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.
2nd Department of Internal Medicine, Johann Wolfgang Goethe University Hospital, 60590 Frankfurt, Germany. christoph.dietrich@ckbm.de
Christoph F
CF
Dietrich
Wolfgang
W
Kratzer
Deike
D
Strobe
Etienne
E
Danse
Robert
R
Fessl
Alfred
A
Bunk
Udo
U
Vossas
Karlheinz
K
Hauenstein
Wilhelm
W
Koch
Wolfgang
W
Blank
Matthijs
M
Oudkerk
Dietbert
D
Hahn
Christian
C
Greis
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