title: Improved detection of hepatic metastases with pulse-inversion US during the liver-specific phase of SHU 508A: multicenter study.
abstract: OBJECTIVE
  To compare conventional B-mode ultrasonography (US) alone with the combination of conventional B-mode US and contrast material-enhanced (SHU 508A) late-phase pulse-inversion US for the detection of hepatic metastases by using dual-phase spiral computed tomography (CT) as the standard of reference.
  
  
  METHODS
  One hundred twenty-three patients underwent conventional US, US in the liver-specific phase of SHU 508A, and single-section spiral CT. US and CT images were assessed by blinded readers. Differences in sensitivity, specificity, and the number and smallest size of metastases at conventional and contrast-enhanced US were compared by using CT as the standard of reference. Lesion conspicuity was assessed objectively (quantitatively) and subjectively by one reader before and after contrast material administration.
  
  
  RESULTS
  In 45 of 80 (56%) patients with metastases, more metastases were seen at contrast-enhanced US than at conventional US. In three of these patients, conventional US images appeared normal. The addition of contrast-enhanced US improved sensitivity for the detection of individual metastases from 71% to 87% (P <.001). On a patient basis, sensitivity improved from 94% to 98% (P =.44), and specificity improved from 60% to 88% (P <.01). Contrast enhancement improved the subjective conspicuity of metastases in 66 of 75 (88%) patients and the objective contrast by a mean of 10.8 dB (P <.001). Contrast-enhanced US showed more metastases than did CT in seven patients, and CT showed more than did contrast-enhanced US in one of 22 patients in whom an independent reference (magnetic resonance imaging, intraoperative US, or pathologic findings) was available.
  
  
  CONCLUSIONS
  Contrast-enhanced US improved sensitivity and specificity in the detection of hepatic metastases.
authors.affiliation: Dept of Radiology and Nuclear Medicine, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Hindenburgdamm 30, Germany. thomas.albrecht@medizin.fu-berlin.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Albrecht
authors.forename: Martin J K
authors.initials: MJ
authors.lastname: Blomley
authors.forename: Peter N
authors.initials: PN
authors.lastname: Burns
authors.forename: Stephanie
authors.initials: S
authors.lastname: Wilson
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Harvey
authors.forename: Edward
authors.initials: E
authors.lastname: Leen
authors.forename: Michel
authors.initials: M
authors.lastname: Claudon
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Calliada
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Correas
authors.forename: Michel
authors.initials: M
authors.lastname: LaFortune
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Campani
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hoffmann
authors.forename: David O
authors.initials: DO
authors.lastname: Cosgrove
authors.forename: Frederic
authors.initials: F
authors.lastname: LeFevre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508