title: Contrast-enhanced sonography in the characterization of small hepatocellular carcinomas in cirrhotic patients: comparison with contrast-enhanced ultrafast magnetic resonance imaging.
abstract: 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.
authors.affiliation: UO di Ecografia Interventistica IX Divisione AO Cotugno, Naples, Italy. assanui1@virgilio.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Giorgio
authors.forename: Giorgio
authors.initials: G
authors.lastname: De Stefano
authors.forename: Carmine
authors.initials: C
authors.lastname: Coppola
authors.forename: Giovanna
authors.initials: G
authors.lastname: Ferraioli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Esposito
authors.forename: Antonella
authors.initials: A
authors.lastname: Di Sarno
authors.forename: Valentina
authors.initials: V
authors.lastname: Giorgio
authors.forename: Manuela
authors.initials: M
authors.lastname: De Stefano
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Sangiovanni
authors.forename: Giulia
authors.initials: G
authors.lastname: Liorre
authors.forename: Luca
authors.initials: L
authors.lastname: Del Viscovo
mesh_terms: 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
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D005682:Gadolinium; D013459:Sulfur Hexafluoride