Diagnostic accuracy of diffusion weighted MRI in differentiating malignant from benign liver lesions taking histopathology as gold standard.

Objective: To determine the diagnostic accuracy of Diffusion Weighted MRI in differentiating malignant from benign liver lesions taking histopathology as gold standard. Methods: This Cross-sectional study was conducted at Departments of Radiology and Medicine, JPMC, Karachi from February 23, 2019 till September 25, 2019. Data was prospectively collected from patients after taking consent. One hundred twenty five patients presenting with hepatic mass who met the inclusion criteria were included. Quantitative data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables as frequency and percentages. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were calculated. P-value of ≤0.05 was considered as significant. Results: Mean age in our study was 59.75±8.57 years. Total 71 (56.8%) were male and 54 (43.2%) were female. Out of 125 patients, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of DW MRI for the diagnosis of malignant focal liver lesion by taking histopathology as gold standard was found to be 92.3%, 93.6%, 96%, 88% and 92.8% respectively. Conclusion: DW MRI scan has high diagnostic accuracy and being accurate in making a diagnosis and differentiation of benign from malignant focal liver lesion would decrease need of invasive modality of histopathology.

MRI of Peliosis Hepatis: A Case Series Presentation With a 2022 Systematic Literature Update.

BACKGROUND: Peliosis hepatis (PH) is a rare benign condition, characterized by hepatic sinusoidal dilatation and blood-filled cystic cavities, often found incidentally, with still challenging diagnosis by imaging due to polymorphic appearance. PURPOSE: Based on a retrospective analysis of our series (12 patients) and systematic literature review (1990-2022), to organize data about PH and identify features to improve characterization. STUDY TYPE: Retrospective case series and systematic review. POPULATION: Twelve patients (mean age 48 years, 55% female) with pathology-proven PH and 49 patients (mean age 52 years, 67% female) identified in 33 studies from the literature (1990-2022). FIELD STRENGTH/SEQUENCE: 1,5-T; T1-weighted (T1W), T2-weighted (T2W), diffusion-weighted (DW), contrast-enhanced (CE) T1W imaging. ASSESSMENT: We compared our series and literature data in terms of demographic (gender/age/ethnicity), clinical characteristics (symptoms/physical examination/liver test), associated conditions (malignancies/infectious/hematologic/genetic or chronic disorders/drugs or toxic exposure) percentage. On magnetic resonance imaging lesion numbers/shape/mean maximum diameter/location/mass effect/signal intensity were compared. PH pathological type/proposed imaging diagnosis/patient follow-up were also considered. STATISTICAL TESTS: Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports/Series quality assessment. Intraclass correlation and Cohen's kappa coefficients for levels of inter/intrareader agreement in our experience. RESULTS: Patients were mainly asymptomatic (92% vs. 70% in our study and literature) with associated conditions (83% vs. 80%). Lesions showed homogeneous T1W-hypointensity (58% vs. 65%) and T2W-hyperintensity (58% vs. 66%). Heterogeneous nonspecific (25% vs. 51%), centrifugal (34% vs. 8%), or rim-like centripetal (25% vs. 23%) patterns of enhancement were most frequent, with hypointensity on the hepatobiliary phase (HBP), without restricted diffusivity. Good inter- and intrareader agreement was observed in our experience. Concerning JBI Checklist, 19 out of 31 case reports met at least 7 out of 8 criteria, whereas 2 case series fulfilled 5 and 6 out of 10 items respectively. DATA CONCLUSION: A homogeneous, not well-demarcated T1W-hypointense and T2W-hyperintense mass, with heterogeneous nonspecific or rim-like centripetal or centrifugal pattern of enhancement, and hypointensity on HBP, may be helpful for PH diagnosis. Among associated conditions, malignancies and drug exposures were the most frequent. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 2.

Shear-wave elastography combined with contrast-enhanced ultrasound algorithm for noninvasive characterization of focal liver lesions.

PURPOSE: To establish shear-wave elastography (SWE) combined with contrast-enhanced ultrasound (CEUS) algorithm (SCCA) and improve the diagnostic performance in differentiating focal liver lesions (FLLs). MATERIAL AND METHODS: We retrospectively selected patients with FLLs between January 2018 and December 2019 at the First Affiliated Hospital of Sun Yat-sen University. Histopathology was used as a standard criterion except for hemangiomas and focal nodular hyperplasia. CEUS with SonoVue (Bracco Imaging) and SCCA combining CEUS and maximum value of elastography with < 20 kPa and > 90 kPa thresholds were used for the diagnosis of FLLs. The diagnostic performance of CEUS and SCCA was calculated and compared. RESULTS: A total of 171 FLLs were included, with 124 malignant FLLs and 47 benign FLLs. The area under curve (AUC), sensitivity, and specificity in detecting malignant FLLs were 0.83, 91.94%, and 74.47% for CEUS, respectively, and 0.89, 91.94%, and 85.11% for SCCA, respectively. The AUC of SCCA was significantly higher than that of CEUS (P = 0.019). Decision curves indicated that SCCA provided greater clinical benefits. The SCCA provided significantly improved prediction of clinical outcomes, with a net reclassification improvement index of 10.64% (P = 0.018) and integrated discrimination improvement of 0.106 (P = 0.019). For subgroup analysis, we divided the FLLs into a chronic-liver-disease group (n = 88 FLLs) and a normal-liver group (n = 83 FLLs) according to the liver background. In the chronic-liver-disease group, there were no differences between the CEUS-based and SCCA diagnoses. In the normal-liver group, the AUC of SCCA and CEUS in the characterization of FLLs were 0.89 and 0.83, respectively (P = 0.018). CONCLUSION: SCCA is a feasible tool for differentiating FLLs in patients with normal liver backgrounds. Further investigations are necessary to validate the universality of this algorithm.

[Application of Diffusion-Weighted Imaging and Hepatobiliary-Specific Contrast Agent Gd-EOB-DTPA in the Diagnosis and Differential Diagnosis of Focal Liver Lesions].

There are many types of focal liver lesions (FLL) presenting different lesion signs and their diagnosis and differential diagnosis are relatively difficult. It is of great clinical significance to accurately detect, classify and characterize focal liver lesions as soon as possible. Diffusion-weighted imaging (DWI) provides information on liver cell density, microstructure, and microcirculation perfusion. Gadolinium-ethoxibenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) is a hepatobiliary-specific contrast agent. Gd-EOB-DTPA-enhanced MRI examination of liver provides information on the blood perfusion of lesions and specific information on the uptake function of normal liver cells. The combined application of the two can significantly improve the sensitivity and diagnostic accuracy in the detection of FLL. Herein, we reviewed the research findings on the application of DWI and Gd-EOB-DTPA in FLL diagnosis in order to provide reference for further clinical application. Most of the existing studies only made comparison and discussion of the DWI image quality of different b values and their fitted apparent diffusion coefficient (ADC) values before and after Gd-EOB-DTPA enhancement, and the reported findings are not only varied, but also inconsistent. Whether Gd-EOB-DTPA will affect DWI images is still been debated. Future research should focus on quantitative comparison, discussion and verification of the enhancement effect after injection of Gd-EOB-DTPA, as well as the changes in the ADC value corresponding to different b values before and after enhancement, in order to provide more objective and consistent research results for clinical application.

Comparison of Sonazoid and SonoVue in the Diagnosis of Focal Liver Lesions: A Preliminary Study.

OBJECTIVE: This study aimed to compare the efficacy of Sonazoid and SonoVue in subjects with focal liver lesions. METHODS: The patients who had untreated focal solid liver lesions confirmed by B-mode ultrasonography were eligible for the study. The target lesion and whole liver were scanned by gray scale ultrasonography; then, contrast-enhanced ultrasonography was performed, and the results were evaluated blindly. The main end point was accuracy improvement with postcontrast versus precontrast ultrasound examination for diagnosis of the target lesion of interest as malignant or benign against the reference standard. RESULTS: There were 65 patients with 65 hepatic tumors enrolled in the study. The improvement of diagnostic accuracy was 0.30 in the Sonazoid group and 0.16 in the SonoVue group (95% confidence interval, -0.828-0.168; P = .24). Using 20% as the noninferiority margin, the upper limit of the 95% confidence interval (0.168) was less than 0.20. The number of lesions detected during the whole-liver scanning in the Sonazoid group was significantly more than that detected in the SonoVue group (P = .024). CONCLUSION: The diagnosis value of Sonazoid is noninferior to SonoVue, and this new contrast agent can improves the whole-liver image quality.

Contrast-Enhanced Ultrasound Features of Hepatic Reactive Lymphoid Hyperplasia: Correlation With Histopathologic Findings.

OBJECTIVES: To find certain specifics of hepatic reactive lymphoid hyperplasia (HRLH) on contrast-enhanced ultrasound (CEUS) imaging as diagnostic imaging clues by retrospectively analyzing its enhancement features. METHODS: From June 2010 to June 2017, 18 histopathologically confirmed HRLH lesions in 18 patients were included in this retrospective study. The lesion's location, maximum diameter, shape, margin, echogenicity, and color flow signal on conventional ultrasound (US) imaging and enhancement pattern, presence of a feeding artery, and donutlike enhancement on CEUS imaging were observed and recorded. The lesion size on CEUS imaging at peak enhancement and that on conventional US imaging were compared and recorded. RESULTS: All of the lesions showed homogeneous hypoechogenicity with a regular well-defined margin on conventional US imaging, with a mean diameter ± SD of 14.3 ± 4.6 mm (range, 8-24 mm). On CEUS imaging, all of the lesions showed "quick-wash-in and quick-wash-out," which showed complete homogeneous hyperenhancement in the arterial phase and wash-out in the second half of the arterial phase or first half of the portal phase. In 83.3% (15 of 18) of the lesions, the lesion size that was enhanced at peak was enlarged compared with the hypoechoic area on conventional US imaging, and transient donutlike enhancement appeared when the lesion showed wash-out. In 55.6% (10 of 18) of cases, the feeding artery was detected. CONCLUSIONS: Enlarged complete homogeneous hyperenhancement in the arterial phase, consequently followed by quick wash-out of the lesion and the appearance of donutlike enhancement, may be the CEUS features of HRLH.

[Exploring focal liver lesions with contrastenhanced ultrasonography]. / Comment j'explore... Une lésion hépatique focale par une échographie de contraste.

Noninvasive diagnosis of focal liver lesions is usually based on unenhanced ultrasonography, computed tomography, or magnetic resonance. Contrast-enhanced ultrasonography (CEUS) can be used among the other imaging modalities in evaluating these lesions. The technique requires the intravenous injection of contrast media. Ultrasound contrast agents are very safe and the technique doesn't involve any radiation. A large body of evidence supports and clarifies the role of CEUS in evaluating focal liver lesions. Hemangiomas, focal nodular hyperplasia, focal fatty change will be diagnosed in a majority of cases and CEUS is also helpful in distinguishing malignant from benign lesions.

Le diagnostic non invasif des lésions hépatiques focales repose habituellement sur l'échographie conventionnelle, la tomodensitométrie ou l'imagerie par résonance magnétique. L'échographie de contraste vient s'ajouter à l'arsenal des techniques d'imagerie disponibles et peut être utilisée dans la mise au point de ces lésions. Elle requiert l'utilisation de produits de contraste ultrasonores qui sont injectés en intraveineux. Ceux-ci présentent un excellent profil de sécurité et le caractère non irradiant de la technique est un avantage supplémentaire. De nombreuses publications illustrent la contribution et la place de l'échographie de contraste dans le bilan des lésions hépatiques focales. Elle est performante dans le diagnostic d'hémangiome, d'hyperplasie nodulaire focale et de stéatose hétérogène, et s'avère également contributive dans l'exploration des lésions malignes.

Liver Masses: What Physicians Need to Know About Ordering and Interpreting Liver Imaging.

PURPOSE OF REVIEW: This paper reviews diagnostic imaging techniques used to characterize liver masses and the imaging characteristics of the most common liver masses. RECENT FINDINGS: The role of recently adopted ultrasound and magnetic resonance imaging contrast agents will be emphasized. Contrast-enhanced ultrasound is an inexpensive exam which can confirm benignity of certain liver masses without ionizing radiation. Magnetic resonance imaging using hepatocyte-specific gadolinium-based contrast agents can help confirm or narrow the differential diagnosis of liver masses.

Focal Liver Lesions: Real-time 3-Dimensional Contrast-Enhanced Ultrasonography Compared With 2-Dimensional Contrast-Enhanced Ultrasonography and Magnetic Resonance Imaging.

OBJECTIVES: This study sought to evaluate the application of real-time 3-dimensional (3D) contrast-enhanced ultrasonography (US) to diagnose focal liver lesions and to compare these results with those from 2-dimensional (2D) contrast-enhanced US and contrast-enhanced magnetic resonance imaging (MRI). METHODS: Patients with focal liver lesions were examined by 2D contrast-enhanced US, 3D contrast-enhanced US, and contrast-enhanced MRI for lesion characterization, and biopsies and comprehensive clinical diagnoses served as reference standards. The sensitivity, specificity, area under the receiver operating characteristic curve, and intermodality agreement were assessed. The number of contrast agent injections and lesions observed per injection were calculated for 3D and 2D contrast-enhanced US. The number and display quality of the feeding arteries observed with 3D and 2D contrast-enhanced US were assessed. RESULTS: A total of 117 patients with 151 focal liver lesions were enrolled, including 67 cases of hepatocellular carcinoma, 51 cases of liver metastasis, and 33 cases of benign liver lesions. No significant differences were found among the modalities. The sensitivity values for 3D contrast-enhanced US, 2D contrast-enhanced US, and contrast-enhanced MRI were 96%, 95%, and 93%, respectively; the specificity values were 87%, 84%, and 89%; and the area under the receiver operating characteristic curve values were 0.92, 0.90, and 0.92. The intermodality agreement was excellent (κ > 0.77). Fewer contrast agent injections were needed, and more lesions and feeding arteries were more clearly displayed on 3D than 2D contrast-enhanced US (P < .001). CONCLUSIONS: Real-time 3D contrast-enhanced US is useful for diagnosing focal liver lesions and for observing feeding arteries with fewer contrast agent injections.

Impact of Modified Anisotropic Diffusion-based Enhancement Method in Computer-Aided Classification of Focal Liver Lesions.

This work is presented with the objective to assess quantitatively the impact of modified anisotropic diffusion-based enhancement method of Mittal et al. in computer-aided classification of focal liver lesions. This assessment was made before and after enhancement of clinically acquired ultrasound images with the comparison of (a) discrimination capability of radiologically important texture contrast feature using box plot and p-value statistics and (b) test results of designed computer-aided classification schemes to detect/classify focal liver tissues using receiver operating characteristic curves. The results reveal that the application of enhancement method on clinically acquired ultrasound image may effectively improve the confidence of clinicians/radiologists in computer-aided diagnostic solutions to detect and classify focal liver lesions.

Visibility of focal liver lesions: Comparison between kupffer phase of CEUS with sonazoid and hepatobiliary phase of gadoxetic acid-enhanced MRI.

BACKGROUND: To investigate the agreement between Kupffer phase of Sonazoid contrast-enhanced sonography (CEUS) and hepatobiliary phase of gadoxetic acid-enhanced MRI in the evaluation of focal liver lesions (FLLs). METHODS: One hundred fifty-four FLLs in 154 patients who underwent both Sonazoid CEUS and gadoxetic acid-enhanced liver MRI were included in this retrospective study. FLL visibility on the Kupffer-phase images was graded as one (invisible or isoenhancing), two (vaguely visible or vaguely hypoenhancing), or three (clearly visible or clearly hypoenhancing), and that on the hepatobiliary-phase images of MRI was graded as one (invisible or hyper/isointense), two (vaguely visible or weakly hypointense), or three (clearly visible or strongly hypointense). Pairwise comparison of lesion visibility between the two modalities was performed, and intermodality agreement was assessed. RESULTS: On Kupffer-phase CEUS, 31 (20.1%) lesions were invisible, 17 (11.1%) were vaguely visible, and 106 (68.9%) were clearly visible. On the hepatobiliary-phase MRI, 9 (5.9%) lesions were invisible, 45 (29.2%) were vaguely visible, and 100 (64.9%) were clearly visible. Overall, lesion visibility scores were not significantly different between the two modalities (p = 0.121), but the visibility was significantly better on MRI in smaller lesions. Twenty-eight lesions (18.2%) showed discrepancy in the visibility on CEUS and MRI, and most of the cases (89.7%) were lesions that were invisible on CEUS but visible on MRI. CONCLUSIONS: The overall visibility of FLLs was comparable between the Kupffer phase of Sonazoid-CEUS and the hepatobiliary-phase images of gadoxetic acid-enhanced MRI, with a discrepancy between the two modalities in 18% of the cases. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:542-550, 2017.

Diffusion-Related MRI Parameters for Assessing Early Treatment Response of Liver Metastases to Cytotoxic Therapy in Colorectal Cancer.

OBJECTIVE: The objective of our study was to evaluate early therapeutic response after cytotoxic chemotherapy in patients with liver metastasis from colorectal cancer (CRC) using intravoxel incoherent motion (IVIM) DWI and dynamic contrast-enhanced MRI (DCE-MRI). SUBJECTS AND METHODS: Nineteen patients with liver metastasis from CRC underwent DCE-MRI and IVIM DWI at baseline and after the first cycle of chemotherapy. IVIM DWI parameters including the apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) and DCE-MRI perfusion parameters including the volume transfer constant (K(trans)), reverse volume transfer constant (Kep), extravascular extracellular volume fraction (Ve), and initial area under the concentration curve in 60 seconds (iAUC) were calculated. The response evaluation was based on Response Evaluation Criteria in Solid Tumors version 1.1. RESULTS: There were eight responding and 11 nonresponding patients. ADC (baseline value vs value after first cycle of chemotherapy [mean ± SD]: 1191.9 ± 232.2 vs 1263.5 ± 266.4 × 10(-3) mm(2)/s; p = 0.012), D (1085.9 ± 232.9 vs 1173.5 ± 248.9 × 10(-3) mm(2)/s; p = 0.012), and f (173.7% ± 39.8% vs 133.5% ± 28.3%; p = 0.017) showed a significant change after the first cycle of chemotherapy in the response group, whereas ADC and D showed no significant change in the nonresponse group. In addition, DCE-MRI perfusion parameters showed no significant changes. A correlation was found between each of perfusion-related IVIM parameters and the DCE-MRI parameters before chemotherapy (r = 1.33, p > 0.05). CONCLUSION: Diffusion-related MRI parameters are useful for the early prediction of therapeutic response after cytotoxic chemotherapy for liver metastasis from CRC.

Real-time contrast-enhanced sonographically guided biopsy or radiofrequency ablation of focal liver lesions using perflurobutane microbubbles (sonazoid): value of Kupffer-phase imaging.

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.

Evaluation of hepatic focal lesions using diffusion-weighted MR imaging: comparison of apparent diffusion coefficient and intravoxel incoherent motion-derived parameters.

PURPOSE: To determine whether parameters obtained from intravoxel incoherent motion (IVIM)-diffusion-weighted imaging (DWI) using multiple b-values can improve characterization of common focal liver lesions (FLLs), compared with the apparent diffusion coefficient (ADCtotal ). MATERIALS AND METHODS: Our Institutional Review Board approved this retrospective study and informed consent was waived. In all, 142 patients with 169 FLLs underwent liver magnetic resonance imaging (MRI) including IVIM-DWI with multiple b factors at 3.0T. ADCtotal and IVIM-DWI-derived parameters including true diffusion (Dt ), pseudodiffusion (Dp ), and perfusion fraction (f) were calculated for each lesion and compared using dedicated software. RESULTS: Dt and ADCtotal were significantly lower in malignancies (0.95 ± 0.21, 1.14 ± 0.24, (×10(-3) mm(2) /sec)) than in benign FLLs (1.61 ± 0.34, 1.72 ± 0.37, (×10(-3) mm(2) /sec)). In the differential diagnosis of malignancies from benign lesions, Dt (Az value: 0.971) showed better diagnostic performance than ADCtotal (Az: 0.933) (P < 0.0005). Dt (Az: 0.961) also showed better diagnostic performance than ADCtotal (Az: 0.919) in differentiating hypervascular malignancies from benign hypervascular FLLs (P < 0.0005). In addition, Dp and f were significantly higher in hypervascular FLLs (35.74 ± 20.08 (×10(-3) mm(2) /sec), 28.14 ± 11.82 (%)) than hypovascular FLLs (21.87 ± 13.8 (×10(-3) mm(2) /sec), 12.2 ± 5.92 (%)) (P < 0.0001). CONCLUSION: Dt provided better diagnostic performance than ADCtotal in differentiating benign from malignant lesions. Dp and f were significant parameters for diagnosing hypervascular FLLs.

Value of wash-in and wash-out time in the diagnosis between hepatocellular carcinoma and other hepatic nodules with similar vascular pattern on contrast-enhanced ultrasound.

BACKGROUND AND AIM: The study aims to demonstrate whether the wash-in and wash-out time can be reliable as a criterion in the differential diagnosis between hepatocellular carcinoma (HCC) and other hepatic nodules with vascular pattern similar to HCC on contrast-enhanced ultrasound (CEUS). METHODS: From February 2012 to February 2013, 214 patients with hepatic nodules displayed rapid hyperenhancement and quick wash-out on CEUS were included in this study. Before performing CEUS, all nodules were examined by grayscale ultrasonography and color Doppler techniques. CEUS was performed with SonoVue and low mechanical index technique. The initial time to enhancement, time to peak, time of the nodule being hypoenhanced were comparatively studied between HCCs and other hepatic nodules. RESULTS: Of all the 214 nodules, 209 were malignant (164 HCCs, 31 metastases, 10 intrahepatic cholangiocarcinomas (ICCs), 3 combined hepatocellular-cholangiocarcinomas, 1 epithelioid hemangioendothelioma), and five were benign (two inflammatory pseudotumors, one focal nodular hyperplasia nodule, one hemangioma, and one hyperplastic nodule). Metastases and ICCs showed more rapid wash-out than HCCs (P < 0.05): 16 of 31 metastases and 7 of all ICCs showed wash-out by 40 s after injection. CONCLUSIONS: Some focal liver lesions can show enhancement pattern similar to HCCs on CEUS. The wash-out time may be useful in the differential diagnosis.

A combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound in the Kupffer phase for the diagnosis of well-differentiated hepatocellular carcinoma and atypical focal liver lesions: a prospective, multicenter study.

OBJECTIVE: The objective of this study was to develop a combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound (CEUS) during the Kupffer phase and to evaluate its value in differentiating well-differentiated hepatocellular carcinoma (w-HCC) from atypical benign focal liver lesions (FLLs). METHODS: A total of 116 patients with preoperatively Sonazoid-CEUS confirmed w-HCC or benign FLL were selected from a prospective multiple study on the clinical application of Sonazoid in FLLs conducted from August 2020 to March 2021. According to the randomization principle, the patients were divided into a training cohort and a test cohort in a 7:3 ratio. Seventy-nine patients were used for establishing and training the radiomics model and combined model. In comparison, 37 patients were used for validating and comparing the performance of the models. The diagnostic efficacy of the models for w-HCC and atypical benign FLLs was evaluated using ROCs curves and decision curves. A combined model nomogram was created to assess its value in reducing unnecessary biopsies. RESULTS: Among the patients, there were 55 cases of w-HCC and 61 cases of atypical benign FLLs, including 28 cases of early liver abscess, 16 cases of atypical hepatic hemangioma, 8 cases of hepatocellular dysplastic nodules (DN), and 9 cases of focal nodular hyperplasia (FNH). The radiomics model and combined model we established had AUCs of 0.905 and 0.951, respectively, in the training cohort, and the AUCs of the two models in the test cohort were 0.826 and 0.912, respectively. The combined model outperformed the radiomics feature model significantly. Decision curve analysis demonstrated that the combined model achieved a higher net benefit within a specific threshold probability range (0.25 to 1.00). A nomogram of the combined model was developed. CONCLUSION: The combined model based on the radiomics features of Sonazoid-CEUS in the Kupffer phase showed satisfactory performance in diagnosing w-HCC and atypical benign FLLs. It can assist clinicians in timely detecting malignant FLLs and reducing unnecessary biopsies for benign diseases.

Diagnostic and therapeutic role of endoscopic ultrasound in liver diseases: A systematic review and meta-analysis.

BACKGROUND: In hepatology, the clinical use of endoscopic ultrasound (EUS) has experienced a notable increase in recent times. These applications range from the diagnosis to the treatment of various liver diseases. Therefore, this systematic review summarizes the evidence for the diagnostic and therapeutic roles of EUS in liver diseases. AIM: To examine and summarize the current available evidence of the possible roles of the EUS in making a suitable diagnosis in liver diseases as well as the therapeutic accuracy and efficacy. METHODS: PubMed, Medline, Cochrane Library, Web of Science, and Google Scholar databases were extensively searched until October 2023. The methodological quality of the eligible articles was assessed using the Newcastle-Ottawa scale or Cochrane Risk of Bias tool. In addition, statistical analyses were performed using the Comprehensive Meta-Analysis software. RESULTS: Overall, 45 articles on EUS were included (28 on diagnostic role and 17 on therapeutic role). Pooled analysis demonstrated that EUS diagnostic tests had an accuracy of 92.4% for focal liver lesions (FLL) and 96.6% for parenchymal liver diseases. EUS-guided liver biopsies with either fine needle aspiration or fine needle biopsy had low complication rates when sampling FLL and parenchymal liver diseases (3.1% and 8.7%, respectively). Analysis of data from four studies showed that EUS-guided liver abscess had high clinical (90.7%) and technical success (90.7%) without significant complications. Similarly, EUS-guided interventions for the treatment of gastric varices (GV) have high technical success (98%) and GV obliteration rate (84%) with few complications (15%) and rebleeding events (17%). CONCLUSION: EUS in liver diseases is a promising technique with the potential to be considered a first-line therapeutic and diagnostic option in selected cases.

Is endoscopic ultrasound a promising technique in the diagnosis and treatment of liver diseases?

Percutaneous ultrasound has been a longstanding method in the diagnostics and interventional procedures of liver diseases. In some countries, its use is restricted to radiologists, limiting access for other clinicians, such as gastroenterologists. Endoscopic ultrasound, as a novel technique, plays a crucial role in diagnosis and treatment of digestive diseases. However, its use is sometimes recommended for conditions where no clear advantage over percutaneous ultrasound exists, leaving the impression that clinicians sometimes resort to an endoscopic approach due to the unavailability of percutaneous options.

Ultrasound tissue scatterer distribution imaging: An adjunctive diagnostic tool for shear wave elastography in characterizing focal liver lesions.

OBJECTIVES: Focal liver lesion (FLL) is a prevalent finding in cross-sectional imaging, and distinguishing between benign and malignant FLLs is crucial for liver health management. While shear wave elastography (SWE) serves as a conventional quantitative ultrasound tool for evaluating FLLs, ultrasound tissue scatterer distribution imaging (TSI) emerges as a novel technique, employing the Nakagami statistical distribution parameter to estimate backscattered statistics for tissue characterization. In this prospective study, we explored the potential of TSI in characterizing FLLs and evaluated its diagnostic efficacy with that of SWE. METHODS: A total of 235 participants (265 FLLs; the study group) were enrolled to undergo abdominal examinations, which included data acquisition from B-mode, SWE, and raw radiofrequency data for TSI construction. The area under the receiver operating characteristic curve (AUROC) was used to evaluate performance. A dataset of 20 patients (20 FLLs; the validation group) was additionally acquired to further evaluate the efficacy of the TSI cutoff value in FLL characterization. RESULTS: In the study group, our findings revealed that while SWE achieved a success rate of 49.43 % in FLL measurements, TSI boasted a success rate of 100 %. In cases where SWE was effectively implemented, the AUROCs for characterizing FLLs using SWE and TSI stood at 0.84 and 0.83, respectively. For instances where SWE imaging failed, TSI achieved an AUROC of 0.78. Considering all cases, TSI presented an overall AUROC of 0.81. There was no statistically significant difference in AUROC values between TSI and SWE (p > 0.05). In the validation group, using a TSI cutoff value of 0.67, the AUROC for characterizing FLLs was 0.80. CONCLUSIONS: In conclusion, ultrasound TSI holds promise as a supplementary diagnostic tool to SWE for characterizing FLLs.

Microvascular flow imaging to differentiate focal hepatic lesions: the spoke-wheel pattern as a specific sign of focal nodular hyperplasia.

Microvascular flow imaging (MVFI) is an advanced Doppler ultrasound technique designed to detect slow-velocity blood flow in small-caliber microvessels. This technique is capable of realtime, highly detailed visualization of tumor vessels without using a contrast agent. MVFI has been recently applied for the characterization of focal liver lesions and has revealed typical vascularity distributions in multiple types thereof. Focal nodular hyperplasia (FNH) constitutes an important differential diagnosis of malignant liver tumors. In this essay, we provide iconographic documentation of the MVFI appearance of FNH and other common solid liver lesions. Identifying the typical patterns of vascularity, including the spoke-wheel pattern with MVFI, can expedite the diagnosis, spare patients from unnecessary procedures, and save costs.