title: Real-time imaging with the sonographic contrast agent SonoVue: differentiation between benign and malignant hepatic lesions.
abstract: OBJECTIVE
  We investigated the ability of contrast-enhanced sonography with SonoVue (Altana Pharma, Konstanz, Germany), a sulfur hexafluoride microbubble contrast agent, to reveal differences between benign and malignant focal hepatic lesions.
  
  
  METHODS
  One hundred twenty-six lesions in 124 patients with focal hepatic lesions detected by B-mode sonography (hepatocellular carcinoma, n = 36; metastasis, n = 25; cholangiocellular carcinoma, n = 1; lymphoma, n = 2; focal nodular hyperplasia, n = 9; adenoma, n = 4; regenerative cirrhotic nodule, n = 13; hemangioma, n = 29; and focal hyposteatosis, n = 7) were examined in a prospective study. After intravenous injection of 2.4 mL of SonoVue, the liver was examined continuously for 3 minutes by low-mechanical index pulse inversion sonography.
  
  
  RESULTS
  For the discrimination of malignant versus benign liver lesions, SonoVue-enhanced sonography improved sensitivity from 78% to 100% and specificity from 23% to 92% compared with baseline sonography. Receiver operating characteristic analysis revealed a significant improvement in this discrimination (area under the receiver operating characteristic curve, 0.510 +/- 0.054 [SD] at baseline sonography, 0.998 +/- 0.003 with SonoVue-enhanced sonography; P < .001). The following flow patterns in the early phase were diagnosis specific: early central starlike pattern for focal nodular hyperplasia, peripheral globular-nodular pattern for hemangioma, and diffuse arterial enhancement for malignant lesions. Homogeneous enhancement in the late phase was predictive for benign lesions (P < .001). Conversely, 93% of patients without contrast enhancement in the late phase had malignant lesions (P < .001).
  
  
  CONCLUSIONS
  SonoVue-enhanced sonography has greater specificity and sensitivity than baseline sonography for the differentiation of benign and malignant liver lesions.
authors.affiliation: Department of Gastroenterology, Hepatology, and Infectiology, Clinic of Internal Medicine 1, University of Tübingen, Otfried-Müller-Strasse 10, D-72076 Tübingen, Germany.
authors.forename: Alexandra
authors.initials: A
authors.lastname: von Herbay
authors.forename: Christoph
authors.initials: C
authors.lastname: Vogt
authors.forename: Reinhard
authors.initials: R
authors.lastname: Willers
authors.forename: Dieter
authors.initials: D
authors.lastname: Häussinger
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000000981:diagnostic imaging; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D014463:Ultrasonography
chemical_list: D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride