Contrast-enhanced ultrasound assessment of arterial vascularization of small nodules arising in the cirrhotic liver.
OBJECTIVE
Aim of this study was to compare contrast-enhanced ultrasound and multi-detector row computed tomography in detecting arterial hypervascularity in small cirrhotic nodules.


METHODS
Sixty-two nodules (41 measuring 1.0-2.0 cm, 21 measuring 2.1-3.0 cm) found in 55 cirrhotic patients were examined with both methods. Lesions displaying arterial hypervascularity with washout in the portal/venous phase on both studies were considered hepatocellular carcinomas and treated; all other nodules were subjected to ultrasound-guided fine-needle biopsy.


RESULTS
The larger nodules (2.1-3.0 cm) included 19 hepatocellular carcinomas (90%), 1 macroregenerative nodule type I and 1 macroregenerative nodule type II; 35 (87%) of the smaller nodules were hepatocellular carcinomas, 2 were macroregenerative nodules type I, 2 macroregenerative nodules type II and 2 hemangiomas. The two studies yielded concordant findings for 54 nodules (87%), including 46 hypervascular on both examinations and 8 that were consistently hypovascular. Two of the latter nodules were hepatocellular carcinomas. The other eight nodules displayed arterial hypervascularity on only one of the studies. Six of these (75%) were hepatocellular carcinomas, including five that were negative in the contrast-enhanced ultrasound study.


CONCLUSIONS
Computed tomography and contrast-enhanced ultrasound show high agreement in the vascular classification of small nodules detected by ultrasound in cirrhotic livers, although the former technique was slightly more sensitive in the detection of arterial hypervascularization.
Pompili
M
M
Department of Internal Medicine, Catholic University of Rome, Largo Gemelli, 8, 00168 Rome, Italy. mpompili@rm.unicatt.it
Riccardi
L
L
Semeraro
S
S
Orefice
R
R
Elia
F
F
Barbaro
B
B
Covino
M
M
Grieco
A
A
Gasbarrini
G
G
Rapaccini
G L
GL
D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006391:Hemangioma / Q000175:diagnosis; D006801:Humans; D007275:Injections, Intravenous; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging* / Q000473:pathology; D010743:Phospholipids / Q000008:administration & dosage; D011446:Prospective Studies; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler / Q000379:methods*
D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride