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      Current consensus and guidelines of contrast enhanced ultrasound for the characterization of focal liver lesions

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          Abstract

          The application of ultrasound contrast agents (UCAs) is considered essential when evaluating focal liver lesions (FLLs) using ultrasonography (US). Microbubble UCAs are easy to use and robust; their use poses no risk of nephrotoxicity and requires no ionizing radiation. The unique features of contrast enhanced US (CEUS) are not only noninvasiveness but also real-time assessing of liver perfusion throughout the vascular phases. The later feature has led to dramatic improvement in the diagnostic accuracy of US for detection and characterization of FLLs as well as the guidance to therapeutic procedures and evaluation of response to treatment. This article describes the current consensus and guidelines for the use of UCAs for the FLLs that are commonly encountered in US. After a brief description of the bases of different CEUS techniques, contrast-enhancement patterns of different types of benign and malignant FLLs and other clinical applications are described and discussed on the basis of our experience and the literature data.

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          Management of hepatocellular carcinoma.

          Jordi Bruix, Morris Sherman (2005)
          Article 0 comments Cited 1334 times – based on 0 reviews     Review now
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            Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma.

            Masao Omata, Laurentius Lesmana, Ryosuke Tateishi … (2010)
            The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference.
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              Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries.

              Amy Berrington de Gonzalez, Sarah Darby (2004)
              Diagnostic X-rays are the largest man-made source of radiation exposure to the general population, contributing about 14% of the total annual exposure worldwide from all sources. Although diagnostic X-rays provide great benefits, that their use involves some small risk of developing cancer is generally accepted. Our aim was to estimate the extent of this risk on the basis of the annual number of diagnostic X-rays undertaken in the UK and in 14 other developed countries. We combined data on the frequency of diagnostic X-ray use, estimated radiation doses from X-rays to individual body organs, and risk models, based mainly on the Japanese atomic bomb survivors, with population-based cancer incidence rates and mortality rates for all causes of death, using life table methods. Our results indicate that in the UK about 0.6% of the cumulative risk of cancer to age 75 years could be attributable to diagnostic X-rays. This percentage is equivalent to about 700 cases of cancer per year. In 13 other developed countries, estimates of the attributable risk ranged from 0.6% to 1.8%, whereas in Japan, which had the highest estimated annual exposure frequency in the world, it was more than 3%. We provide detailed estimates of the cancer risk from diagnostic X-rays. The calculations involved a number of assumptions and so are inevitably subject to considerable uncertainty. The possibility that we have overestimated the risks cannot be ruled out, but that we have underestimated them substantially seems unlikely.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Mol Hepatol
                Journal ID (iso-abbrev): Clin Mol Hepatol
                Journal ID (publisher-id): CMH
                Title: Clinical and molecular hepatology
                Publisher: The Korean Association for the Study of the Liver
                ISSN (Print): 2287-2728
                ISSN (Electronic): 2287-285X
                Publication date (Print): March 2013
                Publication date (Electronic): 25 March 2013
                Volume: 19
                Issue: 1
                Pages: 1-16
                Affiliations
                [1 ]Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea.
                [2 ]Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
                [3 ]Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
                [4 ]Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
                [5 ]Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
                [6 ]Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.
                [7 ]Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
                [8 ]Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
                [9 ]Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
                [10 ]KASCU (Korean Association for the Study of Contrast Enhanced Ultrasonography), Korea.
                Author notes
                Corresponding author: Won Young Tak. Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu 700-721, Korea. Tel. +82-53-200-5519, Fax. +82-53-426-8773, wytak@ 123456knu.ac.kr

                *These authors contributed equally to this work.

                Article
                DOI: 10.3350/cmh.2013.19.1.1
                PMC ID: 3622850
                PubMed ID: 23593604
                SO-VID: a8ef0ea2-1ca1-4dc9-ae48-eb49846d10e4
                Copyright © Copyright © 2013 by The Korean Association for the Study of the Liver
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 04 March 2012
                Date revision received : 08 March 2012
                Date accepted : 14 March 2012
                Categories
                Subject: Review

                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: guidelines,contrast enhanced ultrasonography (ceus),focal liver lesions (flls)
                Data availability:
                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: guidelines, contrast enhanced ultrasonography (ceus), focal liver lesions (flls)

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