By Luigi Bolondi

In contemporary years, the imaging-based analysis of mass liver lesions has turn into more and more complicated as a result quantity and morphological variability of lesions that smooth imaging thoughts are at present capable of show. If the sensitivity in detection has enormously elevated, characterisation has remained tricky and represents a serious problem for the clinician.

The availability of blood-pool distinction brokers for ultrasound (US), specifically second-generation US distinction brokers in response to perfluorocarbon- or sulfur-hexafluoride-filled microbubbles, and the improvement of contrast-specific software program and applied sciences have unfolded new views either for the instant characterisation of any mass lesion detected within the liver and for expanding the sensitivity people within the detection of liver metastases.

Taking into consideration the nice effect of this new expertise on medical perform, the ecu Federation of Societies for Ultrasound in medication and Biology (EFSUMB) organised, in January 2004, in Rotterdam, a consensus assembly of specialists as a way to boost guidance for using US distinction brokers within the analysis of liver illnesses . those guidance, in addition to discussions of extra advances within the scientific software of contrast-enhanced harmonic US are provided during this e-book via an the world over popular staff of specialists. The e-book represents offers an enormous place to begin for medical implementation of this new diagnostic procedure.

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4 ml of SonoVue® (Bracco, Italy) using the VRI modality. The lesion strongly enhanced during the arterial phase (d, e) compared to baseline imaging (c). The increased vascularity of the anterior subcapsular HCC was better seen at CEUS than by CT. 56 Jean-Michel Correas et al. Fig. 4a-c. In the same patient as in Fig. 3, an additional small HCC was also detected in between segment III and II. This lesion was not seen on baseline imaging even during the review of the cineloops acquired during the examination.

Scheme of time-intensity curve between normal liver tissue, hyper-, and hypovascular liver metastases The value of differentiating hyper- from hypovascular lesions is limited and can only offer hints regarding the suspected primary tumor. This approach may become more valuable in monitoring patients, as it reflects the vessel density, blood volume flow, and intratumoral pressure (Figs. 19, 20). Fig. 19. Hypervascular liver metastases from ovarian cancer (a), carcinoid (b), renal cell carcinoma (central hypoxia/necrosis) (c), liposarcoma (3-D) (d) a b c d The Role of Contrast-Enhanced Ultrasound (CEUS) in Identifying Focal Liver Lesions 41 Most metastases are hypovascular, with only a short time interval in which an uptake of contrast material – often in the periphery – is seen (rim enhancement) (Fig.

For an experienced US examiner, CEUS is easy to learn and to interpret. Consequently, CEUS is a reliable diagnostic tool that improves diagnostic overall diagnostic accuracy. One center reported an improvement from about 50% in unenhanced baseline studies to about 88% during contrast examinations [36]. ■ References 1. Giovagnoni A, Piga A, Argalia G et al (1993) Inadequacy of ultrasonography for monitoring response to treatment of liver metastases. J Clin Oncol 11(12):2451-2455 2. Karhunen PJ (1986) Benign hepatic tumours and tumour like conditions in men.

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