{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T22:48:55Z","timestamp":1782254935225,"version":"3.54.5"},"reference-count":22,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Indian J Radiol Imaging"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This article aims to assess the diagnostic accuracy of Kupffer cell\u2013specific contrast-enhanced ultrasound (Sonazoid) for characterization of suspicious malignant focal liver lesions and the diagnostic accuracy of Sonazoid in differentiating tumoral thrombosis of the portal vein from bland thrombosis.<\/jats:p>\n                  <jats:p>This was a single-center, prospective, cross-sectional study conducted in the Department of Radiology. Baseline gray-scale ultrasound, along with contrast-enhanced imaging, was performed in patients who met the inclusion criteria. CEUS images were read by two radiologists with an experience of 3 and 15 years, respectively. Interobserver agreement between two observers was calculated. CECT and CEMRI images were read by a third radiologist with an experience of around 7 years; he was also blinded to the histopathology and CEUS results. CECT\/CEMRI was taken as a gold standard for HCC (based on the evidence-based practice\/AASLD guidelines); for non-HCC lesions, histopathology was taken as a gold standard. Diagnostic accuracy, sensitivity, and positive predictive value (PPV) of CEUS were then calculated with respect to the gold standard. In eight cases included in our study, portal vein thrombosis was present, and so the diagnostic accuracy of CEUS with Sonazoid for differentiating tumoral and bland thrombosis was also calculated.<\/jats:p>\n                  <jats:p>CEUS with Sonazoid has a sensitivity of 90%, an accuracy of 87%, and a PPV of 96% for characterizing focal liver lesions. CEUS with Sonazoid (with respect to histopathology) has a sensitivity of 87.5%, specificity of 87.5%, and diagnostic accuracy of 77.8% for the characterization of lesions. In a limited number of patients included in our study, CEUS had a sensitivity, specificity, negative predictive value, and PPV of 100% for differentiating between tumoral and bland thrombus.<\/jats:p>\n                  <jats:p>CEUS is an excellent modality for differentiating tumoral from bland thrombus, and it can be safely used for lesion characterization in patients where CT\/MRI contrast agent is contraindicated. In cases of diagnostic dilemma, CEUS can be used as an alternative modality. Since it is radiation free, it can be used in regular surveillance of high-risk patients.<\/jats:p>","DOI":"10.1055\/s-0045-1811553","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T22:55:00Z","timestamp":1757372100000},"page":"354-365","source":"Crossref","is-referenced-by-count":0,"title":["Assessment of Kupffer Cell\u2013Specific Contrast-Enhanced Ultrasound for Characterization of Suspicious Malignant Focal Liver Lesions"],"prefix":"10.1055","volume":"36","author":[{"given":"Abhinandan","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Radiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalini T.","family":"Laroia","sequence":"additional","affiliation":[{"name":"Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Arora","sequence":"additional","affiliation":[{"name":"Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8905-5889","authenticated-orcid":false,"given":"Amar","family":"Mukund","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0420-3190","authenticated-orcid":false,"given":"Yashwant","family":"Patidar","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0148-1833","authenticated-orcid":false,"given":"Sushant","family":"Babbar","sequence":"additional","affiliation":[{"name":"Department of Radiology, DMCH, Ludhiana, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1111\/j.1365-2036.2010.04370.x","article-title":"Systematic review: outcome of compensated cirrhosis due to chronic hepatitis C infection","volume":"32","author":"W Alazawi","year":"2010","journal-title":"Aliment Pharmacol Ther"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1159\/000078478","article-title":"Imaging of multistep human hepatocarcinogenesis by CT during intra-arterial contrast injection","volume":"47","author":"O Matsui","year":"2004","journal-title":"Intervirology"},{"issue":"16","key":"ref3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta17160","article-title":"Contrast-enhanced ultrasound using SonoVue\u00ae (sulphur hexafluoride microbubbles) compared with contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging for the characterisation of focal liver lesions and detection of liver metastases: a systematic review and cost-effectiveness analysis","volume":"17","author":"M Westwood","year":"2013","journal-title":"Health Technol Assess"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.2214\/AJR.05.0527","article-title":"Comparison of visual and quantitative analysis for characterization of insonated liver tumors after microbubble contrast injection","volume":"186","author":"E Quaia","year":"2006","journal-title":"AJR Am J Roentgenol"},{"key":"ref5","first-page":"46","article-title":"Contrast-enhanced ultrasonography with Sonazoid in hepatocellular carcinoma diagnosis","volume":"6","author":"Y Minami","year":"2020","journal-title":"Hepatoma Res"},{"issue":"08","key":"ref6","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1007\/s11517-009-0497-1","article-title":"Ultrasonic characterization of ultrasound contrast agents","volume":"47","author":"N de Jong","year":"2009","journal-title":"Med Biol Eng Comput"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"59","DOI":"10.4103\/JMU.JMU_124_19","article-title":"The AFSUMB consensus statements and recommendations for the clinical practice of contrast-enhanced ultrasound using Sonazoid","volume":"28","author":"J Y Lee","year":"2020","journal-title":"J Med Ultrasound"},{"issue":"01","key":"ref8","first-page":"11","article-title":"Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver\u2013update 2012. Ultraschall in der Medizin-","volume":"34","author":"M Claudon","year":"2013","journal-title":"Eur J Ultrasound"},{"issue":"S 01","key":"ref9","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1159\/000333265","article-title":"Diagnostic imaging of hepatocellular carcinoma: recent progress","volume":"81","author":"M Kudo","year":"2011","journal-title":"Oncology"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1159\/000484619","article-title":"Management of hepatocellular carcinoma in Japan as a world-leading model","volume":"7","author":"M Kudo","year":"2018","journal-title":"Liver Cancer"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s00261-017-1250-0","article-title":"CEUS LI-RADS: algorithm, implementation, and key differences from CT\/MRI","volume":"43","author":"S R Wilson","year":"2018","journal-title":"Abdom Radiol (NY)"},{"issue":"10","key":"ref12","doi-asserted-by":"crossref","first-page":"3459","DOI":"10.1007\/s00261-022-03609-y","article-title":"Role of contrast-enhanced ultrasound with Perfluorobutane in lesion detection, guidance for microwave ablation, and response assessment of hepatocellular carcinoma","volume":"47","author":"A Mukund","year":"2022","journal-title":"Abdom Radiol (NY)"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"2978","DOI":"10.21037\/qims-23-1616","article-title":"Compared with SonoVue\u00ae LR-5, Sonazoid\u00ae modified LR-5 has better diagnostic sensitivity for hepatocellular carcinoma: a systematic review and meta-analysis","volume":"14","author":"J Cao","year":"2024","journal-title":"Quant Imaging Med Surg"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"2077","DOI":"10.1007\/s00330-017-5152-x","article-title":"Contrast-enhanced US for characterization of focal liver lesions: a comprehensive meta-analysis","volume":"28","author":"M Wu","year":"2018","journal-title":"Eur Radiol"},{"issue":"01","key":"ref15","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1148\/radiol.2511081324","article-title":"Focal liver tumors: characterization with 3D perflubutane microbubble contrast agent-enhanced US versus 3D contrast-enhanced multidetector CT","volume":"251","author":"W Luo","year":"2009","journal-title":"Radiology"},{"issue":"09","key":"ref16","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.3390\/jcm8091353","article-title":"A prospective assessment of the diagnostic value of contrast-enhanced ultrasound, dynamic computed tomography and magnetic resonance imaging for patients with small liver tumors","volume":"8","author":"C Y Hsiao","year":"2019","journal-title":"J Clin Med"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1186\/s13244-024-01838-x","article-title":"Diagnostic performance of Sonazoid-enhanced CEUS in identifying definitive hepatocellular carcinoma in cirrhotic patients according to KLCA-NCC 2022 and APASL 2017 guidelines","volume":"15","author":"Z Huang","year":"2024","journal-title":"Insights Imaging"},{"issue":"03","key":"ref18","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"},{"issue":"03","key":"ref19","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.jceh.2017.03.003","article-title":"Comparison of contrast enhanced ultrasound with contrast enhanced computed tomography for the diagnosis of hepatocellular carcinoma","volume":"7","author":"S Moudgil","year":"2017","journal-title":"J Clin Exp Hepatol"},{"issue":"04","key":"ref20","doi-asserted-by":"crossref","first-page":"486","DOI":"10.14366\/usg.20120","article-title":"Sonazoid-enhanced ultrasonography: comparison with CT\/MRI Liver Imaging Reporting and Data System in patients with suspected hepatocellular carcinoma","volume":"40","author":"J A Hwang","year":"2021","journal-title":"Ultrasonography"},{"issue":"05","key":"ref21","doi-asserted-by":"crossref","first-page":"2871","DOI":"10.1007\/s00330-019-06649-z","article-title":"Contrast-enhanced ultrasound for the characterization of portal vein thrombosis vs tumor-in-vein in HCC patients: a systematic review and meta-analysis","volume":"30","author":"J Chen","year":"2020","journal-title":"Eur Radiol"},{"issue":"32","key":"ref22","doi-asserted-by":"crossref","first-page":"9457","DOI":"10.3748\/wjg.v21.i32.9457","article-title":"Contrast-enhanced ultrasound in differentiating malignant from benign portal vein thrombosis in hepatocellular carcinoma","volume":"21","author":"L Tarantino","year":"2015","journal-title":"World J Gastroenterol"}],"container-title":["Indian Journal of Radiology and Imaging"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0045-1811553.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T22:34:32Z","timestamp":1782254072000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0045-1811553"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,8]]},"references-count":22,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2026,6,23]]},"published-print":{"date-parts":[[2026,7]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0045-1811553","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0971-3026","1998-3808"],"issn-type":[{"value":"0971-3026","type":"print"},{"value":"1998-3808","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,8]]}}}