Contrast‐Enhanced Ultrasound for the differentiation of benign and malignant focal liver lesions: a meta‐analysis

Friedrich‐Rust, Mireen; Klopffleisch, Tom; Nierhoff, J.; Herrmann, Eva; Vermehren, Johannes; Schneider, M; Zeuzem, Stefan; Bojunga, Joerg

doi:10.1111/liv.12115

Cited by 129 publications

(117 citation statements)

References 68 publications

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“…Considering the characterization of specific FLLs, the overall sensitivity for the diagnosis of hemangioma (612 hemangiomas from 20 studies) was 86% and for the diagnosis of FNH (365 FNHs from 18 studies) was 88%. The sensitivity for the diagnosis of HCC (1333 HCCs from 19 studies) was 88% and for the diagnosis of metastases (828 metastases from 18 studies) was 91% [12]. The conclusion of this meta-analysis is to support the international recommendations on CEUS for the diagnostic work-up of focal liver lesions.…”

supporting

confidence: 61%

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Is Contrast Enhanced Ultrasound (CEUS) ready for use in daily practice for evaluation of Focal Liver Lesions?

Sporea

Şirli

2014

Med Ultrason

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Abdominal ultrasound is one of the most popular imaging methods due to its feasibility, low cost and accessibility. Contrast Enhanced Ultrasound (CEUS) with second generation contrast agents became in the last years a useful tool for the characterization of focal liver lesions (FLL) so that EFSUMB issued guidelines for its use in clinical practice. Several large studies proved that CEUS has similar performance to more expensive imaging methods such as contrast enhanced CT and contrast enhanced MRI for the characterization of FLL. Also, several studies proved that CEUS is cost-effective as a first-line imaging method. Considering all these data, we think that CEUS is ready to be used in daily practice for the evaluation of FLL.

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supporting

confidence: 61%

“…As the final argument in favor of the use of CEUS for the evaluation of FLL we propose a recently published meta-analysis [12], for which literature databases were searched up to March 2012. Inclusion criteria were evaluation of CEUS in FLLs, assessment of sensitivity and specificity of CEUS for the diagnosis of malignant liver lesions.…”

mentioning

confidence: 99%

Is Contrast Enhanced Ultrasound (CEUS) ready for use in daily practice for evaluation of Focal Liver Lesions?

Sporea

Şirli

2014

Med Ultrason

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“…Similar to contrast agents used for CT or MRI, second generation US contrast agents are able to show tissue perfusion, and, based on enhancement patterns in arterial, portal, and late vascular phases, to identify different types of FLLs. The value of CEUS in diagnosing FLLs was demonstrated in two national multicentre studies (a German and a French one) [2,3], each including more than 1000 FLL, while CEUS accuracy was proved to be similar to those of contrast enhanced CT and MRI [4,5]. Furthermore, in 2004 the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) issued Guidelines and Recommendations concerning the use of CEUS [6] revised in 2008 [7] and in 2012 [8], the later developed in cooperation with the World Federation for Ultrasound in Medicine and Biology (WFUMB), thus with universal valability.…”

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confidence: 99%

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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“…CEUS can therefore depict macro-and microvascularization [17][18][19]. As a general statement, the occurence of hypoenhancement of solid liver lesions in the late and post-vascular phases signals malignancy with high accuracy in non cirrhotic livers.…”

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confidence: 99%

Recall strategies for patients found to have a nodule in cirrhosis: is there still a role for CEUS?

et al. 2015

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Development of liver tumors and their evolution to hepatocellular carcinoma (HCC) is a multi-step process in which different HCC-etiologies induce continuous rounds of hepatocyte damage and regeneration. Over an extended time, this triggers cirrhosis which is a pathological state of the liver in which lesions can progress to become dysplastic nodules. Later, these nodules may evolve into HCC and occasionally generate metastatic events. To provide optimal care, patients with liver cancer should be managed using a multidisciplinary approach in specialized centers in which all the diagnostic and therapeutic resources are available. Among the different imaging modalities the introduction on contrast agents for ultrasound use has opened new further applications in different clinical settings. In fact, contrast enhanced ultrasound (CEUS) has been applied for more than ten years and plays increasingly important roles in the management of HCC. Since early 2000, international societies including the American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of the Liver (EASL), the Asian Pacific association for the Study of the Liver (APASL), the Japanese society of Hepatology (JSH), the Italian society for the study of the liver (AISF), the World Federation for Ultrasound in Medicine and Biology (WFUMB), and the European Federation of Societies for Ultrasound in Medicine and Biology (EFUSMB) have discussed the important role of CEUS in the diagnosis of HCC. In the present review an update of the literature and a detailed discussion of the present Guidelines regarding the role of CEUS in the evaluation of nodules in cirrhotic patients is offered.

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Contrast‐Enhanced Ultrasound for the differentiation of benign and malignant focal liver lesions: a meta‐analysis

Abstract: The results of this meta-analysis support the international recommendations on CEUS for the diagnostic work-up of focal liver lesions selecting patients who need further diagnostics.

Cited by 129 publications

References 68 publications

Is Contrast Enhanced Ultrasound (CEUS) ready for use in daily practice for evaluation of Focal Liver Lesions?

Is Contrast Enhanced Ultrasound (CEUS) ready for use in daily practice for evaluation of Focal Liver Lesions?

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

Recall strategies for patients found to have a nodule in cirrhosis: is there still a role for CEUS?

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