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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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Related in: MedlinePlus

Inflammatory nodule in a rectal cancer patient. Portal venous phase CT (A) shows a hypoattenuating mass (arrow). CHA vascular phase imaging (B, 40-sec delay) reveals no vascular pattern within the mass (arrows), which appears as a perfusion defect at both other phases of acoustic emission imaging (C, 2-min delay; D, 5-min delay). Biopsy revealed chronic inflammation and necrosis.
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Figure 9: Inflammatory nodule in a rectal cancer patient. Portal venous phase CT (A) shows a hypoattenuating mass (arrow). CHA vascular phase imaging (B, 40-sec delay) reveals no vascular pattern within the mass (arrows), which appears as a perfusion defect at both other phases of acoustic emission imaging (C, 2-min delay; D, 5-min delay). Biopsy revealed chronic inflammation and necrosis.

Mentions: At US, lesion diameters were found to be 12-35 (mean, 23.3) mm. No lesions in this group (three FENs, two inflammatory nodules, and one focal fatty lesion) showed an intralesional vascular pattern at vascular phase imaging (Figs. 8, 9). At emission imaging, the focal fatty lesion was hyperechoic at precontrast scanning, but after contrast administration, its echo intensity became identical to that of surrounding parenchyma at any phase of acoustic emission imaging (Fig. 8). FENs showed a complete perfusion defect in their center and fuzzy enhancement at the periphery, but for the first one or two minutes, this was weaker than that of surrounding parenchyma. Inflammatory nodules showed a complete lack of enhancement at emission imaging (Fig. 9).


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)

Inflammatory nodule in a rectal cancer patient. Portal venous phase CT (A) shows a hypoattenuating mass (arrow). CHA vascular phase imaging (B, 40-sec delay) reveals no vascular pattern within the mass (arrows), which appears as a perfusion defect at both other phases of acoustic emission imaging (C, 2-min delay; D, 5-min delay). Biopsy revealed chronic inflammation and necrosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 9: Inflammatory nodule in a rectal cancer patient. Portal venous phase CT (A) shows a hypoattenuating mass (arrow). CHA vascular phase imaging (B, 40-sec delay) reveals no vascular pattern within the mass (arrows), which appears as a perfusion defect at both other phases of acoustic emission imaging (C, 2-min delay; D, 5-min delay). Biopsy revealed chronic inflammation and necrosis.
Mentions: At US, lesion diameters were found to be 12-35 (mean, 23.3) mm. No lesions in this group (three FENs, two inflammatory nodules, and one focal fatty lesion) showed an intralesional vascular pattern at vascular phase imaging (Figs. 8, 9). At emission imaging, the focal fatty lesion was hyperechoic at precontrast scanning, but after contrast administration, its echo intensity became identical to that of surrounding parenchyma at any phase of acoustic emission imaging (Fig. 8). FENs showed a complete perfusion defect in their center and fuzzy enhancement at the periphery, but for the first one or two minutes, this was weaker than that of surrounding parenchyma. Inflammatory nodules showed a complete lack of enhancement at emission imaging (Fig. 9).

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