Diagnostic accuracy of contrast-enhanced ultrasound in focal lesions of the liver using cadence contrast pulse sequencing.

UNLABELLED: The purpose of this study was to assess the accuracy of Cadence Contrast Pulse Sequencing (Siemens-Acuson, CA) method with injection of SonoVue (Bracco Imaging SpA, Italy) for the detection and characterisation of focal liver lesions in comparison with a reference modality during routine use. METHODS: 138 consecutive patients (62 women, 76 men; mean age: 52 years for women and 63 years for men) corresponding to 144 examinations with 381 lesions participated in this prospective study from December 2002 to November 2003. Inclusion criteria were lesions detected by conventional US and the availability of a reference imaging examination (CT or MR imaging) within three weeks. The underlying liver lesions characterised by a reference modality (including biopsy in 29 lesions) were distributed as follows: haemangioma (n = 56), focal nodular hyperplasia (n = 27), hepatocellular carcinoma (n = 44), hepatocellular adenoma (n = 5), liver metastasis (n = 174), abscess (n = 2), cysts (n = 45), other benign lesions (n = 24) and 3 peritoneal metastases. RESULTS: A significant improvement was reported in the number of detected lesions between contrast-enhanced ultrasound and baseline ultrasonography (351 lesions versus 280 lesions, respectively, p < 0.01), whereas no significant difference was noted between contrast-enhanced ultrasound and reference imaging (351 versus 377 lesions, respectively). On the whole, contrast-enhanced ultrasound allowed a complete diagnosis in 96 % of the detected nodules with a significant improvement compared to conventional sonography in which the diagnosis was suspected in only 52 % out of these cases (p < 0.001). No significant difference was noted between contrast-enhanced ultrasound and the reference modality concerning characterisation of nodules. CONCLUSION: The present study clearly indicates that contrast-enhanced sonography using Sonovue and Cadence Contrast Pulse Sequencing allows real-time imaging with high accuracy and thus will be a competitive alternative to other modalities such as CT and MR imaging for liver imaging.

[Contrast ultrasound imaging in focal liver lesions: diagnostic value and guidelines]. / Echographie de contraste dans l'exploration des lésions focales hépatiques: valeur diagnostique et recommandations.

The recent introduction of high quality scanners and contrast agents for ultrasound deeply modifies diagnosis strategy in focal liver lesions by using validated criteria. Non-linear imaging methods using low mechanical index (MI<0.2) and second generation contrast agents allow real-time continuous imaging with concomitant limitation in background tIssue signal and also in agent collapse for a high quality contrast imaging giving dramatic improvement in detection and characterization of lesions. Interpretation is based on the presence of contrast agent within the lesion or not (hyper-, hypo- or isosignal) and the delay after injection (arterial, portal or parenchymal or late phase) as previously used by non-ultrasound methods. This allows an easy differentiation of benign from malignant lesions. Moreover, this allows complete characterization in 85 to 95% of all focal liver lesions and 75% in hepatocellular carcinomas. Those results markedly improve ultrasound accuracy compared to conventional sonography and so put contrast-enhanced sonography among recommended non-invasive imaging methods for focal liver lesions with changes in diagnostic strategy according to the lesion type and actual place of US methods. It is recommended to use contrast ultrasound methods in cancer staging for an optimal detection of liver metastases as well as in characterization of lesions detected during conventional sonography with a consecutive decrease of cost-diagnosis ratio.

[Contrast ultrasound imaging in liver disease]. / Echographie de contraste et affections hépatiques.

The recent introduction of high-end ultrasound equipments combined with the introduction of contrast agents provides marked improvements in liver imaging for the detection and the characterization of focal lesions. Previous imaging methods were based on high acoustic power and demonstrated improved detection of focal liver lesions. However, good and reliable results were difficult to achieve due to limited number of sweeps, as most of the microbubbles were destroyed within one pass. Non linear imaging methods at low acoustic power allowed great advances in the characterization by limiting signal from background tissue as well as agent collapse allowing continuous imaging starting from the time of contrast injection until complete disappearance of the agent. Contrast-enhanced imaging of the liver follows conventional sonography performed with high standards for detection and localization of lesions using multiple sweeps. Then targeted acquisition is performed for specific lesion characterization after a second contrast injection. Interpretation is based on the presence or not of microbubbles within the lesion (hyper-, hypo- or isosignal) and the delay from injection (arterial, portal or parenchymal or late phase). A well-recognized semiology is reported in this paper. Based on these criteria, sensitivity and specificity are close to those reported with other modalities with accuracy 85-95% for focal liver lesions and 75% for hepatocellular carcinomas. Those results markedly improve ultrasound accuracy compared to conventional sonography, and so put contrast-enhanced sonography among recommended non-invasive imaging methods for focal liver lesions with changes in diagnostic strategy.

Percutaneous ethanol injection vs. resection in patients with small single hepatocellular carcinoma: a retrospective case-control study with cost analysis.

BACKGROUND: Percutaneous ethanol injection and hepatic resection are the most widely used curative therapeutic options for patients with compensated liver disease and small hepatocellular carcinoma. AIM: To compare percutaneous ethanol injection and hepatic resection in a selected group of consecutive French patients with a single hepatocellular carcinoma, smaller than or equal to 50 mm, in terms of survival, recurrence rate of malignancy and direct costs. METHODS: The analysis of two contemporary cohorts of Child-Pugh A or B patients with a single hepatocellular carcinoma of < or = 50 mm treated by percutaneous ethanol injection (n=55) or hepatic resection (n=50). RESULTS: Long-term survival was not significantly different between the two groups when the size of hepatocellular carcinoma was less than 30 mm. However, the survival of patients with hepatocellular carcinoma larger than 30 mm was higher after hepatic resection than after percutaneous ethanol injection (P=0.044). The cumulative direct costs were significantly higher in patients treated by hepatic resection than in those treated by percutaneous ethanol injection regardless of the tumour size. The calculated costs per month of survival in patients treated with percutaneous ethanol injection and hepatic resection were 999 vs. 3865 euros, respectively (P < 0.001). CONCLUSIONS: Percutaneous ethanol injection is more cost effective than hepatic resection in patients with a single hepatocellular carcinoma smaller than 30 mm. However, in patients with a larger tumour, long-term survival is higher after hepatic resection.