Abstract
AimTo evaluate the diagnostic accuracy of IO-SE in comparison to IO-CEUS for the differentiation between malignant and benign liver lesions.Material and MethodsIn a retrospective diagnostic study IO-CEUS and SE examinations of 49 liver lesions were evaluated and compared to histopathological examinations. Ultrasound was performed using a multifrequency linear probe (6–9 MHz). The loops of CEUS were evaluated up to 5 min. The qualitative characterization of IO-SE was based on a color coding system (blue = hard, red = soft). Stiffness of all lesions was quantified by a specific scaling of 0–6 (0 = low, 6 = high) using 7 ROIs (2 central, 5 peripheral).ResultsAll malignant lesions displayed a characteristic portal venous washout and could be diagnosed correctly by IO-CEUS. 3/5 benign lesions could not be characterized properly either by IO-CEUS or IO-SE prior to resection. Thus for IO-CEUS sensitivity, specificity, positive and negative predictive value and accuracy were 100%, 40%, 94%, 100% and 94%. Lesion sizes were between 8 and 59 mm in diameter. Regarding the IO-SE, malignant lesions showed a marked variability. In qualitative analysis, 31 of the malignant lesions were blue colored denoting overall induration. Thirteen malignant lesions showed an inhomogenous color pattern with partial indurations. Two of the benign lesions also displayed overall induration. The other benign lesions showed an inhomogenous color mapping. Calculated sensitivity of the SE was 70.5%, specificity 60%, PPV 94%, NPV 18.75%, and accuracy 69%.ConclusionIO-CEUS is useful for localization and characterization of liver lesions prior to surgical resection whereas IO-SE provided correct characterization only for a limited number of lesions.
Highlights
Studies have shown that contrast enhanced intraoperative ultrasonography (IO-Contrast Enhanced Ultrasound (CEUS)) has a higher sensitivity for detecting malignant liver lesions compared to conventional intraoperative ultrasound (US) or pre-operative imaging modalities such as Computed tomography (CT) and Magnetic Resonance imaging (MRI) [1,2,3].intraoperative contrast enhanced ultrasound (IO-CEUS) may identify at least one additional malignant lesion in up to 30% of patients [4] causing a change of the therapeutic strategy in up to one-fifth to one-third of the patients [5,6].IO-CEUS has shown to be very useful for characterization of tumor size and morphology, when using its dynamic assessment of the lesion’s microcirculation
IO-CEUS is useful for localization and characterization of liver lesions prior to surgical resection whereas IO-strain elastography (SE) provided correct characterization only for a limited number of lesions
Studies have shown that contrast enhanced intraoperative ultrasonography (IO-CEUS) has a higher sensitivity for detecting malignant liver lesions compared to conventional intraoperative ultrasound (US) or pre-operative imaging modalities such as Computed tomography (CT) and Magnetic Resonance imaging (MRI) [1,2,3]
Summary
Studies have shown that contrast enhanced intraoperative ultrasonography (IO-CEUS) has a higher sensitivity for detecting malignant liver lesions compared to conventional intraoperative ultrasound (US) or pre-operative imaging modalities such as Computed tomography (CT) and Magnetic Resonance imaging (MRI) [1,2,3].IO-CEUS may identify at least one additional malignant lesion in up to 30% of patients [4] causing a change of the therapeutic strategy in up to one-fifth to one-third of the patients [5,6].IO-CEUS has shown to be very useful for characterization of tumor size and morphology, when using its dynamic assessment of the lesion’s microcirculation. IO-CEUS may identify at least one additional malignant lesion in up to 30% of patients [4] causing a change of the therapeutic strategy in up to one-fifth to one-third of the patients [5,6]. The second generation US contrast agent SonoVue (Bracco, Milan, Italy)) consists of stabilized microbubbles that are composed of the hydrophobic gas sulphur hexafluoride (SF6) which is surrounded by a thin and flexible membrane of amphiphilic phospholipids. The gas within the microbubbles is stabilized but the shell remains flexible, allowing the microbubbles to change size and shape . These phospholipids serve as true blood-pool agents, which enable continuous real-time contrast sonography over an extended period of time. Repeated bolus injections of the contrast agent might be necessary [8]
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