Advances in Diagnostic Imaging: The Value of by Luigi Bolondi

By Luigi Bolondi

In contemporary years, the imaging-based prognosis of mass liver lesions has turn into more and more complicated as a result quantity and morphological variability of lesions that smooth imaging concepts are at present in a position to demonstrate. If the sensitivity in detection has tremendously elevated, characterisation has remained tough and represents a serious problem for the clinician.

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

Taking into consideration the nice effect of this new know-how on medical perform, the ecu Federation of Societies for Ultrasound in drugs and Biology (EFSUMB) organised, in January 2004, in Rotterdam, a consensus assembly of specialists with the intention to enhance directions for using US distinction brokers within the prognosis of liver ailments . those guidance, in addition to discussions of extra advances within the medical software of contrast-enhanced harmonic US are provided during this e-book via an across the world well known staff of specialists. The booklet represents offers a major start line for scientific implementation of this new diagnostic procedure.

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35. 36. diagnosis of liver lesions by color doppler ultrasonography. World J Gastroenterol 10(7):965-967 Edmunsen HA, Craig JR (1987) Neoplasms of the liver. In: Schiff L (ed) Diseases of the liver, 8th edn. Lippincott, Philadephia, p 1109 Folkman J, Beckner K (2000) Angiogenesis imaging. Acad Radiol 7(10):783-785 Baker ME, Paulson EK (1993) Hepatic metastatic disease. In: Meyers MA, (ed) Neoplasms of the digestive tract: imaging, staging, and management. Philadelphia, Lippincott-Raven, pp 361-395 Quaia E, Calliada F, Bertolotto M et al (2004) Characterization of focal liver lesions with contrast-specific US modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence.

They are still used in most cases because of their low cost and lack of morbidity. Serum AFP sensitivity and positive predictive value are low, ranging from 39% to 64% and 9% to 32%, respectively [8, 9]. An increase in AFP is not specific for HCC and serum AFP levels remain normal in almost 50% of HCC below 3 cm in diameter. The sensitivity of US examination is limited, ranging from 40% to 70% for lesions below 2 cm in diameter. In cirrhotic patients its sensitivity can reach 78%, with a specificity of 93% and a positive predictive value of 73% [8].

Accompanying the hepatic arteries, the central major portal-venous branches are already contrast-enhanced We have observed three patients (two female, one male, all between 50 and 55 years) with histological proven FNH, which showed marked wash-out during PV and late phases. CT, MR, and, in one case, (Fig. 16) radionuclide scans were inconclusive as well. Fig. 15. Typical time-intensity curve of a FNH. Yellow curve = FNH, green curve = liver tissue The Role of Contrast-Enhanced Ultrasound (CEUS) in Identifying Focal Liver Lesions a b c d 35 Fig.

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