AJR
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Wu, W.
Right arrow Articles by Li, J.-Y.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Wu, W.
Right arrow Articles by Li, J.-Y.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?
Hotlight (NEW!)
Right arrow
What's Hotlight?

The Role of Contrast-Enhanced Sonography of Focal Liver Lesions Before Percutaneous Biopsy

Wei Wu1, Min-Hua Chen1, Shan-Shan Yin1, Kun Yan1, Zhi-Hui Fan1, Wei Yang1, Ying Dai1, Ling Huo1 and Ji-You Li2

1 Department of Ultrasound, School of Oncology, Peking University, 52 Fu-cheng Rd., Beijing 100036, People's Republic of China.
2 Department of Pathology, School of Oncology, Peking University, Beijing 100036, People's Republic of China.


Figure 1
View larger version (13K):

[in a new window]
  		Fig. 1 —Flow chart shows algorithm for diagnosis of liver tumor.

 

Figure 2
View larger version (36K):

[in a new window]
  		Fig. 2 —Bar graph shows accuracy for contrast-enhanced sonography group (light gray) and unenhanced sonography group (black) in diagnosis of malignant lesions by lesion size. There was statistically significant difference between contrast-enhanced sonography group and unenhanced sonography group in accuracy for diagnosis of malignant lesions ≤ 2.0 cm (97.1% [n = 34/35] vs 78.8% [n = 26/33], respectively; {chi}2 = 3.886, p = 0.0490).

 

Figure 3
View larger version (150K):

[in a new window]
  		Fig. 3A —32-year-old man with focal liver lesion in left lobe in unenhanced sonography group. First and second biopsy procedures were performed with 21-gauge manual aspiration needle guided by conventional sonography. Pathologic diagnosis of both biopsy samples was hepatocellular fatty degeneration. Contrast-enhanced sonograms show lesion (arrow) to exhibit slight inhomogeneous enhancement in arterial phase (A). Area of enhancement washed out quickly in parenchymal phase (B).

 

Figure 4
View larger version (148K):

[in a new window]
  		Fig. 3B —32-year-old man with focal liver lesion in left lobe in unenhanced sonography group. First and second biopsy procedures were performed with 21-gauge manual aspiration needle guided by conventional sonography. Pathologic diagnosis of both biopsy samples was hepatocellular fatty degeneration. Contrast-enhanced sonograms show lesion (arrow) to exhibit slight inhomogeneous enhancement in arterial phase (A). Area of enhancement washed out quickly in parenchymal phase (B).

 

Figure 5
View larger version (126K):

[in a new window]
  		Fig. 3C —32-year-old man with focal liver lesion in left lobe in unenhanced sonography group. First and second biopsy procedures were performed with 21-gauge manual aspiration needle guided by conventional sonography. Pathologic diagnosis of both biopsy samples was hepatocellular fatty degeneration. Sonogram shows lesion (arrow), which was biopsied using 18-gauge automated cutting needle.

 

Figure 6
View larger version (148K):

[in a new window]
  		Fig. 3D —32-year-old man with focal liver lesion in left lobe in unenhanced sonography group. First and second biopsy procedures were performed with 21-gauge manual aspiration needle guided by conventional sonography. Pathologic diagnosis of both biopsy samples was hepatocellular fatty degeneration. Photomicrograph of biopsy specimen shows tumor cells to exhibit glandular structures and form into multilayer in some areas. Pathologic diagnosis of biopsy sample was cholangiocarcinoma.

 

Figure 7
View larger version (156K):

[in a new window]
  		Fig. 3E —32-year-old man with focal liver lesion in left lobe in unenhanced sonography group. First and second biopsy procedures were performed with 21-gauge manual aspiration needle guided by conventional sonography. Pathologic diagnosis of both biopsy samples was hepatocellular fatty degeneration. Photograph of sample of tumor shows hepatocellular fatty degeneration (star) and cholangiocarcinoma (arrowhead).

 

Figure 8
View larger version (149K):

[in a new window]
  		Fig. 4A —79-year-old woman with history of hepatitis B-related cirrhosis for 1 year in unenhanced sonography group. Serum {alpha}-fetoprotein level was 800 ng/mL. Hypoechoic lesion was found in hepatic segments V-VIII during routine sonography examination. Initial biopsy guided by conventional sonography was negative. Contrast-enhanced sonogram shows large area of ringlike enhancement (long arrow) and small area of ringlike enhancement (short arrow) in early arterial phase.

 

Figure 9
View larger version (152K):

[in a new window]
  		Fig. 4B —79-year-old woman with history of hepatitis B-related cirrhosis for 1 year in unenhanced sonography group. Serum {alpha}-fetoprotein level was 800 ng/mL. Hypoechoic lesion was found in hepatic segments V-VIII during routine sonography examination. Initial biopsy guided by conventional sonography was negative. Sonogram obtained later in arterial phase than A shows central area of large ringlike area (long arrow) as being enhanced, but central area of small ringlike area (short arrow) is not enhanced at all.

 

Figure 10
View larger version (152K):

[in a new window]
  		Fig. 4C —79-year-old woman with history of hepatitis B-related cirrhosis for 1 year in unenhanced sonography group. Serum {alpha}-fetoprotein level was 800 ng/mL. Hypoechoic lesion was found in hepatic segments V-VIII during routine sonography examination. Initial biopsy guided by conventional sonography was negative. Enhanced area (arrowhead) was washed out in late parenchymal phase.

 

Figure 11
View larger version (124K):

[in a new window]
  		Fig. 4D —79-year-old woman with history of hepatitis B-related cirrhosis for 1 year in unenhanced sonography group. Serum {alpha}-fetoprotein level was 800 ng/mL. Hypoechoic lesion was found in hepatic segments V-VIII during routine sonography examination. Initial biopsy guided by conventional sonography was negative. After contrast-enhanced sonography was performed, repeat biopsy of enhanced area was performed. Arrow points to needle tip.

 

Figure 12
View larger version (169K):

[in a new window]
  		Fig. 4E —79-year-old woman with history of hepatitis B-related cirrhosis for 1 year in unenhanced sonography group. Serum {alpha}-fetoprotein level was 800 ng/mL. Hypoechoic lesion was found in hepatic segments V-VIII during routine sonography examination. Initial biopsy guided by conventional sonography was negative. Photomicrograph shows biopsy sample from enhanced area obtained during repeat biopsy (D). Pathologic diagnosis was well-differentiated hepatocellular carcinoma.

 

Figure 13
View larger version (104K):

[in a new window]
  		Fig. 4F —79-year-old woman with history of hepatitis B-related cirrhosis for 1 year in unenhanced sonography group. Serum {alpha}-fetoprotein level was 800 ng/mL. Hypoechoic lesion was found in hepatic segments V-VIII during routine sonography examination. Initial biopsy guided by conventional sonography was negative. Sonogram obtained during biopsy of unenhanced area shows needle tip (arrow).

 

Figure 14
View larger version (165K):

[in a new window]
  		Fig. 4G —79-year-old woman with history of hepatitis B-related cirrhosis for 1 year in unenhanced sonography group. Serum {alpha}-fetoprotein level was 800 ng/mL. Hypoechoic lesion was found in hepatic segments V-VIII during routine sonography examination. Initial biopsy guided by conventional sonography was negative. Photomicrograph shows biopsy sample from unenhanced area. Pathologic diagnosis was hepatocellular degeneration.

 

Figure 15
View larger version (136K):

[in a new window]
  		Fig. 5A —71-year-old man with radiofrequency-treated hepatocellular carcinoma in unenhanced sonography group. After ablation, tumor was enlarged with suspected recurrence. Serum {alpha}-fetoprotein value was 0.815 ng/mL. Initial biopsy guided by conventional sonography was negative. Contrast-enhanced sonograms obtained after ablation during arterial phase (A) and parenchymal phase (B) show 3.3 x 2.4 cm abnormal enhancement in lesion (arrow). Area of enhancement (arrow, A) in arterial phase washed out quickly in parenchymal phase (arrow, B). However, postablation lesion was not enhanced and presented as hypoechoic during all phases (arrowhead). Area of enhancement was punctured again, and well-differentiated hepatocellular carcinoma was diagnosed.

 

Figure 16
View larger version (152K):

[in a new window]
  		Fig. 5B —71-year-old man with radiofrequency-treated hepatocellular carcinoma in unenhanced sonography group. After ablation, tumor was enlarged with suspected recurrence. Serum {alpha}-fetoprotein value was 0.815 ng/mL. Initial biopsy guided by conventional sonography was negative. Contrast-enhanced sonograms obtained after ablation during arterial phase (A) and parenchymal phase (B) show 3.3 x 2.4 cm abnormal enhancement in lesion (arrow). Area of enhancement (arrow, A) in arterial phase washed out quickly in parenchymal phase (arrow, B). However, postablation lesion was not enhanced and presented as hypoechoic during all phases (arrowhead). Area of enhancement was punctured again, and well-differentiated hepatocellular carcinoma was diagnosed.

 

Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?



HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2006 by the American Roentgen Ray Society.