Contrast-enhanced ultrasound (CEUS) for the characterization of focal liver lesions in clinical practice (DEGUM Multicenter Trial): CEUS vs. MRI--a prospective comparison in 269 patients.
OBJECTIVE
The aim of this prospective multicenter study was to assess the diagnostic role of CEUS in the diagnosis of newly discovered focal liver lesions in clinical practice. One important aspect is the comparison of CEUS with magnetic resonance imaging (MRI).


METHODS
From 05 / 2004 to 12 / 2006, standardized CEUS was performed prospectively on 1349 patients with focal liver lesions that had been newly detected by fundamental ultrasound in order to determine tumor differentiation and tumor entity. 269 patients had a standardized MRI after CEUS. In typical liver hemangioma and focal nodular hyperplasia (FNH), the definitive diagnosis was based on the MRI as the "diagnostic gold standard" and on clinical evidence and additional follow-up (subgroup A) or on histology (subgroup B). 262 patients met the diagnostic standard that had been set.


RESULTS
In the subcollective (n = 262), the tumor differentiation (malignant or benign) of CEUS and MRI was concordant in 225 cases (85.9%), and the assessment of tumor entity in 204 cases (77.9%). In subgroup A (n = 180), concordant results for tumor differentiation were obtained in 169 (93.2%) and for tumor entity in 160 (88.9%) cases. Liver hemangiomas (n = 122) and FNH (n = 43) were most frequent. Subgroup B (n = 82) comprised mainly malignant liver lesions (n = 55), with only a few of hemangiomas (n = 8) or FNH (n = 5). Tumor differentiation was concordant in 56 (68.3%) and tumor entity in 44 cases (53.7%). There were no statistically proven differences between CEUS and MRI.


CONCLUSIONS
CEUS and MRI are of equal value for the differentiation and specification of newly discovered liver tumors in clinical practice. CEUS and MRI are extremely reliable for the differentiation of benign and malignant lesions, the diagnosis of liver hemangiomas and FNH. The characterization of metastases and HCC is also very reliable.
Seitz
K
K
Department of Internal Medicine, District Hospital Sigmaringen, Sigmaringen, Germany. k.seitz@klksig.de
Bernatik
T
T
Strobel
D
D
Blank
W
W
Friedrich-Rust
M
M
Strunk
H
H
Greis
C
C
Kratzer
W
W
Schuler
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology; D015331:Cohort Studies; D003287:Contrast Media / Q000008:administration & dosage; D003911:Dextrans; D003937:Diagnosis, Differential; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis* / Q000473:pathology; D005682:Gadolinium; D019786:Gadolinium DTPA; D006391:Hemangioma / Q000175:diagnosis* / Q000473:pathology; D006571:Heterocyclic Compounds; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary*; D008279:Magnetic Resonance Imaging; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D010743:Phospholipids; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012984:Software; D013459:Sulfur Hexafluoride; D014463:Ultrasonography; D055815:Young Adult
D003287:Contrast Media; D003911:Dextrans; D006571:Heterocyclic Compounds; D058185:Magnetite Nanoparticles; D009942:Organometallic Compounds; D010743:Phospholipids; C420843:contrast agent BR1; C062402:gadoteridol; D005682:Gadolinium; C065507:ferumoxides; D019786:Gadolinium DTPA; D013459:Sulfur Hexafluoride