shu-508 and Bile-Duct-Neoplasms

The aim of this study was to investigate the value of using Levovist in the postvascular phase of sonography performed to assess hepatic hilar biliary obstruction.. In our prospective study, 50 patients underwent routine sonography followed by postvascular Levovist-enhanced pulse inversion imaging of the liver. Thirty-six patients had malignant disease (28 invasive parenchymal tumors and eight intraductal tumors), and 14 had benign disease. The 36 malignancies included 29 cholangiocarcinomas, six invasive gallbladder carcinomas, and one colon metastasis. Fourteen patients had benign disease: benign strictures (n = 5), primary sclerosing cholangitis (n = 5), chronic Mirizzi's syndrome (n = 1), varicosities of the parabiliary venous plexus (n = 1), and inflammatory liver lesions (n = 2). Sonographic findings in all 50 patients were correlated with findings from other imaging modalities (n = 50) as well as surgical specimens (n = 20), core biopsies (n = 3), and both clinical and imaging follow-ups (n = 24).. Seventeen (61%) of the 28 invasive intraparenchymal malignancies were visualized on routine sonograms, whereas all 28 (100%) were visualized on enhanced sonograms (p < 0.01). In 15 (88%) of 17 patients in whom tumor was seen on routine sonograms, contrast-enhanced sonography showed further mass extent, increased conspicuity, or satellite nodules not visualized on the baseline image. All eight noninvasive intraductal malignancies were correctly identified and staged on the routine sonography. In one of these patients, hepatic invasion was prospectively overcalled on the enhanced image. Of the 14 benign lesions, three had inflammatory periductal abnormalities seen exclusively or to advantage on the enhanced study. Correct prediction of resectability in the 16 patients with malignant disease who underwent surgery improved from 11 (69%) of 16 on unenhanced sonography to 15 (94%) of 16 on enhanced sonography (p = 0.13).. Detection and staging of malignant hilar obstructions are improved by the use of Levovist in the postvascular phase of sonography compared with routine sonography.

Topics: Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms; Cholestasis, Intrahepatic; Contrast Media; Female; Humans; Male; Middle Aged; Polysaccharides; Prospective Studies; Ultrasonography

A 49 year old male with carcinoma of the esophagus was staged using conventional US of the abdomen. US revealed signs of cirrhosis and a hyporeflexive focal liver lesion of about 5 mm in diameter was found. Low-MI contrast-enhanced ultrasound (CEUS) with SonoVue (Bracco, Milano, Italy) showed an enhancement pattern which was typical for benign liver lesions while high-MI CEUS with Levovist (Schering, Berlin, Germany) revealed a contrast defect in the liver late phase (4:30 min p. i.) which is typical for a malignant lesion. Due to these findings the lesion was evaluated as a potentially malignant lesion and a biopsy was performed. Histology showed a benign biliary hamartoma and incomplete cirrhosis. The findings confirmed that liver-specific contrast agents have the ability to detect very small focal liver lesions not derived from hepatic tissue but may lead to a misinterpretation as a malignant lesion. Nevertheless biliary duct adenomas are benign lesions with almost the same perfusion properties as normal liver parenchyma. Therefore, while using SonoVue, such a misinterpretation of these very common but in most cases very small and not detectable lesions seems unlikely.

Topics: Adenoma, Bile Duct; Bile Duct Diseases; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Biopsy, Fine-Needle; Contrast Media; Diagnosis, Differential; Esophageal Neoplasms; Hamartoma; Humans; Incidental Findings; Liver Neoplasms; Male; Middle Aged; Neoplasm Staging; Phospholipids; Polysaccharides; Sensitivity and Specificity; Sulfur Hexafluoride; Ultrasonography, Doppler, Duplex

We carried out this study to evaluate the usefulness of contrast-enhanced intraductal ultrasonography (ceIDUS) in the differentiation of thickened bile duct wall at the hepatic bifurcation caused by malignant tumor from that caused by cholangitis.. Seven patients (two with primary sclerosing cholangitis [PSC], one with secondary sclerosing cholangitis [SSC], and four with bile duct carcinomas [BDC] at the hepatic bifurcation underwent endoscopic ceIDUS, in which we used Levovist. The recorded images of echo-brightness were analyzed histographically.. The bile duct wall, in PSC and SSC, but not in BDC, was enhanced by Levovist.. ceIDUS with histographic analysis may be useful for distinguishing thickened bile duct wall caused by malignant tumor from that caused by cholangitis.

Topics: Aged; Bile Duct Neoplasms; Bile Ducts; Cholangiocarcinoma; Cholangitis; Contrast Media; Diagnosis, Differential; Endosonography; Female; Humans; Male; Middle Aged; Polysaccharides

Topics: Bile Duct Neoplasms; Bile Ducts; Cholangiocarcinoma; Cholangitis; Contrast Media; Diagnosis, Differential; Endosonography; Humans; Polysaccharides

The aim of this study was to evaluate capabilities of pulse inversion harmonic imaging (PIHI) in characterization of unifocal liver lesions. We evaluated with PIHI (HDI5000, ATL, Bothell, Wash.) and spiral CT 46 consecutive patients with a single liver lesion identified by fundamental US [7 hepatocellular carcinomas (HCC), 2 cholangiocarcinomas, 7 focal nodular hyperplasias (FNH), 17 hemangiomas and 13 metastases]. The PIHI was performed before and 30 s, 2 and 4 min after bolus administration of Levovist (2.5 g, 300 mg/ml). Scans were digitally stored and reviewed using a dedicated software. Hepatocellular carcinoma was hyperechoic on 30-s scan, and hypoechoic (n = 5) or isoechoic (n = 2) on 2-min scan. Cholangiocarcinoma had inhomogeneous persistent enhancement. Focal nodular hyperplasia was hyperechoic (n = 5) or isoechoic (n = 2) on 30-s scan, hyperechoic (n = 4), isoechoic (n = 2) or slightly hypoechoic (n = 1) on 2-min scan. Large hemangioma revealed peripheral enhancement on 30-s scan which extended centripetally on 2-min scan. Small hemangioma appeared isoechoic on 2-min scan in all but two cases in which they were hypoechoic on 2-min scans and hyperechoic on 4-min scan. Metastasis was hypoechoic on all scans, 70% with rim enhancement. Similar changes in enhancement pattern have been observed at spiral CT. The 30-s and the 2-min scans revealed a conclusive importance in characterization of HCC, cholangiocarcinoma, and large hemangioma. The 2-min scan often furnished enough information for characterization of small hemangioma and metastasis. The 4-min scan allowed characterization of two hemangiomas which appeared hypoechoic on 2-min scans. In the other cases it did not provide further information. Diagnosis of FNH is usually reached with Colour Doppler US; PIHI should be used when colour Doppler is biased by artefacts or when colour Doppler findings are not characteristic. Our results seem to show that PIHI could be a valuable alternative diagnostic approach to spiral CT for unifocal liver lesion characterization. This hypothesis needs to be confirmed with an increased number of lesions.

Topics: Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Female; Focal Nodular Hyperplasia; Hemangioma; Humans; Liver; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color