{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T10:50:00Z","timestamp":1789037400497,"version":"build-2803163510"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ultraschall Med"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Purpose\u2002This multicenter retrospective study highlights the contrast-enhanced ultrasound (CEUS) findings in a series of histologically proven solitary necrotic nodules (SNN) of the liver, a poorly understood pathologic entity of uncertain origin that mimics malignancy.<\/jats:p><jats:p>\n          Materials and Methods\u200222 patients (M\/F 13\/9; mean age 59.4 years, SD \u00b1\u200a10.7, range 35\u201381) with histological diagnosis of SNN and CEUS were selected from clinical, imaging, and pathological archives of 7 US interventional centers, each of which provided 1 to 6 cases (mean 2.8). Pathological diagnosis was made on 20 US-guided biopsies and 2 surgical specimens. 2 patients had 2 SNNs with identical CEUS findings so that imaging analysis was carried out on 24 nodules.<\/jats:p><jats:p>\n          Results\u2002SNN was an incidental finding in healthy people in 10\u00a0cases (45.5\u200a%), and it was discovered during follow-up for either known extrahepatic malignancies (9 cases\u200a=\u200a41\u200a%) or chronic liver disease (3 cases\u200a=\u200a13.5\u200a%). SNNs had a mean size of 19.3\u200amm (SD \u00b1\u200a6.5, range 9\u201340). On B-mode US, SNNs appeared hypoechoic in 14 cases (66.7\u200a%), \u201ctarget-like\u201d in 7\u00a0cases (29.2\u200a%), and homogeneously hyperechoic in 1 case (4.1\u200a%). On CEUS, all lesions appeared devoid of contrast enhancement (\u201cpunched out\u201d aspect) in the arterial, portal venous, and late phases after US contrast agent injection. A uniformly thin, hyperenhancing ring in the early arterial phase and isoenhanced with the surrounding parenchyma in the portal venous and late phases was found in 10 nodules (41.6\u200a%). Clinical and imaging follow-up (mean duration 42.2\u00a0months, SD\u200a\u00b1\u200a34.9, range 2\u2013108) was available in 15\u00a0patients with 16 SNNs: no changes in size and echostructure were seen.<\/jats:p><jats:p>\n          Conclusion\u2002CEUS can contribute to the diagnosis of SNN when a \u201cpunched out\u201d appearance in all vascular phases with or without thin rim enhancement in the very early arterial phase is present in healthy subjects in whom a focal liver lesion is incidentally found. In patients with a history of chronic liver disease or malignancy, US-guided biopsy represents the unavoidable first-line diagnostic modality.<\/jats:p>","DOI":"10.1055\/a-1579-9457","type":"journal-article","created":{"date-parts":[[2021,8,25]],"date-time":"2021-08-25T22:47:50Z","timestamp":1629931670000},"page":"81-88","source":"Crossref","is-referenced-by-count":7,"title":["Contrast-Enhanced Ultrasound Findings in Patients with Rare Solitary Necrotic Nodule of the Liver \u2013 a Multicenter Report"],"prefix":"10.1055","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9821-7966","authenticated-orcid":false,"given":"Giampiero","family":"Francica","sequence":"additional","affiliation":[{"name":"Interventional Ultrasound Unit, Pineta Grande Srl, Castel Volturno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Franca","family":"Meloni","sequence":"additional","affiliation":[{"name":"Radiology, Casa di Cura Igea, Milano, Italy"},{"name":"Radiology, University of Wisconsin-Madison, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Riccardi","sequence":"additional","affiliation":[{"name":"Internal Medicine and Gastroenterology, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilario","family":"de Sio","sequence":"additional","affiliation":[{"name":"Hepatogastroenterology, University of Campania Luigi Vanvitelli School of Medicine and Surgery, Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenio","family":"Caturelli","sequence":"additional","affiliation":[{"name":"Gastroenterology, Belcolle Hospital, Viterbo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fulvia","family":"Terracciano","sequence":"additional","affiliation":[{"name":"Gastroenterology, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Giangregorio","sequence":"additional","affiliation":[{"name":"Hepatogastroenterology, Guglielmo da Saliceto Hospital, Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Chiang","sequence":"additional","affiliation":[{"name":"Radiology, Ronald Reagan UCLA Medical Center, Los\u00a0Angeles, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Danzi","sequence":"additional","affiliation":[{"name":"Radiology, Pineta Grande Srl, Castel Volturno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Marra","sequence":"additional","affiliation":[{"name":"Gastroenterology, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Niosi","sequence":"additional","affiliation":[{"name":"Hepatogastroenterology, University of Campania Luigi Vanvitelli School of Medicine and Surgery, Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa Valentina","family":"Ranalli","sequence":"additional","affiliation":[{"name":"Pathology, Belcolle Hospital, Viterbo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Pompili","sequence":"additional","affiliation":[{"name":"Internal Medicine and Gastroenterology, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,8,25]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1055\/s-2008-1027806","article-title":"Contrast-enhanced ultrasound for the characterization of focal liver lesions--diagnostic accuracy in clinical practice [DEGUM multicenter trial]","volume":"29","author":"D Strobel","year":"2008","journal-title":"Ultraschall in Med"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1055\/s-0029-1245591","article-title":"Contrast-enhanced ultrasound [CEUS] for the characterization of focal liver lesions in clinical practice [DEGUM Multicenter Trial]: CEUS vs. MRI \u2013 a prospective comparison in 269 patients","volume":"31","author":"K Seitz","year":"2010","journal-title":"Ultraschall in Med"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1055\/a-1177-0530","article-title":"Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound [CEUS] in the Liver \u2013 Update 2020 \u2013 WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS","volume":"41","author":"C F Dietrich","year":"2020","journal-title":"Ultraschall in Med"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"289","DOI":"10.14366\/usg.19006","article-title":"Contrast-enhanced ultrasound approach to the diagnosis of focal liver lesions: the importance of washout","volume":"38","author":"H K Yang","year":"2019","journal-title":"Ultrasonography"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"E16","DOI":"10.1148\/rg.2020200109","article-title":"Contrast-enhanced US Approach to the Diagnosis of Focal Liver Masses","volume":"40","author":"D P Burrowes","year":"2020","journal-title":"Radiographics"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1055\/s-0034-1399147","article-title":"CEUS in hepatocellular carcinoma and intrahepatic cholangiocellular carcinoma in 320 patients \u2013 early or late washout matters: a subanalysis of the DEGUM multicenter trial","volume":"36","author":"D Wildner","year":"2015","journal-title":"Ultraschall in Med"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1148\/radiol.2443061520","article-title":"Enhancement patterns of hepatocellular carcinoma at contrast-enhanced US: comparison with histologic differentiation","volume":"244","author":"H J Jang","year":"2007","journal-title":"Radiology"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1136\/jcp.36.10.1181","article-title":"Solitary necrotic nodules of the liver simulating hepatic metastases","volume":"36","author":"N A Shepherd","year":"1983","journal-title":"J Clin Pathol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1136\/jcp.38.11.1278","article-title":"Solitary necrotic nodule of the liver: a probable pathogenesis","volume":"38","author":"C L Berry","year":"1985","journal-title":"J\u00a0Clin Pathol"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1136\/jcp.45.11.975","article-title":"Solitary necrotic nodule of the liver: parasitic origin?","volume":"45","author":"W M Tsui","year":"1992","journal-title":"J Clin Pathol"},{"key":"ref11","first-page":"485","article-title":"Clinical features of solitary necrotic nodule of the liver","volume":"7","author":"Y Zhou","year":"2008","journal-title":"Hepatobiliary Pancreat Dis Int"},{"key":"ref12","first-page":"1210","article-title":"Solitary necrotic nodule of the liver: diagnosis and treatment","volume":"44","author":"S Alfieri","year":"1997","journal-title":"Hepato-Gastroenterol"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1002\/1096-9098(200007)74:3<219::AID-JSO13>3.0.CO;2-Q","article-title":"Solitary necrotic nodule of the liver misinterpreted as malignant lesion: considerations on two cases","volume":"74","author":"M De Luca","year":"2000","journal-title":"J Surg Oncol"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1007\/s12029-007-0002-8","article-title":"\u201cSolitary\u201d necrotic nodule of the liver: an enigmatic entity mimicking malignancy","volume":"37","author":"A I Kondi-Pafiti","year":"2006","journal-title":"Int J Gastrointest Cancer"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1002\/jcu.20342","article-title":"Solitary necrotic nodule of the liver: contrast-enhanced sonography","volume":"35","author":"Y Wang","year":"2007","journal-title":"J Clin Ultrasound"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1055\/s-2007-963785","article-title":"Guidelines and good clinical practice recommendations for contrast enhanced ultrasound [CEUS] \u2013 update 2008","volume":"29","author":"M Claudon","year":"2008","journal-title":"Ultraschall in Med"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.1136\/gut.32.11.1378","article-title":"'Solitary' necrotic nodules of the liver: an aetiology reaffirmed","volume":"32","author":"M Sundaresan","year":"1991","journal-title":"Gut"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/S1091-255X(02)00142-7","article-title":"Solitary necrotic nodule of the liver: a riddle that is difficult to answer","volume":"7","author":"J Koea","year":"2003","journal-title":"J Gastrointest Surg"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1136\/jcp.46.6.578-a","article-title":"Parasitic origin of a solitary necrotic nodule of the liver","volume":"46","author":"A D Clouston","year":"1993","journal-title":"J Clin Pathol"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1007\/s11605-009-1120-3","article-title":"Solitary necrotic nodule of the liver: always benign?","volume":"14","author":"K Deniz","year":"2010","journal-title":"J\u00a0Gastrointest Surg"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"165","DOI":"10.3348\/kjr.2000.1.3.165","article-title":"Solitary necrotic nodules of the liver mimicking hepatic metastasis: report of two cases","volume":"1","author":"K H Yoon","year":"2000","journal-title":"Korean J Radiol"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.2214\/AJR.07.3488","article-title":"Solitary necrotic nodules of the liver: cross-sectional imaging findings and follow-up in nine patients","volume":"191","author":"S Colagrande","year":"2008","journal-title":"Am J Roentgenol"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.ejrad.2011.01.079","article-title":"Solitary necrotic nodule of the liver: MR findings in 33 pathologically proved lesions","volume":"81","author":"L Geng","year":"2012","journal-title":"Eur J Radiol"},{"key":"ref24","first-page":"e6212","article-title":"Solitary Necrotic Nodules of the Liver: Histology and Diagnosis with CT and MRI","volume":"12","author":"L W Wang","year":"2012","journal-title":"Hepat Mon"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1097\/MEG.0000000000000642","article-title":"MRI characteristics for the differential diagnosis of benign and malignant small solitary hypovascular hepatic nodules","volume":"28","author":"H Qian","year":"2016","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"3563","DOI":"10.1007\/s00330-017-4731-1","article-title":"Specific imaging characteristic of solitary necrotic nodule of the liver: Marked peripheral rim-like enhancement with internal hypointensity on longer delayed MRI","volume":"27","author":"J Fang","year":"2017","journal-title":"Eur Radiol"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.7863\/jum.2007.26.11.1545","article-title":"Are metastases really hypovascular in the arterial phase? The perspective based on contrast-enhanced ultrasonography","volume":"26","author":"J Murphy-Lavallee","year":"2007","journal-title":"J Ultrasound Med"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/s00261-015-0567-9","article-title":"Focal hepatic solid lesions incidentally detected on initial ultrasonography in 542 asymptomatic patients","volume":"41","author":"S H Choi","year":"2016","journal-title":"Abdom Radiol [NY]"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"325","DOI":"10.2152\/jmi.53.325","article-title":"Rapid growing solitary necrotic nodule of the liver","volume":"53","author":"S Imura","year":"2006","journal-title":"J Med Invest"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1007\/s12072-010-9199-x","article-title":"Spontaneous regression of a solitary necrotic nodule of the liver","volume":"4","author":"C S Choi","year":"2010","journal-title":"Hepatol Int"}],"container-title":["Ultraschall in der Medizin - European Journal of Ultrasound"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1579-9457.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T00:51:56Z","timestamp":1675817516000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1579-9457"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,25]]},"references-count":30,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2023,2,7]]},"published-print":{"date-parts":[[2023,2]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1579-9457","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0172-4614","1438-8782"],"issn-type":[{"value":"0172-4614","type":"print"},{"value":"1438-8782","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,25]]}}}