Ugnė Kulnickaitė¹, Klaudijus Baranauskas¹ , Domantas Vingrys²

¹Hospital of Lithuanian University of Health Science Kauno Klinikos, Radiology department, Kaunas, Lithuania

²Hospital of Lithuanian University of Health Science Kauno Klinikos, Internal medicine department, Kaunas, Lithuania

Abstract

Background. Contrast-enhanced ultrasound (CEUS) is a low-risk, low-cost imaging technique that uses dedicated imaging ultrasound sequences and FDA-approved contrast microbubbles. Clear description of the benign foci that are seen in this initial imaging study and their differentiation from other lesions allow doctors to choose an appropriate follow-up diagnostic or treatment strategy.

Aim: to summarize the latest studies and present information on the use of contrast-enhanced ultrasound for the evaluation and characterization of benign focal liver lesions.

Methods. the literature used for this review was selected using the Medline (PubMed), SpringerLink and ScienceDirect databases covering 2015 to 2022 period. The literature research was conducted using predetermined keywords: contrast-enhanced ultrasound, focal liver lesions. Exclusion criteria were applied to articles related to malignant focal liver lesions. 26 publications were analyzed.

Results. In the case of benign lesions, contrast-enhanced ultrasonography is a useful technique for evaluating focal liver lesions and may reduce the need for additional imaging and biopsy. A benign liver lesion with arterial enhancement that becomes isoenhancing or remains hyperenhancing in the portal and late phases is a common finding. Contrast-enhanced ultrasound has a high safety profile, is relatively cheap, does not use ionizing radioation and does not cause nephrotoxicity.

Conclusions. Contrast-enhanced ultrasound is an effective technique for evaluating focal liver lesions and should be used instead of contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging tests. Radiologists must be aware of washout, including its definition, subtypes and potential pitfalls in order to make a correct diagnosis.

Keywords: focal liver lesion, contrast-enhanced ultrasound, hemangioma, focal nodular hyperplasia, adenoma.

Full article

https://doi.org/10.53453/ms.2023.1.17

The use of contrast-enhanced ultrasound for the evaluation of

benign focal liver lesions: a literature review

Ugnė Kulnickaitė

1

, Klaudijus Baranauskas

1

, Domantas Vingrys

2

1

Hospital of Lithuanian University of Health Science Kauno Klinikos, Radiology department, Kaunas,

Lithuania

2

Hospital of Lithuanian University of Health Science Kauno Klinikos, Internal medicine department,

Kaunas, Lithuania

Abstract

Background.

 !!!"#

!#$###

#$"

Aim:%##

# %#!# "

Methods.# &'!&(

!  )*+,)*))"-

  $.      #     "  /    

# ")0!$%"

Results. 1     # !   $     #    #

 # $#!$"! 

!$

#"#$# $

%/$"

Conclusions. ## # # 

!#$

"2!##!$

#"

Keywords: #  # $

"

Journal of Medical Sciences. 23 Jan, 2023 - Volume 11 | Issue 1. Electronic - ISSN: 2345-0592

Medical Sciences 2023 Vol. 11 (1), p. 130-137, https://doi.org/10.53453/ms.2023.1.17

130

Kontrastinio ultragarsinio tyrimo panaudojimas vertinant

gerybinius židininius kepenų pakitimus: literatūros apžvalga

Ugnė Kulnickaitė

1

, Klaudijus Baranauskas

1

, Domantas Vingrys

2

1

Lietuvos sveikatos mokslų universiteto ligoninė Kauno klinikos, Radiologijos klinika, Kaunas, Lietuva

2

Lietuvos sveikatos mokslų universiteto ligoninė Kauno klinikos, Vidaus ligų klinika, Kaunas, Lietuva

Santrauka

Įvadas.3$$$ ! %

$  4    %5  6      &    5  4  

 !!" 77 %$5$!5

85  !9    45  #4     5  5  8      

$$"

Tikslas. 2  4    9  !     #46    $!5

8555 6$"

Metodika. (98 ! 4&'!&(

5!%)*+,)*))":"5!

  88    45 !4.      $  8  5  "

  4  !       4    $!  5  8

";9%<! :,*!4575! )0

"

Rezultatai. 3$  %$ 85

=7 5$5!47$!585"'855

5    8$  $      =  #%=      7<

7!%7= =$ #%5"3

$  $  ! $ 8 4%4>  4  8$

#7"

Išvados: $#$ : 85

=  7  $  =5  !9  9    $   =  #4    

%  #4  $"  #44  $!  8  5    

$!5$$4!98=87 6

7"

Raktažodžiai: 8  5        $    8=

%=%4"

Journal of Medical Sciences. 23 Jan, 2023 - Volume 11 | Issue 1. Electronic - ISSN: 2345-0592

131

1. Įvadas

?5  :  

 5@

A+)B $89

=  %    !  ==

5    !  %=   

  A+CB"  5  5   4

8  5      !9

%4$D=8

! A)CB>=

%= $ $ =  75

$5  !  4    #7  A+B"

'=448

$8

85  5  5  : 6  !  

 ==  4  $   =4

44    44  ACB

7%$3-

&2-$AEB" 3

$  $    $   !  

    %  $  A)B

4    %5  6  

  &    5  4

     

!!8

$    %  8  5

A+CB"

2. Tyrimo medžiaga ir metodai

(9  8   !     4

&  '!&  (  

5!%)*+,

)*))  "  :"    

5!88

45  !4.    

$85"

4  !     

4    $!  5  8

";9%<! :,*

!45        7  5  ! 

  )0    !

%4"

3. Rezultatai

3$  %

$ 8 5

 =  7  5 $5 

!475$!55AC,B"

    8:  5  6

=$

  :  :  $6  

85$56 A0B"

'  85  5  5

  8$  $    

=  #%=      7<

7  !  %7

=    =$   #%5    A,FB"

3=  8  7$  ==

#%=  $  $!7  8$  A0  GB  =

    !9    !4  A0B"  H

8$!95

$!5  85  5  5  

>      =4  #%=4

$$!<5<

A0GB" 3    $  

$   !  $  8

4%4>  4    8$

#7ACEB"

3.1. Kontrastinio ultragarsinio tyrimo

indikacijos židininiams kepenų

pakitimams vertinti

 !      4

58 .

+" 35  4$5    8  5

I

)" 35855$I

Journal of Medical Sciences. 23 Jan, 2023 - Volume 11 | Issue 1. Electronic - ISSN: 2345-0592

132

C"   $  $5  5

855!=4 

$I

E" #4$!5$!5

8555I

," &%5    !4    $

  %5  !    6

$%I

0" ?5  5  5  $  

: 5%

(12    4  5

 %: I

F" '  3-  !  &2-  $

%$>%5=

!4I

G"   #$   

$I

J" &4    !4

9I

+*" = 45I

++"  4$$6

!  :%6

5#%46I

+)" 3.  :   7      5

4ACB"

3.2.Dažniausi nepiktybiniai židininiai kepenų

pakitimai

3.2.1.Kepenų cistos

35    $  8  $!

!98 8  5  AC FJB

8      AJB"  '

    =    $

7 9 9

8    !    

8    77=  A+*B"  -  

$ 

779 5$

#%5A++B"'5

7    8$     

: $

=$

  A++  +)B"  3

==

D=8      $  7  :

5 A+)B"- 4

    $    =

4 $!<85

<    85

76  !  #4>

58ACB"

3.2.2.Riebalų sankaupos kepenyse

2!5:%47

5    !#4  !    8

9=    5  5  A+B" -  D=8

    7      

%46A+C+0B=#=

$  !   !  $>    

$!<  6  A+CB"  3  

$  =  =    =$   #%5

 !5 5  8$

    =  5  

A,B"  ;     D=8  

!5$7

A+CB!=455#

79A+C+,+0B"

3.2.3.Kepenų hemangioma

K  $    8  $!=

5  %4  ACB   :  =

%4  4  %

$  A+*B"  2      =

 $   

!7

8$ 8::77=:

A+*+0B"'  % $ =

<        $

Journal of Medical Sciences. 23 Jan, 2023 - Volume 11 | Issue 1. Electronic - ISSN: 2345-0592

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7      AC  ++B"

 !  5  

8$    @  $  #

%  =  8  

=4  #%=4  A+*  +0B    7

8$ =$ 44

!  =4  #%=    L=

#M  #  A++B"  K

78E*,*N 45

A+FB"  &8      8$

  !9  8$    8

=  #%=        7

   !  %   >

  !     =4  !

=$ 44#%=A+0+GB"38$

$  =    OE    =

O+*7=

        

7  #7  !9    



$ $>!%A+GB"H=

  :  $    85

75  %5  A+0B    7

8=4:!5:$

5    A+GB"  H  !

$>  7  

75  %5  4  9

    5    9

4      7   5

4$5        5  

A+0+GB"

3.2.4. Židininė mazginė hiperplazija

?=%=%4?&K$

86$!=5%4AC

+JB  8  %4  C*,*  5

8 :$!=

A+JB"  '  =    $  

 ?&K$#A+G

+JB"  ?&K    !9    

%78$7

%==5=

    $    !9  

  7    $>  4  4  $

  A)*B"  -    

?&K      7  6

8$A+GB=$ 

=  #%=        J*N   45

A++)B"38$$7

  !    ACB"  3    7

%    8      !9

7!?&K>44A+JB"

?&K    !9    7  

7$ =#%=

  !  :  %7  

=$ 44  #%=4"  A+CB"  3  $  

    7  

!9  =  !!5  4  A+E+0B"

174=47=4

  %  #4      L

5MA++FB8$

8    ?&K      

5  5     5

$!58555A+B"

3.2.5. Abscesas

3      !9  

    !5  4

5

    =  #4

$  $    A0B"  -

5  ! =     

=4 =4 =$ 44#%=A+G

+JB"  !    8$

  $      !9  : 9

      4  8

      8 A+FB"  '7

$=4  !    

Journal of Medical Sciences. 23 Jan, 2023 - Volume 11 | Issue 1. Electronic - ISSN: 2345-0592

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  $    !  :

    $  #

7  8$!  8  4

 6A+JB"!<!$ 

 78$6

68::77=:A+JB"

8  !  =4  !9   5  !

=5  A)*B"  3    

#4!$!585

5  5      

$! $>AC

)*B"  -$    =4  #%=4  

!  =  $  7  A)+B"

P  #%=  =  !  9  $

77A+G)+B78$

8    7:  6    $!5

5 58!9: 

 7A+GB"

3.2.6. Hepatoceliulinė adenoma

K=    K $  

$!  5    AC0B  8

%4    4>

    5  =$4  $

  A0B"  ;    $  

AC))BG+*$88

!9+*A))B"

K$$,*

  #4      7

6  >  9  A)C  )EB"  H

8$  !9    

!%=A)CB"3

  $      :

76=4

#%=4    8$      

78$A)*)+),B"D=8

      #5

58$5AC),B!9

  7  %7

778

A),B"  K  4    !9  

7    >

% 7%<Q! :

4 6A)0B"

4. Išvados

3    $    

#$ : $!85

=7$=5!99

  $   =  =

#4      %

#4  $"  #44

$!  8  5    

$!5  $$4    !9

8=87 6

7"

Literatūros šaltiniai

+" RS#&2!

2&2'"

#( ("T2T

2")*+,I)*,+.,000"

)" -

U"        

  #    !  #     "

/2 @K")*+GI+),.

EFJEGJ"

C" %  -  3  U  2  3"

      

%    (   ("    ( 

K!")*)+I+FC.++J+)E"

E" VK'TDW(-X

&WVWU(U"K

2      K

##&D( 

("T-K")*))I+*+.)0

CC"

Journal of Medical Sciences. 23 Jan, 2023 - Volume 11 | Issue 1. Electronic - ISSN: 2345-0592

135

,"  P

     -#      S"

&    $     #

/$# !$

.#"T

")*+JI))C.),+),J"Y

0" W%  T@  '  33  -  K

2!!  &("      #

! "!2ZU")*+GI

ECE.GEGG0*"

F" XTUUVTX(T

(    VX    "  #  #  

    (   1

2$

( (!$1/2"T

&")*)*ICJG.+,CF+,E0"

G" D  '  3 U &  

X  2"Y2@Y.  

            #

  (   &"  2"  )*)*I

E*E.+0)*"

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'   [ &]%  W& 

1^    &  -  -  D  D  

Z[#[PD2"

    #  

%  #  &    D

  (   (      ' 

&/-2&D$"T

@( ")*+JI)G.+J++J0"Y

+*" (PT

"             .  

  !#  #       !

"T2")*+,IGEJ.+0C0_+0EC"

++" (  T  U  3  (  3  U  X

&K" (  (. 2 C

  

$    X  )

  

$    &  2

1"  T    &"  )*+FI  C0+*.

)*+,)*)0"

+)"        S     

    '  "  

'#    #  #  

        ##

  #  $    $  ( 

("T2T2")*+FI)*JC.

X++JX+)F"Y

+C" UXX'P"

  # $

     

"XT@"

)*+0I))+J.EFE+_EFEJ"

+E" %&&$!D

  "    

    /    $  

### .#

$"

&X$")*+JIG*+.+EJ+0C"

+," Z`      @  &

'%3%P&W(

2a!  T    -  1  DX

   "  (  $  $  #

#

#    $"    K

&")*)*IFEE.EE+E,)"

+0"   "  

  #  D    ( Y("

&")*+JIE*+.+))J"

+F" (U(DWU(TW

VK@VVUTXX(VV

V"   #    

      P

#       #  #     .  

     $"    T  -

2")*+GI+*,.+E0J+EG*"

Journal of Medical Sciences. 23 Jan, 2023 - Volume 11 | Issue 1. Electronic - ISSN: 2345-0592

136

+G" @"K#

    "    &

X")*+0I+E++E.+*+J_+*)E"

+J" S!    2$  &"  D   

.  $    

  "  "  )*+,I

)C).++0_+),"

)*" DX3!

&&X".

 #$"1"

)*)*I0*).)*J)+,"Y

)+" D2@"

#  #     .        b

!2ZU")*+GIEC,.++)G++CC"

))" 3X-XX'KDT

K&c"

! 

 ###

  $    

"    & D" )*+,I  E+E.

JEE,+"

)C" V(WWV@

cW(XV-VU"##

      

/    !$  #  #     "

!2ZU")*+JIEE+.C+*C+F"

)E" UK3D'ZTKT3

U33X 23 -3"



#  #     .      #

"  $"  )*+JI  CGE.  )GJ

C*+"

)," X&((XTWU@c

(  V  W  V"      #

%  #  #     .  

 $"2")*+GI

)G,.)*FF)*GG"

)0" -Z3U&SU-

2!! &( D 2@ 3  &$

2"    (   (.  

!$

2"  2$"  )*+GI  )G0C.  +*0)

+*F+"

Journal of Medical Sciences. 23 Jan, 2023 - Volume 11 | Issue 1. Electronic - ISSN: 2345-0592

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