Assessment of metastatic liver disease in patients with primary extrahepatic tumors by contrast-enhanced sonography versus CT and MRI.
OBJECTIVE
To evaluate contrast-enhanced ultrasonography (CEUS) using SonoVue in the detection of liver metastases in patients with known extrahepatic primary tumors versus the combined gold standard comprising CT, MRI and clinical/histological data.


METHODS
It is an international multicenter study, and there were 12 centres and 125 patients (64 males, 61 females, aged 59+/-11 years) involved, with 102 patients per protocol. Primary tumors were colorectal in 35%, breast in 27%, pancreatic in 17% and others in 21%. CEUS using SonoVue was employed with a low-mechanical-index technique and contrast-specific software using Siemens Elegra, Philips HDI 5000 and Acuson Sequoia; continuous scanning for at least five minutes.


RESULTS
CEUS with SonoVue increased significantly the number of focal liver lesions detected versus unenhanced sonography. In 31.4% of the patients, more lesions were found after contrast enhancement. The total numbers of lesions detected were comparable with CEUS (55), triple-phase spiral CT (61) and MRI with a liver-specific contrast agent (53). Accuracy of detection of metastatic disease (i.e. at least one metastatic lesion) was significantly higher for CEUS (91.2%) than for unenhanced sonography (81.4%) and was similar to that of triple-phase spiral CT (89.2%). In 53 patients whose CEUS examination was negative, a follow-up examination 3-6 mo later confirmed the absence of metastatic lesions in 50 patients (94.4%).


CONCLUSIONS
CEUS is proved to be reliable in the detection of liver metastases in patients with known extrahepatic primary tumors and suspected liver lesions.
Dietrich
Christoph F
CF
2nd Department of Internal Medicine, Johann Wolfgang Goethe University Hospital, 60590 Frankfurt, Germany. christoph.dietrich@ckbm.de
Kratzer
Wolfgang
W
Strobe
Deike
D
Danse
Etienne
E
Fessl
Robert
R
Bunk
Alfred
A
Vossas
Udo
U
Hauenstein
Karlheinz
K
Koch
Wilhelm
W
Blank
Wolfgang
W
Oudkerk
Matthijs
M
Hahn
Dietbert
D
Greis
Christian
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology; D015179:Colorectal Neoplasms / Q000473:pathology; D003287:Contrast Media; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology; D011446:Prospective Studies; D036542:Tomography, Spiral Computed; D014463:Ultrasonography / Q000379:methods
D003287:Contrast Media