Jiaying Cao

Value of contrast-enhanced sonography in the diagnosis of peripheral intrahepatic cholangiocarcinoma.

To illustrate contrast‐enhanced harmonic ultrasonography (CEUS) findings of peripheral intrahepatic cholangiocarcinoma (PICC) and to assess the usefulness of CEUS in the diagnosis of this disease.

Contrast-Enhanced Ultrasound Guided Biopsy of Undetermined Abdominal Lesions: A Multidisciplinary Decision-Making Approach

Aim. To investigate the value of contrast-enhanced ultrasound (CEUS) guided biopsy of undetermined abdominal lesions in multidisciplinary treatment (MDT) decision-making approach. Methods. Between Jan 2012 and Dec 2015, 60 consecutive patients (male, 37; female, 23; mean age, 51.3 years ± 14.6) who presented with undetermined abdominal lesions were included. CEUS and core needle percutaneous biopsy was performed under real-time CEUS guidance in all lesions. Data were recorded and compared with conventional ultrasound (US) guidance group (n = 75). All CEUS findings and clinical data were evaluated in MDT. Results. CEUS enabled the delimitation of more (88.3% versus 41.3%) and larger (14.1 ± 10.7u2009mm versus 32.3 ± 18.5u2009mm) nonenhanced necrotic areas. More inner (20.0% versus 6.7%) and surrounding (18.3% versus 2.7%) major vessels were visualized and avoided during biopsies. CEUS-guided biopsy increased the diagnostic accuracy from 93.3% to 98.3%, with correct diagnosis in 57 of 60 lesions (95.0%). The therapeutic plan was influenced by CEUS guided biopsies findings in the majority of patients (98.3%). Conclusion. The combination of CEUS guided biopsy and MDT decision-making approach is useful in the diagnostic work-up and therapeutic management.

Point shear wave speed measurement in differentiating benign and malignant focal liver lesions

AIMnTo investigate the value of ElastPQ measurement for differential diagnosis of benign and malignant focal liver lesionsxa0(FLLs) by using histologic results as a reference standard.nnnMATERIAL AND METHODSnA total of 154 patients were included.xa0ElastPQ measurement was performed for each lesion in which the shear wave speed (SWS) was measured. The difference inxa0SWS and SWS ratio of FLL to surrounding liver were evaluated, and the cut off value was investigated. Receiver operatingxa0characteristic (ROC) curve was plotted to evaluate the diagnostic performance. Histology as a gold standard was obtainedxa0by surgery in all patients.nnnRESULTSnA total of 154 lesions including 129 (83.7 %) malignant FLLs and 25 (16.3 %) benignxa0ones were analysed. The SWS of malignant and benign FLLs was significantly different, 2.77±0.68 m/s and 1.57±0.55 m/sxa0(p<0.05). The SWS ratio of each FLL to surrounding liver parenchyma was 2.23±0.49 for malignant and 1.14±0.36 for benignxa0FLLs (p<0.05). The cut off value for differential diagnosis was 2.06 m/s for SWS and 1.67 for SWS ratio.nnnCONCLUSIONSnxa0ElastPQ measurement provides reliable quantitative stiffness information of FLLs and may be helpful in the differential diagnosisxa0between malignant and benign FLLs.

Differential diagnosis of gallbladder ascariasis debris: the added value of contrast enhanced ultrasound with high frequency transducer

Ascariasis debris of the gallbladder is a very rare incidental or symptomatic presentation. Ascaris debris has a pseudotumorous appearance and may be confused with neoplasia. The aim of the current retrospective study is to investigate the value of contrast enhanced ultrasound (CEUS) for the differential diagnosis of ascariasis debris and neoplasia of the gallbladder.nnnMATERIAL AND METHODSnConventional B-mode ultrasound (BMUS) and CEUS were performed for solitary echo-rich gallbladder lesions. Analysis of the CEUS enhancement pattern of the lesions was conducted according to the current EFSUMB guidelines. Two radiologists assessed the CEUS enhancement patterns in consensus. The final gold standard was surgery with histological examination or imaging follow-up.nnnRESULTSnA total of 9 patients with final diagnoses of gallbladder ascariasis debris were included. As a control group 26 solitary hyperechoic gallbladder lesions without shadowing were included as a control group. The typical zigzag morphology with multiple echogenic parallel lines without shadow were detected inside the lumen of the gallbladder in 6 patients. After injection of 2.4 ml ultrasound contrast agents, all hyperechoic gallbladder ascariasis debris lesions showed no enhancement. All patients in the control group with similar BMUS morphology showed contrast enhancement.nnnCONCLUSIONSnReal time visualization of contrast enhancement without radiation exposure is one of the main advantages of CEUS over other diagnostic modalities to differentiate ascariasis debris in the gallbladder from enhancing neoplasia. Thus, surgery and other interventions and their complications could be avoided.

Dynamic Three-Dimensional Contrast-Enhanced Ultrasound to Predict Therapeutic Response of Radiofrequency Ablation in Hepatocellular Carcinoma: Preliminary Findings

Background & Aims To investigate the value of dynamic three-dimensional contrast-enhanced ultrasound (3D-CEUS) in the assessment of therapeutic response of hepatocellular carcinoma (HCC) treated with radiofrequency ablation (RFA). Methods Forty-two patients (31 men and 11 women; mean age (52.1 ± 13.1 years)) with 42 clinical diagnosed HCC lesions (size range 14-48u2009mm; mean size 28.4 ± 9.9u2009mm) treated by RFA were included. All patients underwent two-dimensional contrast-enhanced ultrasound (2D-CEUS) and 3D-CEUS 1 month after treatment. Two radiologists assessed the absence (complete response, CR) or presence (residual tumor, RT) of any arterially hyperenhancing nodules within or along the margin of the treated HCC lesions. Complete response on magnetic resonance (MR) imaging acted as standard of reference (SOR). Results After RFA treatment, 3D-CEUS was successfully conducted in 34 HCC lesions. CR was observed on both 2D-CEUS and 3D-CEUS in 25/42 (59.5%) HCC and RT in 6/42 (14.3%) HCC lesions. In 3/42 (7.1%) HCC lesion, RT was documented by SOR and 3D-CEUS, but it was not appreciable at 2D-CEUS. In 3/42 (7.1%) HCC lesion, the presence of peripheral RT was suspected by both 2D-CEUS and 3D-CEUS, but it was not confirmed by SOR. No statistically significant difference between 2D-CEUS and 3D-CEUS in depicting either CR or RT was found (P = 0.25). Combined with dynamic 3D-CEUS, the diagnostic accuracy was improved from 85.7% to 92.9%. Conclusions 3D-CEUS might be helpful in better diagnostic performance in the assessment of therapeutic response of HCC treated after RFA.

Detection and characterization of small superficially located focal liver lesions by contrast-enhanced ultrasound with high frequency transducers

AIMnTo evaluate the benefits of contrast-enhanced ultrasound (CEUS) with high frequency transducers in the detectionxa0and characterization of small superficially located focal liver lesions (FLLs).nnnMATERIAL AND METHODSnFrom January 2015 toxa0October 2016, 27 superficial FLLs detected by MRI were examined, first with the low frequency convex transducer (1-5 MHz)xa0and afterwards with a high frequency transducer (7.5-12 MHz). High frequency dynamic CEUS was performed after a bolusxa0injection of 2.4 ml SonoVue®. FLLs were confirmed by histopathology after surgery (n=18) or ultrasound guided 18-gaugexa0core-needle biopsy (n=8), or by MRI follow-up (n =1).nnnRESULTSnThe mean diameter of FLLs was 10.5±3.1 mm, and meandepth was 6.2±5.3 mm. While using a high frequency transducerthe detection rate of FLLs (100%, 27/27) was significantlyxa0higher than low frequency transducer (25.9%, 7/27) (p<0.05). The overall sensitivity, specificity and diagnostic accuracy werexa0significantly improved by CEUS with a high frequency transducer (sensitivity 88.9%; specificity 92.6%; accuracy 96.2%).nnnCONCLUSIONnCombining CEUS with the performance of high-frequency transducers is a promising technique to improve thexa0detection and accurate diagnosis of small and superficial FLLs appearing indistinctive on BMUS.

Characterization of Focal Liver Lesions Indistinctive on B Mode Ultrasound: Benefits of Contrast-Enhanced Ultrasound

Aim. The aim of this prospective study was to evaluate the additional value of contrast-enhanced ultrasound (CEUS) in identifying and characterizing of focal liver lesions (FLLs) that are indistinctive on B mode ultrasound (BMUS). Methods. The study focused on 70 consecutive patients (male 46, female 24; mean age, 53.1 years ± 10). All lesions were detected by MRI but could not be clearly visualized by BMUS. CEUS was performed by injected SonoVue® (Bracco Imaging Spa, Milan, Italy) as a quick bolus into the antecubital vein. All lesions were proved by pathologic and MRI findings as primary or metastatic hepatic malignancies. Results. On CEUS, 45 (64.2%) FLLs displayed arterial hyperenhancement and 55 (78.5%) lesions showed hypoenhancement in portal venous and late phase (PVLP). Homogeneous and complete hyperenhancement pattern during the arterial phase is highly suspicious for HCC in liver cirrhosis (96.8%). Arterial isoenhancement and early washout during PVLP are characteristic for metastasis (73.3%). For recurrence lesions, arterial hyperenhancement and isoenhancement during PVLP are more common (60%). Conclusion. CEUS may provide added diagnostic values in FLLs appearing indistinctive on BMUS. Presence of early arterial enhancement and washout during PVLP may be helpful for detection of those lesions.