title: Undetermined focal liver lesions on gray-scale ultrasound in patients with fatty liver: characterization with contrast-enhanced ultrasound.
abstract: OBJECTIVE
  The purpose of this study was to assess the clinical value and potential impact of contrast-enhanced ultrasound (CEUS) in the characterization of undetermined focal liver lesions (FLLs) in patients with fatty liver.
  
  
  METHODS
  Fifty-two patients (34 men, 18 women) with fatty liver with 67 FLLs (size range, 1-8.6 cm; mean, 4.1 +/- 3.1 cm) undetermined at baseline ultrasound (US) underwent contrast-enhanced US. CEUS examinations were analyzed by two experienced sonologists blinded to the final diagnosis. Readers evaluated by consensus the baseline echogenicity, the dynamic enhancement pattern in comparison with peripheral liver parenchyma. The final diagnosis was based on consensus interpreting of all examinations by another two expert observers with access to histological data. The characterization accuracy, sensitivity, and specificity of CEUS in characterizing the lesion as benign or malignant, and as the correct pathologic type, were analyzed.
  
  
  RESULTS
  After CEUS, two hemangiomas, three inflammatory pseudotumors, and one hepatocellular carcinoma were misdiagnosed. The overall characterization accuracy, sensitivity and specificity of CEUS were 91% (61/67), 91.7% (11/12), and 90.9% (50/55), respectively. Forty-three benign lesions were diagnosed as the correct pathologic type. The portal venous phase and late phase were important in the characterization of the lesions. The characterization accuracy had no relationship with the size of FLLs.
  
  
  CONCLUSIONS
  CEUS can improve the characterization of undetermined FLLs arising from fatty liver.
authors: Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China.
authors: Zhi-Li
authors: ZL
authors: Wang
authors: Jie
authors: J
authors: Tang
authors: Hance Peter
authors: HP
authors: Weskott
authors: Jun-Lai
authors: JL
authors: Li
authors: Wei
authors: W
authors: Wang
authors: Yu-Kun
authors: YK
authors: Luo
authors: Li-Chun
authors: LC
authors: An
authors: Jian-Hong
authors: JH
authors: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000209:etiology; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging; D003287:Contrast Media; D003951:Diagnostic Errors; D005234:Fatty Liver / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006104:Granuloma, Plasma Cell / Q000000981:diagnostic imaging; D006391:Hemangioma / Q000000981:diagnostic imaging; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000209:etiology; D008223:Lymphoma / Q000000981:diagnostic imaging; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D010743:Phospholipids; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride