Diagnostic accuracy of hepatic vein arrival time performed with contrast-enhanced ultrasonography for HCV liver cirrhosis

Ultrasound contrast agents (USCAs) were developed and used extensively in practice. Second-generation USCAs were currently used in liver disease for the characterization of focal lesions (benign tumor, hepatocellular carcinoma [HCC], and liver secondaries) [1], [2], [3], [4], [5].

Contrast-enhanced ltrasonography (CEUS) with SonoVue allows real-time dynamic characterization of focal lesions without radiation exposure, and it is considered as a safe and cost-effective imaging modality. It provides an immediate evaluation of most focal lesions incidentally detected during unenhanced ultrasound [6]. The presence of washout is an important feature of malignant lesions. Washout characteristics regarding the onset and degree of pathology are useful in distinguishing hepatocellular from nonhepatocellular malignancies [7].

CEUS is an imaging tool that provides new perspectives in diagnosing liver disease [8], [9]. CEUS has expanded considerably the use of sonographic hemodynamic studies. Bolus injection of microbubble agents can be used to evaluate transit times [10].

These microbubbles diameters in the range of 2–10 μm, and are almost equal to the size of red blood cells. Owing to their small sizes, they can pass through capillary blood vessels. They remain completely within the intravascular system and behave like a blood pool contrast agent. CEUS uses a low-mechanical index to generate images depending on nonlinear acoustic interaction between the ultrasound transducer and the microbubbles. These microbubbles vibrate and produce enhanced grayscale contrast [11], [12].

Studies have demonstrated that the interpretation of intrahepatic circulatory time of the contrast agent is sensitive to the diagnosis of cirrhosis and is used in the evaluation of liver disease severity [6], [10], [13], [14], [15], [16].

CEUS can be used to classify liver disease into different grades and stages. In addition, it discriminates mild and moderate from severe forms of hepatitis and cirrhosis [8], [16], [9], [17], [18]. The primary aim of this study was to determine the diagnostic accuracy of the detection of the hepatic artery, hepatic vein, and portal vein arrival time, as performed with CEUS to aid the diagnosis of cirrhosis. The secondary aim was to correlate these arrival times with liver stiffness and disease severity in cirrhotic patients.

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