Skip to main content
Top
Published in: European Radiology 3/2011

01-03-2011 | Editorial

The real capabilities of contrast-enhanced ultrasound in the characterization of solid focal liver lesions

Author: Emilio Quaia

Published in: European Radiology | Issue 3/2011

Login to get access

Abstract

Contrast-enhanced US (CEUS) using intravenous agents is a rapidly evolving field even though the main clinically recognized application is the characterization of focal liver lesions. Several reports have described the improvement provided by CEUS in the characterization of focal liver lesions in comparison to unenhanced US. CEUS with low transmit power insonation allows the real-time assessment of focal liver lesion contrast enhancement and vascularity during the different dynamic phases after injection of an intravenous contrast agent. CEUS allows the accurate characterization of focal liver lesions as benign or malignant based on the lesion contrast enhancement pattern during the arterial phase and lesion vascularity during portal—late phase in comparison to the adjacent liver parenchyma. During the portal—late phase, benign lesions present prevalently a sustained contrast enhancement with hyper or isovascular appearance to the adjacent liver while malignant lesions present prevalently microbubble washout with hypovascular appearance. On the other hand, the histology of focal liver lesions can only be confidently predicted in selected cases by CEUS, as in liver haemangiomas presenting typical nodular peripheral enhancement with subsequent centripetal fill-in and focal nodular hyperplasia with central spoke wheel—shaped contrast enhancement.
Literature
1.
go back to reference Dill-Macky M, Burns P, Khalili K, Wilson S (2002) Focal hepatic masses: enhancement patterns with SH U 508 A and Pulse Inversion US. Radiology 222:95–102CrossRefPubMed Dill-Macky M, Burns P, Khalili K, Wilson S (2002) Focal hepatic masses: enhancement patterns with SH U 508 A and Pulse Inversion US. Radiology 222:95–102CrossRefPubMed
2.
go back to reference Blomley MJK, Sidhu PL, Cosgrove DO et al (2001) Do different types of liver lesions differ in their uptake of the microbubble contrast agent SH U 508A in the late liver phase? Early experience. Radiology 220:661–667CrossRefPubMed Blomley MJK, Sidhu PL, Cosgrove DO et al (2001) Do different types of liver lesions differ in their uptake of the microbubble contrast agent SH U 508A in the late liver phase? Early experience. Radiology 220:661–667CrossRefPubMed
3.
go back to reference Von Herbay A, Vogt C, Häussinger D (2002) Late-phase pulse-inversion sonography using the contrast agent Levovist: differentiation between benign and malignant focal lesions of the liver. Am J Roentgenol 179:1273–1279 Von Herbay A, Vogt C, Häussinger D (2002) Late-phase pulse-inversion sonography using the contrast agent Levovist: differentiation between benign and malignant focal lesions of the liver. Am J Roentgenol 179:1273–1279
4.
go back to reference Brannigan M, Burns PN, Wilson SR (2004) Blood flow patterns in focal liver lesions at microbubble-enhanced US. Radiographics 24:921–935CrossRefPubMed Brannigan M, Burns PN, Wilson SR (2004) Blood flow patterns in focal liver lesions at microbubble-enhanced US. Radiographics 24:921–935CrossRefPubMed
5.
go back to reference Bryant TH, Blomley MJ, Albrecht T et al (2004) Improved characterization of liver lesions with liver-phase uptake of liver specific microbubbles: prospective multicenter trials. Radiology 232:799–809CrossRefPubMed Bryant TH, Blomley MJ, Albrecht T et al (2004) Improved characterization of liver lesions with liver-phase uptake of liver specific microbubbles: prospective multicenter trials. Radiology 232:799–809CrossRefPubMed
6.
go back to reference Nicolau C, Catalá V, Vilana R et al (2004) Evaluation of hepatocellular carcinoma using SonoVue, a second generation ultrasound contrast agent: correlation with cellular differentiation. Eur Radiol 14:1092–1099CrossRefPubMed Nicolau C, Catalá V, Vilana R et al (2004) Evaluation of hepatocellular carcinoma using SonoVue, a second generation ultrasound contrast agent: correlation with cellular differentiation. Eur Radiol 14:1092–1099CrossRefPubMed
7.
go back to reference Giorgio A, Ferraioli G, Tarantino L et al (2004) Contrast-enhanced sonographic appearance of hepatocellular carcinoma in patients with cirrhosis: comparison with contrast-enhanced CT appearance. Am J Roentgenol 183:1319–1326 Giorgio A, Ferraioli G, Tarantino L et al (2004) Contrast-enhanced sonographic appearance of hepatocellular carcinoma in patients with cirrhosis: comparison with contrast-enhanced CT appearance. Am J Roentgenol 183:1319–1326
8.
go back to reference Quaia E, Calliada F, Bertolotto M et al (2004) Characterization of focal liver lesions by contrast-specific US modes and a sulfur hexafluoride—filled microbubble contrast agent: diagnostic performance and confidence. Radiology 232:420–430CrossRefPubMed Quaia E, Calliada F, Bertolotto M et al (2004) Characterization of focal liver lesions by contrast-specific US modes and a sulfur hexafluoride—filled microbubble contrast agent: diagnostic performance and confidence. Radiology 232:420–430CrossRefPubMed
9.
go back to reference Quaia E, D’Onofrio M, Cabassa P, Vecchiato F, Caffarri S, Pittiani F, Wittkowski K (2007) The diagnostic value of hepatocellular nodule vascularity after sulfur hexafluoride—filled microbubble injection in patients with liver cirrhosis: analysis of diagnostic performance and confidence in malignancy characterization. Am Journal Roentgenology 189:1474–1483CrossRef Quaia E, D’Onofrio M, Cabassa P, Vecchiato F, Caffarri S, Pittiani F, Wittkowski K (2007) The diagnostic value of hepatocellular nodule vascularity after sulfur hexafluoride—filled microbubble injection in patients with liver cirrhosis: analysis of diagnostic performance and confidence in malignancy characterization. Am Journal Roentgenology 189:1474–1483CrossRef
10.
go back to reference Dai Y, Chen MH, Yin SS, Yan K, Fan ZH, Wu W, Wang YB, Yang W (2007) Focal liver lesions: can SonoVue-enhanced ultrasound be used to differentiate malignant from benign lesions? Invest Radiol 42:596–603CrossRefPubMed Dai Y, Chen MH, Yin SS, Yan K, Fan ZH, Wu W, Wang YB, Yang W (2007) Focal liver lesions: can SonoVue-enhanced ultrasound be used to differentiate malignant from benign lesions? Invest Radiol 42:596–603CrossRefPubMed
11.
go back to reference Luo W, Numata K, Kondo M et al (2009) Sonazoid-enhanced ultrasonography for evaluation of the enhancement patterns of focal liver tumors in the late phase by intermittent imaging with high mechanical index. J Ultrasound Med 28:439–448PubMed Luo W, Numata K, Kondo M et al (2009) Sonazoid-enhanced ultrasonography for evaluation of the enhancement patterns of focal liver tumors in the late phase by intermittent imaging with high mechanical index. J Ultrasound Med 28:439–448PubMed
12.
go back to reference Lin MX, Xu HX, Lu MD et al (2009) Diagnostic performance of contrast-enhanced ultrasound for complex cystic focal liver lesions: blinded reader study. Eur Radiol 19:358–369CrossRefPubMed Lin MX, Xu HX, Lu MD et al (2009) Diagnostic performance of contrast-enhanced ultrasound for complex cystic focal liver lesions: blinded reader study. Eur Radiol 19:358–369CrossRefPubMed
13.
go back to reference Liu GJ, Xu HX, Xie XY et al (2009) Does the echogenicity of focal liver lesions on baseline gray-scale ultrasound interfere with the diagnostic performance of contrast-enhanced ultrasound. Eur Radiol 19:1214–1222CrossRefPubMed Liu GJ, Xu HX, Xie XY et al (2009) Does the echogenicity of focal liver lesions on baseline gray-scale ultrasound interfere with the diagnostic performance of contrast-enhanced ultrasound. Eur Radiol 19:1214–1222CrossRefPubMed
14.
go back to reference Chen LD, Xu HX, Xie XY et al (2010) Intrahepatic cholangiocarcinoma and hepatocellular carcinoma: differential diagnosis with contrast-enhanced ultrasound. Eur Radiol 20:743–753CrossRefPubMed Chen LD, Xu HX, Xie XY et al (2010) Intrahepatic cholangiocarcinoma and hepatocellular carcinoma: differential diagnosis with contrast-enhanced ultrasound. Eur Radiol 20:743–753CrossRefPubMed
15.
go back to reference Bartolotta TV, Taibbi A, Matranga D, Malizia G, Lagalla R, Midiri M (2010) Hepatic focal nodular hyperplasia: contrast-enhanced ultrasound findings with emphasis on lesion size, depth, and liver echogenicity. Eur Radiol 20:2248–2256CrossRefPubMed Bartolotta TV, Taibbi A, Matranga D, Malizia G, Lagalla R, Midiri M (2010) Hepatic focal nodular hyperplasia: contrast-enhanced ultrasound findings with emphasis on lesion size, depth, and liver echogenicity. Eur Radiol 20:2248–2256CrossRefPubMed
16.
go back to reference Soussan M, Aubé C, Bahrami S, Boursier J, Charles Valla D, Vilgrain V (2010) Incidental focal solid liver lesions: diagnostic performance of contrast-enhanced ultrasound and MR Imaging. Eur Radiol 20:1715–1725CrossRefPubMed Soussan M, Aubé C, Bahrami S, Boursier J, Charles Valla D, Vilgrain V (2010) Incidental focal solid liver lesions: diagnostic performance of contrast-enhanced ultrasound and MR Imaging. Eur Radiol 20:1715–1725CrossRefPubMed
17.
go back to reference Nino-Murcia M, Ralls PW, Jeffrey RB Jr, Johnson M (1992) Color flow Doppler characterization of focal hepatic lesions. Am J Roentgenol 159:1195–1197 Nino-Murcia M, Ralls PW, Jeffrey RB Jr, Johnson M (1992) Color flow Doppler characterization of focal hepatic lesions. Am J Roentgenol 159:1195–1197
18.
go back to reference Lee MG, Auh YH, Cho KS et al (1996) Color Doppler flow imaging of hepatocellular carcinomas. Comparison with metastatic tumors and hemangiomas by three step grading color hues. Clin Imaging 20:199–203CrossRefPubMed Lee MG, Auh YH, Cho KS et al (1996) Color Doppler flow imaging of hepatocellular carcinomas. Comparison with metastatic tumors and hemangiomas by three step grading color hues. Clin Imaging 20:199–203CrossRefPubMed
19.
20.
go back to reference Quaia E, Blomley MJK, Patel S et al (2002) Initial observations on the effect of irradiation on the liver-specific uptake of Levovist. Eur J Radiol 41:192–199CrossRefPubMed Quaia E, Blomley MJK, Patel S et al (2002) Initial observations on the effect of irradiation on the liver-specific uptake of Levovist. Eur J Radiol 41:192–199CrossRefPubMed
21.
go back to reference Blomley MJK, Albrecht T, Cosgrove DO et al (1998) Stimulated acoustic emission in liver parenchyma with Levovist. Lancet 351:568–569CrossRefPubMed Blomley MJK, Albrecht T, Cosgrove DO et al (1998) Stimulated acoustic emission in liver parenchyma with Levovist. Lancet 351:568–569CrossRefPubMed
22.
go back to reference Kim TK, Jang HJ, Burns PN, Murphy-Lavallee J, Wilson SR (2008) Focal nodular hyperplasia and hepatic adenoma: differentiation with low-mechanical-index contrast-enhanced sonography. Am J Roentgenol 190:58–66CrossRef Kim TK, Jang HJ, Burns PN, Murphy-Lavallee J, Wilson SR (2008) Focal nodular hyperplasia and hepatic adenoma: differentiation with low-mechanical-index contrast-enhanced sonography. Am J Roentgenol 190:58–66CrossRef
23.
go back to reference Tranquart F, Le Gouge A, Correas JM et al (2008) Role of contrast-enhanced ultrasound in the blinded assessment of focal liver lesions in comparison with MDCT and CEMRI: results from a multicentre trial. Eur J Radiol 6:9–15 Tranquart F, Le Gouge A, Correas JM et al (2008) Role of contrast-enhanced ultrasound in the blinded assessment of focal liver lesions in comparison with MDCT and CEMRI: results from a multicentre trial. Eur J Radiol 6:9–15
24.
go back to reference von Herbay A, Westendorff J, Gregor M (2010) Contrast-enhanced ultrasound with SonoVue: differentiation between benign and malignant focal liver lesions in 317 patients. J Clin Ultrasound 38:1–9 von Herbay A, Westendorff J, Gregor M (2010) Contrast-enhanced ultrasound with SonoVue: differentiation between benign and malignant focal liver lesions in 317 patients. J Clin Ultrasound 38:1–9
25.
go back to reference Claudon M, Cosgrove D, Albrecht T, Bolondi L, Bosio M, Calliada F et al (2008) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS)—update. Ultraschall in Med 29:28–44CrossRef Claudon M, Cosgrove D, Albrecht T, Bolondi L, Bosio M, Calliada F et al (2008) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS)—update. Ultraschall in Med 29:28–44CrossRef
26.
go back to reference Quaia E, Alaimo V, Baratella E, Medeot A, Midiri M, Cova MA (2008) The added diagnostic value of 64-row multidetector CT combined with contrast-enhanced US in the evaluation of hepatocellular nodule vascularity: implications in the diagnosis of malignancy in patients with liver cirrhosis. Eur Radiol 19:651–663CrossRefPubMed Quaia E, Alaimo V, Baratella E, Medeot A, Midiri M, Cova MA (2008) The added diagnostic value of 64-row multidetector CT combined with contrast-enhanced US in the evaluation of hepatocellular nodule vascularity: implications in the diagnosis of malignancy in patients with liver cirrhosis. Eur Radiol 19:651–663CrossRefPubMed
27.
go back to reference Bartolotta TV, Taibbi A, Midiri M, La Grutta L, De Maria M, Lagalla R (2010) Characterisation of focal liver lesions undetermined at grey-scale US: contrast-enhanced US versus 64-row MDCT and MRI with liver-specific contrast agent. Radiol Med 115:714–731CrossRefPubMed Bartolotta TV, Taibbi A, Midiri M, La Grutta L, De Maria M, Lagalla R (2010) Characterisation of focal liver lesions undetermined at grey-scale US: contrast-enhanced US versus 64-row MDCT and MRI with liver-specific contrast agent. Radiol Med 115:714–731CrossRefPubMed
28.
go back to reference Hammerstingl R, Huppertz A, Breuer J et al (2008) Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 18:457–467CrossRefPubMed Hammerstingl R, Huppertz A, Breuer J et al (2008) Diagnostic efficacy of gadoxetic acid (Primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 18:457–467CrossRefPubMed
29.
go back to reference Raman SS, Leary C, Bluemke DA et al (2010) Improved characterization of focal liver lesions with liver-specific gadoxetic acid disodium-enhanced magnetic resonance imaging: a multicenter phase 3 clinical trial. J Comput Assist Tomogr 34:163–172CrossRefPubMed Raman SS, Leary C, Bluemke DA et al (2010) Improved characterization of focal liver lesions with liver-specific gadoxetic acid disodium-enhanced magnetic resonance imaging: a multicenter phase 3 clinical trial. J Comput Assist Tomogr 34:163–172CrossRefPubMed
30.
go back to reference Quaia E, Alaimo V, Baratella E, Pizzolato R, Cester G, Medeot A, Cova MA (2010) Effect of observer experience in the differentiation between benign and malignant liver tumors after ultrasound contrast agent injection. J Ultrasound Med 29:25–36PubMed Quaia E, Alaimo V, Baratella E, Pizzolato R, Cester G, Medeot A, Cova MA (2010) Effect of observer experience in the differentiation between benign and malignant liver tumors after ultrasound contrast agent injection. J Ultrasound Med 29:25–36PubMed
31.
go back to reference Luo W, Numata K, Morimoto M et al (2010) Differentiation of focal liver lesions using three-dimensional ultrasonography: retrospective and prospective studies. World J Gastroenterol 16:2109–2119CrossRefPubMed Luo W, Numata K, Morimoto M et al (2010) Differentiation of focal liver lesions using three-dimensional ultrasonography: retrospective and prospective studies. World J Gastroenterol 16:2109–2119CrossRefPubMed
32.
go back to reference Shiraishi J, Sugimoto K, Moriyasu F, Kamiyama N, Doi K (2008) Computer-aided diagnosis for classification of focal liver lesions by use of contrast-enhanced ultrasonography. Med Phys 35:1734–1746CrossRefPubMed Shiraishi J, Sugimoto K, Moriyasu F, Kamiyama N, Doi K (2008) Computer-aided diagnosis for classification of focal liver lesions by use of contrast-enhanced ultrasonography. Med Phys 35:1734–1746CrossRefPubMed
33.
go back to reference Sugimoto K, Shiraishi J, Moriyasu F, Doi K (2009) Computer-aided diagnosis of focal liver lesions by use of physicians' subjective classification of echogenic patterns in baseline and contrast-enhanced ultrasonography. Acad Radiol 16:401–411CrossRefPubMed Sugimoto K, Shiraishi J, Moriyasu F, Doi K (2009) Computer-aided diagnosis of focal liver lesions by use of physicians' subjective classification of echogenic patterns in baseline and contrast-enhanced ultrasonography. Acad Radiol 16:401–411CrossRefPubMed
Metadata
Title
The real capabilities of contrast-enhanced ultrasound in the characterization of solid focal liver lesions
Author
Emilio Quaia
Publication date
01-03-2011
Publisher
Springer-Verlag
Published in
European Radiology / Issue 3/2011
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-010-2007-0

Other articles of this Issue 3/2011

European Radiology 3/2011 Go to the issue