Contrast-Enhanced Ultrasound (CEUS) for the Characterization of Focal Liver Lesions in Clinical Practice (DEGUM Multicenter Trial): CEUS vs. MRI – a Prospective Comparison in 269 Patients

Seitz, Karlheinz; Bernatik, T.; Strobel, D; Blank, Wolfgang; Friedrich‐Rust, Mireen; Strunk, H.; Greis, Christian; Kratzer, Wolfgang; Schüler, Andreas

doi:10.1055/s-0029-1245591

Cited by 165 publications

(135 citation statements)

References 31 publications

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“…By means of contrastenhanced ultrasound (CEUS), the Sp for benign-malignant differentiation and the final diagnosis of a FLL has significantly increased [9][10][11]. The accuracy of CEUS for the final diagnosis of FLL is similar to that of contrast-enhanced CT (90.3% CEUS vs. 87.8% for contrast-enhanced CT) [11,12] and of contrastenhanced MRI [11,13].…”

Section: Introductionmentioning

confidence: 99%

Diffusion Weighted Magnetic Resonance Imaging for the Classification of Focal Liver Lesions as Benign or Malignant

Caraiani

Chiorean

Fenesan

et al. 2015

JGLD

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Background & Aims: To assess the role of diffusion weighted imaging sequence (DWI), routinely used in hepatic magnetic resonance imaging (MRI) for the differentiation of focal liver lesions (FLLs) as benign or malignant. Method: 99 FLLs assessed by liver MRI in 80 patients were included in the present study. All lesions were retrospectively analyzed by two experienced radiologists, independent from each other, who were not aware of the previous results obtained by using different imaging techniques. All included FLLs had a final histological diagnosis or a final diagnosis based on consensus reading by two experienced radiologists and follow-up at 6 months. The FLLs signal was qualitatively appreciated on the b-800 sequences and on the apparent diffusion coefficient (ADC) map. The ADC value of each FLL was measured and the ADC ratio between the ADC value of the assessed FLL and that of the surrounding liver parenchyma were calculated. Results: The mean ADC value for benign FLLs as assessed by the two independent readers was 1.78 x 10¯³ and 1.72 x 10¯³, respectively. The mean ADC value for malignant FLLs was 0.92 x 10¯³ for the first reader and 0.95 x 10¯³ for the second reader. The mean ADC ratio for benign FLLs was 1.91 and 1.85 for the two readers and for malignant FLLs was 0.91 and 0.94, respectively. Using an ADC value lower than 1.024 x 10¯³ offers a specificity of 100% and a sensitivity of 62.5% for the diagnosis of malignant FLLs. The ADC value is an indicator which is less prone to interobserver variability (correlation of 0.919→1). The ADC ratio has, as the analysis of the ROC curve shows, the best predictive value for differentiation between benign and malignant FLLs. Analysis of the signal intensity on the DWI b-800 image alone is of no significance in differentiating benign from malignant FLLs (p>0.05). Conclusions: The ADC value and the ADC ratio assessed on liver DWI are useful diagnostic tools in the differential diagnosis of benign vs. malignant FLLs. Quantitative methods such as calculating the ADC value or ADC ratio have better diagnostic value than the qualitative techniques.

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Section: Introductionmentioning

confidence: 99%

Diffusion Weighted Magnetic Resonance Imaging for the Classification of Focal Liver Lesions as Benign or Malignant

Caraiani

Chiorean

Fenesan

et al. 2015

JGLD

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“…Regarding the 4 hemangiomas misdiagnosed by CEUS as HCCs, we can speculate that a pseudo washout was observed due to hyperinsonation as showed in the German study [33,34], while the arterial inhomogeneous hyperenhancement observed in these cases can be explained by arterio-venous and/or portal venous shunts, known to be present in 10% of hemangiomas [37]. Also, rapidly filling hemangiomas, usually smaller than 3 cm can be encountered in patients with cirrhosis in up to 16-18% of cases [30,38,39] Previous studies demonstrated that CEUS accuracy for the characterization of FLL is comparable to that of contrast CT [40] and contrast MRI [41], and also that the use of CEUS as a first line imaging method when faced with a new FLL is cost-efficient [42,43]. Also the results of our study and of those mentioned above demonstrate very good accuracy for the diagnosis of hemangioma, so we can safely suggest to use CEUS a first-line imaging technique when faced with a suspected hemangioma based on standard B-mode US, even in high risk patients in which clinical and serologic data should also be taken into consideration.…”

Section: Discussionmentioning

confidence: 84%

Contrast enhanced ultrasound for the diagnosis of liver hemangiomas – results of a Romanian multicentre study

et al. 2015

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Background and aim: Contrast enhanced ultrasound (CEUS) has been proven to be a reliable method for the characterization of focal liver lesions (FLL). The aim of this paper was to evaluate the performance of CEUS for the diagnosis of liver hemangiomas in a large cohort of patients. Material and method: We performed a multicentre prospective study which included successive CEUS examinations from fourteen centers from Romania. CEUS examinations were performed in de novo FLL, using low mechanical index ultrasound, following an intravenous bolus of 2.4 ml SonoVue. CEUS was considered conclusive for hemangioma if a typical pattern was present following contrast (centripetal fill in during the arterial phase, hyperenhanced lesion during venous and late phases). In all cases a reference method was available (contrast CT or MRI or biopsy). The trial was registered in clinicaltrials.gov (Identifier NCT01329458). Results: During February 2011 -May 2015, 1153 CEUS examinations were performed for the evaluation of de novo FLL. Out of the 1153 de novo FLL, 238 cases were diagnosed as hemangiomas by CEUS (typical enhancing pattern). Contrast CT/MRI and biopsy diagnosed additional 24 hemangiomas. From the 238 cases diagnosed as hemangiomas by CEUS, in 11 the final diagnosis was different. Considering contrast CT/MRI and biopsy as reference methods, CEUS had 90.4% sensitivity, 98.8% specificity, 95.4% positive predictive value, 97.4% negative predictive value, resulting in 96.9% diagnostic accuracy for the diagnosis of hemangiomas. Conclusion: CEUS is a sensitive and very specific method for the diagnosis of hemangiomas.

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“…Unfortunately, until now, there has been no systematic report on the CEUS appearance of IP, which needs further study. In routine clinical practice, a definitive and exact differential diagnosis of FLLs with CEUS entire clip is possible only in some types of lesions, whilst the simple categorization of a lesion as benign or malignant can be achieved with extremely high sensitivity (>90 %) and specificity [2], as well as with an accuracy comparable to CT or MRI in most series [23][24][25][26]. Additionally, in typical lesions the 0-1min clip and 1-4min clip could be comparable to the entire clip in diagnosis of FLLs aforementioned.…”

Section: Discussionmentioning

confidence: 99%

Analysis of only 0-1 min clip or 1-4 min Clip for focal liver lesions during contrast-enhanced ultrasonography

Zhang¹,

Yi²,

Ai³

et al. 2016

Trop. J. Pharm Res

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Contrast-Enhanced Ultrasound (CEUS) for the Characterization of Focal Liver Lesions in Clinical Practice (DEGUM Multicenter Trial): CEUS vs. MRI – a Prospective Comparison in 269 Patients

Cited by 165 publications

References 31 publications

Diffusion Weighted Magnetic Resonance Imaging for the Classification of Focal Liver Lesions as Benign or Malignant

Diffusion Weighted Magnetic Resonance Imaging for the Classification of Focal Liver Lesions as Benign or Malignant

Contrast enhanced ultrasound for the diagnosis of liver hemangiomas – results of a Romanian multicentre study

Analysis of only 0-1 min clip or 1-4 min Clip for focal liver lesions during contrast-enhanced ultrasonography

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