Zusammenfassung
Durch die Darstellung der dynamischen Tumorperfusion gelingt die Detektion des hepatozellulären Karzinoms mit Hilfe der kontrastmittelverstärkten Sonographie mit einer Sensitivität von bis zu >90% und einer Charakterisierung von Leberläsionen entsprechend der diagnostischen Sicherheit der kontrastmittelverstärkten Computertomographie.
Die dynamische Erfassung der Mikrovaskularisation mit der kontrastmittelverstärkten Sonographie erlaubt eine Differenzierung zwischen vaskularisierten Tumorläsionen und avaskularisierten Nekrosezonen vor, während und nach Intervention durch die transarterielle Chemoembolisation und Radiofrequenzablation. Zusätzlich können Volumendarstellungen und Bildfusion zur Therapiekontrolle nach diesen Interventionen hilfreich sein.
Abstract
Due to the imaging of dynamic perfusion, hepatocellular carcinoma can be detected with a sensitivity of >90% using contrast-enhanced sonography. The characterization of liver tumors with contrast-enhanced sonography is comparable to the diagnostic accuracy of contrast-enhanced computed tomography. The dynamic detection of microvascularization with contrast-enhanced sonography allows the differentiation between vascularized tumors and non-vascularized necrotic lesions before, during and after transarterial chemoembolization or percutaneous radiofrequency ablation. Image fusion with volume navigation can be useful in the follow-up control.
Literatur
Bargellini I, Vignali C, Cioni R et al (2010) Hepatocellular carcinoma: CT for tumor response after transarterial chemoembolization in patients exceeding Milan criteria-selection parameter for liver tranplantation. Radiology 255:289–300
Bolondi L, Correas JM, Lencioni R et al (2007) New perspectives for the use of contrast-enhanced liver ultrasound in clinical practice. Dig Liver Dis 39:187–195
Catala V, Nicolau C, Vilana R et al (2007) Characterization of focal liver lesions: comparative study of contrast-enhanced ultrasound versus spiral computed tomography. Eur Radiol 17:1066–1073
Chen MH, Wu W, Yang W et al (2007) The use of contrast-enhanced ultrasonography in the selection of patients with hepatocellular carcinoma for radio frequency ablation therapy. J Ultrasound Med 26:1055–1063
Chen MH, Wu W, Yang W et al (2005) Application of contrast-enhanced ultrasonography in selecting indication of radiofrequency ablation among hepatocellular carcinoma patients. Zhonghua Yi Xue Za Zhi 85:3491–3494
Clevert D-A, Horng A, Kopp R et al (2009) Imaging of endoleaks after endovascular aneurysm repair (EVAR) with contrast-enhanced ultrasound (CEUS). Radiologe 49:1033–1039
Clevert D-A, Horng A, Reiser MF (2009) Ultrasound imaging of the abdominal aorta. Radiologe 49:1024–1032
Clevert D-A, Jung EM, Stock KF et al (2009) Evaluation of malignant liver tumors: biphasic MS-CT versus quantitative contrast harmonic imaging ultrasound. Z Gastroenterol 47:1195–1202
Dorffel Y, Wermke W (2008) Neuroendocrine tumors: characterization with contrast-enhanced ultrasonography. Ultraschall Med 29:506–514
Gallotti A, D’Onofrio M, Ruzzenente A et al (2009) Contrast-enhanced ultrasonography (CEUS) immediately after percutaneous ablation of hepatocellular carcinoma. Radiol Med 114:1094–1105
Greis C (2009) Ultrasound contrast agents as markers of vascularity and microcirculation. Clin Hemorheol Microcirc 43:1–9
Horng A, Reiser MF, Clevert D-A (2010) Modern sonography in the diagnosis of acute abdomen. Radiologe 50:214–225
Jung EM, Clevert D-A, Rupp N (2003) Contrast-enhanced ultrasound with optison in percutaneous thermoablation of liver tumors. Rofo 175:1403–1412
Jung EM, Clevert D-A, Schreyer AG et al (2007) Evaluation of quantitative contrast harmonic imaging to assess malignancy of liver tumors: a prospective controlled two-center study. World J Gastroenterol 13:6356–6364
Jung EM, Kubale R, Jungius KP et al (2006) Vascularization of liver tumors – preliminary results with coded harmonic angio (CHA), phase inversion imaging, 3D power Doppler and contrast medium-enhanced B-flow with second generation contrast agent (optison). Clin Hemorheol Microcirc 34:483–497
Jung EM, Ross CJ, Rennert J et al (2010) Characterization of microvascularization of liver tumor lesions with high resolution linear ultrasound and contrast enhanced ultrasound (CEUS) during surgery: first results. Clin Hemorheol Microcirc 46:89–99
Jung EM, Schreyer AG, Schacherer D et al (2009) New real-time image fusion technique for characterization of tumor vascularisation and tumor perfusion of liver tumors with contrast-enhanced ultrasound, spiral CT or MRI: first results. Clin Hemorheol Microcirc 43:57–69
Kim HJ, Kim TK, Kim PN et al (2006) Assessment of the therapeutic response of hepatocellular carcinoma treated with transcatheter arterial chemoembolization: comparison of contrast-enhanced sonography and 3-phase computed tomography. J Ultrasound Med 25:477–486
Kono Y, Lucidarme O, Choi SH et al (2007) Contrast-enhanced ultrasound as a predictor of treatment efficacy within 2 weeks after transarterial chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol 18:57–65
Ladam-Marcus V, Mac G, Job L et al (2009) Contrast-enhanced ultrasound and liver imaging: review of the literature. J Radiol 90:93–106; quiz 107–108
Lu MD, Yu XL, Li AH et al (2007) Comparison of contrast enhanced ultrasound and contrast enhanced CT or MRI in monitoring percutaneous thermal ablation procedure in patients with hepatocellular carcinoma: a multi-center study in China. Ultrasound Med Biol 33:1736–1749
Maruyama H, Kobayashi S, Yoshizumi H et al (2007) Application of percutaneous ultrasound-guided treatment for ultrasonically invisible hypervascular hepatocellular carcinoma using microbubble contrast agent. Clin Radiol 62:668–675
Minami Y, Kudo M, Hatanaka K et al (2010) Radiofrequency ablation guided by contrast harmonic sonography using perfluorocarbon microbubbles (sonazoid) for hepatic malignancies: an initial experience. Liver Int 30:759–764
Moschouris H, Malagari K, Kornezos I et al (2010) Unenhanced and contrast-enhanced ultrasonography during hepatic transarterial embolization and chemoembolization with drug-eluting beads. Cardiovasc Intervent Radiol 33:1215–1222
Nicolau C, Vilana R, Bianchi L, Bru C (2007) Early-stage hepatocellular carcinoma: the high accuracy of real-time contrast-enhanced ultrasonography in the assessment of response to percutaneous treatment. Eur Radiol 17(suppl 6):F80–F88
Nicolau C, Vilana R, Catala V et al (2006) Importance of evaluating all vascular phases on contrast-enhanced sonography in the differentiation of benign from malignant focal liver lesions. AJR Am J Roentgenol 186:158–167
Oldenburg A, Albrecht T (2008) Baseline and contrast-enhanced ultrasound of the liver in tumor patients. Ultraschall Med 29:488–498
Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108
Piscaglia F, Lencioni R, Sagrini E et al (2010) Characterization of focal liver lesions with contrast-enhanced ultrasound. Ultrasound Med Biol 36:531–550
Ross CJ, Rennert J, Schacherer D et al (2010) Image fusion with volume navigation of contrast enhanced ultrasound (CEUS) with computed tomography (CT) or magnetic resonance imaging (MRI) for post-interventional follow-up after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinomas (HCC): Preliminary results. Clin Hemorheol Microcirc 46:101–115
Salvaggio G, Campisi A, Lo Greco V et al (2010) Evaluation of posttreatment response of hepatocellular carcinoma: comparison of ultrasonography with second-generation ultrasound contrast agent and multidetector CT. Abdom Imaging 35:447–453
Schacherer D, Girlich C, Jung ME et al (2009) Transabdominal ultrasound with echoenhancement by contrast media in the diagnosis of hepatocellular carcinoma. Dig Dis 27:109–113
Schacherer D, Girlich C, Zorger N et al (2010) Sono-hepatic-arteriography (Sono-HA) in the assessment of hepatocellular carcinoma in patients undergoing transcatheter arterial chemoembolization (TACE). Ultraschall Med 31:270–275
Seitz K, Strobel D, Bernatik T et al (2009) Contrast-enhanced ultrasound (CEUS) for the characterization of focal liver lesions – prospective comparison in clinical practice: CEUS vs. CT (DEGUM Multicenter Trial). Parts of this manuscript were presented at the Ultrasound Dreiländertreffen 2008, Davos. Ultraschall Med 30:383–389
Strobel D, Seitz K, Blank W et al (2008) Contrast-enhanced ultrasound for the characterization of focal liver lesions – diagnostic accuracy in clinical practice (DEGUM Multicenter Trial). Ultraschall Med 29:499–505
Vilana R, Bianchi L, Varela M et al (2006) Is microbubble-enhanced ultrasonography sufficient for assessment of response to percutaneous treatment in patients with early hepatocellular carcinoma? Eur Radiol 16:2454–2462
Vogl TJ, Eichler K, Zangos S et al (2002) Hepatocellular carcinoma: role of imaging diagnostics in detection, intervention and follow-up. Rofo 174:1358–1368
Weskott HP (2008) Emerging roles for contrast-enhanced ultrasound. Clin Hemorheol Microcirc 40:51–71
Wilson SR, Burns PN (2010) Microbubble-enhanced US in body imaging: what role? Radiology 257:24–39
Xia Y, Kudo M, Minami Y et al (2008) Response evaluation of transcatheter arterial chemoembolization in hepatocellular carcinomas: the usefulness of sonazoid-enhanced harmonic sonography. Oncology 75(suppl 1):99–105
Interessenkonflikt
Die Autoren geben an, dass keine Interessenkonflikte bestehen.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jung, E., Uller, W., Stroszczynski, C. et al. Kontrastmittelverstärkte Sonographie. Radiologe 51, 462–468 (2011). https://doi.org/10.1007/s00117-010-2101-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00117-010-2101-y
Schlüsselwörter
- Tumorperfusion
- Kontrastmittelverstärkte Sonographie (CEUS)
- Hepatozelluläres Karzinom (HCC)
- Transarterielle Chemoembolisation (TACE)
- Radiofrequenzablation (RFA)