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Focal hepatic lesions: evaluation with contrast-enhanced gray-scale harmonic US.

Jang HJ, Lim HK, Lee WJ, Kim SH, Kim MJ, Choi D, Lee SJ, Lim JH - Korean J Radiol (2003 Apr-Jun)

Bottom Line: To determine the findings of various focal hepatic lesions at contrast-enhanced gray-scale ultrasound (US) using a coded harmonic angio (CHA) technique and emphasizing lesion characterization.At contrast-enhanced gray-scale US using a CHA technique, a period of continuous scanning depicted the intratumoral vasculature, and interval-delay scanning demonstrated the sequential enhancement pattern.The characteristic findings of various focal hepatic lesions were thus determined.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-gu, Seoul, Korea.

ABSTRACT

Objective: To determine the findings of various focal hepatic lesions at contrast-enhanced gray-scale ultrasound (US) using a coded harmonic angio (CHA) technique and emphasizing lesion characterization.

Materials and methods: The study involved 95 patients with 105 focal hepatic lesions, namely 51 hepatocellular carcinomas (HCCs), 22 metastases, 22 hemangiomas, four cases of focal nodular hyperplasia (FNH), and six nontumorous nodules. After the injection of a microbubble contrast agent (SH U 508A), gray-scale harmonic US studies using a CHA technique were performed with a combination of continuous scanning to assess the intratumoral vasculature (vascular imaging) and interval-delay scanning to determine the sequential enhancement pattern (acoustic emission imaging). Each imaging pattern was categorized and analyzed.

Results: At vascular imaging, 69% of HCCs (35/51) showed irregular branching vessels, while in 91% of metastases (20/22) a peripherally stippled pattern was observed. Intratumoral vessels were absent in 95% of hemangiomas (21/22) and all nontumorous lesions (6/6), while in 75% of FNHs (3/4) a spoke-wheel pattern was evident. At acoustic emission imaging, 71% of HCCs (36/51) showed heterogeneous enhancement and 86% (19/22) of metastases showed rim- or flame-like peripheral enhancement during the early phase, with washout occurring in all HCCs and metastases (100%, 73/73) during the late phase. In hemangiomas, enhancement was either peripheral and nodular (19/22, 86%) or persistent and homogeneous (3/22, 14%), and 75% of FNHs (3/4) became isoechoic during the late phase.

Conclusion: At contrast-enhanced gray-scale US using a CHA technique, a period of continuous scanning depicted the intratumoral vasculature, and interval-delay scanning demonstrated the sequential enhancement pattern. The characteristic findings of various focal hepatic lesions were thus determined.

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HCC (arrows). Serial acoustic emission images obtained at 20-sec (A), 2-min (B), and 5-min (C) delay show early enhancement (A) and heterogeneous washout (B, C).
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Figure 3: HCC (arrows). Serial acoustic emission images obtained at 20-sec (A), 2-min (B), and 5-min (C) delay show early enhancement (A) and heterogeneous washout (B, C).

Mentions: Tumor diameters as measured at US were 14-55 (mean, 25) mm. For HCCs, the most common intratumoral vascular pattern seen during the vascular imaging phase was irregular branching vessels (69%, 35/51), followed by randomly stippled vascularity (27%, 14/51) (Fig. 2). The intratumoral vessels of the remaining two HCCs (4%, 2/51) were judged to have a spoke-wheel appearance. During the acoustic emission imaging phase, 71% of HCCs (36/51) showed heterogeneous enhancement during the early phase, and the echogenicity of all HCCs diminished and became converse when compared with that of the parenchyma. This was, in other words, a washout pattern (Fig. 3).


Focal hepatic lesions: evaluation with contrast-enhanced gray-scale harmonic US.

Jang HJ, Lim HK, Lee WJ, Kim SH, Kim MJ, Choi D, Lee SJ, Lim JH - Korean J Radiol (2003 Apr-Jun)

HCC (arrows). Serial acoustic emission images obtained at 20-sec (A), 2-min (B), and 5-min (C) delay show early enhancement (A) and heterogeneous washout (B, C).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2698076&req=5

Figure 3: HCC (arrows). Serial acoustic emission images obtained at 20-sec (A), 2-min (B), and 5-min (C) delay show early enhancement (A) and heterogeneous washout (B, C).
Mentions: Tumor diameters as measured at US were 14-55 (mean, 25) mm. For HCCs, the most common intratumoral vascular pattern seen during the vascular imaging phase was irregular branching vessels (69%, 35/51), followed by randomly stippled vascularity (27%, 14/51) (Fig. 2). The intratumoral vessels of the remaining two HCCs (4%, 2/51) were judged to have a spoke-wheel appearance. During the acoustic emission imaging phase, 71% of HCCs (36/51) showed heterogeneous enhancement during the early phase, and the echogenicity of all HCCs diminished and became converse when compared with that of the parenchyma. This was, in other words, a washout pattern (Fig. 3).

Bottom Line: To determine the findings of various focal hepatic lesions at contrast-enhanced gray-scale ultrasound (US) using a coded harmonic angio (CHA) technique and emphasizing lesion characterization.At contrast-enhanced gray-scale US using a CHA technique, a period of continuous scanning depicted the intratumoral vasculature, and interval-delay scanning demonstrated the sequential enhancement pattern.The characteristic findings of various focal hepatic lesions were thus determined.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-gu, Seoul, Korea.

ABSTRACT

Objective: To determine the findings of various focal hepatic lesions at contrast-enhanced gray-scale ultrasound (US) using a coded harmonic angio (CHA) technique and emphasizing lesion characterization.

Materials and methods: The study involved 95 patients with 105 focal hepatic lesions, namely 51 hepatocellular carcinomas (HCCs), 22 metastases, 22 hemangiomas, four cases of focal nodular hyperplasia (FNH), and six nontumorous nodules. After the injection of a microbubble contrast agent (SH U 508A), gray-scale harmonic US studies using a CHA technique were performed with a combination of continuous scanning to assess the intratumoral vasculature (vascular imaging) and interval-delay scanning to determine the sequential enhancement pattern (acoustic emission imaging). Each imaging pattern was categorized and analyzed.

Results: At vascular imaging, 69% of HCCs (35/51) showed irregular branching vessels, while in 91% of metastases (20/22) a peripherally stippled pattern was observed. Intratumoral vessels were absent in 95% of hemangiomas (21/22) and all nontumorous lesions (6/6), while in 75% of FNHs (3/4) a spoke-wheel pattern was evident. At acoustic emission imaging, 71% of HCCs (36/51) showed heterogeneous enhancement and 86% (19/22) of metastases showed rim- or flame-like peripheral enhancement during the early phase, with washout occurring in all HCCs and metastases (100%, 73/73) during the late phase. In hemangiomas, enhancement was either peripheral and nodular (19/22, 86%) or persistent and homogeneous (3/22, 14%), and 75% of FNHs (3/4) became isoechoic during the late phase.

Conclusion: At contrast-enhanced gray-scale US using a CHA technique, a period of continuous scanning depicted the intratumoral vasculature, and interval-delay scanning demonstrated the sequential enhancement pattern. The characteristic findings of various focal hepatic lesions were thus determined.

Show MeSH
Related in: MedlinePlus