Merrill Christina, Samuel Anna, Gupta Saransh, Wilson Stephanie R
Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Medicine, Division of Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
J Ultrasound Med. 2023 Nov;42(11):2603-2614. doi: 10.1002/jum.16296. Epub 2023 Jul 4.
In high-BMI patients with and without fatty liver, we evaluate performance of a commercially available specially designed ultrasound probe (SDP) for scanning at depth. Greyscale and contrast-enhanced ultrasound (CEUS) capability of SDP for parenchymal assessment and liver mass characterization, emphasizing HCC, is compared with standard curvilinear probes.
This retrospective study included 60 patients. Fifty-five with measured BMI included 46/55 (84%) overweight or obese, and 9/55(16%) in the normal range with severe fatty liver. Fifty-six patients with focal liver abnormality included 37 with a mass and 19 with post-ablative treatment site. Masses included 23 confirmed malignancies, 15 HCC, 4 ICC, and 4 metastases. SDP followed suboptimal ultrasound using a standard probe. Images with varying fat content were compared for depth of penetration on greyscale and ability of CEUS to diagnose tumors.
SDP showed statistically significant improvement P = <.05 in CEUS penetration for all degrees of fatty liver (mild, moderate, and severe). In malignant tumors, SDP improved detection of lesion washout in the portal venous/late phase (PVP/LP) at depth >10 cm, and in all malignant masses (P < .05). Fifteen confirmed deep HCC showed arterial phase hyperenhancement on standard probe in 10/15 (67%) and 15/15 (100%) on SDP. PVP/LP washout on standard probe was shown in 4/15 (26%) and on SDP, 14/15, (93%). Therefore, 93% of LR-5 tumors were diagnosed with SDP. Removing necessity for biopsy.
Metabolic syndrome and obesity challenge ultrasound, especially CEUS. SDP overcame limitations of standard probes for CEUS penetration especially in fatty liver. SDP was optimal for the liver mass characterization by detecting washout.
在高体重指数（BMI）且伴有或不伴有脂肪肝的患者中，我们评估一种市售的专门设计的超声探头（SDP）在深度扫描方面的性能。将SDP用于实质评估和肝脏肿块特征描述（重点是肝细胞癌（HCC））的灰阶及对比增强超声（CEUS）能力与标准曲线探头进行比较。
这项回顾性研究纳入了60例患者。55例测量了BMI的患者中，46/55（84%）超重或肥胖，9/55（16%）BMI在正常范围但患有重度脂肪肝。56例有肝脏局灶性异常的患者中，37例有肿块，19例为消融治疗后的部位。肿块包括23例确诊的恶性肿瘤，15例HCC，4例肝内胆管癌（ICC）和4例转移瘤。SDP在使用标准探头进行次优超声检查后使用。比较不同脂肪含量的图像在灰阶上的穿透深度以及CEUS诊断肿瘤的能力。
SDP在所有程度的脂肪肝（轻度、中度和重度）的CEUS穿透方面显示出统计学上的显著改善（P = <.05）。在恶性肿瘤中，SDP改善了深度>10 cm时门静脉/晚期（PVP/LP）病变消退的检测，在所有恶性肿块中也是如此（P <.05）。15例确诊的深部HCC在标准探头上动脉期表现为高增强的有10/15（67%），在SDP上为15/15（100%）。标准探头上PVP/LP消退的有4/15（26%），在SDP上为14/15（93%）。因此，93%的LR-5肿瘤用SDP得以诊断，无需活检。
代谢综合征和肥胖对超声检查，尤其是CEUS构成挑战。SDP克服了标准探头在CEUS穿透方面的局限性，尤其是在脂肪肝中。SDP通过检测消退情况对肝脏肿块特征描述最为理想。
