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Query: UMLS:C0019204 (hepatocellular carcinoma)
 71,386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper summarises the discussions from a meeting held on contrast ultrasound held on 21 October 2000 in Toronto, Canada. The aims of this meeting, supported by ATL/Philips Ultrasound, was to review the current clinical indications for contrast usage in the liver and kidney, arrive at recommendations for use of intravenous contrast agents, and speculate on the future uses. This paper is published to help understand this rapidly evolving field. Consensus points included a recommendation that Levovist in its post-vascular phase was of considerable value in detecting and excluding metastases in the liver, although unlikely realistically to replace CT or MR. Newer agents such as Sonovue, Definity and Sonazoid, suitable for low mechanical index (MI) imaging were also of great value and may have a further role for HCC detection. Equipment manufacturers should strive to keep improving low mechanical index modes for these agents. Promising applications for characterisation included further evaluation of lesions discovered on ultrasound and as a problem solver for CT or MR. To date no contrast agents have received approval from the FDA for radiological applications in the United States. The case for reimbursement for contrast agents was strongly supported by the panel.
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PMID:Seeking consensus: contrast ultrasound in radiology. 1186 Oct 95

Ultrasound (US) contrast agents such as Levovist and Sonazoid are now commercially available in Japan. Innovative contrast agents and ultrasound technologies have dramatically changed both diagnostic and treatment strategies for hepatocellular carcinoma (HCC). Contrast-enhanced US is extremely useful in the differential diagnosis of hepatic tumors as well as in evaluation of post-treatment response of HCC after lipiodol transarterial chemoembolization and radio frequency ablation. Harmonic US sensitively detects residual cancer cells in HCC patients after treatment, to facilitate accurate guidance for needle insertion for US monitoring; no other imaging modalities, including computed tomography (CT) or magnetic resonance imaging (MRI), have such capability. In 2005, the breakthrough technology of pure arterial phase imaging, which depicts only intranodular arterial accumulated maximum intensity projection images, was developed from advanced raw data storing and accumulation technologies. This technique can clearly identify whether blood supplyin the tumor is of arterial or portal origin, to facilitate the non-invasive characterization of nodular lesions associated with liver cirrhosis. Again, CT or MRI do not have such capabilities. This innovative technique can help differentiate premalignant lesions from overt HCC. Concurrent real-time imaging of multi-detector CT and US, known as real-time virtual sonography, has recently become available. This technique greatly facilitates the treatment guidance for HCC. These newly introduced sonographic techniques are dramatically changing the diagnostic and therapeutic strategies for HCC, which are expected to improve the prognosis of HCC patients.
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PMID:New sonographic techniques for the diagnosis and treatment of hepatocellular carcinoma. 1787 82

Hepatocellular carcinoma (HCC) is a malignant tumor which is becoming more prevalent worldwide. Patients at high risk of developing HCC, namely hepatitis B- and C-related liver cirrhosis patients, should be entered into surveillance programs, which should be performed using both ultrasonography and 3 tumor markers (AFP, PIVKA-II, AFP-L3). The surveillance interval needs to be shortened for patients at higher risk of HCC. Therefore, super-high-risk patients should be screened at 3- to 4-month intervals based on their risk of developing HCC. Sonazoid-enhanced US is extremely useful to characterize hepatic tumors when compared with multidetector-row computed tomography (MDCT). Moreover, Sonazoid-enhanced US with defect reperfusion imaging is a breakthrough approach in the treatment of HCC. This technique will markedly change the therapeutic strategy for liver cancer. Furthermore, diagnostic capability using the new imaging technique Gd-EOB-DTPA MRI is promising. A reduced uptake (low intensity) in the hepatobiliary phase of Gd-EOB-DTPA MRI strongly suggests HCC (including early-stage HCC) or a high-grade dysplastic nodule with high malignant potential. Empirically, intrahepatic arterial infusion chemotherapy using implanted reservoir port is known to be effective for advanced HCC with vascular invasion; however, no randomized study exists to prove its efficacy. Further controlled study is necessary to establish this treatment option as a standard of care in a treatment algorithm for HCC. In contrast, sorafenib was established as the first choice of treatment as a standard of care in advanced HCC patients with preserved liver function and vascular invasion/extrahepatic spread. Furthermore, global clinical trials are now ongoing using sorafenib as an adjuvant setting after resection, ablation or TACE. Efficacy of combined use of sorafenib with TACE or intra-arterial infusion chemotherapy is not clear. In order to clarify this issue a randomized clinical trial for intermediate and advanced HCC comparing sorafenib alone versus sorafenib combined with maintenance TACE/intra-arterial infusion chemotherapy and/or intra-arterial infusion chemotherapy is scheduled to be initiated in Japan in 2009. If positive results are obtained by these trials, its impact on treatment strategy for HCC will be drastically changed.
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PMID:Hepatocellular carcinoma 2009 and beyond: from the surveillance to molecular targeted therapy. 1909 66

Contrast-enhanced ultrasound using Sonazoid, a novel contrast medium with a liver-specific Kupffer phase, was evaluated in canine focal liver lesions Twenty-five dogs with a liver mass were given intravenous Sonazoid, and the enhancement pattern in the arterial, portal, and parenchymal phase was characterized. An enhancement defect in the lesion in the parenchymal phase was observed in all malignant lesions, whereas only one of nine benign lesions had a filling defect. The diagnostic value of the presence of a filling defect for malignancy was statistically significant (100% sensitivity, 88.9% specificity, 94.1% positive predictive value, 100% negative predictive value), and was equal to that of hypoenhancement in the portal or delayed phase. The defect pattern (clear or irregular defect) was dependent (P < 0.05) on the types of malignancy (i.e., hepatocellular carcinoma and other types of malignancies). In the arterial phase, five of the six hepatocellular carcinomas had hypervascularity, whereas no other lesion was characterized by hypervascularity. In some dogs, additional lesions that could not be observed with conventional B-mode ultrasonography were detected in the parenchymal phase. The enhancement pattern of Sonazoid, especially in the parenchymal phase, has potential as a diagnostic tool for canine focal liver lesions.
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PMID:Characterization of canine focal liver lesions with contrast-enhanced ultrasound using a novel contrast agent-sonazoid. 1940 Apr 67

Hepatocellular carcinoma (HCC) is responsible for approximately 600,000-700,000 deaths worldwide. It is highly prevalent in the Asia-Pacific region and Africa, and is increasing in Western countries. Alpha fetoprotein (AFP) alone is insufficient for HCC screening. A combination with other tumor markers, such as PIVKA-II and AFP-L3, and periodical ultrasound surveillance is necessary. Sensitivity of AFP in depicting HCC is highest, followed by PIVKA-II and AFP-L3, but the order of the specificity is inverse, AFP-L3, PIVKA-II, and AFP. Sonazoid-enhanced ultrasound (US) is extremely useful to characterize hepatic tumors equal to or more than multidetector row computed tomography (MDCT). Sonazoid-enhanced US with defect re-perfusion imaging is a breakthrough technique in the treatment of HCC. Defect re-perfusion imaging will markedly change the therapeutic strategy for liver cancer. Gd-EOB-DTPA-magnetic resonance imaging is a newly developed imaging technique in the detection and diagnosis of HCC. It is the most sensitive tool in the differentiation of early HCC from dysplastic nodules. Regarding the treatment strategy, there has been no established systemic chemotherapy for advanced HCC, except for Sorafenib. Empirically, intrahepatic arterial infusion chemotherapy using implanted reservoir port is known to be effective in response rate and overall survival for advanced HCC with vascular invasion. Sorafenib in combination with transcatheter arterial chemoembolization or adjuvant use after ablation or resection will significantly prolong the life expectancy if ongoing clinical trials provide positive results. In conclusion, it is expected that readers will gain deeper insight into the latest progress and updated diagnosis and treatment of HCC described in this review.
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PMID:The 2008 Okuda lecture: Management of hepatocellular carcinoma: from surveillance to molecular targeted therapy. 2037 Jul 23

BACKGROUND.: The purpose of this study was to assess the usefulness of contrast-enhanced sonography (CEUS) with Sonazoid to demonstrate local recurrence of hepatocellular carcinoma previously treated with radiofrequency ablation (RFA) and not seen on conventional sonography, prior to repeat RFA. METHODS.: This study included 16 cirrhotic patients with 17 cases of hypervascular locally recurrent hepatocellular carcinoma found by contrast-enhanced multidetector row CT (MDCT) but not seen on noncontrast sonography. We used Kupffer-phase imaging and vascular-phase imaging after re-injection. The morphologic patterns of local recurrence detected on CEUS were compared with those on MDCT. We performed repeat RFA guided by CEUS using Kupffer-phase imaging after re-injection. RESULTS.: We were able to detect on CEUS the location of all local recurrences with positive enhancement after re-injection. The morphologic patterns of local recurrence on CEUS were in concordance with those found on MDCT in all lesions. Repeat percutaneous RFA was successfully performed in all lesions. CONCLUSIONS.: The CEUS appearance of local recurrences correlated well with those on MDCT. A wider use of CEUS to guide repeat of percutaneous RFA may be possible with Sonazoid.
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PMID:Contrast-enhanced sonography-guided radiofrequency ablation for the local recurrence of previously treated hepatocellular carcinoma undetected by B-mode sonography. 2057 66

The aim of this study is to clarify the usefulness of defect reperfusion ultrasound (US) imaging using Sonazoid in the management of hepatocellular carcinoma (HCC). A total of 33 HCC nodules and 34 local recurring nodules after radiofrequency ablation (RFA), which could not be identified by B-mode US but were depicted by dynamic CT, were studied by defect reperfusion US imaging with Sonazoid. In addition, Kupffer phase Sonazoid-enhanced US in combination with defect reperfusion US imaging were used for screening HCC in 262 consecutive cirrhotic patients. As a result, 33 US undetectable HCC nodules and 34 local recurring HCC nodules were successfully confirmed by Sonazoid-enhanced US with defect reperfusion imaging. Subsequently, RFA was successfully performed in all of 67 HCC nodules with a Sonazoid-enhanced US guidance. A total of 7 small HCCs were depicted and confirmed as HCCs by Kupffer phase surveillance and defect reperfusion US imaging. In conclusion, defect reperfusion US imaging is extremely useful in the depiction and confirmation of US undetectable HCCs as well as in the surveillance of HCC in cirrhotic patients.
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PMID:Newly developed novel ultrasound technique, defect reperfusion ultrasound imaging, using sonazoid in the management of hepatocellular carcinoma. 2061 83

Ultrasound (US) contrast agents such as SonoVue and Sonazoid are commercially available worldwide. Innovation of contrast agents and advances of new US technologies have dramatically changed both diagnostic and treatment strategies for hepatocellular carcinoma (HCC). Recently, the breakthrough technique, pure arterial phase (PAP) US imaging, which depicts only intranodular arterial supply by use of maximum intensity projection (MIP) images, was developed from advanced raw data-storing and accumulation technologies. A total of 8 dysplastic nodules (DNs), 16 early HCCs, 5 nodule-in-nodule type early HCCs and 48 overt HCCs were included in this study. All 8 DNs (100%) showed arterial hypovascularity in the PAP followed by preserved portal perfusion at the portal phase and isouptake at the Kupffer phase by Sonazoid-enhanced contrast US. A total of 12 out of 16 early HCCs (75%) showed similar patterns on vascular and Kupffer phase imaging of contrast-enhanced ultrasonography. The remaining 4 HCCs showed slightly hypervascular pattern without venous washout and slightly decreased Kupffer uptake. All 5 nodule-in-nodule type early HCCs presented partial arterial enhancement within hypovascular nodule at the PAP followed by isovascular pattern at the portal phase and partial Kupffer defect within isouptake nodules. All 48 overt HCCs showed a hypervascular pattern with Kupffer defect on contrast-enhanced ultrasonography. This technique can clearly identify whether blood supply in the tumor is of arterial or portal origin, and facilitate the noninvasive characterization of nodular lesions associated with liver cirrhosis. In conclusion, this newly developed innovative technique can depict pure portal supply in early HCC and DN, enabling differentiating premalignant lesions and early HCCs from overt HCC even though dynamic CT or MRI does not have such capabilities.
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PMID:Depiction of portal supply in early hepatocellular carcinoma and dysplastic nodule: value of pure arterial ultrasound imaging in hepatocellular carcinoma. 2061 86

Sonazoid (Daiichi Sankyo, Tokyo, Japan), a second-generation of a lipid-stabilized suspension of a perfluorobutane gas microbubble contrast agent, has been used clinically in patients with liver tumors and for harmonic gray-scale ultrasonography (US) in Japan since January 2007. Sonazoid-enhanced US has two phases of contrast enhancement: vascular and late. In the late phase of Sonazoid-enhanced US, we scanned the whole liver using this modality at a low mechanical index (MI) without destroying the microbubbles, and this method allows detection of small viable hepatocellular carcinoma (HCC) lesions which cannot be detected by conventional US as perfusion defects in the late phase. Re-injection of Sonazoid into an HCC lesion which previously showed a perfusion defect in the late phase is useful for confirming blood flow into the defects. High MI intermittent imaging at 2 frames per second in the late phase is also helpful in differentiation between necrosis and viable hypervascular HCC lesions. Sonazoid-enhanced US by the coded harmonic angio mode at a high MI not only allows clear observation of tumor vessels and tumor enhancement, but also permits automatic scanning with Sonazoid-enhanced three dimensional (3D) US. Fusion images combining US with contrast-enhanced CT or contrast-enhanced MRI have made it easy to detect typical or atypical HCC lesions. By these methods, Sonazoid-enhanced US can characterize liver tumors, grade HCC lesions histologically, recognize HCC dedifferentiation, evaluate the efficacy of ablation therapy or transcatheter arterial embolization, and guide ablation therapy for unresectable HCC. This article reviews the current developments and applications of Sonazoid-enhanced US and Sonazoid-enhanced 3D US for diagnosing and treating hepatic lesions, especially HCC.
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PMID:Contrast enhanced ultrasound of hepatocellular carcinoma. 2116 Sep 20

Chronic heavy consumption of alcohol is associated with increased risks of developing liver cirrhosis, hepatocellular carcinoma, and esophageal varices. Cessation of alcohol consumption is the most important requirement in treating these diseases. However, judging whether patients have actually maintained abstinence from alcohol requires reliance on their reports, which vary substantially across individuals using the test methods currently available. Arrival time parametric imaging (At-PI) using Sonazoid-enhanced ultrasonography is regarded as a useful approach for assessing the progression of lesions that have developed in liver parenchyma. In this study, we report two cases for whom this approach was successfully applied to indicate the drinking status of a heavy drinker. At-PI enables approximate and objective assessment of the drinking status of patients, independent of their reports; therefore, it is a promising method for providing information about drinking status.
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PMID:Drinking status of heavy drinkers detected by arrival time parametric imaging using sonazoid-enhanced ultrasonography: study of two cases. 2150 66


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