Real time contrast enhanced ultrasonography in detection of liver metastases from gastrointestinal cancer.

BACKGROUND: Contrast enhanced ultrasound (CEUS) is an imaging technique which appeared on the market around the year 2000 and proposed for the detection of liver metastases in gastrointestinal cancer patients, a setting in which accurate staging plays a significant role in the choice of treatment. METHODS: A total of 109 patients with colorectal (n = 92) or gastric cancer prospectively underwent computed tomography (CT) scan and conventional US evaluation followed by real time CEUS. A diagnosis of metastases was made by CT or, for lesions not visible at CT, the diagnosis was achieved by histopathology or by a malignant behavior during follow-up. RESULTS: Of 109 patients, 65 were found to have metastases at presentation. CEUS improved sensitivity in metastatic livers from 76.9% of patients (US) to 95.4% (p <0.01), while CT scan reached 90.8% (p = n.s. vs CEUS, p < 0.01 vs US). CEUS and CT were more sensitive than US also for detection of single lesions (87 with US, 122 with CEUS, 113 with CT). In 15 patients (13.8%), CEUS revealed more metastases than CT, while CT revealed more metastases than CEUS in 9 patients (8.2%) (p = n.s.). CONCLUSION: CEUS is more sensitive than conventional US in the detection of liver metastases and could be usefully employed in the staging of patients with gastrointestinal cancer. Findings at CEUS and CT appear to be complementary in achieving maximum sensitivity.

Use of perfusional angiosonography in liver transplantation and conservative management of post-transplant intra-hepatic pseudo-aneurysm.

Hepatic artery pseudo-aneurysm is a rare but severe complication of liver transplantation, which generally requires immediate surgical or angiographic treatment. The diagnosis is usually made by splanchnic percutaneous angiography. We report a case of an intra-hepatic pseudo-aneurysm after surgical correction of a thrombosed hepatic artery and its successful response to conservative management. Duplex Doppler ultrasound, associated with a new B-mode contrast-based sonographic technique, called "perfusional angiosonography", was used to diagnose the intra-hepatic pseudo-aneurysm. The combination of the two ultrasound techniques was useful in following the course of the pseudo-aneurysm, without further need for angiography. Eventually, this pseudo-aneurysm underwent spontaneous obliteration.

Usefulness of contrast-enhanced perfusional sonography in the assessment of hepatocellular carcinoma hypervascular at spiral computed tomography.

BACKGROUND/AIMS: Diagnosis of hepatocellular carcinoma (HCC) relies strongly on the detection of hypervascularity in the arterial phase and, in this setting, spiral computed tomography (CT) is the most widely used method. This prospective study aimed to investigate the usefulness of low mechanical index harmonic ultrasound (US), using a second generation contrast-enhanced technique, in the assessment of vascular pattern of HCC shown to be hypervascular at spiral CT. METHODS: A total of 79 cirrhotic patients with 103 nodules (mean+/-SD 28+/-13 mm) with arterial hypervascularity at spiral CT were studied. US examination was performed by perfusional sonography, using a new dedicated technology (CnTI-Esaote trade mark ), operating at low mechanical index, after injection of a second generation contrast agent (SonoVue trade mark -Bracco), allowing detection of tumoral flow during arterial phase. RESULTS: Selective arterial enhancement on perfusional sonography was observed in 94 /103 nodules (91.3%), with a sensitivity of 66.6, 87.5, 91.7, and 97.3% in nodules 123 cm respectively. CONCLUSIONS: Perfusional sonography shows good diagnostic agreement with spiral CT in hypervascular HCC and may be proposed for the immediate vascular characterization of nodules detected at US and used as second imaging technique to confirm hypervascularity in cirrhotic nodules.