Characterisation of focal liver lesions undetermined at grey-scale US: contrast-enhanced US versus 64-row MDCT and MRI with liver-specific contrast agent

• Published in: Radiologia medica Vol. 115; no. 5; pp. 714 - 731
• Main Authors: Bartolotta, T. V., Taibbi, A., Midiri, M., La Grutta, L., De Maria, M., Lagalla, R.
• Format: Journal Article
• Language: English; Italian
• Published: Milan Springer Milan 01.08.2010
• Subjects: Abdominal Radiology; Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Biopsy, Fine-Needle; Contrast Media; Diagnostic Radiology; Female; Humans; Imaging; Interventional Radiology; Liver Diseases - diagnosis; Liver Diseases - diagnostic imaging; Liver Neoplasms - diagnosis; Liver Neoplasms - diagnostic imaging; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Predictive Value of Tests; Radiologia Addominale; Radiology; Sensitivity and Specificity; Tomography, X-Ray Computed - methods; Ultrasonography; Ultrasound; Neoplasie; Liver; Ecografia con mezzo di contrasto; Fegato; Contrast-enhanced sonography; Ecografia; Ultrasound; Contrast media; Neoplasms; Mezzo di contrasto ecografico
• ISSN: 0033-8362; 1826-6983
• DOI: 10.1007/s11547-010-0506-3

Purpose The aim of this study was to assess the role of contrast-enhanced ultrasonography (CEUS) in the characterisation of focal liver lesions in comparison with multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) with liver-specific contrast agent. Materials and methods One hundred and eighty-seven focal liver lesions, 91 malignant and 96 benign (mean size 3.2 cm) — proved by biopsy (n=12), histology (n=4), MDCT (n=108), MRI (n=44) MDCT/MRI (n=19) — in 159 patients were studied by CEUS. Two expert radiologists consensually evaluated the contrast-enhancement patterns at CEUS. For each lesion, they assessed: (a) nature (benign, malignant, not assessable), (b) specific diagnosis and (c) need for further radiological evaluation. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of CEUS were calculated. Results A total of 167/187 (89.3%) lesions were correctly assessed as benign or malignant at CEUS, whereas 14/187 (7.5%) lesions remained undetermined and 6/187 (3.2%) were incorrectly assessed. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of CEUS were, respectively, 89%, 89.6%, 89%, 89.6% and 89.3%. The need for further radiological evaluation decreased to 46/187 (24.6%) lesions after CEUS ( p <0.001). Conclusions In selected cases, CEUS can be considered an effective alternative to MDCT and MRI and reduce the need for further radiological workup.