Dear Editor,
I read with considerable interest the article “Efficacy of contrast enhanced grey scale ultrasound in characterization of hepatic focal lesions: A pilot study” by Joshi et al in MJAFI 2014; 70: 230–236.1 Having gone through the article I have the following comments/queries:
-
(a)
CEUS has the ability to show the continuous change in the intralesional hemodynamics as the contrast is in the blood pool phase while CECT images are acquired in the three timed phases with no images in the intervening period.
-
(b)
What was the efficacy of CEUS in the detection of small lesions (less than one cm) as compared with CECT, as in some studies CEUS has been compared favorably with CECT?2
-
(c)
It would be helpful to know from the authors if a second bolus was required in case of multiple lesions in liver as has been indicated in the multicenter study by Trillaud et al and Jang et al.3,4
-
(d)
Lastly although the authors have concluded CEUS to be inferior to CECT which is in contrast to study by Trillaud et al, I feel CEUS is here to stay because of the advantages of lack of radiation, contrast reactions, its use even in the case of uremic patients and newer refinements like pulse inversion imaging.3
References
- 1.Joshi P., George R.A., Tyagi A.K., Sinha A. Efficacy of contrast enhanced grey scale ultrasound in characterization of hepatic focal lesions: a pilot study. Med J Armed Forces India. 2014;70:230–236. doi: 10.1016/j.mjafi.2014.05.004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Xu Hui-Xiong. Contrast-enhanced ultrasound: the evolving applications. World J Radiol. 2009 December 31;1(1):15–24. doi: 10.4329/wjr.v1.i1.15. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Trillaud H., Bruel J.M., Valette P.J. Characterization of focal liver lesions with SonoVue®-enhanced sonography: international multicenter-study in comparison to CT and MRI. World J Gastroenterol. 2009 August 14;15(30):3748–3756. doi: 10.3748/wjg.15.3748. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Jang J.Y., Kim M.Y., Jeong S.W. Current consensus and guidelines of contrast enhanced ultrasound for the characterization of focal liver lesions. Clin Mol Hepatol. 2013;19:1–16. doi: 10.3350/cmh.2013.19.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]