Ultrasound-arterioportography (US-AP): A new technical approach to perform detection of liver lesions.
OBJECTIVE
To show the feasibility of a combination of the advantages of modern contrast enhanced ultrasound (CEUS) with the technique of arterioportography to achieve the highest sensitivity of all different modalities.


METHODS
Ten patients (9 m, 1 f, age 52-73 years) with suspected hepatocellular carcinoma (HCC) in liver cirrhosis (8 ethyl toxic, 2 hepatitis) were included before transarterial chemo-embolization (TACE). In all patients during a 6-week period a double enhanced MRI (Gd-DTPA and SPIO) was performed. Before TACE a bolus <2 mL ultrasound contrast agent (SonoVue®, Bracco, Milan, Italy) was injected over a selectively placed catheter in the superior mesenteric artery (SMA) and ultrasound of the liver (2.5-4 MHz, LOGIQ 9; GE Healthcare) was performed in arterioportographic phase (US-AP). Two independent readers evaluate number, size and localisation of detected lesion in MRI and US-AP. Additional diagnostic quality of both modalities was determined using a 4-point scale (1: excellent-4: not diagnostic). Differences were analysed for significance using a t-test. Interobserver variability was calculated (κ-value).


RESULTS
In all 10 patients (100 %) US-AP was feasible. Diagnostic quality was in all cases between 1-2 for both modalities and readers (MRI standard deviation (SD) -0.51, Sono-AP SD -0.421). US-AP detected with 33.5 vs. 24.5 lesions, significant more lesions than double enhanced MRI (p < 0.022). The interobserver variability was κ -0.965 for MRI and κ -0.898 for US-AP.


CONCLUSIONS
US-AP for detection of liver lesions is feasible. Using this technique significantly more lesions in patients with hepatocellular carcinoma could be detected in comparison to MRI with liver-specific contrast agent.
Department of Radiology, Regensburg University School of Medicine, Regensburg, Germany.
Niels
N
Zorger
Ernst-Michael
EM
Jung
Andreas G
AG
Schreyer
Peter
P
Heiss
René
R
Mueller-Wille
Reiner
R
Wiest
Stefan
S
Feuerbach
Janine
J
Rennert
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D011172:Portography / Q000379:methods; D013459:Sulfur Hexafluoride; D014463:Ultrasonography / Q000379:methods*
D010743:Phospholipids; C420843:contrast agent BR1; D019786:Gadolinium DTPA; D013459:Sulfur Hexafluoride