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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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Metastasis from duodenal carcinoma. Serial acoustic emission image depicts rim-or flame-like enhancement during the early phase (A, 40-sec delay) and a homogeneous perfusion defect during a later phase (B, 5-min delay).
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Figure 4: Metastasis from duodenal carcinoma. Serial acoustic emission image depicts rim-or flame-like enhancement during the early phase (A, 40-sec delay) and a homogeneous perfusion defect during a later phase (B, 5-min delay).

Mentions: Tumor diameters as measured at US were 7-72 (mean, 23.5) mm. During the vascular imaging phase, 20 of 22 metastases (91%) showed a peripherally stippled pattern, while the remaining two demonstrated randomly stippled vascularity (2/22, 9%). During the early emission imaging phase (1-2 minute delay), 86% (19/22) showed rim- or flame-like peripheral enhancement (Fig. 4A) and the remaining three (3/22, 14%) showed homogeneous hypoechogenicity, with no intratumoral enhancement. A peripherally stippled vascular pattern was also observed for the few seconds remaining after emission imaging during this phase. The echo intensity of the enhancing areas of the tumor diminished (washout pattern), and the remaining areas with no early-phase enhancement were persistently hypoechoic (Fig. 4B). Accordingly, scans obtained after a delay of three or more minutes showed that all metastases became homogeneous cold lesions within the enhancing parenchyma.


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)

Metastasis from duodenal carcinoma. Serial acoustic emission image depicts rim-or flame-like enhancement during the early phase (A, 40-sec delay) and a homogeneous perfusion defect during a later phase (B, 5-min delay).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Metastasis from duodenal carcinoma. Serial acoustic emission image depicts rim-or flame-like enhancement during the early phase (A, 40-sec delay) and a homogeneous perfusion defect during a later phase (B, 5-min delay).
Mentions: Tumor diameters as measured at US were 7-72 (mean, 23.5) mm. During the vascular imaging phase, 20 of 22 metastases (91%) showed a peripherally stippled pattern, while the remaining two demonstrated randomly stippled vascularity (2/22, 9%). During the early emission imaging phase (1-2 minute delay), 86% (19/22) showed rim- or flame-like peripheral enhancement (Fig. 4A) and the remaining three (3/22, 14%) showed homogeneous hypoechogenicity, with no intratumoral enhancement. A peripherally stippled vascular pattern was also observed for the few seconds remaining after emission imaging during this phase. The echo intensity of the enhancing areas of the tumor diminished (washout pattern), and the remaining areas with no early-phase enhancement were persistently hypoechoic (Fig. 4B). Accordingly, scans obtained after a delay of three or more minutes showed that all metastases became homogeneous cold lesions within the enhancing parenchyma.

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