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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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Hemangioma. Serial CHA acoustic emission images obtained during the precontrast phase (A), and at 20-sec (B), 1-min (C), and 5-min (D) delay, clearly demonstrate typical peripheral nodular enhancement with progressive centripetal fill-in.
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Figure 5: Hemangioma. Serial CHA acoustic emission images obtained during the precontrast phase (A), and at 20-sec (B), 1-min (C), and 5-min (D) delay, clearly demonstrate typical peripheral nodular enhancement with progressive centripetal fill-in.

Mentions: Tumor diameters as measured at US were 7-52 (mean, 23) mm. During the acoustic emission phase imaging, 19 of 22 hemangiomas (86%) showed typical peripheral nodular enhancement and progressive centripetal fill-in (Fig. 5), and the remaining three (3/22, 14%) showed persistent homogeneous enhancement, also one of the characteristic enhancement patterns of hemangiomas. Although the intensity of enhancing areas of the tumor diminished progressively after injection, areas of enhancement enlarged and persisted until the late phase of acoustic emission imaging. As for vascular phase imaging, no intratumoral flow signal was observed in 21 of 22 hemangiomas (95%) during the continuous vascular-phase scanning. Only one unusual hemangioma, with arterioportal shunt, showed diffuse intratumoral stippling during this phase scanning (Fig. 6).


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)

Hemangioma. Serial CHA acoustic emission images obtained during the precontrast phase (A), and at 20-sec (B), 1-min (C), and 5-min (D) delay, clearly demonstrate typical peripheral nodular enhancement with progressive centripetal fill-in.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Hemangioma. Serial CHA acoustic emission images obtained during the precontrast phase (A), and at 20-sec (B), 1-min (C), and 5-min (D) delay, clearly demonstrate typical peripheral nodular enhancement with progressive centripetal fill-in.
Mentions: Tumor diameters as measured at US were 7-52 (mean, 23) mm. During the acoustic emission phase imaging, 19 of 22 hemangiomas (86%) showed typical peripheral nodular enhancement and progressive centripetal fill-in (Fig. 5), and the remaining three (3/22, 14%) showed persistent homogeneous enhancement, also one of the characteristic enhancement patterns of hemangiomas. Although the intensity of enhancing areas of the tumor diminished progressively after injection, areas of enhancement enlarged and persisted until the late phase of acoustic emission imaging. As for vascular phase imaging, no intratumoral flow signal was observed in 21 of 22 hemangiomas (95%) during the continuous vascular-phase scanning. Only one unusual hemangioma, with arterioportal shunt, showed diffuse intratumoral stippling during this phase scanning (Fig. 6).

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