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Contrast‐enhanced ultrasound with SonoVue: Differentiation between benign and malignant focal liver lesions in 317 patients
Author(s) -
von Herbay Alexandra,
Westendorff Julia,
Gregor Michael
Publication year - 2010
Publication title -
journal of clinical ultrasound
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.272
H-Index - 61
eISSN - 1097-0096
pISSN - 0091-2751
DOI - 10.1002/jcu.20626
Subject(s) - medicine , focal nodular hyperplasia , malignancy , ultrasound , hepatocellular carcinoma , radiology , contrast enhanced ultrasound , histopathology , lesion , prospective cohort study , scintigraphy , pathology
Purpose. The aim of the study was to investigate the ability of contrast‐enhanced sonography (CEUS) with the contrast agent SonoVue to differentiate between benign and malignant focal liver lesions. Methods. In a prospective study, we examined 317 patients (204 males, 113 females, aged 59 ± 12 years) with focal liver lesions detected by B‐mode gray‐scale sonography. After intravenous injection of 1.2 mL SonoVue, the liver was examined continuously for 3 minutes using low‐MI sonography with contrast‐specific software. Final diagnosis was established by histopathology, CT, MRI, or HIDA‐scintigraphy. Results. Two hundred nine patients had malignant focal lesions, including 107 hepatocellular carcinomas, 70 metastases, 26 cholangiocellular carcinomas, and 6 other types of malignancy. One hundred eight patients had benign focal lesions, including 30 regenerative nodules, 30 hemangiomas, 13 cases of focal nodular hyperplasia, 12 abscesses, 8 cases of necrosis, 7 cases of focal steatosis areas, and 8 other benign lesions. Hypoenhancement or no enhancement in the late phase was found in 91% of the malignant lesions but in only 37% of the benign lesions ( p < 0.001, sensitivity = 64%, specificity = 93%). Hyperenhancement in the late phase was found in 20% of the benign lesions but in none of the malignant lesions ( p < 0.001, sensitivity = 21%, specificity = 100%). Hyperenhancement in the early phase with diffuse complete enhancement was found in 30% of the patients with malignant lesions but in only 2% of the patients with benign lesions ( p < 0.001, sensitivity = 30%, specificity = 98%). CEUS had a sensitivity of 90%, a specificity of 99%, and an accuracy of 89% in the diagnosis of malignant liver lesions. Conclusion. CEUS is helpful in the differentiation between benign and malignant focal liver lesions. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010