Contrast-enhanced ultrasound of the liver: basics and interpretation of common focal lesions

Ehsan Safai Zadeh; Helmut Prosch; Ahmed Ba-Ssalamah; Hajo Findeisen; Amjad Alhyari; Nils Raab; Christian Görg

doi:10.1055/a-2219-4726

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Rofo 2024; 196(08): 807-818
DOI: 10.1055/a-2219-4726

Review

Contrast-enhanced ultrasound of the liver: basics and interpretation of common focal lesions

Artikel in mehreren Sprachen: English | deutsch

Ehsan Safai Zadeh

¹Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Wien, Austria

,

Helmut Prosch

¹Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Wien, Austria

,

Ahmed Ba-Ssalamah

¹Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Wien, Austria

,

Hajo Findeisen

²Department for Internal Medicine, Red Cross Hospital Bremen, Germany

,

Amjad Alhyari

³Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Gießen and Marburg Campus Marburg, Germany

,

Nils Raab

⁴Department for Internal Medicine, West Mecklenburg Hospital Helene von Bülow, Ludwigslust, Germany

,

Christian Görg

³Interdisciplinary Centre of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital of Gießen and Marburg Campus Marburg, Germany

› Institutsangaben

Abstract

Background

Over the past 20 years, contrast-enhanced ultrasound (CEUS) has become established as a procedure that is complementary to B-mode ultrasound and color Doppler sonography.

Method

The aim of this review is to provide the fundamental knowledge required for examining the liver with CEUS. Additionally, the characteristic CEUS patterns of frequent focal liver lesions are described.

Results and Conclusion

Considering the limitations of ultrasound, CEUS offers an equivalent alternative to other imaging modalities, such as computed tomography and magnetic resonance imaging, for evaluating focal liver lesions. It should be utilized as a primary modality due to its lack of radiation exposure and rapid availability.

Key Points

CEUS plays an important role particularly in the detection and evaluation of incidentally detected liver lesions.
Considering the limitations of ultrasound, CEUS offers an equivalent alternative to other imaging modalities, such as CT and MRI, for evaluating focal liver lesions.

Citation Format

Safai Zadeh E, Prosch H, Ba-Ssalamah A et al. Contrast-enhanced ultrasound of the liver: basics and interpretation of common focal lesions. Fortschr Röntgenstr 2024; 196: 807 – 818

Keywords

CEUS - ultrasound - liver - focal lesions - diagnostic imaging

Volltext

Referenzen

References
1 Dietrich CF, Nolsøe CP, Barr RG. et al. Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver – Update 2020 – WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultraschall in Med 2020; 41: 562-585
2 Safai ZadehE, Baumgarten MA, Dietrich CF. et al. Frequency of synchronous malignant liver lesions initially detected by ultrasound in patients with newly diagnosed underlying non-hematologic malignant disease: a retrospective study in 434 patients. Z Gastroenterol 2021;
3 Schmidt G, Görg C. Kursbuch Ultraschall. 2015.
4 Greis C. Grundlagen. In: Teichgräber U, Fischer T, Clevert DA. Hrsg. Praxisbuch Kontrastmittelsonografie: Kursbuch des CEUS-Kurs-Zertifikats der DRG. Berlin, Heidelberg: Springer Berlin Heidelberg; 2022: 1-20
5 Michels G, Horn R, Helfen A. et al. [Standardized contrast-enhanced ultrasound (CEUS) in clinical acute and emergency medicine and critical care (CEUS Acute): Consensus statement of DGIIN, DIVI, DGINA, DGAI, DGK, ÖGUM, SGUM and DEGUM]. Med Klin Intensivmed Notfmed 2022; 117: 1-23
6 Sidhu PS, Cantisani V, Deganello A. et al. Role of Contrast-Enhanced Ultrasound (CEUS) in Paediatric Practice: An EFSUMB Position Statement. Ultraschall in Med 2017; 38: 33-43
7 Sidhu PS, Huang DY, Fang C. Contrast enhanced ultrasound (CEUS) in Pregnancy: Is this the last frontier for microbubbles?. Ultraschall in Med 2020; 41: 8-11
8 Dietrich CF, Averkiou M, Nielsen MB. et al. How to perform Contrast-Enhanced Ultrasound (CEUS). Ultrasound Int Open 2018; 4: e2-e15
9 Friedrich-Rust M. Kontrastmittelsonografie der Leber: Literatur-Update und systematische Befundung. https://www.pkd-am-staedel.de/Fortbildung_PKD/fortbildung/2009_06_23_Sonografie.pdf
10 Lim AKP, Patel N, Eckersley RJ. et al. Evidence for Spleen-specific Uptake of a Microbubble Contrast Agent: A Quantitative Study in Healthy Volunteers. Radiology 2004; 231: 785-788
11 Yamaguchi A, Taniguchi H, Kunishima S. et al. Correlation between angiographically assessed vascularity and blood flow in hepatic metastases in patients with colorectal carcinoma. Cancer 2000; 89: 1236-1244
12 Nagy JA, Chang SH, Dvorak AM. et al. Why are tumour blood vessels abnormal and why is it important to know?. British Journal of Cancer 2009; 100: 865-869
13 Kaltenbach TE-M, Engler P, Kratzer W. et al. Prevalence of benign focal liver lesions: ultrasound investigation of 45,319 hospital patients. Abdominal Radiology 2016; 41: 25-32
14 Lantinga MA. Evaluation of hepatic cystic lesions. World Journal of Gastroenterology 2013; 19: 3543
15 Larsen LP. Role of contrast enhanced ultrasonography in the assessment of hepatic metastases: A review. World J Hepatol 2010; 2: 8-15
16 Dietrich CF, Douira-Khomsi W, Gharbi H. et al. Cystic and alveolar echinococcosis of the hepatobiliary tract – the role of new imaging techniques for improved diagnosis. Med Ultrason 2020; 22: 75-84
17 Brunetti E, Tamarozzi F, Macpherson C. et al. Ultrasound and Cystic Echinococcosis. Ultrasound Int Open 2018; 4: e70-e78
18 [Anonym]. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop 2003; 85: 253-261
19 Kratzer W, Weimer H, Schmidberger J. Echinococcosis: a Challenge for Liver Sonography. Ultraschall in Med 2022; 43: 120-145
20 Chung JJ, Kim MJ, Kim JH. et al. Fat sparing of surrounding liver from metastasis in patients with fatty liver: MR imaging with histopathologic correlation. Am J Roentgenol 2003; 180: 1347-1350
21 Fröhlich E, Jenssen C, Schuler A. et al. [Contrast-enhanced ultrasound for characterisation of focal liver lesions, practical advice]. Z Gastroenterol 2015; 53: 1099-1107
22 Tamada T, Ito K, Ueki A. et al. Peripheral low intensity sign in hepatic hemangioma: diagnostic pitfall in hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI of the liver. J Magn Reson Imaging 2012; 35: 852-858
23 Bauditz JFK, Wermke W. Sonomorphologie und Kontrastverhalten von Fokal Nodulären Hyperplasien der Leber im Langzeitverlauf. Ultraschall in Med 2006;
24 Vidili G, Piscaglia F, Ainora ME. et al. Focal nodular hyperplasia: new findings at Doppler ultrasonography. Eur Rev Med Pharmacol Sci 2020; 24: 12288-12295
25 Hussain SM, Terkivatan T, Zondervan PE. et al. Focal nodular hyperplasia: findings at state-of-the-art MR imaging, US, CT, and pathologic analysis. Radiographics 2004; 24: 3-17
26 Chandler CM, Labadie KP, Park JO. et al. Hepatocellular carcinoma arising within a β-catenin mutated inflammatory hepatic adenoma. Human Pathology: Case Reports 2021; 24: 200501
27 Goltz D, Fischer HP. Hepatozelluläre Tumoren im nichtzirrhotischen Lebergewebe. Der Pathologe 2015; 36: 597-608
28 Laumonier H, Bioulac-Sage P, Laurent C. et al. Hepatocellular adenomas: magnetic resonance imaging features as a function of molecular pathological classification. Hepatology 2008; 48: 808-818
29 Alhyari A, Görg C, Alakhras R. et al. HCC or Something Else? Frequency of Various Benign and Malignant Etiologies in Cirrhotic Patients with Newly Detected Focal Liver Lesions in Relation to Different Clinical and Sonographic Parameters. Diagnostics (Basel) 2022; 12
30 Laniado M. Bildgebung der Leberzirrhose und ihrer Komplikationen. In: Vogl TJ, Mack MG, Balzer JO. Hrsg. LeberMetastasen: Diagnose – Intervention – Therapie. Berlin, Heidelberg: Springer Berlin Heidelberg; 2002: 175-179
31 Rickes S, Ocran K, Schulze S. et al. [Evaluation of Doppler sonographic criteria for the differentiation of hepatocellular carcinomas and regenerative nodules in patients with liver cirrhosis]. Ultraschall in Med 2002; 23: 83-90
32 Dănilă M, Sporea I, Sirli R. et al. The role of contrast enhanced ultrasound (CEUS) in the assessment of liver nodules in patients with cirrhosis. Med Ultrason 2010; 12: 145-149
33 Jeong YY, Yim NY, Kang HK. Hepatocellular carcinoma in the cirrhotic liver with helical CT and MRI: imaging spectrum and pitfalls of cirrhosis-related nodules. Am J Roentgenol 2005; 185: 1024-1032
34 Lee DH, Lee JM. Primary malignant tumours in the non-cirrhotic liver. Eur J Radiol 2017; 95: 349-361
35 Meitner-Schellhaas B, Jesper D, Goertz RS. et al. Washout appearance of hepatocellular carcinomas using standardized contrast-enhanced ultrasound (CEUS) including an extended late phase observation – Real-world data from the prospective multicentre DEGUM study. Clin Hemorheol Microcirc 2023;
36 Sabrina V, Michael B, Jörg A. et al. [Not Available]. Z Gastroenterol 2022; 60: e56-e130
37 Trenker C, Görg C, Burchert A. et al. Presentation of Chloromas in B-Mode Ultrasound and Contrast-Enhanced Ultrasound. Ultrasound in Medicine & Biology 2022;
38 Valla DC, Condat B. Portal vein thrombosis in adults: pathophysiology, pathogenesis and management. J Hepatol 2000; 32: 865-871
39 Fang C, Anupindi SA, Back SJ. et al. Contrast-enhanced ultrasound of benign and malignant liver lesions in children. Pediatric Radiology 2021; 51: 2181-2197
40 Claudon M, Dietrich CF, Choi BI. et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall in Med 2013; 34: 11-29