Image fusion of contrast enhanced ultrasound (CEUS) with computed tomography (CT) or magnetic resonance imaging (MRI) using volume navigation for detection, characterization and planning of therapeutic interventions of liver tumors.

AIM To evaluate, whether image fusion of contrast enhanced ultrasound (CEUS) with CT or MRI affects the diagnosis and characterization of liver lesions or the therapeutic strategy of surgical or interventional procedures compared to the preliminary diagnosis. MATERIAL AND METHODS In a retrospective study the image fusion scans of CEUS with contrast enhanced CT or MRI of 100 patients (71 male, mean age 59 years, 0.3-85 years) with benign or malignant liver lesions were evaluated. Fundamental B-scan, color Doppler imaging and CEUS were performed in all patients by an experienced examiner using a multifrequency convex transducer (1-5 MHz, LOGIQ 9/GE) and volume navigation (Vnav). After a bolus injections of up to 2.4 ml SonoVue® (BRACCO, Italy) digital raw data was stored as cine-loops up to 5 min. In 74 patients, CEUS was fused with a pre-existing ceCT, in 26 patients a ceMRI was used. RESULTS In all 100 patients (100%) the image quality in all modalities (ceCT, ceMRI and CEUS) was excellent or with only minor diagnostic limitations. Regarding the number of lesions revealed in image fusion of CEUS/ceCT/ceMRI and the preceding diagnostic method, concordant results were found in 84 patients. In 12 patients, additional lesions were found using fusion imaging causing subsequently a change of the therapeutical strategy. In 15 out of 21 patients with either concordant or discordant results regarding the number of lesions, image fusion allowed a definite diagnosis due to a continuous documentation of the microcirculation of the tumor and its contrast enhancement. A significant coherency (p < 0.05) among image fusion with either ceCT or ceMRI and CEUS and a subsequent change of therapeutic strategy was found. CONCLUSION Image fusion with volume navigation (VNav) of CEUS with ceCT or ceMRI frequently allows a definite localization and diagnosis of hepatic lesions in patients with primary hepatic carcinoma or metastatic diseases. This might cause a change of the therapeutic strategy in many patients with hepatic lesions.

[1]  D. Khayat,et al.  Liver metastases: safety and efficacy of detection with superparamagnetic iron oxide in MR imaging. , 1994, Radiology.

[2]  J. Lodge.  Modern surgery for liver metastases. , 2000, Cancer imaging : the official publication of the International Cancer Imaging Society.

[3]  Christian Greis,et al.  Ultrasound contrast agents as markers of vascularity and microcirculation. , 2009, Clinical hemorheology and microcirculation.

[4]  N. Assy,et al.  Characteristics of common solid liver lesions and recommendations for diagnostic workup. , 2009, World journal of gastroenterology.

[5]  D. Häussinger,et al.  Correlation between SonoVue enhancement in CEUS, HCC differentiation and HCC diameter: analysis of 130 patients with hepatocellular carcinoma (HCC). , 2009, Ultraschall in der Medizin.

[6]  H. Weskott.  Emerging roles for contrast-enhanced ultrasound. , 2008, Clinical hemorheology and microcirculation.

[7]  E M Jung,et al.  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. , 2009, Clinical hemorheology and microcirculation.

[8]  D Becker,et al.  Contrast-enhanced ultrasound for the characterization of focal liver lesions--diagnostic accuracy in clinical practice (DEGUM multicenter trial). , 2008, Ultraschall in der Medizin.

[9]  C. Rodríguez,et al.  Contrast-enhanced ultrasound in diagnosis and characterization of focal hepatic lesions. , 2010, World journal of radiology.

[10]  K. Yan,et al.  Diagnosis of small hepatic nodules detected by surveillance ultrasound in patients with cirrhosis: Comparison between contrast‐enhanced ultrasound and contrast‐enhanced helical computed tomography , 2008, Hepatology research : the official journal of the Japan Society of Hepatology.

[11]  F C Simm,et al.  Focal liver disease: comparison of dynamic contrast-enhanced CT and T2-weighted fat-suppressed, FLASH, and dynamic gadolinium-enhanced MR imaging at 1.5 T. , 1992, Radiology.

[12]  R. Weissleder,et al.  Superparamagnetic iron oxide-enhanced MR imaging: pulse sequence optimization for detection of liver cancer. , 1989, Radiology.

[13]  C. Catalano,et al.  Detection of hepatic metastases from colorectal cancer: prospective evaluation of gray scale US versus SonoVue® low mechanical index real time-enhanced US as compared with multidetector-CT or Gd-BOPTA-MRI. , 2010, Ultraschall in der Medizin.

[14]  D. Häussinger,et al.  Real‐time Imaging With the Sonographic Contrast Agent SonoVue , 2004, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[15]  E. Jung,et al.  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. , 2010, Clinical hemorheology and microcirculation.

[16]  E. Jung,et al.  Characterization of microvascularization of liver tumor lesions with high resolution linear ultrasound and contrast enhanced ultrasound (CEUS) during surgery: First results. , 2010, Clinical hemorheology and microcirculation.

[17]  Xiaodong Zhou,et al.  Clinical value of contrast-enhanced ultrasonography in the characterization of focal liver lesions: a prospective multicenter trial. , 2009, Hepatobiliary & pancreatic diseases international : HBPD INT.

[18]  J. Chambers,et al.  Clinical Safety of SonoVue™, a New Contrast Agent for Ultrasound Imaging, in Healthy Volunteers and in Patients with Chronic Obstructive Pulmonary Disease , 2001, Investigative radiology.

[19]  P. Robinson,et al.  Hepatic lesion detection: comparison of MR imaging after the administration of superparamagnetic iron oxide with dual-phase CT by using alternative-free response receiver operating characteristic analysis. , 1999, Radiology.

[20]  P. Burns,et al.  Microbubble-enhanced US in body imaging: what role? , 2010, Radiology.

[21]  Ethical guidelines for publication in Clinical Hemorheology and Microcirculation. , 2010, Clinical hemorheology and microcirculation.

[22]  Y. Yamashita,et al.  Spin‐echo and dynamic gadoliniumenhanced flash MR imaging of hepatocellular carcinoma: Correlation with histopathologic findings , 1994, Journal of magnetic resonance imaging : JMRI.

[23]  M. Reiser,et al.  Contrast-enhanced ultrasound in liver transplant: first results and potential for complications in the postoperative period. , 2009, Clinical hemorheology and microcirculation.

[24]  Weskott Hp.  Emerging roles for contrast-enhanced ultrasound. , 2008 .

[25]  T. Albrecht,et al.  Sonografische Leberdiagnostik bei Tumorpatienten ohne und mit Kontrastmittel , 2008 .

[26]  M. Makuuchi,et al.  Early Hepatocellular Carcinoma: Pathology, Imaging, and Therapy , 2008, Annals of Surgical Oncology.

[27]  B. Marincek,et al.  Detection of liver metastases: comparison of superparamagnetic iron oxide-enhanced and unenhanced MR imaging at 1.5 T with dynamic CT, intraoperative US, and percutaneous US. , 1995, Radiology.

[28]  Carlo Bartolozzi,et al.  Tissue harmonic and contrast-specific imaging: back to gray scale in ultrasound , 2002, European Radiology.

[29]  Christoph F Dietrich,et al.  Quantitative contrast enhanced ultrasound of the liver for time intensity curves-Reliability and potential sources of errors. , 2010, European journal of radiology.

[30]  D A Clevert,et al.  Evaluation of quantitative contrast harmonic imaging to assess malignancy of liver tumors: a prospective controlled two-center study. , 2007, World journal of gastroenterology.