, Adele Taibbi1 and Massimo Midiri1
(1)
Department of Radiology, University Hospital, Palermo, Italy
As reported in the guidelines and good clinical practice recommendations for contrast-enhanced ultrasound (CEUS) in the liver, the use of CEUS is recommended for the following indications [1].
7.1 Focal Liver Lesions in the Noncirrhotic Liver
CEUS should be performed and interpreted with knowledge of the patient’s clinical history and investigation findings. When the enhancement patterns are typical (in appropriate clinical settings), hemangiomas, focal nodular hyperplasia, focal fatty change, and malignancies can all be characterized with confidence. FLL with atypical enhancement patterns or studies that are technically suboptimal require further investigation mainly with CECT and/or CEMRI.
CEUS is indicated for lesion characterization in the following clinical situations:
Incidental findings on routine ultrasound
Lesion(s) or suspected lesion(s) detected with US in patients with a known history of a malignancy as an alternative to CT or MRI
Need for a contrast study when CT and MRI contrasts are contraindicated
Inconclusive MRI/CT
Inconclusive cytology/histology results
Specificity and sensitivity are reduced in moderately or markedly fatty livers and with deeply positioned lesions.
7.2 Focal Liver Lesions in the Cirrhotic Liver
CEUS is recommended
To characterize all nodules found on surveillance and routine US.
To characterize nodules in cirrhosis and establish a diagnosis of HCC. It is a strong belief of the expert panel that CEUS is extremely useful, especially when performed immediately after nodule detection, to make a rapid diagnosis. However, CT or MRI are needed (unless contraindicated) to stage the disease before the treatment strategy is decided.
Whether CEUS has a role as first-line investigation at the same level as CT or MRI is variably accepted in national and international guidelines. For example, CEUS is part of the Japanese guidelines on HCC [2, 3] but has been removed from the American guidelines [4]. This was partly justified by the fact that no UCA is licensed for the liver in the USA and additionally because of the risk of misdiagnosing CCC for HCC when CEUS is used alone (1–2 %). In practice, the likelihood of misdiagnosis is minimal when CEUS is performed by skilled operators [5].
When CT or MRI is inconclusive, especially in nodules not suitable for biopsy
To contribute to the selection of nodule(s) for biopsy when they are multiple or have different contrast patterns
To monitor changes in size and enhancement patterns over time when a nodule is not diagnostic for HCC and is being followedRelated posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
