Washout appearance of hepatocellular carcinomas using standardized contrast-enhanced ultrasound (CEUS) including an extended late phase observation - Real-world data from the prospective multicentre DEGUM study.

IF 2.1 4区医学 Q3 HEMATOLOGY

Clinical hemorheology and microcirculation Pub Date : 2023-01-01 DOI:10.3233/CH-231740

Barbara Meitner-Schellhaas, Daniel Jesper, Rüdiger Stephan Goertz, Sebastian Zundler, Deike Strobel

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引用次数: 1

Abstract

Background: Non-invasive diagnosis of hepatocellular carcinoma (HCC) in contrast-enhanced ultrasound (CEUS) is based on the combination of arterial phase hyperenhancement (APHE) and subsequent late (>60 seconds) and mild contrast washout (WO). Whereas APHE is seen in the majority of HCC, wash-out pattern may vary in onset and intensity. In some HCC lesions, even no washout is seen at all.

Objective: Our prospective multicentre DEGUM HCC CEUS study aimed at identifying typical and atypical washout appearance of HCC in a real-life setting.

Methods: High-risked patients for HCC with focal liver lesions upon B-mode ultrasound were recruited prospectively. In a multicentre real-life setting, a standardised CEUS examination including an extended late phase up to 6 minutes was performed. CEUS patterns of HCC were recorded, and onset and intensity of washout appearance were assessed with respect to patient and tumour characteristics. Histological findings served as reference standard.

Results: In 230/316 HCC (72.8%), a CEUS pattern of APHE followed by WO was observed. In 158 cases (68.7%), WO was typical (onset > 60 seconds, mild intensity). 72 cases (31.3%) showed marked and / or early WO, whereas in 41 HCCs (13%), APHE was followed by sustained isoenhancement.Atypical WO upon CEUS was associated with macroinvasion of the liver vessels, portal vein thrombosis and diffuse growth pattern, but not tumour size and histological grading.

Conclusions: In a prospective multicentre real-life setting, APHE is followed by atypical washout appearance or no washout at all in almost half of the HCCs with APHE. The examiner has to bear in mind that in spite of a characteristic APHE in HCCs, washout appearance can be atypical in CEUS, especially in HCCs with macrovascular invasion or diffuse growth pattern.

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使用标准化对比增强超声（CEUS）对肝细胞癌的冲洗外观，包括延长的晚期观察——来自前瞻性多中心DEGUM研究的真实世界数据。

背景：超声造影（CEUS）对肝细胞癌（HCC）的无创诊断是基于动脉期超强化（APHE）和随后的晚期（>60秒）和轻度造影冲洗（WO）的组合。尽管APHE在大多数HCC中可见，但冲洗模式可能在发病和强度上有所不同。在一些HCC病变中，甚至根本看不到冲洗。目的：我们的前瞻性多中心DEGUM HCC CEUS研究旨在确定现实生活中HCC的典型和非典型冲洗外观。方法：前瞻性地招募经B超检查的肝局灶性肝癌高危患者。在多中心的真实环境中，进行了标准化的CEUS检查，包括延长至6分钟的晚期。记录HCC的CEUS模式，并根据患者和肿瘤特征评估冲洗外观的发作和强度。组织学检查结果作为参考标准。结果：230/316例HCC（72.8%）中，观察到APHE后WO的CEUS模式。在158例（68.7%）中，WO是典型的（发病 > 60秒、轻度强度）。72例（31.3%）显示明显和/或早期WO，而在41例HCC（13%）中，APHE随后持续等增强。CEUS中的非典型WO与肝血管的大侵犯、门静脉血栓形成和弥漫性生长模式有关，但与肿瘤大小和组织学分级无关。结论：在一个前瞻性的多中心现实生活环境中，在几乎一半患有APHE的HCC中，APHE之后出现非典型冲洗或根本没有冲洗。检查人员必须记住，尽管HCC中存在特征性APHE，但CEUS中的冲洗外观可能是非典型的，尤其是在具有大血管侵袭或弥漫性生长模式的HCC中。

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来源期刊

Clinical hemorheology and microcirculation 医学-外周血管病

CiteScore

4.30

自引率

33.30%

发文量

170

期刊介绍： Clinical Hemorheology and Microcirculation, a peer-reviewed international scientific journal, serves as an aid to understanding the flow properties of blood and the relationship to normal and abnormal physiology. The rapidly expanding science of hemorheology concerns blood, its components and the blood vessels with which blood interacts. It includes perihemorheology, i.e., the rheology of fluid and structures in the perivascular and interstitial spaces as well as the lymphatic system. The clinical aspects include pathogenesis, symptomatology and diagnostic methods, and the fields of prophylaxis and therapy in all branches of medicine and surgery, pharmacology and drug research. The endeavour of the Editors-in-Chief and publishers of Clinical Hemorheology and Microcirculation is to bring together contributions from those working in various fields related to blood flow all over the world. The editors of Clinical Hemorheology and Microcirculation are from those countries in Europe, Asia, Australia and America where appreciable work in clinical hemorheology and microcirculation is being carried out. Each editor takes responsibility to decide on the acceptance of a manuscript. He is required to have the manuscript appraised by two referees and may be one of them himself. The executive editorial office, to which the manuscripts have been submitted, is responsible for rapid handling of the reviewing process. Clinical Hemorheology and Microcirculation accepts original papers, brief communications, mini-reports and letters to the Editors-in-Chief. Review articles, providing general views and new insights into related subjects, are regularly invited by the Editors-in-Chief. Proceedings of international and national conferences on clinical hemorheology (in original form or as abstracts) complete the range of editorial features.