title: Improved detection of hepatic metastases with contrast-enhanced low mechanical-index pulse inversion ultrasonography during the liver-specific phase of sonazoid: observer performance study with JAFROC analysis.
abstract: OBJECTIVE
  To compare B-mode ultrasonography (US) alone with the combination of B-mode and contrast-enhanced (Sonazoid) late-phase pulse-inversion US for the detection of hepatic metastases by use of jackknife free-response receiver-operating characteristic (JAFROC) analysis.
  
  
  METHODS
  Twenty-seven patients with 57 hepatic metastases and 6 patients without hepatic metastases underwent B-mode and contrast-enhanced US. We used the diagnoses established by contrast-enhanced computed tomography and contrast-enhanced US as the standard of reference. All ultrasonographic scanning was performed by an experienced radiologist with a routine clinical procedure. All scanning data were archived with digital cine clips. A review system, which can display pairs of cine clips for B-mode and contrast-enhanced US side by side, was developed for off-site observer study. Seven radiologists interpreted each case individually first by B-mode US only, and then by the combination with contrast-enhanced US by identifying locations of possible candidates for hepatic metastasis with their confidence ratings. The figure-of-merit (FOM) values, sensitivity, and false-positives per case were estimated for B-mode US alone, and for the combination of B-mode and contrast-enhanced US.
  
  
  RESULTS
  The sensitivities of the combined ultrasonographic imaging (mean, 72.2%) were clearly improved from that of B-mode US alone (mean, 41.6%) while reducing the average number of false positives from 1.1 to 0.5 per case. In the jackknife analysis, there was a statistically significant difference between mean FOM values for the combined imaging (0.76) and for B-mode US alone (0.44, P < .00001).
  
  
  CONCLUSIONS
  Evaluating cine clips of contrast-enhanced liver US together with B-mode US could improve physicians' accuracy for detection of hepatic metastases.
authors.affiliation: Kurt Rossmann Laboratories for Radiologic Imaging Research, Department of Radiology, The University of Chicago, 5841 S. Maryland Ave., MC 2026, Chicago, IL 60637, USA. sugimoto@comcast.net
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Junji
authors.initials: J
authors.lastname: Shiraishi
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Saito
authors.forename: Kunio
authors.initials: K
authors.lastname: Doi
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D005290:Ferric Compounds; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007501:Iron; D008099:Liver / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D010087:Oxides; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D005290:Ferric Compounds; D010087:Oxides; C069727:Sonazoid; D007501:Iron