Detection and characterization of focal liver lesions with contrast-enhanced ultrasonography in patients with hepatitis C-induced liver cirrhosis.

BACKGROUND: Hepatitis C virus (HCV)-associated liver cirrhosis provides a major preneoplastic condition for hepatocellular carcinoma (HCC). Ultrasonography (US) is usually used for screening of HCC, but needs improvement. PURPOSE: To assess whether use of a second-generation ultrasound contrast agent can improve characterization of focal liver lesions and detection of HCC in HCV-infected patients with liver cirrhosis. MATERIAL AND METHODS: In total, 96 US studies in 49 HCV-infected patients with liver cirrhosis were performed. The patients were first examined with a baseline US. After this, a diagnostic decision was made and recorded. The patients were then re-examined with contrast-enhanced ultrasound (CEUS), and the diagnostic triage was repeated. The patients were followed up for at least 1 year. RESULTS: On baseline US, indeterminate focal lesions were found in 27 examinations. After CEUS, a confident diagnosis of HCC was made in eight of these examinations. In an additional eight US examinations, diagnosis of regenerative/dysplastic noduli was established. In one patient with no detectable focal lesion at baseline examination, an indeterminate malignant lesion was detected with CEUS. This lesion was further investigated with computed tomography and diagnosed as HCC. CONCLUSION: Our study indicates that the use of CEUS significantly improves diagnostic confidence. CEUS improves the detection of HCC in patients with HCV-induced liver cirrhosis. Also, CEUS makes it possible to rule out malignancy in many cases where baseline US shows indeterminate focal lesions. In low-endemic countries, the use of CEUS in screening for HCC may be considered.

Intra-operative uses of contrast-enhanced ultrasound.

Intra-operative ultrasound (IOUS) is considered to be the most sensitive imaging modality for detection of focal liver lesions. It has been shown to affect the clinical management of patients with hepatic colorectal metastases and primary liver tumours undergoing exploratory laparotomy and segmental resection. However, small, and especially iso-echoic lesions are still missed and characterization of subcentimetre lesions is difficult. The improvement of detection and characterization of focal liver lesions using second-generation gas-containing contrast agents with specific non-linear detection modes in transabdominal scanning can be expected to apply to IOUS. Initial experience of contrast-enhanced IOUS based on use of conventional abdominal probes provided impressive results. The recent development of high-frequency linear array probes for small parts use with contrast-specific software enables the detection of lesions as small as 2-3 mm and allows characterization of small lesions. Though only preliminary experience is available, this appears to be an exciting and promising new application.

Radiographic stage of osteoarthritis or sex of the patient does not predict one year outcome after total hip arthroplasty.

OBJECTIVE: To investigate whether patients with severe radiographic osteoarthritis (OA) have a different outcome at one year after total hip replacement than patients with moderate radiographic OA. To investigate sex related differences in preoperative radiographic and self reported status and in postoperative outcome. METHODS: 184 patients (96 women) with a mean age at surgery of 71.4 years (50-92), with primary OA of the hip were investigated preoperatively and six and 12 months postoperatively with two self administered questionnaires, SF-36 and WOMAC. The radiographs were evaluated by two independent radiologists using an atlas. Minimal joint space narrowing, osteophytes, cysts, sclerosis, and deformity were assessed. A summary grade 0-3 was made, based on joint space, where 3 is severe OA. The reference population for SF-36 consisted of 2901 subjects matched for age and sex from the general Swedish population. RESULTS: 162 patients fulfilled the study criteria. 113 had grade 3, 47 grade 2, and two grade 1 radiographic OA. There was no difference in preoperative or postoperative pain and physical impairment between patients with moderate and severe radiographic OA. There were no sex related differences in preoperative radiographic status, or in postoperative outcome. Neither were any differences in preoperative radiographic status of OA found in patients with previous total hip replacement of the contralateral hip, compared with those who had not been operated on before. All patients, regardless of preoperative radiographic OA stage, showed significant postoperative improvement and at one year achieved a health related quality of life similar to that of the reference group. CONCLUSION: The severity of radiographic changes indicating OA often weighs heavily in the surgeon's decision to perform a total hip replacement. Yet, the findings of this study emphasise that the preoperative radiographic stage of OA has no correlation with the postoperative outcome after one year. Furthermore, this study failed to detect any sex related differences in preoperative radiographic and self reported status or in postoperative outcome of hip replacement.