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By Luigi Bolondi

In contemporary years, the imaging-based prognosis of mass liver lesions has develop into more and more complicated end result of the quantity and morphological variability of lesions that sleek imaging concepts are at the moment capable of reveal. If the sensitivity in detection has tremendously elevated, characterisation has remained tough and represents a serious problem for the clinician.

The availability of blood-pool distinction brokers for ultrasound (US), specifically second-generation US distinction brokers in response to perfluorocarbon- or sulfur-hexafluoride-filled microbubbles, and the improvement of contrast-specific software program and applied sciences have spread out new views either for the instant characterisation of any mass lesion detected within the liver and for expanding the sensitivity people within the detection of liver metastases.

Taking under consideration the good influence of this new expertise on medical perform, the ecu Federation of Societies for Ultrasound in medication and Biology (EFSUMB) organised, in January 2004, in Rotterdam, a consensus assembly of specialists in an effort to boost instructions for using US distinction brokers within the analysis of liver illnesses . those directions, in addition to discussions of extra advances within the scientific software of contrast-enhanced harmonic US are offered during this publication by way of an across the world popular team of specialists. The booklet represents presents a major place to begin for medical implementation of this new diagnostic procedure.

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Extra info for Advances in Diagnostic Imaging: The Value of Contrast-Enhanced Ultrasound for Liver

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In the second situation of a nodule smaller than 1 cm detected at conventional US, CEUS can be performed immediately in order to characterize the lesion. 5a-g. The CEUS is performed 15 min after the end of the RF procedure. Fifteen minutes later, most of the macrobubbles have disappeared (c). d-f At baseline VRI imaging (d), no artifact was noted that could be attributed to the presence of residual macrobubbles. After injection of SonoVue®,the lesion was studied during the arterial portal and delayed phases.

CEUS characteristics of hepatic hemangiomas (from [19]) Tumor entity Arterial phase PV phase Delayed (late) phase Typical Peripheral-nodular Partial/complete Complete features enhancement, no centripetal filling enhancement central enhancement Additional Small lesions: complete, Nonenhancing features rapid centripetal central areas enhancement 27 28 Fig. 6. Peripheral nodular enhancement in the arterial phase, followed by a centripetal filling. The quick rise in signal intensity on the timeintensity curve (TIC) demonstrates the arterial character of the supplying peripheral vessels.

22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. of contrast agents in ultrasound. January 2004. Ultraschall Med 25(4):249-256 Nelson RC, Chezmar JL (1990) Diagnostic approach to hepatic hemangiomas. Radiology 176(1):11-13 Leifer DM, Middleton WD, Teefey SA et al (2000) Follow-up of patients at low risk for hepatic malignancy with a characteristic hemangioma at US. Radiology 214(1):167-172 Caturelli E, Pompili M, Bartolucci F et al (2001) Hemangioma-like lesions in chronic liver disease: diagnostic evaluation in patients.

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