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• W2043878412 abstract "The commercially available Navigator system(©) (Esaote, Italy) allows easy 3D reconstruction of a single 2D acquisition of contrast-enhanced US (CEUS) imaging of the whole liver (with volumetric correction provided by the electromagnetic device of the Navigator(©)). The aim of our study was to compare the efficacy of this panoramic technique (Nav 3D CEUS) with that of conventional US and spiral CT in the detection of new hepatic lesions in patients treated for hepatocellular carcinoma (HCC).From November 2006 to May 2007, we performed conventional US, Nav 3D CEUS, and spiral CT on 72 cirrhotic patients previously treated for 1 or more HCCs (M/F: 38/34; all HCV-positive; Child: A/B 58/14) (1 examination: 48 patients; 2 examinations: 20 patients; 3 examinations: 4 patients). Nav 3D CEUS was performed with SonoVue(©) (Bracco, Milan, Italy) as a contrast agent and Technos MPX(©) scanner (Esaote, Genoa, Italy). Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values (PPV and NPV, respectively) were evaluated. Differences between the techniques were assessed with the chi-square test (SPSS release-15).Definitive diagnoses (based on spiral CT and additional follow-up) were: 6 cases of local recurrence (LocRecs) in 4 patients, 49 new nodules >2 cm from a treated nodule (NewNods) in 34 patients, and 10 cases of multinodular recurrence consisting of 4 or more nodules (NewMulti). The remaining 24 patients (22 treated for 1-3 nodules, 2 treated for >3 nodules) remained recurrence-free. Conventional US correctly detected 29/49 NewNods, 9/10 NewMultis, and 3/6 LocRecs (sensitivity: 59.2%; specificity: 100%; diagnostic accuracy: 73.6%; PPV: 100%; NPV: 70.1%). Spiral CT detected 42/49 NewNods plus 1 that was a false positive, 9/10 NewMultis, and all 6 LocRecs (sensitivity: 85.7%; specificity: 95.7%; diagnostic accuracy: 90.9%; PPV: 97.7%; NPV: 75.9%). 3D NAV results were: 46N (+9 multinodularN and 6 LR), 3 false-negatives, and one false-positive (sensitivity: 93.9; specificity: 97.9%; diagnostic accuracy: 95.6; PPV: 97.9; NPV: 93.9).3D Nav CEUS is significantly better than US and very similar to spiral CT for detection of new HCCs. This technique revealed the presence of lesions that could not be visualized with spiral CT.Sommario INTRODUZIONE: Il sistema “Navigator” di Esaote consente di ottenere ricostruzioni 3-D di tutto il fegato (corrette volumetricamente da un sistema di guida) mediante singola acquisizione con CEUS (mediante scansione perpendicolare all'asse lungo del fegato, per una completa acquisizione 2-D del suo asse corto) e sovrappone tali ricostruzioni 3-D con quelle ottenute con la TC. SCOPO: valutare la capacità di tale sistema di diagnosticare nuovi HCC rispetto all'US e alla TC in una popolazione di HCC su cirrosi precedentemente trattati con varie metodiche. MATERIALI E METODI: Settantadue cirrotici con pregressi HCC (M/F: 38/34; tutti HCV +vi, Child A/B: 58/14, con detection di 49 nuovi noduli (N) in 34 pazienti; 10 nuovi HCC multinodulari (NMulti); 6 riprese locali di malattia (Ri) in 4 pazienti (3 riprese singole, in un paziente tre noduli con ripresa di malattia); 47 HCC trattati efficacemente (neg) in 22 pazienti + 2 pazienti con HCC multinodulare senza segni di ripresa (neg-Multi) sono stati sottoposti a 100 esami (1 esame: 48 pazienti; 2 esami: 20 pazienti; 3 esami: 4 pazienti) dal 1 novembre 2006 al novembre 2007. La Nav 3D CEUS è stata eseguita con SonoVue (BR1; Bracco) e con l'ecografo Esaote MPX collegato a un sistema “Navigator” con software di ricostruzione 3-D dedicato. La TC spirale di controllo è stata eseguita entro 30 giorni dall'esecuzione di Nav 3D CEUS. Sono stati valutati sensibilità, specificità, accuratezza diagnostica (ODA), valore predittivo positivo (PPV) e negativo (NPV). RISULTATI: La diagnosi finale fu: 34 pazienti con 49 nuove lesioni (N), 10 con HCC multiN e 6 recidive loco-regionali in 4 pazienti; 47 noduli in 24 pazienti senza nuove lesioni durante il follow-up. Gli US hanno ottenuto: 29 N (+5 multinodularN e 3 LR), 20 falsi negativi (+5 Nmulti e 3 LR) (sensibilità: 59,2, specificità: 100%; accuratezza diagnostica: 73;6; VPP: 100; VPN: 70, 1); la TC spirale ha ottenuto: 42 N (+9 multinodularN e 7 LR), 7 falsi negativi (+1 Nmulti), un falso positivo (sensibilità: 85, 7, specificità: 95,7%, ODA: 90,9, PPV: 97,7; NPV: 75,9); Nav 3D CEUS ha ottenuto: 46 N (+9 multinodularN e 7 LR), 3 falsi negativi, 1 falso positivo (sensibilità: 93,9; specificità: 97,9%; accuratezza diagnostica: 95,6; PPV: 97,9; NPV: 93,9) CONCLUSIONI: La Nav 3D CEUS è significativamente migliore dell'ecografia convenzionale ed è simile alla TC spirale nella ricerca di nuovi HCC. Questa tecnica, in particolare, è stata capace di evidenziare lesioni non viste neanche dalla TC." @default.
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• W2043878412 date "2009-03-01" @default.
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• W2043878412 title "Imaging detection of new HCCs in cirrhotic patients treated with different techniques: Comparison of conventional US, spiral CT, and 3-dimensional contrast-enhanced US with the Navigator technique (Nav 3D CEUS)" @default.
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• W2043878412 doi "https://doi.org/10.1016/j.jus.2009.01.002" @default.
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