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Rofo 2017; 189(05): 431-440
DOI: 10.1055/s-0042-124347
Contrast Agents
© Georg Thieme Verlag KG Stuttgart · New York

Analysis of Liver Tumors Using Preoperative and Intraoperative Contrast-Enhanced Ultrasound (CEUS/IOCEUS) by Radiologists in Comparison to Magnetic Resonance Imaging and Histopathology

Article in several languages: English | deutsch
Severin Huf
1   Radiology, University Medical Center Regensburg, Germany
,
Natascha Platz Batista da Silva
1   Radiology, University Medical Center Regensburg, Germany
,
Isabel Wiesinger
1   Radiology, University Medical Center Regensburg, Germany
,
Matthias Hornung
2   Surgery, University Medical Center Regensburg, Germany
,
Marcus N. Scherer
2   Surgery, University Medical Center Regensburg, Germany
,
Sven Lang
2   Surgery, University Medical Center Regensburg, Germany
,
Christian Stroszczynski
1   Radiology, University Medical Center Regensburg, Germany
,
Thomas Fischer
3   Radiology, University Medical Center Charité, Berlin, Germany
,
Ernst Michael Jung
1   Radiology, University Medical Center Regensburg, Germany
› Author Affiliations
Further Information

Publication History

24 March 2016

29 November 2016

Publication Date:
27 April 2017 (online)

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Abstract

Purpose To evaluate the diagnostic significance of preoperatively and intraoperatively performed contrast-enhanced ultrasound (CEUS/IOCEUS) in the diagnosis of liver tumors in comparison to magnetic resonance imaging (MRI) and histopathology.

Materials and Methods Retrospective analysis of 70/317 patients who underwent surgery for liver tumors between January 2012 and October 2015. Findings of CEUS and IOCEUS were compared to MRI. CEUS and IOCEUS were performed using multifrequency linear probes (1 – 5, 6 – 15 MHz) after bolus injection of 1 – 5 ml sulfur hexafluoride microbubbles. The histopathology after surgical resection, MRI morphology (T1, T2, VIBE, diffusion sequences) and wash-in/wash-out kinetics of CEUS were evaluated.

Results In 70 analyzed patient cases, 64 malignant liver lesions could be detected. 6 patients had benign liver lesions. Among the 64 malignant lesions, there were 28 metastases, 24 hepatocellular carcinomas (HCC), 9 cholangiocellular carcinomas (CCC) and 3 gallbladder carcinomas. 2 of the 6 benign liver lesions were hemangiomas, 2 were adenomas, 1 was an FNH and 1 was a complicated cyst. There was no significant difference when determining the lesion’s malignancy/ benignity (p = 1.000). Furthermore, there was no statistical significance between preoperative CEUS and MRI regarding the general differential diagnosis of a tumor (p = 0.210) and the differential diagnosis classification between HCCs (p = 0.453) and metastases (p = 0.250). There was no statistical significance in tumor size (10 mm – 151 mm; mean 49 mm SD +/– 31 mm) and location (tumor size p = 0.579; allocation to liver lobes p = 0.132; segment diagnosis p = 0.121) between preoperatively performed CEUS and MRI. The combination of preoperative MRI and CEUS for lesion detection showed significant differences compared to CEUS or MRI only (p < 0.001 for CEUS; p = 0.004 for MRI). IOCEUS offered the substantial advantage of locating additional liver lesions (p = 0.004 compared to preoperative MRI, p = 0.002 compared to preoperative CEUS). In 10/37 cases (27 %) IOCEUS could locate further liver lesions which had not been identified during CEUS and/or MRI preoperatively, so that operative therapy was adapted accordingly and resection was extended if necessary.

Conclusion CEUS proves to be a dynamic imaging method for preoperative diagnosis of liver tumors showing high diagnostic significance in the characterization of a tumor’s microvascularization, its entity and its size. During liver operations CEUS plays an important role in surgical therapy decisions.

Citation Format

  • Huf S, Platz Batista da Silva N, Wiesinger I et al. Analyse von Lebertumorentitäten mittels präoperativer und intraoperativer Kontrastmittelsonografie (CEUS/IOCEUS) durch Radiologen im Vergleich zur Magnetresonanztomografie und zur Histopathologie. Fortschr Röntgenstr 2017; 189: 431 – 440

Key words

CEUS - liver tumor - MRI - histopathology - IOCEUS
 

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