shu-508 and Liver-Neoplasms

This review article reports on evidence-based and clinical aspects of contrast-enhanced ultrasound of liver masses. The advanced possibilities of contrast-enhanced ultrasound to detect and characterise liver tumors are described as well as limitations and pitfalls of the method. The choice of the ultrasound device and contrast agents as well as the qualifications of the examiners according to guidelines are discussed.

Topics: Contrast Media; Germany; Humans; Image Enhancement; Liver Neoplasms; Phospholipids; Polysaccharides; Sulfur Hexafluoride; Ultrasonography

This paper reviews the potential of ultrasound for assessing the viability and biological behavior of tumors. Unlike color Doppler sonography, modern techniques for contrast-enhanced ultrasound permit the measurement of tissue perfusion irrespective of vessel size or flow velocity. Perfusion can also be assessed quantitatively, using replenishment kinetics or derivates thereof. The perfusion of tumors is a surrogate parameter of their viability and may mirror their response to therapy. Furthermore, the degree of vascularity in a tumor may express its aggressiveness and help to predict its response to treatment. In animal models, a decrease in blood flow has been shown to precede a shrinkage of tumors treated with anti-angiogenic compounds. In liver metastases, arterial and portal blood supply can be assessed separately, and a response to stereotactic radiotherapy was found to go along with a decrease in arterial perfusion. Moreover, a relatively high arterial perfusion of liver metastases may predict a response to chemotherapy. Contrast-enhanced ultrasound may be a potent tool for assessing the effects of anti-angiogenic treatment in patients.

Topics: Air; Animals; Contrast Media; Gases; Humans; Liver Neoplasms; Neoplasms; Neoplasms, Experimental; Phospholipids; Polysaccharides; Sulfur Hexafluoride; Ultrasonography, Doppler, Color

Topics: Carbon Dioxide; Carcinoma, Hepatocellular; Contrast Media; Humans; Image Enhancement; Liver Neoplasms; Polysaccharides; Ultrasonography

Topics: Artifacts; Contrast Media; Humans; Image Enhancement; Liver Neoplasms; Mass Screening; Phospholipids; Polysaccharides; Reproducibility of Results; Sensitivity and Specificity; Sulfur Hexafluoride; Ultrasonography, Doppler

To present the sonographic appearance of hepatocellular carcinoma imaged with the intravenous contrast agent Levovist.. We reviewed our experience using Levovist (Schering AG, Berlin, Germany) for the sonographic diagnosis of hepatocellular carcinoma.. Contrast-enhanced sonography with Levovist facilitated detailed evaluation of tumor vascularity in hepatocellular carcinoma.. Contrast-enhanced sonography with Levovist enhances the role of sonography in the diagnosis of hepatocellular carcinoma. It provides detailed information about tumor vascularity and the contrast enhancement pattern.

Topics: Carcinoma, Hepatocellular; Contrast Media; Humans; Liver; Liver Neoplasms; Polysaccharides; Treatment Outcome; Ultrasonography, Doppler; Ultrasonography, Doppler, Color

In recent years sonographic contrast agents which can be used for liver imaging have become available. Some of these agents (e.g. Levovist, Schering AG, Berlin) display a liver-specific late phase. Visualisation of this late phase requires contrast-specific imaging techniques such as phase or pulse inversion. When scanned in phase inversion during the late phase, normal liver parenchyma shows strong enhancement. This enhancement spares metastases which stand out as echo-poor or almost echo-free enhancement defects. This improves the conpicuity of metastases markedly. The technique increases the number of detectable metastases in up 45% of patients in comparison to unenhanced sonography. In a multi-centre study on 128 patients the sensitivity in the detection of individual metastases was increased from 71% to 88% and specificity improved from 59% to 88%. Contrast-enhanced sonography thus represents a promising alternative to other cross-sectional imaging modalities in the diagnosis of hepatic metastases.

Topics: Contrast Media; Humans; Image Enhancement; Liver; Liver Neoplasms; Polysaccharides; Sensitivity and Specificity; Ultrasonography

Topics: Carcinoma, Hepatocellular; Contrast Media; Humans; Injections, Intravenous; Liver Neoplasms; Polysaccharides; Ultrasonography

In the present report, a "color-filled pattern", the late phase effect in the intra-venous contrast enhanced color Doppler sonography is introduced, using SH/TA-508 as the contrast agent. This pattern is defined as an image of a tumor area filled with color in contrast to the surrounding liver. After contrast enhancement, the detectability of a "feeding artery" increased. And also "color filled pattern" appeared in 14 of the 21 hepatocellular carcinomas but none of the nine other liver tumors. In conclusion, contrast enhancement increases the detectability of a "feeding artery" and improves the sensitivity for HCC with color Doppler sonography. A "color-filled pattern" is also effective in the diagnosis of HCC because it requires no technical skill and shows high specificity.

Topics: Animals; Carcinoma, Hepatocellular; Contrast Media; Humans; Liver; Liver Neoplasms; Polysaccharides; Rabbits; Ultrasonography, Doppler, Color

Features of enhanced color flow images of small hepatocellular carcinoma (HCC) were studied to elucidate their usefulness in evaluating tumor hemodynamics. Enhanced color Doppler using the contrast agent "SH/TA508" was performed on 16 patients, 13 with HCC, 1 with regenerative nodule, and 2 with hemangiomas, in whom the size of the tumor were smaller than 30 mm. Enhanced color flow appearance was compared with angiographic findings. Significant improvement in the detection of color flow signals was obtained in small HCC using SH/TA508, from 33% in pre-contrast to 92% in post-contrast (p < 0.005). Three patterns of enhanced color flow images, which were related to the angiographic findings, were observed. Enhanced color flow imaging promises to be a useful method for evaluating tumor vascularity noninvasively, and to contribute to the elucidation of the hemodynamics in liver tumor.

Topics: Carcinoma, Hepatocellular; Contrast Media; Humans; Liver Neoplasms; Polysaccharides; Ultrasonography, Doppler, Color

A number of diseases alter the normal pathophysiology of the portohepatic vascular system. The impact of these changes depends on the severity of the disease and the involvement of the entrahepatic vasculature. Cirrhosis of the liver is not a vascular disease but the effects on the liver architecture result in severe disease often accompanied by hepatic vascular changes. Alcohol abuse and viral infections are the most common causes of cirrhosis. Portal hypertension (PHT) is one of the most frequently seen sequelae of liver cirrhosis. It results in the formation of porto-systemic collateral channels which may lead to varices and hemorrhage. Primary liver cancer is also strongly associated with liver cirrhosis. Hepatocellular carcinoma (HCC) is the most common liver cancer seen in patients with cirrhosis. There are four types of HCC based on its growth patterns: infiltrative, expansive, mixed and diffuse. Raised plasma levels of alpha-fetoprotein are a characteristic of HCC. However, this marker is unreliable in patients with smaller tumors. Ultrasound is an inexpensive, non-invasive and safe diagnostic technique used to detect portal vein changes in PHT and to identify HCC lesions in the liver. Grey scale ultrasound reveals the portal vein changes and the portal-systemic collaterals which typify PHT. The technique is most useful for diagnosis or confirmation of moderate to severe disease. HCC nodules have characteristic ultrasound patterns which help in differential diagnosis. Doppler ultrasound provides functional as well as anatomical information about blood flow in the liver and is especially useful in detecting HCC and the abnormal blood vessel architecture which surrounds a tumor. However, despite their usefulness, both imaging techniques have limitations which may be improved by the use of echo-enhancing agents. Levovist(R) is a galactose-based microbubble echo-enhancing agent which has an excellent safety profile and utility in enhancing ultrasound images of the liver. It markedly improves diagnostic confidence and reduces the percentage of non-diagnostic ultrasound scans in patients with abnormal liver pathologies. The use of echo-enhanced ultrasound to diagnose liver disease may obviate the need for more expensive and invasive diagnostic procedures.

Topics: Blood Flow Velocity; Carcinoma, Hepatocellular; Contrast Media; Humans; Hypertension, Portal; Image Enhancement; Liver; Liver Cirrhosis; Liver Neoplasms; Polysaccharides; Regional Blood Flow; Ultrasonography, Doppler

SonoVue and Levovist (SH U 508A) are both ultrasound contrast agents, which are helpful in characterization and detection of malignant liver lesions. This study was performed to compare both contrast agents according to the capability to diagnose hepatocellular carcinoma (HCC).. In a prospective study, 65 patients with histologically proven hepatocellular carcinoma (HCC) were examined with both, Levovist and SonoVue. In all patients HCC lesions had been detected by B-mode sonography before the study start. After injection of 2.4 ml SonoVue i. v., the liver was examined continuously for up to three minutes using "low MI"-pulse inversion sonography. For the Levovist-examinations 2.5 g Levovist were injected i. v. After a delay of at least 2.5 minutes without scanning, the liver was examined with three different scans using "high-MI"-pulse-inversion sonography.. The examination was technically sufficient in 98% after SonoVue-injection and in 92% after Levovist-injection (n. s.). Comparison of the results was performed for the 60/65 patients (61 lesions), in which both methods were technically sufficient. After SonoVue-injection contrast-enhancement in the arterial phase was found in 79% (48/61) of the lesions. Demarcation of the HCC-lesion in the late phase was found in 89% of the SonoVue-examinations and in 98% of the Levovist-examinations (p < 0.05). Early SonoVue-enhancement and/or demarcation in SonoVue late-phase was found in 93% of the HCC-lesions (n. s. compared to Levovist-late phase).. Levovist-late phase has a higher sensitivity in predicting lesion dignity of HCC-lesions compared to SonoVue-late phase, but not compared to combination of SonoVue-early phase and late phase.

Topics: Biopsy; Carcinoma, Hepatocellular; Contrast Media; Humans; Image Processing, Computer-Assisted; Liver; Liver Neoplasms; Phospholipids; Polysaccharides; Prospective Studies; Sulfur Hexafluoride; Ultrasonography

The purpose of this study was to evaluate contrast-enhanced Doppler sonography with perfusion software as a predictor of early tumor response to imatinib (Glivec) in c-kit-positive gastrointestinal stromal tumors (GISTs).. Thirty patients (59 tumors) with metastases or a recurrence from a GIST were prospectively included in a single-center imaging trial. Contrast-enhanced Doppler sonography was performed with an Aplio scanner the day before (day-1) starting oral treatment (400 mg) and at days 1, 7, 14, 60, 90, and 6 months, 9 months, and 1 year. The percentage of contrast uptake (Levovist or Sonovue) before treatment and at the different stages of follow-up was evaluated by two radiologists. Digitized quantification was performed using Photoshop software. To define the benchmark standard, all patients were rated as responders or nonresponders at 2 and 6 months by a board consisting of oncologists and radiologists who had all clinical and imaging data at their disposal. Changes in the percentage of contrast uptake at each sonographic examination were compared statistically.. A total of 185 examinations were performed. Forty-four lesions in 24 patients were completely evaluated at 2 months, and 29 lesions in 15 patients were completely evaluated at 6 months. Initial contrast uptake at day 1 was predictive of the future response. A strong correlation was found between the decline in tumor contrast uptake at days 7 and 14 and tumor response (p < 10(-4)).. Contrast-enhanced Doppler sonography is a noninvasive imaging technique that allows the early prediction of tumor response in c-kit-positive GIST treated with Glivec.

Topics: Antineoplastic Agents; Benzamides; Contrast Media; Female; Gastrointestinal Stromal Tumors; Humans; Imatinib Mesylate; Liver Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Phospholipids; Piperazines; Polysaccharides; Prognosis; Protein Kinase Inhibitors; Protein-Tyrosine Kinases; Proto-Oncogene Proteins c-kit; Pyrimidines; Sulfur Hexafluoride; Ultrasonography, Doppler

To assess the utility of contrast-enhanced agent detection imaging (ADI) in the assessment of the therapeutic response to percutaneous radiofrequency (RF) ablation in patients with hepatocellular carcinoma (HCC).. Ninety patients with a total of 97 nodular HCCs (mean, 2.1+/-1.3 cm; range, 1.0-5.0 cm) treated with percutaneous RF ablation under the ultrasound guidance were evaluated with contrast-enhanced ADI after receiving an intravenous bolus injection of a microbubble contrast agent (SH U 508A). We obtained serial contrast-enhanced ADI images during the time period from 15 to 90 s after the initiation of the bolus contrast injection. All of the patients underwent a follow-up four-phase helical CT at 1 month after RF ablation, which was then repeated at 2-4 month intervals during a period of at least 12 months. The results of the contrast-enhanced ADI were compared with those of the follow-up CT in terms of the presence or absence of residual unablated tumor and local tumor progression in the treated lesions.. On contrast-enhanced ADI, technical success was obtained in 94 (97%) of the 97 HCCs, while residual unablated tumors were found in three HCCs (3%). Two of the three tumors that were suspicious (was not proven) for incomplete ablation were subjected to additional RF ablation. The remaining one enhancing lesion that was suspicious of a residual tumor on contrast-enhanced ADI was revealed to be reactive hyperemia at the 1-month follow-up CT. Therefore; the diagnostic concordance between the contrast-enhanced ADI and 1-month follow-up CT was 99%. Of the 94 ablated HCCs without residual tumors on both the contrast-enhanced ADI and 1-month follow-up CT after the initial RF ablation, five (5%) had CT findings of local tumor progression at a subsequent follow-up CT.. Despite its limitations in predicting local tumor progression in the treated tumors, contrast-enhanced ADI is potentially useful for evaluating the early therapeutic effect of percutaneous RF ablation for HCCs.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Disease Progression; Female; Follow-Up Studies; Humans; Image Enhancement; Liver; Liver Neoplasms; Male; Middle Aged; Observer Variation; Polysaccharides; Predictive Value of Tests; Prognosis; Tomography, Spiral Computed; Treatment Outcome; Ultrasonography, Doppler, Color

Our purpose was to evaluate the value of contrast-enhanced coded phase-inversion harmonic imaging in showing the characteristic intranodular hemodynamics of hepatic tumors. SUBJECTS AND METHODS. Using a microbubble contrast agent we performed coded harmonic angio in 163 patients with 192 hepatic tumor nodules: 153 hepatocellular carcinomas, 13 metastases, 14 hemangiomas, eight dysplastic nodules, and four focal nodular hyperplasias. After injecting Levovist, we performed real-time scanning, interval-delay fast low-angle shot imaging, and sweep scanning in the early arterial phase, late vascular phase, and postvascular phase, respectively.. On contrast-enhanced coded harmonic angio, the typical hemodynamic pattern of hepatocellular carcinomas was shown as abundant tumor vessels supplied from the periphery to the center of the tumor and dense parenchymal tumor staining with fast washout (sensitivity, 92.8%; specificity, 92.3%). The characteristic hemodynamic pattern of metastases was peripheral tumor vessels with a rim parenchymal stain in the vascular phase followed by a perfusion defect in the postvascular phase (sensitivity, 69.2%; specificity, 100%). Hemangiomas were hypovascular in the early arterial phase with gradual spotty or cotton-wool pooling continuing to the late vascular phase (sensitivity, 92.9%; specificity, 100%). Dysplastic nodules were shown as having no early arterial supply with isovascularity in the late vascular phase (sensitivity, 75%; specificity, 100%). Focal nodular hyperplasias were shown to have a spoked wheel pattern of blood vessels accompanied by dense staining in interval-delay scanning (sensitivity, 100%; specificity, 100%).. Contrast-enhanced coded harmonic angio is a promising method to provide useful information for the differential diagnosis of hepatic tumors.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Hemangioma; Humans; Liver Neoplasms; Male; Microbubbles; Middle Aged; Polysaccharides; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography, Doppler

To evaluate in a prospective multicenter study whether conventional ultrasonographic (US) characterization of liver lesions can be improved by imaging during the liver-specific phase of SH U 508A uptake in the microbubble-specific agent detection imaging mode.. One hundred forty-two patients with liver lesions underwent conventional gray-scale and color Doppler US and SH U 508A-enhanced US. Two radiologists blindly read digital cine clips and assigned scores for confidence in diagnosis of benignancy or malignancy, diagnosis of specific lesion types, and relative difference in SH U 508A uptake between the lesion and the liver parenchyma (ie, subjective conspicuity score [SCS]). Comparisons were made to see whether the addition of agent detection imaging led to improved diagnostic performance.. Receiver operating characteristic analysis revealed improved discrimination of benign and malignant lesions for readers 1 (P =.049) and 2 (P <.001). The number of patients with a correct diagnosis of benignancy or malignancy assigned by readers 1 and 2, respectively, improved from 114 and 113 to 125 and 128 with agent detection imaging (reader 1: P =.027; reader 2: P =.008; McNemar test). Specific diagnoses were made more accurately with agent detection imaging: At McNemar testing, the number of correct lesion type determinations increased from 83 to 92 (P =.022) for reader 1 and from 85 to 99 (P <.001) for reader 2. Both readers assigned high scores for differences in SH U 508A uptake between the liver parenchyma and the lesion for metastases and cholangiocarcinomas and low scores for uptake differences in most of the benign lesions. Hepatocellular carcinomas (HCCs), hemangiomas, and adenomas had more variable uptake differences. Fourteen of 22 hemangiomas were assigned an SCS of less than 50%, and 22 (reader 1) and 15 (reader 2) of 31 HCCs were assigned an SCS of greater than 50%.. With use of SH U 508A-enhanced agent detection imaging, liver lesion characterization and diagnostic performance are significantly improved.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Female; Humans; Liver Neoplasms; Male; Microbubbles; Middle Aged; Polysaccharides; Prospective Studies; Ultrasonography

To determine whether examination of focal liver lesions by pulse inversion sonography in the early perfusion phase of the contrast agent Levovist (SH U 508A; Schering AG, Berlin, Germany) enables distinction between benign and malignant lesions.. Seventy-two patients were examined. The cause of the lesion was confirmed by liver biopsy, computed tomography, or both or by hepatic iminodiacetic acid-enhanced scintigraphy. Forty-two patients had malignant liver lesions, and 30 had benign liver lesions. After injection of 2 g of Levovist intravenously, analysis of Levovist arrival was performed by the interval delay imaging technique for 60 seconds.. The early arrival of Levovist less than 30 seconds after injection was used as an indicator for malignancy and had specificity of 67% and sensitivity of 60% (P < .05). The central starlike fill-in as a sign for focal nodular hyperplasia had specificity of 100% and sensitivity of 67% (P < .001). The rimlike pattern followed by centripetal fill-in as a sign for hemangioma had specificity of 100% and sensitivity of 18% (P < .01). In contrast, the early diffuse stippled arrival pattern was found in 60% of malignant lesions and also in 33% of cases of focal nodular hyperplasia and in 1 patient with an adenoma.. Analysis of Levovist arrival time cannot distinguish between a malignant or benign lesion in individual cases. However, the central starlike arrival pattern is characteristic of focal nodular hyperplasia.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Focal Nodular Hyperplasia; Humans; Injections, Intravenous; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Prospective Studies; Sensitivity and Specificity; Ultrasonography, Doppler

Topics: Breast Neoplasms; Colorectal Neoplasms; Contrast Media; Humans; Liver Neoplasms; Lung Neoplasms; Polysaccharides; Ultrasonography

The purpose of our study was to assess whether phase-inversion sonography during the late, liver-specific phase of contrast enhancement using Levovist improves the detection of hepatic metastases relative to unenhanced conventional B-mode sonography.. Sixty-two patients were studied with unenhanced B-mode sonography and phase-inversion sonography 2.5 min after the injection of Levovist. All patients underwent one reference examination (CT, MR imaging, or intraoperative sonography). The conspicuity, number, size, and distribution of metastases before and after contrast administration as judged by a sonographer (who was unaware of other imaging findings) were compared with each other and with reference imaging.. The conspicuity of metastases was improved by contrast-enhanced phase inversion in 94% of patients. Thirty-nine patients showed metastases on reference imaging; 36 of these were positive on baseline sonography and 38 on phase-inversion sonography. Phase-inversion sonography showed more reference imaging-confirmed metastases than baseline sonography in 28 patients (45%). The average number of confirmed metastases per patient was 3.06 for baseline sonography and 5.42 for contrast-enhanced phase-inversion sonography (p < 0.01). The average sensitivity for detecting individual metastases improved from 63% to 91%. Metastases of less than 1 cm were shown in 14 patients on baseline sonography, in 24 patients on phase-inversion sonography, and in 26 on reference imaging. Both sonographic techniques showed false-positive lesions in six patients.. Contrast-enhanced phase-inversion sonography in the liver-specific phase of contrast enhancement using Levovist provides a marked improvement in the detection of hepatic metastases relative to unenhanced conventional sonography, without loss of specificity. Phase-inversion sonography was particularly advantageous in detecting small metastases and may be a competitive alternative to CT and MR imaging.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; False Positive Reactions; Female; Humans; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Prospective Studies; Sensitivity and Specificity; Ultrasonography

Use of new echo enhancers capable of passing the lung filter has extended the clinical applications of color power Doppler flow imaging in many diseases and appears promising in the study of neoplasm vascularization. Levovist (Shering, Berlin Germany) is an ultrasound contrast agent containing galactose microbubbles suspended in palmitic oil. The sensitivity of Levovist-enhanced color power Doppler was compared to that of standard color power Doppler and contrast-enhanced spiral computed tomography (CT) in the detection of vascular signals in hepatocellular carcinoma.. We examined 29 hepatocellular carcinoma nodules in cirrhotic livers that had appeared avascular on unenhanced color power Doppler. Color power Doppler studies were repeated with and without Levovist enhancement before (15 examinations) and/or after (23 examinations) percutaneous ablation procedures. Findings (vascularized vs nonvascularized) were compared to those obtained with contrast-enhanced spiral computed tomography (gold standard) performed no more than 24 h after each of the 38 Doppler examinations.. In pretreatment studies, Levovist-enhanced power Doppler correctly revealed vascularization in 12 of 15 lesions that had appeared avascular without echo enhancement and confirmed the avascularity of one other nodule; the remaining two, which appeared avascular on contrast-enhanced Doppler, displayed vascularization on the spiral CT examination. Levovist-enhanced power Doppler was fully concordant with spiral CT findings in all of the posttreatment examinations.. Considering the absence of false positive results in this study, echo-enhanced color power Doppler can be considered reliable in diagnosing incomplete necrosis of hepatocellular carcinomas after percutaenous ablation. Spiral computed tomography can thus be reserved for those cases in which the enhanced power Doppler examination reveals no evidence of vascularity.

Topics: Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Female; Humans; Liver Neoplasms; Male; Polysaccharides; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color

To assess the reliability of contrast material-enhanced real-time gray-scale ultrasonography (US) in evaluating posttreatment response of hepatocellular carcinoma (HCC).. Fifty HCC nodules were examined with contrast-enhanced coded phase-inversion harmonic US before and after treatment. Intratumoral vascularity was assessed with continuous imaging in the early arterial phase and with interval-delay scanning to depict tumor parenchymal flow during the blood pool phase. Vascular findings at US were compared with those at dynamic computed tomography (CT).. In 50 HCC nodules before treatment, positive enhancement of tumor vessels and tumor parenchymal flow (stain) were observed in 47 (94%) and 46 (92%), respectively. Either tumor vessel or stain was visualized with coded harmonic US in 49 of 50 nodules. Eighty-one coded harmonic US studies were performed in 49 posttreatment HCC nodules. Compared with dynamic CT, the sensitivity, specificity, and accuracy of coded harmonic US in helping to detect positive enhancement in pretreatment HCC were 98% (49 of 50), 100% (50 of 50), and 98% (49 of 50), respectively. After treatment, positive enhancement of tumor vascularity was observed in 39 (48%) of 81 posttreatment studies, and no enhancement was observed in others (52%). Coded harmonic US demonstrated partial and no enhancement of tumor vascularity in four and one nodule, respectively; after transcatheter arterial embolization with iodized oil, evaluation of tumor vascularity with dynamic CT was difficult because of the presence of oil.. With enhancement, coded harmonic US depicted tumor vascularity by showing tumor vessels in a real-time fashion at continuous imaging and tumor parenchymal flow at interval-delay scanning.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Catheter Ablation; Chemoembolization, Therapeutic; Contrast Media; Ethanol; Female; Humans; Injections; Liver Neoplasms; Male; Middle Aged; Observer Variation; Polysaccharides; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography

We investigated the accuracy of contrast-enhanced color Doppler US in the assessment of the effectiveness of intralesional treatment of hepatocarcinomas.. Eight cirrhotic patients (HCV+), Child-Pugh class B, with a single hepatocarcinoma (< 4 cm O) and ineligible for surgical resection for various reasons (age > 70 years, reduced partial hepatic reserve, esophageal varices at risk, postoperative recurrence, no consent to the operation) were submitted to radiohyperthermia (6 patients) and percutaneous alcoholization (2 patients). The diagnosis was made with alpha-fetoprotein titration. CT, B-mode and color Doppler US with the administration of Levovist (Schering AG, Berlin, Germany). Thirty and 60 days after the treatment, both the alpha-fetoprotein titration and contrast-enhanced color Doppler US were repeated.. Baseline color Doppler was carried out before intralesional treatment in the 8 patients and was followed by Levovist color Doppler which showed some intralesional signals, afferent vessels and rich vascularization in all the lesions. At the first follow-up (30 days), no intralesional vascular signals or afferent vessels were detected in any patient, while rich peripheral vascularization persisted in all cases, even after radiofrequency and alcoholization treatments. At 60 days' follow-up, the color Doppler pattern of all cases was the same as at 30 days.. The absence of any intralesional vascular signals in all the treated patients and the possible demonstration of complete tumor necrosis seem to confirm the important role of contrast-enhanced color Doppler US in monitoring focal hepatic lesions after intralesional treatment.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Humans; Liver Neoplasms; Male; Middle Aged; Monitoring, Physiologic; Polysaccharides; Reproducibility of Results; Ultrasonography, Doppler, Color

In a phase IIIb clinical trial of the ultrasound contrast agent Levovist (Schering AG, Berlin, Germany), the role of Levovist in the management of patients with clinically suspected hepatocellular carcinoma (HCC) was evaluated and its efficacy was assessed. The assessment included the duration of diagnostically usable Doppler signal enhancement, and safety and tolerance of intravenous administration. All patients with clinically suspected hepatocellular carcinoma were referred for Doppler sonographic examination over a 5-month period and lesions with absent or suboptimal Doppler signals were included in the trial. A total of 300 mg/mL in concentration (8.5 mL) of Levovist was administered through a peripheral vein while Doppler signal intensity in the lesion, based on a visual score, was recorded. Blood pressure and pulse were recorded before and after injection. Thirty-eight patients were examined, of which 29 were included in the trial. The lesions were subsequently proven histologically to be 19 HCC, one cholangiocarcinoma, two regeneration nodules and one colonic metastasis. For six patients in whom histological proof was not available, the diagnosis of HCC was suggested based on markedly elevated serum alpha-fetoprotein levels. All but one (96%) of the 25 HCC demonstrated increased Doppler signal after Levovist. There were no Doppler signals before and after Levovist injection in three non-HCC lesions (two regeneration nodules and one colonic metastasis). Two patients (6.9%) suffered minor adverse reactions of nausea and vomiting. The results show that Levovist is safe and is able to improve lesion characterization and increase diagnostic confidence of hepatocellular carcinoma by enhancing tumour vascularization Doppler signal intensity.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Humans; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography, Doppler, Color

Assessment of the accuracy of SH U 508 A (Levovist) enhanced Doppler sonography in the evaluation of blood flow abnormalities in the portal vascular system.. In an open label, controlled, prospective multicenter study, patients referred for Doppler sonography of the portal vascular system were randomized to receive SH U 508 A if indicated or to an observation group (ratio of 4:1). Patients who had diagnostically insufficient Doppler signals received SH U 508 A (2.5 g [200, 300 or 400 mg/ml]), followed by confirmatory dynamic CT. Corresponding patients in the observation group received alternative imaging procedure(s).. Of 588 patients 265 patients received SH U 508 A. In 253 (95.5%) of these patients a diagnosis was possible following administration of SH U 508 A (Levovist). Diagnostic confidence improved from 35.3% to 89.7%. If compared with dynamic CT, SH U 508 A enhanced Doppler had a sensitivity of 80.5% and a specificity of 89.7%. Whereas diagnosis was not possible with SH U 508 A enhanced Doppler in only 12 patients, a diagnosis was not possible in 29 patients with dynamic CT. SH U 508 A enhanced Doppler in particular improved visualization of the portal vein (15.6%), TIPS (15.8%), superior mesenteric vein (16.1%), collateral circulation (20.7%) and inferior mesenteric vein (25%). SH U 508 A was very well tolerated; only eight patients experienced minor adverse events possibly related to SH U 508 A administration.. SH U 508 A enhanced Doppler improved the diagnostic confidence and visualization of the portal vascular system compared to base line scans with insufficient Doppler signal and proved reliable compared to dynamic CT.

Topics: Adult; Blood Flow Velocity; Contrast Media; Female; Humans; Hypertension, Portal; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Portal System; Portasystemic Shunt, Transjugular Intrahepatic; Sensitivity and Specificity; Ultrasonography, Doppler, Color

We performed a preliminary study to investigate the possibility of differentiating small hyperechoic liver tumours, including hepatocellular carcinomas (HCCs), haemangiomas and focal fatty lesions, by administering a galactose-based contrast agent (SH/TA-508 (Levovist)) during colour Doppler ultrasonography (US). Ten patients (age range: 48-81 years) with small liver tumours (four HCCs, four hemangiomas and two focal fatty lesions) of less than 20 mm in diameter presented with hyperechoic masses with no intratumoural colour signals on conventional colour Doppler US. All patients subsequently underwent colour Doppler US with this contrast agent. Colour Doppler images of the tumours were assessed before and after the intravenous injection of 8 ml of the contrast agent at a concentration of 400 mg/ml. Prior to injection of the contrast agent, no intratumoural colour signals were observed in any cases. After injection, intratumoural colour signals appeared in all HCCs and in two haemangiomas with tumour-margin enhancement. The enhanced colour signals appeared to be related to cardiac contraction in the HCCs, but not in the haemangiomas. In the remaining two haemangiomas, only tumour-margin enhancement was observed. In the focal fatty lesions, neither intratumoural nor tumour-margin enhancement was observed. These results, although preliminary, suggest that the detection of colour Doppler signals is improved by using a contrast agent and the differences between enhanced colour signals from HCCs and haemangiomas may help differentiate hyperechoic HCCs from other hyperechoic tumours, including haemangiomas and focal fatty lesions.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Hemangioma; Humans; Lipoma; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography, Doppler, Color

The purpose of this study is to examine the effectiveness of intravenously injectable sonographic contrast medium for color Doppler sonographic diagnosis of deeply located hepatocellular carcinoma. Subjects were 7 hepatocellular carcinomas, an adenomatous hyperplasia and a hemangioma located more than 7 cm below the abdominal surface. Levovist, a galactose-based sonographic contrast medium was injected through median cubital vein as a phase-two clinical study, and the pre- and post-enhanced color Doppler sonographic findings of these lesions were compared. The incidence of the positive findings for hepatocellular carcinoma increased from 29% (2/7) to 86% (6/7) of hepatocellular carcinoma after contrast enhancement. Positive findings were 0% in other cases even after enhancement. Levovist brought a certain improvement in the visualization of the tumor vessel by color Doppler sonography without any noteworthy side effects. Contrast enhancement was useful for the diagnosis of liver lesions suspected to be hepatocellular carcinoma by ordinary sonography, but could not be confirmed by color Doppler sonography.

Topics: Adult; Aged; Blood Flow Velocity; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Female; Galactose; Hepatitis; Humans; Injections, Intravenous; Liver Circulation; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography, Doppler, Color

The purpose of this study was to evaluate the clinical usefulness of a galactose-based, IV sonographic contrast agent for assessing tumor vascularity and diagnosing hepatocellular carcinoma.. We used color Doppler sonography with the sonographic contrast agent to examine 22 patients with 26 hepatic nodules (18 hepatocellular carcinomas, four hemangiomas, two adenomatous hyperplasias, and two metastatic tumors). In all 26 lesions, intratumoral arterial flow signals were examined before and after IV injection of the sonographic contrast agent at three concentrations (200, 300, and 400 mg/ml), and the findings on color Doppler sonograms of each lesion were correlated with angiographic findings.. Conventional color Doppler sonograms showed flow in nine hepatocellular carcinomas (50%) and one hemangioma (25%). When the contrast agent was used, color Doppler sonograms showed intratumoral arterial flow in 11 hepatocellular carcinomas (61%) and one hemangioma (25%) at a concentration of 200 mg/ml, in 14 hepatocellular carcinomas (78%) and 1 hemangioma (25%) at 300 mg/ml, and in 15 hepatocellular carcinomas (83%) and two hemangiomas (50%) at 400 mg/ml. The detectability of intratumoral arterial flow was improved by the contrast agent, especially in hepatocellular carcinomas smaller than 30 mm in diameter. Angiography revealed neovascularization or staining in 15 hepatocellular carcinomas, four hemangiomas, and none of the adenomatous hyperplasias or metastatic tumors. Among 15 angiographically hypervascular hepatocellular carcinomas, the detection rate of intratumoral arterial flow with contrast-enhanced color Doppler sonography was 73% at 200 mg/ml, 93% at 300 mg/ml, and 100% at 400 mg/ml. No intratumoral Doppler signals were depicted with the use of contrast agent in any angiographically undetected tumors.. Preliminary findings on contrast-enhanced color Doppler sonograms correlate well with angiographic findings for evaluating tumor vascularity. This noninvasive technique may be useful in diagnosing hypervascular hepatocellular carcinomas.

Topics: Adenoma; Adult; Aged; Angiography; Carcinoma, Hepatocellular; Contrast Media; Female; Hemangioma; Humans; Hyperplasia; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Pulsatile Flow; Regional Blood Flow; Ultrasonography, Doppler, Color

The clinical application of ultrasonographic contrast agents in colour Doppler flow imaging of hepatic tumours is receiving increasing attention. Levovist is a suspension of galactose microparticles that provides reproducible concentrations of stabilized air bubbles with transpulmonary stability. Its effect on colour Doppler imaging was assessed in 26 patients with colorectal cancer and histologically proven hepatic metastases. Colour Doppler flow imaging was performed before and after intravenous injection of 10 ml Levovist 300 mg/ml. At 5-10 s after injection there was significant enhancement of the hepatic lesions with colour Doppler signals in 23 patients, lasting for a mean(s.d.) of 180(45) s. A consistent pattern of colour Doppler signal was observed, with increased enhancement predominantly around the tumour periphery and little or no central enhancement. These data suggest that Levovist may increase the sensitivity and specificity of colour Doppler flow imaging of colorectal hepatic metastases.

Topics: Adult; Aged; Color; Colorectal Neoplasms; Contrast Media; Humans; Liver; Liver Neoplasms; Middle Aged; Polysaccharides; Ultrasonography

To assess the efficacy of a new US contrast agent [SH U 508 A (Levovist), Schering] in evaluating hepatocellular carcinoma (HCC) vascularization, 38 patients with 43 lesions were submitted to color Doppler US before and after i.v. contrast medium administration. Four patients were studied after arterial chemoembolization. The patients had been selected on the basis of suboptimal color Doppler signals on baseline images. Each patient received two to four injections of Levovist in standard doses. Tumor vascularization was qualitatively graded on a 0-3 scale. Twelve tumors (27.9%) appeared avascular at baseline examinations, while 31 (72.1%) exhibited low to moderate flow signals. After contrast agent administration, color Doppler signals were markedly enhanced in 35/43 lesions (81.4%), lasting 40 to 240 seconds. The lack of enhancement was related to tumor hypovascularity (necrosis at CT), portal vein thrombosis, deep location and successful chemoembolization. The detection of flow signals in chemoembolized tumors was explained by the persistence of viable tumor tissue. After Levovist administration, flow signals were detectable in 97.6% of the HCCs. Therefore, Levovist proved to be an effective tool for color Doppler evaluation of HCC vascularization.

Topics: Carcinoma, Hepatocellular; Color; Contrast Media; Female; Humans; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography

In a phase-III multicenter clinical trial, the color Doppler vascular patterns were studied of 34 liver metastases in 18 patients before and after the i.v. injection of SH U 508 A (Levovist), with different US units and probes. The patients were selected as having poor color Doppler signals at unenhanced examinations. Lesion size ranged .8 to 9 cm (mean: 3.5 cm). The primary lesion site was the colon in 14 cases, the breast in 8 cases, the lung in 4, the stomach in 4 cases, the ovary in 3 and finally unknown in 4 cases. Each patient received two to four contrast agent injections, with suggested doses and concentrations (10 ml x 300 mg/ml, 8 ml x 400 mgr/ml). No adverse reactions were observed. Thirteen of 34 lesions exhibited no vascular signals at baseline examinations, 10 exhibited some perilesional color spots or small vessel branches, 5 some internal color spots or vessels and 4 small internal and peripheral vessels. After contrast agent infusion, the vascular patterns were better demonstrated in 28/34 lesions and the signal-to-noise ratio was markedly improved, in a concentration-dependent manner, from 40 to 240s. Five lesions remained avascular, 11 exhibited "basket"-like vascular patterns, 10 "internal flow" patterns and finally 10 lesions exhibited both. No major correlation was observed between vascular pattern and lesion size. To conclude, the use of the intravenous contrast agent SH U 508 A (Levovist) appears to be a promising technique to improve the color Doppler demonstration of focal metastatic liver lesions. Nonetheless, further studies on larger series of cases are needed to differentiate the different primary sites of the metastases.

Topics: Aged; Color; Contrast Media; Female; Humans; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography

The differential diagnosis of focal hepatic lesions is a current problem even though many study methods are available. Color Doppler US has been recently suggested as a diagnostic technique capable of depicting lesion vascularization patterns to better understand lesion nature. However, this examination is often difficult and long. In this study, we investigated the role of a US contrast agent SH U 508 A (Levovist) enhancing the color Doppler signals for easier and better depiction of lesion vascularization. Seventy-four patients with one or more focal hepatic lesions (mean diameter: 5.6 cm) were examined. The lesions were 38 HCCs, 4 cholangiocarcinomas, 1 intrahepatic biliary duct carcinoma, 1 case of multiple adenomas, 2 regenerations nodules in cirrhosis, 2 cases of FNH, 18 metastases and 8 hemangiomas. In 54 cases the US contrast agent allowed the visualization of some vessels inside the lesions which had been missed at baseline examinations. Moreover, the vessels which had been depicted on baseline images were better demonstrated. In all but one patient with severe hepatic steatosis, normal parenchymal vessels were markedly enhanced. Our results in the different kinds of tumors are here reported.

Topics: Color; Contrast Media; Diagnosis, Differential; Hemangioma; Humans; Hyperplasia; Liver; Liver Cirrhosis; Liver Neoplasms; Polysaccharides; Ultrasonography

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

Liver metastases lead to a shortening of the HTT of an echo enhancer. Studies using SonoVue™ also showed a shortening of the HTT in healthy controls. Hence the HTT depends on the applied contrast agent. We examined whether the HTT of SonoVue™, Luminity™ und Levovist™ is useful to discriminate between patients with and without liver metastases.. We compared the arteriovenous HTT of Levovist™, Sonovue™ und Luminity™ in 20 patients with liver metastases and in 15 controls. An Acuson Sequoia™ ultrasound system was used. The HTT results from the difference of the arrival time of the microbubbles in the hepatic artery and a hepatic vein.. Using Levovist™ six patients and three controls had to be excluded from further analysis. The arrival time was undetectable. The mean HTT values in healthy controls were: Levovsit™ 14.75 sec (SD ± 2.53 sec), SonoVue™ 9.27 sec (SD ± 2.41 sec) and Luminity™ 9.2 sec (SD ± 2.34 sec). In patients the mean HTT values were: Levovist™ 9.89 sec (SD ± 1.04 sec), SonoVue™ 6.28 sec (SD ± 2.41 sec) and Luminity™ 6.33 sec (SD ± 1.37 sec). Using a cut off of 8 sec for SonoVue™ and Luminity™, the sensitivity to exclude liver metastases was 75% and 80%.. The mean HTT values of all contrast agents were shorter in patients. Levovist™ showed a longer HTT in patients and controls than Luminity™ and SonoVue™. Levovist™ showed the best separation between patients and controls but some patients and controls had to be excluded. The HTT could still be a useful tool to exclude liver metastases but the HTT depends on the contrast agent and the applied contrast technique.

Topics: Adult; Aged; Contrast Media; Female; Fluorocarbons; Humans; Image Enhancement; Liver Neoplasms; Male; Metabolic Clearance Rate; Middle Aged; Phospholipids; Polysaccharides; Reference Values; Sulfur Hexafluoride; 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

The purpose of this study is to evaluate tumor vascularity of pancreatic carcinoma noninvasively by contrast-enhanced ultrasound (US) and clarify the diagnostic value of tumor vascularity in subjects with nonresectable advanced pancreatic carcinoma. The study was approved by our institutional review board and written informed consent was obtained from all subjects. Twenty-seven subjects with advanced pancreatic ductal carcinoma were treated by chemoradiotherapy. Contrast-enhanced US, US guided biopsies and dynamic computed tomography (CT) were performed before and after the therapy. We assigned the intratumoral enhancement pattern of US as an enhanced ultrasound (EU) score, from 1 to 4, according to the degree of enhancement area. Intratumoral microvessel density (IMD) and average vessel diameter (AVD) were calculated by means of CD 34 immunostaining. Vascular endothelial growth factor (VEGF) staining was graded on a scale of 1 to 3. EU scores before chemoradiotherapy were compared with IMD, AVD, VEGF, histological grading and hepatic metastasis. After the therapy, local treatment response was evaluated by dynamic CT calculating the maximum area of the tumor, by comparing it with its size in pre- therapy. Subjects who had at least a 50% or more decrease of tumor size lasting more than 4 wk were estimated as partial response (PR), more than a 50% of increase progressive disease (PD) and if neither PR nor PD criteria were met, they were classified as stabled disease (SD). Next, EU scores were compared with IMD, AVD, VEGF and treatment response. Statistically significant differences were evaluated by Pearson's correlation, post-hoc, Spearman's rank correlation, Wilcoxon rank sum and Student's t-test. A p < 0.05 was defined as being statistically significant. Before the therapy, the EU score and IMD were significantly correlated (r = 0.50, p < 0.02), as was VEGF (r = 0.45, p < 0.05). The EU score and AVD were negatively correlated (r = - 0.56, p < 0.02). Significant correlation was found between the EU score and histological grading (p < 0.004). The EU score was higher in subjects who had hepatic metastasis compared with subjects who had no hepatic metastasis (p < 0.05). After chemoradiotherapy, 14 subjects exhibited PR, while 13 showed SD. None of the subjects showed PD. The EU score was smaller in PR than SD (p < 0.05). The EU score significantly decreased after the therapy in PR (p < 0.01) but not in SD. IMD and AVD did not significantly decrease in either

Topics: Aged; Aged, 80 and over; Antigens, CD34; Biomarkers; Carcinoma, Pancreatic Ductal; Contrast Media; Female; Humans; Image Enhancement; Immunohistochemistry; Liver Neoplasms; Male; Microbubbles; Middle Aged; Neovascularization, Pathologic; Pancreatic Neoplasms; Polysaccharides; Prospective Studies; Statistics, Nonparametric; Tomography, X-Ray Computed; Ultrasonography, Doppler; Vascular Endothelial Growth Factor A

The objective of our study was to investigate whether liver parenchymal phase contrast-enhanced sonography can provide additional information for assessing histologic grades of hepatocellular carcinoma (HCC).. Contrast-enhanced sonography using Levovist of 50 hepatic nodules was performed. The vascular and liver parenchymal perfusion patterns were evaluated. The sensitivity, specificity, and accuracy of the histologic diagnosis of the tumors using vascular phase imaging only and systematically combined vascular phase imaging with liver parenchymal phase imaging were calculated. We also performed histologic examination and immunostaining for the detection of Kupffer cells and calculated the Kupffer cell count in the tumorous tissue relative to that in the nontumorous tissue (Kupffer cell ratio) and quantitatively evaluated the relationship between the Kupffer cell ratio and the perfusion patterns seen on liver parenchymal phase imaging.. The specificity and accuracy of contrast-enhanced sonography in the diagnosis of dysplastic nodules and of moderately and poorly differentiated HCCs were improved by adding liver parenchymal phase imaging (dysplastic nodules, 74% and 78% vs 83% and 86%, respectively; moderately and poorly differentiated HCCs, 74% and 86% vs 85% and 92%). The diagnostic accuracy of contrast-enhanced sonography for dysplastic nodules showed a trend of improvement with the addition of liver parenchymal phase imaging (p = 0.07). Kupffer cell ratios for tumors that showed hypoperfusion during the liver parenchymal phase were significantly lower than those for tumors showing isoperfusion (p < 0.05).. Adding liver parenchymal phase imaging to contrast-enhanced sonography protocols may yield additional information that can be used to assess histologic grades of tumor and that leads to an improvement in the differential diagnosis of nodular lesions associated with the cirrhotic liver. Further case studies are required in larger numbers of patients for a longer follow-up period.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chi-Square Distribution; Contrast Media; Female; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Staging; Polysaccharides; Precancerous Conditions; Sensitivity and Specificity; Statistics, Nonparametric; Ultrasonography

The objective of our study was to assess whether percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is a safe procedure in patients with ascites.. From October 2005 to January 2008, 35 patients with one or more HCCs and ascites were referred to our department for planning sonography of RFA. In 15 patients, RFA was determined to be unfeasible. One patient was excluded from the study because of the absence of ascites at the time of RFA. Percutaneous ultrasound-guided RFA was performed in the remaining 19 patients with 24 HCCs. The electrode tract was cauterized at the time of electrode removal. Retrospective assessments of the preprocedural platelet counts and prothrombin times were performed, and patients were evaluated for bleeding complication by checking vital signs, checking serum hemoglobin level, and using CT to determine whether the attenuation value of ascites had increased > 30 HU.. There were no cases of mortality or major complications that developed after RFA. No significant difference in the maximum thickness of the perihepatic ascites and in the hemoglobin level between the pre- and postprocedural measurements was detected. Hemoperitoneum as a minor complication was noted in two (10.5%) of 19 patients. However, in those two patients, vital signs were stable, follow-up laboratory data were normal, and hemoperitoneum had been completely absorbed on CT images obtained 1 month after RFA.. Percutaneous RFA for HCC can be performed safely in patients with ascites.

Topics: Aged; Ascites; Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Female; Humans; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Postoperative Complications; Retrospective Studies; Safety; Ultrasonography, Interventional

Although hypervascular appearance is characteristic in hepatocellular carcinoma (HCC), hepatic nodules without hypervascular appearance are sometimes found in patients with chronic liver disease (CLD). The aim of the present study was to clarify the efficacy of contrast-enhanced ultrasound (CEUS) with Levovist to characterize small, non-hypervascular hepatic nodules on contrast-enhanced computed tomography (CECT) in patients with CLD.. The subject was 41 hepatic nodules (<30 mm, 18.5 +/- 5.6 mm) which showed non-hypervascular appearance on CECT in 35 patients with CLD; their histological results were 31 HCC (15 well, 14 moderate, and two poor) and 10 regenerative nodules (RN). CEUS with Levovist was performed under intermittent scanning (1-s interval) using APLIO at the early phase and the liver-specific phase, and the contrast enhancement of the nodule was assessed in comparison to that of the surrounding liver parenchyma. The contrast-enhanced findings with the time-intensity analysis were compared with the histological results.. Twelve nodules with weak enhancement in the liver-specific phase were HCC, regardless of their early-phase appearances. The other 29 nodules with equivalent or weak enhancement in the early phase and equivalent enhancement in the liver-specific phase were 19 HCC and 10 RN. Among them, the maximum-intensity ratio of tumor to non-tumor in the early phase was significantly higher in HCC than in RN (P < 0.01, n = 16), and the receiver-operating characteristic analysis showed a sensitivity of 1.0 and a specificity of 0.83 for their characterization.. CEUS with Levovist may be an alternative to biopsy to characterize small, non-hypervascular hepatic nodules on CECT in patients with CLD.

Topics: Biopsy, Needle; Carcinoma, Hepatocellular; Chronic Disease; Contrast Media; Feasibility Studies; Humans; Liver Diseases; Liver Neoplasms; Microbubbles; Polysaccharides; Predictive Value of Tests; Time Factors; Tomography, X-Ray Computed; Ultrasonography

Topics: Combined Modality Therapy; Contrast Media; Hemangiopericytoma; Humans; Liver Neoplasms; Male; Middle Aged; Muscle Neoplasms; Polysaccharides; Thigh; Tomography, X-Ray Computed; Ultrasonography

To demonstrate that liver metastases with a diameter of < or =40 mm show characteristic features on three-dimensional (3D) fusion sonographic images and that these sonographic findings can be correlated with histopathologic features of surgical specimens.. Liver metastases measuring < or =40 mm were examined via contrast-enhanced 3D fusion sonography. The characteristic sonographic findings of 17 tumor nodules in 11 patients with a histopathologically confirmed diagnosis of liver metastases were investigated, and their correspondence to the pathologic features were examined in 12 resected nodules.. On sonograms, central vessels were visualized in all 17 tumor nodules and peripheral vessels were visualized in 12 nodules. On histopathologic examination, the portal triad vessels corresponded to the central vessels and were located at the center of the tumors. A thin layer of peritumoral hepatocytes showing various changes was also observed, and a group of tiny vessels were seen running along this layer of cells.. Liver metastases measuring 40 mm or less in diameter were characterized by the presence of both central and peripheral vessels on contrast-enhanced 3D fusion sonography. There was good correlation between sonographic and histopathologic findings.

Topics: Adult; Aged; Chi-Square Distribution; Contrast Media; Female; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Liver Neoplasms; Male; Middle Aged; Neovascularization, Pathologic; Polysaccharides; Ultrasonography

To evaluate the efficacy of contrast-enhanced ultrasound for the localization of ultrasonically invisible hypervascular lesions in the liver to facilitate percutaneous ultrasound-guided treatment.. Forty patients with 47 ultrasonically invisible hypervascular lesions (5-20mm) diagnosed on contrast-enhanced computed tomography were enrolled in the retrospective study. Contrast-enhanced ultrasound (CEUS) with Levovist was performed to localize the lesions both in the early phase and liver-specific phase. Diagnosis of was confirmed by percutaneous needle biopsy where feasible, and on the basis of on treatment outcomes or changes in computed tomography findings in those not amenable to biopsy.. Thirty-two lesions were diagnosed as hepatocellular carcinoma (HCC). Contrast-enhanced ultrasound localized hepatocellular carcinoma in 24/32 (75%) lesions, the mean diameter (15.1+/-4.9mm), as measured using computed tomography, being significantly larger than that of the remaining eight lesions (10.5+/-2.1mm). Ultrasound-guided treatment was performed in 19 of the 24 lesions, and transarterial chemoembolization (TACE) was applied for the other five lesions because of difficult percutaneous access. Five of the eight non-visualised lesions were treated by transarterial chemoembolization, and the other three by surgical resection. The beneficial effect of CEUS was significantly greater when the reason for poor initial visualisation was the coarse liver architecture (17/17) than when it was due to adverse location (seven of 15, p<0.005). Fifteen of the CT-detected hypervascular lesions were considered to represent false positives for HCC, based on their behaviour during follow-up.. Contrast-enhanced ultrasound with Levovist facilitates the application of percutaneous ultrasound-guided treatment by improving localization of ultrasonically invisible hypervascular hepatocellular carcinomas in the liver.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Contrast Media; Female; Humans; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Retrospective Studies; Tomography, X-Ray Computed; Ultrasonography, Interventional

Topics: Biopsy, Needle; Contrast Media; Diagnosis, Differential; Fatty Liver; Female; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Middle Aged; Polysaccharides; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color; Uterine Cervical Neoplasms

In 1.5 Harmonic Imaging ultrasonography (1.5 HI US), images are obtained in a band intermediate between the fundamental and 2nd harmonic components, resulting in stronger contrast enhancement than in conventional harmonic imaging. We attempted to assess the hemodynamics of hepatocellular carcinomas (HCC) with special attention to blood drainage using 1.5 HI US. Forty-two HCC nodules, metastatic liver tumors and hepatic hemangiomas were studied. In contrast studies, intermittent ultrasound transmission was performed for a period of up to 45 sec after the injection of contrast agent, which was regarded as the vascular phase. The time point of 5 min later was specified as the post-vascular phase, and images were obtained by single manual transmission for comparison of contrast enhancement with surrounding hepatic parenchyma. In addition, histological examination was performed. 1.5 HI US clearly demonstrated the strong tumor vessels in most HCCs. Corona enhancement, in which the areas surrounding the tumor are enhanced, was observed in 71.4% (30/42) of HCC nodules during the post-vascular phase. This sign was not observed in any other tumors. Histological findings revealed that CD34-positive-endothelial cells were prominent in the surrounding area of HCC. In conclusion, 1.5 HI US is an effective tool for evaluating hemodynamics in both early- and post-vascular phase. Corona enhancement may be due to the trapping of contrast agent in the endothelial cells in the surround of HCC nodules and be a novel specific sign for HCC.

Topics: Adult; Aged; Antigens, CD; Antigens, CD34; Antigens, Differentiation, Myelomonocytic; Carcinoma, Hepatocellular; Contrast Media; Female; Hemangioma; Humans; Image Enhancement; Immunohistochemistry; Liver; Liver Neoplasms; Male; Microbubbles; Middle Aged; Polysaccharides; Ultrasonography

Features of hepatocellular carcinoma (HCC) observed by contrast-enhanced ultrasonography (CEUS) were compared to pathological features of corresponding resected HCC specimens, to evaluate the ability of CEUS to depict the pathological features of HCC. We investigated 50 HCC nodules that were treated by surgical resection. All nodules had been examined by CEUS with intravenous contrast agent (Levovist) before surgery. CEUS findings were divided into three phases for evaluation and classification of enhancement patterns: two vascular phases (arterial phase and portal venous phase) and the delayed phase. Pathological examination focused on differentiation and on the presence or absence of a tumor capsule, intratumoral septum, and intratumoral necrosis. All 21 nodules that showed a linear or annular vessel around the tumor margin in the arterial phase had capsular formation. Of the 27 nodules that showed heterogeneous perfusion in the portal venous phase, 21 (77.8%) had an intratumoral septum and 23 (85.2%) showed intratumoral necrosis. All nodules that were depicted as a defect with an unclear margin in the delayed phase were well-differentiated HCCs, whereas all nodules that were depicted as a defect with a clear margin were moderately or poorly differentiated HCCs. From our observations, the arterial, portal venous, and delayed phases of CEUS could reflect different pathological aspects of HCC. Some pathological characteristics of HCC might be evaluated preoperatively and non-invasively, by means of combined analysis of three phases of CEUS findings.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Chi-Square Distribution; Contrast Media; Female; Humans; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography

Six adult healthy Beagles were used to investigate the hepatic perfusion dynamics of Levovist, a contrast agent used in contrast harmonic imaging (CHI). In addition, 8 dogs with hepatocellular carcinoma (HCC) and 2 dogs with metastatic hepatic hemangiosarcoma (HSA) were used to characterize both the CHI findings with Levovist. In the Beagles, the start of intravenously injected Levovist into the aorta between the cranial mesenteric and renal arteries and the portal vein at the hepatic hilum were 5.47 +/- 1.52 sec and 16.03 +/- 3.39 sec, respectively. As a characteristic CHI finding in the 8 dogs with HCC, the early arterial phase showed a fine network of blood flow enhanced at the surrounding region and within the tumor in all the 8 dogs (100%), and the post vascular phase demonstrated a defect in the whole tumor and an enhancement of the surrounding hepatic tissues in 7 dogs (87.5%). In the 2 dogs with HSA, characteristic finding in which the early arterial and late vascular phases showed a rim contrast enhancement pattern, and the post vascular phase revealed that the whole tumor lacked contrast enhancement and the surrounding hepatic tissues was clearly enhanced. In dogs, the start of the early arterial and late vascular phases, and the characterizations of the CHI findings in HCC and HSA were suggested to be similar to those in humans. Therefore, CHI is thought to be useful for the diagnosis of HCC and metastatic hepatic HSA in dogs as well as in humans.

Topics: Animals; Carcinoma, Hepatocellular; Contrast Media; Dog Diseases; Dogs; Female; Hemangiosarcoma; Liver; Liver Neoplasms; Male; Neoplasm Metastasis; Polysaccharides; Ultrasonography

The aim was to clarify the features of contrast-enhanced ultrasound (CEUS) with Levovist for diagnosis of hypervascular benign nodules in the liver of heavy drinkers.. Seven heavy drinkers with hypervascular nodules in the liver were studied. Findings of CEUS with Levovist (wide-band Doppler, 7/7), contrast-enhanced computed tomography (CECT, 7/7) and magnetic resonance imaging (MRI, 5/7) were compared for one nodule in each patient.. Diagnosis of all seven nodules on CECT was HCC, whereas pathological results were HCC for four nodules and benign lesion for three nodules. The former four showed compatible findings for HCC on CEUS (4/4) and MRI (2/4). However, the latter three showed characteristic liver-specific sonograms with a ring-shaped appearance--peripheral enhancement with a central non-enhanced area. Two of the three nodules showed decreased signal-intensity in the periphery on SPIO-enhanced MRI.. The ring-shaped appearance on liver-specific sonograms with Levovist may be a useful sign for the differential diagnosis of hypervascular benign nodule from HCC in heavy drinkers.

Topics: Adult; Aged; Alcohol Drinking; alpha-Fetoproteins; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Humans; Liver; Liver Cirrhosis, Alcoholic; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Polysaccharides; Tomography, X-Ray Computed; Ultrasonography

To determine the utility of contrast-enhanced ultrasonography (CEUS) in assessing hepatic tumors with central feeding arteries found by color/power Doppler ultrasonograophy (CDUS/PDUS).. We prospectively studied 37 hepatic tumors (34 patients), with a mean size of 2.9cm and each having a central feeding artery, by CDUS/PDUS. The CEUS was performed with a galactose-based microbubble contrast agent. The detection of a spoke-wheel sign was interpreted as evidence of focal nodular hyperplasia (FNH). All patients underwent tumor biopsies or surgical resection.. CEUS showed a central feeding artery with a spoke-wheel sign in 36 tumors, including 34 FNHs and 2 hepatocellular carcinomas. The remaining tumor was demonstrated to be FNH despite the absence of a spoke-wheel sign as detected by CEUS. The sensitivity of the spoke-wheel sign or central scar for FNH was 97.1% (34/35), 40% (14/35), 28.6% (10/35), 50% (8/16) and 0% (0/15) for CEUS, CDUS/PDUS, dynamic computed tomography (CT) or magnetic resonance imaging (MRI), hepatic angiography and liver scintigraphy, respectively. The two hepatocellular carcinomas showed scirrhous changes histologically.. CEUS is more sensitive than CDUS/PDUS, dynamic CT, MRI, hepatic angiography and liver scintigraphy in the detection of the spoke-wheel sign or central scar in FNH. Scirrhous hepatocellular carcinoma should be included in the differential diagnosis for liver tumors with spoke-wheel sign detected by CEUS.

Topics: Adolescent; Adult; Biopsy; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Microbubbles; Middle Aged; Polysaccharides; Prospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color

The purpose of this study was to investigate the efficacy of late-phase pulse inversion harmonic imaging (PIHI) in detecting occult metastases and to compare the results with helical computed tomography (CT) in a group of patients whose fundamental liver sonographic results were normal.. Thirty-two patients (21 women and 11 men; age range, 20-87 years) with a known primary malignancy were enrolled in the study. The patients were evaluated with conventional sonography, unenhanced PIHI, and PIHI 3 minutes after the injection of Levovist (SH U 508A; Schering AG, Berlin, Germany). All patients also underwent triphasic helical CT within 1 week after sonography. In 1 patient, mangafodipir-enhanced magnetic resonance imaging was performed as part of the clinical workup.. After Levovist injection, in 4 (12.5%) of 32 patients, at least 1 hypoechoic lesion was detected by PIHI; multiple lesions were shown in 1 patient. The mean diameter of newly detected lesions was 12 mm. Triphasic helical CT also showed all of the lesions that were detected by PIHI. The diagnoses were confirmed by biopsy and CT findings in 2 patients and by the typical CT and magnetic resonance imaging findings in 1 patient. For the fourth patient, the diagnosis was confirmed by follow-up and CT. Conclusions. Late-phase PIHI is comparable to helical CT for detecting occult hepatic metastases, but it protects patients from the potentially hazardous effects of radiation and iodinated contrast agents. Further series involving a larger number of patients are needed to determine its place in the evaluation of cancer staging and treatment planning.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Female; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Metastasis; Polysaccharides; Sensitivity and Specificity; Tomography, Spiral Computed; Ultrasonography

Intracystic slow bleeding is very difficult to diagnose using conventional sonography; consequently, a new sonographic technique has been sought. We present a histologically proven hepatobiliary cystadenoma with intracystic bleeding in which contrast-enhanced sonography (CEUS) showed microbubbles oozing from the cyst wall into the cystic cavity 10 minutes after intravenous injection of contrast medium. CEUS is an important diagnostic tool for diagnosing liver tumors, but the CEUS finding of slow intracystic bleeding has not been reported. Our observation suggests that this technique may be a new diagnostic tool for this purpose.

Topics: Contrast Media; Cystadenoma; Female; Hemorrhage; Humans; Liver Neoplasms; Middle Aged; Polysaccharides; Ultrasonography

We evaluated the efficacy of contrast-enhanced ultrasonography (CEUS) for the characterization of small hepatic nodules (< or =2 cm) in cirrhosis patients.. Thirty cirrhosis patients with 30 hepatic nodules (1-2 cm) were enrolled in this study. Eighteen hepatic nodules were hepatocellular carcinomas (HCC) and 12 were benign lesions. CEUS was performed using microbubble contrast (Levovist). With surrounding hepatic parenchyma as a reference, two characteristics of hepatic nodules, including arterial phase enhancement (AE) and the absence of delayed phase enhancement (ADE), were evaluated as criteria for the diagnosis of HCC. A radiologist independently reviewed the dynamic computed tomographies (CT) of 26 hepatic nodules.. CEUS showed AE in 15 nodules (13 HCC and two benign) and ADE in 17 lesions (14 HCC and three benign). For HCC, the coincidental AE of both CEUS and dynamic CT was 40%. Using both AE and ADE for HCC diagnosis, the sensitivity, specificity, accuracy, positive predictive value and negative predictive values were 55.6%, 91.7%, 70%, 90.9% and 57.9%, respectively. When using either AE or ADE for HCC diagnosis, the same parameters were 94.4%, 66.7%, 83.3%, 81% and 88.9%, respectively. One benign hepatic nodule with both AE and ADE was diagnosed as HCC 29 months after the CEUS study.. A combination of characteristics of AE and ADE as determined by CEUS was highly specific for small HCCs in cirrhosis patients. Concurrent delayed phase imaging is useful in the diagnosis of small hypovascular HCCs.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Humans; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Retrospective Studies; Ultrasonography, Doppler

Contrast enhancement in the portal vein was repeatedly observed at 1 min intervals with wide-band Doppler ultrasonography in 152 consecutive patients (132 with liver cirrhosis and HCC, 20 controls), 5 min after the injection of Levovist. The duration time of contrast enhancement in the portal vein (microbubble disappearance-time; MD-T) was measured in all patients and contrast-enhanced appearances were compared between the 5 min phase and MD-T phase in 68 HCC nodules. MD-T in patients with liver cirrhosis (572.4 +/- 117.9 s) was significantly longer than in controls (481.6 +/- 89.3 s, p < 0.05). MD-T was prolonged in patients with Child B and C compared with Child A (p < 0.05). The contrast-enhanced appearances between the two phases were different in 30 of 68 HCC nodules (44.1%), showing positive enhancement in the 5 min phase and negative enhancement in the MD-T phase. The proposed MD-T may become an essential factor for the evaluation of liver-specific sonograms.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Humans; Image Enhancement; Injections, Intravenous; Liver; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Male; Microbubbles; Middle Aged; Polysaccharides; Portal Vein; Retrospective Studies; Time Factors; Ultrasonography, Doppler

The detection rate of liver lesions using ultrasonography is 53-77%, rendering this method inferior to CT and MRI. Despite well-known limitations, development of stable second-generation contrast agents in conjunction with new techniques of contrast display has led to increased diagnostic accuracy. Characterization of focal liver lesions with ultrasound contrast agents follows known features of iodine- and gadolinium-containing contrast agents, but compared to CT and MRI sensitive visualization of intratumoral vessels takes place in real time. In addition to very high diagnostic accuracy in differentiating benign from malignant lesions, detectability of tumors of nonhepatocellular origin is increased significantly and direct assessment of treatment success with minimally invasive tumor ablative interventions in the liver is possible. The active principle of ultrasound contrast agents, examination technique as well as distinguishing features and appearance of various, frequently observed focal liver lesions are illustrated by cases from our department.

Topics: Carcinoma, Hepatocellular; Contrast Media; Cysts; Diagnosis, Differential; Focal Nodular Hyperplasia; Half-Life; Hemangioma; Hepatic Veins; Humans; Image Enhancement; Liver; Liver Diseases; Liver Neoplasms; Microbubbles; Neovascularization, Pathologic; Phospholipids; Polysaccharides; Sensitivity and Specificity; Sulfur Hexafluoride; Ultrasonography, Interventional

To classify hepatocellular carcinoma (HCC) based on the findings of digital subtraction imaging (DSI) and to compare DSI against other diagnostic imaging modalities to assess its reliability DSI was performed in 68 patients with HCC (72 nodules) and the enhancement patterns of blood flow in the tumor were assessed during the early phase, the portal phase and the late phase. In addition, the findings obtained by DSI were compared with those obtained by helical CT, digital subtraction angiography (DSA), CO2 angiography and CT during arterial portography (CTAP). Of the 72 nodules, blood flow was detected in 64 (88.9%) by early-phase DSI, in 61 (84.7%) by helical CT, in 62 (86.1%) by DSA and in 67 (93.1%) by CO2 angiography. Early-phase DSI did not demonstrate hypervascular enhancement in 8 HCC nodules (16.7%). These included 5 nodules in which other diagnostic imaging modalities also failed to identify tumor blood vessels and 3 nodules located in deep regions 87.5 mm or more from the body surface. With regard to these 5 nodules (10.4%) in which tumor vessels were not visualized during the early phase, late-phase DSI demonstrated relatively poor enhancement compared with normal hepatic parenchyma. Such late-phase defects in tumor enhancement were observed in 69 nodules (95.8%). DSI demonstrated characteristic findings of HCC enhancement during the early phase, the portal phase and the late phase, permitting classification of HCC to be performed.

Topics: Aged; Aged, 80 and over; Angiography, Digital Subtraction; Carcinoma, Hepatocellular; Contrast Media; Female; Humans; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Subtraction Technique; Ultrasonography, Doppler

Hepatocellular carcinoma (HCC) is a malignant liver tumour with a high prevalence world-wide. For screening procedures conventional transabdominal B-mode ultrasound and AFP determination are commonly used. We investigated 100 consecutive patients with histologically proven hepatocellular carcinoma in order to evaluate sonographic characteristics in unselected patients and to compare native and contrast-enhanced ultrasonographic techniques.. We investigated 100 consecutive patients with hepatocellular carcinoma at time of diagnosis with respect to echogenicity, patterns of vascularity, and portal/hepatic vein thrombosis. In addition to B-mode and native power Doppler sonography, contrast-enhanced power Doppler sonography with SHU 508A was used in 65 patients.. The ultrasound appearance with conventional B-mode of hepatocellular carcinoma was hypoechoic in 48 % of the cases, isoechoic in 9 %, hyperechoic in 19 %, and in 25 % a mixture between hyper- and hypoechoic appearance was found compared to the surrounding liver tissue. Contrast-enhanced power Doppler sonography with SHU 508A changed the pattern of tumour vascularity in 27 % of patients into hypervascular, mainly in small lesions.. At the time of diagnosis, the most commonly observed finding in hepatocellular carcinoma is that they appear hypervascular, independent of their size. The use of ultrasound contrast media should be considered to achieve characterisation of liver nodules in cirrhotic livers because they can improve the evaluation of tumour vascularity. Hypovascular HCC are found in about 10 % even after the administration of a contrast agent.

Topics: Adenoma; Adult; Aged; Aged, 80 and over; Budd-Chiari Syndrome; Carcinoma, Hepatocellular; Contrast Media; Data Interpretation, Statistical; Female; Hemangioma; Humans; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Portal Vein; Ultrasonography, Doppler, Color; Venous Thrombosis

Our aim was to assess the diagnostic performance of contrast-enhanced agent detection sonographic imaging to characterize focal hepatic lesions in patients with diffuse liver disease in comparison with baseline sonographic images and to determine whether agent detection imaging can reduce the necessity of further diagnostic workup for lesion characterization.. Contrast-enhanced sonography using 4 g of Levovist at a concentration of 300 mg/mL was performed on 75 focal hepatic lesions in 75 patients with diffuse liver disease. Interval reviews for both baseline without and with contrast-enhanced sonography were performed independently by two radiologists. They were requested to determine the malignity of focal hepatic lesions using a 5-point confidence level and to record the specific diagnoses and the necessity for further imaging for lesion characterization. Radiologists' performances for lesion differentiation using baseline and contrast-enhanced sonography were evaluated using receiver operating characteristic (ROC) analysis. Interobserver agreement was also analyzed.. When contrast-enhanced sonography was used, ROC analysis revealed a significant improvement for both reviewers (area under the receiver operating characteristic curve [A(z)] = 0.753 and 0.830 and 0.971 and 0.974 at baseline sonography and contrast-enhanced sonography, respectively; p < 0.002) for differentiating malignant and benign focal liver lesions. Contrast-enhanced sonography also improved specificity from 12% to 91% for reviewer 1 and from 26% to 85% for reviewer 2 compared with baseline sonography. Furthermore, excellent interobserver agreement was achieved for contrast-enhanced sonography (weighted kappa = 0.919), whereas only good agreement was achieved for baseline sonography (weighted kappa = 0.656). A better result for specific diagnosis was obtained by contrast-enhanced sonography (79% and 75%) than by baseline sonography (37% and 48%, p < 0.05). Contrast-enhanced sonography (72% and 63%) outperformed baseline sonography (35% and 28%, p < 0.05) as a confirmatory imaging technique.. Contrast-enhanced agent detection sonography can be used to characterize focal hepatic lesions in patients with diffuse liver disease reliably and with a higher diagnostic confidence than baseline sonography. Furthermore, contrast-enhanced sonography reduced the need for further diagnostic workups for focal hepatic lesion characterization.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Chi-Square Distribution; Contrast Media; Diagnosis, Differential; Female; Humans; Image Processing, Computer-Assisted; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Prospective Studies; ROC Curve; Sensitivity and Specificity; Statistics, Nonparametric; Ultrasonography

We have reported that proton radiotherapy for hepatocellular carcinoma (HCC) is a safe and effective therapeutic option. However, it is difficult to evaluate its effect in certain cases. Recently, it has been reported that the usage of contrast-enhanced color Doppler ultrasonography (CECDU) can improve diagnostic accuracy, both in terms of the presence of hepatic tumor and in the evaluation of treatment. The aim of this study was to determine the usefulness of CECDU in assessing the therapeutic response of HCC treated with proton radiotherapy.. Twenty-two patients treated with the proton radiotherapy were studied. We inspected HCC lesions by CECDU, before and after the irradiation, over time. The magnitude of blood flow in the HCC was quantified on still images by CECDU. The ratio of the number of color pixels against that of the total number of pixels in the tumor area was defined as the tumor blood flow ratio (TBFR).. Immediately after the proton treatment, a transient increase of blood flow in the tumor was recognized in more than half of the patients, while the TBFR was unchanged or decreased in the remaining patients. At longer periods after irradiation, the TBFR in all HCCs gradually decreased, and this reduction of TBFR was statistically significant from 9 months after irradiation. These findings are consistent with those obtained previously by computed tomography (CT) as well as magnetic resonance imaging (MRI).. We propose CECDU as a useful diagnostic option for the evaluation of HCC treated with proton radiotherapy.

Topics: Aged; Aged, 80 and over; Blood Flow Velocity; Carcinoma, Hepatocellular; Contrast Media; Cyclotrons; Female; Follow-Up Studies; Humans; Injections, Intravenous; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Protons; Radiotherapy, High-Energy; Reproducibility of Results; Ultrasonography, Doppler, Color

Topics: Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Disease Progression; Fatal Outcome; Hepatitis C; Humans; Image Enhancement; Liver; Liver Failure; Liver Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Polysaccharides; Rupture, Spontaneous; Tomography, X-Ray Computed; Ultrasonography

The aim of the study is to evaluate the contrast enhanced power doppler technique as a method to detect and differentiate vascular patterns of focal liver lesions. Fourty-nine patients with focal liver lesions were included in the study, twenty-nine of them with malignant liver lesions (9 HCC, 20 metastatic), twenty patients with benign lesions (12 haemangiomas, 5 focal nodular hyperplasia, 3 focal steatosis). In all patients classic B-mode and power doppler sonography was performed prior to administration of the contrast medium Levovist (300 mg/ml) and a power doppler examination subsequent to medium administration. Contrast administration led to lowering the number of "no-flow" lesions from 19 to 11. Postcontrast scan analysis revealed markedly enhanced flow in 15 cases in comparison to only 4 in pre-contrast examinations. The pre-contrast power doppler showed central flow in 7, and peripheral in 26 focal liver lesions. On the other hand, the postcontrast study revealed a central flow in 14, and peripheral in 34 focal liver lesions. Statistical significance between pre- and post-contrast power doppler detection of vascularization existed in malignant focal liver lesions and haemangiomas. The same pre- and post-contrast evaluation proved to be statistically non-significant in the focal nodular hyperplasia and focal steatosis groups. Administration of contrast medium enables a better visualization of intratumor blood vessels in focal liver lesions. This, in combination with the power doppler technique, brings such scans close to angiographic findings.

Topics: Contrast Media; Humans; Liver Diseases; Liver Neoplasms; Polysaccharides; Ultrasonography, Doppler, Color

In contrast-enhanced 1.5 harmonic imaging sonography, images are obtained in a band intermediate between the fundamental and the 2nd harmonic components. In the present study, we investigated the usefulness of 1.5 harmonic imaging sonography with the use of the contrast agent Levovist for the diagnosis of hepatocellular carcinoma (HCC), metastatic hepatic tumor, and hepatic hemangioma. The subjects in this study were 64 patients with 70 nodules of hepatic tumors (42 nodules in 36 cases of hepatocellular carcinoma, 20 nodules in 20 cases of metastatic hepatic tumor, and 8 nodules in 8 cases of hepatic hemangioma). Contrast enhancement of tumors acquired in the early, portal, and late phases with 1.5 harmonic imaging sonography were compared to classify the tumors. 1.5 harmonic imaging sonography of HCC showed contrast enhancement of 36 nodules (85.7%). Hypervascular enhancement in the early phase, which was maintained in the portal phase, changed to images with no contrast enhancement with partial persistence of contrast enhancement in the late phase. 1.5 harmonic imaging sonography of metastatic hepatic tumor showed hypervascular enhancement of the margin of 20 nodules (100%) in the early and portal phases, which changed to images with no contrast enhancement in the late phase. 1.5 harmonic imaging sonography of hepatic hemangiomas maintained hypervascular enhancement on the tumor margin of 5 nodules (62.5%) in the early and portal phases. When early phase 1.5 harmonic imaging sonography did not show hypervascular enhancement in 3 nodules (37.5%), and late-phase images confirmed that these 3 nodules were hypervascular enhancement on the tumor margin. 1.5 harmonic imaging sonography of hepatic tumors (hepatocellular carcinoma, metastatic hepatic tumor and hepatic hemangioma) provided characteristic findings of contrast enhancement in the early, portal, and late phases, and will contribute to differential diagnosis.

Topics: Adult; Aged; Aged, 80 and over; Angiography; Carbon Dioxide; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Hemangioma; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Polysaccharides; Ultrasonography

Institutional review board approval and informed consent were obtained. To prospectively assess if continuous infusion of galactose-palmitic acid can prolong the duration of hepatic enhancement at ultrasonography over bolus injection, 11 patients received two injections--one bolus injection (2 mL/sec) and one continuous infusion (1.5 mL/min)--with the same dose of galactose-palmitic acid (4 g, 300 mg/dL). Two unenhanced baseline sweep scans (mechanical index of 0.7 and 1.3) of the relevant liver lobe were acquired followed by contrast-enhanced sweeps after bolus injection and continuous infusion. Each sweep was saved as cine loops and analyzed with a personal computer. Duration of enhancement more than 3 dB was prolonged by continuous infusion from 4.3 minutes +/- 2.4 (+/-standard deviation) at bolus injection to 10.1 minutes +/- 3.0 (P < .005). Maximal parenchymal enhancement was 11.0 dB +/- 3.2 (bolus injection) and 9.2 dB +/- 3.8 (infusion, P < .05). Peak liver-to-lesion contrast was 14.2 dB +/- 6.3 (bolus injection) and 13.2 dB +/- 7.1 (infusion, not significant). Continuous infusion of galactose-palmitic acid markedly prolongs but slightly diminishes hepatic enhancement; liver-to-lesion contrast remains unchanged.

Topics: Adult; Aged; Area Under Curve; Female; Humans; Infusions, Intravenous; Injections, Intravenous; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Prospective Studies; Statistics, Nonparametric; Ultrasonography, Doppler, Pulsed

We investigated the diagnostic utility of post-vascular phase contrast-enhanced ultrasonography (US) and superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) as compared to the histological diagnosis of differential grades of hepatocellular carcinomas (HCCs).. Forty-nine patients with histologically characterized liver nodules (well-differentiated HCC, n = 20; moderately differentiated HCC, n = 19; poorly differentiated HCC, n = 1; dysplastic nodule, n = 9) received contrast-enhanced US and SPIO-MRI. Subsequently, we quantitatively evaluated the relationships between the images of the nodules and their histological diagnosis and differential grades.. The ratio of the echogenicity of the tumorous area to that of the nontumorous area with post-vascular phase contrast-enhanced US (post-vascular phase ratio) decreased as nodules became less differentiated (P < 0.05; Kruskal-Wallis test). The ratio of the intensity of the nontumorous area to that of the tumorous area on SPIO-enhanced MR images (SPIO intensity index) also decreased as nodules became less differentiated (P < 0.01). The post-vascular phase ratio correlated with the SPIO intensity index for HCCs and dysplastic nodules (r = 0.76). The conformity of the result from the post-vascular phase contrast-enhanced US and SPIO-MRI was 96%.. Contrast-enhanced US is a valuable method for predicting the histological grade of HCCs in cirrhotic patients, and may be a good alternative to SPIO-enhanced MRI.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Ferric Compounds; Humans; Image Enhancement; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Polysaccharides; Ultrasonography

The purpose of this study was to evaluate the detection rate of tumor vessels and vascularity in hepatocellular carcinoma (HCC) by contrast-enhanced coded US using Levovist, and to compare with conventional color/power Doppler US (CDUS) and dynamic CT. Ninety nodules (72 hypo/isoechoic nodules, 18 hyperechoic nodules) in 61 patients were studied. We observed tumor vessels by continuous transmission at the early vascular phase (40 s following administration of Levovist) and vascularity by intermittent transmission (intervals of 2-3 s) at the late vascular phase (40 to approximately 120 s). The detection rate of tumor vessels at the early vascular phase was 97% in hypo/isoechoic nodules and 70% in hyperechoic nodules with high density in dynamic CT being higher than that by CDUS. Tumor vascularity at the late vascular phase in hypo/isoechoic and hyperechoic nodules was hyper-enhancement in 78 and 40%, iso-enhancement in 19 and 40%, and hypo-enhancement in 3 and 0%, respectively. The detection rates of tumor vessels and vascularity in hyperechoic nodules were similar to those by CDUS. The detection rates of tumor vessels and vascularity were not affected by the tumor size in HCC tumors with high density in dynamic CT. Contrast-enhanced US with Levovist was superior to CDUS and equal to dynamic CT to assess tumor vessels in hypo/isoechoic nodules. Although it was equal to CDUS for hyperechoic nodules, this modality is useful in evaluating tumor hemodynamics.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Humans; Image Enhancement; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Tomography, X-Ray Computed; Ultrasonography

Ultrasound is reported to be relatively unreliable in the characterisation of liver tumours. The purpose of this study was to assess the ability of contrast enhanced phase inversion ultrasound (PIUS), a new highly sensitive contrast specific technique, performed during the liver specific phase of Levovist, to differentiate between benign and malignant lesions of the liver.. A total of 174 patients with histologically proven liver tumours were prospectively examined with conventional B mode ultrasound and two minutes after intravenous bolus injection of SHU 508A (Levovist). The examination technique comprised: Siemens Sonoline Elegra, phase inversion harmonic imaging (ECI); high mechanical index (1.2-1.7) using a delayed two minute post contrast scanning technique.. In all patients with malignant disease, hypoechoic contrast enhancement was seen during the portal venous phase, and convincing but variably less demarcated in 13 patients with hepatocellular carcinoma compared with all patients with liver metastases. The liver tumours proved to be histologically benign in 95 patients and malignant in 79 patients. Homogenous contrast enhancement with a mainly isoechogenic appearance in the portal venous and liver specific late phase was seen in almost all patients with benign liver lesions with the exception of one patient with an inflammatory pseudotumour of the liver and five patients with abscesses. These six exceptions all demonstrated a hypoechoic appearance in the portal venous and liver specific late phase.. The ability of unenhanced ultrasonography to characterise liver disease is known to be limited. PIUS performed during the portal venous and liver specific late phase of Levovist may differentiate between benign and malignant liver tumours in most cases, with the exception of, for example, abscesses, scars, necrosis, cysts, and calcifications, which need to be excluded clinically and by conventional B mode ultrasonography.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Contrast Media; Diagnosis, Differential; Female; Humans; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Prospective Studies; Ultrasonography

In a 65-year-old female patient, B-mode sonography detected a single focal lesion in the right liver lobe with a diameter < 3 cm. Histopathologic examination revealed a low differentiated hepatocellular carcinoma (HCC; G3). Tumor staging was performed by CT (computed tomography) scan and Resovist MRI (magnetic resonance imaging). Both examinations found a single liver lesion without signs of additional focal hepatic lesions. In addition, phase-inversion sonography in the late phase was performed using the ultrasound contrast agent Levovist. This examination of late-phase Levovist uptake detected more than five additional focal hepatic lesions in the right liver lobe, which were invisible by CT scan and Resovist MRI. This finding of multiloculated HCC was very important to decide on the patient's correct therapy. While liver transplantation is the treatment of choice in single HCC < 3 cm, it is contraindicated in multicentric HCC. In the patient described here, hemihepatectomy of the right liver lobe was performed. The histopathologic examination of the resected liver confirmed the diagnosis of multicentric HCC, which was noninvasively diagnosed only by contrast-enhanced sonography, but not by CT scan or MRI.

Topics: Aged; Biopsy; Carcinoma, Hepatocellular; Dextrans; Female; Ferrosoferric Oxide; Hepatectomy; Humans; Iron; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Magnetite Nanoparticles; Oxides; Polysaccharides; Tomography, X-Ray Computed; Ultrasonography

This study was undertaken to determine whether the examination of color stimulated acoustic emission in the late phase of Levovist (SH U 508A; Schering AG, Berlin, Germany) enhancement is helpful in the discrimination between benign and malignant liver lesions.. Fifty-six patients with focal hepatic lesions were examined. Diagnosis of the lesions was confirmed by liver biopsy, computed tomography, or scintigraphy. Thirty-one patients had malignant liver lesions: hepatocellular carcinoma (n = 14), cholangiocellular carcinoma (n = 1), metastasis (n = 14), and lymphoma (n = 2). Twenty-five patients had benign lesions: focal nodular hyperplasia (n = 8), hepatic adenoma (n = 1), focal hyposteatosis or hypersteatosis (n = 6), hemangioma (n = 7), and regenerative cirrhotic nodules (n = 3). After a delay of 5 to 10 minutes without scanning, the liver was examined by color stimulated acoustic emission with a fast sweep of 1 to 3 seconds.. All patients with homogeneous color stimulated acoustic emission in the late phase of Levovist enhancement had benign liver lesions (P < .001; specificity, 100%; sensitivity, 68%; positive predictive value, 100%; and negative predictive value, 79%). Eighty-one percent of the patients with nonenhancing lesions in the late phase surrounded by enhanced liver parenchyma had malignant liver lesions (P < .001; specificity, 72%; sensitivity, 94%; positive predictive value, 81%; and negative predictive value, 90%). Interobserver agreement (weighted kappa value) improved from 0.570 +/- 0.038 for baseline sonography to 0.918 +/- 0.028 for color stimulated acoustic emission sonography. The area under the receiver operating characteristic curves for color stimulated acoustic emission sonography (0.927) was significantly higher than for baseline sonography (0.739; P < .05).. Color stimulated acoustic emission in the late phase of Levovist enhancement has a high specificity and sensitivity for differentiation between benign and malignant focal liver lesions.

Topics: Analysis of Variance; Contrast Media; Diagnosis, Differential; Female; Humans; Image Processing, Computer-Assisted; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Polysaccharides; ROC Curve; Ultrasonography, Doppler

To assess the potential of contrast-enhanced gray scale harmonic sonography in the evaluation of the typical vascular and enhancement patterns of hepatic focal nodular hyperplasia.. Thirteen patients with 13 lesions of hepatic focal nodular hyperplasia underwent contrast-enhanced gray scale harmonic sonography. After the injection of a microbubble contrast agent (SH U 508A), gray scale harmonic sonographic studies using a Coded Harmonic Angio technique were performed with a combination of a period of continuous scanning to assess the vascular pattern (vascular imaging) and interval delay scanning to determine the sequential enhancement pattern (acoustic emission imaging). Each imaging pattern was categorized and analyzed by consensus of 2 experienced radiologists.. In 12 (92%) of 13 lesions, vascular imaging during the arterial phase showed central arteries of a spoked wheel pattern, whereas the remaining lesion had stippled vascularity. On acoustic emission imaging, 11 (85%) of 13 lesions were hyperechoic during the early phase, and the remaining 2 (15%) were isoechoic compared with surrounding parenchyma. Ten (77%) of 13 lesions remained either hyperechoic (5 of 13) or isoechoic (5 of 13) during the delay phase, whereas the remaining 3 lesions (23%) were hypoechoic.. Contrast-enhanced gray scale harmonic sonography showed the typical vascularity of a spoked wheel pattern during the vascular phase and persistent enhancement on serial acoustic emission imaging in most cases of hepatic focal nodular hyperplasia, and thereby it can be a promising technique in noninvasive diagnosis of this entity.

Topics: Adolescent; Adult; Contrast Media; Female; Focal Nodular Hyperplasia; Humans; Image Processing, Computer-Assisted; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Retrospective Studies; Ultrasonography

The aim of this study was to characterize focal hepatic lesions using agent detection imaging and Levovist.. Sixty-five patients (21 male and 44 female; age range, 8-82 years; mean +/- standard deviation, 58.1 +/- 14.5 years) were independently evaluated by two observers in a blinded manner using stored sonographic images. Seventy-five lesions were found: 15 hepatocellular carcinomas, nine focal nodular hyperplasias, two adenomas, 21 hemangiomas, 23 metastases, and five regenerative nodules. Nine patients were excluded (six because of technical failures, three with unproven diagnoses). New high-mechanical-index software was used to reveal power harmonic responses from contrast microbubble destruction. After a venous bolus injection of 4 g of Levovist at a strength of 400 mg/mL, delayed imaging was used to study lesion enhancement in the arterial, portal, and parenchymal phases. Two comparisons were made. The first was between the B-mode image and the first contrast-enhanced image after the flash. The second was between color Doppler sonograms and real-time contrast-enhanced perfusion images.. Contrast-enhanced images after the flash and real-time contrast-enhanced images revealed more information for the characterization of the lesion than did gray-scale and color Doppler images (p < 0.0001, Wilcoxon's signed rank test). Different types of lesions showed statistically significant differences in enhancement during each of the three vascular phases (p < 0.005, Kruskal-Wallis test). Lesions with lower contrast enhancement were metastases and regenerating nodules. Good agreement was present between the two observers; differences were not statistically significant (p > 0.05).. Agent detection imaging with Levovist increased diagnostic confidence in the characterization of focal hepatic lesions as compared with standard sonography.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Contrast Media; Female; Humans; Liver Neoplasms; Male; Middle Aged; Observer Variation; Polysaccharides; Single-Blind Method; Ultrasonography

The aim of this study was to investigate the feasibility of contrast-enhanced US (conE US) in differentiating pyogenic hepatic abscesses (PyHAs) from hypovascular hepatic malignancies. conE US images of 16 PyHAs in 12 patients were evaluated retrospectively and were compared with those of 22 hypovascular hepatic malignancies in 12 patients. The conE US images were obtained at 30, 90, 150 and 270 s after a bolus injection of 4 g of SH U 508A (Levovist, Schering; 300 mg/mL). The images were specifically analyzed for the shape (round or ovoid, lobulating or coalescent according to the complexity), the margin (sharp or ill-defined), and the pattern of contrast agent enhancement of the lesion (internal and rim enhancement). In our experience, as to the shape of the lesion, PyHAs were usually coalescent (94%), and hepatic malignancies were more frequently round or ovoid (36%) or lobulating (50%) (p < 0.0001). The margin of the lesion was usually sharp in PyHAs (81%), whereas it was more commonly ill-defined (59%) in hepatic malignancies (p = 0.02). Whereas PYHAs usually produced no internal enhancement (94%), diffuse (73%) or peripheral (27%) hypoechoic intratumoral enhancement was seen in hepatic malignancies (p < 0.0001). This study shows that conE US is potentially useful in differentiation of PyHAs from hypovascular hepatic malignancies. PyHAs usually produce characteristic features, such as coalescent appearance, sharp boundary of necrotic cavity, and lack of internal enhancement on conE US.

Topics: Adult; Aged; Contrast Media; Diagnosis, Differential; Feasibility Studies; Female; Humans; Liver Abscess; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Retrospective Studies; Ultrasonography

To assess the value of combined conventional and contrast-material enhanced sonography for the characterization of focal liver lesions.. Simultaneous imaging with grey scale and contrast enhanced US was performed in 90 patients following Levovist injection (Schering, Berlin, Germany) using the "Agent Detection Imaging" method (ADI, Siemens-Acuson, Mountain View, USA). US scanning was performed at least 4 minutes after contrast injection with review of both grayscale and contrast enhanced modes. Results for detection and characterization of lesions were compared to the selected gold standard imaging modality (CT or MRI).. Final diagnoses included: 20 normal examinations, 41 patients with metastases, 6 patients with hepatocellular carcinoma, 13 patients with hemangioma, 6 patients with other benign lesions, 4 patients with cysts and 6 patients with two types of lesions. Delayed phase contrast enhanced US allowed diagnosis of all lesions except for one metastasis and all hepatocellular carcinomas. While the diagnosis of hepatoma could not be confirmed, the features suggested a malignant etiology. For 7 patients with metastases, more lesions were detected at ADI (4.9 lesions) than at conventional US (1.1 lesion). For 3 patients, CT showed more lesions than ADI US (3.3 versus 1.6 lesions). The accuracy of ADI US for differentiating between benign and malignant lesions was 98.7% compared to 49.6% for conventional US (p<0.001). The total number of lesions detected at ADI US was higher (p<0.01) than at conventional US and not significantly different from that obtained by the gold standard reference methods. Complete characterization was achieved in 92.2% of cases with ADI US compared to 59.2% with conventional US (p<0.001).. Contrast-material enhanced US combined with conventional US markedly improves the diagnostic accuracy of US in terms of lesion detection and characterization.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Cysts; Diagnosis, Differential; Female; Hemangioma; Humans; Image Enhancement; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Polysaccharides; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography, Doppler; Ultrasonography, Doppler, Color

The newly developed contrast-enhanced harmonic gray-scale sonography technique enables us to improve the real-time detectability of viable tumor tissue in hepatocellular carcinoma lesions. We evaluated the usefulness of real-time percutaneous ablation therapy under guidance with this method for patients with hepatocellular carcinoma that is not depicted on conventional sonography.. We examined 30 patients with 56 hepatocellular carcinomas using real-time contrast-enhanced harmonic gray-scale sonography after injection of a galactose-palmitic acid contrast agent and compared the results with the findings of contrast-enhanced helical CT. We performed percutaneous ablation therapy guided by this modality for treatment of viable hepatocellular carcinoma lesions that could not be detected using conventional sonography.. High detection rates of viable hepatocellular carcinoma lesions were obtained using real-time contrast-enhanced harmonic gray-scale sonography (52/56 lesions, 93%); these rates were comparable to those of helical CT (54/56 lesions, 96%). Nine (90%) of the 10 lesions that were not detected on conventional sonography but were depicted on real-time contrast-enhanced harmonic gray-scale sonography (incomplete local treatment, n = 4; small new lesion, n = 6) were successfully treated with percutaneous ablation therapy guided by this method.. Real-time contrast-enhanced harmonic gray-scale sonography improved the sensitivity for the detection of viable hepatocellular carcinoma lesions. Percutaneous ablation therapy guided by this modality may be useful in patients with hypervascular hepatocellular carcinoma lesions that cannot be detected using conventional sonography.

Topics: Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Ethanol; Female; Humans; Injections; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Tomography, Spiral Computed; Ultrasonography, Interventional

This study was designed to evaluate digital subtraction imaging (DSI) with Levovist in the diagnosis of hepatocellular carcinoma (HCC), metastatic hepatocellular carcinoma, and hepatic hemangioma. The subjects in this study were 70 patients with 76 nodules of hepatic tumors (48 nodules in 46 cases of hepatocellular carcinoma, 20 nodules in 16 cases of metastatic hepatocellular carcinoma, and 8 nodules in 8 cases of hepatic hemangioma). Contrast enhancement of tumors acquired in the early, portal, and late phases with DSI were compared to classify the tumors. DSI of HCC showed contrast enhancement of 40 nodules (82.2%). High contrast enhancement in the early phase, which was maintained in the portal phase, changed to images with no contrast enhancement with partial persistence of contrast enhancement in the late phase. DSI of metastatic hepatic carcinomas demonstrated contrast enhancement of tumor of 18 nodules (90%) to a high degree in the early and portal phases, which changed to images with no contrast enhancement in the late phases. DSI of hepatic hemangioma maintained high contrast enhancement on tumor margins of 5 nodules (62.5%) and on the entire tumor of 3 nodules (37.5%) in the early, portal, and late phases. DSI of hepatic tumors (hepatocellular carcinoma, metastatic hepatocellular carcinoma, and hepatic hemangioma) provided characteristic findings of contrast enhancement in the early, portal, and late phases, and contribute to differential diagnosis.

Topics: Aged; Aged, 80 and over; Angiography; Carcinoma; Carcinoma, Hepatocellular; Contrast Media; Female; Hemangioma; Humans; Image Processing, Computer-Assisted; Leiomyosarcoma; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Subtraction Technique; Tomography, X-Ray Computed; Ultrasonography

The aim of this study was to evaluate capabilities of pulse inversion harmonic imaging (PIHI) with Levovist in detection of liver metastases compared with conventional ultrasound (US) and helical CT (HCT). One hundred sixty consecutive patients with known malignancies were evaluated by conventional US, PIHI 2 min (40 patients) or 4 min (120 patients) after Levovist injection and HCT. Conspicuity and number of the identified metastatic lesions were evaluated and assessed by statistical analysis (significance p<0.05). Mean diameter of the smallest identified metastases was computed for conventional US, PIHI and HCT. In cases where PIHI revealed more lesions suspicious for metastases than HCT, intraopertive US with surgical biopsy or 3-6-month US follow-up were performed to confirm diagnosis. Images were stored on magneto-optical disk and evaluated off-line by a dedicated software. Metastases conspicuity was significantly improved on PIHI if compared with conventional US ( p<0.05). In 49 patients all the employed imaging techniques did not reveal any lesion, whereas in the remaining 111 patients, 28 patients revealed more than five metastatic lesions and 83 patients presented from one to five metastatic lesions. In comparison with conventional US, PIHI revealed more metastases in 39/83 (47%), the same number in 44/83 (53%) and a lower number in 0/83 (0%) patients. In comparison with HCT, PIHI revealed more metastases in 10/83 (12%), the same number in 61/83 (74%) and a lower number in 12/83 (14%) patients. Average number +/- SD (standard deviation) of confirmed metastases for patients was 2.21+/-1.6 for conventional US, 3.1+/-2.44 for PIHI and 3.05+/-2.41 for HCT. The difference between PIHI and conventional US was statistically significant ( p<0.0001), whereas the difference between PIHI and HCT was not significant ( p=0.9). The smallest identified metastases presented 3-mm mean diameter on PIHI, 5-mm on HCT and 7-mm on conventional US. PIHI with Levovist is a reliable technique in metastases detection.

Topics: Aged; Aged, 80 and over; Chi-Square Distribution; Cohort Studies; Contrast Media; Female; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Polysaccharides; Probability; Prospective Studies; Sensitivity and Specificity; Statistics, Nonparametric; Tomography, Spiral Computed; Ultrasonography

To compare conventional B-mode ultrasonography (US) alone with the combination of conventional B-mode US and contrast material-enhanced (SHU 508A) late-phase pulse-inversion US for the detection of hepatic metastases by using dual-phase spiral computed tomography (CT) as the standard of reference.. One hundred twenty-three patients underwent conventional US, US in the liver-specific phase of SHU 508A, and single-section spiral CT. US and CT images were assessed by blinded readers. Differences in sensitivity, specificity, and the number and smallest size of metastases at conventional and contrast-enhanced US were compared by using CT as the standard of reference. Lesion conspicuity was assessed objectively (quantitatively) and subjectively by one reader before and after contrast material administration.. In 45 of 80 (56%) patients with metastases, more metastases were seen at contrast-enhanced US than at conventional US. In three of these patients, conventional US images appeared normal. The addition of contrast-enhanced US improved sensitivity for the detection of individual metastases from 71% to 87% (P <.001). On a patient basis, sensitivity improved from 94% to 98% (P =.44), and specificity improved from 60% to 88% (P <.01). Contrast enhancement improved the subjective conspicuity of metastases in 66 of 75 (88%) patients and the objective contrast by a mean of 10.8 dB (P <.001). Contrast-enhanced US showed more metastases than did CT in seven patients, and CT showed more than did contrast-enhanced US in one of 22 patients in whom an independent reference (magnetic resonance imaging, intraoperative US, or pathologic findings) was available.. Contrast-enhanced US improved sensitivity and specificity in the detection of hepatic metastases.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Contrast Media; Female; Humans; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Sensitivity and Specificity; Ultrasonography

The aim of this study was to compare the sensitivity of pulse inversion harmonic digital sonography, unenhanced transabdominal sonography, and ferumoxides-enhanced MR imaging in the depiction of liver metastases. In addition, pulse inversion harmonic digital sonography was performed at different scanning times after Levovist injection to define the best phase for depiction.. Twenty-six consecutive patients with findings of extrahepatic primary malignancies and liver metastases suspected on transabdominal sonography were examined with both pulse inversion harmonic imaging and ferumoxides-enhanced MR imaging within a 7-day period. Pulse inversion harmonic imaging was performed before and at 20, 100, and 180 sec after a bolus injection of Levovist. MR imaging was performed before and after ferumoxides administration, using breath-hold gradient-recalled echo T1-weighted and turbo spin-echo short tau inversion recovery T2-weighted sequences. Two radiologists independently evaluated image quality, and the number, location, and diameter of lesions scanned using both techniques. Intraoperative sonography or at least 8-month follow-up confirmed the lesions depicted. Analyses included Wilcoxon's signed rank test and Interclass correlation test.. Levovist-enhanced pulse inversion harmonic imaging revealed 104 metastases on the first scan after contrast injection, 126 on the second scan, and 118 on the third, compared with 66 on the unenhanced scan. Pulse inversion harmonic digital sonography depicted 90% of lesions shown on ferumoxides-enhanced MR imaging (140 metastases) (p = 0.001).. Levovist-enhanced pulse inversion harmonic digital sonography is a sensitive technique for depiction of liver metastases. Pulse inversion harmonic digital sonography may have a potential role in imaging patients with possible metastatic involvement of the liver. Further studies are needed to define its place in the workup of these patients. At present, ferumoxides-enhanced MR imaging, being more sensitive, must be performed in all patients in whom pulse inversion harmonic digital sonography is not conclusive or when after pulse inversion harmonic digital sonography, patients remain eligible for surgery.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Dextrans; Female; Ferrosoferric Oxide; Humans; Iron; Liver Neoplasms; Magnetic Resonance Imaging; Magnetite Nanoparticles; Male; Middle Aged; Oxides; Polysaccharides; Sensitivity and Specificity

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

This study was performed to evaluate the usefulness of contrast-enhanced coded phase-inversion harmonic sonography in assessing the therapeutic response of percutaneous radiofrequency ablation in patients with hepatocellular carcinoma.. Sixty-seven patients with a total of 107 examinations on 91 hepatocellular carcinoma nodules underwent coded harmonic angio, a technique of coded phase-inversion harmonic sonography, using the IV microbubble contrast agent Levovist before and after percutaneous radiofrequency ablation. The intratumoral blood vessels and tumor parenchymal stain were detected in the early arterial phase and the late vascular phase, respectively. The results of contrast-enhanced imaging with coded harmonic angio were compared with those of three-phase dynamic CT.. Before treatment, all examined 107 hepatocellular carcinoma nodules were found to be hypervascular on contrast-enhanced imaging with coded harmonic angio. After radiofrequency ablation, contrast-enhanced coded harmonic angio detected persistent signal enhancement in 41 examined nodules (38.3%), whereas this technique showed no intratumoral enhancement in the remaining 66 (61.7%) examined nodules. Compared with dynamic CT, the sensitivity, specificity, and diagnostic accuracy of contrast-enhanced coded harmonic angio were 95.3%, 100%, and 98.1%, respectively. With contrast-enhanced coded harmonic angio, we found that it was difficult to identify the safety margin that can be detected on dynamic CT.. Contrast-enhanced imaging with coded harmonic angio may provide an alternative approach that has high diagnostic agreement with dynamic CT in assessing the therapeutic effect of radiofrequency ablation in hypervascular hepatocellular carcinomas, in spite of having limitations in identifying the safety margin.

Topics: Aged; Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Female; Humans; Liver Neoplasms; Male; Polysaccharides; Predictive Value of Tests; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography

We evaluated the usefulness of contrast-enhanced harmonic wideband gray-scale sonography in the assessment of the therapeutic effects of transcatheter arterial chemoembolization in patients with hepatocellular carcinoma and compared the performance of this imaging modality with the histologic findings for the patients.. Twenty-nine patients with 29 hepatocellular carcinoma lesions were examined. Tumor vascularity was evaluated before and 7 days after transcatheter arterial chemoembolization with contrast-enhanced harmonic wideband gray-scale sonography performed after injection of the contrast agent Levovist. Several biopsy specimens were obtained from the evaluated lesions, and the histologic findings were compared with the results of contrast-enhanced sonography.. Contrast-enhanced harmonic wideband gray-scale sonography performed after transcatheter arterial chemoembolization showed tumor vascularity in 16 of the 29 lesions, but none in the other 13 lesions. At histologic examination, 13 of the 16 lesions with tumor vascularity had residual tumor revealed, and the 13 lesions without tumor vascularity were found to have no histologically evident tumor residue, although three of these lesions showed tumor progression detected on CT during a 9- to 12-month follow-up period. Contrast-enhanced harmonic wideband gray-scale sonographic images were compared with the histologic findings as the gold standard, and the sensitivity and specificity of these images for discerning viable and nonviable hepatocellular carcinoma after transcatheter arterial chemoembolization were 100% and 81%, respectively.. Contrast-enhanced harmonic wideband gray-scale sonography is potentially useful for evaluating the therapeutic effects of transcatheter arterial chemoembolization on hepatocellular carcinoma.

Topics: Aged; Biopsy; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Contrast Media; Female; Humans; Liver; Liver Neoplasms; Male; Neoplasm, Residual; Polysaccharides; Sensitivity and Specificity; Ultrasonography

Topics: Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Germany; Humans; Image Enhancement; Image Processing, Computer-Assisted; Liver; Liver Diseases; Liver Neoplasms; Phospholipids; Polysaccharides; Quality Assurance, Health Care; Sensitivity and Specificity; Sulfur Hexafluoride; Ultrasonography

To characterize enhancement patterns of focal hepatic lesions using C-cube gray scale sonography with a microbubble contrast agent and to evaluate its usefulness in differential diagnosis of hepatic lesions.. Fifty-four patients with 58 focal hepatic lesions were examined with Levovist-enhanced C-cube gray scale sonography. The final diagnosis of hepatic lesions was 29 primary liver cancers, 4 metastases, 8 hemangiomas, 12 focal nodular hyperplasias, 2 inflammatory pseudotumors of the liver and 3 angiomyolipomas. The initiation time of enhancement in various lesions and enhancement duration after administration of contrast agent were compared. Vascular findings in lesions were classified as peripheral enhancement, homogenous enhancement, mosaic enhancement and no enhancement depending on microbubble signals in the lesion relative to the liver parenchyma.. The initiation time of enhancement in hemangioma (48+/-12 s) was significantly later compared to other lesions (P<0.05). The enhancement duration of malignancies (69+/-33 s in primary liver cancer, 61+/-23 s in metastasis) was significantly shorter compared to benign lesions (P<0.05). Intranodular enhancement appearing at arterial phase and decreasing at portal venous phase was considered characteristic for malignancy. Intranodular enhancement did not appear earlier than the liver parenchyma, and peripheral enhancement pattern was regarded as positive findings for hemangioma. Intranodular enhancement appeared in the arterial phase, and homogenous enhancement pattern sustained in the whole portal venous phase were regarded as positive findings for focal nodular hyperplasia. No microbubble signals appeared in two inflammatory pseudotumors of the liver.. C-cube gray scale sonography can demonstrate dynamic intranodular enhancement in various focal hepatic lesions. The information provided by this methodology may be useful in the differential diagnosis of hepatic lesions.

Topics: Adult; Aged; Contrast Media; Diagnosis, Differential; Female; Humans; Liver; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography

Usefulness of Levovist contrast ultrasonography by the B-Flow method was evaluated in cases of hepatic tumor. Subjects included 14 patients with moderately differentiated hepatocellular carcinoma and 4 patients with hepatic hemangioma. Each patients had a single tumor mass. Images showed strong staining in 11 of the 14 nodes in the hepatocellular carcinomas and all 4 hemangiomas. Staining was seen only in lesions located within 4 cm of the probe. Thus B-Flow ultrasonography using Levovist was proved useful for evaluating vascularity of superficially located.

Topics: Adult; Aged; Aged, 80 and over; Female; Hemangioma; Humans; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography

To evaluate the hemodynamic features of hepatocellular carcinoma on single-level dynamic ultrasonography during the arterial phase.. Twenty-two hepatocellular carcinomas were examined by single-level dynamic ultrasonography with high transmit intensity and SH U 508A. The scans were performed for 40 seconds with a 1-second interval between each ultrasound transmission and with individual optimization of the scan delay time. The times of initiation of enhancement for both the hepatic artery and the tumor and the time of maximal enhancement for the tumor were recorded, and the mean echo values at every second for the tumor and hepatic parenchyma were measured.. Twelve tumors showed hyperechoic enhancement compared with hepatic parenchyma throughout the scans. The other 10 showed hyperechoic enhancement during some segments (range, 8-34 seconds) and either isoechoic (n = 5) or hypoechoic (n = 5) enhancement during the remaining parts; the hyperechoic segments were often short (< 20 seconds, 14%). Although the times for initiation of enhancement for the hepatic artery and hepatocellular carcinoma and the time of maximal enhancement for the tumor varied, the tumor usually initiated enhancement immediately after the hepatic artery (r = 0.986; P = .000001). The interval between the time of initiation of enhancement for the tumor or hepatic artery and that of maximal enhancement for the tumor was significantly correlated with the tumor size (r = 0.700; P = .008; and r = 0.780; P = .002).. With individual optimization of the scan delay time, single-level dynamic ultrasonography is useful for depicting the hypervascularity of hepatocellular carcinoma during the arterial phase.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Hepatic Artery; Humans; Liver Neoplasms; Male; Middle Aged; Neovascularization, Pathologic; Polysaccharides; Ultrasonography

To assess the value of SH U 508A-enhanced agent detection imaging in the characterization of focal hepatic lesions.. Contrast-enhanced agent detection imaging was performed on 78 focal hepatic lesions: 34 hepatocellular carcinomas, 22 metastases, 9 hemangiomas, 9 abscesses, 3 cysts, and 1 focal nodular hyperplasia. After administration of SH U 508A, interval delay scanning with agent detection imaging was performed with intervals of approximately 7 seconds (phase I), 30 seconds (phase II), and 90 seconds (phase III) after the first arrival of the contrast agent to the liver. Two observers blinded to the final diagnosis reviewed selected images and assessed the enhancement patterns of the lesions. For quantitative analysis, we calculated the enhancement ratio of the lesions and the difference of enhancement between the lesions and the liver parenchyma.. Agent detection imaging showed a distinctive enhancement pattern in focal liver lesions compared with that in the liver. Hepatocellular carcinomas were characterized by early enhancement (phase I) and washout (phases II and III; sensitivity, 94.1%; specificity, 93.2%; positive predictive value, 91.4%). Metastases showed peripheral rim or targetlike enhancement (phase I, phase II, or both) and a defect (phase III) and had sensitivity of 77.3%, specificity of 100%, and a positive predictive value of 100%. Hemangiomas showed peripheral nodular or inhomogeneous (phase I, phase II, or both) and gradually centripetal (phase II, phase III, or both) enhancement (sensitivity, 88.9%; specificity, 100%; positive predictive value, 100%). Abscesses were partially enhanced from phase I to phase III (sensitivity, 66.7%; specificity, 95%; positive predictive value, 85.7%). The results of the quantitative analysis of lesion enhancement were compatible with those of the qualitative analysis.. SH U 508A-enhanced agent detection imaging may yield distinctive enhancement characteristics in focal liver lesions that would contribute positively to the characterization of these hepatic lesions.

Topics: Adult; Aged; Aged, 80 and over; Analysis of Variance; Carcinoma, Hepatocellular; Contrast Media; Cysts; Female; Focal Nodular Hyperplasia; Hemangioma; Humans; Image Enhancement; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Ultrasonography

To assess the usefulness of microbubble contrast-enhanced agent detection imaging in evaluating the therapeutic response of malignant hepatic masses to treatment with interventional procedures.. Fifty-eight patients with 68 hepatocellular carcinomas and 6 metastases who were treated with interventional procedures were evaluated with SH U 508A-enhanced agent detection imaging and helical computed tomography. Helical computed tomography was also performed to help establish the outcome of therapy with unenhanced computed tomography 2 weeks after transcatheter arterial chemoembolization and with dynamic contrast-enhanced computed tomography 1 day after radio frequency ablation or percutaneous ethanol injection. The studies were reviewed separately and randomly, and the sensitivity and specificity of agent detection imaging for detection of viable tumor residue were determined by follow-up imaging performed at least 3 months later.. Follow-up computed tomography or magnetic resonance imaging revealed complete tumor responses in 44 (59.5%) of 74 cases after the therapeutic procedures. The sensitivity of agent detection imaging was 94.7% after transcatheter arterial chemoembolization and 72.7% after radio frequency ablation and percutaneous ethanol injection. The specificity of agent detection imaging for the detection of residual tumors was 80% after transcatheter arterial chemoembolization and 79.2% after radio frequency ablation and percutaneous ethanol injection. The false-positive rate for agent detection imaging in cases of radio frequency ablation or percutaneous ethanol injection was 20.8% (5 of 24), resulting from reactive hyperemia or vascularity within the safety margin. In the assessment of the therapeutic effects, the concordance of contrast-enhanced agent detection imaging with helical computed tomography was statistically significant after transcatheter arterial chemoembolization (P < .00001) and radio frequency ablation or percutaneous ethanol injection (P < .02).. Contrast-enhanced agent detection imaging proved useful and as effective as helical computed tomography for evaluating the therapeutic effects of interventional therapeutic procedures for malignant hepatic masses.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Catheter Ablation; Chemoembolization, Therapeutic; Contrast Media; Ethanol; Female; Humans; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Sensitivity and Specificity; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Interventional

To describe the enhancement patterns of atypical hepatic haemangiomas with Pulse Inversion Harmonic Imaging (PIHI) using SH U 508A (Levovist).. Twenty-five patients (15 women, 10 men; age range: 29-65 years, mean: 48.2 years) with 28 hepatic haemangiomas (size: 1.5 - 11.5 cm; mean: 4.6 cm) underwent PIHI before and after i.v. administration of Levovist. Selected images obtained at baseline and 25-30s, 55-60s and 240s after Levovist injection were sequentially reviewed to determine the changes in echogenicity of haemangiomas in comparison to surrounding liver parenchyma.. At the baseline US study, 22/28 (79%) haemangiomas revealed highly inhomogeneous echotexture; 5/28 (18%) were homogeneously hypoechoic and 1/28 (3%) was isoechoic with respect to hepatic parenchyma. After Levovist administration, 16/28 (57%) haemangiomas showed peripheral hyperechoic nodules in the arterial phase with progressive centripetal fill-in in portal and late phases; such fill-in was complete in 14/16 cases and incomplete in 2/16. Four of twenty-eight (14%) haemangiomas revealed a rapid and complete homogeneous fill-in on arterial phase that lasted throughout the portal and late phases. Finally, 8/28 (29%) showed a rim-like enhancement with progressive and complete centripetal fill-in on portal and late phases.. According to our results, PIHI with Levovist allows demonstration of typical enhancement patterns in most of atypical haemangiomas, thus providing useful diagnostic information for their characterization.

Topics: Adult; Aged; Contrast Media; Female; Hemangioma; Humans; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography

To evaluate the utility of gray scale harmonic ultrasonography with a microbubble contrast agent in the early assessment of the therapeutic response to radio frequency ablation for hepatocellular carcinoma.. Seventy-five patients with 81 nodular hepatocellular carcinomas (1.3-4.8 cm) treated with percutaneous radio frequency ablation were evaluated with contrast-enhanced gray scale harmonic ultrasonography after intravenous bolus injection of a galactose-based microbubble contrast agent. The vascularity within the ablation zones was evaluated with a continuous scan for 3 to 5 seconds between 15 and 30 seconds after initiation of contrast agent injection. To evaluate the perfusion of the ablation zones, intermittent stimulated acoustic emission imaging was performed with a rapid sweeping technique from the end of the continuous scan. All patients underwent follow-up 3-phase helical computed tomography at 1 month after radio frequency ablation and were followed for at least 1 year. The results of contrast-enhanced ultrasonography were compared with those of follow-up computed tomography in terms of the presence or absence of residual unablated tumors.. In 10 (12%) of the 81 treated hepatocellular carcinomas, contrast-enhanced ultrasonography showed either nodular or crescentic enhancing foci at the margins of ablation zones, suggesting residual unablated tumors. Contrast-enhanced computed tomography obtained 1 month after radio frequency ablation confirmed the residual unablated tumors in the same 10 lesions. Diagnostic agreement between 1-month follow-up computed tomography and contrast-enhanced ultrasonography was achieved in all 81 cases (100%).. Contrast-enhanced gray scale harmonic ultrasonography can be a reliable alternative to contrast-enhanced computed tomography in the early assessment of the therapeutic response to radio frequency ablation for hepatocellular carcinoma.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Female; Humans; Liver Neoplasms; Male; Microspheres; Middle Aged; Polysaccharides; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography

Topics: Contrast Media; Diagnosis, Differential; Humans; Image Processing, Computer-Assisted; Liver Neoplasms; Polysaccharides; Sensitivity and Specificity; Ultrasonography

Topics: Antineoplastic Agents; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Contrast Media; Female; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Polysaccharides; Treatment Outcome; Ultrasonography, Doppler

To describe our experience with percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography with Levovist (SH U 508A; Nihon Schering, Osaka, Japan) for hepatocellular carcinoma after transcatheter arterial infusion.. Twenty patients (17 men and 3 women; mean age, 58.4 years) with 23 hepatocellular carcinoma nodules (mean +/- SD, 2.7 +/- 1.5 cm) underwent percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography 1 week after transcatheter arterial infusion. Therapeutic effects were assessed by contrast-enhanced computed tomography and posttreatment fine-needle biopsy. This study was performed on a prospective basis.. After the transcatheter arterial infusion, contrast-enhanced color Doppler sonography showed intense intratumoral color signals in all 23 hepatocellular carcinomas. After the percutaneous ethanol injection, contrast-enhanced color Doppler sonography, fine-needle biopsy, and contrast-enhanced computed tomography showed no color signals, no viable tumor tissues, and no enhancement in any of the 23 hepatocellular carcinomas. Three to 5 (mean, 3.3) percutaneous ethanol injection sessions with a 5.2- to 15.6-mL (mean, 12.8-mL) total volume of ethanol per tumor were required for complete disappearance of color signals on contrast-enhanced color Doppler sonography.. Percutaneous ethanol injection under real-time contrast-enhanced color Doppler sonography has considerable efficacy in treating hepatocellular carcinoma.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Ethanol; Female; Humans; Image Enhancement; Infusions, Intra-Arterial; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Prospective Studies; Ultrasonography, Doppler, Color

The aim of this study was to determine the histopathologic grades of hepatocellular carcinomas (HCCs) on the basis of the presence of Kupffer cells, using color Doppler sonography with the liver-specific microbubble contrast agent Levovist.. Color Doppler sonograms generated by stimulated acoustic emission were obtained 7 minutes after intravenous injection of 5 ml of Levovist (300 mg/dl) in patients with histopathologically confirmed HCCs. CT scans were also obtained and evaluated, and hematoxylin and eosin staining for morphologic examination and immunostaining (anti-CD68) for detecting Kupffer cells were performed for confirmation of the sonographic findings.. Eighteen tumors had a defect in the color Doppler signal (color void) that corresponded with the baseline gray-scale image of the tumor. On histopathologic examination, these 18 tumors were all found to be either poorly or moderately differentiated HCCs with either a marked reduction in the number of or the absence of Kupffer cells. The remaining 2 tumors showed color signals. Histopathologic examination of these 2 tumors disclosed well-differentiated components within the tumors, with Kupffer cells in the tumor tissue.. Color Doppler sonography using a liver-specific microbubble ultrasound contrast agent appears to reflect the histopathologic features of HCCs and may thus be useful for differentiating liver tumors and determining a treatment strategy.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Humans; Immunosorbent Techniques; Kupffer Cells; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography, Doppler, Color

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Fatal Outcome; Humans; Liver Neoplasms; Male; Polysaccharides; Rupture, Spontaneous; Ultrasonography, Doppler, Color

We assessed the ability of contrast-enhanced sonography to reveal differences between benign and malignant focal hepatic lesions.. We examined 67 patients with focal hepatic lesions in a prospective study. The causes of the lesions were confirmed by histology, CT, MR imaging, or scintigraphy. The liver was screened for focal lesions using sonography. Thereafter, 2 g of Levovist (300 mg/mL; 1 mL/sec) was injected IV as a bolus. After a delay of at least 2.5 min without scanning, the liver was examined via three different scans using pulse-inversion sonography.. For the discrimination of malignant versus benign liver lesions, contrast-enhanced sonography improved sensitivity from 85% to 100% and specificity from 30% to 63%, as compared with baseline sonography. Receiver operating characteristic analysis revealed a significant improvement in this discrimination (A(z) = 0.692 +/- 0.065 at baseline sonography, A(z) = 0.947 +/- 0.037 with contrast-enhanced sonography, p < 0.001). Furthermore, a lower interobserver variability was found for contrast-enhanced sonography (weighted kappa = 0.947), as compared with baseline sonography (weighted kappa = 0.469). All lesions that had homogeneous enhancement in the late phase of Levovist enhancement were benign. In distinction, 90% of lesions without contrast enhancement in the late phase were malignant. All lesions were malignant that were isoechoic (invisible) on baseline sonography but visible because of lack of enhancement after injection.. Contrast-enhanced sonography has greater specificity and sensitivity than baseline sonography for the differentiation of benign and malignant liver lesions.

Topics: Adult; Aged; Contrast Media; Diagnosis, Differential; Female; Humans; Image Processing, Computer-Assisted; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Prospective Studies; ROC Curve; Sensitivity and Specificity; Ultrasonography, Doppler, Color

To evaluate the capability of contrast-enhanced wideband harmonic imaging (WHI) to detect liver metastases in comparison with fundamental B-mode US and postcontrast CT.. We studied 27 patients with hepatic metastases from different malignancies with conventional B-mode sonography, WHI 3 min after injection of contrast agent (Levovist(R) 2.5 g, 300 mg/ml) and postcontrast helical CT (HCT). The number and location of the lesions and the smallest lesion for each patient were noted by two different observers and compared.. Both readers recorded an increase in the number of lesions in harmonic mode compared with conventional B-mode in all 27 patients with hepatic metastases with a mean increase in both observers from 9.3 lesions with B-mode to 18.8 lesions with WHI. The smallest lesions were detected with WHI when compared with conventional US and HCT (2 mm with WHI, 5 mm with B-mode and 5 mm with CT). WHI detected more lesions than conventional US or HCT.. Contrast-enhanced WHI seems superior to conventional US and HCT for the detection of hepatic metastases, specially for those nodules under 1 cm of diameter.

Topics: Adult; Aged; Breast Neoplasms; Colonic Neoplasms; Contrast Media; Female; Humans; Image Enhancement; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Sensitivity and Specificity; Tomography, Spiral Computed; Ultrasonography

To evaluate the capabilities of Pulse Inversion Harmonic Imaging (PIHI) with hepatospecific US contrast agent Levovist in the characterization of focal liver lesions in cirrhotic patients.. Thirty-nine focal hepatic lesions in 25 consecutive cirrhotic patients identified by conventional ultrasound (US), were evaluated by color Doppler (CD), power Doppler (PD) with spectral analysis of tumoural vessels and PIHI. PIHI was performed 30 seconds (vascular phase) and 3-5 minutes (late phase) after Levovist injection. To definitely characterize the evaluated focal hepatic lesions, helical-CT (HCT) enhancement patterns (15 patients) and/or surgical/bioptic histologic findings (10 patients) were considered as reference procedures.. Thirty focal hepatic lesions classified as hepatocellular carcinoma (HCC) by reference procedures appeared hypoechoic (n=19), isoechoic (n=5) or hyperechoic (n=6) on conventional US, with basket arterial pattern (n=10), vessels within the tumor (n=6), peripheral arterial pattern (n=4) or no vascular pattern (n=10) on CD/PD evaluation. On PIHI they appeared hyperechoic (n=26) or isoechoic (n=4) in the vascular phase, if compared to the surrounding liver parenchyma, and hypoechoic (n=23) or isoechoic (n=7) in the late phase. Four focal hepatic lesions classified as regenerative nodules (RNs) by reference procedures appeared hypoechoic on conventional US, with peripheral venous/arterial pattern (n=1) or no vascular pattern (n=3) on CD/PD. On PIHI they appeared hypoechoic (n=3) or isoechoic (n=1) in the vascular phase, remaining prevalently hypoechoic (n=3) or isoechoic (n=1) in the late phase. Five focal hepatic lesions classified as hemangioma by reference procedures appeared hyperechoic (n=4) or hypoechoic (n=1) on conventional US with few peripheral venous vessels on CD/PD. On PIHI they revealed progressive fill-in from the periphery toward the centre during the vascular and late phase after Levovist injection.. PIHI seems to be a reliable technique to characterize focal lesions in cirrhotic patients.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Hemangioma; Humans; Liver; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography, Doppler, Color

To evaluate the role of SH U 508A-enhanced ultrasonography (US) in the differentiation of focal hepatic masses.. Contrast material-enhanced pulse inversion US was performed on 58 unknown hepatic lesions: 23 hepatocellular carcinomas, 10 focal nodular hyperplasias, 16 hemangiomas, and nine metastases. Selected images were sequentially reviewed by readers blinded to the final diagnosis. On a baseline image, they determined lesion echogenicity, and on a vascular image, the presence or absence of distinct vascularity. On an arterial phase interval-delay flash image and a postvascular image, they assessed enhancement of the lesion and liver. Responses were compared with confirmed diagnoses.. Focal nodular hyperplasia was characterized by detectable vascularity and positive enhancement on interval-delay and postvascular scans (sensitivity, 83% [eight of 10 lesions]; specificity, 98% [40 of 41 lesions]). Hepatocellular carcinoma also showed detectable vascularity and positive enhancement on interval-delay images but no postvascular enhancement (sensitivity, 68% [14 of 20 lesions]; specificity, 74% [23 of 31 lesions]). Vascular imaging with SH U 508A did not contribute to the diagnosis of metastasis or hemangioma. However, no or weak enhancement during the arterial phase flash without postvascular enhancement produced a sensitivity of 83% (seven of eight lesions) and sensitivity of 77% (33 of 43 lesions) for metastasis. Peripheral nodular enhancement on arterial phase flash images was highly specific (98% [37 of 38 lesions]) but not sensitive (44% [six of 13 lesions]) for hemangioma.. SH U 508A-enhanced pulse-inversion interval-delay flash and postvascular phase imaging are helpful in differential diagnosis of focal hepatic lesions.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Hemangioma; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Sensitivity and Specificity; Ultrasonography

To evaluate the pattern of contrast enhancement with Levovist on coded harmonic angiographic ultrasonography of hepatic hemangiomas.. Twenty hemangiomas were evaluated with coded harmonic angiographic ultrasonography and a microbubble contrast agent. Verification of the diagnosis of a hemangioma was made by means of dynamic computed tomography (n = 8), dynamic magnetic resonance imaging (n = 1), radionuclide scanning (n = 6), or follow-up ultrasonography (n = 5). Ultrasonographic images were obtained before contrast agent administration and with a bolus injection of 2.5 g of a microbubble contrast agent (300 mg/mL Levovist; Schering AG, Berlin, Germany) every 10 to 15 seconds for 5 minutes. The contrast enhancement patterns of the 20 hemangiomas were assessed.. The tumor diameters as measured on ultrasonography were 7 to 97 mm (mean, 26.7 mm). Of the 20 hemangiomas, peripheral globular enhancement with progressive centripetal fill-in was shown in 15 (75%), rimlike enhancement with progressive centripetal fill-in was shown in 2 (10%), and homogeneous enhancement was shown in 1 (5%). In the remaining 2 lesions (10%), the enhancement patterns could not be seen, because they were not found on coded harmonic angiographic ultrasonography.. Coded harmonic angiographic ultrasonography with a microbubble contrast agent can depict the typical enhancement pattern in most hepatic hemangiomas.

Topics: Contrast Media; Female; Hemangioma; Humans; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography

The purpose of this study was to investigate whether late-phase pulse inversion harmonic imaging (PIHI) increases conspicuity in hepatic masses, helps to differentiate benign from malignant lesions, and demonstrates a greater number of and smaller metastatic lesions than do conventional (fundamental) sonography and helical CT.. Thirty patients (17 women and 13 men; age range, 35-77 years; mean age, 54 years) with known or suspected liver masses were evaluated using both fundamental sonography and contrast-enhanced PIHI during the liver-specific late phase of Levovist. The patients also underwent contrast-enhanced triphasic helical CT examinations within 1 week after sonography. In 4 of the patients, gadolinium-enhanced MRI was also performed as a part of their clinical work-up.. The increase in the lesions' conspicuity on PIHI compared with fundamental sonography was significantly greater in malignant lesions than in benign lesions (p< 0.001). An echogenic rim was observed on PIHI in 8 (53%) of 15 malignant lesions. The mean number of metastatic lesions visualized on PIHI (5.5 +/- 5.3) was significantly higher than the mean number visualized on fundamental sonography (2.5 +/- 2.1, p < 0.05). Although lesions as small as 3 mm were observed on PIHI, the mean sizes of the smallest lesions demonstrated using fundamental sonography, PIHI, and helical CT were not significantly different.. Late-phase PIHI is a useful technique for characterizing hepatic lesions and demonstrating both a greater number of and smaller metastases. It may help to differentiate benign from malignant liver masses and may obviate unnecessary and expensive further imaging.

Topics: Adult; Aged; Contrast Media; Diagnosis, Differential; Female; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Polysaccharides; Prospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography

We evaluated the usefulness of contrast-enhanced, wide-band harmonic gray scale imaging for the diagnosis of hepatocellular carcinoma and compared it with helical computed tomography. Forty-eight patients with 61 hepatocellular carcinoma lesions were scanned by contrast-enhanced, wide-band harmonic gray scale imaging after an intravenous bolus injection of the contrast agent Levovist. Fifty-seven of the 61 hepatocellular carcinoma lesions showed hypervascular enhancement, and intratumoral vessels could be observed in 40 of the 57 lesions. Helical computed tomography revealed a high-attenuation area in 54 of the 61 lesions, whereas the other lesions showed an equivocal-attenuation area. Contrast-enhanced, wide-band harmonic gray scale imaging is a useful method for diagnosing the vascularity of hepatocellular carcinoma.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Female; Humans; Image Enhancement; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Tomography, X-Ray Computed; Ultrasonography

Our objective was to assess the usefulness of contrast-enhanced subtraction harmonic sonography in evaluating the treatment response of patients with hepatocellular carcinoma.. Thirty-two hepatocellular carcinoma lesions in 26 patients (age range, 44-85 years; mean age, 66 years) were examined with Levovist-enhanced intermittent harmonic imaging before and after therapy. A Toshiba Powervision 8000 was used. A subtraction image was obtained by digitally subtracting the last-frame harmonic image from the first-frame image when multishot mode was preset. Results of contrast-enhanced CT were compared with the results of subtraction harmonic imaging.. Before therapy, an enhancement pattern of tumor vascularity was seen for 93.8% (30/32) of hepatocellular carcinoma nodules on subtraction harmonic imaging. After therapy, subtraction harmonic imaging showed 46.7% (14/30) enhancement (incomplete tumor necrosis) and 53.3% (16/30) no enhancement (complete tumor necrosis). When dynamic CT was the gold standard, the sensitivity, specificity, and accuracy of subtraction harmonic imaging were 93.3%, 100%, and 96.7%, respectively. Intratumoral flow signals in hepatocellular carcinoma after therapy on harmonic imaging were used as a guide to target additional percutaneous therapy.. Digital subtraction contrast-enhanced harmonic imaging can depict tumor vascularity in hepatocellular carcinoma after therapy sensitively and accurately. Because it is easy to perform and provides real-time needle insertion guidance, it may be preferable to perform after localized therapy to monitor treatment response, which will reduce unnecessary CT scanning.

Topics: Aged; Antibiotics, Antineoplastic; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Contrast Media; Epirubicin; Female; Humans; Liver Neoplasms; Male; Polysaccharides; Sensitivity and Specificity; Subtraction Technique; Tomography, X-Ray Computed; Ultrasonography

To assess the therapeutic effect of percutaneous ethanol injection on small hepatocellular carcinoma by using a flash echo imaging system, a newly developed technique for detecting echoes from microbubble contrast agents more efficiently.. Six patients with 7 small nodular hepatocellular carcinomas, proved by fine-needle aspiration cytologic or pathologic examination, were included. Percutaneous ethanol injection was performed until there was no intratumoral color signal on conventional color and power Doppler ultrasonography. A bubble contrast agent was then injected, and flash echo imaging in the subtraction mode was performed for assessment of the therapeutic effect. Dynamic computed tomography, magnetic resonance imaging, and hepatic angiography were also used for evaluation of the therapeutic effect.. Five tumors had perfusion defects that were equal in size to or larger than the tumors. No tumor stain was shown on hepatic angiography. Two tumors had partial perfusion defects. Viable tumors were confirmed by tumor resection in 1 case and cytologic examination in the other.. Our preliminary results show that flash echo imaging with subtraction has potential value in evaluation of the therapeutic effect of percutaneous ethanol injection on small hepatocellular carcinoma.

Topics: Adult; Aged; Biopsy, Needle; Carcinoma, Hepatocellular; Contrast Media; Ethanol; Female; Humans; Image Enhancement; Injections, Intralesional; Liver Neoplasms; Male; Microspheres; Middle Aged; Polysaccharides; Treatment Outcome; Ultrasonography, Doppler

To evaluate if Pulse Inversion Harmonic Imaging with contrast agent injection (Levovist) is able to determine an increase of echogenicity in normal hepatic parenchyma, and to compare its capability to detect metastatic focal lesions with that of standard US and spiral CT. To define and standardize the technical and methodological aspects of this new technique.. A selected group of 72 patients (42 males and 30 females) with clinical and instrumental suspect of hepatic metastatic lesions was included in the prospective study. Each patient was examined by conventional ultrasound (US), Pulse Inversion Harmonic Imaging (PI) and spiral-CT (spCT). US examination was performed using an HDI 5000 (ATL, Bothell, USA) equipped with a broadband probe (5.0-2.0 MHz). 2.5 g Levovist (Schering AG-Berlin) was administered intravenously, at concentration of 300 mg/ml and a flow rate of 7 ml/min. Video clips obtained with the acquired images before and after contrast medium administration were transferred to a magnet optic disk unit. Examinations were evaluated by an experienced radiologist blindly on a workstation that allowed a qualitative-quantitative analysis. SpCT images were evaluated separately by another experienced radiologist. US images were evaluated qualitatively (number of lesions, site of lesion, diameter of the smallest lesion detectable) and quantitatively (increase in parenchymal echogenicity 20", 40", 60" and 5' after the injection of contrast agent).. In all cases examined, the echogenicity of normal hepatic parenchyma increased after contrast agent administration, reaching a peak of about 250% (1DS) at 60 s and a decreasing gradually in 5 minutes. Conventional US detected 195 focal lesions, CT 231, and US with pulse inversion technique and contrast agent (US-PI) 287. Mean differences among the number of lesions detected by the different techniques per each patient were also calculated. Wilcoxon Signed Rank Test showed a statistically significant difference between US-PI and US (p < .0001), CT and US (p = .0052) and US-PI and CT (p = .0121). US-PI detected the smallest lesions, which went undetected by the CT and conventional US examinations.. In 10 cases (14.3%) contrast enhanced US-PI demonstrated the presence of a number of lesions greater than 5 (diffuse metastatization and inoperability) in comparison to that detected by spCT). The greater echogenicity of normal hepatic parenchyma using pulse inversion technique after Levovist infusion allowed to better demonstrate hepatic metastases. This technique showed a higher identification rate of small lesions in comparison to basal examination and to spiral CT. Contrast enhanced US-PI demonstrated a remarkable increase in echogenicity of hepatic parenchyma in portal phase. The technique significantly improves the detection of focal lesions allowing visualization of smaller lesions compared to CT and US. These results indicate that the technique could be used in the staging of liver metastasis. However, large multicentric trials are required to validate US-PI and better define its role in the work-up of patients with neoplastic disorder.

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

The aim of this study was to ascertain whether a new ultrasound technique, namely pulse inversion imaging, could assess the arrival of a contrast agent in the hepatic veins, and to describe possible advantages of this procedure in determining transit time over a previously described method based upon spectral Doppler quantification. 15 subjects were scanned using pulse inversion imaging. A bolus injection of 2.5 g Levovist (Schering AG, Berlin, Germany) 300 mg x ml(-1) was given into an antecubital vein. Median transit times of 16 s (range 14-20 s) were found in patients with liver cirrhosis (n=4), 22 s (range 16-27 s) in patients with focal liver lesions (n=8) and 31 s (range 30-32 s) in control subjects (n=3). The maximum interobserver variation was 2 s and the maximum intraobserver variation was 3 s (n=10). Transit time was assessed by both pulse inversion imaging and spectral Doppler quantification in six patients. Comparison of the two methods showed transit times within 2 s apart in five patients and within 5 s apart in one patient. In conclusion, it is possible to assess transit time using pulse inversion imaging. This method is simpler than a previously described method requiring computer analysis. Moreover, several liver veins can be assessed simultaneously. Different transit times were observed in different liver veins in two patients with liver tumours. A short transit time (<27 s) appears to be found only in patients with liver disease. After transit time assessment, it is possible to use the injected contrast agent for late phase imaging of the liver parenchyma.

Topics: Adult; Aged; Contrast Media; Hepatic Veins; Humans; Liver Cirrhosis; Liver Diseases; Liver Neoplasms; Middle Aged; Observer Variation; Polysaccharides; Ultrasonography

The aim of this paper was to investigate the diagnostic value of dynamic contrast-enhanced power Doppler sonography in the differential diagnosis of liver lesions. We prospectively examined 85 focal liver lesions in 71 patients by real-time gray-scale sonography, power Doppler sonography, and contrast-enhanced power Doppler using two ultrasound contrast agents (Levovist, Optison). Amount and architecture of lesion vascularity and the kinetics of contrast enhancement within the lesions were analyzed. Vascularity was detected in 61% of liver lesions (52/85) by conventional power Doppler, compared to 86% (73/85) by contrast-enhanced power Doppler sonography. Dynamic contrast-enhanced power Doppler identified arterial radial hypervascularity <16 s after contrast injection in 19/22 focal nodular hyperplasias (86%). Irregular hypervascularity was seen with contrast enhancement in the arterial phase in 14/15 hepatocellular carcinomas (93%). In 14/25 hemangiomas (56%), a circular vascularization pattern was noted. Specific lesion diagnosis based on B-scan and conventional and dynamic contrast-enhanced power Doppler sonography led to correct diagnosis in 86% (73/85, 95% confidence interval 78%-94%) compared to 57% (48/85, 95% confidence interval 47%-94%) by B-scan criteria and conventional power Doppler sonography. Contrast-enhanced power Doppler sonography improves diagnostic accuracy in the differential diagnosis of focal liver lesions.

Topics: Albumins; Contrast Media; Diagnosis, Differential; Fluorocarbons; Humans; Image Enhancement; Injections, Intravenous; Liver Neoplasms; Polysaccharides; Prospective Studies; Ultrasonography, Doppler

To compare the uptake of SH U 508A in different types of liver lesions by using stimulated acoustic emission.. Thirty-seven patients with characterized lesions (metastasis, n = 17; hepatocellular carcinoma, n = 4; hemangioma, n = 9; focal nodular hyperplasia, n = 7) received 2.5 g SH U 508A. After 5 minutes, stimulated acoustic emission was elicited by using a previously described method. Liver and/or lesional differences were assessed with videodensitometry (objective conspicuity score), and two observers assessed each lesion by using a six-point scale (subjective conspicuity score).. Metastases and hepatocellular carcinoma had low stimulated acoustic emission; median objective conspicuity scores were 70% and 68% (all scores were > or =43%), respectively, and subjective conspicuity scores were 2 or higher for both observers. Hemangiomas had reduced stimulated acoustic emission, with more variability; the median objective conspicuity score was 41% (range, 9%-72%), and the median subjective conspicuity scores were 2 (range, 1-4) and 3.5 (range, 1-5) for observers 1 and 2, respectively. Focal nodular hyperplasia had stimulated acoustic emission comparable to that of the liver in all cases; the median objective conspicuity score was -4.7% (all scores were <6%), and the subjective conspicuity score was 1 or lower for both observers. This finding completely separated focal nodular hyperplasia and malignancies. Significant differences were seen between focal nodular hyperplasia and all other lesion types (P < .05).. Strong late-phase lesional uptake of SH U 508A is characteristic of focal nodular hyperplasia, is seen in some hemangiomas, and was not observed in malignancies.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Focal Nodular Hyperplasia; Hemangioma; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography

To investigate the usefulness of enhanced ultrasonography after the administration of intravenous contrast agent in the evaluation of therapeutic effect in the treatment of hepatocellular carcinoma (HCC) comparison with dynamic CT, and to examine the efficacy of percutaneous ethanol injection therapy (PEIT) for residual tumor.. Thirty patients (22 men, 8 women; age range, 42-76 years; mean age 60 years) underwent enhanced ultrasonography with the intravenous ultrasonographic agents Levovist, after transcatheter arterial embolization (TAE) (n = 15, size range 23-35 mm, mean 25.3 mm) or PEIT (n = 15, 15-35 mm, mean 24.5 mm), to compare the therapeutic effect with dynamic CT. If residual lesions were detected by enhanced ultrasonography, we performed additional PEIT.. The evaluation of enhanced ultrasonography correlated almost completely with that of dynamic CT. Two residual lesions could not be detected by dynamic CT due to lipiodol, but enhanced ultrasonography and dynamic MRI showed them clearly. In total, eight residual tumors (3-15 mm, mean 8.3 mm) were seen. We performed PEIT on seven lesions and obtained good control for six months.. Enhanced ultrasonography with Levovist could be performed to evaluate the therapeutic effect of treatment for HCC, and could serve as be a good marker for additional US-guided therapy.

Topics: Adult; Aged; Biomedical Enhancement; Carcinoma, Hepatocellular; Contrast Media; Ethanol; Female; Humans; Injections, Intralesional; Injections, Intravenous; Liver Neoplasms; Male; Middle Aged; Neoplasm, Residual; Polysaccharides; Ultrasonography

To quantify liver blood flow using US contrast agents and to evaluate arterial and portal changes in control patients and patients with liver metastases.. Twenty eight patients were included in this study, 8 controls (M0) and 20 patients with liver metastases from colon carcinoma (M+). Hepatic blood flow from hepatic artery and portal vein were determined using quantification of enhancement after contrast injection using Power Doppler US. The ratio of enhancement rise from artery and vein allows calculation of Contrast Enhanced Doppler Perfusion Index (CEDPI) as previously described for Doppler Perfusion Index (DPI).. A significant difference was noted for CEDPI between controls (0.49 +/- 0.07) and liver with metastases (0.70 +/- 0.12).. This functional method of evaluation of liver blood flow was easy to perform, and would be valuable for early detection of overt micro-metastases before anatomical changes observed by conventional imaging. This is helpful for accurate staging of colon carcinoma.

Topics: Adult; Aged; Aged, 80 and over; Colorectal Neoplasms; Contrast Media; Data Interpretation, Statistical; Female; Hepatic Artery; Humans; Liver Circulation; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Portal Vein; Ultrasonography, Doppler

To compare contrast material-enhanced harmonic power Doppler ultrasonography (US) with conventional power Doppler US in depicting the vascularity of hepatocellular carcinoma (HCC).. Twenty patients with nodular HCCs (2.6-13.2 cm in diameter; mean diameter, 4.8 cm) were prospectively examined with both conventional and harmonic power Doppler US. US was performed with a 2-4-MHz curved linear-array transducer according to a standard examination protocol (1,000-Hz pulse repetition frequency, medium wall filter, and power gain of 55%-84% for conventional power Doppler US; 700-Hz pulse repetition frequency, low wall filter, and power gain of 95%-98% for harmonic power Doppler US). Serial, dynamic scans were obtained before intravenous injection of the contrast agent (SH U 508A) and at 30, 60, 90, 120, 180, 240, and 300 seconds after injection with both techniques.. The number of intratumoral power Doppler US signals was similar with both techniques at 30-90 seconds after contrast agent injection; however, after 90 seconds, conventional power Doppler US depicted significantly more signals than did harmonic power Doppler US. Harmonic power Doppler US was superior to conventional power Doppler US in terms of power Doppler artifacts such as "blooming" or motion-related artifacts.. Although the effective enhancement duration is relatively short compared with that for conventional power Doppler US, contrast-enhanced harmonic power Doppler US can be effective in evaluating the vascularity of HCCs because of the advantage of fewer power Doppler artifacts.

Topics: Aged; Artifacts; Carcinoma, Hepatocellular; Contrast Media; Female; Filtration; Humans; Image Enhancement; Injections, Intravenous; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Prospective Studies; Time Factors; Transducers; Ultrasonography, Doppler

Pulse-inversion mode (a new ultrasound mode) can be used to image the late liver-specific parenchymal phase of the microbubble contrast-agent Levovist. Scanning in pulse-inversion mode after Levovist improves the detection of liver metastases and reveals more lesions of smaller size than conventional ultrasonography and computed tomography.

Topics: Colorectal Neoplasms; Contrast Media; Humans; Image Enhancement; Liver Neoplasms; Polysaccharides; Sensitivity and Specificity; Ultrasonography

The purpose of this study was systematically to investigate stimulated acoustic emission (SAE) with the microbubble contrast agent Levovist (Schering AG, Berlin) in vivo with regards to reproducibility, distribution in various organs over time, dependence on technical factors, and influence on the delineation of focal liver lesions.. 2 intravenous injections of 1 g of Levovist were given to 2 dogs and 1-6 injections of 2.5 g Levovist to 5 healthy volunteers and 37 patients. The liver, spleen, large abdominal vessels, and kidney were intermittently scanned for up to 30 min. Studies were evaluated for the presence of SAE signals by 2 observers. In 20 patients with focal liver lesions (15 with metastases, 4 haemangiomata, 1 hepatocellular carcinoma, and 1 cyst) the influence on lesion visualization was also assessed.. SAE effects, lasting up to 30 minutes, were seen in all subjects in the liver and spleen. Vascular and renal SAE signals were noted shortly after injection, lasting up to 6 minutes. SAE was absent or markedly reduced in focal liver lesions, which were seen as colour voids. This increased the conspicuity of focal lesions, and in 5 patients additional metastases were detected that could not be delineated on B-mode alone.. A liver- and spleen-specific late phase of Levovist can be consistently demonstrated using SAE and the effect increases the conspicuity of focal liver lesions.

Topics: Adult; Aged; Aged, 80 and over; Animals; Carcinoma, Hepatocellular; Contrast Media; Dogs; Dose-Response Relationship, Drug; Female; Focal Nodular Hyperplasia; Hemangioma; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Reference Values; Ultrasonography, Doppler, Color

The aim of the present paper was to assess the utility of Levovist in defining the pathology of liver masses. Levovist is a new ultrasound contrast agent consisting of galactose microparticles, air bubbles and palmitic acid. Prospective studies were performed in patients referred for further evaluation of known liver masses. Levovist was peripherally injected and colour Doppler ultrasound studies were performed. Findings were correlated with clinicopathology and three other imaging modalities: biphasic spiral CT, CT arterial portography and contrast MRI. Twenty-five patients were studied (15 male and 10 female) in the age range 25-74 years. Liver masses ranged from 0.5 to 7 cm in maximum diameter. Thirteen lesions were benign and 12 were malignant (four hepatomas (HCC) and eight metastases). Levovist enhancement occurred in 18 lesions. Of these, six were benign (four focal nodular hyperplasias (FNH) and two haemangiomas). All 12 malignant lesions demonstrated enhancement. The HCC showed a mosaic pattern of central and peripheral enhancement, and the FNH demonstrated a spoke-wheel pattern. It was not possible to distinguish between haemangiomas and malignant lesions. Non-enhancing lesions may well be benign, with all malignancies showing some enhancement. Characteristic enhancement patterns were found for HCC (mosaic) and FNH (spoke-wheel). It was not possible to distinguish between metastases and benign lesions (haemangiomas) when the pattern of enhancement was peripheral.

Topics: Adult; Contrast Media; Female; Humans; Liver Diseases; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Polysaccharides; Portography; Tomography, X-Ray Computed; Ultrasonography

Objective of the present study was the comparison of various administration forms of the ultrasound contrast medium Levovist with regard to duration and intensity of contrast enhancement in patients with tumors of the liver or pancreas.. Seven patients with tumors of the liver or pancreas were examined prospectively using power Doppler sonography. Ultrasound contrast enhancement was achieved using Levovist (8 ml, 400 mg/ml) in three different administration forms: 1st as a bolus injection through the main channel, 2nd through the injection valve of an intravenous cannula, or 3rd as a continuous infusion. Semiquantitative evaluation of the degree of contrast enhancement over the course of the examination was conducted by three independent examiners.. Levovist, administered by continuous infusion, resulted in a significantly longer average period of contrast enhancement (9:43 min (extratumoral), 7:34 min (intratumoral)) than did the same dosage administered as a bolus injection through the main channel (6:01 min (extratumoral), 4:54 min (intratumoral), p = 0.0156 (extratumoral); p = 0.0313 (intratumoral), but contrast intensity was decreased. Bolus injection through the injection valve of the i.v. cannula was associated with decreased duration and intensity of contrast enhancement compared with injection through the main channel.. Compared with bolus injection, the continuous infusion of Levovist resulted in a significant prolongation of the duration but in a decreased intensity of contrast enhancement. Administration of Levovist through the injection valve does not result in optimal contrast enhancement and is therefore not recommended.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Female; Humans; Infusions, Intravenous; Injections, Intravenous; Liver Neoplasms; Male; Middle Aged; Pancreatic Neoplasms; Polysaccharides; Reproducibility of Results; Sensitivity and Specificity; Ultrasonography, Doppler

To evaluate contrast agent-enhancement patterns in hepatic hemangiomas, hepatic metastases, and hepatocellular carcinomas (HCCs) at pulse-inversion harmonic ultrasonography (US) with a microbubble contrast agent.. Twenty hepatic hemangiomas in 20 patients and 41 malignant hepatic tumors in 23 patients (33 metastases and eight HCCs) were evaluated with pulse-inversion harmonic US. US images were obtained before injection and every 10-15 seconds after injection of a 4-g bolus (300 mg/mL) of SH U 508A (a microbubble contrast agent) for 5 minutes. The contrast-enhancement patterns of 61 hepatic lesions were assessed.. Of 20 hemangiomas, 19 revealed peripheral enhancement, which was globular in 14 (70%) and rimlike in five (25%), with centripetal fill-in; the remaining one (5%) showed homogeneous enhancement. In 33 metastases, the enhancement was rimlike in 16 (48%), homogeneous in seven (21%), and stippled in two (6%); in the remaining eight metastases (24%), no enhancement was seen. Of eight HCCs, four (50%) showed homogeneous enhancement and the remaining four (50%) showed heterogeneous enhancement. Centripetal fill-in of lesions with intratumoral enhancement was not seen in any malignancy.. Pulse-inversion harmonic US with a microbubble contrast agent is potentially useful for the specific diagnosis of hemangiomas that demonstrate characteristic enhancement features.

Topics: Adult; Aged; Carcinoma; Carcinoma, Hepatocellular; Carcinoma, Islet Cell; Contrast Media; Female; Follow-Up Studies; Hemangioma; Humans; Image Enhancement; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Polysaccharides; Tomography, X-Ray Computed; Ultrasonography

The authors investigated the effect of intermittent second-harmonic gray-scale (ISHGS) ultrasonography (US) with SH U 508A microbubbles on the conspicuity of focal liver lesions. Twenty-three patients were included in the study. Images were analyzed subjectively and quantitatively. Objective lesion conspicuity was increased. In 12 of the 15 patients with liver malignancy, gray-scale defects were seen in previously unsuspected areas. ISHGS US may improve the sensitivity of US for liver lesions.

Topics: Adult; Aged; Carcinoid Tumor; Carcinoma; Contrast Media; Female; Focal Nodular Hyperplasia; Humans; Image Enhancement; Image Processing, Computer-Assisted; Infusions, Intravenous; Liver; Liver Neoplasms; Male; Middle Aged; Observer Variation; Phantoms, Imaging; Polysaccharides; Sensitivity and Specificity; Ultrasonics; Ultrasonography; Videotape Recording

Comparison between contrast harmonic imaging (CHI) in B-mode with stimulated acoustic emission (SAE), conventional B-mode US, and spiral CT in the detection of focal liver lesions.. In this pilot study 26 patients with liver lesions diagnosed by B-mode US and contrast-enhanced spiral-CT were additionally examined with CHI in B-mode. Each examination started with a bolus injection of 4 g of the US contrast agent Levovist (300 mg/ml) after a delay of at least 5 minutes to ensure liver-specific phase. All examinations were documented on video tapes and analysed by two radiologists.. 81 liver lesions were diagnosed with both US examinations and spiral CT. B-mode US detected 66 lesions, CHI with SAE 72 lesions, and spiral CT 73 lesions. Compared to spiral CT 8 lesions in 3 patients could be depicted additionally with both US methods. Metastases and HCC present in CHI with SAE as not-enhancing signal contrast agent areas. Delineation of haemangiomas and FNH was often worse compared to the native examinations.. The new US method CHI with SAE depicted more lesions than conventional B-mode US and is in some cases superior to spiral CT.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Cysts; Diagnosis, Differential; Female; Hemangioma; Humans; Liver Abscess; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Tomography, X-Ray Computed; Ultrasonography

Twenty consecutive patients with known liver malignancies underwent ultrasonography (US) in conventional B mode and in pulse-inversion mode in the late hepatic-specific parenchymal phase after intravenous administration of SH U 508A, a microbubble US contrast agent. Two experienced readers assessed subjective and objective conspicuity, number of lesions, and smallest lesion diameter in each mode. Subjective and objective conspicuity were improved with pulse-inversion mode, and smaller lesions were depicted with pulse-inversion mode than with conventional B mode, improving the detection of metastases less than 1 cm in size.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Humans; Image Enhancement; Liver; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Reference Values; Sensitivity and Specificity; Ultrasonography

The aim of the current study was to compare Levovist-enhanced power Doppler (PD) imaging with contrast-enhanced spiral computed tomography (CT) in the evaluation of intratumoral vascularity of hepatocellular carcinomas at diagnosis and after percutaneous ethanol injection (PEI). Nineteen patients with hepatocellular carcinoma (HCC) underwent PD with and without Levovist and spiral CT at diagnosis and 1 month after PEI treatment. Compared to spiral CT at baseline evaluation, the PD showed intratumoral vascularity in 36.8% of the cases; this percentage reached 78.9% after Levovist enhancement. One month after PEI, only 5 out of 19 treated HCCs appeared as hypodense areas at CT and showed no contrast enhancement. Only 3 of the 14 patients with a positive spiral CT scan were positive at the PD performed without the Levovist administration (sensitivity, 21.4%). The use of contrast-enhanced ultrasonography led to detection of residual signal in six other HCCs treated by ethanol injection (sensitivity, 64.2%). We confirm that spiral CT is the most sensitive and accurate technique in evaluating the effect of ethanol injection in HCC. It correctly identifies most cases of treatment failure as enhanced areas within the lesion. The lower rate of detection of tumoral vascularity by Doppler sonography was significantly increased by Levovist. The evidence of residual vascularity within HCC at Levovist Doppler sonography allows the targeting of additional ethanol injections.

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Ethanol; Female; Humans; Image Enhancement; Injections, Subcutaneous; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography, Doppler

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

The aim of this study was to investigate the usefulness of contrast-enhanced harmonic power Doppler ultrasound (US) for the detection of residual viable hepatocellular carcinoma (HCC) after treatment with transcatheter arterial chemoembolization (TACE). Forty-seven patients with 68 HCC lesions 1.8-9.5 cm in diameter (mean +/- SD 4.3 +/- 1.7 cm) underwent contrast-enhanced power Doppler US, in the harmonic mode, before and after treatment with TACE. Unenhanced spiral CT and contrast-enhanced dynamic MR imaging were also performed to help establish the outcome of therapy. Before treatment, intratumoral blood flow signals were detected at contrast-enhanced harmonic power Doppler US in 65 (95%) of 68 lesions. After TACE, flow signals were no longer detectable in 22 of these 65 lesions, which showed complete response at spiral CT and dynamic MR imaging. In 38 (88%) of the 43 lesions with partial response, intratumoral flow signals were still identified at contrast-enhanced harmonic power Doppler US. Twenty-eight of these 38 lesions underwent additional treatment with percutaneous ethanol injection (PEI) using contrast-enhanced harmonic power Doppler US guidance. Complete response was seen after PEI in 23 of 28 lesions. Contrast-enhanced harmonic power Doppler US proved useful for assessing the therapeutic effect of TACE on HCC and for guiding additional treatment with PEI in cases of partial response.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Blood Flow Velocity; Carcinoma, Hepatocellular; Catheterization, Peripheral; Chemoembolization, Therapeutic; Contrast Media; Female; Humans; Injections, Intra-Arterial; Injections, Intravenous; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Prospective Studies; Sensitivity and Specificity; Ultrasonography, Doppler, Color; Video Recording

Topics: Aged; Carcinoma, Hepatocellular; Contrast Media; Female; Hepatitis C, Chronic; Humans; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Sensitivity and Specificity; Ultrasonography, Doppler, Color

To evaluate the usefulness of power Doppler ultrasonography (US) with a microbubble contrast agent in assessing the therapeutic response of hepatocellular carcinomas (HCCs) treated with percutaneous radio-frequency (RF) ablation.. Forty patients with 45 nodular HCC lesions 1.0-3.8 cm in diameter underwent power Doppler US before and after intravenous injection of a microbubble contrast agent. The same procedures were repeated after US-guided percutaneous RF ablation. The results of these studies were compared with those of three-phase helical computed tomography (CT) performed immediately after RF ablation.. Before RF ablation, nonenhanced power Doppler US demonstrated flow signals within tumor in 33 of 45 HCCs. After contrast agent administration, flow signals increased or newly appeared in all cases. After RF ablation, none of the ablated tumors showed intratumoral flow signals at nonenhanced power Doppler US, whereas six showed marginal intratumoral flow signals at contrast agent-enhanced power Doppler US. These six tumors were found to have small enhancing foci, suggestive of viable tumor, in corresponding areas at immediate follow-up CT. Additional RF ablation or transcatheter arterial chemoembolization was performed in these tumors.. The results of power Doppler US with a microbubble contrast agent in HCCs treated with RF ablation correlated well with those of contrast-enhanced CT. Preliminary data suggest that contrast-enhanced power Doppler US can be a promising noninvasive technique for assessing therapeutic response.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Catheter Ablation; Contrast Media; Female; Humans; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Tomography, X-Ray Computed; Ultrasonography, Doppler

We describe three cases where biopsies from various tumors were guided by contrast enhancement of tumor perfusion. After i.v. administration of Levovist (Schering AG, Berlin, Germany), the tumors showed both hyper- and hypovascular areas. Biopsies from the latter showed marked necrosis or fibrosis. This may cause biopsies not being conclusive. To ensure fully diagnostic biopsies from irregular tumors we propose the biopsy to be performed from the most vascular part demonstrated by contrast enhancement.

Topics: Abdominal Neoplasms; Biopsy; Breast Neoplasms; Carcinoma, Renal Cell; Contrast Media; Female; Humans; Liver Neoplasms; Middle Aged; Neurofibrosarcoma; Polysaccharides; Ultrasonography, Interventional

To investigate the feasibility of delayed pulse-inversion harmonic imaging (PIHI) with the SH U 508A to improve imaging of hepatic metastases, we evaluated 20 patients with known hepatic metastases. Conventional ultrasound (US) was performed before administration, and PIHI was performed 5 min after a bolus injection of 4 G of microbubble contrast agent (300 mg/mL of SH U 508A). Intense, homogeneous enhancement in the liver parenchyma was seen in all patients on delayed PIHI. In 10 patients (50%), 1 or more focal liver lesions that were not seen on unenhanced imaging were detected on delayed PIHI. When comparing 55 lesions that were seen on both techniques, delayed PIHI was superior to unenhanced imaging in terms of lesion conspicuity and lesion-to-liver contrast (p < 0.001, respectively). Delayed PIHI with SH U 508A can improve conspicuity of hepatic metastases and reveal focal liver lesions that are not detected on unenhanced imaging.

Topics: Adult; Aged; Contrast Media; Female; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography

The purpose of this study was to determine the efficacy of using an ultrasound contrast agent (levovist) to enhance the color Doppler imaging of liver neoplasms. Thirty patients with hepatic tumors were enrolled in this study. After intravenous administration of levovist, the color Doppler signals of normal hepatic vessels were enhanced. In various hepatic tumors, the different patterns of tumor vascularity were observed, which had not been demonstrated in conventional non-contrast color Doppler imaging. In 11 of 16 patients with hepatocarcinoma, additional color Doppler signals were observed in the central part of the tumors. On the contrary, 3 patients with metastatic liver lesions the enhanced color Doppler signals appear only at the peripheral of tumors. A typical rim-like color enhancement was seen in 2 of the 3 cases. In six patients with hepatic hemangiomas contrast-enhanced color Doppler imaging demonstrated the blood vessels at the margin of the neoplasms. Contrast-enhanced color Doppler imaging improves the visualization of the hepatic neoplasm vascularity. This technique holds great promise for detecting small liver tumors and differentiating hepatic neoplasms.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular; Contrast Media; Feasibility Studies; Female; Humans; Image Enhancement; Injections, Intravenous; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Ultrasonography, Doppler, Color

The differentiation of focal liver processes is a daily clinical problem. A new option in addition to magnetic resonance tomography has been created with the development of new stable sonographic contrast agents. In this paper, Levovist was studied as a sonographic contrast agent in the detection of specific tumour perfusion patterns. All focal liver processes were proven by cytology or histology. In 19 of 22 cases there was a pathological diagnosis. In 5 of 7 haemangiomas a feeding vessel was visualised. In 3 focal nodular hyperplasias intense intratumoural enhancement was visible shortly after injection. In 2 cases of hepatocellular carcinomas tumoural neovascularisations were visualised which were not seen before the injection of Levovist. The new sonographic contrast agents provide better differentiation of specific perfusion patterns of liver tumours than normal duplex sonography.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Female; Humans; Image Enhancement; Liver; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Sensitivity and Specificity; Ultrasonography, Doppler, Duplex

To see whether stimulated acoustic emission (SAE) in the liver parenchyma in the late phase of enhancement with SH U 508A increases the conspicuity of occult metastases at ultrasonography (US).. Eighteen patients with known hypo- or hypervascular hepatic metastases underwent US after SH U 508A administration, after a delay of at least 5 minutes, to ensure decay of blood pool enhancement. In 16 patients with visible metastases, conspicuity was compared on registered SAE and gray-scale scans by two blinded readers and by using computerized analysis of relative gray-scale and color Doppler conspicuity scores inside and outside the lesion. In nine patients, areas suspected of being involved but without definite gray-scale masses were imaged in the same way. Paired sections were analyzed by two blinded readers looking for parenchymal color defects without corresponding gray-scale masses; nine control images from three healthy volunteers were also included.. Intense, transient parenchymal SAE was seen in all subjects. All metastases appeared as areas of reduced or absent signal. The conspicuity score was 80% for SAE versus 9% for gray-scale US (P < .001, Wilcoxon signed rank test). SAE-specific defects were seen in all patients but in none of the volunteers. Metastases seen on SAE but undetectable on gray-scale images were proved in three patients.. SAE with SH U 508A improves the conspicuity of metastases. SAE-specific defects may reveal isoechoic or subtle metastases.

Topics: Biopsy; Contrast Media; Female; Humans; Image Processing, Computer-Assisted; Liver; Liver Neoplasms; Male; Middle Aged; Pilot Projects; Polysaccharides; Time Factors; Ultrasonography

To evaluate contrast agent-enhanced ultrasonography (US) in the detection of untreated tumor after radio-frequency (RF) ablation of hepatic metastases.. Twenty patients with solitary colorectal liver metastases underwent percutaneous RF tumor ablation. Pre- and postablation imaging was performed with nonenhanced and enhanced color and power Doppler US and contrast-enhanced helical computed tomography (CT). Initial follow-up CT and US were performed 24 hours after ablation. The findings at US and CT were compared.. Nonenhanced US demonstrated intratumoral signal in 15 of 20 metastases before ablation. This signal increased after contrast agent administration. Contrast-enhanced US performed 24 hours after ablation demonstrated residual foci of enhancement in three tumors, whereas no US signals were seen in any tumor on nonenhanced scans. CT demonstrated small (< 3-mm) persistent foci of residual enhancement in these three tumors and in three additional lesions that were not seen at US (US sensitivity, 50%; specificity, 100%; diagnostic agreement with CT, 85%). All six patients with evidence of residual tumor underwent repeat RF ablation.. Contrast-enhanced US may depict residual tumor after RF application and thereby enable additional directed therapy. The potential reduction in treatment sessions and/or ancillary imaging procedures might increase the ease and practicality of percutaneous ablation of focal hepatic metastases.

Topics: Aged; Catheter Ablation; Colorectal Neoplasms; Contrast Media; Humans; Liver Neoplasms; Middle Aged; Neoplasm, Residual; Polysaccharides; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color; Ultrasonography, Interventional

Topics: Contrast Media; Diagnosis, Differential; False Positive Reactions; Humans; Injections, Intravenous; Liver Neoplasms; Polysaccharides; Reproducibility of Results; Ultrasonography

The aim of this study is to evaluate capability of contrast enhanced ultrasonography (US) using pulse inversion harmonic imaging (PIHI) to detect liver metastases in comparison to fundamental B-mode ultrasound and spiral CT. Thirty-six consecutive patients with known malignancies and sonographically proved or suspicious liver metastases have been examined with fundamental B-mode US, with PIHI 2', 4' and 6' after Levovist injection and with four phase spiral-CT. Presence, conspicuity and number of lesions have been evaluated comparing PIHI with fundamental B-mode US and spiral-CT. A strong grey-scale enhancement of the liver parenchyma has been observed 2' and 4' after Levovist injection. The optimum parenchymal enhancement and contrast difference between liver and metastases was observed during the 2' measurements. PIHI revealed more lesions than fundamental B-mode US in 56 % of patients, while in 39 % and in 5 % revealed respectively the same number and fewer lesions. PIHI and spiral-CT were in agreement in 67 % of patients, while in 22 % and 11 % PIHI revealed respectively more and fewer lesions. PIHI accurancy presents restrictions in anterior superficial and in deep liver areas, whereas it may be superior to spiral-CT in studying sub-diaphragmatic liver regions.

Topics: Aged; Aged, 80 and over; Biopsy; Contrast Media; Female; Humans; Injections, Intravenous; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Tomography, X-Ray Computed; Ultrasonography

Intravenously injected ultrasonic contrast agents have improved sonographic visualization of blood flow. On enhanced color Doppler sonography using Levovist (Schering AG, Germany) and FS069 (Molecular Biosystems, USA), minute tumor blood flow in woodchuck hepatoma was clearly demonstrated as vascular flow around and within the tumors. Furthermore, on enhanced gray scale sonography using FS069, parenchymal flow was demonstrated as sonographic "tumor stain". However, larger doses of the agent provided shadowing that disturbed sonographic evaluation of deeper portions of the liver. With advances of second harmonic imaging, it may be possible to evaluate only blood perfusion in that it eliminates the signals of fundamental frequency.

Topics: Albumins; Animals; Carcinoma, Hepatocellular; Contrast Media; Fluorocarbons; Hepatitis B Virus, Woodchuck; Injections, Intravenous; Liver Neoplasms; Marmota; Microspheres; Polysaccharides; Ultrasonography, Doppler, Color

The purpose of this study is to evaluate hemodynamic characteristics of various hepatic tumors using color Doppler echography administered galactose-based intravenous contrast medium "SH/TA 508 (Levovist)". Subject were 9 cases of hepatocellular carcinomas, 5 cases of metastatic liver tumors and a case of hemangioma. We evaluated the characteristics of blood flows inside various hepatic tumors, and also evaluated the first pass through the hepatic tumors during administration of Levovist. The strongly pulsatile branched blood flows inside tumor and the slow-increased and plateau patterns were observed in the all cases of hepatocellular carcinomas, the weakly pulsatile blood flows surrounding tumor and the rapid-increased and slow-decreased patterns were observed in the cases of metastatic liver tumors, and the continuous blood streams in the margin of tumor and the slow-increased and slow-decreased pattern were observed in the case of hemangioma. These findings were characteristic in various hepatic tumors, and color Doppler echography enhanced by Levovist was very useful to distinguish hepatic tumors.

Topics: Carcinoma, Hepatocellular; Contrast Media; Humans; Liver Neoplasms; Polysaccharides; Ultrasonography, Doppler, Color

To evaluate the characterisation of liver lesions using power Doppler sonography before and after intravenous injection of the ultrasound contrast agent Levovist.. 39 patients with 41 liver lesions (10 haemangiomas, 2 focal nodular hyperplasias (FNH), 2 focal fatty infiltrations, 1 echinococcal lesion, 11 hepatocellular carcinomas, 14 metastases and one cholangiocarcinoma) were evaluated prospectively. Power Doppler images before and after intravenous injection of the ultrasound contrast agent Levovist were analysed by two radiologists and one gastroeterologist, who subjectively classified the distribution (peripheral, central, diffuse) and amount (none, minimal, moderate and strong) of flow pattern in each sonographic examination. Histological verification was obtained in all liver lesions, except in haemangiomas, where MR imaging and in one FNH where scintigraphy was regarded as sufficient proof.. On the whole, power Doppler sonography after contrast injection was superior to unenhanced power Doppler-sonography in 20 liver lesions and equal in 7. After contrast injection, previously visible flow was enhanced in 14 patients, in 6 lesions flow was detected, which was not seen before in the power mode. Moderate or strong flow signals were detected before contrast injection in 8/26, post contrast injection in 18/26 malignant tumours. Contrawise, 13/15 benign lesions did show any or only minimal flow signals before and 10/15 after contrast injection.. Intratumoural flow signals favour a malignant tumour. The absence of flow signals is a frequent finding in benign lesions but does not rule out malignancy.

Topics: Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Echinococcosis, Hepatic; Fatty Liver; Hemangioma; Humans; Hyperplasia; Liver; Liver Diseases; Liver Neoplasms; Polysaccharides; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Lidofenin; Ultrasonography, Doppler

We report our preliminary experience concerning Doppler studies with the intravenous injection of a galactose-based echo contrast agent (SHU 508 A) in hepatocellular carcinomas (HCCs) treated with transcatheter arterial chemoembolization. We correlated US findings with those of iodized-oil helical CT.. In 1997 we examined 18 patients with cirrhosis and HCC (31 nodules in all) submitted to hepatic oily chemoembolization 15-30 days earlier. The lesions were studied with color and power Doppler US before and after echo contrast agent infusion (300 mg/mL, injection/nodule, constant rate in 60-90 s) and with Lipiodol CT (0-7 days after US). In the retrospective analysis, special care was paid to Doppler signals from pulsatile intra- and perinodular flow and to the detection of new small vessels on enhanced images. The signal was graded as absent (0), weak (1), medium (2) and strong (3). The oily agent uptake on CT images was graded as absent (0), grade I (< 10%), II (< 50%), III (> 50%) and homogeneous (IV). All scores were given on a blind basis.. Liver enhancement was found in all cases and always lasted long enough to allow the accurate depiction of parenchymal lesions (at least 8 minutes). Signal intensity could be evaluated in 27 of 31 HCCs (2 were too deeply seated and two were too affected by cardiac activity). We had the following scores: basal color Doppler: grade 0 = 15 lesions, grade 1 = 8 lesions, grade 2 = 4 lesions; contrast-enhanced color Doppler: grade 0 = 11 lesions, grade 1 = 7 lesions, grade 2 = 8 lesions, grade 3 = 1 lesion; basal power Doppler: grade 0 = 12 lesions, grade 1 = 8 lesions, grade 2 = 6 lesions, grade 3 = 1 lesion; contrast-enhanced power Doppler: grade 0 = 10 lesions, grade 1 = 7 lesions, grade 2 = 8 lesions, grade 3 = 2 lesions; Lipiodol-CT: grade 0 = 1 lesion, grade I = 1 lesion, grade II = 7 lesions, grade III = 8 lesions, grade IV = 10 lesions. The difference between color and power Doppler scores, both compared to each other and between basal and enhanced images, never exceeded one.. Contrast-enhanced Doppler US is a simple and fast technique allowing strong, constant and long-lasting enhancement. Doppler US techniques permit the effective and realistic study of HCC nodules treated with chemoembolization and show a better correlation with Lipiodol CT than basal studies. Power Doppler is slightly more sensitive and accurate than color Doppler and shows a better correlation with Lipiodol CT.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Contrast Media; Evaluation Studies as Topic; Female; Humans; Iodized Oil; Liver; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Retrospective Studies; Tomography, X-Ray Computed; Ultrasonography, Doppler

To investigate the value of contrast material-enhanced power Doppler ultrasonography (US) in the demonstration and characterization of tumor vascularity in hepatocellular carcinoma (HCC).. Twenty patients with HCC were prospectively evaluated with power Doppler US before and after injection of the contrast agent SH U 508 A. The grade and pattern of tumor vascularity at power Doppler US were analyzed, along with the degree of tumor staining at angiography.. Intra- and peritumoral flow signals were detected in 19 HCCs (95%) at unenhanced power Doppler US. After injection of contrast agent, flow signals increased in 19 lesions (95%). At contrast-enhanced power Doppler US, two tumors demonstrated grade 1 vascularity; four, grade 2; three, grade 3; and 11, grade 4. At angiography, two tumors demonstrated grade 1 staining; four, grade 2; eight, grade 3; and six, grade 4. The correlation between vascularity grades at contrast-enhanced power Doppler US and at angiography was statistically significant (P < .0001). Seventeen HCCs (85%) showed the intratumoral or basket pattern of vascularity at unenhanced power Doppler US; after injection of contrast material, 15 HCCs (75%) showed the mixed pattern.. Contrast-enhanced power Doppler US is superior to unenhanced power Doppler US in the demonstration and characterization of tumor vascularity in HCC.

Topics: Adult; Aged; Angiography; Carcinoma, Hepatocellular; Contrast Media; Female; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Prospective Studies; Ultrasonography, Doppler

To investigate the ability of contrast agent-enhanced color Doppler ultrasonography (US) in evaluating the response of hepatocellular carcinoma (HCC) to percutaneous ethanol injection (PEI).. Forty-two patients (36 men, six women; age range, 51-79 years) with 54 1.3-7.0-cm-diameter (mean +/- SD, 2.8 cm +/- 1.1) HCC lesions were examined with contrast-enhanced color Doppler US before and after PEI. Spiral computed tomography (CT) and percutaneous biopsy also were performed to establish the outcome of therapy.. Before PEI, intratumoral color signals were demonstrated at contrast-enhanced color Doppler US in 47 (87%) lesions (in 40 patients). After PEI, blood flow signals were no longer detected in all 34 of the lesions that were found to be necrotic at spiral CT and biopsy. In 12 (92%) of 13 lesions containing residual viable tumor, intratumoral color signals corresponding to the enhancing areas at spiral CT were still identified at contrast-enhanced color Doppler US. These 12 lesions were retreated with PEI by targeting the areas of residual tumor with contrast-enhanced color Doppler US guidance. Complete necrosis was seen after the second PEI cycle in nine of 12 lesions.. Contrast-enhanced color Doppler US shows promise in assessing the therapeutic effect of PEI on HCC and in guiding additional treatment in cases of incomplete response.

Topics: Aged; Biopsy; Carcinoma, Hepatocellular; Contrast Media; Ethanol; Female; Humans; Injections, Intralesional; Liver; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color

Spectral Doppler intensitometry to study transit of a bolus of an ultrasonographic (US) contrast agent in the hepatic veins was performed in seven patients suspected of having liver metastases and seven control subjects. All control subjects had a late response (rise time, > 25 seconds; time to peak intensity, > 45 seconds), whereas six of seven patients had an early response (rise time, < 25 seconds; time to peak intensity, < 45 seconds) (P < .01).

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Feasibility Studies; Female; Humans; Liver; Liver Circulation; Liver Neoplasms; Male; Middle Aged; Phlebography; Pilot Projects; Polysaccharides; Ultrasonography

Morphology of focal liver lesions was studied by power Doppler. Plain images and images after i.v. application of galactose-based microbubbles (Levovist, Schering AG) were compared.. 21 patients with focal liver lesions were studied by power Doppler before and after application of the signal enhancer.. In lesions that showed short pulsations in plain studies, vascular structures were visible after application of the signal enhancer. In hepatocellular carcinomas, multiple arteries with small diameter became visible. Peripheral veins were detected in metastases. A large feeding artery was detected in 1/2 haemangiomas with flow and in a focal nodular hyperplasia.. In comparison to plain amplitude-modulated colour-coded duplex ultrasound, vascular patterns of focal liver lesions were more clearly visible after injection of a signal-enhancer.

Topics: Adult; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Female; Hemangioma, Cavernous; Humans; Image Enhancement; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Prospective Studies; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color

Topics: Contrast Media; Humans; Liver Neoplasms; Polysaccharides; Ultrasonography, Doppler, Color

Patients with focal liver lesions (hemangioma, focal nodular hyperplasia, adenoma, hepatocellular carcinoma, metastatic lesions, focal fatty lesion) received the ultrasound contrast agent Levovist (300 mg/mL and 400 mg/mL) intravenously. This ultrasound contrast agent (a suspension of micrometer-sized microparticles of galactose and microscopic gaseous bubbles) can pass through the lungs without impairment. After the administration of Levovist, increased color flow signals were detected in the liver. Five of 6 patients with metastatic liver lesions showed previously undetected blood flow in the rim of the tumor. In 4 patients with hepatocellular carcinoma, enhanced signal intensity was observed in the vessels of the rim and in 3 of those patients in the center of the tumor. One patient with adenoma and one patient with focal nodular hyperplasia showed signal enhancement in the central area of the tumor. No signal enhancement was observed in hemangiomas, a focal fatty lesion, or in a carcinoid metastatic lesion. Levovist increased the echointensity of normal and tumor vessels in liver lesions. This new ultrasound contrast agent led to the detection of tumor vessels previously not detectable by conventional color flow imaging.

Topics: Adenoma; Adult; Carcinoid Tumor; Carcinoma, Hepatocellular; Contrast Media; Fatty Liver; Female; Hemangioma; Humans; Hyperplasia; Image Enhancement; Injections, Intravenous; Liver; Liver Diseases; Liver Neoplasms; Male; Middle Aged; Polysaccharides; Regional Blood Flow; Ultrasonography, Doppler, Color