Original Title: Expert consensus regarding the clinical application of liver contrast-enhanced US with Sonazoid (Sonazoid CEUS)
Journal: International journal of surgery (London, England)
DOI: 10.1097/JS9.0000000000003510
Overview
This document presents an expert consensus on the clinical use of Sonazoid contrast-enhanced ultrasound for managing focal liver lesions. Sonazoid is a second-generation agent that functions as both a blood pool and a Kupffer-cell agent, with a phagocytic rate of 99 percent. Unlike pure blood-pool agents, it provides a stable post-vascular phase that lasts for approximately sixty minutes, enabling thorough liver scans. The consensus covers surveillance, diagnosis of hepatocellular carcinoma, detection of metastases, and interventional guidance. In high-risk patients, Sonazoid improves the detection of small tumors that might be missed by standard ultrasound. For instance, studies show that lesions detected via this method have a mean diameter of 13.0 millimeters compared to 16.7 millimeters with conventional imaging. The consensus also standardizes the application of the Liver Imaging Reporting and Data System to Sonazoid, facilitating better communication among clinicians and researchers.
Novelty
The novelty of this consensus lies in the formal standardization of the post-vascular phase for diagnosing hepatocellular carcinoma and other malignancies. It specifically addresses the integration of Sonazoid with the Liver Imaging Reporting and Data System, showing that modified criteria incorporating post-vascular defects can increase sensitivity from 69 percent to 81 percent without a significant loss in specificity. Furthermore, the document provides evidence-based recommendations for using Sonazoid in interventional settings, such as percutaneous biopsy and local ablation. For lesions that are difficult to visualize on standard ultrasound, Sonazoid-guided biopsy achieved a success rate of 87.6 percent. It also highlights the utility of defect reperfusion imaging, a technique where a second injection is used to confirm the nature of a suspected lesion within a post-vascular defect. This approach effectively differentiates malignant tumors from benign regenerative nodules in cirrhotic livers.
Potential Clinical / Research Applications
The clinical applications of Sonazoid extend to predicting treatment outcomes and guiding complex surgeries. In patients undergoing systematic treatment with agents like Sorafenib or Lenvatinib, perfusion parameters derived from Sonazoid imaging can predict efficacy within one to four weeks of starting therapy. This early assessment allows for timely adjustments to treatment plans. Research is also exploring the use of imaging features and radiomics signatures to predict microvascular invasion before surgery, which is a key prognostic factor for tumor recurrence. In the operating room, combining Sonazoid with fluorescence navigation systems helps surgeons precisely identify tumor margins and resection lines. This integration ensures more radical resections while preserving healthy liver tissue. The agent also shows promise in monitoring the response to radiotherapy, where a reduction in tumor vascularity can be observed in patients without local recurrence.
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