Title Dijagnostika žarišnih promjena jetre primjenom kontrastnog ultrazvuka Title (english) Diagnostic Assessment of Focal Liver Lesions Using Contrast-Enhanced Ultrasound Author Vinko Michael Dodig Mentor Ivica Grgurević (mentor) Committee member Tajana Filipec Kanižaj (predsjednik povjerenstva) Committee member Ivana Vuković Brinar (član povjerenstva) Committee member Ivica Grgurević (član povjerenstva) Granter University of Zagreb Defense date and country 2024-07-12, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Žarišne promjene jetre (ŽPJ) su heterogena skupina solidnih ili cističnih tvorbi koje se najčešće nađu slučajno tijekom ultrazvučnog pregleda abdomena. Uzimajući u obzir da je prevalencija benignih ŽPJ u općoj populaciji oko 15%, jednostavno i brzo razlikovanje od malignih lezija je od velike važnosti. Cilj ovog rada je pružiti pregled mogućnosti dijagnostike ŽPJ primjenom kontrastnog ultrazvuka (engl. contrast enhanced ultrasound, CEUS).
Kontrastni ultrazvuk je naziv za pregled ultrazvukom uz dodatak intravenskog ultrazvučnog kontrastnog sredstva koji je građen od mikromjehurića napunjenih plinovitim sumporovim heksafluoridom. Nakon intravenske primjene kontrasta razlikuju se tri specifične vaskularne faze (arterijska, portovenska i kasna faza) zahvaljujući dvostrukoj opskrbi jetre krvlju iz jetrene arterije i portalne vene. Najčešće benigne promjene jetre su hemangiom, fokalna nodularna hiperplazija, hepatocelularni adenom i fokalna masna infiltracija (hipersteatoza), ili zona poštede jetrenog parenhima od steatoze (hiposteatoza, engl. focal fatty sparing, FFS). Maligne ŽPJ dijele se na češće primarne (od kojih su najčešće hepatocelularni karcinom i kolangiokarcinom) te na sekundarne (metastaze), pri čemu su zadnje znatno češće u odnosu na primarne. Osim solidnih lezija jetre, razlikujemo i cistične ŽPJ. Maligne lezije su u pravilu hipervaskularne u arterijskoj fazi (u cijelosti ili djelomično) zbog obilne arterijske opskrbe, dok u portovenskoj, a pogotovo u kasnoj fazi, pokazuju fenomen ispiranja kontrasta. Benigne lezije ne pokazuju fenomen ispiranja kontrasta u portovenskoj i kasnoj fazi. Višestruka istraživanja i meta-analize potvrđuju sposobnost kontrastnog ultrazvuka da razgraniči benigne od malignih žarišnih promjena jetre sa značajno višom osjetljivošću i senzitivnošću u odnosu na klasični ultrazvuk. Također, osjetljivost i senzitivnost CEUS-a su jednake u odnosu na CT i MR. Što se tiče diferencijalne dijagnostike lezija, CEUS se pogotovo pokazao korisnim za definitivnu karakterizaciju benignih lezija jetre, dok potvrda dijagnoze malignih lezija većinom zahtijeva dodatnu dijagnostiku.
Kontrastni ultrazvuk predstavlja vrijedan dijagnostički alat kojim se može isključiti malignost i okarakterizirati benigna lezija u velikom broju slučajeva. Ovo predstavlja višestruku korist kako za pacijente, zbog brže dijagnostike i smanjenog ionizirajućeg zračenja, tako i za zdravstveni sustav zbog manje brojčane i financijske opterećenosti.
Abstract (english) Focal liver lesions (FLL) are a heterogeneous group of solid or cystic formations often discovered incidentally during abdominal ultrasound examinations. Considering the prevalence of benign FLLs in the general population is around 15%, the ability to quickly and accurately distinguish them from malignant lesions is of great importance. This paper aims to provide an overview of the diagnostic capabilities of contrast-enhanced ultrasound (CEUS) for FLLs.
Contrast-enhanced ultrasound involves the use of intravenous ultrasound contrast agents composed of microbubbles filled with gaseous sulfur hexafluoride. After intravenous administration, three specific vascular phases (arterial, portal venous, and late phases) can be distinguished due to the liver's dual blood supply from the hepatic artery and portal vein. The most common benign liver lesions include hemangioma, focal nodular hyperplasia, hepatocellular adenoma, and focal fatty infiltration (hypersteatosis), or focal fatty sparing (hyposteatosis, FFS). Malignant FLLs are categorized into more common primary lesions (with hepatocellular carcinoma and cholangiocarcinoma being the most prevalent) and secondary lesions (metastases), with the latter being significantly more frequent than the former. In addition to solid liver lesions, cystic FLLs are also identified. Malignant lesions are typically hypervascular in the arterial phase (either completely or partially) due to abundant arterial supply, whereas in the portal venous and especially in the late phase, they exhibit a washout phenomenon. Benign lesions do not exhibit the washout phenomenon in the portal venous and late phases. Multiple studies and meta-analyses confirm the ability of contrast-enhanced ultrasound to distinguish between benign and malignant FLLs with significantly higher sensitivity and specificity compared to conventional ultrasound. Furthermore, the sensitivity and specificity of CEUS are comparable to those of CT and MRI. Regarding the differential diagnosis of lesions, CEUS has proven particularly useful for the definitive characterization of benign liver lesions, whereas the confirmation of malignant lesions often requires additional diagnostic methods.
Contrast-enhanced ultrasound represents a valuable diagnostic tool that can exclude malignancy and characterize benign lesions in a large number of cases. This offers multiple benefits for patients, including faster diagnosis and reduced exposure to ionizing radiation, as well as for the healthcare system by reducing numerical and financial burdens.
Keywords
žarišne promjene jetre
kontrastni ultrazvuk (CEUS)
neinvazivna dijagnostika
Keywords (english)
focal liver lesions
contrast-enhanced ultrasound (CEUS)
non-invasive diagnostics
Language croatian URN:NBN urn:nbn:hr:105:789106 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2024-07-02 12:31:11
