3D analysis is superior to 2D analysis for contrast-enhanced ultrasound in revealing vascularity in focal liver lesions – A retrospective analysis of 83 cases

doi:10.1016/j.ultras.2016.05.007

Ultrasonics

Volume 70, August 2016, Pages 221-226

https://doi.org/10.1016/j.ultras.2016.05.007 Get rights and content

Highlights

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The current study included a total of 83 patients with FLL.
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The diagnosis was established based on histopathology, computer tomography (CT), and magnetic resonance imaging (MRI).
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Among the 83 cases, 61 were hepatocellular carcinomas (n = 10 with metastasis), and the remaining 22 were benign lesions: hemangiomas (n = 15), focal nodular hyperplasias (n = 4), and inflammatory lesions (n = 3).
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The overall analysis showed similar pattern of enhancement between the 2D and 3D CEUS in the following features: morphological characteristics, and spatial relationships.
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In comparison to 2D imaging, 3D CEUS reveal more details of the boundary and feeding arteries of the lesions, as well as distorted features of nourishing vasculature of hepatocellular carcinomas.
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Dynamic 3D-CEUS is superior to 2D-CEUS in displaying the spatial relationship of FLLs and vascularity patterns, and simultaneous imaging of FLL perfusion and anatomic features.

Abstract

Objective

To examine whether dynamic 3D contrast-enhanced ultrasound (CEUS) is superior to 2D imaging in revealing vascularization of focal liver lesions (FLLs).

Methods

Dynamic 2D and 3D CEUS were used to assess the vascularity of FLLs in 83 patients. The two analyses were carried out sequentially following a bolus intravenous injection of SonoVue contrast agent, one injection of 1.5–2 mL was given for each part of the study (one for the 2D and another for the 3D). Due to the large data volume for 3D analysis, only the arterial phase (20–25 s) was recorded and analyzed. The data were analyzed by two independent analysts.

Results

The current study included a total of 83 patients with FLL. The diagnosis was established based on histopathology, Computed Tomography (CT), and magnetic resonance imaging (MRI). Among the 83 cases, 61 were hepatocellular carcinomas (include 10 metastasis, 51 HCCs), and the remaining 22 were benign lesions: hemangiomas (n = 15), focal nodular hyperplasias (n = 4), and inflammatory lesions (n = 3). The overall analysis showed similar patterns of enhancement between the 2D and 3D CEUS in the following features: morphological characteristics, and spatial relationships. In comparison to 2D imaging, 3D CEUS reveal more details of the boundary and feeding arteries of the lesions, as well as distorted features of supply vessels of hepatocellular carcinomas.

Conclusions

Dynamic 3D-CEUS is superior to 2D-CEUS in displaying the spatial relationship of FLLs and their vascularity patterns, and simultaneous imaging of FLL perfusion and anatomic features.

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.

Section snippets

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).

References (5)

H.X. Xu et al.
Three-dimensional contrast-enhanced ultrasound of the liver: experience of 92 cases
Ultrasonics
(2009)
K. Seitz et al.
Contrast-Enhanced Ultrasound (CEUS) for the characterization of focal liver lesions – prospective comparison in clinical practice: CEUS vs. CT (DEGUM multicenter trial)
Ultraschall Med.
(2009)

There are more references available in the full text version of this article.

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3D analysis is superior to 2D analysis for contrast-enhanced ultrasound in revealing vascularity in focal liver lesions – A retrospective analysis of 83 cases

Highlights

Abstract

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Patients

Results

Discussion

IRB

Acknowledgement

Ultrasonics

Contrast-Enhanced Ultrasound (CEUS) for the characterization of focal liver lesions – prospective comparison in clinical practice: CEUS vs. CT (DEGUM multicenter trial)

Ultraschall Med.