Contrast-enhanced Ultrasonography in Small Liver Tumors (< 3 cm)

Ultrasonography is a safe, convenient, low cost and noninvasive diagnostic modality for liver tumors. Power Doppler sonography may demonstrate fine tumor vessels in small lesions and hypovascular lesions. However, it has limitations including motion artifacts, less sensitivity to slow vascular flow, poor demonstration of deep-seated lesions (> 7 cm in depth), and high sensitivity to tissue motion (heart beat or aortic pulsation). Owing to improvements in contrast agents and new technologies such as harmonic and pulse inversion imaging, contrast-enhanced ultrasound (CEUS) has improved the detection rate compared with Doppler ultrasound in studies of liver lesions. The enhanced vascular patterns have been proved to correlate well with the findings from dynamic computed tomography or magnetic resonance imaging. CEUS provides the ability to detect small focal liver lesions and even metastatic liver tumors of less than 1 cm in diameter. This review attempts to determine ways to allow the diagnosis of small hepatocellular carcinomas (HCCs), especially in cirrhotic patients, using CEUS. Because HCCs are small, the feeding arteries are fine and the arterial blood flow to the tumor is slow, CEUS used in the diagnosis of nodules of 1–2 cm in cirrhotic patients is not satisfactory. The portal and late phases in pulse inversion imaging may provide more information to detect small lesions in the cirrhotic liver and improve the diagnostic sensitivity and specificity. Contrast-enhanced flash echo with subtraction mode is another way of detecting this type of small tumor. In the arterial phase, some tumors are hard to identify, owing to the isoechoic status of the tumors with respect to the surrounding liver parenchyma. However, these small lesions may be shown by flash echo subtraction imaging. Concurrent delayed phase imaging is useful in the diagnosis of small hypovascular HCCs. In conclusion, CEUS improves the diagnostic accuracy of focal liver lesions, even in tumors as small as 1–2 cm. This safe, convenient, low cost and noninvasive diagnostic modality should be promoted in routine clinical practice

EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound - Part 1: Examination Techniques and Normal Findings (Long version).

Abstract ▼ In October 2014 the European Federation of Societies for Ultrasound in Medicine and Biology formed a Gastrointestinal Ultrasound (GIUS) task force group to promote the use of GIUS in a clinical setting. One of the main objectives of the task force group was to develop clinical recommendations and guidelines for the use of GIUS under the auspices of EFSUMB. The first part, gives an overview of the examination techniques for GIUS recommended by experts in the field. It also presents the current evidence for the interpretation of normal sonoanatomical and physiological features as examined with different ultrasound modalities

Role of contrast-enhanced ultrasound (CEUS) in paediatric practice: an EFSUMB position statement

The use of contrast-enhanced ultrasound (CEUS) in adults is well established in many different areas, with a number of current applications deemed off-label, but the use supported by clinical experience and evidence. Paediatric CEUS is also an off-label application until recently with approval specifically for assessment of focal liver lesions. Nevertheless there is mounting evidence of the usefulness of CEUS in children in many areas, primarily as an imaging technique that reduces exposure to radiation, iodinated contrast medium and the patient-friendly circumstances of ultrasonography. This position statement of the European Federation of Societies in Ultrasound and Medicine (EFSUMB) assesses the current status of CEUS applications in children and makes suggestions for further development of this technique

Is contrast-enhanced US alternative to spiral CT in the assessment of treatment outcome of radiofrequency ablation in hepatocellular carcinoma?

Purpose: The present study was conducted to assess the efficacy of contrast-enhanced ultrasound with low mechanical index in evaluating the response of percutaneous radiofrequency ablation treatment of hepatocellular carcinoma by comparing it with 4-row spiral computed tomography. Materials and Methods: 100 consecutive patients (65 men and 35 women; age range: 62 – 76 years) with solitary hepatocellular carcinomas (mean lesion diameter: 3.7cm± 1.1cm SD) underwent internally cooled radiofrequency ablation. Therapeutic response was evaluated at one month after the treatment with triple-phasic contrast-enhanced spiral CT and low-mechanical index contrast-enhanced ultrasound following bolus injection of 2.4 ml of Sonovue (Bracco, Milan). 60 out of 100 patients were followed up for another 3 months. Contrast-enhanced sonographic studies were reviewed by two blinded radiologists in consensus. Sensitivity, specificity, NPV and PPV of contrast-enhanced ultrasound examination were determined. Results: After treatment, contrast-enhanced ultrasound identified persistent signal enhancement in 24 patients (24%), whereas no intratumoral enhancement was detected in the remaining 76 patients (76%). Using CT imaging as gold standard, the sensitivity, specificity, NPV, and PPV of contrast enhanced ultrasound were 92.3% (95% CI = 75.9 – 97.9%), 100% (95% CI = 95.2 – 100%), 97.4% (95% CI = 91.1 – 99.3%), and 100% (95% CI = 86.2 – 100%). Conclusion: Contrast-enhanced ultrasound with low mechanical index using Sonovue is a feasible tool in evaluating the response of hepatocellular carcinoma to radiofrequency ablation. Accuracy is comparable to 4-row spiral CT

EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound - Part 1: Examination Techniques and Normal Findings (Short version)

Abstract ▼ In October 2014 the European Federation of Societies for Ultrasound in Medicine and Biology formed a Gastrointestinal Ultrasound (GIUS) task force group to promote the use of GIUS in a clinical setting. One of the main objectives of the task force group was to develop clinical recommendations and guidelines for the use of GIUS under the auspices of EFSUMB. The first part, gives an overview of the examination techniques for GIUS recommended by experts in the field. It also presents the current evidence for the interpretation of normal sonoanatomical and physiological features as examined with different ultrasound modalities

The contribution of new US technologies to US differential diagnosis of nonpalpable lesions

Background. Gray-scale ultrasound (US) patterns are still the best indicators of the risk of malignancy and correlation with mammography and guidance to bioptical procedures are still the gold standard in breast diagnosis. But recent technological advancements in ultrasound offer new diagnostic capabilities that integrate conventional US imaging: 3D, CAD, perfusion imaging and elastography. Conclusions. The US technologies allow to differentiate and grade the vascularity of breast lesions (both with conventional technologies and with contrast enhancers) and to evaluate the elastic properties of the normal and pathologic tissues (elastography). Both these technologies are on the way of becoming commer cially available on medium and high-end US instruments. But they must still be considered as research tools because their diagnostic efficacy requires more widely clinicaltesting