nach oben

European Radiology

Erschienen in:

11.08.2023 | Contrast Media

Contrast-enhanced ultrasound with microbubbles containing sulfur hexafluoride and perfluorobutane with Kupffer phase for the detection of colorectal liver metastases

verfasst von: Si Qin, Yao Chen, YiMin Wang, FangQian Li, Rui Cui, GuangJian Liu

Erschienen in: European Radiology | Ausgabe 1/2024

Einloggen, um Zugang zu erhalten

Abstract

Objective

To compare contrast-enhanced ultrasound (CEUS) with microbubbles containing sulfur hexafluoride (SHF) and perfluorobutane (PFB) for the detection of colorectal liver metastasis (CRLM).

Methods

In this prospective study, conducted from September to November 2021, patients with colorectal cancer were consecutively recruited and underwent same-day ultrasound, SHF-CEUS, and PFB-CEUS. The reference standard was contrast-enhanced MRI and follow-up imaging. The size, depth, echogenicity, and calcification of each focal liver lesion were recorded. The number and conspicuity of CRLMs, based on washout appearance during the late phase (LP) (> 120 s)/Kupffer phase (KP), were evaluated offsite by two blinded readers.

Results

Overall, 230 lesions (CRLMs, n = 219; benign lesions, n = 11) in 78 patients were evaluated. Lesion conspicuity (p = 0.344) and accuracy in the detection of CRLM were comparable for SHF- and PFB-CEUS (0.877 for SHF vs. 0.770 for PFB, p = 0.087). More CRLMs ≥ 10 mm were identified by LP contrast washout in SHF-CEUS than in KP PFB-CEUS (p < 0.001). More CRLMs < 10 mm were identified by KP washout in PFB-CEUS than in LP SHF-CEUS (p < 0.001). Conspicuity was better on PFB-CEUS than on SHF-CEUS (p = 0.027). In hyperechoic lesions, lesions located deeper than 80 mm, and calcified lesions, CRLM conspicuity on PFB-CEUS was inferior to that on SHF-CEUS (p < 0.05).

Conclusions

The overall accuracy of detection and conspicuity of washout in CRLMs were comparable between SHF and PFB-CEUS. PFB-CEUS has the advantage of identifying washout in small CRLMs. However, larger, hyperechogenic, deep-seated, or calcified lesions were better identified using SHF-CEUS.

Clinical relevance statement

Accuracy of detection and conspicuity of washout in CRLMs were comparable between SHF- and PFB-CEUS. PFB-CEUS has the advantage in detecting small CRLMs, whereas SHF-CEUS is better for detecting larger, hyperechogenic, deep-seated, or calcified lesions.

Key Points

Contrast-enhanced ultrasound with sulfur hexafluoride in the late phase and perfluorobutane microbubbles in the Kupffer phase were comparable in terms of accuracy in the detection and conspicuity of colorectal liver metastases.
Small colorectal liver metastases (< 10 mm) were more often identified in the Kupffer phase contrast-enhanced ultrasound imaging when using perfluorobutane microbubbles.
Larger, hyperechogenic, deep-seated, or calcified lesions were better identified in the late phase contrast-enhanced ultrasound imaging (> 120 s) when using sulfur hexafluoride microbubbles.

Nur mit Berechtigung zugänglich

Chakedis J, Squires MH, Beal EW et al (2017) Update on current problems in colorectal liver metastasis. Curr Probl Surg 54:554–602. https://doi.org/10.1067/j.cpsurg.2017.10.002CrossRefPubMed

Sawatzki M, Güller U, Güsewell S, Husarik DB, Semela D, Brand S (2021) Contrast-enhanced ultrasound can guide the therapeutic strategy by improving the detection of colorectal liver metastases. J Hepatol 74:419–427. https://doi.org/10.1016/j.jhep.2020.09.036CrossRefPubMed

Lincke T, Zech CJ (2017) Liver metastases: detection and staging. Eur J Radiol 97:76–82. https://doi.org/10.1016/j.ejrad.2017.10.016CrossRefPubMed

Vreugdenburg TD, Ma N, Duncan JK, Riitano D, Cameron AL, Maddern GJ (2016) Comparative diagnostic accuracy of hepatocyte-specific gadoxetic acid (Gd-EOB-DTPA) enhanced MR imaging and contrast enhanced CT for the detection of liver metastases: a systematic review and meta-analysis. Int J Colorectal Dis 31:1739–1749. https://doi.org/10.1007/s00384-016-2664-9CrossRefPubMed

Baghdadi A, Mirpour S, Ghadimi M et al (2022) Imaging of colorectal liver metastasis. J Gastrointest Surg 26:245–257. https://doi.org/10.1007/s11605-021-05164-1CrossRefPubMed

Qin S, Chen Y, Liu XY et al (2017) Clinical application of contrast-enhanced ultrasound using high-frequency linear probe in the detection of small colorectal liver metastases. Ultrasound Med Biol 43:2765–2773. https://doi.org/10.1016/j.ultrasmedbio.2017.08.932CrossRefPubMed

Tsili AC, Alexiou G, Naka C, Argyropoulou MI (2021) Imaging of colorectal cancer liver metastases using contrast-enhanced US, multidetector CT, MRI, and FDG PET/CT: a meta-analysis. Acta Radiol 62:302–312. https://doi.org/10.1177/0284185120925481CrossRefPubMed

Dietrich CF, Nolsøe CP, Barr RG et al (2020) Guidelines and good clinical practice recommendations for contrast-enhanced ultrasound (CEUS) in the liver-update 2020 WFUMB in cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultrasound Med Biol 46:2579–2604. https://doi.org/10.1016/j.ultrasmedbio.2020.04.030CrossRefPubMed

Lv K, Zhai H, Jiang Y et al (2021) Prospective assessment of diagnostic efficacy and safety of Sonazoid^TM and SonoVue® ultrasound contrast agents in patients with focal liver lesions. Abdom Radiol (NY) 46:4647–4659. https://doi.org/10.1007/s00261-021-03010-1CrossRefPubMed

10.

Barr RG, Huang P, Luo Y et al (2020) Contrast-enhanced ultrasound imaging of the liver: a review of the clinical evidence for SonoVue and Sonazoid. Abdom Radiol (NY) 45:3779–3788. https://doi.org/10.1007/s00261-020-02573-9CrossRefPubMed

11.

Zhai HY, Liang P, Yu J et al (2019) Comparison of SonoVue and Sonazoid in the diagnosis of focal liver lesions: a preliminary study. J Ultrasound Med 38:2417–2425. https://doi.org/10.1002/jum.14940CrossRefPubMed

12.

Kang HJ, Lee JM, Yoon JH, Lee K, Kim H, Han JK (2020) Contrast-enhanced US with sulfur hexafluoride and perfluorobutane for the diagnosis of hepatocellular carcinoma in individuals with high risk. Radiology 297:108–116. https://doi.org/10.1148/radiol.2020200115CrossRefPubMed

13.

Piscaglia F, Corradi F, Mancini M et al (2007) Real time contrast enhanced ultrasonography in detection of liver metastases from gastrointestinal cancer. BMC Cancer 7:171. https://doi.org/10.1186/1471-2407-7-171CrossRefPubMedPubMedCentral

14.

Kobayashi N, Iijima H, Tada T et al (2021) A new ultrasonographic “fluttering sign” for hepatic hemangioma. Ultrasound Med Biol 47:941–946. https://doi.org/10.1016/j.ultrasmedbio.2020.12.004CrossRefPubMed

15.

Kang TW, Jeong WK, Kim YY et al (2021) Comparison of super-resolution US and contrast material-enhanced US in detection of the spoke wheel sign in patients with focal nodular hyperplasia. Radiology 298:82–90. https://doi.org/10.1148/radiol.2020200885CrossRefPubMed

16.

Lee MW, Kim YJ, Park SW et al (2010) Sequential changes in echogenicity and conspicuity of small hepatocellular carcinoma on gray scale sonography after transcatheter arterial chemoembolization. J Ultrasound Med 29:1305–1312. https://doi.org/10.7863/jum.2010.29.9.1305CrossRefPubMed

17.

Lee JY, Minami Y, Choi BI et al (2020) The AFSUMB consensus statements and recommendations for the clinical practice of contrast-enhanced ultrasound using Sonazoid. J Med Ultrasound 28:59–82. https://doi.org/10.4103/JMU.JMU_124_19CrossRefPubMedPubMedCentral

18.

Cantisani V, Ricci P, Erturk M et al (2010) Detection of hepatic metastases from colorectal cancer: prospective evaluation of gray scale US versus SonoVue® low mechanical index real time-enhanced US as compared with multidetector-CT or Gd-BOPTA-MRI. Ultraschall Med 31:500–505. https://doi.org/10.1055/s-0028-1109751CrossRefPubMed

19.

Shiozawa K, Watanabe M, Ikehara T et al (2017) Comparison of contrast-enhanced ultrasonograpy with Gd-EOB-DTPA-enhanced MRI in the diagnosis of liver metastasis from colorectal cancer. J Clin Ultrasound 45:138–144. https://doi.org/10.1002/jcu.22421CrossRefPubMed

20.

Sun L, Yin S, Xing B, Li Z, Fan Z, Yan K (2023) Contrast-enhanced ultrasound with SonoVue and Sonazoid for the diagnosis of colorectal liver metastasis after chemotherapy. J Ultrasound Med 42:355–362. https://doi.org/10.1002/jum.16042CrossRefPubMed

21.

Mainenti PP, Mancini M, Mainolfi C et al (2010) Detection of colo-rectal liver metastases: prospective comparison of contrast enhanced US, multidetector CT, PET/CT, and 1.5 Tesla MR with extracellular and reticulo-endothelial cell specific contrast agents. Abdom Imaging 35:511–521. https://doi.org/10.1007/s00261-009-9555-2CrossRefPubMed

22.

Zhang L, Zhang L, Wang H, Chen L, Sui G (2019) Diagnostic performance of contrast-enhanced ultrasound and magnetic resonance imaging for detecting colorectal liver metastases: a systematic review and meta-analysis. Dig Liver Dis 51:1241–1248. https://doi.org/10.1016/j.dld.2019.06.004CrossRefPubMed

23.

Goto E, Masuzaki R, Tateishi R et al (2012) Value of post-vascular phase (Kupffer imaging) by contrast-enhanced ultrasonography using Sonazoid in the detection of hepatocellular carcinoma. J Gastroenterol 47:477–485. https://doi.org/10.1007/s00535-011-0512-9CrossRefPubMed

24.

Sugimoto K, Moriyasu F, Saito K, Yoshiara H, Imai Y (2014) Kupffer-phase findings of hepatic hemangiomas in contrast-enhanced ultrasound with Sonazoid. Ultrasound Med Biol 40:1089–1095. https://doi.org/10.1016/j.ultrasmedbio.2013.12.019CrossRefPubMed

25.

Tochio H, Sugahara M, Imai Y et al (2015) Hyperenhanced rim surrounding liver metastatic tumors in the postvascular phase of Sonazoid-enhanced ultrasonography: a histological indication of the presence of Kupffer cells. Oncology 89:33–41. https://doi.org/10.1159/000440629CrossRefPubMed

26.

Ciner AT, Jones K, Muschel RJ, Brodt P (2020) The unique immune microenvironment of liver metastases: challenges and opportunities. Semin Cancer Biol 71:143–156. https://doi.org/10.1016/j.semcancer.2020.06.003CrossRefPubMed

27.

Qiao T, Yang W, He X et al (2023) Dynamic differentiation of F4/80+ tumor-associated macrophage and its role in tumor vascularization in a syngeneic mouse model of colorectal liver metastasis. Cell Death Dis 14:117. https://doi.org/10.1038/s41419-023-05626-1CrossRefPubMedPubMedCentral

28.

Zhou Y, Zhang J, Dan P et al (2019) Tumor calcification as a prognostic factor in cetuximab plus chemotherapy-treated patients with metastatic colorectal cancer. Anticancer Drugs 30:195–200. https://doi.org/10.1097/CAD.0000000000000726CrossRefPubMedPubMedCentral

29.

Dietrich CF, Averkiou M, Nielsen MB et al (2018) How to perform contrast-enhanced ultrasound (CEUS). Ultrasound Int Open 4:E2–E15. https://doi.org/10.1055/s-0043-123931CrossRefPubMedPubMedCentral

30.

Fetzer DT, Vijay K, Caserta MP, Patterson-Lachowicz A, Dahiya N, Rodgers SK (2023) Artifacts and technical considerations at contrast-enhanced US. Radiographics 43:e220093. https://doi.org/10.1148/rg.220093CrossRefPubMed

Titel: Contrast-enhanced ultrasound with microbubbles containing sulfur hexafluoride and perfluorobutane with Kupffer phase for the detection of colorectal liver metastases
verfasst von: Si Qin
Yao Chen
YiMin Wang
FangQian Li
Rui Cui
GuangJian Liu
Publikationsdatum: 11.08.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 1/2024
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-023-10051-1

Deep learning reconstruction CT for liver metastases: low-dose dual-energy vs standard-dose single-energy

Computed Tomography

Challenges and outlook in the management of pulmonary nodules detected on CT

Commentary

An artificial intelligence algorithm for pulmonary embolism detection on polychromatic computed tomography: performance on virtual monochromatic images

Imaging Informatics and Artificial Intelligence

Posterior capsule edema in adhesive capsulitis: comparison with established non-contrast MRI findings and multivariable analysis

Musculoskeletal

LI-RADS category is associated with treatment outcomes of small single HCC: surgical resection vs. radiofrequency ablation

Hepatobiliary-Pancreas

The MRI radiomics signature can predict the pathologic response to neoadjuvant chemotherapy in locally advanced esophageal squamous cell carcinoma

Gastrointestinal

Neu im Fachgebiet Radiologie

KI-gestütztes Mammografiescreening überzeugt im Praxistest

16.01.2025
Künstliche Intelligenz im Gesundheitswesen
Nachrichten

Mit dem Einsatz künstlicher Intelligenz lässt sich die Detektionsrate im Mammografiescreening offenbar deutlich steigern. Mehr unnötige Zusatzuntersuchungen sind laut der Studie aus Deutschland nicht zu befürchten.

Stumme Schlaganfälle − ein häufiger Nebenbefund im Kopf-CT?

12.01.2025
Computertomografie
Nachrichten

In 4% der in der Notfallambulanz initiierten zerebralen Bildgebung sind „alte“ Schlaganfälle zu erkennen. Gar nicht so selten handelt es sich laut einer aktuellen Studie dabei um unbemerkte Insulte. Bietet sich hier womöglich die Chance auf ein effektives opportunistisches Screening?

Die elektronische Patientenakte kommt: Das sollten Sie jetzt wissen

12.01.2025
Elektronische Patientenakte
Nachrichten

Am 15. Januar geht die „ePA für alle“ zunächst in den Modellregionen an den Start. Doch schon bald soll sie in allen Praxen zum Einsatz kommen. Was ist jetzt zu tun? Was müssen Sie wissen? Wir geben in einem FAQ Antworten auf 21 Fragen.

Stören weiße Wände und viel Licht die Bildqualitätskontrolle?

09.01.2025
Mammografie
Nachrichten

Wenn es darum geht, die technische Qualität eines Mammogramms zu beurteilen, könnten graue Wandfarbe und reduzierte Beleuchtung im Bildgebungsraum von Vorteil sein. Darauf deuten zumindest Ergebnisse einer kleinen Studie hin.

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Contrast-enhanced ultrasound with microbubbles containing sulfur hexafluoride and perfluorobutane with Kupffer phase for the detection of colorectal liver metastases