Comparison of diagnostic performance of unenhanced vs SonoVue - enhanced ultrasonography in focal liver lesions characterization. The experience of three Italian centers.
OBJECTIVE
To evaluate the diagnostic performance of contrast-enhanced US with SonoVue (Bracco, Milan, Italy) compared to baseline US in focal hepatic lesions characterization.


METHODS
A comprehensive number of four operators from 3 hospitals evaluated 57 consecutive patients with 60 focal hepatic lesions (28 hepatocellular carcinomas, 11 metastases, 13 hemangiomas, 1 hepatocellular adenoma and 7 focal nodular hyperplasias) by baseline gray-scale ultrasound (US) and color Doppler US. The same lesions were subsequently scanned by contrast-enhanced US after intravenous bolus administration of 2,4-4,8 ml of SonoVue by employing intermittent high or continuous low transmit power imaging. The diagnosis of lesions nature (benign or malignant) and histotype proposed by the on-site operator was finally compared to the definite diagnosis reached by reference procedures (multiphasic contrast-material enhanced helical-computed tomography or magnetic resonance in 24 lesions and fine needle US guided biopsy in 36 lesions). Diagnostic performance (sensitivity, specificity and overall accuracy expressed by the agreement with the reference procedures) of baseline and contrast enhanced US were compared.


RESULTS
Differences in sensitivity (baseline vs contrast-enhanced US: 13/39 [33%] vs 32/39 [82%]), specificity (baseline vs contrast-enhanced US: 12/21 [57%] vs 16/21 [76%]) and overall accuracy (baseline vs contrast-enhanced US: 25/60 [41%] vs 47/60 [78%]) were significant (p<0.05; McNemar test).


CONCLUSIONS
SonoVue-enhanced US determined a significant improvement in diagnostic performance in the characterization of focal liver lesions if compared to baseline US.
Istituto di Radiologia, Ospedale di Cattinara, Università degli Studi, Trieste. equaia@yahoo.com
Emilio
E
Quaia
Fulvio
F
Stacul
Stefano
S
Gaiani
Paolo
P
Ricci
Roberto
R
Passariello
Daniela
D
Curzio
Roberto
R
Pozzi Mucelli
D018248:Adenoma, Liver Cell / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging; D003287:Contrast Media; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000000981:diagnostic imaging; D006391:Hemangioma / Q000000981:diagnostic imaging; D006801:Humans; D008107:Liver Diseases / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D010865:Pilot Projects; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D036542:Tomography, Spiral Computed; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride