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Focal liver lesions: contrast-enhanced ultrasound

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Abstract

Contrast-enhanced ultrasound (CEUS) represents a significant breakthrough in sonography and it is being increasingly used for the evaluation of focal liver lesions (FLLs). The unique feature of CEUS of non-invasively assessing in real-time liver perfusion throughout the vascular phase has led to a dramatic improvement in diagnostic accuracy of US in either detection or characterization of FLLs, as well as in the guidance and evaluation of response of therapeutic procedures. Currently, CEUS is included as a part of the suggested diagnostic work-up of FLLs, resulting in a better patient management and cost-effective therapy delivering. After a brief description of the basis of different CEUS techniques, contrast-enhancement patterns of different types of benign and malignant FLLs, among hepatic pseudolesions, will be described and discussed on the basis of our experience and literature data. At the same time, the most recent concepts and the use of CEUS in different clinical settings will be presented.

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References

  1. Harvey CJ, Albrecht T (2001) Ultrasound of focal liver lesions. Eur Radiol 11:1578–1593

    PubMed  CAS  Google Scholar 

  2. Mergo PJ, Ros PR (1998) Benign lesions of the liver. Radiol Clin North Am 36:319–331

    PubMed  CAS  Google Scholar 

  3. Lin ZY, Wang LY, Wang JH, et al.. (1997) Clinical utility of color Doppler sonography in the differentiation of hepatocellular carcinoma, from metastases and hemangioma. J Ultrasound Med 16:51–58

    PubMed  CAS  Google Scholar 

  4. Wang LY, Wang JH, Lin ML, et al.. (1997) Hepatic focal nodular hyperplasia: findings on color Doppler ultrasound. Abdom Imaging 22:178–181

    PubMed  CAS  Google Scholar 

  5. Tanaka S, Kitamura T, Fujita M, et al. (1990) Color Doppler flow imaging of liver tumors. Am J Roengtenol 154:509–514

    CAS  Google Scholar 

  6. Lee MG, Auh YH, Cho KS, et al. (1996) Color Doppler flow imaging of hepatocellular carcinoma: comparison with metastatic tumors and hemangiomas by three-step grading for color hues. Clin Imaging 20:199–203

    PubMed  CAS  Google Scholar 

  7. Hosten N, Puls R, Bechstein WO, Felix R (1999) Focal liver lesions: Doppler ultrasound. Eur Radiol 9:428–435

    PubMed  CAS  Google Scholar 

  8. Uggowitzer MM, Kugler C, Mischinger HJ, et al. (1999) Echo-enhanced Doppler sonography of focal nodular hyperplasia of the liver. J Ultrasound Med 18:445–451

    PubMed  CAS  Google Scholar 

  9. Dill-Macky MJ, Burns PN, Khalili K, Wilson SR (2002) Focal hepatic masses: Enhancement patterns with SH U 508 A and Pulse-Inversion US. Radiology 22: 95–102

    Google Scholar 

  10. Bertolotto M, Dalla Palma L, Quaia E, Locatelli M (2000) Characterization of unifocal liver lesions with pulse inversion harmonic imaging after Levovist injection: preliminary results. Eur Radiol 10:1369–1376

    PubMed  CAS  Google Scholar 

  11. Wilson SR, Burns PN (2001) Liver mass evaluation of ultrasound: the impact of microbubble contrast agents and pulse inversion imaging. Semin Liver Dis 21: 147–159

    PubMed  CAS  Google Scholar 

  12. Wilson SR, Burns PN, Muradali D, et al. (2000) Harmonic hepatic US with microbubble contrast agent: initial experience showing improved characterization of hemangioma, hepatocellular carcinoma, and metastasis. Radiology 215:153–161

    PubMed  CAS  Google Scholar 

  13. Kim TK, Choi BI, Han JK, et al. (2000) Hepatic tumors: contrast agent-enhancement patterns with Pulse-Inversion harmonic US. Radiology 216:411–417

    PubMed  CAS  Google Scholar 

  14. Tanaka S, Ioka T, Oshikawa O, et al. (2001) Dynamic sonography of hepatic tumors. AJR Am J Roengtenol 177:799–805

    CAS  Google Scholar 

  15. Correas JM, Bridal L, Lesavre A, et al. (2001) Ultrasound contrast agent: properties, principles of action, tolerance, and artefacts. Eur Radiol 11:1316–1328

    PubMed  CAS  Google Scholar 

  16. Dalla Palma L, Bertolotto M (1999) Introduction to ultrasound contrast agents: physics overview. Eur Radiol 9(Suppl 3):S338–S342

    PubMed  Google Scholar 

  17. Bouakaz A, de Jong N (2007) WFUMB Safety Symposium on Echo-Contrast Agents: nature and types of ultrasound contrast agents. Ultrasound Med Biol 33:187–196

    PubMed  Google Scholar 

  18. Madjar H, Prömpeler HJ, Del Favero C, et al. (2000) A new Doppler signal enhancing agent for flow assessment in breast lesions. Eur J Ultrasound 12:123–130

    PubMed  CAS  Google Scholar 

  19. Schneider M (1999) Sono Vue, a new ultrasound contrast agent. Eur Radiol 9(suppl 3):S347–S348

    PubMed  Google Scholar 

  20. Cosgrove D (2006) Ultrasound contrast agents: an overview. Eur J Radiol 60:324–330

    PubMed  Google Scholar 

  21. Quaia E (2007) Microbubble ultrasound contrast agents: an update. Eur Radiol 2007 17:1995–2008

    Google Scholar 

  22. Kollmann C (2007) New sonographic techniques for harmonic imaging—underlying physical principles. Eur J Radiol 64:164–172

    PubMed  Google Scholar 

  23. Quaia E (2007) Contrast-specific ultrasound techniques. Radiol Med 112:473–490

    PubMed  CAS  Google Scholar 

  24. Leen E (2001) The role of contrast-enhanced ultrasound in the detection of focal liver lesions. Eur Radiol 11(suppl 3):E27–E34

    PubMed  Google Scholar 

  25. Lencioni R, Cioni D, Bartolozzi C (2002) Tissue harmonic and contrast agent and contrast-specific imaging: back to gray scale in ultrasound. Eur Radiol 12:151–65

    PubMed  Google Scholar 

  26. Cosgrove D, Blomley M (2004) Liver tumors: evaluation with contrast-enhanced ultrasound. Abdom Imaging 29:446–454

    PubMed  CAS  Google Scholar 

  27. Burns PN, Wilson SR (2007) Focal liver masses: enhancement patterns on contrast-enhanced images—concordance of US scans with CT scans and MR images. Radiology 242:162–174

    PubMed  Google Scholar 

  28. Wilson SR, Kim TK, Jang HJ, Burns PN (2007) Enhancement patterns of focal liver masses: discordance between contrast-enhanced sonography and contrast-enhanced CT and MRI. AJR Am J Roentgenol 189:W7–W12

    PubMed  Google Scholar 

  29. Ricci P, Laghi A, Cantisani V, et al. (2005) Contrast-enhanced sonography with SonoVue: enhancement patterns of benign focal liver lesions and correlation with dynamic gadobenate dimeglumine-enhanced MRI. AJR Am J Roentgenol 184:821–827

    PubMed  Google Scholar 

  30. Nicolau C, Brú C (2004) Focal liver lesions: evaluation with contrast-enhanced ultrasonography. Abdom Imaging 29:348–359

    PubMed  CAS  Google Scholar 

  31. Brannigan M, Burns PN, Wilson SR (2004) Blood flow patterns in focal liver lesions at microbubble-enhanced US. Radiographics 24:921–935

    Google Scholar 

  32. Quaia E, Calliada F, Bertolotto M, et al. (2004) Characterization of focal liver lesions with contrast-specific US modes and sulphur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence. Radiology 232:420–430

    PubMed  Google Scholar 

  33. Solbiati L, Tonolini M, Cova L, Goldberg N (2001) The role of contrast-enhanced ultrasound in the detection of focal liver lesions. Eur Radiol 11(suppl 3):E15–E26

    PubMed  Google Scholar 

  34. Catala V, Nicolau C, Vilana R, et al. (2007) Characterization of focal liver lesions: comparative study of contrast-enhanced ultrasound versus spiral computed tomography. Eur Radiol 17:1066–1073

    PubMed  CAS  Google Scholar 

  35. Li R, Guo Y, Hua X, et al. (2007) Characterization of focal liver lesions: comparison of pulse-inversion harmonic contrast-enhanced sonography with contrast-enhanced CT. J Clin Ultrasound 35:109–117

    PubMed  Google Scholar 

  36. Bleuzen A, Huang C, Olar M, Tchuenbou J, Tranquart F (2006) Diagnostic accuracy of contrast-enhanced ultrasound in focal lesions of the liver using cadence contrast pulse sequencing. Ultraschall Med 27:40–48

    PubMed  CAS  Google Scholar 

  37. Quaia E, D’Onofrio M, Palumbo A, Rossi S, Bruni S, Cova M (2006) Comparison of contrast-enhanced ultrasonography versus baseline ultrasound and contrast-enhanced computed tomography in metastatic disease of the liver: diagnostic performance and confidence. Eur Radiol 16:1599–1609

    PubMed  Google Scholar 

  38. Larsen LP, Rosenkilde M, Christensen H, et al. (2007) The value of contrast enhanced ultrasonography in detection of liver metastases from colorectal cancer: a prospective double-blinded study. Eur J Radiol 62:302–307

    PubMed  Google Scholar 

  39. Konopke R, Kersting S, Bergert H, et al. (2007) Contrast-enhanced ultrasonography to detect liver metastases: A prospective trial to compare transcutaneous unenhanced and contrast-enhanced ultrasonography in patients undergoing laparotomy. Int J Colorectal Dis 22:201–207

    PubMed  CAS  Google Scholar 

  40. Li R, Guo Y, Hua X, He Y, et al. (2007) Characterization of focal liver lesions: comparison of pulse-inversion harmonic contrast-enhanced sonography with contrast-enhanced CT. J Clin Ultrasound 35:109–117

    PubMed  Google Scholar 

  41. Bolondi L, Correas JM, Lencioni R, Weskott HP, Piscaglia F (2007) New perspectives for the use of contrast-enhanced liver ultrasound in clinical practice. Dig Liver Dis 39:187–195

    PubMed  CAS  Google Scholar 

  42. Lencioni R, European Federation of Societies for Ultrasound in Medicine, Biology (EFSUMB) (2006) Impact of European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines on the use of contrast agents in liver ultrasound. Eur Radiol 16:1610–1613

    PubMed  Google Scholar 

  43. Rettenbacher T (2007) Focal liver lesions: role of contrast-enhanced ultrasound. Eur J Radiol 64:173–182

    PubMed  Google Scholar 

  44. Wilson SR, Jang HJ, Kim TK, Burns PN (2007) Diagnosis of focal liver masses on ultrasonography: comparison of unenhanced and contrast-enhanced scans. J Ultrasound Med 26:775–787

    PubMed  Google Scholar 

  45. Bartolotta TV, Taibbi A, Galia M, et al. (2007) Characterization of hypoechoic focal hepatic lesions in patients with fatty liver: diagnostic performance and confidence of contrast-enhanced ultrasound. Eur Radiol 17:650–661

    PubMed  Google Scholar 

  46. Lanka B, Jang HJ, Kim TK, Burns PN, Wilson SR (2007) Impact of contrast-enhanced ultrasonography in a tertiary clinical practice. J Ultrasound Med 26:1703–1714

    PubMed  Google Scholar 

  47. Faccioli N, D’Onofrio M, Comai A, Cugini C (2007) Contrast-enhanced ultrasonography in the characterization of benign focal liver lesions: activity-based cost analysis. Radiol Med 112:810–820

    PubMed  CAS  Google Scholar 

  48. Torzilli G (2005) Adverse effects associated with SonoVue use. Expert Opin Drug Saf 4:399–401

    PubMed  CAS  Google Scholar 

  49. Jakobsen JA, Oyen R, Thomsen HS, Morcos SK, Members of Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR) (2005) Safety of ultrasound contrast agents. Eur Radiol 15:941–945

    PubMed  Google Scholar 

  50. Blomley M, Claudon M, Cosgrove D (2007) WFUMB Safety Symposium on Ultrasound Contrast Agents: clinical applications and safety concerns. Ultrasound Med Biol 33:180–186

    PubMed  Google Scholar 

  51. Dalecki D (2007) WFUMB Safety Symposium on Echo-Contrast Agents: bioeffects of ultrasound contrast agents in vivo. Ultrasound Med Biol 33:205–213

    PubMed  Google Scholar 

  52. Burns PN, Hope Simpson D, Averkiou M (2000) Nonlinear imaging. Ultrasound Med Biol 6:19–22

    Google Scholar 

  53. Burns PN, Wilson SR, Simpson DH (2000) Pulse inversion imaging of liver blood flow: improved method for characterizing focal masses with microbubble contrast. Invest Radiol 35:58–71

    PubMed  CAS  Google Scholar 

  54. Ros PR, Menu Y, Vilgrain V, et al. (2001) Liver neoplasms and tumor-like conditions. Eur Radiol 11(suppl 2):S145–S165

    Google Scholar 

  55. Mortelé KJ, Segatto E, Ros PR. (2004) The infected liver: radiologic-pathologic correlation. Radiographics 24:937–955

    PubMed  Google Scholar 

  56. Czermak BV, Akhan O, Hiemetzberger R, et al. (2007) Echinococcosis of the liver. Abdom Imaging. Oct 3; [Epub ahead of print]

  57. Antonopoulos P, Tavernaraki K, Charalampopoulos G, et al. (2007) Hydatid hepatic cysts rupture into the biliary tract, the peritoneal cavity, the thoracic cavity and the hepatic subcapsular space: specific computed tomography findings. Abdom Imaging. Jul 17; [Epub ahead of print]

  58. Quaia E, D’Onofrio M, Bartolotta TV, et al. (2005) Characterization of focal liver lesions. In: Quaia E, (eds). Contrast Media in Ultrasonography. Berlin: Springer, pp 125–166

    Google Scholar 

  59. Hui JY, Yang MK, Cho DH, et al. (2007) Pyogenic liver abscesses caused by Klebsiella pneumoniae: US appearance and aspiration findings. Radiology 242:769–776

    PubMed  Google Scholar 

  60. Catalano O, Nunziata A, Lobianco R, Siani A. (2005) Real-time harmonic contrast material-specific US of focal liver lesions. Radiographics 25:333–349

    PubMed  Google Scholar 

  61. Catalano O, Sandomenico F, Raso MM, Siani A (2004) Low mechanical index contrast-enhanced sonographic findings of pyogenic hepatic abscesses. AJR Am J Roentgenol 182:447–450

    PubMed  Google Scholar 

  62. Ding H, Wang WP, Huang BJ, et al. (2005) Imaging of focal liver lesions: low-mechanical-index real-time ultrasonography with SonoVue. J Ultrasound Med 24:285–297

    PubMed  Google Scholar 

  63. Kim KW, Choi BI, Park SH, et al. (2004) Pyogenic hepatic abscesses: distinctive features from hypovascular hepatic malignancies on contrast-enhanced ultrasound with SH U 508A; early experience. Ultrasound Med Biol. 30:725–733

    PubMed  Google Scholar 

  64. Leifer DM, Middleton WD, Teefey SA, Menias CO, Leahy JR (2000) Follow-up of patients at low risk for hepatic malignancy with a characteristic hemangioma at US. Radiology 214:167–72

    PubMed  CAS  Google Scholar 

  65. Mirk P, Rubaltelli L, Bazzocchi M, et al. (1982) Ultrasonographic patterns in hepatic hemangiomas. J Clin Ultrasound 10:373–378

    PubMed  CAS  Google Scholar 

  66. Farrell MA, Charboneau JW, Reading CC (2000) Sonographic-pathologic correlation of the hyperechoic border of an atypical hepatic hemangioma. J Ultrasound Med 20:169–170

    Google Scholar 

  67. Caseiro-Alves F, Brito J, Araujo AE, et al. (2007) Liver haemangioma: common and uncommon findings and how to improve the differential diagnosis. Eur Radiol 17:1544–1554

    PubMed  Google Scholar 

  68. Moody AR, Wilson SR (1993) Atypical hepatic hemangioma: a suggestive sonographic morphology. Radiology 188:413–417

    PubMed  CAS  Google Scholar 

  69. Vilgrain V, Boulous L, Vullierme MP, et al. (2000) Imaging of atypical hemangiomas of the liver with pathological correlation. Radiographics 20:379–397

    PubMed  CAS  Google Scholar 

  70. Brancatelli G, Federle MP, Blachar A, et al. (2001) Hemangioma in the cirrhotic liver: diagnosis and natural history. Radiology 219:69–74

    PubMed  CAS  Google Scholar 

  71. Caturelli E, Pompili M, Bartolucci F, et al. (2001) Hemangioma-like lesions in chronic liver disease: diagnostic evaluation in patients. Radiology 220: 337–342

    PubMed  CAS  Google Scholar 

  72. Perkins AB, Imam K, Smith WJ, Cronan JJ (2000) Color and Power Doppler sonography of liver hemangiomas: a dream unfulfilled? J Clin Ultrasound 28:159–165

    PubMed  CAS  Google Scholar 

  73. Bollinger A, Putti P, Barras JP, et al. (1974) Red blood cell velocity in nailfold capillaries of men, measured by a television microscopy technique. Microvasc Res 7:61–72

    PubMed  CAS  Google Scholar 

  74. Young LK, Yang WT, Chan KW, et al. (1998) Hepatic hemangiomas: quantitative color power US angiography—facts and fallacies. Radiology 207:51–57

    PubMed  CAS  Google Scholar 

  75. Kim TK, Han JK, Kim AY, et al. (1999) Hepatic hemangiomas using a sonographic contrast agent (Levovist) and Power Doppler ultrasonography. J Ultrasound Med 18:737–743

    PubMed  CAS  Google Scholar 

  76. Strobel D, Krodel U, Martus P, et al. (2000) Clinical evaluation of contrast-enhanced color Doppler sonography in the differential diagnosis of liver tumors. J Clin Ultrasound 28:1–13

    PubMed  CAS  Google Scholar 

  77. Quaia E, Bertolotto M, Dalla Palma L (2002) Characterization of liver hemangiomas with pulse inversion harmonic imaging. Eur Radiol 12:537–544

    PubMed  Google Scholar 

  78. Bartolotta TV, Midiri M, Galia M, et al. (2003) Atypical liver hemangiomas: contrast enhancement patterns with SH U 508A and pulse-inversion US. Radiol Med 106:320–328

    PubMed  Google Scholar 

  79. Quaia E, Bartolotta TV, Midiri M, et al. (2006) Analysis of different contrast enhancement patterns after microbubble-based contrast agent injection in liver hemangiomas with atypical appearance on baseline scan. Abdom Imaging 31:59–64

    PubMed  CAS  Google Scholar 

  80. Horton KM, Bluemke DA, Hruban RH, et al. (1999) CT and MR imaging of benign hepatic and biliary tumors. Radiographics 19:431–451

    PubMed  CAS  Google Scholar 

  81. Semelka RC, Sofka CM (1997) Hepatic hemangiomas. Magn Reson Imaging Clin N Am 5:241–253

    PubMed  CAS  Google Scholar 

  82. Bartolotta TV, Midiri M, Quaia E, et al. (2005) Liver haemangiomas undetermined at grey-scale ultrasound: contrast-enhancement patterns with SonoVue and pulse-inversion US. Eur Radiol 15:685–693

    PubMed  Google Scholar 

  83. Jang HJ, Kim TK, Lim HK, et al. (2003) Hepatic hemangioma: atypical appearances on CT, MR imaging and sonography. AJR 180:135–141

    PubMed  Google Scholar 

  84. Coumbaras M, Wendum D, Monnier-Cholley L, Dahan H, Tubiana JM, Arrivé L (2002) CT and MR imaging features of pathologically proven atypical giant hemangiomas of the liver. AJR Am J Roentgenol 179:1457–1463

    PubMed  CAS  Google Scholar 

  85. Kato H, Kanematsu M, Matsuo M, Kondo H, Hoshi H (2001) Atypically enhancing hepatic cavernous hemangiomas: high-spatial-resolution gadolinium-enhanced triphasic dynamic gradient-recalled-echo imaging findings. Eur Radiol 11:2510–2515

    PubMed  CAS  Google Scholar 

  86. Kim T, Federle MP, Baron RL, Peterson MS, Kawamori Y (2001) Discrimination of small hepatic hemangiomas from hypervascular malignant tumors smaller than 3 cm with three-phase helical CT. Radiology 219:699–706

    PubMed  CAS  Google Scholar 

  87. Nicolau C, Vilana R, Catalá V, et al. (2006) Importance of evaluating all vascular phases on contrast-enhanced sonography in the differentiation of benign from malignant focal liver lesions. AJR Am J Roentgenol 186:158–167

    PubMed  Google Scholar 

  88. von Herbay A, Vogt C, Häussinger D (2002) Late-phase pulse-inversion sonography using the contrast agent levovist: differentiation between benign and malignant focal lesions of the liver. AJR Am J Roentgenol 179:1273–1279

    Google Scholar 

  89. Jang HJ, Kim TK, Wilson SR (2006) Imaging of malignant liver masses: characterization and detection. Ultrasound Q 22:19–29

    PubMed  Google Scholar 

  90. D’Onofrio M, Martone E, Faccioli N, Zamboni G, Malagò R, Mucelli RP (2006) Focal liver lesions: sinusoidal phase of CEUS. Abdom Imaging 31:529–536

    PubMed  Google Scholar 

  91. Wilson SR, Burns PN (2006) An algorithm for the diagnosis of focal liver masses using microbubble contrast-enhanced pulse-inversion sonography. AJR Am J Roentgenol 186:1401–1412

    PubMed  Google Scholar 

  92. Bartolotta TV, Midiri M, Quaia E, et al. (2005) Benign focal liver lesions: spectrum of findings on SonoVue-enhanced pulse-inversion ultrasonography. Eur Radiol 15:1643–1649

    PubMed  Google Scholar 

  93. Kim S, Chung JJ, Kim MJ, et al. (2001) Atypical inside-out pattern of hepatic hemangiomas. AJR 174:1571–1574

    Google Scholar 

  94. Bartolotta TV, Taibbi A, Galia M, et al. (2007) Centrifugal (inside-out) enhancement of liver hemangiomas: a possible atypical appearance on contrast-enhanced US. Eur J Radiol 64:447–455

    PubMed  Google Scholar 

  95. Cherqui D, Rahmouni A, Charlotte F, et al. (1995) Management of focal nodular hyperplasia and hepatocellular adenoma in young women: a series of 41 patients with clinical, radiological, and pathological correlations. Hepatology 22:1674–1681

    Article  PubMed  CAS  Google Scholar 

  96. Herman P, Pugliese V, Machado MA, et al. (2000) Hepatic adenoma and focal nodular hyperplasia: differential diagnosis and treatment. World J Surg 24:372–376

    PubMed  CAS  Google Scholar 

  97. Pain JA, Gimson AES, Williams R, Howard ER (1991) Focal nodular hyperplasia of the liver: results of treatment and options in management. Gut 32:524–527

    PubMed  CAS  Google Scholar 

  98. Belghiti J, Pateron D, Panis Y, et al. (1993) Resection of presumed benign liver tumours. Br J Surg 80:380–383

    PubMed  CAS  Google Scholar 

  99. Terkivatan T, de Wilt JH, de Man RA, et al. (2001) Indications and long-term outcome of treatment for benign hepatic tumors: a critical appraisal. Arch Surg 136:1033–1038

    PubMed  CAS  Google Scholar 

  100. Bartolozzi C, Lencioni R, Paolicchi A, et al. (1997) Differentiation of hepatocellular adenoma and focal nodular hyperplasia of the liver: comparison of power Doppler imaging and conventional color Doppler sonography. Eur Radiol 7:1410–1415

    PubMed  CAS  Google Scholar 

  101. Golli M, Mathieu D, Anglade MC, et al. (1993) Focal nodular hyperplasia of the liver: value of color Doppler US in association with MR imaging. Radiology 187:113–117

    PubMed  CAS  Google Scholar 

  102. Von Herbay A, Vogt C, Haussinger D. (2002) Pulse Inversion sonography in the early phase of the sonographic contrast agent Levovist: differentiation between benign and malignant focal liver lesions. J Ultrasound Med 21:1191–1200

    Google Scholar 

  103. Yen YH, Wang JH, Lu SN, et al. (2006) Contrast-enhanced ultrasonographic spoke-wheel sign in hepatic focal nodular hyperplasia. Eur J Radiol 60:439–444

    PubMed  Google Scholar 

  104. Ungermann L, Eliás P, Zizka J, Ryska P, Klzo L (2007) Focal nodular hyperplasia: spoke-wheel arterial pattern and other signs on dynamic contrast-enhanced ultrasonography. Eur J Radiol 63:290–294

    PubMed  Google Scholar 

  105. Bartolotta TV, Midiri M, Scialpi M, Sciarrino E, Galia M, Lagalla R (2004) Focal nodular hyperplasia in normal and fatty liver: a qualitative and quantitative evaluation with contrast-enhanced ultrasound. Eur Radiol 14:583–591

    PubMed  Google Scholar 

  106. Brancatelli G, Federle MP, Grazioli L, et al. (2001) Focal nodular hyperplasia: CT findings with emphasis on multiphasic helical CT in 78 patients. Radiology 219:61–68

    PubMed  CAS  Google Scholar 

  107. Hussain SM, Terkivatan T, Zondervan PE, et al. (2004) Focal nodular hyperplasia: findings at state-of-the-art MR imaging, US, CT, and pathologic analysis. Radiographics 24:3–17

    PubMed  Google Scholar 

  108. Vilgrain V, Flejou JF, Arrivé L, et al. (1992) Focal Nodular Hyperplasia of the liver: MR imaging and pathologic correlation in 37 patients. Radiology 184:699–703

    PubMed  CAS  Google Scholar 

  109. Kim TK, Jang HJ, Burns PN, Murphy-Lavallee J, Wilson SR (2008) Focal nodular hyperplasia and hepatic adenoma: differentiation with low-mechanical-index contrast-enhanced sonography. AJR Am J Roentgenol 190:58–66

    PubMed  Google Scholar 

  110. Dietrich CF, Schuessler G, Trojan J, Fellbaum C, Ignee A (2005) Differentiation of focal nodular hyperplasia and hepatocellular adenoma by contrast-enhanced ultrasound. Br J Radiol 78:704–707

    PubMed  CAS  Google Scholar 

  111. Konno K, Ishida H, Sato M, et al. (2001) Liver tumors in fatty liver: difficulty in ultrasonographic interpretation. Abdom Imaging 26:487–491

    PubMed  CAS  Google Scholar 

  112. Kim SH, Lee JM, Lee JY, et al. (2005) Value of contrast-enhanced sonography for the characterization of focal hepatic lesions in patients with diffuse liver disease: receiver operating characteristic analysis. AJR 184:1077–1084

    PubMed  Google Scholar 

  113. Bartolotta TV, Midiri M, Galia M, et al. (2007) Characterization of benign hepatic tumors arising in fatty liver with SonoVue and pulse inversion. US Abdom Imaging 32:84–91

    CAS  Google Scholar 

  114. Colagrande S, Politi LS, Messerini L, et al. (2003) Solitary necrotic nodule of the liver: imaging and correlation with pathologic features. Abdom Imaging 28:41–44

    PubMed  CAS  Google Scholar 

  115. Aytac S, Fitoz S, Akyar S, et al. (1999) Focal intrahepatic extramedullary hematopoiesis: color Doppler US and CT findings. Abdom Imaging 24:366–368

    PubMed  CAS  Google Scholar 

  116. Wong Y, Chen F, Tai KS, et al. (1999) Imaging features of Focal intrahepatic extramedullary hematopoiesis. Br J Radiol 72:906–910

    PubMed  CAS  Google Scholar 

  117. Nam KJ, Kang HK, Lim JH (1996) Inflammatory pseudotumor of the liver: CT and sonographic findings. AJR Am J Roentgenol 167:485–487

    PubMed  CAS  Google Scholar 

  118. Gillams A (2007) Minimally invasive treatment for liver and lung metastases in colorectal cancer. BMJ 334:1056–7

    PubMed  Google Scholar 

  119. Garden OJ, Rees M, Poston GJ, et al. (2006) Guidelines for resection of colorectal cancer liver metastases. Gut 55(Suppl 3):iii1–8

    PubMed  Google Scholar 

  120. Gillams AR, Lees WR (2005) Radiofrequency ablation of colorectal liver metastases. Abdom Imaging 30:419–426

    PubMed  CAS  Google Scholar 

  121. Elvin A, Skogseid B, Hellman P (2005) Radiofrequency ablation of neuroendocrine liver metastases. Abdom Imaging 30:427–434

    PubMed  CAS  Google Scholar 

  122. Gillams A, Cassoni A, Conway G, Lees W (2005) Radiofrequency ablation of neuroendocrine liver metastases: the Middlesex experience. Abdom Imaging 30:435–441

    PubMed  CAS  Google Scholar 

  123. 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

    PubMed  Google Scholar 

  124. Bipat S, van Leeuwen MS, Comans EF, et al. (2005) Colorectal liver metastases: CT, MR imaging, and PET for diagnosis—meta-analysis. Radiology 237:123–131

    PubMed  Google Scholar 

  125. Rappeport ED, Loft A, Berthelsen AK, et al. (2007) Contrast-enhanced FDG-PET/CT vs. SPIO-enhanced MRI vs. FDG-PET vs. CT in patients with liver metastases from colorectal cancer: a prospective study with intraoperative confirmation. Acta Radiol 48:369–378

    PubMed  CAS  Google Scholar 

  126. Ward J, Robinson PJ, Guthrie JA, et al. (2005) Liver metastases in candidates for hepatic resection: comparison of helical CT and gadolinium- and SPIO-enhanced MR imaging. Radiology 237:170–180

    PubMed  Google Scholar 

  127. Onishi H, Murakami T, Kim T, et al. (2006) Hepatic metastases: detection with multi-detector row CT, SPIO-enhanced MR imaging, and both techniques combined. Radiology 239:131–138

    PubMed  Google Scholar 

  128. Wernecke K, Rummeny E, Bongartz G, et al. (1991) Detection of hepatic masses in patients with carcinoma: comparative sensitivities of sonography, CT, and MR imaging. AJR Am J Roentgenol 157:731–739

    PubMed  CAS  Google Scholar 

  129. Albrecht T, Hohmann J, Oldenburg A, Skrok J, Wolf KJ (2004) Detection and characterisation of liver metastases. Eur Radiol 14(suppl 8):P25–P33

    PubMed  Google Scholar 

  130. Oldenburg A, Hohmann J, Foert E, et al. (2005) Detection of hepatic metastases with low MI real time contrast enhanced sonography and SonoVue. Ultraschall Med 26:277–284

    PubMed  CAS  Google Scholar 

  131. Hohmann J, Albrecht T, Oldenburg A, Skrok J, Wolf KJ (2004) Liver metastases in cancer: detection with contrast-enhanced ultrasonography. Abdom Imaging 29:669–681

    PubMed  CAS  Google Scholar 

  132. Janica JR, Lebkowska U, Ustymowicz A, et al. (2007) Contrast-enhanced ultrasonography in diagnosing liver metastases. Med Sci Monit 13(suppl 1):111–115

    PubMed  Google Scholar 

  133. Yarmenitis SD, Karantanas A, Bakantaki A, Papantoniou Y, Gourtsoyiannis N (2007) Detection of colorectal cancer hepatic metastases with contrast-enhanced ultrasound: comparison with conventional B-mode ultrasound. Dig Dis 25:86–93

    PubMed  CAS  Google Scholar 

  134. Del Frate C, Zuiani C, Londero V, et al. (2003) Comparing Levovist-enhanced pulse inversion harmonic imaging and ferumoxides-enhanced MR imaging of hepatic metastases. AJR Am J Roentgenol 180:1339–1346

    PubMed  Google Scholar 

  135. Sahani DV, Kalva SP, Tanabe KK, et al. (2004) Intraoperative US in patients undergoing surgery for liver neoplasms: comparison with MR imaging. Radiology 232:810–814

    PubMed  Google Scholar 

  136. Albrecht T, Blomley MJ, Burns PN, et al. (2003) Improved detection of hepatic metastases with pulse-inversion US during the liver-specific phase of SHU 508A: multicenter study. Radiology 227:361–370

    PubMed  Google Scholar 

  137. Quaia E, Bertolotto M, Forgács B, Rimondini A, Locatelli M, Mucelli RP (2003) Detection of liver metastases by pulse inversion harmonic imaging during Levovist late phase: comparison with conventional ultrasound and helical CT in 160 patients. Eur Radiol 13:475–483

    PubMed  Google Scholar 

  138. Konopke R, Bunk A, Kersting S (2007) The role of contrast-enhanced ultrasound for focal liver lesion detection: an overview. Ultrasound Med Biol 33:1515–1526

    PubMed  CAS  Google Scholar 

  139. Murphy-Lavallee J, Jang HJ, Kim TK, Burns PN, Wilson SR (2007) Are metastases really hypovascular in the arterial phase?: the perspective based on contrast-enhanced ultrasonography. J Ultrasound Med 26:1545–1556

    PubMed  Google Scholar 

  140. Fioole B, de Haas RJ, Wicherts DA, Elias SG, et al. (2007) Additional value of contrast enhanced intraoperative ultrasound for colorectal liver metastases. Eur J Radiol. Apr 27; [Epub ahead of print]

  141. Leen E, Ceccotti P, Moug SJ, et al. (2006) Potential value of contrast-enhanced intraoperative ultrasonography during partial hepatectomy for metastases: an essential investigation before resection? Ann Surg 243:236–240

    PubMed  Google Scholar 

  142. Torzilli G, Del Fabbro D, Palmisano A, et al. (2005) Contrast-enhanced intraoperative ultrasonography during hepatectomies for colorectal cancer liver metastases. J Gastrointest Surg 9:1148–1153

    PubMed  Google Scholar 

  143. Ong KO, Leen E (2007) Radiological staging of colorectal liver metastases. Surg Oncol 16:7–14

    PubMed  Google Scholar 

  144. McGrane S, McSweeney SE, Maher MM (2007) Which patients will benefit from percutaneous radiofrequency ablation of colorectal liver metastases? Critically appraised topic. Abdom Imaging. Sep 15; [Epub ahead of print]

  145. Bhosale P, Szklaruk J, Silverman PM (2006) Current staging of hepatocellular carcinoma: imaging implications. Cancer Imaging 6:83–94

    PubMed  CAS  Google Scholar 

  146. Hussain SM, Zondervan PE, IJzermans JN, Schalm SW, de Man RA, Krestin GP (2002) Benign versus malignant hepatic nodules: MR imaging findings with pathologic correlation. Radiographics 22:1023–1036

    PubMed  Google Scholar 

  147. Choi BI, Takayasu K, Han MC (1993) Small hepatocellular carcinomas and associated nodular lesions of the liver: pathology, pathogenesis, and imaging findings. AJR Am J Roentgenol 160:1177–1187

    PubMed  CAS  Google Scholar 

  148. Matsui O, Kadoya M, Kameyama T, et al. (1991) Benign and malignant nodules in cirrhotic livers: distinction based on blood supply. Radiology 178:493–497

    PubMed  CAS  Google Scholar 

  149. Nakashima Y, Nakashima O, Hsia CC, Kojiro M, Tabor E (1999) Vascularization of small hepatocellular carcinomas: correlation with differentiation. Liver 19:12–18

    PubMed  CAS  Google Scholar 

  150. Hayashi M, Matsui O, Ueda K, et al. (1999) Correlation between the blood supply and grade of malignancy of hepatocellular nodules associated with liver cirrhosis: evaluation by CT during intraarterial injection of contrast medium. AJR Am J Roentgenol 172:969–976

    PubMed  CAS  Google Scholar 

  151. Catalano O, Lobianco R, Cusati B, Siani A (2004) Hepatocellular carcinoma: spectrum of contrast-enhanced gray-scale harmonic sonography findings. Abdom Imaging 29:341–347

    PubMed  CAS  Google Scholar 

  152. Ogawa S, Kumada T, Toyoda H, et al. (2006) Evaluation of pathological features of hepatocellular carcinoma by contrast-enhanced ultrasonography: comparison with pathology on resected specimen. Eur J Radiol 59:74–81

    PubMed  Google Scholar 

  153. Efremidis SC, Hytiroglou P, Matsui O (2007) Enhancement patterns and signal-intensity characteristics of small hepatocellular carcinoma in cirrhosis: pathologic basis and diagnostic challenges. Eur Radiol 17:2969–2982

    PubMed  Google Scholar 

  154. Jang HJ, Kim TK, Burns PN, Wilson SR (2007) Enhancement patterns of hepatocellular carcinoma at contrast-enhanced US: comparison with histologic differentiation. Radiology 244:898–906

    PubMed  Google Scholar 

  155. Nicolau C, Catala V, Vilana R, et al. (2004) Evaluation of hepatocellular carcinoma using SonoVue, a second generation ultrasound contrast agent: correlation with cellular differentiation. Eur Radiol 14:1092–1099

    Google Scholar 

  156. Strobel D, Kleinecke C, Hänsler J, et al. (2005) Contrast-enhanced sonography for the characterisation of hepatocellular carcinomas—correlation with histological differentiation. Ultraschall Med 26:270–276

    PubMed  CAS  Google Scholar 

  157. Fan ZH, Chen MH, Dai Y, Wang, et al. (2006) Evaluation of primary malignancies of the liver using contrast-enhanced sonography: correlation with pathology. AJR Am J Roentgenol 186:1512–1519

    PubMed  Google Scholar 

  158. Liu GJ, Xu HX, Lu MD, et al. (2007) Correlation between enhancement pattern of hepatocellular carcinoma on real-time contrast-enhanced ultrasound and tumour cellular differentiation on histopathology. Br J Radiol 80:321–330

    PubMed  Google Scholar 

  159. Bolondi L, Gaiani S, Celli N, et al. (2005) Characterization of small nodules in cirrhosis by assessment of vascularity: the problem of hypovascular hepatocellular carcinoma. Hepatology 42:27–34

    PubMed  Google Scholar 

  160. Kudo M (2006) Early detection and characterization of hepatocellular carcinoma: value of imaging multistep human hepatocarcinogenesis. Intervirology 49:64–69

    PubMed  Google Scholar 

  161. Bruix J, Sherman M, Practice Guidelines Committee, American Association for the Study of Liver Diseases (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236

    Google Scholar 

  162. Isozaki T, Numata K, Kiba T, et al. (2003) Differential diagnosis of hepatic tumors by using contrast enhancement patterns at US. Radiology 229:798–805

    PubMed  Google Scholar 

  163. Nicolau C, Vilana R, Bru C (2004) The use of contrast-enhanced ultrasound in the management of the cirrhotic patient and for detection of HCC. Eur Radiol 14(suppl 8):P63–71

    PubMed  Google Scholar 

  164. Tarantino L, Francica G, Sordelli I, et al. (2006) Diagnosis of benign and malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma: color Doppler US, contrast-enhanced US, and fine-needle biopsy. Abdom Imaging 31:537–544

    PubMed  CAS  Google Scholar 

  165. Bartolotta TV, Taibbi A, Midiri M, De Maria M (2007) Hepatocellular cancer response to radiofrequency tumor ablation: contrast-enhanced ultrasound. Abdom Imaging. Aug 31 [Epub ahead of print]

  166. Xu HX, Lu MD, Liu GJ, et al. (2006) Imaging of peripheral cholangiocarcinoma with low-mechanical index contrast-enhanced sonography and SonoVue: initial experience. J Ultrasound Med 25:23–33

    PubMed  Google Scholar 

  167. Bauditz J, Schade T, Wermke W (2007) Sonographic diagnosis of hilar cholangiocarcinomas by the use of contrast agents. Ultraschall Med 28:161–167

    PubMed  CAS  Google Scholar 

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Bartolotta, T.V., Taibbi, A., Midiri, M. et al. Focal liver lesions: contrast-enhanced ultrasound. Abdom Imaging 34, 193–209 (2009). https://doi.org/10.1007/s00261-008-9378-6

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