BACKGROUND:Contrast agents help to improve visibility in magnetic resonance(MR)imaging.However,owing to the large interstitial spaces of the liver,there is a reduction in the natural contrast gradient between lesions ...BACKGROUND:Contrast agents help to improve visibility in magnetic resonance(MR)imaging.However,owing to the large interstitial spaces of the liver,there is a reduction in the natural contrast gradient between lesions and healthy tissue.This study was undertaken to evaluate the efficacy and safety of the liverspecific MR imaging contrast agent gadoxetate disodium(GdEOB-DTPA)in Chinese patients.METHODS:This was a single-arm,open-label,multicenter study in patients with known or suspected focal liver lesions referred for contrast-enhanced MR imaging.MR imaging was performed in 234 patients before and after a single intravenous bolus of Gd-EOB-DTPA(0.025 mmol/kg body weight).Images were evaluated by clinical study investigators and three independent,blinded radiologists.The primary efficacy endpoint was sensitivity in lesion detection.RESULTS:Gd-EOB-DTPA improved sensitivity in lesion detection by 9.46%compared with pre-contrast imaging for the average of the three blinded readers(94.78%vs 85.32%for Gd-EOB-DTPA vs pre-contrast,respectively).Improvements in detection were more pronounced in lesions less than 1cm.Gd-EOB-DTPA improved diagnostic accuracy in lesion classification.CONCLUSIONS:This open-label study demonstrated that Gd-EOB-DTPA improves diagnostic sensitivity in liver lesions,particularly in those smaller than 1 cm.Gd-EOB-DTPA also significantly improves the diagnostic accuracy in lesion classification,and furthermore,Gd-EOB-DTPA is safe in Chinese patients with liver lesions.展开更多
Benign hepatic tumors are commonly observed in adults,but rarely reported in children.The reasons for this remain speculative and the exact data concerning the incidence of these lesions are lacking.Benign hepatic tum...Benign hepatic tumors are commonly observed in adults,but rarely reported in children.The reasons for this remain speculative and the exact data concerning the incidence of these lesions are lacking.Benign hepatic tumors represent a diverse group of epithelial and mesenchymal tumors.In pediatric patients,most benign focal liver lesions are inborn and may grow like the rest of the body.Knowledge of pediatric liver diseases and their imaging appearances is essential in order to make an appropriate differential diagnosis.Selection of the appropriate imaging test is challenging,since it depends on a number of age-related factors.This paper will discuss the most frequently encountered benign liver tumors in children(infantile hepatic hemangioendothelioma,mesenchymal hamartoma,focal nodular hyperplasia,nodular regenerative hyperplasia,and hepatocellular adenoma),as well as a comparison to the current knowledge regarding such tumors in adult patients.The current emphasis is on imaging features,which are helpful not only for the initial diagnosis,but also for pre- and posttreatment evaluation and follow-up.In addition,future perspectives of contrast-enhanced ultrasound(CEUS) in pediatric patients are highlighted,with descriptions of enhancement patterns for each lesion being discussed.The role of advanced imaging tests such as CEUS and magnetic resonance imaging,which allow for non-invasive assessment of liver tumors,is of utmost importance in pediatric patients,especially when repeated imaging tests are needed and radiation exposure should be avoided.展开更多
BACKGROUND: Contrast-enhanced ultrasonography (CEUS) is increasingly accepted in clinical settings for diagnostic imaging of focal liver lesions (FLLs). This study aimed to assess the efficacy of CEUS in the character...BACKGROUND: Contrast-enhanced ultrasonography (CEUS) is increasingly accepted in clinical settings for diagnostic imaging of focal liver lesions (FLLs). This study aimed to assess the efficacy of CEUS in the characterization of FLLs in comparison with final diagnosis based on gold standard assessment. METHODS: The study was approved by the local ethics committee and participating patients provided written informed consent. A total of 148 patients with 164 FLLs were studied. Unenhanced ultrasonography (US) and CEUS were performed using fundamental and harmonic imaging, respectively. Contrast enhancement was assessed during the arterial, portal and late vascular phases after intravenous administration of contrast (SonoVue (R), Bracco, Italy). Sensitivity, specificity and diagnostic accuracy of US and CEUS were compared in identifying the lesion as benign, malignant or indeterminate and its actual tumor type. Final diagnosis was established by biopsy (129/164), MR imaging (11/164) or medical history (24/164). RESULTS: When compared to the gold standard, the number of indeterminate diagnoses was reduced from 56.7% (93/164) as assessed by fundamental imaging to 6.1% (10/164) after SonoVue (R) enhanced US examination. Sensitivity and specificity improved from 49% and 25% at baseline US to 93% and 75% with CEUS, respectively (P<0.01). Diagnostic accuracy of CEUS was 88% in contrast to 41% of baseline US. CONCLUSION: SonoVue (R) enhanced US improves the characterization of FLLs and may limit the need for further investigations.展开更多
目的探讨联合应用两种超声弹性成像技术诊断肝脏局灶性病变(FLLs)良恶性的价值。方法选取2018年10月至2019年5月在哈尔滨医科大学附属第一医院腹部超声科检查的FLLs患者51例,共59处常规超声难以定性的FLLs,使用具备实时组织弹性成像(RTE...目的探讨联合应用两种超声弹性成像技术诊断肝脏局灶性病变(FLLs)良恶性的价值。方法选取2018年10月至2019年5月在哈尔滨医科大学附属第一医院腹部超声科检查的FLLs患者51例,共59处常规超声难以定性的FLLs,使用具备实时组织弹性成像(RTE)和剪切波速度测量(SWM)功能的超声诊断仪进行检查,以病理诊断作为金标准,评估比较联合弹性成像的诊断效能。结果59个FLLs病灶病理检查结果显示:恶性病灶39个(肝细胞癌26个,胆管细胞癌5个,肝转移癌8个),良性病灶20个(血管瘤11个,肝硬化结节3个,腺瘤3个,炎性结节3个)。参照病理组织检查结果,共确诊恶性病灶31个,良性病灶10个,准确度为69.49%(41/59)。在59个FLLs病灶中,良性组杨氏模量值低于恶性组[6.31(4.59,11.45)k Pa比11.14(6.77,15.44)k Pa](P<0.05)。受试者工作特征曲线显示,SWM的曲线下面积为0.722,诊断FLLs良恶性的截断值为7.075 k Pa,其中23个病灶截断值<7.075 k Pa,诊断为良性,36个病灶截断值≥7.075 k Pa,诊断为恶性。联合弹性成像诊断的准确度为83.05%(49/59)。联合弹性成像的灵敏度、特异度、阳性预测值、阴性预测值、准确度均高于两种方法单独检测,其中联合检测的阳性率与RTE的阳性率比较差异无统计学意义(P>0.05),两种方法诊断结果的一致性一般(Kappa=0.422,P<0.01);联合检测的阳性率与SWM的阳性率比较差异无统计学意义(P>0.05),两种方法诊断结果的一致性一般(Kappa=0.435,P<0.01)。结论联合弹性成像结果可为临床医师判断肝内病灶的性质提供硬度信息,与其他影像学方法联合可进一步提高诊断准确率,有助于鉴别良恶性病灶。展开更多
基金supported by a grant from Bayer HealthCare/Bayer Schering Pharma AG
文摘BACKGROUND:Contrast agents help to improve visibility in magnetic resonance(MR)imaging.However,owing to the large interstitial spaces of the liver,there is a reduction in the natural contrast gradient between lesions and healthy tissue.This study was undertaken to evaluate the efficacy and safety of the liverspecific MR imaging contrast agent gadoxetate disodium(GdEOB-DTPA)in Chinese patients.METHODS:This was a single-arm,open-label,multicenter study in patients with known or suspected focal liver lesions referred for contrast-enhanced MR imaging.MR imaging was performed in 234 patients before and after a single intravenous bolus of Gd-EOB-DTPA(0.025 mmol/kg body weight).Images were evaluated by clinical study investigators and three independent,blinded radiologists.The primary efficacy endpoint was sensitivity in lesion detection.RESULTS:Gd-EOB-DTPA improved sensitivity in lesion detection by 9.46%compared with pre-contrast imaging for the average of the three blinded readers(94.78%vs 85.32%for Gd-EOB-DTPA vs pre-contrast,respectively).Improvements in detection were more pronounced in lesions less than 1cm.Gd-EOB-DTPA improved diagnostic accuracy in lesion classification.CONCLUSIONS:This open-label study demonstrated that Gd-EOB-DTPA improves diagnostic sensitivity in liver lesions,particularly in those smaller than 1 cm.Gd-EOB-DTPA also significantly improves the diagnostic accuracy in lesion classification,and furthermore,Gd-EOB-DTPA is safe in Chinese patients with liver lesions.
文摘Benign hepatic tumors are commonly observed in adults,but rarely reported in children.The reasons for this remain speculative and the exact data concerning the incidence of these lesions are lacking.Benign hepatic tumors represent a diverse group of epithelial and mesenchymal tumors.In pediatric patients,most benign focal liver lesions are inborn and may grow like the rest of the body.Knowledge of pediatric liver diseases and their imaging appearances is essential in order to make an appropriate differential diagnosis.Selection of the appropriate imaging test is challenging,since it depends on a number of age-related factors.This paper will discuss the most frequently encountered benign liver tumors in children(infantile hepatic hemangioendothelioma,mesenchymal hamartoma,focal nodular hyperplasia,nodular regenerative hyperplasia,and hepatocellular adenoma),as well as a comparison to the current knowledge regarding such tumors in adult patients.The current emphasis is on imaging features,which are helpful not only for the initial diagnosis,but also for pre- and posttreatment evaluation and follow-up.In addition,future perspectives of contrast-enhanced ultrasound(CEUS) in pediatric patients are highlighted,with descriptions of enhancement patterns for each lesion being discussed.The role of advanced imaging tests such as CEUS and magnetic resonance imaging,which allow for non-invasive assessment of liver tumors,is of utmost importance in pediatric patients,especially when repeated imaging tests are needed and radiation exposure should be avoided.
文摘目的探讨应用钆塞酸二钠增强MR检查对肝脏局灶性病变的诊断效能。方法 2015年6月～2017年6月我院诊治的肝脏局灶性病变患者47例,行无肝胆期和有肝胆期钆塞酸二钠增强MR和增强CT检查,行肝穿刺活组织病理学检查,以此为金标准,计算各检查方法的诊断效能。结果在47例肝脏局灶性病变患者中,病变大小为0.7～6.2 cm (2.1±0.8) cm。经病理学检查诊断为胆管细胞癌15例,胆管囊腺癌1例,结肠癌肝转移8例,直肠癌肝转移3例和肝血管瘤5例,局灶性结节性增生8例,肝硬化结节4例,脂肪瘤2例,腺瘤1例;有肝胆期钆塞酸二钠增强MRI诊断的敏感度为88.9%,特异度为80.0%,准确度为85.1%,显著高于无肝胆期钆塞酸二钠增强MRI的60.0%、61.7%和63.0%或增强CT检查的45.0%、48.9%和51.9%,差异有统计学意义(P<0.05)。结论有肝胆期钆塞酸二钠增强MRI检查有利于提高对肝脏局灶性病变的临床定性诊断,值得进一步验证。
文摘BACKGROUND: Contrast-enhanced ultrasonography (CEUS) is increasingly accepted in clinical settings for diagnostic imaging of focal liver lesions (FLLs). This study aimed to assess the efficacy of CEUS in the characterization of FLLs in comparison with final diagnosis based on gold standard assessment. METHODS: The study was approved by the local ethics committee and participating patients provided written informed consent. A total of 148 patients with 164 FLLs were studied. Unenhanced ultrasonography (US) and CEUS were performed using fundamental and harmonic imaging, respectively. Contrast enhancement was assessed during the arterial, portal and late vascular phases after intravenous administration of contrast (SonoVue (R), Bracco, Italy). Sensitivity, specificity and diagnostic accuracy of US and CEUS were compared in identifying the lesion as benign, malignant or indeterminate and its actual tumor type. Final diagnosis was established by biopsy (129/164), MR imaging (11/164) or medical history (24/164). RESULTS: When compared to the gold standard, the number of indeterminate diagnoses was reduced from 56.7% (93/164) as assessed by fundamental imaging to 6.1% (10/164) after SonoVue (R) enhanced US examination. Sensitivity and specificity improved from 49% and 25% at baseline US to 93% and 75% with CEUS, respectively (P<0.01). Diagnostic accuracy of CEUS was 88% in contrast to 41% of baseline US. CONCLUSION: SonoVue (R) enhanced US improves the characterization of FLLs and may limit the need for further investigations.
文摘目的探讨联合应用两种超声弹性成像技术诊断肝脏局灶性病变(FLLs)良恶性的价值。方法选取2018年10月至2019年5月在哈尔滨医科大学附属第一医院腹部超声科检查的FLLs患者51例,共59处常规超声难以定性的FLLs,使用具备实时组织弹性成像(RTE)和剪切波速度测量(SWM)功能的超声诊断仪进行检查,以病理诊断作为金标准,评估比较联合弹性成像的诊断效能。结果59个FLLs病灶病理检查结果显示:恶性病灶39个(肝细胞癌26个,胆管细胞癌5个,肝转移癌8个),良性病灶20个(血管瘤11个,肝硬化结节3个,腺瘤3个,炎性结节3个)。参照病理组织检查结果,共确诊恶性病灶31个,良性病灶10个,准确度为69.49%(41/59)。在59个FLLs病灶中,良性组杨氏模量值低于恶性组[6.31(4.59,11.45)k Pa比11.14(6.77,15.44)k Pa](P<0.05)。受试者工作特征曲线显示,SWM的曲线下面积为0.722,诊断FLLs良恶性的截断值为7.075 k Pa,其中23个病灶截断值<7.075 k Pa,诊断为良性,36个病灶截断值≥7.075 k Pa,诊断为恶性。联合弹性成像诊断的准确度为83.05%(49/59)。联合弹性成像的灵敏度、特异度、阳性预测值、阴性预测值、准确度均高于两种方法单独检测,其中联合检测的阳性率与RTE的阳性率比较差异无统计学意义(P>0.05),两种方法诊断结果的一致性一般(Kappa=0.422,P<0.01);联合检测的阳性率与SWM的阳性率比较差异无统计学意义(P>0.05),两种方法诊断结果的一致性一般(Kappa=0.435,P<0.01)。结论联合弹性成像结果可为临床医师判断肝内病灶的性质提供硬度信息,与其他影像学方法联合可进一步提高诊断准确率,有助于鉴别良恶性病灶。
