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CEUS in the Diagnosis of Liver Tumor in Taiwan
S146
Ultrasound in Medicine and Biology
It is well-known that contrast-enhanced ultrasound (CEUS) is most widely used for the evaluation of various hepatic diseases, especially for focal hepatic lesions. Of two 2nd generation US contrast agents, e.g., SonazoidTM (GE Healthcare, USA) and SonoVueTM (Bracco Imaging, Italy) that are available in Korea, SonazoidTM provides more information in characterizing various hepatic tumors, and even in guiding for interventional procedures, e.g., radiofrequency ablation of hepatocellular carcinoma, because it allows acquisition of the Kupffer phase, during which it is taken up actively by Kupffer cell, after acquisition of conventional multi-phase dynamic imaging. SonoVueTM is also easily applicable to evaluate various vascular compromises for which the Kupffer phase is unnecessary. In this lecture, we demonstrate essential characteristics of both US contrast agents, CEUS findings of various hepatic tumors with differential points, guiding methods using CEUS for radiofrequency ablation of hepatocellular carcinoma with brief introduction of fusion imaging techniques, and other applications for vascular compromises. T12-13-IN06 Novel Guidance for Percutaneous Treatment of Hepatic Tumors: Fusion Images and Cone-Beam CT Olivier Seror1,2,3 1 Unit of Interventional Radiology, Jean Verdier Hospital, Bondy, France, 2University Paris 13, Bobigny, France, 3Inserm, UMR-1162, Genomique fonctionnelle des tumeurs solides, Paris, France US fusion images guidance is now routinely used for percutaneous ablations of liver tumors. Indeed, real time display of US slice with corresponding refreshed MPR of co-registered 3D data set of pretherapeutic CT or MR examinations improves the conspicuity of the target. However, several conditions could limit even wreck the co-registration of US with 3D data set of referral examinations. Thus, spatial mismatching between the images of two modalities can be due to static or dynamic anatomic differences between pretherapeutic referral examinations commonly achieved several days before the intervention. Finding similar land marks between US and referral images to set the registration could be also some time too tricky. Automatic coregistration of US with referral volume of images acquired just before the procedure avoids these common pitfalls. Cone beam CT volume as referral image offers additional advantage to be used for 3D fluoroscopic display of the target. For very challenging liver ablation requiring the insertion of several applicators, double real-time guidance relying on US fused with cone beam CT and virtual 3D fluoroscopic display allows safe punctures within acceptable ranges of time and X-ray dose. T12-13-IN07 Doppler Ultrasound in Liver Diseases Antonio Carlos Matteoni de Athayde The hepatic ultrasonography associated with color Doppler, amplitude Doppler and spectral Doppler are very important tools in the daily routine of the professional that performs the ultrasound, being possible to diagnose pathologies and discard others, as well as, it allows to infer the possibility of extra illnesses -hepatic, such as heart disease. It is also of great importance in the evaluation of the transplanted hepatic patient. Color Doppler and Doppler amplitude and spectral Doppler are safe techniques and can be performed several times in a short time in patients of any age group. The identification of flow, whether arterial or venous, sense of the same, as well as, spectral study etc, provide us with relevant information that should always be used. We try to demonstrate situations that these techniques are extremely important and avoid other studies.
Volume 43, Number S1, 2017 T12-13-IN08 CEUS in the Diagnosis of Liver Tumor in Taiwan Yi-Hong Chou, M.D.,1,2 Hong-Jen Chiou, M.D.,1 Chui-Mei Tiu, M.D.,1 Yi-You Chiou,1 Ja-Der Liang,3 Shen-Yung Wang,4 Shih-Jer Hsu,5 Jui-Ting Hu,6 Sien-Sing Yang,6 Peter Lee7 1 Department of Radiology, Taipei Veterans General Hospital, and National Yang Ming University, Taipei, Taiwan, 2Medical Imaging and Radiological Technology, Yuan Pei University of Medical Technology, Hsinchu, Taiwan, 3Attending doctor of internal medicine department, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, 4 Senior Attending Physician, Division of Gastroenterology, Department of Medicine, MacKay Memorial Hospital Tamshui Branch, Taiwan, 5 Attending Physician, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, 6Director of Liver Unit, Liver Center, Cathay General Hospital, and School of Medicine, Fu-Jen Catholic University College of Medicine, Taipei, Taiwan, 7Yee Zen Hospital, Taoyuan, Taiwan During the past three decades, exciting advances have been made in contrast-enhanced ultrasound (CEUS) imaging. Before the currently available second-generation ultrasonic contrast agents(USCA), transarterial infusion of carbon dioxide microbubbles had been used to enhance US examination of hepatic tumors as early as mid-1990s, chiefly by the Jen-Ai Hospital group (Dr. Wang, Dr. Chen, Dr. Liaw). Levovist (Schering AG, Germany), the most important first-generation intravenous USCA is the first agent introduced to Taiwan ultrasound community in 1996 by Dr. Yi-Hong Chou. The clinical experience of Levovist was promising in characterization of focal liver lesions and in assessing treatment efficacy of malignant hepatic tumors. Sonovue (Bracco, Italy) was introduced to many laboratories in Taiwan since 2008 mainly for animal studies. ‘‘Lab-produced’’ USCAs were produced in some of the leading laboratories such as Tsing Hua University (Prof. Chih-Kuang Yeh) and National Taiwan University (Prof. Jen-Ho Tsao). One of the lab-produced USCAs is now registered in Taiwan with pending approval of Taiwan Food and Drug Administration (TFDA). Now, there are totally 12 medical centers and 8 teaching hospitals joining the USCA Working Group and a total of more than 40 research members are invited to form a subcommittee in Committee of Research and Development in Ultrasound Medicine under the umbrella of Society of Ultrasound in Medicine of the Republic of China (SUMROC, also known as CTSUM). Now we have 2 USCA available in Taiwan, i.e., Sonazoid and Definity. Although the Taiwan ultrasound community has been discussing on setting up a guideline of CEUS of the liver for at least 4 years, we still have not yet officially started to do that. We are now adopting the guideline from EFSUMB and WFUMB as references. The Advanced Ultrasound Technology Committee of SUMROC and US Contrast Agent Subcommittee (Chaired by Prof. Yi-Hong Chou) plan to invite the Taiwan Liver Cancer Association (TLCA) and Taiwan Academy of Tumor Ablation (TATA) to create a guideline most suitable for Taiwan physicians to follow. This can be after Q3 of 2017. Any aiready-proposed guidelines from any of the experienced regional or national societies may be also used as references. T12-13-IN09 Fusion Imaging in the Diagnosis and Treatment of Liver Tumors in Taiwan Sheng-Nan Lu Division of Hepatogastroenterology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan
Ultrasound in Medicine and Biology
It is well-known that contrast-enhanced ultrasound (CEUS) is most widely used for the evaluation of various hepatic diseases, especially for focal hepatic lesions. Of two 2nd generation US contrast agents, e.g., SonazoidTM (GE Healthcare, USA) and SonoVueTM (Bracco Imaging, Italy) that are available in Korea, SonazoidTM provides more information in characterizing various hepatic tumors, and even in guiding for interventional procedures, e.g., radiofrequency ablation of hepatocellular carcinoma, because it allows acquisition of the Kupffer phase, during which it is taken up actively by Kupffer cell, after acquisition of conventional multi-phase dynamic imaging. SonoVueTM is also easily applicable to evaluate various vascular compromises for which the Kupffer phase is unnecessary. In this lecture, we demonstrate essential characteristics of both US contrast agents, CEUS findings of various hepatic tumors with differential points, guiding methods using CEUS for radiofrequency ablation of hepatocellular carcinoma with brief introduction of fusion imaging techniques, and other applications for vascular compromises. T12-13-IN06 Novel Guidance for Percutaneous Treatment of Hepatic Tumors: Fusion Images and Cone-Beam CT Olivier Seror1,2,3 1 Unit of Interventional Radiology, Jean Verdier Hospital, Bondy, France, 2University Paris 13, Bobigny, France, 3Inserm, UMR-1162, Genomique fonctionnelle des tumeurs solides, Paris, France US fusion images guidance is now routinely used for percutaneous ablations of liver tumors. Indeed, real time display of US slice with corresponding refreshed MPR of co-registered 3D data set of pretherapeutic CT or MR examinations improves the conspicuity of the target. However, several conditions could limit even wreck the co-registration of US with 3D data set of referral examinations. Thus, spatial mismatching between the images of two modalities can be due to static or dynamic anatomic differences between pretherapeutic referral examinations commonly achieved several days before the intervention. Finding similar land marks between US and referral images to set the registration could be also some time too tricky. Automatic coregistration of US with referral volume of images acquired just before the procedure avoids these common pitfalls. Cone beam CT volume as referral image offers additional advantage to be used for 3D fluoroscopic display of the target. For very challenging liver ablation requiring the insertion of several applicators, double real-time guidance relying on US fused with cone beam CT and virtual 3D fluoroscopic display allows safe punctures within acceptable ranges of time and X-ray dose. T12-13-IN07 Doppler Ultrasound in Liver Diseases Antonio Carlos Matteoni de Athayde The hepatic ultrasonography associated with color Doppler, amplitude Doppler and spectral Doppler are very important tools in the daily routine of the professional that performs the ultrasound, being possible to diagnose pathologies and discard others, as well as, it allows to infer the possibility of extra illnesses -hepatic, such as heart disease. It is also of great importance in the evaluation of the transplanted hepatic patient. Color Doppler and Doppler amplitude and spectral Doppler are safe techniques and can be performed several times in a short time in patients of any age group. The identification of flow, whether arterial or venous, sense of the same, as well as, spectral study etc, provide us with relevant information that should always be used. We try to demonstrate situations that these techniques are extremely important and avoid other studies.
Volume 43, Number S1, 2017 T12-13-IN08 CEUS in the Diagnosis of Liver Tumor in Taiwan Yi-Hong Chou, M.D.,1,2 Hong-Jen Chiou, M.D.,1 Chui-Mei Tiu, M.D.,1 Yi-You Chiou,1 Ja-Der Liang,3 Shen-Yung Wang,4 Shih-Jer Hsu,5 Jui-Ting Hu,6 Sien-Sing Yang,6 Peter Lee7 1 Department of Radiology, Taipei Veterans General Hospital, and National Yang Ming University, Taipei, Taiwan, 2Medical Imaging and Radiological Technology, Yuan Pei University of Medical Technology, Hsinchu, Taiwan, 3Attending doctor of internal medicine department, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, 4 Senior Attending Physician, Division of Gastroenterology, Department of Medicine, MacKay Memorial Hospital Tamshui Branch, Taiwan, 5 Attending Physician, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, 6Director of Liver Unit, Liver Center, Cathay General Hospital, and School of Medicine, Fu-Jen Catholic University College of Medicine, Taipei, Taiwan, 7Yee Zen Hospital, Taoyuan, Taiwan During the past three decades, exciting advances have been made in contrast-enhanced ultrasound (CEUS) imaging. Before the currently available second-generation ultrasonic contrast agents(USCA), transarterial infusion of carbon dioxide microbubbles had been used to enhance US examination of hepatic tumors as early as mid-1990s, chiefly by the Jen-Ai Hospital group (Dr. Wang, Dr. Chen, Dr. Liaw). Levovist (Schering AG, Germany), the most important first-generation intravenous USCA is the first agent introduced to Taiwan ultrasound community in 1996 by Dr. Yi-Hong Chou. The clinical experience of Levovist was promising in characterization of focal liver lesions and in assessing treatment efficacy of malignant hepatic tumors. Sonovue (Bracco, Italy) was introduced to many laboratories in Taiwan since 2008 mainly for animal studies. ‘‘Lab-produced’’ USCAs were produced in some of the leading laboratories such as Tsing Hua University (Prof. Chih-Kuang Yeh) and National Taiwan University (Prof. Jen-Ho Tsao). One of the lab-produced USCAs is now registered in Taiwan with pending approval of Taiwan Food and Drug Administration (TFDA). Now, there are totally 12 medical centers and 8 teaching hospitals joining the USCA Working Group and a total of more than 40 research members are invited to form a subcommittee in Committee of Research and Development in Ultrasound Medicine under the umbrella of Society of Ultrasound in Medicine of the Republic of China (SUMROC, also known as CTSUM). Now we have 2 USCA available in Taiwan, i.e., Sonazoid and Definity. Although the Taiwan ultrasound community has been discussing on setting up a guideline of CEUS of the liver for at least 4 years, we still have not yet officially started to do that. We are now adopting the guideline from EFSUMB and WFUMB as references. The Advanced Ultrasound Technology Committee of SUMROC and US Contrast Agent Subcommittee (Chaired by Prof. Yi-Hong Chou) plan to invite the Taiwan Liver Cancer Association (TLCA) and Taiwan Academy of Tumor Ablation (TATA) to create a guideline most suitable for Taiwan physicians to follow. This can be after Q3 of 2017. Any aiready-proposed guidelines from any of the experienced regional or national societies may be also used as references. T12-13-IN09 Fusion Imaging in the Diagnosis and Treatment of Liver Tumors in Taiwan Sheng-Nan Lu Division of Hepatogastroenterology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan