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Application of new ultrasound techniques for focal liver lesions

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Abstract

Ultrasonography (US) has the overwhelming advantages of not entailing radiation exposure and being a noninvasive, real-time, convenient, easy-to-perform, and relatively inexpensive imaging modality. It is used as the first-line imaging modality for screening, detection, and diagnosis of focal liver lesions (FLLs) [small hepatocellular carcinomas (HCCs), in particular]. However, with the increasing demand for accurate and early diagnosis of small HCCs, newer radiologic methods need to be explored to overcome certain limitations of US. For example, the imaging is easily negatively affected by the presence of gas, rib cage, and subcutaneous fat, and is insensitive for capturing the subtle but vital information on the blood flow. It was in response to this need that new promising technologies such as contrast-enhanced ultrasound and fusion imaging were introduced for the detection of liver lesions. This paper presents an overview of the epidemiology and mechanisms of the development of HCCs, with an emphasis on the application of US in the diagnosis and treatment of FLLs. The aim of this article is to provide the state-of-the-art developments in the imaging diagnosis of FLLs and evaluation of ablation treatment of early HCCs. By keeping abreast of these recent advances, we hope that doctors and researchers working in the field of diagnosis/treatment of liver diseases will be able to discriminate benign FLLs such as regenerative nodules and focal nodular hyperplasia from HCCs, so as to avoid unnecessary repeated tumor biopsies and overtreatment. In particular, we expect that small HCCs or precancerous nodules (such as dysplastic nodules) can be accurately diagnosed and appropriately treated even at an early stage.

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Abbreviations

CEUS:

Contrast-enhanced ultrasound

CoCC:

Cholangiolocellular carcinoma

DN:

Dysplastic nodule

FLL:

Focal liver lesion

FNH:

Focal nodular hyperplasia

EOB-MRI:

Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid magnetic resonance imaging

HBP:

Hepatobiliary phase

HCC:

Hepatocellular carcinoma

ICC:

Intrahepatic cholangiocarcinoma

MI:

Mechanical index

RFA:

Radiofrequency ablation

RN:

Regenerative nodule

SMI:

Superb microvascular Imaging

US:

Ultrasonography/ultrasound

UCA:

Ultrasound contrast agent

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Acknowledgements

The research-related costs of staying in Yokohama and concentrating on preparing the paper in Japan were supported by Natural Science Foundation of Shaanxi Province (No. 2018SF-245) of China and Fundamental Research Funds for the Central Universities (Grant number 1191329109).

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Correspondence to Kazushi Numata.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from all patients for being included in the study.

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Wang, F., Numata, K., Nihonmatsu, H. et al. Application of new ultrasound techniques for focal liver lesions. J Med Ultrasonics (2020). https://doi.org/10.1007/s10396-019-01001-w

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Keywords

  • Contrast-enhanced ultrasound
  • Fusion imaging
  • Focal liver lesions
  • Hepatocellular carcinoma