Characterization of focal liver lesions with contrast-specific US modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence.
OBJECTIVE
To assess whether characterization of solid focal liver lesions could be improved by using ultrasonographic (US) contrast-specific modes after sulfur hexafluoride-filled microbubble contrast agent injection, as compared with lesion characterization achieved with preliminary baseline US.


METHODS
Four hundred fifty-two solid focal hepatic lesions that were considered indeterminate at baseline gray-scale and color Doppler US were examined after microbubble contrast agent injection performed by using low-acoustic-power contrast-specific modes during the arterial (10-40 seconds after injection), portal venous (50-90 seconds after injection), and late (100-300 seconds after injection) phases. Two readers independently and retrospectively reviewed baseline and contrast material-enhanced US scans and classified each depicted lesion as malignant or benign according to standard diagnostic criteria. Sensitivity, specificity, accuracy, and positive and negative predictive values and areas under the receiver operating characteristic curve (Az) were calculated by considering histologic analysis (317 patients) or contrast-enhanced helical computed tomography followed by serial US 3-6 months apart (135 patients) as the reference standards.


RESULTS
Different contrast enhancement patterns were observed according to lesion characteristics. During the late phase, benign lesions were predominantly hyper- or isoechoic relative to the adjacent liver parenchyma, whereas malignant lesions were predominantly hypoechoic. Review of the contrast-enhanced US scans after baseline image review yielded significantly improved diagnostic performance (P <.05). Overall diagnostic accuracy was 49% before versus 85% after review of the contrast-enhanced scan for reader 1 and 51% before versus 88% after review of the contrast-enhanced scan for reader 2. Diagnostic confidence-that is, the Az-was 0.820 before versus 0.968 after review of the contrast-enhanced scan for reader 1 and 0.831 before versus 0.978 after review of the contrast-enhanced scan for reader 2.


CONCLUSIONS
The use of contrast-specific modes with a sulfur hexafluoride contrast agent led to improved characterization of solid focal liver lesions.
Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, Trieste 34149, Italy. equaia@yahoo.com
Emilio
E
Quaia
Fabrizio
F
Calliada
Michele
M
Bertolotto
Sandro
S
Rossi
Lorena
L
Garioni
Laura
L
Rosa
Roberto
R
Pozzi-Mucelli
D018248:Adenoma, Liver Cell / Q000000981:diagnostic imaging / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology; D003287:Contrast Media; D004867:Equipment Design; D005234:Fatty Liver / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000000981:diagnostic imaging* / Q000473:pathology; D006391:Hemangioma / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation*; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008107:Liver Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D015588:Observer Variation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D036542:Tomography, Spiral Computed; D014159:Transducers; D014463:Ultrasonography / Q000295:instrumentation*; D018615:Ultrasonography, Doppler, Color / Q000295:instrumentation
D003287:Contrast Media; D013459:Sulfur Hexafluoride