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A Case of Hepatic Inflammatory Pseudotumor with Time-Dependent Contrast-Enhanced Ultrasonography Findings
Abstracts of image fusion-guided CEUS in detecting liver nodules with abnormal blood supply missed by conventional ultrasonography and CEUS. Methods: 35 patients with forty-two liver nodules and HBV cirrhosis missed by US and CEUS, detected by contrast-enhanced CT/MRI, were analyzed retrospectively. Image fusion-guided CEUS was performed after the fusion of ultrasound and contrast enhanced CT/MRI images. Results: Our results show that image fusion were performed successfully in all 35 patients. The technical success rate was 100%. Average fusion time was 4.161.8 min. Forty liver nodules with abnormal blood supply were detected by image fusion guided CEUS, and the detection rate was 95.2%. The diagnosis accuracy rate of image fusion guided CEUS was 97.5%. Two nodules misdiagnosed by contrast-enhanced CT were achieved by image fusion guided CEUS. Conclusions: Our results indicate that Image fusion guided CEUS has a high detection rate and diagnosis accuracy for liver nodules with abnormal blood supply missed by US and CEUS. This method can improve the clinical diagnosis and guide interventional procedures. Poster Session PPT4-001 A Case of Hepatic Inflammatory Pseudotumor with Time-Dependent Contrast-Enhanced Ultrasonography Findings Takahito Iwai,1 Mutsumi Nishida,1 Satomi Omotehara,1 Satoshi Yabusaki,2 Koji Ogawa,3 Keisuke Okamura,4 Satoshi Hirano,4 Tomoko Mitsuhashi,5 Eiko Hayase,6 Chikara Shimizu6 1 Division of Laboratory and Transfusion Medicine / Diagnostic Center for Sonography, Hokkaido University Hospital, Japan, 2Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, 3Department of Gastroenterology, Hokkaido University Hospital, 4Department of Gastroenterological Surgery II, Hokkaido University Hospital, 5Department of Surgical Pathology, Hokkaido University Hospital, 6Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital Objectives: Hepatic inflammatory pseudotumor (IPT) is a rare benign disorder with non-specified image findings that depend on the inflammatory stage. Here, we report a case of hepatic IPT with contrast-enhanced ultrasonography (CEUS) findings that changed over time. Methods: Case report and literature review. Results: The female patient in her 40s referred for close examinations of a new lesion appearance in hepatic segment 5 on contrast-enhanced computed tomography (CT) during follow-up for a solitary necrotic nodule in hepatic segment 6. Ultrasonography revealed a 13-mm hypoechoic solid lesion with an ill-defined border in her liver. At the first visit, the new hepatic nodule showed a strong homogeneous enhancement pattern in the arterial phase of the CEUS, while it showed a prolonged enhancement pattern in the portal phase of CEUS. In the post-vascular phase, the nodule showed an enhancement defect. Six months after these initial findings, the contrast enhancement pattern of the portal phase has changed into a wash-out pattern. The
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nodule showed a wash-out pattern in both the portal and equilibrium phases of contrast enhanced CT. Dedifferentiation of hepatocellular carcinoma was not denied and laparoscopic partial hepatectomy was performed. The resected specimen clearly showed a distinct tumor without a capsule. Pathological finding showed increased number of spindle cells and small blood vessels with infiltration of inflammatory cells including plasma cells in the tumor. The nodule was diagnosed IPT. Conclusions: This case suggested that follow-up with CEUS might be useful to diagnose IPTs for hypoechoic solid lesions with ill-defined borders.
PPT4-002 Sonazoid-Enhanced Ultrasonography Guidance Improves the Quality of Pathological Diagnosis in the Biopsy of Focal Hepatic Lesions Yuji Eso, Atsushi Takai, Yoshihide Ueda, Hiroyuki Marusawa, Hiroshi Seno Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Japan Objectives: Contrast-enhanced ultrasonography (US) using secondgeneration contrast agent Sonazoid has improved the detection and characterization of focal hepatic lesions. We evaluated the utility of Sonazoid-enhanced ultrasonography (SEUS) in guiding percutaneous biopsy of focal hepatic lesions by comparing accuracy of histopathological diagnosis between B-mode US and SEUS guidance. Methods: This retrospective study included 140 focal hepatic lesions in 127 patients (mean age; 63.6 years) referred for US-guided percutaneous biopsy between April 2012 and September 2016. The diagnostic accuracy of the biopsy was defined as the percentage of the total number of lesions clearly diagnosed at the initial biopsy. A case was considered a technical failure when pathological results failed to specifically indicate final diagnosis owing to insufficient material or when pathological results changed from benign to malignant by re-biopsy. Results: Among 140 focal hepatic lesions, 57 lesions underwent biopsy with B-mode US guidance while 83 received SEUS guidance. Patient characteristics (sex, age, lesion location and diameter, and reasons for biopsy) did not differ significantly between groups. Diagnostic accuracy was significantly higher under SEUS guidance than B-mode US guidance (91.6% vs. 75.4%, respectively; p , 0.05). When biopsies were performed to diagnose or rule out malignancy in indeterminate focal hepatic lesions, diagnostic accuracy was also significantly higher under SEUS guidance than B-mode US guidance (100% vs. 70.8%, respectively; p , 0.05). SEUS guidance resulted in a significantly higher rate of successful singlepuncture attempts during biopsy procedures than B-mode US guidance (53.0% vs. 35.1%, respectively; p , 0.05). Conclusions: SEUS guidance improves the accuracy of hepatic tumor biopsy pathological diagnosis compared to B-mode US guidance. SEUS guidance is recommended for more accurate localization of suitable hepatic lesion biopsy areas since it increases conspicuity and differentiates viable area from denaturalization or necrosis.
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nodule showed a wash-out pattern in both the portal and equilibrium phases of contrast enhanced CT. Dedifferentiation of hepatocellular carcinoma was not denied and laparoscopic partial hepatectomy was performed. The resected specimen clearly showed a distinct tumor without a capsule. Pathological finding showed increased number of spindle cells and small blood vessels with infiltration of inflammatory cells including plasma cells in the tumor. The nodule was diagnosed IPT. Conclusions: This case suggested that follow-up with CEUS might be useful to diagnose IPTs for hypoechoic solid lesions with ill-defined borders.
PPT4-002 Sonazoid-Enhanced Ultrasonography Guidance Improves the Quality of Pathological Diagnosis in the Biopsy of Focal Hepatic Lesions Yuji Eso, Atsushi Takai, Yoshihide Ueda, Hiroyuki Marusawa, Hiroshi Seno Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Japan Objectives: Contrast-enhanced ultrasonography (US) using secondgeneration contrast agent Sonazoid has improved the detection and characterization of focal hepatic lesions. We evaluated the utility of Sonazoid-enhanced ultrasonography (SEUS) in guiding percutaneous biopsy of focal hepatic lesions by comparing accuracy of histopathological diagnosis between B-mode US and SEUS guidance. Methods: This retrospective study included 140 focal hepatic lesions in 127 patients (mean age; 63.6 years) referred for US-guided percutaneous biopsy between April 2012 and September 2016. The diagnostic accuracy of the biopsy was defined as the percentage of the total number of lesions clearly diagnosed at the initial biopsy. A case was considered a technical failure when pathological results failed to specifically indicate final diagnosis owing to insufficient material or when pathological results changed from benign to malignant by re-biopsy. Results: Among 140 focal hepatic lesions, 57 lesions underwent biopsy with B-mode US guidance while 83 received SEUS guidance. Patient characteristics (sex, age, lesion location and diameter, and reasons for biopsy) did not differ significantly between groups. Diagnostic accuracy was significantly higher under SEUS guidance than B-mode US guidance (91.6% vs. 75.4%, respectively; p , 0.05). When biopsies were performed to diagnose or rule out malignancy in indeterminate focal hepatic lesions, diagnostic accuracy was also significantly higher under SEUS guidance than B-mode US guidance (100% vs. 70.8%, respectively; p , 0.05). SEUS guidance resulted in a significantly higher rate of successful singlepuncture attempts during biopsy procedures than B-mode US guidance (53.0% vs. 35.1%, respectively; p , 0.05). Conclusions: SEUS guidance improves the accuracy of hepatic tumor biopsy pathological diagnosis compared to B-mode US guidance. SEUS guidance is recommended for more accurate localization of suitable hepatic lesion biopsy areas since it increases conspicuity and differentiates viable area from denaturalization or necrosis.