Contrast-enhanced sonography in the characterization of small hepatocellular carcinomas in cirrhotic patients: comparison with contrast-enhanced ultrafast magnetic resonance imaging.
OBJECTIVE
To evaluate the role of low mechanical index (MI) contrast-enhanced sonography (CEUS) for the characterization of small hepatocellular carcinomas (HCC) in cirrhotic patients by comparing the results to ultrafast dynamic gadolinium-enhanced magnetic resonance imaging (MRI) studies.


METHODS
Between September 2003 and June 2004, 73 patients (49 male and 24 female; mean age, 63 years; age range, 40-84 years) with a single liver nodule (< or =30 mm) were selected to enter into the study. CEUS and MRI studies were performed in all patients on consecutive days. All lesions were histologically confirmed after both imaging studies. CEUS was performed at low MI after i.v. administration of the contrast agent SonoVue. The enhancement pattern related to tumor hypervascularity was analyzed. The Chi-square test was used for statistical analysis.


RESULTS
HCCs < or =10 mm (11 cases): On CEUS, 3/11 HCCs were hypervascular, while 8/11 were not visible (sensitivity, 27.3%; specificity, 100%; positive predictive value, 100%; negative predictive value, 55.6%). MRI studies showed a typical pattern in eight HCCs (sensitivity, 72.7%; specificity, 90.0%; positive predictive value, 88.9%; negative predictive value, 75.0%). HCCs 11-30 mm (37 cases): On CEUS, 34/37 (91.9%) HCCs were hypervascular, 2/37 avascular, and 1/37 not visible (sensitivity, 91.9%; specificity, 93.3%; positive predictive value, 97.1%; negative predictive value, 82.4%). MRI studies showed a typical pattern in 35/37 HCCs (sensitivity, 94.6%; specificity, 86.7%; positive predictive value, 94.6%; negative predictive value, 86.7%). The overall concordance between CEUS and MRI results was 75.0%.


CONCLUSIONS
CEUS is a promising technique for the characterization of small HCCs in cirrhotic patients. It could be complementary to conventional sonography in evaluating focal liver lesions larger than 10 mm.
Giorgio
Antonio
A
UO di Ecografia Interventistica IX Divisione AO Cotugno, Naples, Italy. assanui1@virgilio.it
De Stefano
Giorgio
G
Coppola
Carmine
C
Ferraioli
Giovanna
G
Esposito
Vincenzo
V
Di Sarno
Antonella
A
Giorgio
Valentina
V
De Stefano
Manuela
M
Sangiovanni
Vincenzo
V
Liorre
Giulia
G
Del Viscovo
Luca
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D005682:Gadolinium; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D014463:Ultrasonography
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D005682:Gadolinium; D013459:Sulfur Hexafluoride