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Invited Lecture (JSGE)
Fri. October 13th   9:00 - 9:30   Room 5: Fukuoka International Congress Center 201+202
Invited Lecture-1
Ultrasonography characteristics of hepatic neuroendocrine neoplasm and early evaluation of treatment response evaluation with contrast-enhanced ultrasound quantative analysis
X.-Y. Xie
Department of Medical Ultrasonics, First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-Sen University
 Purpose: To compare theimagingfeatures of hepatic neuroendocrine neoplasm (HNEN)and hepatocellular carcinoma(HCC) using baseline ultrasound and contrast-enhanced ultrasound.
Materials and methods: From August 2010 to April 2016, 50 consecutive patients (mean age, 52.7 years ± 12.4 [standard deviation];age range, 19-73 years; 27 women, 23 men) with 54 hepatic neuroendocrine neoplasms(HNEN) confirmed by pathology and imaging underwent baseline and contrast-enhanced ultrasound (CEUS) in the First Affiliated Hospital of Sun Yat-sen University were enrolled in our retrospective research. Among the lesions, 5 lesions were primary hepatic neuroendocrine neoplasm(PHNEN), and 49 lesions were metastatic hepatic neuroendocrine neoplasm(MHNEN). Another 54 hepatocellular carcinoma (HCC) patients (mean age, 49.9 years ± 12.9 [standard deviation];age range, 22-74 years; 11 women, 43 men) with 54 lesions who were randomly selected at the same time were enrolled in the study. The imaging features of baseline ultrasound (BUS) and CEUS were retrospectively investigated and compared between HNEN and HCC.
Results: 1) Comparison of baseline ultrasound characteristics: distinctions of the total number of lesions located in liver, margin, level and uniformity of echogenicity, acoustic halo, posterior echo attenuation of lesions and echo of adjacent liver parenchyma were statistically significant (P<0.001,P=0.016,P<0.001,P=0.029,P=0.005,P=0.002,P<0.001). 79.6% (39/54) HNEN were multiple lesions, and 89.8% (44/54) HCC were solitary lesion. More HNEN lesions had vague margin than HCC [46.3%(25/54) VS 24.1%(13/54)]; 48.2% (26/54) HNEN were hyper-echogenicity, and 40.7%(22/54) HCC were hypo-echogenicity; more HNEN lesions presented uniform echogenicity than HCC[72.2%(39/54) VS 51.9%(28/54)]; less HNEN lesions surrounded by acoustic halo than HCC[22.2%(12/54) VS 48.1%(26/54)];94.4%(51/54)HNEN lesions with normal adjacent liver parenchyma, 2.0% (1/54) with cirrhosis adjacent, while 51.9% (28/54) HCC lesions with cirrhosis. 2) Comparison of CEUS enhancement characteristic: duration time subsided into iso-enhancement, hypo-enhancement and capsule enhancement at delay phase between HNEN and HCC were statistically significantly (P=0.012,P=0.001,P=0.038). HNEN lesions subsided into iso-enhancement or hypo-enhancement earlier than HCC (32.1±17.0s VS 39.5±12.1s,56.3±52.6s VS 96.4±66.8s). 58.3%(28/48)HNEN subsided into iso-enhancement within 30s, while 63.0%(34/54)HCC subsided into iso-enhancement between 31-60s. 75.5%(37/49) HNEN subsided into hypo-enhancement within 60s, whereas 63.0%(34/54) HCC subsided into hypo-enhancement after 60s. 18.5%(10/54)HNEN presented capsule enhancement at delay phase, while only 5.6%(3/54)HCC showed this sign. Differences of other CEUS features(enhancement pattern, blood vessel within lesions, necrotic zone within lesions)were not statistically significant (P> 0.05).
Conclusion: There were different imaging characteristic between HNEN and HCC for baseline ultrasound. Compared with HCC, the duration time for HNEN subsiding into iso-enhancement and hypo-enhancement were earlier than HCC, and more lesions presented capsule enhancement at delayed phase than HCC. BUS and CEUS may provide some valuable information for the differential diagnosis of HNEN and HCC.
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