title: Tumor-specific vascularization pattern of liver metastasis, hepatocellular carcinoma, hemangioma and focal nodular hyperplasia in the differential diagnosis of 1,349 liver lesions in contrast-enhanced ultrasound (CEUS).
abstract: OBJECTIVE
  To evaluate the incidence and diagnostic accuracy of tumor-specific vascularization pattern in contrast-enhanced ultrasound (CEUS) in 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 CEUS using a standardized protocol (pulse/phase inversion imaging, mechanical index < 0.4). Vascularity pattern and contrast enhancement pattern were analyzed in focal lesions during the arterial, portal, and late phase. The tumor-specific diagnosis established after CEUS was compared to histology (> 75 % cases) or in some cases to CT or MRI.
  
  
  RESULTS
  The final diagnosis of 573 benign hepatic tumors included hemangiomas (n = 242) and focal nodular hyperplasia (n = 170), other benign lesions (n = 161). Tumor-specific vascularization pattern such as a wheel-spoke pattern and arterial hyperenhancement followed by isoenhancement in the late phase in FNH or a nodular peripheral enhancement and partial or complete fill-in pattern in hemangiomas could be assessed in the majority, but not all lesions. The diagnostic accuracy of CEUS was 83.1 % for all benign lesions and 82.2 % for hemangioma and 87.1 % for FNH. The final diagnosis of 755 malignant hepatic tumors included metastases n = 383, hepatocellular carcinoma n = 279 and other malignant lesions n = 93. Late phase hypoenhancement was seen in almost all liver metastases (94.7 %) The diagnostic accuracy of CEUS was 95.8 % for all malignant lesions and 91.4 % for liver metastases and 84.9 % for hepatocellular carcinomas.
  
  
  CONCLUSIONS
  Tumor-specific vascularization pattern in CEUS have a high diagnostic impact on the overall high diagnostic accuracy of CEUS for the differential diagnosis of hepatic tumors in clinical practice.
authors.affiliation: Internal medicine I, University of Erlangen, Ulmenweg 18, 91058 Erlangen. deike.strobel@uk-erlangen.de
authors.forename: D
authors.initials: D
authors.lastname: Strobel
authors.forename: K
authors.initials: K
authors.lastname: Seitz
authors.forename: W
authors.initials: W
authors.lastname: Blank
authors.forename: A
authors.initials: A
authors.lastname: Schuler
authors.forename: C F
authors.initials: CF
authors.lastname: Dietrich
authors.forename: A
authors.initials: A
authors.lastname: von Herbay
authors.forename: M
authors.initials: M
authors.lastname: Friedrich-Rust
authors.forename: T
authors.initials: T
authors.lastname: Bernatik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000098:blood supply* / Q000000981:diagnostic imaging*; D002648:Child; D003287:Contrast Media / Q000008:administration & dosage*; D003937:Diagnosis, Differential; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000000981:diagnostic imaging*; D006406:Hematoma / Q000000981:diagnostic imaging*; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D007089:Image Enhancement; D033162:Incidental Findings; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D011169:Portal Vein / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D003287:Contrast Media