/16) needed tomography with contrast. To 43.75% (7/16) underwent tumor markers and of these 42.85% (3/7) reported neoplasm. Normal hepatic function reported in 75% of cases. An abdominal ultrasound is the method of choice for the diagnosis and management of focal liver lesions, while the origin of them, guide therapeutic conduct
Subject(s)
Female , Child , Adenoma, Liver Cell/pathology , Carcinoma/pathology , Hemangioma/pathology , Hematoma/pathology , Hepatoblastoma/pathology , Liver Diseases/complications , Liver/injuries , Gastroenterology , PediatricsABSTRACT
The application of ultrasound contrast agents (UCAs) is considered essential when evaluating focal liver lesions (FLLs) using ultrasonography (US). Microbubble UCAs are easy to use and robust; their use poses no risk of nephrotoxicity and requires no ionizing radiation. The unique features of contrast enhanced US (CEUS) are not only noninvasiveness but also real-time assessing of liver perfusion throughout the vascular phases. The later feature has led to dramatic improvement in the diagnostic accuracy of US for detection and characterization of FLLs as well as the guidance to therapeutic procedures and evaluation of response to treatment. This article describes the current consensus and guidelines for the use of UCAs for the FLLs that are commonly encountered in US. After a brief description of the bases of different CEUS techniques, contrast-enhancement patterns of different types of benign and malignant FLLs and other clinical applications are described and discussed on the basis of our experience and the literature data.