title: Comparing Levovist-enhanced pulse inversion harmonic imaging and ferumoxides-enhanced MR imaging of hepatic metastases.
abstract: OBJECTIVE
  The aim of this study was to compare the sensitivity of pulse inversion harmonic digital sonography, unenhanced transabdominal sonography, and ferumoxides-enhanced MR imaging in the depiction of liver metastases. In addition, pulse inversion harmonic digital sonography was performed at different scanning times after Levovist injection to define the best phase for depiction.
  
  
  METHODS
  Twenty-six consecutive patients with findings of extrahepatic primary malignancies and liver metastases suspected on transabdominal sonography were examined with both pulse inversion harmonic imaging and ferumoxides-enhanced MR imaging within a 7-day period. Pulse inversion harmonic imaging was performed before and at 20, 100, and 180 sec after a bolus injection of Levovist. MR imaging was performed before and after ferumoxides administration, using breath-hold gradient-recalled echo T1-weighted and turbo spin-echo short tau inversion recovery T2-weighted sequences. Two radiologists independently evaluated image quality, and the number, location, and diameter of lesions scanned using both techniques. Intraoperative sonography or at least 8-month follow-up confirmed the lesions depicted. Analyses included Wilcoxon's signed rank test and Interclass correlation test.
  
  
  RESULTS
  Levovist-enhanced pulse inversion harmonic imaging revealed 104 metastases on the first scan after contrast injection, 126 on the second scan, and 118 on the third, compared with 66 on the unenhanced scan. Pulse inversion harmonic digital sonography depicted 90% of lesions shown on ferumoxides-enhanced MR imaging (140 metastases) (p = 0.001).
  
  
  CONCLUSIONS
  Levovist-enhanced pulse inversion harmonic digital sonography is a sensitive technique for depiction of liver metastases. Pulse inversion harmonic digital sonography may have a potential role in imaging patients with possible metastatic involvement of the liver. Further studies are needed to define its place in the workup of these patients. At present, ferumoxides-enhanced MR imaging, being more sensitive, must be performed in all patients in whom pulse inversion harmonic digital sonography is not conclusive or when after pulse inversion harmonic digital sonography, patients remain eligible for surgery.
authors.affiliation: Institute of Radiology, Udine University, Via Colugna 50, 33100 Udine, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Del Frate
authors.forename: Chiara
authors.initials: C
authors.lastname: Zuiani
authors.forename: Viviana
authors.initials: V
authors.lastname: Londero
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Como
authors.forename: Massimo
authors.initials: M
authors.lastname: Bazzocchi
authors.forename: Koenraad
authors.initials: K
authors.lastname: Mortele
authors.forename: Pablo R
authors.initials: PR
authors.lastname: Ros
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003911:Dextrans; D005260:Female; D052203:Ferrosoferric Oxide; D006801:Humans; D007501:Iron; D008113:Liver Neoplasms / Q000473:pathology* / Q000556:secondary*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D010087:Oxides; D011134:Polysaccharides; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; D010087:Oxides; D011134:Polysaccharides; C059891:SHU 508; D007501:Iron; C065507:ferumoxides; D052203:Ferrosoferric Oxide