Phase inversion harmonic imaging versus contrast-enhanced power Doppler sonography for the characterization of focal liver lesions

Abstract Background and aims. We compared contrast-enhanced power Doppler sonography (CEPD) and phase-inversion harmonic imaging (PIHI) in the assessment of liver lesion vascularity and characterization of focal liver lesions. Materials and methods. We examined 101 focal liver lesions by CEPD and PIHI using Optison as echo-enhancing agent. Amount and architecture of lesion vascularity and the kinetics of contrast enhancement in the lesions were analyzed. A tumor diagnosis was assessed after each examination. Results. Analysis of tumor vascularity was not possible in 30 liver lesions (30%) due to motion or blooming artifacts by CEPD. Vascularity was detected in 61% of liver lesions by CEPD and in 95% by PIHI. PIHI identified significantly more tumor vascularity pattern (93%) than CEPD (57%). Specific lesion diagnosis based on PIHI led to correct results in 92% compared to 59% by CEPD. Conclusion. PIHI is highly efficient in detecting tumor vascularity and is superior to CEPD in characterizing focal liver lesions.

[1]  B. Choi,et al.  Hepatocellular carcinoma: power Doppler US with a contrast agent--preliminary results. , 1998, Radiology.

[2]  S Tano,et al.  Possibility of differentiating small hyperechoic liver tumours using contrast-enhanced colour Doppler ultrasonography: a preliminary study. , 1997, Clinical radiology.

[3]  C. Bartolozzi,et al.  Small Hepatocellular Carcinoma , 1996, Acta radiologica.

[4]  F Forsberg,et al.  Artifacts in ultrasonic contrast agent studies. , 1994, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[5]  P. Burns.  Harmonic imaging with ultrasound contrast agents. , 1996, Clinical radiology.

[6]  A. Bauer.  Wideband Harmonic Imaging with Levovist -- Preliminary Studies , 1997 .

[7]  Peter N. Burns,et al.  Pulse Inversion Imaging of Liver Blood Flow , 2000 .

[8]  A. C. Baker,et al.  Nonlinear propagation applied to the improvement of resolution in diagnostic medical ultrasound. , 1997, The Journal of the Acoustical Society of America.

[9]  M. Mitomo,et al.  Visualization of tumor vessels in hepatocellular carcinoma , 1997, Acta radiologica.

[10]  Power Doppler Us: A Potentially Useful Alternative to Mean Frequency-Based Color Doppler Us , 1996 .

[11]  P. Burns,et al.  Pulse inversion Doppler: a new method for detecting nonlinear echoes from microbubble contrast agents , 1997, 1997 IEEE Ultrasonics Symposium Proceedings. An International Symposium (Cat. No.97CH36118).

[12]  B. Choi,et al.  Power versus conventional color Doppler sonography: comparison in the depiction of vasculature in liver tumors. , 1996, Radiology.

[13]  C. Harvey,et al.  Ultrasound of focal liver lesions , 2001, European Radiology.

[14]  F Forsberg,et al.  Ultrasonic characterization of the nonlinear properties of contrast microbubbles. , 2000, Ultrasound in medicine & biology.

[15]  B B Goldberg,et al.  Hepatic tumors: signal enhancement at Doppler US after intravenous injection of a contrast agent. , 1990, Radiology.

[16]  B. Choi,et al.  Hepatic tumors: contrast agent-enhancement patterns with pulse-inversion harmonic US. , 2000, Radiology.

[17]  P. Burns.  Ultrasound contrast agents in radiological diagnosis. , 1994, La Radiologia medica.

[18]  E. Hahn,et al.  Dynamic contrast-enhanced power Doppler sonography improves the differential diagnosis of liver lesions , 2001, International Journal of Colorectal Disease.

[19]  G. Steinbach,et al.  High-resolution harmonic gray-scale imaging of normal and abnormal vessels and tissues in animals. , 1998, Academic radiology.

[20]  T Nakamura,et al.  Gray scale second harmonic imaging of the liver: a preliminary animal study. , 1997, Ultrasound in medicine & biology.

[21]  Color Doppler Sonography of Hepatic Tumors with a Galactose-Based Contrast Agent: Correlation with Angiographic Findings , 1995 .

[22]  E. Hahn,et al.  Clinical evaluation of contrast‐enhanced color Doppler sonography in the differential diagnosis of liver tumors , 2000 .

[23]  C. Bartolozzi,et al.  Differentiation of hepatocellular adenoma and focal nodular hyperplasia of the liver: comparison of power Doppler imaging and conventional color Doppler sonography , 1997, European Radiology.

[24]  F Forsberg,et al.  On the feasibility of real‐time, in vivo harmonic imaging with proteinaceous microspheres. , 1996, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[25]  K. Ohtomo,et al.  Power Doppler sonography for hepatocellular carcinoma: factors affecting the power Doppler signals of the tumors. , 2008, Liver.

[26]  L. K. Young,et al.  Hepatic hemangioma: quantitative color power US angiography--facts and fallacies. , 1998, Radiology.

[27]  K J Wolf,et al.  B-mode enhancement at phase-inversion US with air-based microbubble contrast agent: initial experience in humans. , 2000, Radiology.

[28]  L. Bonomo,et al.  [Neoplasms of the glomus caroticum: magnetic resonance angiography versus magnetic resonance]. , 1994, La Radiologia medica.

[29]  D. Cosgrove.  Ultrasound contrast enhancement of tumours. , 1996, Clinical radiology.

[30]  A. Scott,et al.  A simple method for the analysis of clustered binary data. , 1992, Biometrics.

[31]  P. Burns,et al.  Harmonic hepatic US with microbubble contrast agent: initial experience showing improved characterization of hemangioma, hepatocellular carcinoma, and metastasis. , 2000, Radiology.

[32]  P. Hauff,et al.  Wideband harmonic imaging: A novel contrast ultrasound imaging technique , 1999, European Radiology.

[33]  E. Hahn,et al.  [Tissue harmonic imaging and contrast harmonic imaging. Improving the diagnosis of liver metastasis?]. , 2000, Der Internist.

[34]  H. Mischinger,et al.  Sonographic evaluation of focal nodular hyperplasias (FNH) of the liver with a transpulmonary galactose-based contrast agent (Levovist). , 1998, The British journal of radiology.

[35]  H. Mischinger,et al.  Echo‐enhanced Doppler sonography of focal nodular hyperplasia of the liver. , 1999, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[36]  Peter N. Burns,et al.  Harmonic power mode Doppler using microbubble contrast agents: an improved method for small vessel flow imaging , 1994, 1994 Proceedings of IEEE Ultrasonics Symposium.

[37]  L. Dalla Palma,et al.  Characterization of unifocal liver lesions with pulse inversion harmonic imaging after Levovist injection: preliminary results , 2000, European Radiology.

[38]  K J Wolf,et al.  Phase-inversion sonography during the liver-specific late phase of contrast enhancement: improved detection of liver metastases. , 2001, AJR. American journal of roentgenology.

[39]  H. Mischinger,et al.  Power Doppler imaging and evaluation of the resistive index in focal nodular hyperplasia of the liver , 1997, Abdominal Imaging.