Accuracy Of Contrast-enhanced Ultrasound Research Articles

Contrast-enhanced ultrasound for the differential diagnosis between benign and metastatic superficial lymph nodes: a meta-analysis.

PurposeContrast-enhanced ultrasound (CEUS) is a new technique used to distinguish benign from metastatic superficial lymph nodes (LNs) with variable accuracy. The objective of this meta-analysis was to evaluate the accuracy of CEUS for the diagnosis of superficial metastatic LNs.MethodsA comprehensive literature search of PubMed, Web of Science, Medline, Embase, and the Cochrane Library was performed until April 2018. Nine articles reporting the diagnosis of 436 LNs by CEUS were investigated. The Mantel–Haenszel and DerSimonian–Laird methods were used to analyze pooled sensitivity, specificity, diagnostic OR, positive likelihood ratio (LR), and negative LR, and a summary receiver operating characteristic (SROC) curve was also evaluated.ResultsThe pooled sensitivity and specificity of CEUS for the differential diagnosis of benign and metastatic superficial LNs were 0.88 (95% CI, 0.83–0.92) and 0.80 (95% CI, 0.74–0.85), respectively. The pooled positive LR, negative LR, and diagnostic OR were 4.36 (95% CI, 2.38–7.99), 0.17 (95% CI, 0.10–0.31), and 32.75 (95% CI, 11.08–96.84), respectively. SROC area under the curve (AUC) was 0.9288. The subgroup analysis excluding outliers implied that the heterogeneity was almost eliminated, and the pooled sensitivity and specificity were 0.87 (95% CI, 0.81–0.92) and 0.79 (95% CI, 0.71–0.85), respectively. The SROC AUC was 0.8950.ConclusionCEUS, a novel imaging modality for the characterization of superficial LNs, shows a high sensitivity and specificity in the diagnosis of superficial metastatic LNs. The different diagnostic standards, contrast agents, and contrast modes contribute to a considerable level of heterogeneity among studies. A uniform standard for distinguishing between benign and metastatic LNs is needed for further clinical application.

Significance of contrast-enhanced ultrasonography in differential diagnosis of thyroid nodules.

The present study was aimed to compare the application values between 2-dimensional color Doppler ultrasonography (2DUS) and contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of thyroid malignant nodules.A total of 124 patients suspectedly diagnosed with malignant thyroid nodules under conventional gray-scale ultrasonography were recruited in this study. All enrolled patients were examined by both 2DUS and CEUS.A total of 153 nodules (94.44%) and 45 cases (90.00%) with malignant nodules were detected by the CEUS. No significant differences were noted in nodule detection rates between 2DUS and CEUS (χ2 = 1.170, P = .279; χ2 = 0.796, P = .372). The aspect ratio, microcalcification, internal echo, borderline, Vmax, resistance index, and total scores of malignant nodules were higher than those of benign nodules (all P < .05) when diagnosed by 2DUS. The peripheral/internal enhancement time, peak intensity, local enhancement, ring enhancement, and total scores of malignant nodules were significantly higher compared with those of benign nodules (all P < .05) by CEUS. Total score of malignant nodules diagnosed by 2DUS was approximately 3.5 and 2.3 points for CEUS. The diagnostic accuracy of 2DUS as observed by area under the curve was 0.821 with the cut-off value of 3.9, the sensitivity was 82.5%, and the specificity was 85.6%. The diagnostic accuracy of CEUS was 0.862 with the cut-off value of 2.8, the sensitivity was 86.7%, and the specificity was 91.3%.Both 2DUS and CEUS are worthy of application values in the differential diagnosis from benign to malignant thyroid nodules.

Contrast-enhanced ultrasound for the evaluation of hepatic artery occlusion after liver transplantation

Introduction:Vascular complications after liver transplantation remain a major threat to the survival of recipients.HAT is a major cause of graft loss and patient mortality, with an incidence between 3% to 8% in transplant recipients.Early detection of HAT is critical because urgent revascularization is required to avoid severe graft loss. Although ultrasound is the preferred first-line imaging modality in patients with suspected HAT, the accuracy and positive predictive value of HAT on Doppler US are reported to be low. Moreover, Doppler examination of the hepatic vasculature is time consuming and requires a high level of operator skill. Conventional angiography remains the gold standard for diagnosis. Recently, contrast-enhanced ultrasound (CEUS) has begun providing real-time angiographic-like images of vessels at bed side and allowing the accurate diagnosis of arterial diseases such as hepatic artery thrombosis. The purpose of this study was to evaluate the efficacy of CEUS in detecting HAT after liver transplantation: Materials and Methods: This is a retrospective data of the medical records of patients undergoing Liver transplantation in the Osmania General Hospital, Hyderabad between 2016 to 2018. Status of hepatic vascular assessment following liver transplantation done by conventional Doppler Ultra sonography and Contrast Enhanced Ultrasonography tests were obtained from registries of medical records. Results:23 cases of post Liver transplantation aged between 4years and 58 years, with a median age of 30 years were included in the analysis. There were 20 males and 3 females. 14 patients underwent DDLT, 7 patients underwent LDLT, 1underwent split Liver transplantation and another 1 patient underwent Auto liver transplantation. Doppler US was inconclusive regarding patency of the hepatic artery (HA) circulation in 5 (21.7 %) of 23 transplantations. CEUS was performed in these 5 patients and detected HA thrombosis (HAT) in 2 cases and patent HA in 3 transplants. These 5 Transplants were confirmed by CT Angiography /conventional Angiography. In the subset of transplantations examined with CEUS, the sensitivity, specificity and accuracy of CEUS were 100%. CEUS was done at bedside without any Radiation and Nephro toxicity. In approximately 21.7% of cases, conventional Doppler US did not provide sufficient visualization of the HA after liver transplantation. In these cases, correct diagnosis was achieved by supplementary CEUS. Conclusion:CEUS may be a new approach for early diagnosis of postoperative vascular complications after Liver Transplantation, and it can be performed at the bedside. It is safe will not cause any nephron toxicity and Radiation. CEUS is a fast, non-ionizing imaging modality for the initial exclusion of vascular complications after liver transplantation. CEUS shows a high specificity and PPV in the detection of vascular complications. In unclear cases CT still is considered as the gold standard

Contrast enhanced ultrasound in diagnosis of endometrial carcinoma and endometrial hyperplasia

The present study was aimed to compare application of contrast enhanced ultrasound (CEUS) in diagnosis of endometrial carcinoma (EC) and endometrial hyperplasia (EH). A total of 81 patients with EC and simple EH were selected in this study. Among all patients, 39 cases were diagnosed as EC and 42 cases were diagnosed with EH. All patients were diagnosed by CEUS examination. The diagnosis of EC and EH was also confirmed by endometrial biopsy. CEUS was conducted for all patients. Eendometrial thickness was measured and the mean arrival time, time-to-peak, enhancement time, arrival intensity, peak intensity, enhancement intensity, rising rate, washout half-time and clearance half-time were recorded. Myometrial invasion was categorized into 2 stages &lt;50% and &gt;50%. No significant difference was observed in clinical basis between the two groups. Endometrial thickness of EC was significantly higher than that of EH, P&lt;0.05. Results of CEUS parameters showed that in EC patients, all values of arrival time, time-to-peak, washout half-time and clearance half-time were all shorter in EC group compared with those in EH patients, P&lt;0.05. And values of peak intensity, enhancement intensity, and rising rate were also lower in EC patients than those in EH patients, P&lt;0.05. Diagnostic accuracy of CEUS in myometrial invasion for EC was shown showed that 26 of 30 cases were diagnosed as myometrial invasion &lt;50% by CEUS and 7 of 9 cases were diagnosed as myometrial invasion &gt;50%. The total diagnostic accuracy of CEUS is 82.62% (33/39). We conducted a comparison study to analyze different diagnostic effects of CEUS for EC and EH. The study may give more clinical basic data in the field of CEUS application in diagnosis of EC and can give a reference to the difference between EC and EH.

Application of contrast enhanced ultrasound in TN staging of pancreas cancer: comparison with contrast enhanced computed tomography

Objective To assess value of contrast enhanced ultrasound (CEUS) in TN staging of pancreatic cancer and compared with contrast enhanced computed tomography(CECT). Methods Seventy-eight cases with pancreatic cancer confirmed by pathology were enrolled in this study. All patients were examined using CEUS and CECT and staged according to the 8th guideline of pancreas tumors of AJCC. The diagnostic accuracies of CEUS in TN staging of pancreas tumors were compared with CECT. Results The diagnostic accuracies of CEUS in T staging and N staging of pancreatic cancer were 80.8%, and 78.2%, respectively. For CECT, the diagnostic accuracies in T staging and N staging were 88.5%, and 88.5%, respectively. There was no significant difference in the diagnostic accuracies between CEUS and CECT in T staging(χ2=1.56, P=0.21). The diagnostic accuracy of CEUS in N staging was significantly lower than that of CECT(χ2=3.86, P=0.04). Conclusions The diagnostic accuracy of CEUS in T staging of pancreatic cancer is similar to that of CECT, while in its N staging is lower than that of CECT. Key words: Contrast-enhanced ultrasound; Pancreatic neoplasms; Contrast enhanced computed tomography

Assessment of the use of contrast enhanced ultrasound in guiding microdissection testicular sperm extraction in nonobstructive azoospermia

BackgroundThe aim of this study is to assess the value of contrast-enhanced ultrasound (CEUS) as a new non-invasive approach to locate the testicular area in which spermatogenesis is most likely to be found in non-obstructive azoospermic testes and to evaluate the accuracy of CEUS as a predictor of successful sperm retrieval.MethodsCEUS was performed in 120 nonobstructive azoospermia (NOA) patients. Microdissection testicular sperm extraction (M-TESE) was performed on the best and poorest perfusion areas selected by CEUS and on conventional areas.ResultsIn the 187 testicles that underwent M-TESE, the sperm retrieval rates (SRRs) in the best perfusion area and poorest perfusion area over the maximal longitudinal section and conventional area were 63.1, 34.7 and 47.1%. According to receiver operating characteristic (ROC) analysis, the arrival times (AT) ≤27 s, time-to-peak intensity (TTP) ≤45 s, and peak intensity (PI) ≥11 dB were the best predictors of positive sperm retrieval. The location of the best perfusion area was able to guide M-TESE to improve the success rates.ConclusionsTesticle CEUS is suggested to be performed in all patients with NOA. If AT≤27 s, TTP ≤ 45 s or PI≥11 dB are found in the best perfusion area, M-TESE is strongly recommended.

Vascular rejection in renal transplant: Diagnostic value of contrast-enhanced ultrasound (CEUS) compared to biopsy.

Despite of the more potent immunosuppressive medication, vascular rejection is still a major issue after renal transplantation. Renal biopsy is the gold standard diagnostic to evaluate acute and chronic allograft rejection. As it is an invasive diagnostic there is the risk of complications like haematoma, arteriovenous fistulas, active bleeding or infection. Contrast-enhanced ultrasound is a non-invasive imaging modality that allows visualising renal transplant perfusion. To analyse the sensitivity and specificity of contrast-enhanced ultrasound (CEUS) compared to biopsy as gold standard in diagnosing vascular rejection in renal transplant patients. A total of 57 renal transplant recipients with poor renal allograft function with initial diagnostic imaging between 2006 and 2017 were included in the study. Clinical data and imaging studies were analysed retrospectively. The diagnostic accuracy of CEUS in diagnosing vascular rejection of the renal transplant was compared to renal biopsy as gold standard. Out of 57 patients 7 patients showed signs of vascular rejection in biopsy. In 6 out of these 7 patients CEUS described irregularities in renal perfusion suspicious of vascular rejection. CEUS showed a sensitivity of 85.7%, a specificity of 100%, a positive predictive value (PPV) of 100%, and a negative predictive value (NPV) of 98.0%. CEUS is a safe, non-nephrotoxic imaging modality for the initial imaging of renal transplant recipients with elevated kidney function parameters suspicious of vascular rejection. Compared to renal biopsy as gold standard CEUS shows a high specificity and PPV in detecting signs of vascular rejection. Since sub-types of vascular rejection with cellular and humoral components with greater risk for allograft loss have been described renal biopsy is inevitable in these cases.

Meta-analysis of the diagnostic value of contrast-enhanced ultrasound for the detection of vascular complications after liver transplantation.

contrast-enhanced ultrasound (CEUS) is increasingly used to identify vascular complications in patients after liver transplantation. The present study aimed to evaluate the diagnostic accuracy of CEUS using all available data. relevant studies published before February 2018 were retrieved from PubMed, EMBASE, ScienceDirect and Web of Science. Pooled sensitivity and specificity, diagnostic odds ratio (DOR) and summary receiver operating characteristic curve (SROC) were calculated to estimate the diagnostic performance of CEUS for vascular complications. Sensitivity analysis was performed that stratified studies according to age, study design and sample size in order to determine the influence of these factors on the overall effect. Meta-regression analyses were performed to examine the possible sources of heterogeneity. Quality assessment and publication bias of the included studies were also evaluated. thirteen studies which consisted of 2,781 CEUS cases were included in the analysis. The pooled weighted estimates of sensitivity and specificity were 0.90 (95% CI, 0.84 to 0.95) and 1.00 (95% CI, 1.00 to 1.00), the diagnostic odds ratio (DOR) was 431.96 (95% CI, 164.60 to 1,133.59) and the area under the curve (AUC) of SROC was 0.9741. According to the sensitivity analysis, age, study design and sample size had an insignificant influence on the diagnostic performance of CEUS. The meta-regression analyses did not reveal a strong correlation between CEUS accuracy and study design, treatment time of patients and experience of the radiologists. the results of our meta-analysis showed a high sensitivity, specificity and accuracy of the CEUS modality for the identification of vascular complications in patients after liver transplantation. Since this is the first meta-analysis investigating in this aspect, more evidence is required to validate the clinical utility of CEUS for the identification of vascular complications in patients with a transplanted liver.

The diagnostic value of contrast-enhanced ultrasound (CEUS) as a new technique for imaging of vascular complications in renal transplants compared to standard imaging modalities.

Vascular complications in renal transplant patients are a well-known issue in post transplant patient care. If malfunctioning of the renal transplant is suspected to be caused by vascular complications an early diagnosis and therapy is required to maintain the renal transplant. Computed tomography (CT), digital substraction angiography (DSA) and radioisotope renography are the gold standard imaging modalities to diagnose vascular complications. To analyse the sensitivity and specificity of contrast-enhanced ultrasound (CEUS) in comparison to the standard imaging modalities CT, DSA and radioisotope renography in the diagnosis of vascular complications in renal transplant patients. A total of 33 renal transplant recipients with elevated kidney function parameters with initial diagnostic imaging between 2006 and 2017 were included in the study. The imaging studies and clinical data were analysed retrospectively. The diagnostic accuracy of CEUS was compared to CT, DSA and renal scintigraphy respectively which are classified as gold standard for diagnosis of vascular complications in renal transplant patients. Out of 23 patients 15 patients showed vascular complications in CT, DSA or radioisotope renography and in 15 out of 15 patients CEUS detected the vascular complication. CEUS showed a sensitivity of 100%, a specificity of 66.7%, a positive predictive value (PPV) of 71.4%, and a negative predictive value (NPV) of 100%. CEUS is a non-nephrotoxic and safe method for the initial imaging of vascular complications in renal transplant recipients. Compared to the gold standard imaging modalities CT, DSA and radioisotope renography CEUS shows a high sensitivity and NPV in detecting vascular complications. In cases with suspected stenosis of the transplant renal artery additional DSA might be needed.

Value of contrast enhanced ultrasound combined with elastography in differential diagnosis of non-mass-like lesions on breast

Objective To explore the diagnostic value of contrast enhanced ultrasound (CEUS), elastography and their combined use in diagnosing non-mass-like lesions on breast. Methods From November 2015 to January 2017, 79 nodules diagnosed by conventional ultrasound were prospectively enrolled and examined by CEUS and elastography before surgery. Multivariate logistic regression models were established for CEUS and CEUS combined with elastography to diagnose breast malignancy. The diagnostic performances of CEUS, elastography and their combined use were evaluated with the receiver operating characteristic (ROC) curve. Results The CEUS features significantly predicting malignancy were hyperenhancement, heterogeneous enhancement, visualization of penetrating vessels (P<0.01). Furthermore, the multivariate logistic regression for CEUS combined with elastography showed that heterogeneous enhancement, visualization of penetrating vessels and elasticity score were the independent predictors of breast malignancy. The area under the ROC curve of CEUS combined with elastography was (0.915±0.223), which was higher than that of CEUS and elatography (0.851±0.029, 0.790±0.038, P<0.05). Moreover, the sensitivity, and accuracy of CEUS combined with elastography were 89.1%, and 86.1%, respectively. The omission diagnostic rate of CEUS combined with elastography (8.9%) was reduced. The diagnostic accuracy of CEUS combined with elastography was significantly higher than that of CEUS and elastography. Conclusions The diagnostic value of CEUS combined with elastography was remarkably significant in the differential diagnosis of non-mass-like lesions on breast. Key words: Ultrasonography; Elasticity imaging techniques; Breast diseases/DI

Value of contrast-enhanced ultrasound in differential diagnosis of solid lesions of pancreas (SLP): A systematic review and a meta-analysis.

Background:Contrast-enhanced ultrasound (CEUS) is considered a novel method for diagnosing pancreatic cancer, but currently, there is no conclusive evidence of its accuracy. Using CEUS in discriminating between pancreatic carcinoma and other pancreatic lesions, we aimed to evaluate the diagnostic accuracy of CEUS in predicting pancreatic tumours.Methods:Relevant studies were selected from the PubMed, Cochrane Library, Elsevier, CNKI, VIP, and WANFANG databases dating from January 2006 to May 2017. The following terms were used as keywords: “pancreatic cancer” OR “pancreatic carcinoma,” “contrast-enhanced ultrasonography” OR “contrast-enhanced ultrasound” OR “CEUS,” and “diagnosis.” The selection criteria are as follows: pancreatic carcinomas diagnosed by CEUS while the main reference standard was surgical pathology or biopsy (if it involved a clinical diagnosis, particular criteria emphasized); SonoVue or Levovist was the contrast agent; true positive, false positive, false negative, and true negative rates were obtained or calculated to construct the 2 × 2 contingency table; English or Chinese articles; at least 20 patients were enrolled in each group. The Quality Assessment for Studies of Diagnostic Accuracy was employed to evaluate the quality of articles. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, summary receiver-operating characteristic curves, and the area under curve were evaluated to estimate the overall diagnostic efficiency. Pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio with 95% confidence intervals (CIs) were calculated with fixed-effect models.Results:Eight of 184 records were eligible for a meta-analysis after independent scrutinization by 2 reviewers. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratios were 0.86 (95% CI 0.81–0.90), 0.75 (95% CI 0.68–0.82), 3.56 (95% CI 2.64–4.78), 0.19 (95% CI 0.13–0.27), and 22.260 (95% CI 8.980–55.177), respectively. The area under the SROC curve was 0.9088.Conclusion:CEUS has a satisfying pooled sensitivity and specificity for discriminating pancreatic cancer from other pancreatic lesions.

Diagnostic accuracy of contrast enhanced ultrasound in patients with blunt abdominal trauma presenting to the emergency department: a systematic review and meta-analysis

We aimed to investigate the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in evaluating blunt abdominal trauma for patients presenting to the emergency department. Electronic search of Scopus and Pubmed was performed from inception to September 2016. Human studies investigating the diagnostic accuracy of CEUS in identifying abdominal solid organ injuries were included. Risk of bias was assessed using the QUADAS tool. A total of 10 studies were included in the study and 9 of them were included for meta-analysis. The log(DOR) values ranged from 3.80 (95% CI: 2.81–4.79) to 8.52 (95% CI: 4.58–12.47) in component studies. The combined log(DOR) was 6.56 (95% CI: 5.66–7.45). The Cochran’s Q was 11.265 (p = 0.793 with 16 degrees of freedom), and the Higgins’ I2 was 0%. The CEUS had a sensitivity of 0.981 (95% CI: 0.868–0.950) and a false positive rate of 0.018 (95% CI: 0.010–0.032) for identifying parenchymal injuries, with an AUC of 0.984. CEUS performed at emergency department had good diagnostic accuracy in identifying abdominal solid organ injuries. CEUS can be recommended in monitoring solid organ injuries, especially for patients managed with non-operative strategy.

Contrast-Enhanced Ultrasound Classification of Previously Indeterminate Renal Lesions.

To determine the utility of contrast-enhanced ultrasound (US) for characterizing renal lesions that were indeterminate on prior imaging. This Institutional Review Board-approved retrospective diagnostic accuracy study evaluated all patients who underwent renal contrast-enhanced US examinations from 2006 to 2015 at our tertiary care hospital. We compared the number of lesions definitively characterized by contrast-enhanced US with the indeterminate lesions by prior imaging. The accuracy of contrast-enhanced US was compared with the final diagnosis by histologic examination and follow-up (mean, 3.63 years). Accuracy and agreement estimates were compared with the exact binomial distribution to assess statistical significance. A total of 134 lesions were evaluated with contrast-enhanced US, and 106 were indeterminate by preceding computed tomography, magnetic resonance imaging, or US. Only the largest lesion per patient was included in analysis. A total of 95.7% (90 of 94) of the previously indeterminate lesions were successfully classified with contrast-enhanced US. The sensitivity was 100% (20 of 20; 95% confidence interval [CI], 83%-100%; P < .0001); specificity was 85.7% (18 of 21; 95% CI, 62%-97%; P = .0026); positive predictive value was 87.0% (20 of 23; 95% CI, 66%-97%; P = .0005); negative predictive value was 100% (18 of 18; 95% CI, 81%-100%; P < .001); and accuracy was 90.2% (37 of 41; 95% CI, 80%-98%; P < .0001). Contrast-enhanced US has a high likelihood of definitively classifying a renal lesion that is indeterminate by computed tomography, magnetic resonance imaging, or conventional US.

Role of Contrast-Enhanced Ultrasound in Diagnosis of Thyroid Nodules in Acoustic Radiation Force Impulse “Gray Zone”

The aim of this study was to evaluate the clinical value of contrast-enhanced ultrasound (CEUS) in the diagnosis of thyroid nodules in the acoustic radiation force impulse (ARFI) “gray zone” (the shear wave velocity is in the range 2.5–3 m/s). ARFI was performed before thyroidectomy in 70 patients with 200 thyroid nodules, and then CEUS was performed in 40 thyroid nodules in the “gray zone.” The accuracy of ARFI for the 200 thyroid nodules was 82% (164/200). The accuracy of ARFI for the 40 “gray zone” thyroid nodules was 70% (28/40), whereas the accuracy of CEUS for the “gray zone” thyroid nodules was 90% (36/40). There was a significant difference in accuracy (p < 0.05). CEUS has better accuracy for thyroid nodules in the ARFI “gray zone.” CEUS supplemented ARFI in differential diagnosis of benign and malignant thyroid nodules.

Liver Focal Fatty Change Evaluated by Contrast-Enhanced Ultrasound: A Retrospective Study in an Ultrasound Expert Center

The goal of this paper was to evaluate the liver focal fatty change (either fat infiltration or fatty sparing) assessed by contrast-enhanced ultrasound (CEUS), in a tertiary center. A retrospective study was performed that evaluated a cohort of 2904 de novo focal liver lesions (FLLs) assessed by CEUS (according to EFSUMB guidelines) over a period of seven years (2010-2016). Focal fatty change (FFC) lesions that were referred for contrast assessment were 319/2904 (11%). From 2904 FLLs, 979 (33.7%) were also evaluated by a second line imaging technique or histology (due to the incomplete EFSUMB diagnostic pattern criteria). We evaluated the sensitivity, specificity and accuracy of CEUS for the FFC that were confirmed by a second line imaging technique (CT, MRI) or histology. For the statistical analysis we used OpenEpi software. From 2904 de novo FLLs, 319 (11%) were FFC, in female 46.4%, in male 53,6%; mean age 54.3+/- 11.9 years, mean lesion size: 3.37±2.13 cm. 233/319 (73%)- were fatty sparing and 86/319 (27%)-fat infiltration. FFC represented by focal infiltration were diagnosed on liver with chronic hepathopaty: 25/319 (7.8%) and 61/319 (92.8%) on liver without fibrosis. CEUS was conclusive (lesions with typical enhancement pattern as presented in EFSUMB guidelines) for the diagnosis of FFC in 97.2% of cases. From 979 FLLs group (CT, MRI or histology for the final diagnosis), 31/979 (3.2%) were FFC. 22/31 (71%) were fatty sparing and 9/31 (29%) were fat infiltration. CEUS performance in the diagnosis of FFC was: 72.73% Sensitivity; 99.67% Specificity; 98.28% Accuracy. The performance of CEUS was influenced by the diameter of the lesion (>5cm) and the presence of sever fibrosis ≥F3. CEUS is an accurate and specific method for the diagnosis of focal fatty changes; still the results can be influenced by the size of the lesion and the presence of liver cirrhosis.

Contrast-Enhanced Ultrasound Performance in the Evaluation of Focal Nodular Hyperplasia in a Multicenter Study

Contrast-enhanced ultrasound (CEUS) has become the main player in the evaluation of focal liver lesions. The aim of this study was to evaluate the sensitivity, specificity and accuracy of CEUS for focal nodular hyperplasia from a large study group. A multicenter prospective study was performed in fourteen Romanian centers, over a period of 6 years (02.2011-03.2017), that gathered 2062 newly detected focal liver lesions evaluated by CEUS. Each lesion had a contrast CT, MRI or histology as reference method. The lesions have not been previously diagnosed by other imaging technique, and they were considered conclusive if they had an obvious enhancement pattern, as recommended by the guidelines. CEUS performance for the FNH was assessed using OpenEpi software for the statistical analysis. During the 6 years study, 2062 “de novo” focal liver lesions, have been evaluated by CEUS. From this cohort, 94/2062 (4.5%) had a typical FNH enhancing pattern as described in the EFSUMB guidelines. Contrast CT/MRI and biopsy diagnosed additional 15 FNH. From the 94 cases diagnosed as FNH by CEUS, in 9 the final diagnosis was different (5 of them adenomas). CEUS performance for the FNH was: 84% sensitivity, 99.4% specificity, 89.7% positive predictive value, 99.0% negative predictive value and 98.5% diagnostic accuracy for the diagnosis of focal nodular hyperplasia. FNH is a benign liver lesion that can accurately be characterized by CEUS as a first-line imaging method.

Application of contrast enhanced ultrasound in the diagnosis of carotid plaque characteristics: comparison with magnetic resonance angiography

Objective To compare the application value of contrast enhanced ultrasound (CEUS) and contrast enhanced magnetic resonance angiography (CEMRA) in the diagnosis of carotid plaque characteristics. Methods Fourty-six patients (48 carotid plaques) were performed with carotid CEUS and CEMRA examination prior to carotid endarterectomy. The following characteristics of plaque including the surface of the plaque,the presence of calcification,the internal composition and the diameter stenosis were observed and measured,which were compared with pathologic and digital subtraction angiography(DSA) results. Results There were 42 vulnerable plaques and 6 stable plaques in the 48 plaques. Fourty-seven carotid plaques had been correctly diagnosed by CEUS and CEMRA,and one plaque had been misdiagnosed. The sensitivity,specificity and accuracy between CEUS and CEMRA had no obvious differences in terms of the overall evaluation of plaque vulnerability (P>0.05); CEUS and CEMRA in the diagnosion of the plaque surface situation had no statistical difference in terms of sensitivity,specificity and accuracy compared with pathological results(P>0.05); There was no significant difference in diagnostic accuracy rate between two modalities (P 0.05). With DSA examination results as the gold standard,the accuracy of CEUS in the diagnosis of the diameter stenosis was 97.92% (47/48),CEMRA was 100% (48/48),they had no significant difference between two groups (P>0.05). Conclusions CEUS and CEMRA in carotid plaques characteristic evaluation have respective advantages,are highly complementary,and combining two methods can systematically evaluate for plaque characteristics. Key words: Ultrasonography; Magnetic resonance angiography; Carotid artery diseases; Plaque

Contrast-Enhanced Ultrasound and Computed Tomography Assessment of Hepatocellular Carcinoma after Transcatheter Arterial Chemo-Embolization: A Systematic Review.

Contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT) are used to assess the response of hepatocellular carcinoma after transarterial chemoembolization. Our aim was to perform a systematic review to compare CEUS and CECT for therapeutic response assessment to transarterial chemoembolization in the treatment of hepatocellular carcinoma. PubMed, Embase, and the Cochrane Library databases were searched from inception until January 1, 2016. patients with hepatocellular carcinoma. transarterial chemoembolization and CECT vs CEUS. Sixteen studies were included in the systematic review. The total number of patients was 858 and the mean patient age ranged from 42 to 73 years. The mean tumor size ranged from 1.0 cm to 4.3 cm. The sensitivity and specificity of CEUS ranged from 46% to 100% and 65% to 100%, respectively, and that of CECT ranged from 34% to 87% and 92% to 100%, respectively. The accuracy of CEUS ranged from 72.6% to 100% and that of CECT from 61% to 94%. Marked heterogeneity was present among the studies. CEUS is comparable with CECT for the therapeutic response assessment after transarterial chemoembolization.

Detection of liver metastases in cancer patients with geographic fatty infiltration of the liver: the added value of contrast-enhanced sonography.

PurposeThe aim of this study is to assess the role of contrast-enhanced ultrasonography (CEUS) in the detection of liver metastases in cancer patients with geographic liver fatty deposition on greyscale ultrasonography (US).MethodsThirty-seven consecutive cancer patients (24 women and 13 men; age, 33 to 80 years; mean, 58.1 years) with geographic liver fatty deposition, but without any detectable focal liver lesion on greyscale US, underwent sulphur hexafluoride-enhanced US. Two readers reported by consensus the presence, size, and location of any detected lesion. All patients underwent magnetic resonance imaging (MRI) as a confirmatory study. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy were calculated.ResultsSeven focal liver lesions (size, 4 to 10 mm; mean, 6.1 mm) were detected in 4/37 patients (10.8%): four metastases (size, 5 to 10 mm; mean, 6.7 mm) were detected both by CEUS and MRI, with one hemangioma and two cysts (size range, 4 to 6 mm; mean, 5.3 mm) detected by MRI only. In 1/37 patients (2.7%), CEUS misdiagnosed geographic fatty change as three metastases. In 32/37 patients (86.5%), no lesions were detected. Sensitivity, specificity, PPV, NPV, and accuracy of CEUS were 100% (95% confidence Interval [CI], 1.000 to 1.000), 97.1% (95% CI, 0.914 to 1.027), 75%, 100%, and 97.3%, respectively. No statistically significant differences were found between CEUS and MRI in the detection of focal liver lesions (P=0.480), whereas both of them performed better than baseline US (P<0.001).ConclusionCEUS improves the detection of liver metastases in cancer patients with geographic liver fatty deposition on greyscale US.

Meta-analysis of contrast-enhanced ultrasonography for the detection of gallbladder carcinoma.

To systematically evaluate the accuracy of contrast-enhanced ultrasonography (CEUS) for the detection of gallbladder carcinoma. Relevant studies were identified searching PubMed, Embase, Elsevier, the CNKI (China National Knowledge Infrastructure) database and the Cochrane Trial Register searches until August 2015. Patient clinical characteristics, sensitivity and specificity were extracted. The summary receiver operating characteristic (ROC) curve was used to examine the accuracy of CEUS. A meta-analysis was performed to evaluate the clinical utility in the diagnosis of gallbladder carcinoma. Sensitivity analysis was performed after omitting outliers identified in a bivariate boxplot and publication bias was assessed with Egger testing. From 89 citations, 16 were included in the meta-analysis with a total of 1673 lesions. We detected heterogeneity between studies and evidence of publication bias. The methodological quality was moderate. The pooled weighted sensitivity with a corresponding 95% confidence interval (CI) was 0.92 (95%CI: 0.90, 0.94), the specificity was 0.91 (95%CI: 0.89, 0.93), the positive likelihood ratio was 10.01 (95%CI: 7.02, 14.29), the negative likelihood ratio was 0.10 (95%CI: 0.07, 0.14), and the diagnostic odds ratio was 123.02 (95%CI: 78.40, 193.03). The area under the ROC curve was 0.9689 (95%CI: 0.9376, 0.9879). CEUS is a reliable, non-invasive, and no-radiation-exposure imaging modality with a high sensitivity and specificity for detection of gallbladder carcinoma. Nonetheless, it should be applied cautiously, and large scale, well-designed trials are necessary to assess its clinical value.