The Role of CEUS in the Characterization of Hepatocellular Nodules Detected During the US Surveillance Program – Current Practices in Europe

Abstract

The basic pathological feature for the differential diagnosis between hepatocellular carcinoma (HCC) and non-malignant hepatocellular nodules in cirrhotic patients detected during ultrasound (US) is the vascular supply to the nodule. Computed tomography (CT) and magnetic resonance imaging (MRI) are considered reference imaging techniques for depicting hepatocellular nodule vascularity in the noninvasive diagnosis of HCC. Contrast-enhanced US (CEUS) improves the diagnostic performance of unenhanced US in the diagnosis of HCC, giving an overall diagnostic accuracy that is similar to that of CT, even for nodules smaller than 2 cm. An additional diagnostic feature of CEUS relative to CT is the possibility to visualize contrast wash-in to hepatic nodules during the arterial phase and contrast washout during the portal venous and late phases. Sensitivity for the diagnosis of HCC with combined assessment of CEUS and CT is higher than for separate assessments of CEUS and CT due to the reduction of false-negative findings. CEUS represents a competitive imaging method from an economic point of view, and is an effective imaging tool for assessing the therapeutic outcome after surgery, ablation therapy, and transarterial chemoembolization (TACE).

Zusammenfassung

Bei der Differenzialdiagnose von hepatozellulären Karzinomen (HCC) und benignen hepatozellulären Knoten bei Zirrhose-Patienten ist das im Ultraschall (US) festzustellende, wesentliche pathologische Merkmal die Gefäßversorgung des Knotens. Die Computertomografie (CT) und die Magnetresonanztomografie (MRT) gelten als bildgebende Referenzmethoden in der nicht invasiven Diagnostik des HCC, um die Vaskularisierung des hepatozellulären Knotens darzustellen. Der kontrastverstärkte US (CEUS) verbessert die diagnostische Aussage des nicht kontrastverstärkten US bei der Diagnose eines HCC, wobei selbst für Knoten unter 2 cm eine diagnostische Genauigkeit erreicht wird, die der einer CT entspricht. Eine weitere diagnostische Leistung des CEUS im Vergleich zur CT ist durch die Möglichkeit gegeben, das Wash-in des Kontrastmittels in die hepatischen Knoten während der arteriellen Phase und das Wash-out des Kontrastmittels während der portalen venösen und späten Phase darzustellen. Die Sensitivität für die Diagnose eines HCC bei kombinierter Bewertung mittels CEUS und CT ist höher, als bei voneinander getrennten Auswertungen beider Methoden, da dadurch falsch negative Befunde verringert werden. Vom ökonomischen Standpunkt her gesehen ist der CEUS ein konkurrenzfähiges bildgebendes Verfahren, ebenso ist er ein effektives bildgebendes Verfahren, um das therapeutische Ansprechen nach Operation, Ablationstherapie oder transarterielle Chemoembolisierung (TACE) zu bewerten.

Key words

microbubbles - nodule - liver - cirrhosis

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