Xiao-Yan Xie

Intrahepatic cholangiocarcinoma and hepatocellular carcinoma: differential diagnosis with contrast-enhanced ultrasound

ObjectiveWe assessed the usefulness of contrast-enhanced ultrasound (CEUS) in the differentiation of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC).MethodsThe CEUS enhancement patterns of 50 ICCs were retrospectively analysed and compared with 50 HCCs. Two readers independently reviewed the baseline ultrasound (BUS) and CEUS images and the diagnostic performances were evaluated by receiver operating characteristic (ROC) analysis. Time–intensity curves (TIC) were plotted for quantification analysis.ResultsIn the arterial phase, peripheral rim-like hyperenhancement, heterogeneous hyperenhancement, homogeneous hyperenhancement and heterogeneous hypoenhancement were found in 25, 10, 3 and 12 of the ICCs versus 2, 29, 19 and 0 of the HCCs (Pu2009<u20090.001), respectively. The diagnostic performance of both readers in terms of the area under the ROC curve (0.745 vs. 0.933 for reader 1, and 0.803 vs. 0.911 for reader 2), sensitivity (28% vs. 90%, and 44% vs. 82%) and accuracy (64% vs. 90%, and 71% vs. 90%) improved significantly after CEUS (all Pu2009<u20090.05). The interobserver agreement increased from κu2009=u20090.575 at BUS to κu2009=u20090.720 after CEUS. TICs demonstrated that the intensities of the peripheral and central portions of the ICCs were lower than those of HCCs (both Pu2009<u20090.05).ConclusionCEUS improves the diagnostic performance significantly in the differentiation between ICC and HCC.

Percutaneous thermal ablation of medium and large hepatocellular carcinoma: long-term outcome and prognostic factors.

Radiofrequency ablation (RFA) and microwave ablation (MWA) were found to be effective in treating hepatocellular carcinoma (HCC) smaller than 3 cm; however, to the authors knowledge, the usefulness of thermal ablation in treating larger HCC, especially those >5 cm, has not been well documented. The present study evaluated the therapeutic efficacy of percutaneous thermal ablation with curative intention for HCC measuring between 3.0 cm and 7.0 cm.

Differential diagnosis between benign and malignant gallbladder diseases with real-time contrast-enhanced ultrasound

The value of contrast-enhanced ultrasound (CEUS) in differential diagnosis between benign and malignant gallbladder diseases was investigated. Thirty-three patients with gallbladder carcinomas and 47 with benign gallbladder diseases underwent CEUS. The lesion enhancement time, enhancement extent, pattern, dynamic change of enhancement and the intactness of gallbladder wall were evaluated. In the early phase at CEUS, hyper-, iso-, hypo-, and non-enhancement were found in 84.8% (28/33), 9.1% (3/33), 6.1% (2/33), and 0% (0/33) of gallbladder carcinomas, and 70.3% (33/47), 17.0% (8/47), 2.1% (1/47), and 10.6% (5/47) of benign diseases (pu2009>u20090.05). Hyper-enhancement or iso-enhancement in the early phase and then fading out to hypo-enhancement within 35xa0s after contrast agent administration was found in 90.9% (30/33) of carcinomas and 17.0% (8/47) of benign lesions (pu2009<u20090.001). Destruction of the gallbladder wall intactness was absent in benign diseases, whereas it was present in 28 (84.8%) of the 33 carcinomas (pu2009<u20090.001). Destruction of gallbladder wall intactness on CEUS yielded the highest capability in differential diagnosis, with sensitivity, specificity, and Youden’s index of 84.8% (28/33), 100% (47/47), and 0.85, respectively. Conventional US made correct original diagnoses in 55 (68.8%) patients, whereas CEUS in 77 (96.3%). Thus, CEUS is useful in differential diagnosis between malignant and benign gallbladder diseases.

Percutaneous thermal ablation for recurrent hepatocellular carcinoma after hepatectomy

Tumour ablation using a thermal energy source has shown promising results, and is particularly suitable for recurrent hepatocellular carcinoma (HCC). The present study evaluated long‐term outcomes after percutaneous thermal ablation for recurrent HCC following liver resection.

Renal cell carcinoma: real-time contrast-enhanced ultrasound findings

ObjectiveTo investigate the findings of renal cell carcinomas (RCCs) on contrast-enhanced ultrasound (CEUS).MethodsCEUS features of 84 RCCs confirmed by pathologic examination in 81 patients were retrospectively analyzed. A contrast-specific mode and a sulfur hexafluoride-filled microbubble contrast agent were used for CEUS. The enhancement pattern, extent, and dynamic change in the cortical, corticomedullary, and late phases were evaluated.ResultsOn CEUS, the emergence of tumor enhancement was earlier in two nodules (2.4%), simultaneous in 71 (84.5%), and later in 11 (13.1%), in comparison with the adjacent renal cortex. Seventy-four RCC nodules (88.1%) showed hyper-enhancement (nxa0=xa02) or iso-enhancement (nxa0=xa072) during the cortical phase, and the remaining 10 (11.9%) showed hypo-enhancement. Twenty-three nodules (27.4%) showed homogeneous enhancement and 61 (72.6%) inhomogeneous enhancement. In the corticomedullary phase, the nodules showed hypo-enhancement in 68 (81.0%) and iso-enhancement in 16 (19.0%). In the late phase, all RCCs showed the same enhancement pattern as that shown in the corticomedullary phase. Seventy-two (85.7%) nodules showed a clear perilesional rim-like enhancement in late phase.ConclusionsHyper- or iso-enhancement during the cortical phase, subsequent washout in late phase, inhomogeneous enhancement, and perilesional rim-like enhancement are clues for RCCs, which might be useful for characterization of RCCs.

Long-Term Outcome of Percutaneous Ablation in Very Early-Stage Hepatocellular Carcinoma

PurposeThe aim of this study was to investigate the long-term outcomes of percutaneous ablation (PA) of very early-stage hepatocellulcar carcinoma (HCC) with a multimodal strategy.MethodsWritten informed consent was obtained from all patients before treatment. Percutaneous ethanol injection (PEI) was performed for tumors in unfavorable locations; microwave ablation (MWA) was performed for tumors in favorable positions without a capsule; and radiofrequency ablation (RFA) was carried out in favorable tumors with a capsule. Since 2003, these advanced PA techniques have been used.ResultsEighty-three patients with very early HCC were treated with PA, including 33 with PEI, 19 with MWA, and 31 with RFA. Initial complete response (CR) was achieved in 79 patients (95%). The mean follow-up period was 45u2009±u200927xa0months (range, 24–155xa0months). Late treatment failure was observed in eight patients (10%), which was significantly associated with tumor size (Pu2009=u20090.046) and technique advancements (Pu2009=u20090.009). Sustained CR was achieved in 51 patients (61%) at the end of follow-up. Major complications occurred in two patients (2%). The 1-, 3-, 5-, and 6-year disease-free survival rates were 87%, 69%, 62%, and 59%, respectively. The 1-, 3-, 5-, and 7-year overall survival rates were 94%, 88%, 78%, and 74%, respectively.ConclusionsTreatment of very early-stage HCC using a multimodal strategy tailored to tumor characteristics achieves equivalent initial CR rates and long-term survival rates compared to surgical resection.

Diagnostic performance of contrast-enhanced ultrasound for complex cystic focal liver lesions: blinded reader study

The study was aimed at evaluating the diagnostic performance of contrast-enhanced ultrasound (CEUS) in characterizing complex cystic focal liver lesions (FLLs). Sixty-seven complex cystic FLLs in 65 patients were examined with conventional ultrasound (US) and real-time CEUS. The US and CEUS images were reviewed by a resident radiologist and a staff radiologist independently. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance, and the interobserver agreement was analysed. The results showed that complete non-enhancement throughout three phases of CEUS or sustained enhancement in the portal and late phases were exhibited in most benign lesions. Conversely, hypo-enhancement in the late phase was seen in all malignancies. After ROC analysis, the areas (Az) under the ROC curve were 0.774 at US versus 0.922 at CEUS (Pu2009=u20090.047) by the resident radiologist, and 0.917 versus 0.935 (Pu2009=u20090.38) by the staff radiologist. A significant difference in Az between the resident and the staff radiologists was found for US (0.774 versus 0.917, Pu2009=u20090.044), whereas not found for CEUS (0.922 versus 0.935, Pu2009=u20090.42). Interobserver agreement was improved after CEUS (κu2009=u20090.325 at US versus κu2009=u20090.774 at CEUS). Real-time CEUS improves the capability of discrimination between benign and malignant complex cystic FLLs, especially for the resident radiologist.

Contrast-Enhanced Ultrasound in the Diagnosis of Gallbladder Diseases: A Multi-Center Experience

Objective To assess the usefulness of contrast–enhanced ultrasound (CEUS) in differentiating malignant from benign gallbladder (GB) diseases. Methods This study had institutional review board approval. 192 patients with GB diseases from 9 university hospitals were studied. After intravenous bonus injection of a phospholipid-stabilized shell microbubble contrast agent, lesions were scanned with low acoustic power CEUS. A multiple logistic regression analysis was performed to identify diagnostic clues from 17 independent variables that enabled differentiation between malignant and benign GB diseases. Receiver operating characteristic (ROC) curve analysis was performed. Results Among the 17 independent variables, multiple logistic regression analysis showed that the following 4 independent variables were associated with the benign nature of the GB diseases, including the patient age, intralesional blood vessel depicted on CEUS, contrast washout time, and wall intactness depicted on CEUS (all P<0.05). ROC analysis showed that the patient age, intralesional vessels on CEUS, and the intactness of the GB wall depicted on CEUS yielded an area under the ROC curve (Az) greater than 0.8 in each and Az for the combination of the 4 significant independent variables was 0.915 [95% confidence interval (CI): 0.857–0.974]. The corresponding Az, sensitivity, and specificity for the age were 0.805 (95% CI: 0.746–0.863), 92.2%%, and 59.6%; for the intralesional vessels on CEUS were 0.813 (95% CI: 0.751–0.875), 59.8%, and 98.0%; and for the GB wall intactness were 0.857 (95% CI: 0.786–0.928), 78.4%, and 92.9%. The cut-off values for benign GB diseases were patient age <53.5 yrs, dotted intralesional vessels on CEUS and intact GB wall on CEUS. Conclusion CEUS is valuable in differentiating malignant from benign GB diseases. Branched or linear intralesional vessels and destruction of GB wall on CEUS are the CEUS features highly suggestive of GB malignancy and the patient age >53.5 yrs is also a clue for GB malignancy.

Treatment response evaluation with three-dimensional contrast-enhanced ultrasound for liver cancer after local therapies

OBJECTIVEnTo investigate the potential usefulness of three-dimensional contrast-enhanced ultrasound (3D-CEUS) in evaluating the treatment response for liver cancer after local therapies.nnnMETHODSnA total of 107 lesions in 95 consecutive patients with liver cancer underwent local therapies and thereafter received low acoustic power 3D-CEUS examination. The LOGIQ 9 ultrasound scanner and a volume transducer were used and the ultrasound contrast agent was SonoVue. The image quality of 3D-CEUS images was evaluated and the influence of 3D-CEUS to clinical outcome was investigated.nnnRESULTSnThe image quality of 3D-CEUS was defined as high in 102 (102/107, 95.3%) lesions and common in 5 (5/107, 4.7%) lesions. 3D-CEUS did not change the diagnosis in any patient compared with 2D-CEUS. However, 3D-CEUS changed the management in 3 (2.8%) of 107 lesions, increased confidence but made no change in diagnosis in 85 (79.5%) lesions, added some information but did not change management or diagnosis in 15 (14.0%), and made no change in 4 (3.7%), respectively, in comparison with 2D-CEUS.nnnCONCLUSIONn3D-CEUS enhances the diagnostic confidence in the majority of the patients and even changes the management in some patients. 3D-CEUS has potential usefulness in evaluating treatment response for liver cancer after local therapies.

Objective differential characteristics of cystic biliary atresia and choledochal cysts in neonates and young infants: sonographic findings.

To prospectively evaluate the objective differential characteristics between cystic biliary atresia and choledochal cysts on sonography among neonates and young infants.