title: Diagnosis of liver cirrhosis by transit-time analysis at contrast-enhanced ultrasonography.
abstract: OBJECTIVE
  The aims of this prospective study were to evaluate analysis of sulfur-hexafluoride-filled microbubble contrast agent (Sonovue) transit times as a tool for differentiating liver cirrhosis from the noncirrhotic stage of liver disease and to compare its performance with that of conventional B-mode and Doppler ultrasonography (US).
  
  
  METHODS
  Contrast-enhanced hepatic ultrasonography with the US contrast agent Sonovue was performed on 38 patients with diagnoses of hepatic cirrhosis based on unequivocal clinical signs or liver biopsy findings (Child-Pugh classes A in 19, B in 16 and C in three), 31 patients with noncirrhotic diffuse liver disease (biopsy confirmed) and 14 controls without diffuse liver disease. Time curves of hepatic-vein signal intensity were analysed using objective criteria to determine the time of enhancement onset (hepatic-vein arrival time) and peak enhancement (hepatic-vein peak enhancement). Accuracy in diagnosing cirrhosis was compared with that based on B-mode and Doppler data.
  
  
  RESULTS
  Hepatic-vein arrival time in cirrhotic patients was significantly shorter (p < 0.01) than in noncirrhotic (chronic liver disease and controls) patients. Peak enhancement times in these three groups were not significantly different. An arrival-time cutoff of 17 s distinguished cirrhotic from noncirrhotic patients with high accuracy (100% sensitivity, 93.3% specificity, positive and negative predictive values 92.6% and 100%, respectively) and excellent reproducibility (kappa coefficients of 1.0 and 0.93 for intraand interobserver agreement). Contrast-enhanced US showed better sensitivity than the B-mode and Doppler data.
  
  
  CONCLUSIONS
  Analysis of the time of onset of US contrast enhancement of the hepatic vein appears to be a potentially useful noninvasive supplement to conventional sonography and Doppler in the follow-up of patients with chronic diffuse liver disease.
authors.affiliation: Unità di Radiologia, SIUMB Ultrasound School, Ospedale Civile di Senigallia, Via Cellini 1, Senigallia, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Abbattista
authors.forename: F
authors.initials: F
authors.lastname: Ridolfi
authors.forename: E
authors.initials: E
authors.lastname: Ciabattoni
authors.forename: F
authors.initials: F
authors.lastname: Marini
authors.forename: E
authors.initials: E
authors.lastname: Bendia
authors.forename: E
authors.initials: E
authors.lastname: Brunelli
authors.forename: P
authors.initials: P
authors.lastname: Busilacchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001706:Biopsy; D016009:Chi-Square Distribution; D003627:Data Interpretation, Statistical; D003937:Diagnosis, Differential; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008107:Liver Diseases / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D018608:Ultrasonography, Doppler
chemical_list: D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride