Alteration of contrast enhanced ultrasound (CEUS) of hepatocellular carcinoma in patients with cirrhosis and transjugular intrahepatic portosystemic shunt (TIPS)

Nina Böhling,Maria A Gonzalez-Carmona,Michael Praktiknjo,Jasmin Abu-Omar,Carsten Meyer,Johannes Chang,Alexia Dumitrache,Jürgen Rockstroh,Deike Strobel,Andreas Minh Luu,Julian Luetkens,Milka Marinova,Jonel Trebicka,Christian P Strassburg

doi:10.1038/s41598-020-77801-9

Abstract

Transjugular intrahepatic portosystemic shunt (TIPS) can treat portal hypertensive complications and modifies hepatic hemodynamics. Modification of liver perfusion can alter contrast enhancement dynamics of liver nodules. This study investigated the diagnostic performance of contrast-enhanced ultrasound (CEUS) to diagnose hepatocellular carcinoma (HCC) in cirrhosis with TIPS. In this prospective monocentric observational study, CEUS was used to characterize focal liver lesions in patients at risk for HCC with and without TIPS. Times of arterial phase hyperenhancement (APHE) und washout were quantified. Perfusion-index (PI) and resistance-index (RI) of hepatic artery and portal venous flow parameters were measured via doppler ultrasonography. Diagnostic gold standard was MRI/CT or histology. This study included 49 liver lesions [23 TIPS (11 HCC), 26 no TIPS (15 HCC)]. 26 were diagnosed as HCC by gold standard. Sensitivity and specificity of CEUS to diagnose HCC with and without TIPS were 93.3% and 100% vs. 90.9% and 93.3%, respectively. APHE appeared significantly earlier in patients with TIPS compared to patients without TIPS. TIPS significantly accentuates APHE of HCC in CEUS. CEUS has good diagnostic performance for diagnosis of HCC in patients with TIPS.

Highlights

Transjugular intrahepatic portosystemic shunt (TIPS) can treat portal hypertensive complications and modifies hepatic hemodynamics
Arterial phase hyperenhancement (APHE) reflects the process of arterial angiogenesis which is a key component of hepatocellular carcinoma (HCC) pathogenesis, where predominantly arterial rather than portal-venous blood supply is drawn by HCC16
49 focal liver lesions from 33 patients with liver cirrhosis were included in this study. 18 patients had TIPS

Summary

Introduction

Transjugular intrahepatic portosystemic shunt (TIPS) can treat portal hypertensive complications and modifies hepatic hemodynamics. This study investigated the diagnostic performance of contrast-enhanced ultrasound (CEUS) to diagnose hepatocellular carcinoma (HCC) in cirrhosis with TIPS. In this prospective monocentric observational study, CEUS was used to characterize focal liver lesions in patients at risk for HCC with and without TIPS. Abbreviations CEUS Contrast-enhanced ultrasound TIPS Transjugular intrahepatic portosystemic shunt PVT Portal vein thrombosis MELD Model of end-stage liver disease CLIF-C-AD CLIF consortium acute decompensation score CLIF-C-ACLF CLIF consortium acute-on-chronic liver failure WBC White-blood-cells MRI Magnetic resonance imaging CT Computed tomography PVV Portal vein velocity RI Resistance-index PI Perfusion-index HCC Hepatocellular carcinoma. The diagnostic algorithm for HCC in high risk patients is widely performed according to Liver Imaging Reporting and Data System (LI-RADS)8 This algorithm accounts for size, arterial phase hyperenhancement and wash out phenomenon in later phases.

Methods

Results

Conclusion