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Semin Liver Dis 2001; 21(2): 147-160
DOI: 10.1055/s-2001-15342
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Liver Mass Evaluation with Ultrasound: The Impact of Microbubble Contrast Agents and Pulse Inversion Imaging

Stephanie R. Wilson1 , Peter N. Burns2
  • 1Section of Ultrasound, Toronto General Hospital-University Health Network, and Medical Imaging, University of Toronto, Toronto, Canada
  • 2Department of Medical Biophysics, Sunnybrook and Women's College Health Sciences Centre, and Medical Biophysics, University of Toronto, Toronto, Canada
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Publication History

Publication Date:
31 December 2001 (online)

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ABSTRACT

Liver mass evaluation includes two essential elements-lesion detection and lesion characterization. Both of these are greatly improved on sonography with the addition of contrast agents and the use of specialized imaging techniques, particularly pulse inversion imaging. Ultrasound contrast agents are comprised of tiny microbubbles of gas that interact with the ultrasound beam producing an enhancement of the Doppler signal from blood. Pulse inversion imaging allows preferential detection of the signal from the microbubble agents with suppresion of the signal from background tissue. Two imaging techniques include a low mechanical index (MI) nondestructive method to show lesional vascularity and a high MI destructive mode that produces disruption of the bubbles in a single frame. The latter allows for quantitative assessment of the relative enhancement of a lesion as compared with the adjacent liver parenchyma, which is a reflection of the relative vascular volumes. Vascular imaging has shown characteristic and reproducible features of common liver masses, including hemangioma, focal nodular hyperplasia, hepatocellular carcinoma, and liver metastases. Delayed postvascular enhancement of the normal liver, a phenomenon that is unique to certain classes of microbubble contrast agents, allows detection of more and smaller malignant lesions than on baseline.

KEYWORD

Contrast agents - liver - neoplasm - pulse inversion imaging - ultrasound

REFERENCES

  • 1 Becher H, Burns P N. Handbook of contrast echocardiography. Berlin: Springer; 2000
    Google Scholar
  • 2 Burns P N, Wilson S R, Muradali D. Microbubble destruction is the origin of harmonic signals from FS069.  Radiology . 1996;  201 158
    PubMedGoogle Scholar
  • 3 Burns P N, Powers J E, Fritzsch T. Harmonic imaging: a new imaging and Doppler method for contrast enhanced ultrasound.  Radiology (Abst). 1992;  185(P) 142
    PubMedGoogle Scholar
  • 4 Burns P N, Powers J E, Hope Simpson D. Harmonic imaging: principles and preliminary results.  Angiology . 1996;  47 63-73
    PubMedGoogle Scholar
  • 5 Hope Simpson D, Chin C T, Burns P N. Pulse inversion Doppler: a new method for detecting nonlinear echoes from microbubble contrast agents.  IEEE Transactions UFFC . 1999;  46 372-382
    PubMedGoogle Scholar
  • 6 Burns P N, Hope Simpson D, Averkiou M. Nonlinear imaging.  Ultrasound Med Biol . 2000;  26 19-22
    CrossrefPubMedGoogle Scholar
  • 7 Burns P N, Wilson S R, Hope Simpson D. Pulse inversion imaging of liver blood flow: an improved method for characterization of focal masses with microbubble contrast.  Invest Radiol . 2000;  35 58-71
    CrossrefPubMedGoogle Scholar
  • 8 Wilson S R, Burns P N, Muradali D. Harmonic hepatic ultrasound with microbubble contrast agent: initial experience showing improved characterization of hemangioma, hepatocellular carcinoma, and metastasis.  Radiology . 2000;  215 153-161
    CrossrefPubMedGoogle Scholar
  • 9 Kim T K, Choi B I, Han J K. Hepatic tumors: contrast agent-enhancement patterns with pulse-inversion harmonic US.  Radiology . 2000;  216 411-417
    PubMedGoogle Scholar
  • 10 Tiemann K, Lohmeier S, Kuntz S. Real-time contrast echo assessment of myocardial perfusion at low emission power: first experimental and clinical results using power pulse inversion imaging.  Echocardiography . 1999;  16 799-809
    CrossrefPubMedGoogle Scholar
  • 11 Ophir J, Parker K J. Contrast agents in diagnostic ultrasound [published erratum appears in Ultrasound Med Biol 1990; 16(2):209].  Ultrasound Med Biol . 1989;  15 319-333
    CrossrefPubMedGoogle Scholar
  • 12 Bertolotto M, dalla Parma L, Quaia E, Locatelli M. Characterization of unifocal liver lesions with pulse inversion harmonic imaging after Levovist injection: preliminary results.  Eur Radiol . 2000;  10 1369-1376
    CrossrefPubMedGoogle Scholar
  • 13 Dill-Macky M J, Burns P N, Khalili K, Wilson S R. Focal liver masses: interpreting patterns of enhancement with Levovist and pulse inversion imaging.  Radiology (in press).
    PubMedGoogle Scholar
  • 14 Uggowitzer M, Kugler C, Groll R. Sonographic evaluation of focal nodular hyperplasia (FNH) of the liver with a transpulmonary contrast agent (Levovist).  Br J Radiol . 1998;  71 1026-1032
    PubMedGoogle Scholar
  • 15 Blomley M JK, Albrecht T, Cosgrove D O. Improved imaging of liver metastases with stimulated acoustic emission in the late phase of enhancement with the US contrast agent SH U 508A: early experience.  Radiology . 1999;  210 409-416
    CrossrefPubMedGoogle Scholar
  • 16 Blomley M J, Albrecht T, Wilson S R. Improved detection of metastic liver lesions using pulse inversion harmonic imaging with Levovist: a multicenter study.  Radiology . 1999;  213(P) 491
    PubMedGoogle Scholar
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