scholarly journals Complicated Sonographic View of Diffuse Hepatic Steatosis

2020 ◽  
Vol 71 (1) ◽  
pp. 220-222
Author(s):  
Melania Ardelean ◽  
Roxana Buzas ◽  
Daniel Lighezan ◽  
Basa Norina ◽  
Corina Duda-Seiman ◽  
...  
Keyword(s):  
Hepatic Steatosis ◽  
Late Phase ◽  
Correct Diagnosis ◽  
Abdominal Ultrasound ◽  
Arterial Phase ◽  
Benign Pathology ◽  
Uptake Pattern ◽  
Contrast Enhanced ◽  
Venous Phase

The aim of this study was to reveal the important role of CEUS in identifying correctly benign hepatic lesion vs a malignant one. We report a case of a diffuse hepatic steatosis particular sonographic aspect in a middle aged male presenting with general malaise. History revealed cardiac pathology, diabetes mellitus type 2 and chemotreated prostate neoplasia. The abdominal ultrasound (US) presented numerous hyperechoic lesions disseminated in the whole parenchyma. A contrast enhanced ultrasound (CEUS) of the lesions described an isoenhancement pattern of the lesions in the arterial phase, followed by the same aspect in the venous phase, with a high uptake pattern in the late phase. The CT and MRI also confirmed a diagnosis of a benign pathology. Hepatic steatosis may occur in chemotreated cancer patients, raising a suspicion of hepatic metastasis, but also due to the amount of lipid deposit distribution in the liver. Thus, CEUS was able to establish a correct diagnosis in a fast and reliable way.

scholarly journals Conspicuity of Malignant Pleural Mesothelioma in Contrast Enhanced MDCT – Arterial Phase or Late Phase?

2021 ◽  
Author(s):  
Lukas Luerken ◽  
Philipp Laurin Thurn ◽  
Florian Zeman ◽  
Christian Stroszczynski ◽  
Okka Wilkea Hamer
Keyword(s):  
Multiple Regression ◽  
Late Phase ◽  
Objective Analysis ◽  
Surrounding Tissue ◽  
Arterial Phase ◽  
Subjective Analysis ◽  
Portal Venous Phase ◽  
Contrast Enhanced ◽  
Venous Phase ◽  
Phase Scan

Abstract Background: To compare two different contrast phases intraindividually regarding conspicuity of MPM in chest MDCT. Methods: 28 patients with MPM were included in this retrospective study. For all patients, chest CT in standard arterial phase and abdominal CT in portal venous phase (scan delay ca. 70 s) was performed. First, subjective analysis of tumor conspicuity was done independently by two radiologists. Second, objective analysis was done by measuring Hounsfield units (HU) in tumor lesions and in the surrounding tissue in identical locations in both phases. Differences of absolute HUs in tumor lesions between phases and differences of contrast (HU in lesion – HU in surrounding tissue) between phases were determined. HU measurements were compared using paired t-test for related samples. Potential confounding effects by different technical and epidemiological parameters between phases were evaluated performing a multiple regression analysis.Results: Subjective analysis: In all 28 patients and for both readers conspicuity of MPM was better on late phase compared to arterial phase. Objective analysis: MPM showed a significantly higher absolute HU in late phase (75.4 vs 56.7 HU, p < 0.001). Contrast to surrounding tissue was also significantly higher in late phase (difference of contrast between phases 18.5 HU, SD 10.6 HU, p < 0.001). Multiple regression analysis revealed contrast phase and tube voltage to be the only significant independent predictors for tumor contrast.Conclusions: In contrast enhanced chest-MDCT for MPM late phase scanning seems to provide better conspicuity and higher contrast to surrounding tissue compared to standard arterial phase scans.

scholarly journals How Can We Manage Gallbladder Lesions by Transabdominal Ultrasound?

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 784
Author(s):  
Shinji Okaniwa
Keyword(s):  
High Frequency ◽  
Layer Structure ◽  
Wall Layer ◽  
Pancreaticobiliary Maljunction ◽  
Doppler Imaging ◽  
Wall Thickening ◽  
Contrast Enhanced ◽  
Postural Changes ◽  
Venous Phase

The most important role of ultrasound (US) in the management of gallbladder (GB) lesions is to detect lesions earlier and differentiate them from GB carcinoma (GBC). To avoid overlooking lesions, postural changes and high-frequency transducers with magnified images should be employed. GB lesions are divided into polypoid lesions (GPLs) and wall thickening (GWT). For GPLs, classification into pedunculated and sessile types should be done first. This classification is useful not only for the differential diagnosis but also for the depth diagnosis, as pedunculated carcinomas are confined to the mucosa. Both rapid GB wall blood flow (GWBF) and the irregularity of color signal patterns on Doppler imaging, and heterogeneous enhancement in the venous phase on contrast-enhanced ultrasound (CEUS) suggest GBC. Since GWT occurs in various conditions, subdividing into diffuse and focal forms is important. Unlike diffuse GWT, focal GWT is specific for GB and has a higher incidence of GBC. The discontinuity and irregularity of the innermost hyperechoic layer and irregular or disrupted GB wall layer structure suggest GBC. Rapid GWBF is also useful for the diagnosis of wall-thickened type GBC and pancreaticobiliary maljunction. Detailed B-mode evaluation using high-frequency transducers, combined with Doppler imaging and CEUS, enables a more accurate diagnosis.

scholarly journals Noninvasive Diagnosis of Hepatocellular Carcinoma on Sonazoid-Enhanced US: Value of the Kupffer Phase

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 141
Author(s):  
Hiroshi Takahashi ◽  
Katsutoshi Sugimoto ◽  
Naohisa Kamiyama ◽  
Kentaro Sakamaki ◽  
Tatsuya Kakegawa ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Diagnostic Performance ◽  
Late Phase ◽  
Imaging Feature ◽  
Arterial Phase ◽  
Liver Imaging ◽  
Noninvasive Diagnosis ◽  
Contrast Enhanced ◽  
Treatment Naïve ◽  
Hepatic Lesions

The aim of this study was to compare the diagnostic performance of Contrast-Enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) version 2017, which includes portal- and late-phase washout as a major imaging feature, with that of modified CEUS LI-RADS, which includes Kupffer-phase findings as a major imaging feature. Participants at risk of hepatocellular carcinoma (HCC) with treatment-naïve hepatic lesions (≥1 cm) were recruited and underwent Sonazoid-enhanced US. Arterial phase hyperenhancement (APHE), washout time, and echogenicity in the Kupffer phase were evaluated using both criteria. The diagnostic performance of both criteria was analyzed using the McNemar test. The evaluation was performed on 102 participants with 102 lesions (HCCs (n = 52), non-HCC malignancies (n = 36), and benign (n = 14)). Among 52 HCCs, non-rim APHE was observed in 92.3% (48 of 52). By 5 min, 73.1% (38 of 52) of HCCs showed mild washout, while by 10 min or in the Kupffer phase, 90.4% (47 of 52) of HCCs showed hypoenhancement. The sensitivity (67.3%; 35 of 52; 95% CI: 52.9%, 79.7%) of modified CEUS LI-RADS criteria was higher than that of CEUS LI-RADS criteria (51.9%; 27 of 52; 95% CI: 37.6%, 66.0%) (p = 0.0047). In conclusion, non-rim APHE with hypoenhancement in the Kupffer phase on Sonazoid-enhanced US is a feasible criterion for diagnosing HCC.

scholarly journals Use of Contrast-Enhanced Ultrasonography for the Characterization of Tumor Thrombi in Seven Dogs

Animals ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 1613
Author(s):  
Alessia Cordella ◽  
Pascaline Pey ◽  
Nikolina Linta ◽  
Manuela Quinci ◽  
Marco Baron Toaldo ◽  
...  
Keyword(s):  
Color Doppler ◽  
Case Series ◽  
Arterial Phase ◽  
Retrospective Case ◽  
Primary Tumors ◽  
Contrast Enhanced ◽  
Venous Phase ◽  
Contrast Enhanced Ultrasonography ◽  
Tumor Thrombi

Tumors of adrenal and thyroid glands have been associated with vascular invasions—so-called tumor thrombi, both in humans and dogs. The detection and characterization of venous thrombi is an important diagnostic step in patients with primary tumors for both surgical planning and prognosis. The aim of this study was to describe the use of contrast-enhanced ultrasonography (CEUS) for the characterization of tumor thrombi. Dogs with tumor thrombus who underwent bi-dimensional ultrasound (B-mode US) and CEUS were included. Seven dogs were enrolled in this retrospective case series. On B-mode US, all thrombi were visualized, and vascular distension and thrombus-tumor continuity were seen in three and two cases, respectively. On color Doppler examination, all thrombi were identified, seemed non-occlusive and only two presented vascularity. On CEUS, arterial-phase enhancement and washout in the venous phase were observed in all cases. Non-enhancing areas were identified in the tumor thrombi most likely representing non-vascularized tissue that could potentially be embolized in the lungs after fragmentation of the tumor thrombi. On the basis of these preliminary study, CEUS appeared to be useful for the characterization of malignant intravascular invasion.

Tips and Tricks in Contrast-Enhanced Ultrasound (CEUS) for the Characterization and Detection of Liver Malignancies

2019 ◽  
Vol 40 (04) ◽  
pp. 404-424 ◽  
Author(s):  
Barbara Schellhaas ◽  
Deike Strobel
Keyword(s):  
Liver Cirrhosis ◽  
Contrast Enhancement ◽  
Late Phase ◽  
Therapeutic Monitoring ◽  
Arterial Phase ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Liver Malignancies ◽  
Contrast Enhanced

AbstractContrast-enhanced ultrasound (CEUS) has a high diagnostic accuracy in the assessment of focal liver lesions. Clinical context (presence of liver cirrhosis, history of other malignancy versus incidental finding) is crucial for the correct interpretation of CEUS findings. CEUS has to be preceded by structured anamnesis and clinical examination as well as accurate B-mode sonography. Metastases are the most common malignant liver lesions in a non-cirrhotic liver. According to their contrast enhancement in the arterial phase, metastases are categorized as hyper- and hypo-vascular metastases. A common feature of all metastatic lesions is washout of the contrast agent in the portal venous or late phase. In the context of liver cirrhosis, > 95 % of focal liver lesions are hepatocellular carcinomas (HCCs). HCCs typically show arterial phase hyperenhancement, followed by mild and gradual contrast washout occurring very late in the late phase. For intrahepatic cholangiocellular carcinoma (ICC), the pattern of contrast enhancement in the arterial phase can vary. However, all ICCs typically show early and pronounced washout. Other liver malignancies like lymphoma, angiosarcoma, epithelioid hemangioendothelioma and others are very rare. Except for the contrast washout seen in all liver malignancies, they do not display pathognomonic enhancement patterns upon CEUS. Thus, biopsy is indispensable for definite diagnosis of the tumor entity. Furthermore, CEUS is used for the detection of metastases and therapeutic monitoring after local ablative procedures. The examination procedure differs slightly depending on the specific indication (characterization, detection).

scholarly journals Influence of Contrast Media on Bone Mineral Density (BMD) Measurements from Routine Contrast-Enhanced MDCT Datasets using a Phantom-less BMD Measurement Tool

2017 ◽  
Vol 189 (06) ◽  
pp. 537-543 ◽  
Author(s):  
Andrea Toelly ◽  
Constanze Bardach ◽  
Michael Weber ◽  
Rui Gong ◽  
Yanbo Lai ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Intraclass Correlation ◽  
Arterial Phase ◽  
Measurement Tool ◽  
Mineral Density ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Venous Phase ◽  
The Mean

Aim To evaluate the differences in phantom-less bone mineral density (BMD) measurements in contrast-enhanced routine MDCT scans at different contrast phases, and to develop an algorithm for calculating a reliable BMD value. Materials and Methods 112 postmenopausal women from the age of 40 to 77 years (mean age: 57.31 years; SD 9.61) who underwent a clinically indicated MDCT scan, consisting of an unenhanced, an arterial, and a venous phase, were included. A retrospective analysis of the BMD values of the Th12 to L4 vertebrae in each phase was performed using a commercially available phantom-less measurement tool. Results The mean BMD value in the unenhanced MDCT scans was 79.76 mg/cm³ (SD 31.20), in the arterial phase it was 85.09 mg/cm³ (SD 31.61), and in the venous phase it was 86.18 mg/cm³ (SD 31.30). A significant difference (p < 0.001) was found between BMD values on unenhanced and contrast-enhanced MDCT scans. There was no significant difference between BMD values in the arterial and venous phases (p = 0.228). The following conversion formulas were calculated using linear regression: unenhanced BMD = -2.287 + 0.964 * [arterial BMD value] and -4.517 + 0.978 * [venous BMD value]. The intrarater agreement of BMD measurements was calculated with an intraclass correlation (ICC) of 0.984 and the interobserver reliability was calculated with an ICC of 0.991. Conclusion Phantom-less BMD measurements in contrast-enhanced MDCT scans result in increased mean BMD values, but, with the formulas applied in our study, a reliable BMD value can be calculated. However, the mean BMD values did not differ significantly between the arterial and venous phases. Key points  Citation Format

Functioning islet cell tumor of the pancreas

1997 ◽  
Vol 38 (1) ◽  
pp. 135-138 ◽  
Author(s):  
M. J. Chung ◽  
B. I. Choi ◽  
J. K. Han ◽  
J. W. Chung ◽  
M. C. Han ◽  
...  
Keyword(s):  
Islet Cell ◽  
Late Phase ◽  
Islet Cell Tumor ◽  
Ct Scanning ◽  
Spiral Ct ◽  
Arterial Phase ◽  
Islet Cell Tumors ◽  
Contrast Enhanced ◽  
Projection Images ◽  
Detection And Localization

Purpose: The purpose of this study was to evaluate the usefulness of dynamic spiral CT, including multidimensional reformation, in the detection and localization of islet cell tumors of the pancreas. Material and Methods: Seven patients with histopathologically proven functioning islet cell tumors of the pancreas were studied with 2-phase contrast-enhanced spiral CT. Scanning of the arterial phase and late phase was started 30 s and 180 s, respectively, after injection of 100 ml of contrast medium at a rate of 3 ml/s. Results: Axial images in the arterial phase depicted the lesions in 5 patients, but in the late phase in only one patient. Multiplanar reformatted images of the arterial phase depicted the lesions in all 7 patients. Maximal intensity projection images demonstrated all lesions with information of their relationship to the vascular structure. Conclusion: Dynamic spiral CT with scanning during the arterial phase and retrospective multidimensional reformation is useful for preoperative detection and localization of small islet cell tumors of the pancreas.

scholarly journals Pancreatico-biliary pathologies: correlation of USG and MRCP

2019 ◽  
Vol 6 (7) ◽  
pp. 2373
Author(s):  
Priyanka Ashok Khopde ◽  
Abhimanyu Kelkar ◽  
Priscilla Joshi ◽  
Amol Bandgar ◽  
Mangal Mahajan
Keyword(s):  
Obstructive Jaundice ◽  
Imaging Modality ◽  
Correct Diagnosis ◽  
Age Groups ◽  
Biliary Disease ◽  
Age Group ◽  
Frequent Form ◽  
Ultrasound Study ◽  
Benign Pathology

Background: Obstructive jaundice is the most frequent form of hepato-biliary pathologies. The main aim is to confirm the presence of obstruction and to identify its cause, location and extent of the lesion. This study evaluated the role of USG and MRCP in hepato-biliary pathology.Methods: Twenty-five patients of all age groups with suspicion of obstructive jaundice referred for Ultrasound were included in our study. The patients with findings suggestive of biliary obstruction underwent MRCP.Results: Out of 25 patients, maximum patients were in the age group of 61-80 yrs. 52% were male and 48% were female. The jaundice was due to a benign etiology in 64% patients and malignant etiology in 36%. The most common benign pathology was choledocholithiasis (25%) and malignant pathology was periampullary carcinoma (44%). Overall 11 cases were inconclusive on ultrasound study while 2 cases were false positive for malignancy on MRCP. In 92% cases the correct diagnosis was detected on MRCP.Conclusions: USG is the initial and sometimes the only imaging modality in obstructive biliary disease. However the distal CBD which is poorly seen on USG can be well evaluated on MRCP thus improving the diagnosis in pancreatico-biliary pathologies.

scholarly journals Size measurements of hepatocellular carcinoma: comparisons between contrast and two-dimensional ultrasound

2020 ◽  
Author(s):  
Fei Chen ◽  
Fei Wang ◽  
Mei Zhu ◽  
Si Sun ◽  
Zheng Liu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Late Phase ◽  
Size Difference ◽  
Arterial Phase ◽  
Two Dimensional ◽  
Test Results ◽  
Contrast Enhanced ◽  
2D Imaging ◽  
The Mean ◽  
Longitudinal Diameter

Abstract Background Ultrasound (US) imaging is known to underestimate tumor size in clinical. This study is aimed to compare the size measurements of hepatocellular carcinoma (HCC) in three US imaging modalities, i.e. two-dimensional (2D) imaging, the arterial phase (AP) and the late phase (LP) imaging of contrast-enhanced US (CEUS). Methods Fifty-eight clinically proved HCC patients were included. The 2D and CEUS imaging were performed with Siemens S2000, Philips iu22 and BioSound Twice. 2.5 mL of SonoVue® was injected for every CEUS performance. Two physicians measured the maximal longitudinal and the transverse diameters of the tumors in 2D, the AP and the LP of CEUS from one image section. The three measurements were compared by paired t test. Results The mean longitudinal diameter of HCC appeared to be maximal in the AP (4.73 ± 2.04 cm) of CEUS and minimal in the LP (3.98 ± 1.99 cm) of CEUS. The 2D diameter (4.26 ± 2.07 cm) was in the middle between two CEUS measurements. There were significant differences between any two measurements. Conclusion There is size difference between the three kinds of HCC measurement. It appeared to be maximal in the AP of CEUS and minimal in the LP. The 2D diameter was in the middle.

scholarly journals Size measurements of hepatocellular carcinoma: comparisons between contrast and two-dimensional ultrasound

2020 ◽  
Author(s):  
Fei Chen ◽  
Fei Wang ◽  
Si Sun ◽  
Mei Zhu ◽  
Zheng Liu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Late Phase ◽  
Size Difference ◽  
Arterial Phase ◽  
Two Dimensional ◽  
Test Results ◽  
Contrast Enhanced ◽  
2D Imaging ◽  
The Mean ◽  
Longitudinal Diameter

Abstract Background Ultrasound (US) imaging is known to underestimate tumor size in clinical. This study is aimed to compare the size measurements of hepatocellular carcinoma (HCC) in three US imaging modalities, i.e. two-dimensional (2D) imaging, the arterial phase (AP) and the late phase (LP) imaging of contrast-enhanced US (CEUS). Methods Fifty-eight clinically proved HCC patients were included. The 2D and CEUS imaging were performed with Siemens S2000, Philips iu22 and BioSound Twice. 2.5 mL of SonoVue® was injected for every CEUS performance. Two physicians measured the maximal longitudinal and the transverse diameters of the tumors in 2D, the AP and the LP of CEUS from one image section. The three measurements were compared by paired t test. Results The mean longitudinal diameter of HCC appeared to be maximal in the AP (4.73±2.04 cm) of CEUS and minimal in the LP (3.98±1.99 cm) of CEUS. The 2D diameter (4.26±2.07 cm) was in the middle between two CEUS measurements. There were significant differences between any two measurements. Conclusion There is size difference between the three kinds of HCC measurement. It appeared to be maximal in the AP of CEUS and minimal in the LP. The 2D diameter was in the middle.

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