Download PDF
Z Gastroenterol 2017; 55(08): 748-753
DOI: 10.1055/s-0043-114672
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Contrast-enhanced ultrasound features of hepatocellular carcinoma not detected during the screening procedure

Kontrastmittelsonografische Charakterisierung von hepatozellulären Karzinomen, die während der Screeninguntersuchung nicht detektiert wurden
Yi Dong
1   Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
2   Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
,
Wen-Ping Wang
1   Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
,
Feng Mao
1   Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
,
Christoph Dietrich
2   Medizinische Klinik 2, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
3   Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
› Author Affiliations
Further Information

Publication History

27 September 2016

16 June 2017

Publication Date:
10 August 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Aim The aim of this retrospective study is to report on the characteristics of contrast-enhanced ultrasound (CEUS) of primarily not detected hepatocellular carcinoma (HCC) during the screening procedure of patients at risk.

Methods Sixty-four patients with a finally solitary and histologically proven HCC not detected HCC during the screening procedure were retrospectively analyzed. Most of HCC lesions (90.6 %, 58/64) measured < 20 mm in diameter. All HCC lesions were not detected during the initial screening procedure but suspected using contrast-enhanced magnetic resonance imaging. The final gold standard was biopsy or surgery with histological examination.

Results On CEUS, 62/64 (96.8 %) of HCC were characterized as an obviously hyperenhanced lesion in arterial phase, and 41/64 (64.1 %) of HCC were characterized as hypoenhancing lesions in the portal venous and late phases. During the arterial phase of CEUS, 96.8 % of HCC displayed homogeneous hyperenhancement. Knowing the CEUS and magnetic resonance imaging findings, 45/64 (70.3 %) could have been detected using B-mode ultrasound (BMUS).

Conclusion BMUS as a screening procedure is generally accepted. Contrast-enhanced imaging modalities have improved detection and characterization of HCC. Homogeneous hyperenhancement during the arterial phase and mild washout are indicative for HCC in liver cirrhosis.

Zusammenfassung

Ziel Ziel dieser retrospektiven Studie ist die Charakterisierung von hepatozellulären Karzinomen (HCCs), die bei sonografischen Screening-Untersuchungen übersehen wurden. Die kontrastmittelsonografischen (CEUS) Charakteristika dieser im Screening nicht detektierten Läsionen wurden bisher nicht analysiert und sind Inhalt dieser Studie.

Methoden 64 Patienten mit solitären und histologisch gesicherten HCCs wurden retrospektiv analysiert. Die meisten dieser Läsionen waren < 20 mm 58/64 (90,6 %). Die Läsionen wurden mittels kontrastverstärkter Magnetresonanztomografie (ceMRT) vermutet und letztendlich operativ-histologisch gesichert.

Ergebnisse Die CEUS-Charakteristika der HCCs waren die homogene arterielle Mehranreicherung bei 62/64 (96,8 %) und die portalvenöse Minderanreicherung (washout) bei 41/64 (64,1 %). Die erneute B-Bild-Sonografie erlaubte unter Kenntnis des MRT- und CEUS-Befundes bei 45/64 (70,3 %) die Zuordnung nunmehr auch im B-Bild.

Schlussfolgerung Die B-Bild-Sonografie ist zum Screening von HCCs etabliert. CEUS erlaubt die verbesserte Detektion und Charakterisierung von Leberknoten in der Leberzirrhose. Die typischen Kontrastmittelcharakteristika sind einerseits die arterielle Mehranreicherung und andererseits das milde Washout.

Key words

guidelines - screening - hepatocellular carcinoma (HCC) - contrast-enhanced ultrasound (CEUS) - LI-RADS

Schlüsselwörter

Leitlinien - Screening - hepatozelluläres Karzinom (HCC) - Kontrastmittelsonografie - LI-RADS
 

  • References

  • 1 European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012; 56: 908-943
    CrossrefPubMedGoogle Scholar
  • 2 Claudon M, Dietrich CF, Choi BI. et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver – update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol 2013; 39: 187-210
    CrossrefPubMedGoogle Scholar
  • 3 Claudon M, Dietrich CF, Choi BI. et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall in Med 2013; 34: 11-29
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Singal A, Volk ML, Waljee A. et al. Meta-analysis: surveillance with ultrasound for early-stage hepatocellular carcinoma in patients with cirrhosis. Aliment Pharmacol Ther 2009; 30: 37-47
    CrossrefPubMedGoogle Scholar
  • 5 Fröhlich E, Jenssen C, Schuler A. et al. Contrast-enhanced ultrasound for characterisation of focal liver lesions, practical advice. Z Gastroenterol 2015; 53: 1099-1107
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Chiorean L, Tana C, Braden B. et al. Advantages and limitations of focal liver lesion assessment with ultrasound contrast agents: comments on the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Guidelines. Med Princ Pract 2016; 25: 399-407
    CrossrefPubMedGoogle Scholar
  • 7 Chiorean L, Cantisani V, Jenssen C. et al. Focal masses in a non-cirrhotic liver: the additional benefit of CEUS over baseline imaging. Eur J Radiol 2015; 84: 1636-1643
    CrossrefPubMedGoogle Scholar
  • 8 Dietrich CF, Sharma M, Gibson RN. et al. Fortuitously discovered liver lesions. World J Gastroenterol 2013; 19: 3173-3188
    CrossrefPubMedGoogle Scholar
  • 9 Jang HJ, Kim TK, Burns PN. et al. CEUS: an essential component in a multimodality approach to small nodules in patients at high-risk for hepatocellular carcinoma. Eur J Radiol 2015; 84: 1623-1635
    CrossrefPubMedGoogle Scholar
  • 10 Dietrich CF, Cui XW, Boozari B. et al. Contrast-enhanced ultrasound (CEUS) in the diagnostic algorithm of hepatocellular and cholangiocellular carcinoma, comments on the AASLD guidelines. Ultraschall in Med 2012; 33: S57-S66
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Seitz K, Strobel D, Bernatik T. 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 in Med 2009; 30: 383-389
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Dietrich CF, Cui XW, Schreiber-Dietrich DG. et al. EFSUMB guidelines 2011: comments and illustrations. Ultraschall in Med 2012; 33: S11-S21
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Ignee A, Weiper D, Schuessler G. et al. Sonographic characterisation of hepatocellular carcinoma at time of diagnosis. Z Gastroenterol 2005; 43: 289-294
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Dietrich CF, Ignee A, Trojan J. et al. Improved characterization of histologically proven liver tumours by contrast enhanced ultrasonography during the portal venous and specific late phase of SHU 508A. Gut 2004; 53: 401-405
    CrossrefPubMedGoogle Scholar
  • 15 Forner A, Vilana R, Ayuso C. et al. Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology 2008; 47: 97-104
    PubMedGoogle Scholar
  • 16 Dong Y, Wang WP, Gan YH. et al. Radiofrequency ablation guided by contrast-enhanced ultrasound for hepatic malignancies: preliminary results. Clin Radiol 2014; 69: 1129-1135
    CrossrefPubMedGoogle Scholar
  • 17 Sherman M. Hepatocellular carcinoma: epidemiology, surveillance, and diagnosis. Semin Liver Dis 2010; 30: 3-16
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet 2012; 379: 1245-1255
    CrossrefPubMedGoogle Scholar
  • 19 Park YN, Kim MJ. Hepatocarcinogenesis: imaging-pathologic correlation. Abdom Imaging 2011; 36: 232-243
    CrossrefPubMedGoogle Scholar
  • 20 Strobel D, Bernatik T, Blank W. et al. Diagnostic accuracy of CEUS in the differential diagnosis of small (≤20mm) and subcentimetric (≤10mm) focal liver lesions in comparison with histology results of the DEGUM multicenter trial. Ultraschall in Med 2011; 32: 593-597
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Cantisani V, David E, Meloni FM. et al. Recall strategies for patients found to have a nodule in cirrhosis: is there still a role for CEUS?. Med Ultrason 2015; 17: 515-520
    PubMedGoogle Scholar
  • 22 Furlana A, Marinb D, Cabassad P. et al. Enhancement pattern of small hepatocellular carcinoma (HCC) at contrast-enhanced US (CEUS), MDCT, and MRI: intermodality agreement and comparison of diagnostic sensitivity between 2005 and 2010 American Association for the Study of Liver Diseases (AASLD) guidelines. Eur J Radiol 2012; 81: 2099-2105
    CrossrefPubMedGoogle Scholar
  • 23 Dietrich CF, Maddalena ME, Cui XW. et al. Liver tumor characterization – review of the literature. Ultraschall in Med 2012; 33: S3-S10
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Dietrich CF. Liver tumor characterization-comments and illustrations regarding guidelines. Ultraschall in Med 2012; 33: S22-S30
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Dietrich CF, Ignee A, Greis C. et al. Artifacts and pitfalls in contrast-enhanced ultrasound of the liver. Ultraschall in Med 2014; 35: 108-125
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Dietrich CF. Comments and illustrations regarding the guidelines and good clinical practice recommendations for contrast-enhanced ultrasound – update 2008. Ultraschall in Med 2008; 29: 188-202
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Jang HJ, Kim TK, Burns PN. et al. Enhancement patterns of hepatocellular carcinoma at contrast-enhanced US: comparison with histologic differentiation. Radiology 2007; 244: 898-906
    CrossrefPubMedGoogle Scholar
  • 28 Sangiovanni A, Manini MA, Iavarone M. et al. The diagnostic and economic impact of contrast imaging techniques in the diagnosis of small hepatocellular carcinoma in cirrhosis. Gut 2010; 59: 638-644
    CrossrefPubMedGoogle Scholar
  • 29 D’Onofrio M, Crosara S, Robertis RD. et al. Contrast-enhanced ultrasound of focal liver lesions. Am J Roentgenol 2015; 205: W56-W66
    CrossrefPubMedGoogle Scholar
  • 30 Leoni S, Piscaglia F, Golfieri R. et al. The impact of vascular and nonvascular findings on the noninvasive diagnosis of small hepatocellular carcinoma based on the EASL and AASLD criteria. Am J Gastroenterol 2010; 105: 599-609
    CrossrefPubMedGoogle Scholar
  • 31 Strobel D, Kleinecke C, Hänsler J. et al. Contrast-enhanced sonography for the characterisation of hepatocellular carcinomas--correlation with histological differentiation. Ultraschall in Med 2005; 26: 270-276
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Barreiros AP, Piscaglia F, Dietrich CF. Contrast enhanced ultrasound for the diagnosis of hepatocellular carcinoma (HCC): comments on AASLD guidelines. J Hepatol 2012; 57: 930-932
    CrossrefPubMedGoogle Scholar
  • 33 Piscaglia F, Cucchetti A, Dietrich CF. et al. Towards new tools for refined management of patients with advanced hepatocellular carcinoma under systemic therapy: some enthusiasm with a word of caution. J Hepatol 2013; 59: 924-925
    CrossrefPubMedGoogle Scholar
  • 34 Cantisani V, David E, Meloni FM. et al. Recall strategies for patients found to have a nodule in cirrhosis: is there still a role for CEUS?. Med Ultrason 2015; 17: 515-520
    PubMedGoogle Scholar
  • 35 Meloni MF, Galimberti S, Dietrich CF. et al. Microwave ablation of hepatic tumors with a third generation system: locoregional efficacy in a prospective cohort study with intermediate term follow-up. Z Gastroenterol 2016; 54: 541-547
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Bernatik T, Seitz K, Blank W. et al. Unclear focal liver lesions in contrast-enhanced ultrasonography--lessons to be learned from the DEGUM multicenter study for the characterization of liver tumors. Ultraschall in Med 2010; 31: 577-581
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Dong Y, Zhang XL, Mao F. et al. Contrast-enhanced ultrasound features of histologically proven small (≤20 mm) liver metastases. Scand J Gastroenterol 2017; 52: 23-28
    CrossrefPubMedGoogle Scholar