Contrast-enhanced ultrasound features of hepatocellular carcinoma not detected during the screening procedure

Abstract

Aim The aim of this retrospective study is to report on the characteristics of contrast-enhanced ultrasound (CEUS) of primarily not detected hepatocellular carcinoma (HCC) during the screening procedure of patients at risk.

Methods Sixty-four patients with a finally solitary and histologically proven HCC not detected HCC during the screening procedure were retrospectively analyzed. Most of HCC lesions (90.6 %, 58/64) measured < 20 mm in diameter. All HCC lesions were not detected during the initial screening procedure but suspected using contrast-enhanced magnetic resonance imaging. The final gold standard was biopsy or surgery with histological examination.

Results On CEUS, 62/64 (96.8 %) of HCC were characterized as an obviously hyperenhanced lesion in arterial phase, and 41/64 (64.1 %) of HCC were characterized as hypoenhancing lesions in the portal venous and late phases. During the arterial phase of CEUS, 96.8 % of HCC displayed homogeneous hyperenhancement. Knowing the CEUS and magnetic resonance imaging findings, 45/64 (70.3 %) could have been detected using B-mode ultrasound (BMUS).

Conclusion BMUS as a screening procedure is generally accepted. Contrast-enhanced imaging modalities have improved detection and characterization of HCC. Homogeneous hyperenhancement during the arterial phase and mild washout are indicative for HCC in liver cirrhosis.

Zusammenfassung

Ziel Ziel dieser retrospektiven Studie ist die Charakterisierung von hepatozellulären Karzinomen (HCCs), die bei sonografischen Screening-Untersuchungen übersehen wurden. Die kontrastmittelsonografischen (CEUS) Charakteristika dieser im Screening nicht detektierten Läsionen wurden bisher nicht analysiert und sind Inhalt dieser Studie.

Methoden 64 Patienten mit solitären und histologisch gesicherten HCCs wurden retrospektiv analysiert. Die meisten dieser Läsionen waren < 20 mm 58/64 (90,6 %). Die Läsionen wurden mittels kontrastverstärkter Magnetresonanztomografie (ceMRT) vermutet und letztendlich operativ-histologisch gesichert.

Ergebnisse Die CEUS-Charakteristika der HCCs waren die homogene arterielle Mehranreicherung bei 62/64 (96,8 %) und die portalvenöse Minderanreicherung (washout) bei 41/64 (64,1 %). Die erneute B-Bild-Sonografie erlaubte unter Kenntnis des MRT- und CEUS-Befundes bei 45/64 (70,3 %) die Zuordnung nunmehr auch im B-Bild.

Schlussfolgerung Die B-Bild-Sonografie ist zum Screening von HCCs etabliert. CEUS erlaubt die verbesserte Detektion und Charakterisierung von Leberknoten in der Leberzirrhose. Die typischen Kontrastmittelcharakteristika sind einerseits die arterielle Mehranreicherung und andererseits das milde Washout.

Key words

guidelines - screening - hepatocellular carcinoma (HCC) - contrast-enhanced ultrasound (CEUS) - LI-RADS

Schlüsselwörter

Leitlinien - Screening - hepatozelluläres Karzinom (HCC) - Kontrastmittelsonografie - LI-RADS

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