ICUS Weekly News Monitor 2-27-2015

1.  Journal of Ultrasound in Medicine,  Mar 1, 2015,  Real-time Contrast-Enhanced Sonographically Guided Biopsy or Radiofrequency Ablation of Focal Liver Lesions Using Perflurobutane Microbubbles (Sonazoid); Value of Kupffer-Phase Imaging
Authors: Hee Sun Park, MD, et al
 
2.  Journal of Ultrasound in Medicine,  Mar 1, 2015,  Diagnosis of Hepatocellular Carcinoma Nodules in Patients With Chronic Liver Disease Using Contrast-Enhanced Sonography; Usefulness of the Combination of Arterial- and Kupffer-Phase Enhancement Patterns
Authors: Kunio Suzuki, MD, PhD, et al
 
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Journal of Ultrasound in Medicine
doi: 10.7863/ultra.34.3.411   JUM March 1, 2015   vol. 34  no. 3  411-421
Mar 1, 2015
 
Real-time Contrast-Enhanced Sonographically Guided Biopsy or Radiofrequency Ablation of Focal Liver Lesions Using Perflurobutane Microbubbles (Sonazoid)
Value of Kupffer-Phase Imaging
 
Authors: Hee Sun Park, MD, Young Jun Kim, MD⇑, Mi Hye Yu, MD, Sung Il Jung, MD and Hae Jeong Jeon, MD
Author Affiliations: Department of Radiology, Konkuk University School of Medicine, Seoul, Korea.
 
Address correspondence to Young Jun Kim, MD, Department of Radiology, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 143-729, Korea. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 
Abstract
 
Objectives—To evaluate the utility of Kupffer-phase imaging by real-time contrast-enhanced sonography using the perflurobutane microbubble contrast agent Sonazoid (GE Healthcare, Oslo, Norway) in guiding biopsy or radiofrequency (RF) ablation of focal liver lesions.
 
Methods—A total of 75 patients (mean age, 59.7 years) who were referred for percutaneous biopsy (n = 42) or RF ablation (n = 33) were included in the study. Grayscale sonography and contrast-enhanced sonography using Sonazoid were performed in all patients before the procedure. The conspicuity of each targeted liver lesion on grayscale sonography, vascular-phase contrast-enhanced sonography, and Kupffer-phase contrast-enhanced sonography was graded using a 5-point scale. Lesion detection rates were calculated, and the conspicuity of the lesions among the imaging modalities was compared. The technical success of the procedures was also assessed.
 
Results—The procedures were conducted in 66 patients (biopsy in 41 and RF ablation in 25) under real-time guidance by Kupffer-phase contrast-enhanced sonography. Lesion detection rates were 77.3% (58 of 75), 84.0% (63 of 75), and 92.0% (69 of 75) on grayscale sonography, vascular-phase contrast-enhanced sonography, and Kupffer-phase contrast-enhanced sonography, respectively, and were significantly different among the 3 modalities (P= .034). Overall, lesion conspicuity was significantly increased on vascular-phase and Kupffer-phase contrast-enhanced sonography compared to grayscale sonography (P < .001). Technical success rates for the procedures were 95.2% (40 of 42) for biopsy and 69.7% (23 of 33) for RF ablation.
 
Conclusions—Kupffer-phase imaging by contrast-enhanced sonography using Sonazoid increases the conspicuity of the liver lesions compared to grayscale sonography, and it is useful for real-time guidance of percutaneous biopsy or RF ablation of focal liver lesions.
 
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Journal of Ultrasound in Medicine
doi: 10.7863/ultra.34.3.423   JUM March 1, 2015   vol. 34  no. 3  423-433
Mar 1, 2015
 
Diagnosis of Hepatocellular Carcinoma Nodules in Patients With Chronic Liver Disease Using Contrast-Enhanced Sonography
Usefulness of the Combination of Arterial- and Kupffer-Phase Enhancement Patterns
 
Authors: Kunio Suzuki, MD, PhD⇑, Yorihide Okuda, MD, PhD, Makiyo Ota, MD, Fumiyoshi Kojima, MD, PhD and Masayoshi Horimoto, MD, PhD
Author Affiliations: Departments of Gastroenterology (K.S., Y.O., M.O., M.H.) and Pathology (F.K.), Saiseikai Senri Hospital, Osaka, Japan.
 
Address correspondence to Kunio Suzuki, MD, PhD, Department of Gastroenterology, Saiseikai Senri Hospital, 1-1-6 Tsukumodai, Suita, Osaka 565-0862, Japan. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 
Abstract
 
Objectives—To determine the usefulness of contrast-enhanced sonography using the perfluorobutane contrast agent Sonazoid (Daiichi-Sankyo, Tokyo, Japan) for establishing the diagnosis and cellular differentiation of hepatocellular carcinoma in patients with chronic liver disease.
 
Methods—Patients with chronic liver disease in whom hepatic nodules were detected during screening for hepatocellular carcinoma were examined by imaging modalities, including contrast-enhanced computed tomography (CT), contrast-enhanced sonography, and contrast-enhanced magnetic resonance imaging. Nodules with negative imaging findings were further investigated with core biopsy or followed at our hospital. Between April 2007 and March 2011, all patients with hepatic nodules who underwent core biopsy of the nodules or hepatic resection for hepatocellular carcinoma were reviewed. Fifty-nine nodules from 47 patients with 42 contrast-enhanced sonographic findings and 41 contrast-enhanced CT findings were examined. Arterial- and Kupffer-phase enhancement patterns of the nodules on contrast-enhanced sonography were compared with the diagnosis and cellular differentiation of hepatocellular carcinoma. Arterial- and late-phase enhancement patterns on contrast-enhanced CT were also compared with histologic findings.
 
Results—The combination of hyperenhancement in the arterial phase and hypoenhancement in the Kupffer phase on contrast-enhanced sonography (n = 11) correlated with moderately differentiated hepatocellular carcinoma (P = .0028, Fisher exact test). The combination of hypoenhancement in the arterial phase and isoenhancement in the Kupffer phase on contrast-enhanced sonography (n = 14) correlated with well-differentiated hepatocellular carcinoma (P = .0006, Fisher exact test). The combination of high density in the arterial phase and low density in the late phase on contrast-enhanced CT (n = 21) correlated with moderately differentiated hepatocellular carcinoma (P = .0059, Fisher exact test), but no enhancement pattern combination on contrast-enhanced CT correlated with well-differentiated hepatocellular carcinoma.
 
Conclusions—Sonazoid contrast-enhanced sonography is useful for diagnosis of well-differentiated hepatocellular carcinoma.

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