By Luigi Bolondi
In fresh years, the imaging-based prognosis of mass liver lesions has develop into more and more advanced because of the quantity and morphological variability of lesions that smooth imaging ideas are at present capable of reveal. If the sensitivity in detection has significantly elevated, characterisation has remained tough and represents a severe problem for the clinician.
The availability of blood-pool distinction brokers for ultrasound (US), specifically second-generation US distinction brokers in response to perfluorocarbon- or sulfur-hexafluoride-filled microbubbles, and the improvement of contrast-specific software program and applied sciences have unfolded new views either for the instant characterisation of any mass lesion detected within the liver and for expanding the sensitivity people within the detection of liver metastases.
Taking into consideration the nice impression of this new know-how on medical perform, the eu Federation of Societies for Ultrasound in drugs and Biology (EFSUMB) organised, in January 2004, in Rotterdam, a consensus assembly of specialists as a way to strengthen guidance for using US distinction brokers within the analysis of liver illnesses . those guidance, in addition to discussions of additional advances within the medical software of contrast-enhanced harmonic US are provided during this booklet via an across the world well known team of specialists. The ebook represents presents an enormous place to begin for medical implementation of this new diagnostic procedure.
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Extra info for Advances in Diagnostic Imaging: The Value of Contrast-Enhanced Ultrasound for Liver
Typically they also lack portal veins. US, CT, and MR findings frequently are nonspecific. Small adenomas are mostly missed on baseline US, larger ones often show hemorrhage. On baseline US, adenomas may be hypo-, iso- or hyperechoic. Most small adenomas are difficult to detect, as they have the same or similar B-mode characteristic as the surrounding tissue. In CEUS during arterial phase, some small peripheral arteries enhance before the liver tissue, and the tumor is quickly filled. During PV and late phase, the small, isoenhancing tumors disappear within the normal liver tissue.
The CEUS is performed 15 min after the end of the RF procedure. Fifteen minutes later, most of the macrobubbles have disappeared (c). d-f At baseline VRI imaging (d), no artifact was noted that could be attributed to the presence of residual macrobubbles. After injection of SonoVue®,the lesion was studied during the arterial portal and delayed phases. The procedure was apparently successful. The ablated area seemed homogeneous without residual tumor (e). However,a careful review of the cineloop during the arterial phase revealed the persistence of a rim of strongly enhancing tissues (f, arrow).
15. Typical time-intensity curve of a FNH. Yellow curve = FNH, green curve = liver tissue The Role of Contrast-Enhanced Ultrasound (CEUS) in Identifying Focal Liver Lesions a b c d 35 Fig. 16. Atypical FNH of the left liver lobe (tumor was surgically removed). A wash-out already starts during late arterial phase and is much more pronounced in later phases. a Baseline, b Arterial phase (14s), c PV phase (26s), d Late phase (135s) Liver Abscess The main source of pyogenic liver abscess are biliary-tract diseases, which are responsible for about 60% of cases.