TY - JOUR
T1 - Utility of contrast-enhanced ultrasonography with perflubutane in evaluating indications for diagnostic percutaneous tumor biopsy in a case of hepatic sclerosed hemangioma
AU - Ando, Yusuke
AU - Ishigami, Masatoshi
AU - Ishizu, Yoji
AU - Kuzuya, Teiji
AU - Honda, Takashi
AU - Hirooka, Yoshiki
N1 - Publisher Copyright:
© 2018, Japanese Society of Gastroenterology.
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Sclerosed hemangioma is difficult to distinguish from intrahepatic cholangiocarcinoma or liver metastasis due to their imaging resemblance, thus pathological diagnosis is often required; however, percutaneous biopsy entails a risk of dissemination if the tumor is malignant. Perflubutane, a contrast agent of ultrasonography, has a characteristic feature of being phagocytosed by Kupffer cells. Hepatic malignant lesions contain few or no Kupffer cells, therefore, they are shown as a contrast defect. We report a case in which contrast enhanced ultrasonography (CEUS) with perflubutane was useful to evaluate indications for percutaneous tumor biopsy. A 69-year-old woman had a hypoattenuating mass with slight enhancement in peripheral lesion of the tumor in the arterial phase on dynamic computed tomography. From the arterial phase to the delayed phase, the hypoattenuating area was gradually and slightly enhanced, and peripheral enhancement also increased gradually, appearing as ring enhancement. We considered intrahepatic cholangiocarcinoma, liver metastasis, and sclerosed hemangioma as differential diagnoses. Most of the tumor did not display contrast defects in the post-vascular phase on CEUS, therefore, we considered the possibility of malignancy was low and performed percutaneous biopsy. The tumor was diagnosed as sclerosed hemangioma. CEUS may be useful in evaluating indications for diagnostic percutaneous tumor biopsy.
AB - Sclerosed hemangioma is difficult to distinguish from intrahepatic cholangiocarcinoma or liver metastasis due to their imaging resemblance, thus pathological diagnosis is often required; however, percutaneous biopsy entails a risk of dissemination if the tumor is malignant. Perflubutane, a contrast agent of ultrasonography, has a characteristic feature of being phagocytosed by Kupffer cells. Hepatic malignant lesions contain few or no Kupffer cells, therefore, they are shown as a contrast defect. We report a case in which contrast enhanced ultrasonography (CEUS) with perflubutane was useful to evaluate indications for percutaneous tumor biopsy. A 69-year-old woman had a hypoattenuating mass with slight enhancement in peripheral lesion of the tumor in the arterial phase on dynamic computed tomography. From the arterial phase to the delayed phase, the hypoattenuating area was gradually and slightly enhanced, and peripheral enhancement also increased gradually, appearing as ring enhancement. We considered intrahepatic cholangiocarcinoma, liver metastasis, and sclerosed hemangioma as differential diagnoses. Most of the tumor did not display contrast defects in the post-vascular phase on CEUS, therefore, we considered the possibility of malignancy was low and performed percutaneous biopsy. The tumor was diagnosed as sclerosed hemangioma. CEUS may be useful in evaluating indications for diagnostic percutaneous tumor biopsy.
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U2 - 10.1007/s12328-018-0880-2
DO - 10.1007/s12328-018-0880-2
M3 - Article
C2 - 29931440
AN - SCOPUS:85048778767
SN - 1865-7257
VL - 11
SP - 514
EP - 520
JO - Clinical Journal of Gastroenterology
JF - Clinical Journal of Gastroenterology
IS - 6
ER -