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Contrast-enhanced ultrasound with microbubbles containing sulfur hexafluoride and perfluorobutane with Kupffer phase for the detection of colorectal liver metastases

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Abstract

Objective

To compare contrast-enhanced ultrasound (CEUS) with microbubbles containing sulfur hexafluoride (SHF) and perfluorobutane (PFB) for the detection of colorectal liver metastasis (CRLM).

Methods

In this prospective study, conducted from September to November 2021, patients with colorectal cancer were consecutively recruited and underwent same-day ultrasound, SHF-CEUS, and PFB-CEUS. The reference standard was contrast-enhanced MRI and follow-up imaging. The size, depth, echogenicity, and calcification of each focal liver lesion were recorded. The number and conspicuity of CRLMs, based on washout appearance during the late phase (LP) (> 120 s)/Kupffer phase (KP), were evaluated offsite by two blinded readers.

Results

Overall, 230 lesions (CRLMs, n = 219; benign lesions, n = 11) in 78 patients were evaluated. Lesion conspicuity (p = 0.344) and accuracy in the detection of CRLM were comparable for SHF- and PFB-CEUS (0.877 for SHF vs. 0.770 for PFB, p = 0.087). More CRLMs ≥ 10 mm were identified by LP contrast washout in SHF-CEUS than in KP PFB-CEUS (p < 0.001). More CRLMs < 10 mm were identified by KP washout in PFB-CEUS than in LP SHF-CEUS (p < 0.001). Conspicuity was better on PFB-CEUS than on SHF-CEUS (p = 0.027). In hyperechoic lesions, lesions located deeper than 80 mm, and calcified lesions, CRLM conspicuity on PFB-CEUS was inferior to that on SHF-CEUS (p < 0.05).

Conclusions

The overall accuracy of detection and conspicuity of washout in CRLMs were comparable between SHF and PFB-CEUS. PFB-CEUS has the advantage of identifying washout in small CRLMs. However, larger, hyperechogenic, deep-seated, or calcified lesions were better identified using SHF-CEUS.

Clinical relevance statement

Accuracy of detection and conspicuity of washout in CRLMs were comparable between SHF- and PFB-CEUS. PFB-CEUS has the advantage in detecting small CRLMs, whereas SHF-CEUS is better for detecting larger, hyperechogenic, deep-seated, or calcified lesions.

Key Points

  • Contrast-enhanced ultrasound with sulfur hexafluoride in the late phase and perfluorobutane microbubbles in the Kupffer phase were comparable in terms of accuracy in the detection and conspicuity of colorectal liver metastases.

  • Small colorectal liver metastases (< 10 mm) were more often identified in the Kupffer phase contrast-enhanced ultrasound imaging when using perfluorobutane microbubbles.

  • Larger, hyperechogenic, deep-seated, or calcified lesions were better identified in the late phase contrast-enhanced ultrasound imaging (> 120 s) when using sulfur hexafluoride microbubbles.

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Abbreviations

AP:

Arterial phase

AUC:

The area under the ROC curve

CEUS:

Contrast-enhanced ultrasound

CRC:

Colorectal cancer

CRLM:

Colorectal liver metastasis

FLL:

Focal liver lesion

KP:

Kupffer phase

LP:

Late phase

PFB:

Microbubbles containing perfluorobutane

PVP:

Portal venous phase

ROC:

Receiver operating characteristic

SHF:

Microbubbles containing sulfur hexafluoride

UCA:

Ultrasound contrast agent

US:

Ultrasound

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Acknowledgements

Supported by National Key Clinical Discipline. Supported by the program of Guangdong Provincial Clinical Research Center for Digestive Diseases (2020B1111170004).

Funding

This study has received funding by the program of Guangdong Provincial Clinical Research Center for Digestive Diseases (2020B1111170004).

Author information

Authors and Affiliations

  1. Department of Medical Ultrasonics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China

    Si Qin, Yao Chen, YiMin Wang, Rui Cui & GuangJian Liu

  2. Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China

    Si Qin, Yao Chen, YiMin Wang, FangQian Li, Rui Cui & GuangJian Liu

  3. Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, No. 26 Yuancunerheng Rd, Guangzhou, 510655, Guangdong, China

    Si Qin, Yao Chen, YiMin Wang, FangQian Li, Rui Cui & GuangJian Liu

  4. Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China

    FangQian Li

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  1. Si Qin
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Correspondence to GuangJian Liu.

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The scientific guarantor of this publication is GuangJian Liu.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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Written informed consent was obtained from all subjects (patients) in this study.

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Qin, S., Chen, Y., Wang, Y. et al. Contrast-enhanced ultrasound with microbubbles containing sulfur hexafluoride and perfluorobutane with Kupffer phase for the detection of colorectal liver metastases. Eur Radiol 34, 622–631 (2024). https://doi.org/10.1007/s00330-023-10051-1

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