Ying Dai

Evaluation of Primary Malignancies of the Liver Using Contrast-Enhanced Sonography: Correlation With Pathology

OBJECTIVE Our purpose was to investigate the correlation of contrast-enhanced sonographic patterns with the histopathology of primary malignancies of the liver. MATERIAL AND METHODS Of the 318 contrast-enhanced sonographic examinations performed between April and September 2004, 95 patients with 117 lesions confirmed by surgery or biopsy pathology were reviewed in this study. We analyzed the enhancement time and patterns according to the types and degrees of pathologic differentiation. RESULTS All 65 moderately to poorly differentiated hepatocellular carcinomas (HCCs) enhanced in the arterial phase, and 96.9% (63 lesions) of them quickly washed out in the portal venous phase. All 32 well-differentiated HCCs enhanced in the arterial phase, and 50.0% (16 lesions) washed out slowly during the late phase. The washout time of the two differentiated types was significantly different (p < 0.05). Seventy-five percent of the clear cell carcinomas (12/16) enhanced in the arterial phase, 25% (4/16) did not enhance until the portal venous phase, and 31.3% (5/16) of the clear cell carcinomas washed out slowly during the late phase. The enhancement and washout times of clear cell carcinomas were significantly different than those of moderately to poorly differentiated HCCs (p < 0.05). All four intrahepatic cholangiocarcinomas presented the same patterns as moderately to poorly differentiated HCCs: enhanced in the arterial phase and quickly washed out in the portal venous phase. Among the 72 lesions enhanced homogeneously, 46 lesions (63.9%) were smaller than 3 cm. Thirty-seven lesions (82.2%) of the 45 lesions that enhanced heterogeneously were larger than 3 cm (including the four cholangiocarcinomas). Larger lesions were mainly less differentiated. There were significant differences in tumor sizes in regard to cellular differentiations and types. CONCLUSION Our study showed that the enhancement manifestations of primary malignancies of the liver are related to pathologic types and grades. Contrast-enhanced sonograms may provide the histopathologic information for malignant tumors of the liver.

Treatment Strategy to Optimize Radiofrequency Ablation for Liver Malignancies

PURPOSE The purposes of this study were to investigate a treatment strategy to increase liver tumor necrosis and minimize complications with ultrasound-guided percutaneous radiofrequency (RF) ablation and to evaluate its therapeutic efficacy. MATERIALS AND METHODS A total of 332 patients with 503 liver malignancies underwent RF ablation according to a mathematical protocol with adjunctive measures. In the 332 patients, 205 had 308 hepatocellular carcinomas (HCCs) with a mean largest diameter of 4.1 cm and 127 had 195 metastatic liver carcinomas (MLCs) with a mean largest diameter of 3.9 cm. In patients with HCC, 60 (29.3%) had stage I/II disease and 145 (70.7%) had stage III/IV disease. Depending on tumor size, shape, and location, a defined treatment strategy was adopted that consisted of a mathematical protocol, an individualized protocol, and adjunctive measures. The mathematical protocol was followed for tumors larger than 3.5 cm. The individualized protocol was used for tumors located adjacent to the diaphragm, gastrointestinal tract, or gallbladder. Some adjunctive measures such as supplementary fine needle localization, local saline solution injection, and feeding vessel ablation were used to deal with different features of these liver tumors. Patients were followed regularly to assess treatment efficiency, and the tumor was considered to have early complete necrosis if no viability was found on enhanced computed tomography 1 month after RF ablation. RESULTS In this series, the early necrosis rates were 95.8% for HCC (295 of 308 tumors), 94.9% for MLC (185 of 195 tumors), 91.3% for tumors larger than 3.5 cm (189 of 207 tumors), 90.7% for tumors near the gastrointestinal tract (49 of 54 tumors), 91.5% for tumors near the diaphragm (86 of 94 tumors), and 90.6% for tumors near the gallbladder (48 of 53 tumors). The local recurrence rates were 10.7% for HCC (33 of 308 tumors) and 14.9% for MLC (29 of 195 tumors). The 1-, 2-, and 3-year overall survival rates were 89.6%, 69.4%, and 59.6%, respectively, for HCC and 80.3%, 52.8%, and 30.9%, respectively, for MLC. The 1-, 2-, and 3-year survival rates in 60 patients with stage I/II HCC were 93.7%, 87.1%, and 76.2%, respectively. The incidence of major complications was 1.4% (eight of 574 sessions), which included of three hemorrhages, four injuries to adjacent structures, and one case of needle tract seeding. CONCLUSION In RF ablation of hepatic tumors, application of a proper protocol and adjunctive measures play important roles in improving tumor necrosis rate and minimizing potential complications.

The Role of Contrast-Enhanced Sonography of Focal Liver Lesions Before Percutaneous Biopsy

OBJECTIVE The objective of our study was to evaluate the clinical utility of performing contrast-enhanced sonography before percutaneous biopsy of focal liver lesions. SUBJECTS AND METHODS One hundred eighty-six patients with focal liver lesions detected on either sonography or contrast-enhanced CT were randomly divided into two groups: a group who underwent contrast-enhanced sonography and another who underwent unenhanced sonography. The contrast-enhanced sonography group (79 patients, 129 lesions) underwent SonoVue-enhanced sonography before biopsy, and the unenhanced sonography group (107 patients, 143 lesions) did not undergo contrast-enhanced sonography before biopsy. Conventional sonography was used in all patients to guide the biopsy procedures. The pathologic diagnosis was considered definitive and final if the biopsy result was malignant. If the initial biopsy result was benign or negative for malignancy, then the result was either confirmed or denied on the basis of contrast-enhanced CT, MRI, angiography, serum alpha-fetoprotein level, or clinical follow-up over a period of 6 months. In some patients with suspected malignancy, biopsy was repeated when considered necessary during the follow-up. The diagnostic accuracy of the initial biopsy was defined as the percentage of the total number of lesions that were correctly diagnosed at the initial biopsy. The difference in diagnostic accuracy between the two groups was analyzed to evaluate the value of performing contrast-enhanced sonography before biopsy. RESULTS Of the 129 lesions in the contrast-enhanced sonography group, 28 (21.7%) were benign and 101 (78.3%) were malignant. Of the 143 lesions in the unenhanced sonography group, 36 (25.2%) were benign and 107 (74.8%) were malignant. There was no significant difference in the distribution of malignant and benign lesions in these two groups (p > 0.05). There was no statistically significant difference in the distribution of lesions by size between the contrast-enhanced and unenhanced sonography groups (chi(2) = 0.619, p > 0.05). The diagnostic accuracy of the initial biopsy was significantly higher in the contrast-enhanced sonography group than in the unenhanced sonography group (95.3% vs 87.4%, respectively; p < 0.05). The diagnostic accuracy of the initial biopsy for malignant lesions < or = 2.0 cm was also significantly higher in the contrast-enhanced sonography group than in the unenhanced sonography group (97.1% vs 78.8%, respectively; p < 0.05). No major complications occurred in our study except one case of pneumothorax in the unenhanced sonography group. CONCLUSION Contrast-enhanced sonography before percutaneous focal liver lesion biopsy improved the diagnostic accuracy of the procedure by providing important intralesional information for differentiating viable, denaturalized, or necrotic tissue; consequently, by providing more accurate information about the site of biopsy even in lesions < or = 2.0 cm, contrast-enhanced sonography before biopsy reduced the number of puncture attempts.

Focal Liver Lesions: Can Sonovue-enhanced Ultrasound Be Used to Differentiate Malignant From Benign Lesions?

Objective:To evaluate whether contrast-enhanced ultrasound (CEUS) with SonoVue could differentiate malignant focal liver lesions (FLLs) from benign lesions and provide lesion type diagnoses. Materials and Methods:Four hundred fifty-six patients with 554 FLLs were examined by CEUS with SonoVue using low mechanical index, nonlinear imaging techniques. Each lesion was characterized by 2 independent off-site readers as malignant or benign and given specific lesion type diagnosis, if possible, both at baseline ultrasound (US) and after SonoVue administration (CEUS). The final diagnosis was achieved by histopathology obtained from biopsy or surgical specimens, or by typical manifestation on contrast-enhanced CT or MRI. Results:The diagnostic accuracies of the 2 readers were 41.9% and 35.2% for baseline US, which improved significantly to 87.2% and 87.9% for CEUS (P < 0.05). Interreader agreement also increased with CEUS compared with baseline US (ê value changed from 0.49 to 0.77). The accuracy for lesion type diagnosis was 38.4% and 32.5% for baseline US, which increased to 77.6% and 78.0% for CEUS (P < 0.05). Conclusions:CEUS with SonoVue improves differentiation between malignant and benign FLLs, and also provides improved lesion type (differential) diagnosis.

Combination therapy of radiofrequency ablation and transarterial chemoembolization in recurrent hepatocellular carcinoma after hepatectomy compared with single treatment

Aim:  To assess the efficacy and safety of radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) in recurrent hepatocellular carcinoma (HCC) after hepatectomy and to compare its outcome with a single modality.

Diagnosis of small hepatic nodules detected by surveillance ultrasound in patients with cirrhosis: Comparison between contrast-enhanced ultrasound and contrast-enhanced helical computed tomography

Aim:  To investigate the diagnostic value for the diagnosis of small (1–2 cm) hepatic nodules detected by surveillance ultrasound in patients with cirrhosis using contrast‐enhanced ultrasound (CEUS) compared with that of contrast‐enhanced helical computed tomography (CECT).

The Use of Contrast-Enhanced Ultrasonography in the Selection of Patients With Hepatocellular Carcinoma for Radio Frequency Ablation Therapy

The purpose of this study was to evaluate the use of contrast‐enhanced ultrasonography (CEUS) in selecting patients with hepatocellular carcinoma (HCC) for radio frequency ablation (RFA).

Clinical Value of Contrast‐Enhanced Ultrasound Enhancement Patterns for Differentiating Focal Pancreatitis From Pancreatic Carcinoma: A Comparison Study With Conventional Ultrasound

We explored the clinical value of using contrast‐enhanced ultrasound (US) enhancement patterns for the differential diagnosis of focal pancreatitis from pancreatic carcinoma.

Application of Contrast-Enhanced Sonography for Diagnosis of Space-Occupying Lesions in the Extrahepatic Bile Duct Comparison With Conventional Sonography and Contrast-Enhanced Computed Tomography

To investigate the application of contrast‐enhanced sonography compared with conventional sonography and contrast‐enhanced computed tomography (CT) for diagnosis of space‐occupying lesions in the extrahepatic bile duct.

Effects of Gray-Scale Ultrasonography Immediate Post-Contrast on Characterization of Focal Liver Lesions

This study compared the imaging features of conventional gray scale ultrasound (US) before and after contrast-enhanced ultrasound (CEUS) for focal liver lesions and 22 evaluated the role of US post-CEUS in characterizing liver lesions. 126 patients with 158 focal liver lesions underwent CEUS and US post-CEUS examination and entered this study. There were 74 hepatocellular carcinomas (HCC), 43 hepatic metastases, and 41 hemangiomas. Imaging features of US pre-CEUS and US post-CEUS were analyzed offsite by two blinded experienced radiologists to evaluate size, boundary, echogenicity, internal texture, posterior acoustic enhancement, spatial resolution, and contrast resolution. In the end with pathological and clinical evidence, the diagnostic accuracy rate of US pre-CEUS was 53.8% (85/158 lesions), lower than that of CEUS (88.0%, 139/158 lesions); with the complementation of US post-CEUS the rate rose to 93.0% (147/158 lesions). US post-CEUS could improve the visibility of typical structures of focal liver lesions and might provide important complementary information for CEUS diagnosis. It also increases the visibility of small liver lesions compared with US pre-CEUS and helps to guide local interventional procedure.