Contrast-enhanced ultrasound for the characterization of focal liver lesions--diagnostic accuracy in clinical practice (DEGUM multicenter trial).
OBJECTIVE
To evaluate the diagnostic benefit of contrast-enhanced ultrasound for the differential diagnosis of liver tumors in clinical practice.


METHODS
From May 2004 to December 2006 1349 patients (male 677, female 672) with a hepatic tumor lacking a definite diagnosis based on B-mode ultrasound and power Doppler ultrasound were examined at 14 hospitals by contrast-enhanced ultrasound using a standardized protocol (pulse/phase inversion imaging, mechanical index < 0.4). The Tumor status was assessed based on the vascularity pattern and contrast enhancement seen in focal lesions during the arterial, portal, and late phase. The diagnosis established after contrast-enhanced ultrasound was compared to histology (> 75% cases) or in some cases to CT or MRI.


RESULTS
The final diagnosis of hepatic tumors included 573 benign hepatic tumors (hemangiomas n = 242, focal nodular hyperplasia n = 170, hepatocellular adenoma n = 19, other benign lesions n = 142) and 755 malignant hepatic tumors (metastases n = 383, hepatocellular carcinoma n = 279, other malignant lesions n= 93). The overall diagnostic accuracy of contrast-enhanced ultrasound in comparison to the correct final diagnosis based on the combined gold standard was 90.3%. Contrast-enhanced ultrasound was able to correctly assess 723/755 malignant lesions (sensitivity 95.8%) and 476/573 benign lesions (specificity 83.1%). The positive predictive value of contrast-enhanced ultrasound for the diagnosis of a malignant tumor was 95.4% and the negative predictive value of contrast-enhanced ultrasound was 95.7%.


CONCLUSIONS
Contrast-enhanced ultrasound clearly improves the differential diagnosis of hepatic tumors and is very helpful in clinical practice when B-scan or power Doppler morphological criteria are missing.
Strobel
D
D
Internal medicine I, University of Erlangen, Erlangen. deike.strobel@uk-erlangen.de
Seitz
K
K
Blank
W
W
Schuler
A
A
Dietrich
C
C
von Herbay
A
A
Friedrich-Rust
M
M
Kunze
G
G
Becker
D
D
Will
U
U
Kratzer
W
W
Albert
F W
FW
Pachmann
C
C
Dirks
K
K
Strunk
H
H
Greis
C
C
Bernatik
T
T
D003287:Contrast Media; D006801:Humans; D007089:Image Enhancement; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography
D003287:Contrast Media