The use of a standardized dynamic contrast enhanced ultrasound (CEUS) protocol to determine perfusion of hepatocellular carcinomas (HCC) using quantitative analysis.
METHODS:
Retrospective analysis of 27 patients with hepatocellular carcinoma examined by a standardized protocol (bolus injection of 2.4 ml sulphur hexafluoride microbubbles, arterial phase to portal venous phase using continuous CINE-loops over 1 minute, short CINE-loops after 2, 3, 4, 5 and 6 minutes and additional single images for B-mode, CCDS). The examination was performed by an experienced sonographer with a high resolution, multi-frequency transducer (1–6 MHz). The reading of the reference imaging (contrast enhanced CT and MRI) and histopathology, if necessary, was performed independently. Retrospective analysis of the CEUS DICOM loops was done using time intensity curve analysis (TIC) with evaluation of the time to peak (TTP) and the area under the curve (AUC).
RESULTS:
All tumor lesions were characterized by CEUS, based on typical contrast patterns for HCC lesions with arterial enhancement and wash out in the late phase, corresponding to MRI with liver specific contrast agent or contrast enhanced CT. Mean TTP (SD) in the tumor centre (C) was 19.93 (11.31), in the periphery (P) 22.94 (9.44) and in the normal liver tissue (LT) 28.19 (11.34) with significant differences between all zones C/P (p = 0.013), C/LT (p = 0.005) and P/LT (p = 0.022). AUC mean (SD) in the tumor centre (C) was 660.03 (292.64), in the periphery (P) 586.04 (237.01) and in the normal liver tissue (LT) 484.20 (236.99), also with significant differences between all zones C/P (p = 0.001), C/LT (p < 0.001) and P/LT (p < 0.001).
CONCLUSION:
TIC-analysis is an easy-to-use tool for the dynamic evaluation of microvascularization in hepatocellular carcinoma and allows a fast and cost-efficient quantitative analysis.
HufS, Platz Batista da SilvaN, WiesingerI, HornungM, SchererM, LangS, et al.Analysis of Liver Tumors Using Preoperative and Intraoperative Contrast-Enhanced Ultrasound (CEUS/IOCEUS) by Radiologists in Comparison to Magnetic Resonance Imaging and Histopathology. RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der Bildgeb Verfahren [Internet]. 2017 Apr 27 [cited 2019 Jul 21];189(05):431–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28449169
2.
PutzFJ, VerlohN, ErlmeierA, SchelkerRC, SchreyerAG, HautmannMG, et al.Influence of limited examination conditions on contrast-enhanced sonography for characterising liver lesions. JungF, FornalM, editors. Clin Hemorheol Microcirc [Internet]. 2019 Apr 4 [cited 2019 Jul 21];71(2):267–76. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30584135
3.
StrobelD, SeitzK, BlankW, SchulerA, DietrichC, HerbayA, et al.Contrast-enhanced Ultrasound for the Characterization of Focal Liver Lesions – Diagnostic Accuracy in Clinical Practice (DEGUM multicenter trial). Ultraschall der Medizin - Eur J Ultrasound [Internet]. 2008 Oct 1 [cited 2019 Jun 8];29(05):499–505.Available from: http://www.thiemeconnect.de/DOI/DOI?10.1055/s-2008-1027806
4.
SeitzK, StrobelD, BernatikT, BlankW, Friedrich-RustM, von HerbayA, et al.Contrast-Enhanced Ultrasound (CEUS) for the Characterization of Focal Liver Lesions – Prospective Comparison in Clinical Practice: CEUS vs. CT (DEGUM Multicenter Trial) Parts of this Manuscript were presented at the Ultrasound Dreiländertreffen 2008, Davos. Ultraschall der Medizin - Eur J Ultrasound [Internet]. 2009 Aug 17 [cited 2019 Jun 8];30(04):383–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19688670
5.
BernatikT, SeitzK, BlankW, SchulerA, DietrichC, StrobelD. Unclear Focal Liver Lesions in Contrast-Enhanced Ultrasonography – Lessons to be Learned from the DEGUM Multicenter Study for the Characterization of Liver Tumors. Ultraschall der Medizin - Eur J Ultrasound [Internet]. 2010 Aug 25 [cited 2019 Jun 8];31(06):577–81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20740399
6.
StrobelD, BernatikT, BlankW, SchulerA, GreisC, DietrichC, et al.Diagnostic Accuracy of CEUS in the Differential Diagnosis of Small (≤20 mm) and Subcentimetric (≤10 mm) Focal Liver Lesions in Comparison with Histology. Ultraschall der Medizin - Eur J Ultrasound [Internet]. 2011 Dec 9 [cited 2019 Jun 8];32(06):593–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22161556
7.
WiesingerI, JungW, ZausigN, WohlgemuthWA, PreglerB, WiggermannP, et al.Evaluation of dynamic effects of therapy-induced changes in microcirculation after percutaneous treatment of vascular malformations using contrast-enhanced ultrasound (CEUS) and time intensity curve (TIC) analyses. Clin Hemorheol Microcirc [Internet]. 2018 May 4 [cited 2019 Aug 18];69(1-2):45–57. Available from: http://www.medra.org/servlet/aliasResolver?alias=iospress&doi=10.3233/CH-189118
8.
SidhuP, CantisaniV, DietrichC, GiljaO, SaftoiuA, BartelsE, et al.The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version). Ultraschall der Medizin - Eur J Ultrasound [Internet]. 2018 Apr 6 [cited 2019 Jul 21];39(02):e2℃44. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29510439
9.
SchellhaasB, WildnerD, PfeiferL, GoertzR, HagelA, NeurathM, et al.LI-RADS-CEUS – Proposal for a Contrast-Enhanced Ultrasound Algorithm for the Diagnosis of Hepatocellular Carcinoma in High-Risk Populations. Ultraschall der Medizin - Eur J Ultrasound [Internet]. 2016 Aug 3 [cited 2019 Jun 8];37(06):627–34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27486793
10.
KonoY, LyshchikA, CosgroveD, DietrichC, JangH-J, KimT, et al.Contrast Enhanced Ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS®): The official version by the American College of Radiology (ACR). Ultraschall der Medizin - Eur J Ultrasound [Internet]. 2017 Mar 1 [cited 2019 Jun 8];38(01):85–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28249328
11.
PiscagliaF, WilsonS, LyshchikA, CosgroveD, DietrichC, JangH-J, et al.American College of Radiology Contrast Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) for the diagnosis of Hepatocellular Carcinoma: A pictorial essay. Ultraschall der Medizin - Eur J Ultrasound [Internet]. 2017 Jun 22 [cited 2019 Jun 8];38(03):320–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28329875
12.
StrobelD, SchellhaasB. Letter to the Editor on “LI-RADS-CEUS – Proposal for a Contrast-Enhanced Ultrasound Algorithm for the Diagnosis of Hepatocellular Carcinoma in High-Risk Populations”. Ultraschall in Med. 2016;37:627–634. Ultraschall der Medizin - Eur J Ultrasound [Internet]. 2017 Mar 1 [cited 2019 Jun 8];38(01):87. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28249329
13.
BeyerL, WassermannF, PreglerB, MichalikK, RennertJ, WiesingerI, et al.Characterization of Focal Liver Lesions using CEUS and MRI with Liver-Specific Contrast Media: Experience of a Single Radiologic Center. Ultraschall der Medizin - Eur J Ultrasound [Internet]. 2017 Dec 6 [cited 2019 Jul 21];38(06):619–25. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29108077
14.
SeitzK, GreisC, SchulerA, BernatikT, BlankW, DietrichC, et al.Frequency of Tumor Entities among Liver Tumors of Unclear Etiology Initially Detected by Sonography in the Noncirrhotic or Cirrhotic Livers of 1349 Patients. Ultraschall der Medizin - Eur J Ultrasound [Internet]. 2011 Dec 9 [cited 2019 Jun 8];32(06):598–603. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22161557
15.
MaXH, WangS, ZhaoXM, OuyangH, WangM, ZhuYJ, et al.[The quantitative analysis of MR dynamic contrast-enhangced imaging on efficacy and prognosis of transcatheter arterial chemoembolization on hepatocellular carcinoma]. Zhonghua Zhong Liu Za Zhi [Internet]. 2017 Sep 23 [cited 2019 Aug 3];39(9):689–94. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28926899
16.
JiangT, XuJH, ZouY, ChenR, PengLR, ZhouZD, et al.Diffusion-weighted imaging (DWI) of hepatocellular carcinomas: A retrospective analysis of the correlation between qualitative and quantitative DWI and tumour grade. Clin Radiol [Internet]. 2017 Jun [cited 2019 Aug 3];72(6):465–72. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28109531
17.
WiesingerI, WiggermannP, ZausigN, BeyerL, SalzbergerB, StroszczynskiC, et al.Percutaneous Treatment of Malignant Liver Lesions: Evaluation of Success Using Contrast- Enhanced Ultrasound (CEUS) and Perfusion Software. Ultraschall der Medizin - Eur J Ultrasound [Internet]. 2018 Aug 25 [cited 2019 Jul 21];39(04):440–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28946152
18.
WiesingerI, BeyerLP, ZausigN, VerlohN, WiggermannP, StroszczynskiC, et al.Evaluation of integrated color-coded perfusion analysis for contrast-enhanced ultrasound (CEUS) after percutaneous interventions for malignant liver lesions: First results. Clin Hemorheol Microcirc [Internet]. 2018 May 5 [cited 2019 Jul 21];69(1-2):59–67. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29758936
19.
JungEM, ClevertDA. Kontrastmittelsonographie (CEUS) und Bildfusion zur Durchführung von Leberinterventionen. Radiologe [Internet]. 2018 Jun 24 [cited 2019 Jul 21];58(6):538℃44. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29797043
20.
da SilvaN, HornungM, BeyerL, HacklC, BrunnerS, SchlittH, et al.Intraoperative Shear Wave Elastography vs. Contrast-Enhanced Ultrasound for the Characterization and Differentiation of Focal Liver Lesions to Optimize Liver Tumor Surgery. Ultraschall der Medizin - Eur J Ultrasound [Internet]. 2019 Apr 19 [cited 2019 Jul 21];40(02):205–11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30340245
21.
KondoS, TakagiK, NishidaM, IwaiT, KudoY, OgawaK, et al.Computer-Aided Diagnosis of Focal Liver Lesions Using Contrast-Enhanced UltrasonographyWith Perflubutane Microbubbles. IEEE Trans Med Imaging [Internet]. 2017 Jul [cited 2019 Aug 3];36(7):1427–37. Available from: http://ieeexplore.ieee.org/document/7835111/
