shu-508 and Cholangiocarcinoma

Topics: Albumins; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Diagnosis, Differential; Fluorocarbons; Humans; Image Enhancement; Liver Neoplasms; Microbubbles; Phospholipids; Polysaccharides; Sulfur Hexafluoride; Ultrasonography, Interventional; Vesico-Ureteral Reflux

The purpose of the study was to assess contrast enhancement patterns of hepatic tumours during the vascular phase using contrast-enhanced ultrasound and Levovist to differentiate hepatocellular carcinoma from other hepatic tumours. 89 hepatic tumours in 82 consecutive patients were evaluated using coded harmonic ultrasound imaging. The procedure used a phase inversion harmonic technique and coded technology. We observed images for 2 min from the beginning of the administration as the vascular phase using continuous transmission and intermittent transmissions of 1 s or 2 s. The contrast agent Levovist was administered intravenously as a bolus infusion of 2.5 g. Tumour vessels with flow spreading into the tumour and/or homogeneously stained hyperechoic images were observed in 34 of the 41 hepatocellular carcinomas (sensitivity, 82.9%; specificity, 93.8%). Peripheral enhancements were characteristic of intrahepatic cholangiocarcinoma and metastatic hepatic tumours (sensitivity, 60.0% and 83.3%; specificity, 65.5% and 76.4%, respectively). Pooling at the periphery or throughout the tumour was apparent only in haemangioma (sensitivity, 76.5%; specificity, 100%). A tortuous feeding artery and spoke-like vascularization were evident only in the two focal nodular hyperplasias. Contrast-enhanced ultrasound using coded harmonic ultrasound imaging and Levovist provided detailed information about tumour vascularity and contrast enhancement patterns in hepatic tumours.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Cholangiocarcinoma; Contrast Media; Female; Hemangioma; Humans; Image Enhancement; Liver; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography

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