Recently, contrast-enhanced (CE) ultrasound (US) appeared as an important modality to show the vascularity in the areas of interest, and has been used widely in clinical diagnosis of liver lesions. Three dimensional ultrasonography (3D US) allows three orthogonal planes to spatially demonstrate the features of subjects, which has been frequently used in fetal US. Different from the 2D images, CE 3D US acquires the data in a volume of interest (VOI) by automatically scanning with a desired angle and allows reconstruction of tomographic images in three orthogonal planes and renders angiogram-like images. The combination of 3D US and CE US can present the enhancement of lesions in three dimensions and also in parallel slices by multiple-planar visualization. Although many studies on differentiation among various focal liver tumors have been conducted using CE 2D US and recently a few using CE 2D US with Sonazoid, the exact value of CE 3D US with Sonazoid in the differential diagnosis of various focal liver tumors has not yet been clarified.
A research article to be published on May 7, 2010 in the World Journal of Gastroenterology addresses this question. This authors retrospectively evaluated tumor enhancement patterns, and the diagnostic criteria established using dominant enhancement patterns were then applied to differentiation among focal liver tumors in a prospective study.
In the study, with analysis of the combination of the enhancement in three phases at CE 3D US, the dominant patterns were used as the diagnostic criteria for individual category, and prospective differentiation yielded a good sensitivity, specificity, high Az value, and good to excellent inter-reader agreement, which revealed the potential usage of CE 3D US in differentiating various focal liver lesions. Although there were no significant differences between the prospective diagnosis at CE 3D US and that at CE 2D US, CE 3D US created a spatial and easily understood view for both hemodynamic and morphologic evaluation of focal liver tumors, which were formed only in the doctors' imagination by 2D imaging using complex acquisition methods. The good to excellent inter-reader agreement in the authors' previous study about CE 3D US demonstrating characteristic enhancement of hepatocellular carcinomas (HCCs) have indicated CE 3D US can exhibit the characteristic enhancement of HCC tumors objectively.
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Reference: Luo W, Numata K, Morimoto M, Nozaki A, Ueda M, Kondo M,Morita S, Tanaka K. Differentiation of focal liver lesions using three-dimensional ultrasonography: Retrospective and prospectivestudies. World J Gastroenterol 2010; 16(17): 2109-2119
http://www.wjgnet.com/1007-9327/full/v16/i17/2109.htm
Correspondence to: Kazushi Numata, MD, Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan. kz-numa@urahp.yokohama-cu.ac.jp
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About World Journal of Gastroenterology
World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2008 IF: 2.081. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.