Contrast-enhanced ultrasound with SonoVue: differentiation between benign and malignant focal liver lesions in 317 patients.
OBJECTIVE
The aim of the study was to investigate the ability of contrast-enhanced sonography (CEUS) with the contrast agent SonoVue to differentiate between benign and malignant focal liver lesions.


METHODS
In a prospective study, we examined 317 patients (204 males, 113 females, aged 59 +/- 12 years) with focal liver lesions detected by B-mode gray-scale sonography. After intravenous injection of 1.2 mL SonoVue, the liver was examined continuously for 3 minutes using low-MI sonography with contrast-specific software. Final diagnosis was established by histopathology, CT, MRI, or HIDA-scintigraphy.


RESULTS
Two hundred nine patients had malignant focal lesions, including 107 hepatocellular carcinomas, 70 metastases, 26 cholangiocellular carcinomas, and 6 other types of malignancy. One hundred eight patients had benign focal lesions, including 30 regenerative nodules, 30 hemangiomas, 13 cases of focal nodular hyperplasia, 12 abscesses, 8 cases of necrosis, 7 cases of focal steatosis areas, and 8 other benign lesions. Hypoenhancement or no enhancement in the late phase was found in 91% of the malignant lesions but in only 37% of the benign lesions (p < 0.001, sensitivity = 64%, specificity = 93%). Hyperenhancement in the late phase was found in 20% of the benign lesions but in none of the malignant lesions (p < 0.001, sensitivity = 21%, specificity = 100%). Hyperenhancement in the early phase with diffuse complete enhancement was found in 30% of the patients with malignant lesions but in only 2% of the patients with benign lesions (p < 0.001, sensitivity = 30%, specificity = 98%). CEUS had a sensitivity of 90%, a specificity of 99%, and an accuracy of 89% in the diagnosis of malignant liver lesions.


CONCLUSIONS
CEUS is helpful in the differentiation between benign and malignant focal liver lesions.
University of Tübingen, Department of Medicine, Otfried-Müller-Str. 10, D-72076 Tübingen, Germany.
Alexandra
A
von Herbay
Julia
J
Westendorff
Michael
M
Gregor
D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging*; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008099:Liver / Q000000981:diagnostic imaging; D008107:Liver Diseases / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D014463:Ultrasonography
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride