Using contrast enhanced ultrasound (CEUS) we can define hepatocellular carcinoma (HCC) as a hepatic mass with enhancement pattern in the arterial phase and washout mostly in the late phase. The AIM of this paper was to assess the utilityof prolonged examination (more that 5 minutes after the injection of contrast agent) in the diagnosis of HCC.
METHODS: We performed a prospective study in 21 patients with liver cirrhosis and HCC, in which the first CEUS examination didn’t show washout in the late phase (until 5 minutes after injection). For all this patients we performed another CEUS examination in the same session, and evaluated the liver lesion only in the late phase (in order to preserve the contrast bubbles). For the second examination we used the same dose of contrast media (2.4 ml SonoVue). The second examination was lasted until 7 minutes after the injection.
RESULTS: In 20/21 cases the HCC’s had an hyperenhancement pattern in the arterial phase and is oenhancement pattern in the portal and late phases (only one case was hyperenhanced in all three phases. After the second CEUS examination, 15/21 (71%) of the HCC’s had washout in the late phase, most of the lesions after 5 minutes from the injection of the contrast agent. In all this cases another imaging method was performed (contrast enhanced CT or MRI) to confirm the diagnosis.
In another study performed in our department (1), 79/114 HCC nodules (69.3%) had washout in the late phase. If we could perform a second CEUS examination in the inconclusive cases we could raise our sensitivity for the diagnostic of HCC to 91%.
CONCLUSIONS: A prolonged CEUS examination and the second injection of the contrast agent increased the sensitivity of this method regarding the diagnosis of the hepatocellular carcinoma, mostly because of the higher incidence of the late washout.
BIBLIOGRAPHY:
1. Martie A., Sporea I., Sirli R., Popescu A., Danila M. How Often Hepatocellular Carcinoma Has a
Typical Pattern in Contrast Enhanced Ultrasound?.Maedica (Buchar). 2012 September; 7(3): 236–240.
