Contrast Enhanced Ultrasound in CT-undetermined Focal Liver Lesions

Abstract

Purpose: The purpose of this study was to examine the diagnostic accuracy of CEUS in the diagnosis of focal liver lesions, which were undetermined at CT scan. Materials and Methods: From January 2010 to December 2010, patients with CT-undetermined focal liver lesions were included in this study. A total of 78 patients were evaluated: 41 men and 37 women, mean age 61.8 years; age range 30?91 years. All patients were examined with GE LOGIQ 9E ultrasound scanners with contrast-specific software, and SonoVue intravenous bolus. The standard of reference was composite consisting of: percutaneous biopsy, surgical resection, PET/CT and clinical follow-up. Results: The 78 included patients had 163 undetermined focal liver lesions, mean size 1.1?cm, range 0.1?5.3?cm. There were 18 malignant and 145 benign liver lesions, as defined by the standard of reference. In differentiating between benign vs. malignant CEUS demonstrated sensitivity, specificity, PPV, NPV and accuracy of 94.4% (95% CI: 56.3?99.5%), 99.3% (95% CI: 94.9??99.9%), 94.4% (95% CI: 56.3?99.5%), 99.3% (95% CI: 94.9?99.9%) and 98.7% (95% CI: 94.9?99.7%), respectively. If the CEUS-inconclusive results were assumed to indicate malignancy, then sensitivity, specificity, PPV, NPV and accuracy would be 95.8% (95% CI: 66.4?99.6%), 98.6% (95% CI: 94.4?99.7%), 92.0% (95CI: 65.1?98.6%), 99.3% (95% CI: 95.0?99.9%), 98.2% (95% CI: 94.4?99.5%). Conclusion: The results of this study showed a high diagnostic accuracy for CEUS in undetermined focal liver lesions found by CT. Due to a high diagnostic accuracy of CEUS in this study, it was cautiously concluded that CEUS is useful in differentiating between malignant and benign focal liver lesions in clinical practice.

Differentiation of atypical hepatic hemangioma from liver metastases: Diagnostic performance of a novel type of color contrast enhanced ultrasound

“…In the present study, we used SonoVue as a contrast agent together with color parameter imaging of the liver lesion. Compared to CT imaging, low-MI CEUS has several advantages, including no ionizing radiation, real-time imaging and low cost [29,30] . However, multiple imaging modalities and referring to the results of laboratory examinations and needle biopsy are still required for final diagnosis when necessary.…”

Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver – Update 2020 – WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS

“…The primary aim of CEUS in patients with a non-cirrhotic liver is to differentiate benign from malignant FLLs [29,33,45,[56][57][58][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78]. Thus, CEUS is useful to facilitate the clinical decision as to whether a sonographically detected liver lesion needs further investigation or surgery [79].…”

Percutaneous ablation of liver metastases from colorectal cancer: a comparison between the outcomes of ultrasound guidance and CT guidance using propensity score matching

“…However, the hyperechoic region during ablation (before it gradually diminishes) is an interference factor that can present irregular contours and obscure the tumor and electrode, potentially increasing the difficulty of ablation [ 26 , 27 ]. Fifth, some small cystic liver metastases can be effectively detected and differentiated by dynamic CEUS [ 28 , 29 ], especially in patients who show a good response to neoadjuvant chemotherapy. These small and highly suspicious lesions could have been ablated, and local disease control improved.…”