Imaging Characteristics and Interpretation Strategy for Renal Hyperparathyroidism: A Retrospective 4-Dimensional Computed Tomography Study.

OBJECTIVE: Parathyroidectomy treats uncontrolled renal hyperparathyroidism (RHPT), requiring identification of all glands. Three types of enhancement are proposed. Type A lesions have higher arterial phase attenuation than the thyroid, type B lesions lack higher arterial phase attenuation but have lower venous phase attenuation, and type C lesions have neither higher arterial phase attenuation nor lower venous phase attenuation than the thyroid. We aimed to outline the image features of problematic parathyroid glands in RHPT and propose a 4-dimensional computed tomography (4DCT) interpretation algorithm. METHODS: This retrospective study involved data collection from patients with RHPT who underwent preoperative 4DCT for parathyroidectomy between January and November 2022. Pathologically confirmed parathyroid lesions were retrospectively identified on 4DCT according to the location and size described in the surgical notes. The attenuation of parathyroid lesions and the thyroid glands was assessed in 3 phases, and demographic data of the patients were collected. RESULTS: Ninety-seven pathology-proven parathyroid glands from 27 patients were obtained, with 86 retrospectively detected on 4DCT. In the arterial phase, the attenuation of parathyroid lesions in RHPT did not exceed that of the thyroid gland (P < .001). In the venous phase, parathyroid lesions demonstrated lower attenuation than the thyroid gland (P < .001). A total of 81 parathyroid lesions (94.2%) exhibited type B patterns. CONCLUSION: Unlike primary hyperparathyroidism, lesions in RHPT exhibited more type B enhancement, making them less readily identifiable in the arterial phase. Therefore, we propose a distinct imaging interpretation strategy to locate these problematic glands more efficiently.

Prognostic Value of MRI Arterial-phase Enhancement Pattern in Intrahepatic Cholangiocarcinoma Patients / 中山大学学报(医学科学版)

ObjectiveTo investigate the prognostic value of the enhancement pattern in arterial phase of preoperative Gd-EOB-DTPA enhanced magnetic resonance imaging （MRI） in evaluating the disease-free survival （DFS） and overall survival （OS） in patients undergoing curative resection for intrahepatic cholangiocarcinoma （ICC）. MethodsA retrospective analysis was done on the clinical， preoperative MRI findings and postoperative follow-up results of 93 pathologically confirmed ICC patients undergoing surgery in our hospital between January 2018 and December 2021. Kaplan-Meier survival curves and log-rank test were used to compare the DFS and OS of three groups with different arterial enhancement patterns. Cox regression analysis was used to identify the factors affecting DFS and OS. ResultsThere were significant differences in DFS and OS among the 3 groups （log-rank test， P < 0.05）. The arterial enhancement pattern was an independent predictive factor for DFS （using diffuse hyperenhancement as a reference， peripheral rim enhancement： HR = 3.550； 95%CI： 1.16 ~ 10.8； P = 0.026；diffuse hypoenhancement： HR = 3.430； 95%CI： 1.04 ~ 11.3； P = 0.042）. The arterial enhancement pattern and tumor location were predictive factors for OS （（using diffuse hyperenhancement as a reference， diffuse hypoenhancement， HR = 8.500； 95%CI： 1.09-66.3； P = 0.041； using tumor distal location as a reference， tumor perihilar location HR=2.583，95%CI： 1.14-5.83， P =0.022）. The AUC of arterial enhancement patterns in predicting 1-， 2-， and 3- year DFS were 0.722， 0.748， and 0.617， respectively； in OS， 0.720， 0.704， and 0.730， respectively， which showed better prognostic efficacy than AJCC-TNM staging system. ConclusionArterial-phase enhancement pattern of preoperative Gd-EOB-DTPA enhanced MRI is an independent predictive factor for DFS and OS of ICC patients， with a better prognostic value than AJCC-TNM staging system， and can be used for the clinical management of ICC patients.

Enhancement pattern of differentiated and undifferentiated gastric carcinoma on multiphasic contrast-enhanced computed tomography.

PURPOSE: To study the enhancement pattern of differentiated and undifferentiated gastric carcinoma on multiphasic contrast-enhanced computed tomography (CT). MATERIAL AND METHODS: Seventy patients with biopsy-proven gastric cancer underwent multiphasic contrast-enhanced CT. The CT protocol include plain, arterial, portal venous, and hepatic venous phase. Tumour size, location, peak-enhancement characteristics, and staging were evaluated. RESULTS: The peak-enhancement type was 'arterial' in 20 out of 28 within the differentiated-type GCAs and 'portalvenous' in 37 out of 42 within the undifferentiated-type GCAs (c2 statistic with Yates correction = 23.3981, p < 0.00001). The maximum attenuation value was statistically significant for the arterial phase between differentiated and undifferentiated GCAs (p < 0.05). CONCLUSIONS: Assessing peak-enhancement in a multiphasic CT can help identify the histological subcategory of gastric carcinomas that has prognostic significance. Arterial phase peak-enhancement is frequently seen in differentiated carcinomas whereas venous phase peak-enhancement is seen in undifferentiated carcinomas.

Correlation Between Enhancement Patterns on Transabdominal Ultrasound and Survival for Pancreatic Ductal Adenocarcinoma.

OBJECTIVE: Investigate the CEUS enhancement patterns of PDAC and analyse correlations between the CEUS enhancement pattern and both the degree of tumour tissue differentiation and overall survival (OS). METHODS: The study included 56 patients with locally advanced PDAC, performed conventional ultrasound and CEUS, and analysed characteristics of the CEUS enhancement patterns. In addition, clinical data, such as serum level of CA19-9, TNM stage were collected, and patients' survival times were followed up. TICs of dynamic CEUS images were acquired using image processing software to obtain the peak, TP, sharpness, and AUC. Correlations of the CEUS enhancement patterns of PDAC with the degree of differentiation of tumour tissue and OS were quantitatively analysed, as were the correlations of the TIC parameters and CEUS enhancement patterns with OS. RESULTS: Enhancement in the arterial phase included iso-enhancement (30.3%) and hypo-enhancement (69.6%), and was not significantly correlated with sex, age at disease onset, or lesion size. Also was not significantly correlated with tumour tissue differentiation. Clear survival times were obtained for 50 patients during follow-up, and the median survival time was significantly longer for the patients with iso-enhancement than hypo-enhancement. Among the TIC parameters, peaktumour, sharpnesstumour, AEsharpness, and REsharpness differed significantly between the group with iso-enhancement and hypo-enhancement (p < 0.05). CONCLUSION: The CEUS enhancement patterns of PDAC in the arterial phase include iso-enhancement and hypo-enhancement. Enhancement pattern was not significantly correlated with the degree of differentiation of tumour tissue, but patient survival time differed significantly between the two enhancement patterns, with longer survival for patients with iso-enhancement.

Value of Low-Mechanical-Index Contrast-Enhanced Transabdominal Ultrasound for Diagnosis of Pancreatic Cancer: A Meta-analysis.

The incidence and mortality rates of pancreatic cancer (PC) are increasing. It is important to discriminate PC from the other pancreatic lesions; however, differential diagnosis based on conventional transabdominal ultrasound (US) remains challenging even though US is often the first examination performed. Transabdominal contrast-enhanced ultrasound (CEUS) has high diagnostic accuracy for PC. This meta-analysis aimed to examine the utility of low-mechanical-index CEUS with enhancement for PC diagnosis. A systematic meta-analysis of all potentially relevant articles was performed. Fixed-effects or random-effects models were used to investigate pooled sensitivity, specificity, positive likelihood ratio (LR) and negative LR. The study enrolled 983 patients from nine eligible studies. The pooled estimates of sensitivity and specificity were 92% (95% confidence interval [CI]: 0.89-0.94) and 76% (95% CI: 0.71-0.81), respectively. The diagnostic odds ratio (DOR) for CEUS was high (53.62). The area under the summary receiver operating characteristic curve was 0.95. Funnel plots revealed no publication bias, and there was no significant relationship between the DORs and study characteristics, including continent, type of contrast agent, contrast agent dosage and scan phase. Only number of patients affected diagnostic ability. This meta-analysis indicates that CEUS with enhancement pattern is useful for diagnosis of PC.

Contrast-Enhanced Ultrasound Patterns for the Non-invasive Diagnosis of Hepatocellular Carcinoma: A Prospective Multicenter Study in Histologically Proven Liver Lesions in a Real-Life Setting Demonstrating the Benefit of Extended Late Phase Observation.

The hallmark for the non-invasive diagnosis of hepatocellular carcinoma (HCC) with contrast-enhanced ultrasound (CEUS) in cirrhosis is arterial phase hyperenhancement (APHE), followed by late-onset (>60 s), mild washout. Large retrospective studies report this pattern of washout to occur in the vast majority of HCCs. However, a prospective multicenter validation of these findings is still missing. Thus, we initiated a prospective multicenter validation study assessing CEUS enhancement patterns in focal liver lesions of patients at risk for HCC. We analyzed lesions that were eventually histology proven in a real-life setting. CEUS patterns were assessed for subgroups of HCC, intrahepatic cholangiocellular carcinoma (iCCA) and non-HCC, non-iCCA lesions. The diagnosis was HCC in 316 lesions (median size: 40 mm), iCCA in 26 lesions (median size: 47.5 mm) and non-HCC, non-iCCA in 53 lesions (median size: 27 mm). Overall, 85.8% of HCCs exhibited APHE. APHE followed by washout occurred in 72.8% of HCCs and 50% of iCCAs and non-HCC, non-iCCA malignancies (p < 0.05). Early and marked washout was associated more commonly with iCCA; HCCs exhibited mostly late and mild washout (onset >4-6 min in 10% of cases). Our prospective data confirm that the typical pattern of APHE followed by late-onset, mild washout occurs in the majority of HCCs.

Hepatic mosaic enhancement pattern correlates with increased inflammatory activity and adverse therapeutic outcomes in patients with Crohn's disease.

PURPOSE: This study aimed to evaluate the role of hepatic mosaic enhancement pattern (HMEP) on computed tomography images in the disease activity and therapeutic outcome of Crohn's Disease (CD). METHODS: Twenty-five CD patients with HMEP comprised the HMEP group, and 25 CD patients without HMEP, who had a similar onset age, sex, and disease course with those in the HMEP group, comprised the non-HMEP group. No underlying liver/biliary disease was observed in any of the patients. Clinical characteristics, laboratory test results, Lémann index, and CD endoscopic index of severity (CDEIS) were compared between the groups using the Student t-, Mann-Whitney U, Chi square, or Fisher's exact tests. Patients received top-down, step-up, or traditional treatment during the follow-up period. After the 1-year follow-up, therapeutic outcomes (active inflammation [CDEIS > 3.5 if the endoscopic data were available, or C-reactive protein level > 5 mg/L if the endoscopic data were unavailable] or remission) were evaluated. RESULTS: The occurrence rate of fistulas/abscesses was higher in the HMEP group (84%, 21/25) than in the non-HMEP group (48%, 12/25) with no statistical significance (P = 0.056). The HMEP group showed a higher C-reactive protein level (P = 0.001), erythrocyte sedimentation rate (P = 0.013), and blood platelet count (P = 0.005). There was no significant difference in therapeutic strategies between the groups (P = 0.509). The HMEP group showed a significantly lower remission ratio after anti-inflammatory treatment than the non-HMEP group (P = 0.045). CONCLUSIONS: HMEP was correlated with increased inflammatory activity and adverse therapeutic outcomes in CD. This finding provided insights regarding novel markers of CD diagnosis and treatment.

Findings on intraprocedural non-contrast computed tomographic imaging following hepatic artery embolization are associated with development of contrast-induced nephropathy.

BACKGROUND: Contrast-induced nephropathy (CIN) is a reversible form of acute kidney injury that occurs within 48-72 h of exposure to intravascular contrast material. CIN is the third leading cause of hospital-acquired acute kidney injury and accounts for 12% of such cases. Risk factors for CIN development can be divided into patient- and procedure-related. The former includes pre-existing chronic renal insufficiency and diabetes mellitus. The latter includes high contrast volume and repeated exposure over 72 h. The incidence of CIN is relatively low (up to 5%) in patients with intact renal function. However, in patients with known chronic renal insufficiency, the incidence can reach up to 27%. AIM: To examine the association between renal enhancement pattern on non-contrast enhanced computed tomographic (CT) images obtained immediately following hepatic artery embolization with development of CIN. METHODS: Retrospective review of all patients who underwent hepatic artery embolization between 01/2010 and 01/2011 (n = 162) was performed. Patients without intraprocedural CT imaging (n = 51), combined embolization/ablation (n = 6) and those with chronic kidney disease (n = 21) were excluded. The study group comprised of 84 patients with 106 procedures. CIN was defined as 25% increase above baseline serum creatinine or absolute increase ≥ 0.5 mg/dL within 72 h post-embolization. Post-embolization CT was reviewed for renal enhancement patterns and presence of renal artery calcifications. The association between non-contrast CT findings and CIN development was examined by Fisher's Exact Test. RESULTS: CIN occurred in 11/106 (10.3%) procedures (Group A, n = 10). The renal enhancement pattern in patients who did not experience CIN (Group B, n = 74 with 95/106 procedures) was late excretory in 93/95 (98%) and early excretory (EE) in 2/95 (2%). However, in Group A, there was a significantly higher rate of EE pattern (6/11, 55%) compared to late excretory pattern (5/11) (P < 0.001). A significantly higher percentage of patients that developed CIN had renal artery calcifications (6/11 vs 20/95, 55% vs 21%, P = 0.02). CONCLUSION: A hyperdense renal parenchyma relative to surrounding skeletal muscle (EE pattern) and presence of renal artery calcifications on immediate post-HAE non-contrast CT images in patients with low risk for CIN are independently associated with CIN development.

Gradual enhancement pattern of tracheobronchial adenoid cystic carcinoma on multiphasic dynamic computed tomography†:†a case series.

Tracheobronchial adenoid cystic carcinoma is a rare malignancy. To the best of our knowledge, its enhancement pattern on multiphasic contrast-enhanced multidetector computed tomography has not been reported. Herein, we report the computed tomography findings of three consecutive cases of tracheobronchial adenoid cystic carcinoma. All lesions presented a gradual enhancement pattern on multiphasic contrast-enhanced computed tomography. We speculate that the gradual enhancement pattern on multiphasic contrast-enhanced computed tomography could potentially serve as a characteristic imaging feature and may therefore be a clue to diagnose tracheobronchial adenoid cystic carcinoma. J. Med. Invest. 67 : 378-381, August, 2020.

Multiphase convolutional dense network for the classification of focal liver lesions on dynamic contrast-enhanced computed tomography.

BACKGROUND: The accurate classification of focal liver lesions (FLLs) is essential to properly guide treatment options and predict prognosis. Dynamic contrast-enhanced computed tomography (DCE-CT) is still the cornerstone in the exact classification of FLLs due to its noninvasive nature, high scanning speed, and high-density resolution. Since their recent development, convolutional neural network-based deep learning techniques has been recognized to have high potential for image recognition tasks. AIM: To develop and evaluate an automated multiphase convolutional dense network (MP-CDN) to classify FLLs on multiphase CT. METHODS: A total of 517 FLLs scanned on a 320-detector CT scanner using a four-phase DCE-CT imaging protocol (including precontrast phase, arterial phase, portal venous phase, and delayed phase) from 2012 to 2017 were retrospectively enrolled. FLLs were classified into four categories: Category A, hepatocellular carcinoma (HCC); category B, liver metastases; category C, benign non-inflammatory FLLs including hemangiomas, focal nodular hyperplasias and adenomas; and category D, hepatic abscesses. Each category was split into a training set and test set in an approximate 8:2 ratio. An MP-CDN classifier with a sequential input of the four-phase CT images was developed to automatically classify FLLs. The classification performance of the model was evaluated on the test set; the accuracy and specificity were calculated from the confusion matrix, and the area under the receiver operating characteristic curve (AUC) was calculated from the SoftMax probability outputted from the last layer of the MP-CDN. RESULTS: A total of 410 FLLs were used for training and 107 FLLs were used for testing. The mean classification accuracy of the test set was 81.3% (87/107). The accuracy/specificity of distinguishing each category from the others were 0.916/0.964, 0.925/0.905, 0.860/0.918, and 0.925/0.963 for HCC, metastases, benign non-inflammatory FLLs, and abscesses on the test set, respectively. The AUC (95% confidence interval) for differentiating each category from the others was 0.92 (0.837-0.992), 0.99 (0.967-1.00), 0.88 (0.795-0.955) and 0.96 (0.914-0.996) for HCC, metastases, benign non-inflammatory FLLs, and abscesses on the test set, respectively. CONCLUSION: MP-CDN accurately classified FLLs detected on four-phase CT as HCC, metastases, benign non-inflammatory FLLs and hepatic abscesses and may assist radiologists in identifying the different types of FLLs.

Association between Histological Types and Enhancement of Dynamic CT for Primary Lung Cancer.

The aim of this study was to explore enhancement patterns of different types of primary lung cancers on 2-phase dynamic computed tomography (CT). This study included 217 primary lung cancer patients (141 adenocarcinomas [ADs], 48 squamous cell carcinomas [SCCs], 20 small cell lung carcinomas [SCLCs], and 8 others) who were examined using a 2-phase dynamic scan. Regions of interest were identified and mean enhancement values were calculated. After excluding the 20 SCLCs because these lesions had different clinical stages from the other cancer types, the mean attenuation values and subtractions between phases were compared between types of non-small cell lung carcinomas (NSCLCs) using the Kruskal-Wallis test. Late phase attenuation and attenuation of the late minus unenhanced phase (LMU) of SCCs were significantly higher than those of ADs (p<0.05). To differentiate SCC and AD in the late phase, a threshold of 80.21 Hounsfield units (HU) gave 52.9% accuracy. In LMU, a threshold of 52.16 HU gave 59.3% accuracy. Dynamic lung CT has the potential to aid in differentiating among NSCLC types.

Multicentre study on dynamic contrast computed tomography findings of focal liver lesions with clinical and histological correlation.

BACKGROUND: Current advancements in dynamic contrast imaging of the liver have enabled increased sensitivity in the diagnosis of liver lesions. Evaluation and characterisation of the enhancement pattern of liver lesions in respect to the liver parenchyma aids in making a specific diagnosis. OBJECTIVES: The aim of this study was to determine the liver findings on dynamic contrast computed tomography (CT) scanning and correlate them with clinicopathologic findings. METHODS: This prospective cross-sectional study included 61 patients and took place between August 2017 and February 2018. Dynamic contrast CT was performed and the images were evaluated by two experienced radiologists. Correlation of the CT findings with histology results from an ultrasound-guided biopsy was done. Data analysis was performed using SPSS version 20.0. RESULTS: Hepatocellular carcinoma (HCC) was the most common malignant lesion seen and showed three patterns of enhancement: homogenous, abnormal internal vessels and heterogeneous enhancement. Abnormal internal vessel pattern was most specific (90.6%) and showed a high positive predictive value (PPV) of 78.6%. Rapid washout showed a specificity of 87.5% and a PPV of 72.2% in the diagnosis of HCC. Dynamic contrast CT scan had a sensitivity of 93%, specificity of 50%, PPV of 91% and diagnostic accuracy of 95.5% in differentiation of benign and malignant liver lesions. Considering only Liver Imaging Reporting and Data System (LI-RADS) category 5 as conclusive for HCC diagnosis, our study did not miss a significant number of HCCs. Liver Imaging Reporting and Data System category 5 showed specificity of 81.3% and PPV of 75%. CONCLUSION: Enhancement patterns on a dynamic contrast CT scan of the liver are useful in the interpretation of CT images for specific diagnoses.

Liver metastases of neuroendocrine tumors: is it possible to diagnose different histologic subtypes depending on multiphasic CT features?

PURPOSE: To assess and compare the multiphasic computed tomography (CT) features of neuroendocrine tumor (NET) liver metastases and to investigate the possibility to predict the histologic subtype of the primary tumor. MATERIALS AND METHODS: Between January 2013 and December 2017 patients with biopsy proven NET with at least one liver metastasis who underwent multiphasic CT were enrolled in this study. All cases were acquired using a standardized multiphasic liver CT protocol, arterial, portal, and hepatic venous phases were obtained. Images were retrospectively analyzed in consensus by two abdominal radiologists blinded to clinical data and histologic subtype. The size, number, and location of lesions were noted. Enhancement patterns of each lesion on arterial, portal, and hepatic venous phases were assessed. For quantitative analysis, CT attenuation of tumors, liver parenchyma, and aorta were measured using a circular region of interest (ROI) on arterial, portal, and hepatic venous phases for reflecting the blood supply of the tumor. Tumor-to-aorta and tumor-to-liver ratio were calculated in all three phases. Differences between subtypes of NET liver metastases were studied using ROC analysis of clustered data. RESULTS: A total of 255 neuroendocrine tumor liver metastases divided into 101 (39.6%) pancreatic, 60 (23.5%) gastroenteric and 94 (36.8%) lung NET liver metastases were analyzed. Contrast enhancement of lesions was homogeneous in 78% of patients (n = 199), which was significantly more frequent in patients with pancreatic group than in those with gastroenteric origin (n = 90, 89.1% vs. n = 28, 46.7%; p < 0.001). Gastroenteric NET metastases frequently showed heterogeneous enhancement, which was significantly higher than in the other two groups (50% vs. 3% and 2%). With respect to the location of the primary tumor, the difference in enhancement patterns of the liver lesions was statistically significant (p < 0.001). Pancreatic NET metastases were mostly hyperdense on arterial images and isodense on portal and hepatic venous phase images (79.2%, n = 80). Gastroenteric NET metastases were mostly hyperdense on arterial phase images and hypodense on portal and hepatic venous phase images (n = 28, 46.7%). The most frequent pattern for lung NET metastases was hypoattenuation on all three phase images (n = 44, 46.8%). ROC analysis of clustered data revealed statistically significant differences between pancreatic NET liver metastases, gastroenteric NET liver metastases, and lung NET liver metastases in terms of tumor-to-aorta (T-A) ratio and tumor-to-liver (T-L) ratio (p < 0.001). CONCLUSION: We observed statistically significant differences in multiphasic CT features (enhancement pattern, T-A ratio, and T-L ratio) between histologic subtypes of NET liver metastases. As the difference in histological subtypes of NET liver metastases results in a different prognosis and different management strategy, these CT features might help to identify the primary tumor when it is not known to ensure accurate tumor staging and to provide optimal treatment.

Contrast-enhanced ultrasound (CEUS) for the diagnosis of hypoechoic hepatic hemangioma in clinical practice.

AIM: To investigate the specific findings and characteristics of real-time contrast-enhanced ultrasound (CEUS) in hypoechoic hepatic hemangioma. METHODS: A total of 101 lesions in 83 patients were included. Analysis was made of the relationship between tumor size and CEUS enhance patterns in arterial phase, portal phase and delayed phase, phase changes, echoic changes in perfusion regression stage and filling defect. RESULTS: CEUS showed a lesion detection rate of 92.7%. In regression stage, only 46.5% lesions were fully filled. Enhancement of the lesions was categorized into Pattern I, peripheral nodular enhancement and centripetal filling (68.3%); Pattern II, peripheral ring enhancement and centripetal filling (27.7%); and Pattern III, overall rapid enhancement (4.0%). The most common phase changes were "fast-in slow-out" (74.3%). More than half (61.4%) lesions were hyperechoic in regression stage. Among all the lesions, 4 (3.9%) lesions regressed to hypo-echo in portal phase and 2(2.0%) in delayed phase). The frequent enhancement in tumors >3.0 cm was of Pattern I or II, "fast-in slow-out" or "slow-in slow-out" phase change, and hyperechoic or isoechoic change in perfusion regression stage, but in those ≤3.0 cm, the enhancement was of Pattern III, "fast-in fast-out" phase change and hypoechoic change in perfusion regression stage. The differences were statistically significant (p < 0.05). The percentage of lesions with complete filling on CEUS in the larger hypoechoic hepatic hemangiomas was significantly lower than that of smaller ones (p < 0.01). CONCLUSIONS: CEUS has high diagnostic value in hypoechoic hepatic hemangiomas mainly characterized by peripheral nodular or ring enhancement, centripetal filling, and "fast-in slow-out" and "slow-in slow-out" phase changes.

The differential enhancement pattern of contrast enhanced ultrasound and magnetic resonance imaging characteristics in hepatic angiomyolipoma: 7 case reports.

OBJECTIVE: To compare the enhancement pattern of hepatic angiomyolipoma (HAML) on contrast enhanced ultrasound (CEUS) and magnetic resonance (MR). METHODS: The data of seven patients (females; age 28-52 years; mean, 42 years) with histologically proven HAMLs were retrospectively reviewed. All patients underwent CEUS and MR examination. The images were analyzed by two experienced doctors who blinded to the clinical and pathological information of cases. RESULTS: The mean diameter of the nodule was 5.7 cm (range: 3.2-10 cm). Histopathologic results revealed 4 nodules to be myomatous type and 3 nodules to be mixed type. All nodules showed hyperenhanced during arterial phase on both CEUS and MRI. During portal and delayed phase, washout was more showed on MRI (5/7, 71.4%) than on CEUS (2/7, 28.6%). CONCLUSIONS: There is discrepancy of enhancement pattern between CEUS and MRI. The quick wash-in and sustained hyperenhancement on CEUS may be helpful for the diagnosis of HAML.

Value of contrast-enhanced harmonic endoscopic ultrasonography with enhancement pattern for diagnosis of pancreatic cancer: A meta-analysis.

BACKGROUND: Current imaging modalities are limited in their ability to distinguish pancreatic cancer (PC) from non-neoplastic pancreatic lesions. The diagnostic use of contrast-enhanced endoscopic ultrasonography (CE-EUS) has increased, and its utility has been reported. Recently, contrast-enhanced harmonic EUS (CH-EUS) was reported to facilitate imaging of parenchymal perfusion and microvessels in pancreatobiliary diseases, leading to a high diagnostic accuracy for PC. The present meta-analysis aims to investigate the usefulness of CH-EUS with enhancement pattern for PC diagnosis. METHODS: A systematic meta-analysis of all potentially relevant articles identified in PubMed, the Cochrane library, and Medline was carried out. Fixed-effects or random-effects models were used to investigate pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio with 95% confidence interval (CI). RESULTS: The study enrolled 887 patients from nine eligible studies. Pooled estimates of sensitivity and specificity were 93% (95% CI, 0.91-0.95) and 80% (95% CI, 0.75-0.85), respectively. Subgroup analyses were carried out on the main results after excluding two outliers. Area under summary receiver operating characteristics curve was 0.97. No publication bias was found using funnel plots. No significant relationship was found between the diagnostic odds ratios and the characteristics of the studies including continent and contrast agent. CONCLUSIONS: This meta-analysis showed that CH-EUS with qualitative analysis of enhancement pattern is useful for the diagnosis of PC, and has high sensitivity and accuracy, regardless of the type of contrast agent used. This modality may provide improved diagnostic accuracy for PC in clinical practice.

Clinical role of fludeoxyglucose (18F) positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with pancreatic neuroendocrine tumors.

PURPOSES: Clinical predictive markers for the malignant potential of pancreatic neuroendocrine tumors (PNETs) are limited without histological investigation. We reported previously that a loss of the regular enhancement pattern in preoperative computed tomography (CT) was correlated with the malignant tumor phenotype. This study aimed to establish whether the metabolic aspect of the tumor evaluated by fludeoxyglucose (18F) positron emission tomography/computed tomography 18F-FDG PET/CT is associated with the tumor imaging characteristics and postoperative oncological outcome. METHODS: Among 77 patients who underwent surgery with curative intent for a PNET at our institution between 2001 and 2017, 24 who received 18F-FDG PET/CT before surgery were enrolled in this study. The clinical importance of the standardized uptake value (SUVmax) was investigated with regard to tumor progression and prognosis after curative surgery. RESULTS: There were four (16%) patients with insulinoma. The mean tumor size was 17 mm and when the median value of the SUVmax (= 2.0) was measured as the cut-off value, the SUVmax ≥ 2.0 group (n = 12) was associated with large tumor size (p = 0.021), high tumor grade (p = 0.015), and irregular pattern on CT (p = 0.0055). The SUVmax was not correlated with age, gender, whether the tumor was functioning or non-functioning, or lymph node metastasis. The SUVmax ≥ 2.0 group had significantly poorer disease-free survival (median, 3.5 vs 16.2 months; p = 0.023) and poorer overall survival (median, 8.8 vs 16.2 months; p = 0.042). CONCLUSION: An SUVmax ≥ 2.0 on 18F-FDG PET/CT might be associated with higher malignant potential of PNETs.

Predicting IDH mutation status of intrahepatic cholangiocarcinomas based on contrast-enhanced CT features.

OBJECTIVES: To explore the difference in contrast-enhanced computed tomography (CT) features of intrahepatic cholangiocarcinomas (ICCs) with different isocitrate dehydrogenase (IDH) mutation status. METHODS: Clinicopathological and contrast-enhanced CT features of 78 patients with 78 ICCs were retrospectively analysed and compared based on IDH mutation status. RESULTS: There were 11 ICCs with IDH mutation (11/78, 14.1%) and 67 ICCs without IDH mutation (67/78, 85.9%). IDH-mutated ICCs showed intratumoral artery more often than IDH-wild ICCs (p = 0.023). Most ICCs with IDH mutation showed rim and internal enhancement (10/11, 90.9%), while ICCs without IDH mutation often appeared diffuse (26/67, 38.8%) or with no enhancement (4/67, 6.0%) in the arterial phase (p = 0.009). IDH-mutated ICCs showed significantly higher CT values, enhancement degrees and enhancement ratios in arterial and portal venous phases than IDH-wild ICCs (all p < 0.05). The CT value of tumours in the portal venous phase performed best in distinguishing ICCs with and without IDH mutation, with an area under the curve of 0.798 (p = 0.002). CONCLUSIONS: ICCs with and without IDH mutation differed significantly in arterial enhancement mode, and the tumour enhancement degree on multiphase contrast-enhanced CT was helpful in predicting IDH mutation status. KEY POINTS: • IDH mutation occurred frequently in ICCs. • ICCs with and without IDH mutation differed significantly in arterial enhancement mode. • ICCs with IDH mutation enhanced more than those without IDH mutation. • Enhancement ratio and tumour CT value can predict IDH mutation status.

The value of contrast-enhanced ultrasound for sentinel lymph node identification and characterisation in pre-operative breast cancer patients: A prospective study.

OBJECTIVE: To explore the feasibility of sentinel lymph node (SLN) identification by contrast-enhanced ultrasound (CEUS) in pre-operative breast cancer patients and the value of enhancement patterns for diagnosing lymph node metastases and characterising axillary nodal burden. METHODS: 110 consecutive breast cancer patients were enrolled. Before the surgery, microbubbles were injected intradermally. The lymphatic drainage pathway was detected to identify the SLNs. Blue dye and indocyanine green (ICG) fluorescence were used to trace SLNs during the operation. The enhancement patterns of SLNs were recorded and compared with the final pathological diagnosis. RESULTS: SLN detection rate was 96.4 % of 110 patients, 134 SLNs were detected in total. The sensitivity, specificity, positive-predictive value, negative-predictive value and accuracy of predicting SLNs metastases by CEUS enhancement patterns were 100 %, 52.0 %, 43.4 %, 100 % and 64.9 %, respectively. No metastatic SLNs were presented as homogeneous enhancement. Low nodal burden with 0-2 SLN metastases in 92.5 % nodes presented as heterogeneous enhancement. No enhancement pattern was proved to be SLN metastases in 100 % patients. CONCLUSIONS: CEUS is a feasible approach for SLN identification. CEUS enhancement patterns can be helpful in recognising metastatic SLNs and nodal burden. KEY POINTS: • CEUS is a feasible approach for SLN identification and characterisation. • The enhancement patterns on CEUS can be helpful in recognising metastasised SLNs. • Homogeneous enhancement pattern has the highest negative-predictive value.

Enhancement characteristics of liver focal nodular hyperplasia ( less than 3 cm ) by contrast-enhanced ultrasound / 中华超声影像学杂志

Objective To analyze the typical contrast-enhanced ultrasound ( CEUS ) enhancement characteristics of hepatic focal nodular hyperplasia ( FNH) within 3 cm ,and to discuss the diagnostic value of CEUS in small FNH lesions . Methods Forty-eight cases of FNH were retrospectively studied . All lesions were confirmed histopathologically after surgical resection . CEUS examinations with SonoVue were performed to characterize the enhancement patterns of lesions in 5 minutes . The whole wash in and wash out enhancement procedure of lesions were recorded and analyzed . Results All FNH lesions displayed a rapid hyper-enhancement in arterial phase by CEUS ,39 lesions of which showed spring-like enhancement ;8 lesions showed spoke-like enhancement ;1 lesion showed dendritic enhancement . 6 .3% (3/48) of the lesions showed central scar ,and feeding arteries was found in 52 .1% (25/48) lesions . According to echogenicity shift of the lesions in various phases ,20 .8% (10/48) FNH showed fast-in and slow-out" ,64 .6% (31/48) showed fast-in and synchronous-out" ,and 14 .6% (7/48) showed fast-in and fast-out" . According to fast-in and synchronous-out" or fast-in and slow-out" by CEUS ,the accuracy rate of benignity reached 85 .4% (41/48) . According to any of the spring-like enhancement ,spoke-like enhancement ,central scars or feeding arteries ,the accuracy rate of diagnosis of FNH within 3 cm reached 97 .9% (47/48) ,and 81 .3%(39/48) of which were diagnosed through spring-like enhancement . Conclusions CEUS is helpful in diagnosis of FNH within 3 cm by showing various characteristic enhancement patterns ,and spring-like enhancement is the most important sign in diagnosis of FNH less than 3 cm . CEUS has high diagnostic value for FN H less than 3 cm .