title: Imaging of focal liver lesions: low-mechanical-index real-time ultrasonography with SonoVue.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the usefulness of a contrast-enhanced contrast-specific ultrasonographic technique with a low mechanical index for characterization of focal liver lesions.
  
  
  METHODS
  Contrast-specific ultrasonography was used to assess 144 patients with 147 focal liver lesions: 87 primary liver carcinomas, 27 hemangiomas, 16 focal nodular hyperplasias, 5 hepatic abscesses, 3 inflammatory pseudotumors of the liver, and 9 metastases. A sulfur hexafluoride gas-based contrast agent was used with a mechanical index of 0.08 to 0.11.
  
  
  RESULTS
  On contrast-enhanced ultrasonography, the typical hemodynamic pattern of primary liver carcinoma was the whole-lesion enhancement or mosaic enhancement in the arterial phase with an enhancement defect in the late phase (sensitivity, 92.0%; specificity, 86.7%). The most common enhancement pattern of hemangioma was that enhancement appeared in the periphery first and progressively filled into the lesion center (sensitivity, 96.3%; specificity, 97.5%). The enhancement pattern of focal nodular hyperplasia was that the whole lesion enhanced early and rapidly in the arterial phase with a centrifugal radiating configuration and appeared isoechoic or hyperechoic until the late phase (sensitivity, 87.6%; specificity, 94.5%). The central scar was detected in 31.3% of cases in the late phase. The specific enhancement of a hepatic abscess was the honeycomblike enhancement in all phases (sensitivity, 80.0%; specificity, 100%). No enhancement of a lesion in all phases was specific for an inflammatory pseudotumor of the liver.
  
  
  CONCLUSIONS
  Contrast-enhanced real-time ultrasonography is a promising approach in the noninvasive characterization of focal liver lesions and can be useful as a first-line imaging technique clinically when a focal liver lesion is detectable on ultrasonography.
authors.affiliation: Department of Ultrasound, Zhongshan Hospital of Fudan University, 180 Fenglin Rd, Shanghai 200032, China. hongding3@hotmail.com
authors.forename: Hong
authors.initials: H
authors.lastname: Ding
authors.forename: Wen-Ping
authors.initials: WP
authors.lastname: Wang
authors.forename: Bei-Jian
authors.initials: BJ
authors.lastname: Huang
authors.forename: Rui-Xue
authors.initials: RX
authors.lastname: Wei
authors.forename: Nian-An
authors.initials: NA
authors.lastname: He
authors.forename: Qing
authors.initials: Q
authors.lastname: Qi
authors.forename: Chao-Lun
authors.initials: CL
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D013459:Sulfur Hexafluoride; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride