3D analysis is superior to 2D analysis for contrast-enhanced ultrasound in revealing vascularity in focal liver lesions – A retrospective analysis of 83 cases
Introduction
Two-dimensional contrast-enhanced ultrasound (2D-CEUS) is a useful tool to differentiate malignant from benign focal liver lesions (FLLs) [1], [2], [3]. Since 2D-CEUS displays all information on a single plane, it could not capture all details of the lesions, and particularly vascular characteristics. Previous studies have suggested that three-dimensional contrast-enhanced ultrasound (3D-CEUS) possesses advantages over 2D-CEUS in displaying lesions with spatial relationship [1], [2]. However, conventional 3D-CEUS is a static image, and does not provide enhancement patterns along with evolving phase. Dynamic 3D-CEUS displays live enhancement images of lesions in different phases. Thus, dynamic 3D-CEUS is a potential modality for routine FLLs diagnosis. The aim of the current study was to compare morphological images, the number of the nutrient arteries, and the spatial relationships in FLLs, and determine the diagnostic value of 2D-CEUS and dynamic 3D-CEUS.
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Patients
Over the periods of July 2012 to December 2014. A total of 83 patients with FLLs were involved in this study. The patients ranged in age from 20 to 75 years (Mean 55.6 ± 13.5 years). All 83 subjects (54 men, 29 women) had FLLs, the size ranged from 1.4 to 3.5 cm (Mean 2.8 ± 1.6 cm). The FLLs were diagnosed by histological (62 cases), CE-CT (12 cases) or CE-MRI (9 cases). Only the cases analyzed with both 2D and 3D CEUS, each upon a single injection of SonoVue contrast agent were included in the
Results
All 83 FLLs were diagnostically validated using histopathology, CT, and MRI. Sixty-one cases were diagnosed with malignant lesions including hepatocellular carcinomas (n = 51) and metastases (n = 10). Benign lesions, including hemangiomas (n = 15), focal nodular hyperplasias (n = 4), and inflammatory lesion (n = 3) were found in the remaining 22 cases.
The enhancement patterns were similar under 3D vs. 2D CEUS. Of the 51 hepatocellular carcinomas (HCCs), 32 showed a fast-in and fast-out pattern.
Discussion
Tumor growth rate and metastasis largely depend on angiogenesis. The number, structure, and distribution of new blood vessels are different in benign and malignant lesions. A majority of malignant tumors contain a large number of invasive internal and peripheral capillary vessels, but the number of invasive capillary vessels in benign tumors is relatively few [4]. Distinct blood supply characteristics of FLLs provided a physio-pathologic basis for differential diagnosis, treatment, and
IRB
This retrospective study was approved by the Institutional Review Board, and informed consent was obtained from each patient.
Acknowledgement
This project was supported by the Medjaden Academy & Research Foundation for Young Scientists (Grant No. MJA20141225).
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