Contrast-Enhanced Ultrasound in the Diagnosis of Malignant Mesenchymal Liver Tumors
ABSTRACT Contrast-enhanced ultrasound can differentiate malignant from benign hepatic tumors, but has not been studied in malignant mesenchymal liver tumors.
We describe the findings of contrast-enhanced ultrasound in a cohort of five patients with histological-proven malignant hepatic mesenchymal tumors.
The presence of imaging features such as peripheral (nodular) enhancement, chaotic central vascularization, and absence of contrast enhancement in the late phase allowed differentiation from hemangiomas.
If these findings are demonstrated in large hepatic tumors, then the diagnosis of hemangioma is unlikely and further workup is necessary.
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ABSTRACT: Ultrasound is the method of choice in the detection and characterization of diffuse and focal organic diseases. For B-mode and colour (power) Doppler ultrasound, besides manual skills, (hands-on) a technical knowledge about ultrasound images is of the upmost importance for the investigator. Contrast enhanced ultrasound (CEUS) has become an important diagnostic tool for hepatic, renal, pancreatic indications and several others due to: (a) an increasing rate of studies resulting in sufficient evidence especially in hepatic indications, (b) a rate of adverse events close to zero (1:10,000 in comparison to iodinated contrast agents from 1-12:100) enabling the application of CEUS in patients with severe renal insufficiency or thyroid gland autonomy, and (c) a reasonable price (depends on the country and influence of the health-care system [reimbursement]) and the dosage used. Mini-doses from 0.1 to 0.4 mL are used depending on the contrast agent and applied indication. Therefore a well founded knowledge concerning the technical aspects of CEUS is important for the investigator to avoid misinterpretation especially when artefacts specific for CEUS occur. Special literature is rare. In the presented article we present pitfalls concerning CEUS. The following aspects are considered and illustrated by images: (i) acoustic power (mechanical index) and other aspects resulting in micro bubble destruction, (ii) the possibility of false positive contrast signals in non-vascularized areas, (iii) attenuation caused by too high contrast agent dose, (iv) influence of the frame rate on the spatial resolution, (v) dealing with deep located lesions, (vi) differences in focus positioning in detection and characterization studies, (vii) advantages and disadvantages of replenishment studies, (viii) reliability of contrast enhanced spectral Doppler measurements.Zeitschrift für Gastroenterologie 03/2011; 49(3):350-6. DOI:10.1055/s-0029-1245851 · 1.67 Impact Factor
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ABSTRACT: To investigate the contrast-enhanced ultrasound (CEUS) characteristics of primary hepatic angiosarcoma (PHA). The sonographic findings and CEUS images of PHA in three patients were retrospectively analyzed. In our study, 3 cases of PHA (2 multiple nodules and 1 solitary mass) showed similar enhancement pattern on CEUS, characterized by remarkable central non-enhancement and peripheral irregular enhancement in the arterial and portal phase, and complete wash-out in the late phase. Furthermore, we unexpectedly found that abundant neoplastic tissues were present in the central area of non-enhancement on pathological evaluation. Based on literature review, we supposed that the unusual finding may be associated with the very low velocity of blood flow in the central region of tumors. CEUS could well depict PHA with some common features, which may provide valuable clues in diagnosis of this rare disease. And non-necrotic tumor tissue of PHA could also demonstrate non-enhancement on CEUS, which warrant further investigations.European journal of radiology 07/2011; 81(9):2054-9. DOI:10.1016/j.ejrad.2011.06.026 · 2.16 Impact Factor
- Sonography, 02/2012; , ISBN: 978-953-307-947-9