Contrast-Enhanced Ultrasound: a Simple and Effective Tool in Defining a Rapid Diagnostic Work-up for Small Nodules Detected in Cirrhotic Patients during Surveillance.
OBJECTIVE
Disappearance of portal blood flow and arterial vascularization is the hallmark of hepatocarcinogenesis. The capability of a dynamic imaging modality detecting arterial hypervascularization of small nodules is crucial to promote a rapid diagnostic and therapeutic work-up improving survival. We aimed to evaluate the capability of CEUS to detect arterial vascularization of ≤ 2 cm HCC nodules arising during surveillance so as to shorten the diagnostic and therapeutic work-up.


METHODS
From October 2009 to September 2014, among 1757 consecutive cirrhotic patients under surveillance with ultrasound (US), 243 patients had new single nodules 7-20 mm; 229/243 had a conclusive histologic diagnosis and comprised the study group. All patients underwent CEUS followed by enhanced MRI and US guided percutaneous 18G needle core biopsy of the nodules. Of the 229 nodules, 27 were hyperechoic, 171 hypoechoic and 31 isoechoic lesions.


RESULTS
The histology results revealed that 199/229 nodules were HCC and 30 were benign. Of 199 HCC, CEUS evidenced arterial hypervascularity in 190 nodules (95.5%) (sensitivity 94.48 %, specificity 100%, PPV 100%, NPV 76.92 %). Of the 39 CEUS arterial-unenhanced nodules, 30 were benign and 9 (23%) were well-differentiated HCC. eMRI showed arterial hypervascularity in 199 nodules (86,9%). Of these, only 193 (97%) were histologically HCCs while 6 were benign (sensitivity: 97%, specificity: 80%, PPV: 97%, NPV: 80%).


CONCLUSIONS
CEUS has a great capability to detect arterial hypervascularity of small HCC. Because only 4.5% of new nodules escape the demonstration of arterial hyervascularity, CEUS must be performed immediately after conventional US to contrast the malignant fate of small lesions arising in a cirrhotic liver.
Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy. agiorgio28@gmail.com.
Antonio
A
Giorgio
Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy.
Luca
L
Montesarchio
Department of Oncology, University Hospital of Bari, Bari, Italy.
Piero
P
Gatti
Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy.
Ferdinando
F
Amendola
Radiotherapy and Oncology Department, Campus Biomedico University, Rome, Italy.
Paolo
P
Matteucci
Interventional Ultrasound Unit, Athena Cinical Institute, Caserta, Italy.
Bruno
B
Santoro
Interventional Ultrasound Unit, Athena Cinical Institute, Caserta, Italy.
Maria Gabriella
MG
Merola
Interventional Ultrasound Unit, Athena Cinical Institute, Caserta, Italy.
Francesca
F
Merola
Hepatology and Interventional US Unit, Gragnano Hospital, Gragnano, Italy.
Carmine
C
Coppola
Pediatric Department, Fondazione Policlinico Gemelli, Rome, Italy.
Valentina
V
Giorgio
D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000209:etiology; D003287:Contrast Media / Q000008:administration & dosage*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging*; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010743:Phospholipids / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013459:Sulfur Hexafluoride / Q000008:administration & dosage*; D013997:Time Factors; D047368:Tumor Burden; D014463:Ultrasonography
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride