Diagnostic Accuracy of CEUS in the Differential Diagnosis of Small (≤ 20 mm) and Subcentimetric (≤ 10 mm) Focal Liver Lesions in Comparison with Histology

Abstract

CEUS has a high diagnostic accuracy for the differential diagnosis of small and subcentimetric FLLs in clinical practice.

Detection and characterization of small superficially located focal liver lesions by contrast-enhanced ultrasound with high frequency transducers

“…This technique fails to reliably differentiate between malignant and benign lesions [13,[25][26][27][28][29][30]. Some FLLs are particularly difficult to diagnose even by biopsy because of their small size (<10 mm) or superficial location (close to liver capsule) [12,15,26].…”

“…Previous studies have shown that transabdominal CEUS with low frequency convex transducer is significantly better than unenhanced BMUS for the detection [1,3] and classification [7,10,33] of FLLs. For unclear small FLLs which could not be characterized with confidence by using transabdominal BMUS or Doppler ultrasound techniques, real-time CEUS has demonstrated the ability to characterize them reliably [1,12,21].…”

“…Detection of small FLLs of less than 5 mm always is challenging as these lesions often appear isoechoic on B mode ultrasound (BMUS); the same is true for superficial FLLs close to the liver capsule [6]. Over the last decade, with the wide clinical application of microbubble ultrasound contrast agents, contrastenhanced ultrasound (CEUS) has noticeably improved the identification and characterization of FLLs, especially for FLLs less than 10 mm in size [7][8][9][10][11][12]. However, it still proves to be difficult to differentiate malignant and benign FLLs, especially when the lesion is smaller than 10 mm or located superficially [2,13].…”

“…Initial studies using dynamic CEUS with multifrequency matrix probes have indicated a high diagnostic value for the evaluation of tumor microvascularization in animal experiments [19,20]. Recent publications in intra-operative CEUS with high frequency transducers exhibited high diagnostic potential for the detection and differentiation between benign and malignant FLLs [2,[11][12][13]21], particularly for liver lesions less than 10 mm. The detection rate was comparable to pre-operative contrast enhanced spiral computer tomography (ceCT) and contrast enhanced magnetic resonance imaging (ceMRI) [3,17].…”

Ultrasound Examination in Detection and Characterization of Colorectal Liver Metastases

“…CEUS has been widely used in many different applications, especially in the detection and diagnosis of FLLs [28] . In many clinical trials, CEUS has shown high performance comparable to CECT and CEMRI in detection and characterization of FLLs [29][30][31] . Malignant FLLs, especially liver metastasis usually present arterial rim-like or homogeneous hyper-enhancement with "defect of enhancement" during the late phase or liver specific phase of CEUS, which makes the characterization and detection as accurate and easy as CECT [32] .…”