Unclear focal liver lesions in contrast-enhanced ultrasonography--lessons to be learned from the DEGUM multicenter study for the characterization of liver tumors

• Published in: Ultraschall in der Medizin Vol. 31; no. 6; p. 577
• Main Authors: Bernatik, T, Seitz, K, Blank, W, Schuler, A, Dietrich, C F, Strobel, D
• Format: Journal Article
• Language: English
• Published: Germany 01.12.2010
• Subjects: Biopsy; Biopsy, Fine-Needle; Carcinoma, Hepatocellular - blood supply; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - pathology; Contrast Media - administration & dosage; Diagnosis, Differential; Focal Nodular Hyperplasia - diagnostic imaging; Focal Nodular Hyperplasia - pathology; Hemangioma - diagnostic imaging; Hemangioma - pathology; Humans; Image Enhancement - methods; Liver - diagnostic imaging; Liver - pathology; Liver Diseases - diagnostic imaging; Liver Diseases - pathology; Liver Neoplasms - blood supply; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - pathology; Liver Neoplasms - secondary; Phospholipids; Regional Blood Flow - physiology; Sensitivity and Specificity; Sulfur Hexafluoride; Ultrasonography - methods
• ISSN: 1438-8782
• DOI: 10.1055/s-0029-1245649

To discuss the difficulties of contrast-enhanced ultrasound (CEUS) in a large multi-center trial. CEUS was performed on 1349 liver lesions with an unclear diagnosis after native ultrasound using a standardized protocol (phase inversion; low MI < 0.4; Sonovue Bolus 1.2 - 4.8 ml). The early arterial, arterial, portal venous and late phase > 2 min. were documented. The diagnosis based on CEUS results was compared to the final diagnosis (histology: n = 1006; MRI: n = 269; CT: n = 269 - multiple examinations possible). Of the 1349 enclosed liver lesions, 20 could not be definitively diagnosed even using all diagnostic steps including histology (the others were proven to be benign n = 573 or malignant n = 756). Of the 1349 unclear liver lesions, 1257 could be differentiated with an accuracy of 90.3% using CEUS. The sensitivity, specificity, and positive and negative predictive value for malignant liver lesions was 95.8%, 83.1%, 88.2% and 93.7% respectively. 92 liver lesions (6.8%) could not be definitively diagnosed using CEUS. Most of them were benign (n = 67) on final diagnosis. The CEUS diagnosis was wrong for 39 lesions. However, only 8 lesions classified as benign by CEUS turned out to be malignant. In 3 cases HCC proven by histology was incorrectly diagnosed by CEUS as adenoma and 2 lesions incorrectly diagnosed by CEUS as FNH turned out to be an HCC and a metastasis. Two lesions diagnosed by CEUS as hemangiomas turned out to be an HCC and a metastasis. One lesion classified as benign by CEUS was ultimately diagnosed as a lymphoma. Even in this multi-center trial, CEUS proved to be an excellent method for clarifying liver lesions remaining unclear after native ultrasound. The CEUS diagnosis of benign was only incorrect in a few cases.