Letter to the Editor: Ewertsen et al. Characterization by Biopsy or CEUS of Liver Lesions Guided by Image Fusion between Ultrasonography and CT, PET/CT or MRI

 

 Buy Article Permissions and Reprints

We read with great interest the recent article of Ewertsen et al. in the European Journal of Ultrasound on the characterization of liver lesions by biopsy or contrast enhanced ultrasound (CEUS) in combination with CT ± PET or MRI [1].

The usage of a high end ultrasound (prototype) system in this field may basically seem to be pathbreaking if tailored to definitive diagnostic needs: so what can we learn from the paper by Ewertsen et al. [1]? Do we necessarily need such fusion systems for defining suspect liver areas to perform CEUS? Do we need such fusion systems to perform reliable US guided biopsies in the highly breath-dependent liver (see also the at least not correctly correlating image-pair on Fig. 2 of the paper by Ewertsen et al. [1])? That is at least rather questionable and is in our opinion not even rudimentary answered by this “rapid communication” paper: nobody would biopsy lesions only on secondarily fused image data alone (i. e. only if seen by any instance by US or CEUS!). Equally US or CEUS imaging to secondarily assess otherwise unclear liver lesions (as they must have been already seen by another imaging modality!) needs actually no exact fusion to another modality!

However, in our opinion radiologists/sonographers have to be very critical on technical “revolutions” before all in the context of “what is the actual use and benefit”. Real-time fusion systems of several providers are presently going to flood the market resembling to the 3D-ultrasound “hype” years ago (no actual scientifically founded indication was to date defined also for this “tool”!) and if we are not critical enough in defining relevance, who else should? Thus in our opinion such fusion systems are at most rather “cool” gimmicks than necessary adjuncts to state of the art imaging based diagnostics or guided biopsy. We must take care not to become the actually unneeded subworkers of companies that understandingly want to sell their products.

A. Loizides, H. Gruber, Medical University, Departement of Radiology, Innsbruck

References

• 1 Ewertsen C, Henriksen B M, Torp-Pedersen S et al. Characterization by Biopsy or CEUS of Liver Lesions Guided by Image Fusion between Ultrasonography and CT, PET/CT or MRI.  Ultraschall in Med. 2011;  32 191-197
  Google Scholar
• 2 Comment from Dr. Loizides. 
  Google Scholar
• 3 Seitz K, Strobel D, Bernatik T et al. Contrast-Enhanced Ultrasound (CEUS) for the Characterization of Focal Liver Lesions – Prospective Comparison in Clinical Practice: CEUS vs. CT (DEGUM Multicenter Trial).  Ultraschall in Med. 2009;  30 383-389
  Google Scholar
• 4 Laghi F, Catalano O, Maresca M et al. Indeterminate, Subcentrimetric Focal Liver Lesions in Cancer Patients: Additional Role of Contrast-Enhanced Ultrasound.  Ultraschall in Med. 2010;  31 283-288
  Google Scholar
• 5 Piscaglia F, Venturi A, Mancini M et al. Diagnostic Features of Real-Time Contrast-Enhanced Ultrasound in Focal Nodular Hyperplasia of the Liver.  Ultraschall in Med. 2010;  31 276-282
  Google Scholar