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Contrast-Enhanced Ultrasound

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Abstract

Contrast-enhanced ultrasound (CEUS) is an effective method for the diagnosis of focal liver lesions. The differences in contrast enhancement of different types of liver masses ensure reliable differential diagnosis. Evaluation of contrast washout permits objective diagnosis of malignant liver tumors, with its velocity serving for differentiation between hepatocellular carcinoma (HCC) and non-HCC malignancies. Prominent early contrast washout is characteristic for liver metastasis and facilitates their detection. Benign liver lesions typically exhibit persistent contrast enhancement in portal and late phase. However, many of them may be differentiated based on arterial enhancement. For example, peripheral globular centripetal contrast enhancement is associated with liver hemangioma and “spoke-wheel” centrifugal enhancement is characteristic for focal nodular hyperplasia. Difficulties arise in the differential diagnosis of hepatocellular adenoma (HCA) with slow washout in the late phase. Some authors report that contrast enhancement of HCA is related with its molecular subtype. Additionally, some difficulties may occur in the diagnosis of well-differentiated HCC in the cases of slow washout. ACR proposed CEUS LIRADS algorithm, which serves to improve the accuracy of diagnosis of HCC in patients at high risk. Quantitative analysis of contrast enhancement shows certain diagnostic prospects and is currently the subject of scientific research. High diagnostic accuracy of CEUS is observed liver cysts. Contrast ultrasound of liver abscess, several types of rare liver tumors, diffuse liver disorders, portal vein thrombosis, and liver transplant evaluation is also discussed within the chapter.

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Authors and Affiliations

  1. Department of Ultrasound Diagnostics of the Center for Radiological Diagnostics, Private Healthcare Institution “Clinical Hospital “RZD-Medicina” of Yaroslavl City”, Yaroslavl, Russian Federation

    Ella I. Peniaeva

  2. Petrovsky National Research Centre of Surgery, Moscow, Russian Federation

    Yuly R. Kamalov

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  1. Ella I. Peniaeva
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Editors and Affiliations

  1. Department of Visual and Functional Diagnostics, Federal State Budget Institution National Medical Research Center for Obstetrics, Moscow, Russia

    Alexander N. Sencha

  2. Department of Ultrasound Diagnostics, Clinical Hospital “RZD-Medicina”, Yaroslavl, Russia

    Yury N. Patrunov

4.1 Electronic Supplementary Material

Liver hemangioma. Typical peripheral globular contrast enhancement. CEUS cine loop at ×1.5 speed (MP4 45,243 kb)

Liver hemangioma. Typical peripheral globular centripetal enhancement. CEUS cine loop at ×1.5 speed (MP4 26,277 kb)

Contrast enhancement of a liver hemangioma as a thin rim on the periphery of the lesion. Cine loop at ×1.5 speed (MP4 25,928 kb)

Focal nodular hyperplasia. Patient A. CEUS cine loop at ×1.5 speed (MP4 28,280 kb)

Focal nodular hyperplasia. Patient B. CEUS cine loop at ×1.5 speed (MP4 27,787 kb)

Hepatic adenoma. CEUS cineloop at ×1.5 speed (MP4 15,004 kb)

Hepatic adenoma. Parametric map of enhancement. CEUS cineloop at ×1.5 speed for Fig. 4.9c (MP4 23,313 kb)

Metastasis of breast carcinoma in the liver. CEUS cine loop at ×1.5 speed (MP4 51,703 kb)

HCC CEUS. Cineloop at ×1.5 speed (MP4 37,786 kb)

Multiple liver metastases. Patient A. CEUS cine loop at ×1.5 speed (MP4 44,367 kb)

Multiple liver metastases. Patient B. CEUS cine loop at ×1.5 speed (MP4 81,424 kb)

Multiple liver metastases. CEUS cine loop at ×1.5 speed (MP4 79,241 kb)

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Peniaeva, E.I., Kamalov, Y.R. (2022). Liver. In: Sencha, A.N., Patrunov, Y.N. (eds) Contrast-Enhanced Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-030-91764-7_4

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