Laroia Shalini Thapar, Bawa Simranjeet Singh, Jain Deepak, Mukund Amar, Sarin Shiv
Shalini Thapar Laroia, Simranjeet Singh Bawa, Department of Radiodiagnosis, Institute of Liver and Biliary Sciences, New Delhi 110070, India.
World J Radiol. 2013 Jun 28;5(6):229-40. doi: 10.4329/wjr.v5.i6.229.
To assess the role of contrast enhanced ultrasonography in evaluation of hepatocellular carcinoma (HCC) at the first Indian tertiary liver center.
Retrospective analysis of contrast enhanced ultrasound (CEUS) examinations over 24 mo for diagnosis, surveillance, characterization and follow up of 50 patients in the context of HCC was performed. The source and indication of referrals, change in referral rate, accuracy and usefulness of CEUS in a tertiary liver center equipped with a 64 slice dual energy computer tomography (CT) and 3 tesla magnetic resonance imaging (MRI) were studied. Sonovue (BR1, Bracco, Italy, a second generation contrast agent) was used for contrast US studies. Contrast enhanced CT/MRI or both were performed in all patients. The findings were taken as a baseline reference and correlation was done with respect to contrast US. Contrast enhanced MRI was performed using hepatocyte specific gadobenate dimeglumine (Gd-BOPTA). Iomeron (400 mg; w/v) was used for dynamic CT examinations.
About 20 (40%) of the examinations were referred from clinicians for characterization of a mass from previous imaging. About 15 (30%) were performed for surveillance in chronic liver disease; 5 (10%) examinations were performed for monitoring lesions after radiofrequency ablation (RFA); 3 (6%) were post trans-arterial chemo-embolization (TACE) assessments and 3 (6%) were patients with h/o iodinated contrast allergy. About 2 (4%) were performed on hemodynamically unstable patients in the intensive care with raised alpha fetoprotein and 2 (4%) patients were claustrophobic. The number of patients referred from clinicians steadily increased from 12 in the first 12 mo of the study to 38 in the last 12 mo. CEUS was able to diagnose 88% of positive cases of HCC as per reference standards. In the surveillance group, specificity was 53.3% vs 100% by CT/MRI. Post RFA and TACE specificity of lesion characterization by CEUS was 100% in single/large mass assessment, similar to CT/MRI. For non HCC lesions such as regenerative and dysplastic nodules, the specificity was 50% vs 90% by CT/MRI. The positive role of CEUS in imaging spectrum of HCC included a provisional urgent diagnosis of an incidentally detected mass. It further led to a decrease in time for further management. A confident diagnosis on CEUS was possible in cases of characterization of an indeterminate mass, in situations where the patient was unfit for CT/MRI, was allergic to iodinated contrast or had claustrophobia, etc. CEUS was also cost effective, radiation free and an easy modality for monitoring post RFA or TACE lesions.
CEUS is a valuable augmentation to the practice of ultrasonography, and an irreplaceable modality for confounding cases and interpretation of indeterminate lesions in imaging of HCC.
在印度首个三级肝脏中心评估超声造影在肝细胞癌（HCC）评估中的作用。
对24个月内50例HCC患者进行超声造影（CEUS）检查的回顾性分析，以用于诊断、监测、特征描述及随访。研究了转诊的来源和指征、转诊率的变化、CEUS在配备64层双能计算机断层扫描（CT）和3特斯拉磁共振成像（MRI）的三级肝脏中心的准确性和实用性。使用声诺维（BR1，意大利博莱科公司，第二代造影剂）进行超声造影研究。所有患者均进行了增强CT/MRI或两者检查。将这些检查结果作为基线参考，并与超声造影结果进行相关性分析。使用肝细胞特异性钆贝葡胺（Gd - BOPTA）进行增强MRI检查。使用碘海醇（400 mg；w/v）进行动态CT检查。
约20例（40%）检查由临床医生转诊，目的是对先前影像学检查发现的肿块进行特征描述。约15例（30%）用于慢性肝病的监测；5例（10%）检查用于射频消融（RFA）后病变的监测；3例（6%）为经动脉化疗栓塞（TACE）后评估，3例（6%）为有碘造影剂过敏史的患者。约2例（4%）是对重症监护病房中血流动力学不稳定且甲胎蛋白升高的患者进行的检查，2例（4%）患者有幽闭恐惧症。临床医生转诊的患者数量从研究前12个月的12例稳步增加到最后12个月的38例。根据参考标准，CEUS能够诊断出88%的HCC阳性病例。在监测组中，CEUS的特异性为53.3%，而CT/MRI为100%。在RFA和TACE后，CEUS对单个/大肿块病变特征描述的特异性在单/大肿块评估中为100%，与CT/MRI相似。对于非HCC病变，如再生结节和发育异常结节，CEUS的特异性为50%，而CT/MRI为90%。CEUS在HCC成像谱中的积极作用包括对偶然发现的肿块进行初步紧急诊断。这进一步缩短了进一步治疗的时间。在对不确定肿块进行特征描述的情况下，当患者不适合进行CT/MRI检查、对碘造影剂过敏或有幽闭恐惧症等情况时，CEUS能够做出可靠诊断。CEUS也是具有成本效益的、无辐射的，并且是监测RFA或TACE后病变的简便方法。
CEUS是超声检查实践的一项有价值的补充，并且是HCC成像中疑难病例和不确定病变解读中不可替代的检查方法。
