Dados do Trabalho

Título

MICROBOLHAS (CEUS) NO FÍGADO: O QUE TODO IMAGINOLOGISTA DEVE SABER

Introdução e objetivo(s)

Microbubble ultrasound is an excellent tool for evaluating the liver parenchyma, especially in
patients with formal contraindications for contrast-enhanced CT and MRI examinations. The
technique also has a lower cost and the possibility of being carried out portablely, and serial
exams can be performed without radiation or nephrotoxicity. The objective of this panel is to
review indications, instructions for performing the exam and interpreting images of this
important diagnostic tool.

Método(s)

Case based review. Excellent references are available on the interpretation of liver lesions.
In general, findings are similar to CT and MRI. Because UCAs are purely intravascular, there
is a potential benefit to characterize malignant liver tumors with high vascular permeability
and large interstitial space, allowing clearer demonstration of wash-out phenomenon than
CT or MRI. For liver lesions, contrast wash-out is indicative of a malignant lesion. Globular
peripheral to centripetal fill-in is indicative of a hemangioma. Marked early enhancement with
a spoke-wheel appearance, sometimes with a central scar, is indicative of focal nodular
hyperplasia.

Discussão

Contrast-enhanced ultrasound can provide similar diagnostic performance to CECT and
CEMRI. Major clinical applications include: (1) patients with renal impairment requiring a
contrast study, (2) patients with CT and/or MRI contrast allergy, (3) if CT or MRI have not
answered the clinical question or conflict, and (4) when it is important to know that no flow is
present (eg, after radiofrequency ablation).

Conclusões

US is the main initial imaging modality for many situations, due to its easy availability and
high sensitivity in the detection of hepatic lesions. There is no question that we can help our
patients by adding CEUS to our diagnostic toolbox. This is especially true for patients with
contraindications for contrast-enhanced CT or MRI (CECT or CEMRI), such as allergic
reaction and renal failure.

Palavras Chave

Microbolhas; Ultrassonografia; FIGADO

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