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CEUS Liver: Multimodality Assessment of Focal Lesions (US, CEUS, CT, MR)
Maija Radzina, MD, PhD; Madara Rauda, MD; Mirko D‘Onofrio, MD
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KEY FACTS

  • General Discussion

    • CEUS Characterization of Nodules Detected on B-Mode US

      • CEUS Characterization of Indeterminate CT or MR Findings

        IMAGING

        • CT/MR Findings

          • US Findings

            • CEUS Findings

              CEUS Characterization of Nodules Detected on B-Mode US

              • Immediate Characterization of Benign Nodules

                • Cirrhotic Nodules Detected on Surveillance US

                  • Occult Nodules Detected on CT and MR

                    • Nodule in Nodule

                      CEUS Characterization of Indeterminate CT or MR Findings

                      • Pseudolesions

                        • Absence of Arterial-Phase Hyperenhancement

                          • Absence of Portal Venous Phase Washout

                            Selected References

                            1. Barr RG: Contrast enhanced ultrasound for focal liver lesions: how accurate is it? Abdom Radiol (NY). 43(5):1128-1133, 2018
                            2. Jo PC et al: Integration of Contrast-enhanced US into a multimodality approach to imaging of nodules in a cirrhotic liver: How I do it. Radiology. 282(2):317-331, 2017
                            3. CEUS Li-RADS v2017 Core. American College of Radiology, 2017
                            4. Kim TK et al: Contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) 2017 - a review of important differences compared to the CT/MRI system. Clin Mol Hepatol. 23(4):280-289, 2017
                            5. Lassau N et al: Study of Intrapatient Variability and Reproducibility of Quantitative Tumor Perfusion Parameters Evaluated With Dynamic Contrast-Enhanced Ultrasonography. Invest Radiol. 52(3):148-154, 2017
                            6. Wilson SR et al: CEUS LI-RADS: algorithm, implementation, and key differences from CT/MRI. Abdom Radiol (NY). ePub, 2017
                            7. Dietrich CF et al: EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III - Abdominal Treatment Procedures (Short Version). Ultraschall Med. 37(1):27-45, 2016
                            8. Giorgio A et al: Contrast-Enhanced Ultrasound: a Simple and Effective Tool in Defining a Rapid Diagnostic Work-up for Small Nodules Detected in Cirrhotic Patients during Surveillance. J Gastrointestin Liver Dis. 25(2):205-11, 2016
                            9. Chiorean L et al: Vascular phases in imaging and their role in focal liver lesions assessment. Clin Hemorheol Microcirc. 62(4):299-326, 2015
                            10. D'Onofrio M et al: Malignant focal liver lesions at contrast-enhanced ultrasonography and magnetic resonance with hepatospecific contrast agent. Ultrasound. 22(2):91-8, 2014
                            11. Claudon M 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. Ultrasound Med Biol. 39(2):187-210, 2013
                            12. Patel DV et al: Investigating focal liver lesions. BMJ. 344:e657, 2012
                            13. Iavarone M et al: Diagnosis of hepatocellular carcinoma in cirrhosis by dynamic contrast imaging: the importance of tumor cell differentiation. Hepatology. 52(5):1723-30, 2010
                            14. Seitz K et al: Contrast-enhanced ultrasound (CEUS) for the characterization of focal liver lesions - prospective comparison in clinical practice: CEUS vs. CT (DEGUM multicenter trial). Parts of this manuscript were presented at the Ultrasound Dreiländertreffen 2008, Davos. Ultraschall Med. 30(4):383-9, 2009
                            15. Trillaud H et al: Characterization of focal liver lesions with SonoVue-enhanced sonography: international multicenter-study in comparison to CT and MRI. World J Gastroenterol. 15(30):3748-56, 2009
                            16. Quaia E et al: Characterization of focal liver lesions with contrast-specific US modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence. Radiology. 232(2):420-30, 2004
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • General Discussion

                              • CEUS Characterization of Nodules Detected on B-Mode US

                                • CEUS Characterization of Indeterminate CT or MR Findings

                                  IMAGING

                                  • CT/MR Findings

                                    • US Findings

                                      • CEUS Findings

                                        CEUS Characterization of Nodules Detected on B-Mode US

                                        • Immediate Characterization of Benign Nodules

                                          • Cirrhotic Nodules Detected on Surveillance US

                                            • Occult Nodules Detected on CT and MR

                                              • Nodule in Nodule

                                                CEUS Characterization of Indeterminate CT or MR Findings

                                                • Pseudolesions

                                                  • Absence of Arterial-Phase Hyperenhancement

                                                    • Absence of Portal Venous Phase Washout

                                                      Selected References

                                                      1. Barr RG: Contrast enhanced ultrasound for focal liver lesions: how accurate is it? Abdom Radiol (NY). 43(5):1128-1133, 2018
                                                      2. Jo PC et al: Integration of Contrast-enhanced US into a multimodality approach to imaging of nodules in a cirrhotic liver: How I do it. Radiology. 282(2):317-331, 2017
                                                      3. CEUS Li-RADS v2017 Core. American College of Radiology, 2017
                                                      4. Kim TK et al: Contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) 2017 - a review of important differences compared to the CT/MRI system. Clin Mol Hepatol. 23(4):280-289, 2017
                                                      5. Lassau N et al: Study of Intrapatient Variability and Reproducibility of Quantitative Tumor Perfusion Parameters Evaluated With Dynamic Contrast-Enhanced Ultrasonography. Invest Radiol. 52(3):148-154, 2017
                                                      6. Wilson SR et al: CEUS LI-RADS: algorithm, implementation, and key differences from CT/MRI. Abdom Radiol (NY). ePub, 2017
                                                      7. Dietrich CF et al: EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III - Abdominal Treatment Procedures (Short Version). Ultraschall Med. 37(1):27-45, 2016
                                                      8. Giorgio A et al: Contrast-Enhanced Ultrasound: a Simple and Effective Tool in Defining a Rapid Diagnostic Work-up for Small Nodules Detected in Cirrhotic Patients during Surveillance. J Gastrointestin Liver Dis. 25(2):205-11, 2016
                                                      9. Chiorean L et al: Vascular phases in imaging and their role in focal liver lesions assessment. Clin Hemorheol Microcirc. 62(4):299-326, 2015
                                                      10. D'Onofrio M et al: Malignant focal liver lesions at contrast-enhanced ultrasonography and magnetic resonance with hepatospecific contrast agent. Ultrasound. 22(2):91-8, 2014
                                                      11. Claudon M 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. Ultrasound Med Biol. 39(2):187-210, 2013
                                                      12. Patel DV et al: Investigating focal liver lesions. BMJ. 344:e657, 2012
                                                      13. Iavarone M et al: Diagnosis of hepatocellular carcinoma in cirrhosis by dynamic contrast imaging: the importance of tumor cell differentiation. Hepatology. 52(5):1723-30, 2010
                                                      14. Seitz K et al: Contrast-enhanced ultrasound (CEUS) for the characterization of focal liver lesions - prospective comparison in clinical practice: CEUS vs. CT (DEGUM multicenter trial). Parts of this manuscript were presented at the Ultrasound Dreiländertreffen 2008, Davos. Ultraschall Med. 30(4):383-9, 2009
                                                      15. Trillaud H et al: Characterization of focal liver lesions with SonoVue-enhanced sonography: international multicenter-study in comparison to CT and MRI. World J Gastroenterol. 15(30):3748-56, 2009
                                                      16. Quaia E et al: Characterization of focal liver lesions with contrast-specific US modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence. Radiology. 232(2):420-30, 2004