Lisotti Andrea, Serrani Marta, Caletti Giancarlo, Fusaroli Pietro
Department of Medical and Surgical Sciences, Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy.
Endosc Ultrasound. 2018 Jul-Aug;7(4):252-256. doi: 10.4103/eus.eus_29_18.
Transabdominal-US is the first-line imaging modality used to assess the whole liver parenchyma and vascularization; EUS assessment of the liver is incomplete and is not sufficient to rule out the presence of focal liver lesions. On the other hand, due the high diagnostic yield in detecting very small (< 1 cm) lesions, EUS is considered complementary to radiological imaging techniques for the investigation of liver parenchyma. Scarce data are available regarding the investigation of liver parenchyma using both EUS-elastography (EUS-E) and CH-EUS. The aim of this review is to evaluate the clinical role of image enhancement techniques, namely EUS-E and contrast harmonic-EUS (CH-EUS), for the evaluation liver diseases. Despite a potential interest for the application of EUS-E in the assessment of liver diseases, available evidence relegates this technique only to research areas, such as the differential diagnosis between benign and malignant focal liver lesions and the quantification of liver fibrosis in diffuse parenchymal diseases. With the future introduction of EUS shear-wave elastography, interesting data can be obtained for the assessment of liver fibrosis during real-time EUS evaluation. The usefulness of CH-EUS for the evaluation of liver disease is limited by the intrinsic EUS ability to explore only the left lobe and a small part of the right lobe. CH-EUS could be used to increase the diagnostic ability of EUS for the detection and characterization of small lesions and for guiding tissue sampling. Targeting EUS-guided treatments with either EUS-E or CH-EUS might represent potential future applications.
经腹超声是用于评估整个肝实质和血管化的一线成像方式；超声内镜对肝脏的评估不完整，不足以排除肝脏局灶性病变的存在。另一方面，由于超声内镜在检测非常小（<1cm）的病变方面具有较高的诊断率，因此在肝实质检查中被认为是放射成像技术的补充。关于同时使用超声内镜弹性成像（EUS-E）和对比谐波超声内镜（CH-EUS）对肝实质进行检查的数据较少。本综述的目的是评估图像增强技术，即EUS-E和对比谐波超声内镜（CH-EUS）在评估肝脏疾病中的临床作用。尽管EUS-E在肝脏疾病评估中的应用可能具有一定价值，但现有证据仅将该技术局限于研究领域，如肝脏局灶性病变的良恶性鉴别诊断以及弥漫性实质疾病中肝纤维化的量化。随着超声内镜剪切波弹性成像技术的未来引入，在实时超声内镜评估过程中可获得有关肝纤维化评估的有趣数据。CH-EUS对肝脏疾病评估的有用性受到超声内镜本身仅能探查左叶和右叶一小部分的限制。CH-EUS可用于提高超声内镜对小病变的检测和特征描述能力以及引导组织采样。使用EUS-E或CH-EUS靶向超声内镜引导治疗可能代表未来的潜在应用。
