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. 2015 Jun 23;19(1):15-23.
doi: 10.1007/s40477-015-0172-3. eCollection 2016 Mar.

Focal hepatic lesions characterisation by different sonographic techniques: a prospective analysis

Upasana Ranga  1 , Naveen Kalra  1 , Akshay K Saxena  1 , Anmol Bhatia  1 , Manavjit S Sandhu  1 , Ajay K Duseja  2 , Yogesh K Chawla  2 , Niranjan Khandelwal  1
Affiliations

Focal hepatic lesions characterisation by different sonographic techniques: a prospective analysis

Upasana Ranga et al. J Ultrasound. .

Abstract
in English, Italian

Introduction: Ultrasound is usually the first diagnostic investigation for the assessment of liver lesions. Apart from conventional sonography (CS), new grey-scale sonographic techniques have been developed which have increased the application of ultrasound in liver imaging. The present study was undertaken to compare image quality of CS, real-time compound sonography (RTCS), tissue harmonic sonography (THS) and tissue harmonic compound sonography (THCS) in focal liver lesions.

Materials and methods: 100 patients with focal hepatic lesions were enroled. Lesions were divided into solid and cystic group. Solid lesions were evaluated for lesion conspicuity and elimination of artefacts. For cystic lesions, lesion conspicuity, posterior acoustic enhancement and internal echoes within the lesion were evaluated. Grading was done using 3-5-point scales. Overall image quality was assessed depending on the total points.

Results: 78 solid and 22 cystic liver lesions were included. THCS showed superior results for lesion conspicuity, elimination of artefacts and overall image quality in solid lesions. RTCS showed similar results as THCS for lesion conspicuity and overall image quality in solid lesions. THS gave better results in cystic lesions for all imaging parameters. Results of THCS though slightly inferior, showed no significant difference from THS, in cystic lesions. CS was found to have least diagnostic value in characterisation.

Conclusions: For evaluation of focal hepatic lesions, a combination of compound and harmonic sonography, i.e. THCS, is the preferred sonographic technique.

Introduzione: l’ecografia è di solito l’indagine radiologica iniziale, non invasiva e semplice, per la valutazione delle lesioni epatiche. Oltre alla tradizionale ecografia in scala di grigi (CS), sono state sviluppate delle nuove tecniche, che hanno aumentato le applicazioni dell’ecografia nell’imaging del fegato. Il presente studio è stato intrapreso per confrontare la qualità delle immagini in: CS, ecografia in tempo reale con compound (RTCS), armonica tissutale (THS) e armonica tissutale con compound (THC) nello studio delle lesioni focali epatiche.

Materiali e metodi: sono stati arruolati 100 pazienti con lesioni focali epatiche. Le lesioni sono state divise in solide e cistiche. Per le lesioni solide sono stati valutati la visibilità e l’eliminazione di artefatti. Per le lesioni cistica sono stati valutati la visibilità, il rinforzo acustico posteriore e gli echi all’interno delle lesioni. La classificazione è stata effettuata utilizzando una scala da 3 a 5. La qualità generale dell’immagine è stata valutata in base al totale dei punti.

Risultati: sono state incluse 78 lesioni epatiche solide e 22 cistiche. La THC ha mostrato risultati superiori per la visibilità delle lesioni, l’eliminazione di artefatti e la qualità complessiva dell’immagine delle lesioni solide. La RTCS ha mostrato risultati simili a quelli di THC per la visibilità delle lesioni e la qualità complessiva dell’immagine delle lesioni solide. THS ha dato risultati migliori per tutti i parametri di imaging delle lesioni cistiche. I risultati della THC, anche se leggermente inferiori, non hanno mostrato differenze significativa dalla THS, nelle lesioni cistiche. E’ stato valutato che la CS abbia un valore diagnostica minore nella caratterizzazione.

Conclusioni: per la valutazione delle lesioni focali epatiche, una combinazione di compound ed armonica tissutale (THC) è la tecnica ecografica da preferire.

Keywords: Compound US; Liver; Liver lesions; Tissue harmonic imaging; Ultrasonography.

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Figures

Fig. 1
Fig. 1
Lesion conspicuity of solid lesion in 45-year-old male with metastasis showing isoechoic lesion in segment II with hypoechoic rim. a CS image shows moderately obscured margins. Faint ill-defined peripheral hypoechoic halo is also seen (LC score = 2). b RTCS image shows well-defined margins. Peripheral halo is better appreciated (LC score = 4). c THS image showing partially obscured margins with ill-defined peripheral hypoechoic halo (LC score = 3). d THCS image shows well-defined margins of the lesion with well appreciated thin peripheral halo around it (LC score = 4)
Fig. 2
Fig. 2
Posterior acoustic enhancement (PAE) in cystic liver lesion in a 29-year-old male patient with hepatic cyst in segment II of liver. a CS image shows grey PAE behind the lesion with vague demarcation (PAE score = 3). b RTCS image shows presence of grey PAE with sharp demarcation (PAE score = 4). c THS image shows white PAE with sharp demarcation behind the cystic hepatic lesion (PAE score = 5). d THCS image also shows white PAE with sharp demarcation behind the cystic hepatic lesion (PAE score = 5)
Fig. 3
Fig. 3
Internal echoes within cystic liver lesion in a 8-year-old female child with simple hepatic cyst in segment VI of liver. a CS image shows presence of internal echoes in more than 2/3rd of this cystic lesion (IE score = 1). b RTCS image also shows presence of internal echoes in more than 2/3rd of this cystic lesion (IE score = 1). c Corresponding THS image shows no internal echoes within the lesion (IE score = 4). d THCS image shows internal echoes confined to less than 1/3rd of the lesion (IE score = 3)
Fig. 4
Fig. 4
Posterior acoustic enhancement (PAE) in cystic liver lesion in a 29-year-old male patient with hepatic cyst in segment II of liver. a CS image shows grey PAE behind the lesion with vague demarcation (PAE score = 3). b RTCS image shows presence of grey PAE with sharp demarcation (PAE score = 4). c THS image shows white PAE with sharp demarcation behind the cystic hepatic lesion (PAE score = 5). d THCS image also shows white PAE with sharp demarcation behind the cystic hepatic lesion (PAE score = 5)
Fig. 5
Fig. 5
Internal echoes within cystic liver lesion in 8-year-old female child with simple hepatic cyst in segment VI of liver. a CS image shows presence of internal echoes in more than 2/3rd of this cystic lesion (IE score = 1). b RTCS image also shows presence of internal echoes in more than 2/3rd of this cystic lesion (IE score = 1). c Corresponding THS image shows no internal echoes within the lesion (IE score = 4). d THCS image shows internal echoes confined to less than 1/3rd of the lesion (IE score = 3)
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