title: Sonazoid-enhanced ultrasonography for evaluation of the enhancement patterns of focal liver tumors in the late phase by intermittent imaging with a high mechanical index.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the enhancement patterns of focal liver tumors in the late phase of Sonazoid-enhanced ultrasonography by intermittent imaging with a high mechanical index (MI).
  
  
  METHODS
  A total of 142 patients with 208 lesions, including 109 hepatocellular carcinomas (HCCs), 61 metastases, 30 hemangiomas, and 8 focal nodular hyperplasias (FNHs), were enrolled in this prospective study. Contrast-enhanced ultrasonography with intermittent scanning at 2 frames per second (MI, 0.7-1.2) was conducted in the late phase (>5 minutes after bolus intravenous injection of the perflubutane-based contrast agent Sonazoid; Daiichi Sankyo, Tokyo, Japan). Two blinded readers classified the enhancement patterns of the lesions. The sensitivity, specificity, and positive predictive value (PPV) of the dominant enhancement patterns and inter-reader agreement were assessed.
  
  
  RESULTS
  A combination of diffuse enhancement with intratumoral vessels and intratumoral vessels alone yielded sensitivity of 85% (average of both readers), specificity of 88%, and a PPV of 88% for HCC. For metastasis, a combination of peripheral ringlike enhancement with peritumoral vessels and peripheral ringlike enhancement with intratumoral vessels yielded sensitivity of 79%, specificity of 95%, and a PPV of 85%. For hemangiomas, a combination of peripheral nodular enhancement with peritumoral vessels and peripheral nodular enhancement without peritumoral vessels yielded sensitivity of 75%, specificity of 99%, and a PPV of 92%. Diffuse enhancement with spoked wheel arteries yielded sensitivity of 82%, specificity of 100%, and a PPV of 87% for FNHs. Good inter-reader agreement was achieved.
  
  
  CONCLUSIONS
  Sonazoid-enhanced ultrasonography using intermittent imaging with a high MI can potentially be used for evaluating the enhancement patterns of focal liver tumors in the late phase.
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Kanagawa 232-0024, Japan.
authors.forename: Wen
authors.initials: W
authors.lastname: Luo
authors.forename: Kazushi
authors.initials: K
authors.lastname: Numata
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kondo
authors.forename: Manabu
authors.initials: M
authors.lastname: Morimoto
authors.forename: Kazuya
authors.initials: K
authors.lastname: Sugimori
authors.forename: Kingo
authors.initials: K
authors.lastname: Hirasawa
authors.forename: Akito
authors.initials: A
authors.lastname: Nozaki
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Zhou
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Tanaka