[Value of combined conventional and contrast enhanced sonography in the evaluation of hepatic disorders].
OBJECTIVE
To assess the value of combined conventional and contrast-material enhanced sonography for the characterization of focal liver lesions.


METHODS
Simultaneous imaging with grey scale and contrast enhanced US was performed in 90 patients following Levovist injection (Schering, Berlin, Germany) using the "Agent Detection Imaging" method (ADI, Siemens-Acuson, Mountain View, USA). US scanning was performed at least 4 minutes after contrast injection with review of both grayscale and contrast enhanced modes. Results for detection and characterization of lesions were compared to the selected gold standard imaging modality (CT or MRI).


RESULTS
Final diagnoses included: 20 normal examinations, 41 patients with metastases, 6 patients with hepatocellular carcinoma, 13 patients with hemangioma, 6 patients with other benign lesions, 4 patients with cysts and 6 patients with two types of lesions. Delayed phase contrast enhanced US allowed diagnosis of all lesions except for one metastasis and all hepatocellular carcinomas. While the diagnosis of hepatoma could not be confirmed, the features suggested a malignant etiology. For 7 patients with metastases, more lesions were detected at ADI (4.9 lesions) than at conventional US (1.1 lesion). For 3 patients, CT showed more lesions than ADI US (3.3 versus 1.6 lesions). The accuracy of ADI US for differentiating between benign and malignant lesions was 98.7% compared to 49.6% for conventional US (p<0.001). The total number of lesions detected at ADI US was higher (p<0.01) than at conventional US and not significantly different from that obtained by the gold standard reference methods. Complete characterization was achieved in 92.2% of cases with ADI US compared to 59.2% with conventional US (p<0.001).


CONCLUSIONS
Contrast-material enhanced US combined with conventional US markedly improves the diagnostic accuracy of US in terms of lesion detection and characterization.
Tranquart
F
F
Service de Médecine Nucléaire et Ultrasons - CIT Ultrasons, CHU Bretonneau, 37044 Tours cedex. tranquart@med.univ-tours.fr
Bleuzen
A
A
Kissel
A
A
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000556:secondary; D003287:Contrast Media; D003560:Cysts / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005260:Female; D006391:Hemangioma / Q000000981:diagnostic imaging; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D008107:Liver Diseases / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008279:Magnetic Resonance Imaging / Q000592:standards; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000592:standards; D018608:Ultrasonography, Doppler / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D018615:Ultrasonography, Doppler, Color / Q000295:instrumentation / Q000379:methods* / Q000592:standards
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508