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Is Strain Elastography (IO-SE) Sufficient for Characterization of Liver Lesions before Surgical Resection--Or Is Contrast Enhanced Ultrasound (CEUS) Necessary?

Jung EM, Platz Batista da Silva N, Jung W, Farkas S, Stroszczynski C, Rennert J - PLoS ONE (2015)

Bottom Line: The other benign lesions showed an inhomogenous color mapping.Calculated sensitivity of the SE was 70.5%, specificity 60%, PPV 94%, NPV 18.75%, and accuracy 69%.IO-CEUS is useful for localization and characterization of liver lesions prior to surgical resection whereas IO-SE provided correct characterization only for a limited number of lesions.

View Article: PubMed Central - PubMed

Affiliation: University Hospital Regensburg, Department of Radiology, Regensburg, Germany.

ABSTRACT

Aim: To evaluate the diagnostic accuracy of IO-SE in comparison to IO-CEUS for the differentiation between malignant and benign liver lesions.

Material and methods: In a retrospective diagnostic study IO-CEUS and SE examinations of 49 liver lesions were evaluated and compared to histopathological examinations. Ultrasound was performed using a multifrequency linear probe (6-9 MHz). The loops of CEUS were evaluated up to 5 min. The qualitative characterization of IO-SE was based on a color coding system (blue = hard, red = soft). Stiffness of all lesions was quantified by a specific scaling of 0-6 (0 = low, 6 = high) using 7 ROIs (2 central, 5 peripheral).

Results: All malignant lesions displayed a characteristic portal venous washout and could be diagnosed correctly by IO-CEUS. 3/5 benign lesions could not be characterized properly either by IO-CEUS or IO-SE prior to resection. Thus for IO-CEUS sensitivity, specificity, positive and negative predictive value and accuracy were 100%, 40%, 94%, 100% and 94%. Lesion sizes were between 8 and 59 mm in diameter. Regarding the IO-SE, malignant lesions showed a marked variability. In qualitative analysis, 31 of the malignant lesions were blue colored denoting overall induration. Thirteen malignant lesions showed an inhomogenous color pattern with partial indurations. Two of the benign lesions also displayed overall induration. The other benign lesions showed an inhomogenous color mapping. Calculated sensitivity of the SE was 70.5%, specificity 60%, PPV 94%, NPV 18.75%, and accuracy 69%.

Conclusion: IO-CEUS is useful for localization and characterization of liver lesions prior to surgical resection whereas IO-SE provided correct characterization only for a limited number of lesions.

No MeSH data available.


Related in: MedlinePlus

High resolution intraoperative contrast enhanced ultrasound (IO-CEUS) using a multifrequency linear probe (6–9 MHz) for detection of the primary tumor lesions and surrounding satellite lesions < 10 mm (arrow) in HCC.
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pone.0123737.g002: High resolution intraoperative contrast enhanced ultrasound (IO-CEUS) using a multifrequency linear probe (6–9 MHz) for detection of the primary tumor lesions and surrounding satellite lesions < 10 mm (arrow) in HCC.

Mentions: The dynamic intraoperative contrast enhanced ultrasound (IO-CEUS) with bolus injections of 2.4 ml up to 5 ml of sulphur hexaflouride microbubbles (SonoVue, BRACCO, Italy) was conducted with a low mechanical index (MI < 0.16) applying CEUS with amplitude modulation and pulse inversion harmonic imaging (PIHI) technique (Fig 2). The contrast harmonic imaging technique (CHI) uses a contrast-specific detection mode for real-time evaluation of the contrast-agent enhancement. The complete data of the contrast-agent examination was recorded up to 5 min. The liver microcirculation was evaluated continuously from an early arterial phase (beginning 15 sec. after contrast application) until a late parenchymal phase (> 3 min.)


Is Strain Elastography (IO-SE) Sufficient for Characterization of Liver Lesions before Surgical Resection--Or Is Contrast Enhanced Ultrasound (CEUS) Necessary?

Jung EM, Platz Batista da Silva N, Jung W, Farkas S, Stroszczynski C, Rennert J - PLoS ONE (2015)

High resolution intraoperative contrast enhanced ultrasound (IO-CEUS) using a multifrequency linear probe (6–9 MHz) for detection of the primary tumor lesions and surrounding satellite lesions < 10 mm (arrow) in HCC.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4482620&req=5

pone.0123737.g002: High resolution intraoperative contrast enhanced ultrasound (IO-CEUS) using a multifrequency linear probe (6–9 MHz) for detection of the primary tumor lesions and surrounding satellite lesions < 10 mm (arrow) in HCC.
Mentions: The dynamic intraoperative contrast enhanced ultrasound (IO-CEUS) with bolus injections of 2.4 ml up to 5 ml of sulphur hexaflouride microbubbles (SonoVue, BRACCO, Italy) was conducted with a low mechanical index (MI < 0.16) applying CEUS with amplitude modulation and pulse inversion harmonic imaging (PIHI) technique (Fig 2). The contrast harmonic imaging technique (CHI) uses a contrast-specific detection mode for real-time evaluation of the contrast-agent enhancement. The complete data of the contrast-agent examination was recorded up to 5 min. The liver microcirculation was evaluated continuously from an early arterial phase (beginning 15 sec. after contrast application) until a late parenchymal phase (> 3 min.)

Bottom Line: The other benign lesions showed an inhomogenous color mapping.Calculated sensitivity of the SE was 70.5%, specificity 60%, PPV 94%, NPV 18.75%, and accuracy 69%.IO-CEUS is useful for localization and characterization of liver lesions prior to surgical resection whereas IO-SE provided correct characterization only for a limited number of lesions.

View Article: PubMed Central - PubMed

Affiliation: University Hospital Regensburg, Department of Radiology, Regensburg, Germany.

ABSTRACT

Aim: To evaluate the diagnostic accuracy of IO-SE in comparison to IO-CEUS for the differentiation between malignant and benign liver lesions.

Material and methods: In a retrospective diagnostic study IO-CEUS and SE examinations of 49 liver lesions were evaluated and compared to histopathological examinations. Ultrasound was performed using a multifrequency linear probe (6-9 MHz). The loops of CEUS were evaluated up to 5 min. The qualitative characterization of IO-SE was based on a color coding system (blue = hard, red = soft). Stiffness of all lesions was quantified by a specific scaling of 0-6 (0 = low, 6 = high) using 7 ROIs (2 central, 5 peripheral).

Results: All malignant lesions displayed a characteristic portal venous washout and could be diagnosed correctly by IO-CEUS. 3/5 benign lesions could not be characterized properly either by IO-CEUS or IO-SE prior to resection. Thus for IO-CEUS sensitivity, specificity, positive and negative predictive value and accuracy were 100%, 40%, 94%, 100% and 94%. Lesion sizes were between 8 and 59 mm in diameter. Regarding the IO-SE, malignant lesions showed a marked variability. In qualitative analysis, 31 of the malignant lesions were blue colored denoting overall induration. Thirteen malignant lesions showed an inhomogenous color pattern with partial indurations. Two of the benign lesions also displayed overall induration. The other benign lesions showed an inhomogenous color mapping. Calculated sensitivity of the SE was 70.5%, specificity 60%, PPV 94%, NPV 18.75%, and accuracy 69%.

Conclusion: IO-CEUS is useful for localization and characterization of liver lesions prior to surgical resection whereas IO-SE provided correct characterization only for a limited number of lesions.

No MeSH data available.


Related in: MedlinePlus