title: [Characterization of hepatic tumors with contrast-enhanced ultrasound and digital grey-scale analysis].
abstract: OBJECTIVE
  The characterization of different liver tumors is of therapeutic and prognostic relevance and has been the purpose of several studies. Although ultrasound offers the opportunity to detect hepatic tumors without ionizing radiation, its previous techniques did not lead toward a definitive differentiation of different tumor entities. The purpose of this study was the clinical evaluation of contrast enhanced ultrasound followed by quantitative digital analysis in patients with focal hepatic tumors.
  
  
  METHODS
  In a prospective study, 50 patients (18 females, 32 males, age 28 to 83 years, mean age 59.4 years) with liver tumors previously detected by CT (n = 47) or MRI (n = 3) were examined by ultrasound of the upper abdomen using conventional technique and phase inversion technique after intravenous application of sulfur-based contrast enhancer SonoVue. At scheduled intervals after application of the contrast enhancer, a digital image was stored and the characteristic signal course of each lesion determined semiquantitatively. The gold standard was either resection (n = 17), percutaneous needle biopsy (n = 19) or the clinical course (n = 14).
  
  
  RESULTS
  While the percentage of tumors correctly characterized by CT/MRI amounted to 78 %, the percentage increased from 60 % using conventional ultrasound to 86 % using contrast enhanced ultrasound including grey-scale analysis. Typical graphs were achieved for different tumor entities on digital grey-scale analysis. The optimal intervals for the differentiation of particular entities were 20 and 100 seconds after injection.
  
  
  CONCLUSIONS
  Quantification of contrast enhanced ultrasound is an addition to the previous diagnostic procedure in hepatic tumors. It offers the possibility of an investigator-independent characterization of lesions and should be evaluated in further studies.
authors.affiliation: Charité, Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin. lemke@charite.de
authors.forename: A-J
authors.initials: AJ
authors.lastname: Lemke
authors.forename: S S
authors.initials: SS
authors.lastname: Chopra
authors.forename: S A
authors.initials: SA
authors.lastname: Hengst
authors.forename: M J
authors.initials: MJ
authors.lastname: Brinkmann
authors.forename: T
authors.initials: T
authors.lastname: Steinmüller
authors.forename: R
authors.initials: R
authors.lastname: Felix
mesh_terms: D018248:Adenoma, Liver Cell / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000000981:diagnostic imaging*; D006391:Hemangioma / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D014463:Ultrasonography
chemical_list: D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride