Contrast-enhanced Ultrasound Enhancement Patterns Research Articles

Contrast-enhanced ultrasound appearances of enhancement patterns of intrahepatic cholangiocarcinoma: correlation with pathological findings.

The aim of this study was to investigate the correlation between enhancement patterns of intrahepatic cholangiocarcinoma (ICC) on contrast-enhanced ultrasound (CEUS) and pathological findings. The CEUS enhancement patterns of 40 pathologically proven ICC lesions were retrospectively analysed. Pathologically, the degree of tumour cell and fibrosis distribution in the lesion was semi-quantitatively evaluated. Four enhancement patterns were observed in the arterial phase for 32 mass-forming ICCs: peripheral rim-like hyperenhancement (n = 19); heterogeneous hyperenhancement (n = 6); homogeneous hyperenhancement (n = 3); and heterogeneous hypo-enhancement (n = 4). Among the four enhancement patterns, the differences in tumour cell distribution were statistically significant (p < 0.05). The hyperenhancing area on CEUS corresponded to more tumour cells for mass-forming ICCs. Heterogeneous hyperenhancement (n = 2) and heterogeneous hypo-enhancement (n = 2) were observed in the arterial phase for four periductal-infiltrating ICCs. In this subtype, fibrosis was more commonly found in the lesions. Heterogeneous hyperenhancement (n = 1) and homogeneous hyperenhancement (n = 3) were observed in the arterial phase for four intraductal-growing ICCs. This subtype tended to have abundant tumour cells. The CEUS findings of ICC relate to the degree of carcinoma cell proliferation at pathological examination. Hyperenhancing areas in the tumour always indicated increased density of cancer cells.

Dynamic Vascular Pattern (DVP), a Quantification Tool for Contrast Enhanced Ultrasound

Contrast-enhanced ultrasound (CEUS) is widely applied in tumour diagnosis, especially for focal liver lesions (FLL), due to its high sensitivity and specificity. According to the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) CEUS guidelines (2012) and non-liver guidelines (2011), the majority of tumours, regardless of location, show specific CEUS enhancement patterns that can distinguish benign from malignant lesions. However, even experienced clinicians evaluating FLL may find occasional irregularities in these patterns, due to particular FLL pathologies, that make a definitive diagnosis difficult. Hence, there is a need to train physicians to utilize contrast enhancement kinetics to aid in the correct interpretation of data from CEUS examinations in patients with divergent liver tumour pathologies. Here we report on a CEUS quantitation software, SonoLiver®, to verify and improve diagnostic accuracy in the characterization of suspicious liver lesions through the analysis of dynamic vascular patterns (DVP).

Contrast-enhanced ultrasound of intrahepatic cholangiocarcinoma: correlation with pathological examination

To investigate the correlation between enhancement patterns of intrahepatic cholangiocarcinoma (ICC) on contrast-enhanced ultrasound (CEUS) and pathological findings. The CEUS enhancement patterns of 40 pathologically proven ICC lesions were retrospectively analysed. Pathologically, the degree of tumour cell and fibrosis distribution in the lesion was semi-quantitatively evaluated. 4 enhancement patterns were observed in the arterial phase for 32 mass-forming ICCs: peripheral rim-like hyperenhancement (n=19); heterogeneous hyperenhancement (n=6); homogeneous hyperenhancement (n=3); and heterogeneous hypo-enhancement (n=4). Among the four enhancement patterns, the differences in tumour cell distribution were statistically significant (p<0.05). The hyperenhancing area on CEUS corresponded to more tumour cells for mass-forming ICCs. Heterogeneous hyperenhancement (n=2) and heterogeneous hypo-enhancement (n=2) were observed in the arterial phase for four periductal infiltrating ICCs. In this subtype, fibrosis was more commonly found in the lesions. Heterogeneous hyperenhancement (n=1) and homogeneous hyperenhancement (n=3) were observed in the arterial phase for four intraductal growing ICCs. This subtype tended to have abundant tumour cells. The CEUS findings of ICC relate to the degree of carcinoma cell proliferation at pathological examination. Hyperenhancing areas in the tumour always indicated increased density of cancer cells.

Utility of Contrast-Enhanced Ultrasound for Evaluation of Thyroid Nodules

No conventional imaging method reliably distinguishes between benign and malignant thyroid nodules. Our objectives were to characterize the enhancement patterns of thyroid nodules on gray-scale contrast-enhanced ultrasound (US) and to evaluate whether these patterns were useful in the differential diagnosis of thyroid nodules. Ninety-five patients, scheduled for surgery for thyroid nodules detected by gray-scale sonography, were enrolled in this prospective study. In all, there were 104 nodules (47 papillary carcinomas, 3 medullary carcinomas, 1 metastatic carcinoma, 44 hyperplasia nodule, 7 follicular adenomas, 1 suture granulomas, and 1 Hashimoto's disease). After intraveneous (i.v.) injection of a 1.2 mL bolus of SonoVue, lesions were scanned with real-time gray-scale pulse inversion harmonic imaging US for at least 3 minutes at low mechanical index (MI) (0.05 to 0.08). The enhancement patterns were classified into one of four patterns by two experienced readers. After administration of SonoVue, four enhancement patterns (homogeneous, heterogeneous, ring-enhancing, and no enhancement) were observed. Four benign and 3 malignant nodules had homogeneous enhancement pattern, 4 benign and 45 malignant nodules had heterogeneous enhancement, 44 benign and 3 malignant nodules had ring enhancement, and 1 benign nodule had no enhancement. There was a significant difference between benign and malignant nodules (p < 0.001). The benign thyroid nodules showed four enhancement patterns: ring enhancement 44/53 (83.0%), homogeneous enhancement 4/53 (7.5%), heterogeneous enhancement 4/53 (7.5%), and no enhancement 1/44 (1.9%). The malignant thyroid nodules showed three enhancement patterns: heterogeneous enhancement 45/51 (88.2%), ring enhancement 3/51 (5.9%), and homogeneous enhancement 3/51 (5.9%). Ring enhancement correlated highly with a benign diagnosis (sensitivity 83.0%, specificity 94.1%, positive predictive value 93.6%, negative predictive value 84.2%, and accuracy 88.5%). Heterogeneous enhancement correlated highly with a malignant diagnosis (sensitivity 88.2%, specificity, 92.5% positive predictive value 91.8%, negative predictive value 89.1%, and accuracy 90.4%). In both mixed and solid nodules, ring enhancement was highly predictive of a benign finding, whereas heterogeneous enhancement was highly predictive of a malignant finding. Contrast-enhanced US enhancement patterns were different in benign and malignant lesions. Ring enhancement was predictive of benign lesions, whereas heterogeneous enhancement was helpful for detecting malignant lesions.

Intrahepatic cholangiocarcinoma and hepatocellular carcinoma: differential diagnosis with contrast-enhanced ultrasound

We assessed the usefulness of contrast-enhanced ultrasound (CEUS) in the differentiation of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC). The CEUS enhancement patterns of 50 ICCs were retrospectively analysed and compared with 50 HCCs. Two readers independently reviewed the baseline ultrasound (BUS) and CEUS images and the diagnostic performances were evaluated by receiver operating characteristic (ROC) analysis. Time-intensity curves (TIC) were plotted for quantification analysis. In the arterial phase, peripheral rim-like hyperenhancement, heterogeneous hyperenhancement, homogeneous hyperenhancement and heterogeneous hypoenhancement were found in 25, 10, 3 and 12 of the ICCs versus 2, 29, 19 and 0 of the HCCs (P < 0.001), respectively. The diagnostic performance of both readers in terms of the area under the ROC curve (0.745 vs. 0.933 for reader 1, and 0.803 vs. 0.911 for reader 2), sensitivity (28% vs. 90%, and 44% vs. 82%) and accuracy (64% vs. 90%, and 71% vs. 90%) improved significantly after CEUS (all P < 0.05). The interobserver agreement increased from kappa = 0.575 at BUS to kappa = 0.720 after CEUS. TICs demonstrated that the intensities of the peripheral and central portions of the ICCs were lower than those of HCCs (both P < 0.05). CEUS improves the diagnostic performance significantly in the differentiation between ICC and HCC.