Focal hepatic masses: enhancement patterns with SH U 508A and pulse-inversion US.
OBJECTIVE
To evaluate the role of SH U 508A-enhanced ultrasonography (US) in the differentiation of focal hepatic masses.


METHODS
Contrast material-enhanced pulse inversion US was performed on 58 unknown hepatic lesions: 23 hepatocellular carcinomas, 10 focal nodular hyperplasias, 16 hemangiomas, and nine metastases. Selected images were sequentially reviewed by readers blinded to the final diagnosis. On a baseline image, they determined lesion echogenicity, and on a vascular image, the presence or absence of distinct vascularity. On an arterial phase interval-delay flash image and a postvascular image, they assessed enhancement of the lesion and liver. Responses were compared with confirmed diagnoses.


RESULTS
Focal nodular hyperplasia was characterized by detectable vascularity and positive enhancement on interval-delay and postvascular scans (sensitivity, 83% [eight of 10 lesions]; specificity, 98% [40 of 41 lesions]). Hepatocellular carcinoma also showed detectable vascularity and positive enhancement on interval-delay images but no postvascular enhancement (sensitivity, 68% [14 of 20 lesions]; specificity, 74% [23 of 31 lesions]). Vascular imaging with SH U 508A did not contribute to the diagnosis of metastasis or hemangioma. However, no or weak enhancement during the arterial phase flash without postvascular enhancement produced a sensitivity of 83% (seven of eight lesions) and sensitivity of 77% (33 of 43 lesions) for metastasis. Peripheral nodular enhancement on arterial phase flash images was highly specific (98% [37 of 38 lesions]) but not sensitive (44% [six of 13 lesions]) for hemangioma.


CONCLUSIONS
SH U 508A-enhanced pulse-inversion interval-delay flash and postvascular phase imaging are helpful in differential diagnosis of focal hepatic lesions.
Dill-Macky
Marcus J
MJ
Department of Medical Imaging, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4.
Burns
Peter N
PN
Khalili
Korosh
K
Wilson
Stephanie R
SR
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000000981:diagnostic imaging*; D006391:Hemangioma / Q000000981:diagnostic imaging*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides; D012680:Sensitivity and Specificity; D014463:Ultrasonography
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508