title: Imaging detection of new HCCs in cirrhotic patients treated with different techniques: Comparison of conventional US, spiral CT, and 3-dimensional contrast-enhanced US with the Navigator technique (Nav 3D CEUS)().
abstract: BACKGROUND
  The commercially available Navigator system(©) (Esaote, Italy) allows easy 3D reconstruction of a single 2D acquisition of contrast-enhanced US (CEUS) imaging of the whole liver (with volumetric correction provided by the electromagnetic device of the Navigator(©)). The aim of our study was to compare the efficacy of this panoramic technique (Nav 3D CEUS) with that of conventional US and spiral CT in the detection of new hepatic lesions in patients treated for hepatocellular carcinoma (HCC).
  
  
  METHODS
  From November 2006 to May 2007, we performed conventional US, Nav 3D CEUS, and spiral CT on 72 cirrhotic patients previously treated for 1 or more HCCs (M/F: 38/34; all HCV-positive; Child: A/B 58/14) (1 examination: 48 patients; 2 examinations: 20 patients; 3 examinations: 4 patients). Nav 3D CEUS was performed with SonoVue(©) (Bracco, Milan, Italy) as a contrast agent and Technos MPX(©) scanner (Esaote, Genoa, Italy). Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values (PPV and NPV, respectively) were evaluated. Differences between the techniques were assessed with the chi-square test (SPSS release-15).
  
  
  RESULTS
  Definitive diagnoses (based on spiral CT and additional follow-up) were: 6 cases of local recurrence (LocRecs) in 4 patients, 49 new nodules >2 cm from a treated nodule (NewNods) in 34 patients, and 10 cases of multinodular recurrence consisting of 4 or more nodules (NewMulti). The remaining 24 patients (22 treated for 1-3 nodules, 2 treated for >3 nodules) remained recurrence-free. Conventional US correctly detected 29/49 NewNods, 9/10 NewMultis, and 3/6 LocRecs (sensitivity: 59.2%; specificity: 100%; diagnostic accuracy: 73.6%; PPV: 100%; NPV: 70.1%). Spiral CT detected 42/49 NewNods plus 1 that was a false positive, 9/10 NewMultis, and all 6 LocRecs (sensitivity: 85.7%; specificity: 95.7%; diagnostic accuracy: 90.9%; PPV: 97.7%; NPV: 75.9%). 3D NAV results were: 46N (+9 multinodularN and 6 LR), 3 false-negatives, and one false-positive (sensitivity: 93.9; specificity: 97.9%; diagnostic accuracy: 95.6; PPV: 97.9; NPV: 93.9).
  
  
  CONCLUSIONS
  3D Nav CEUS is significantly better than US and very similar to spiral CT for detection of new HCCs. This technique revealed the presence of lesions that could not be visualized with spiral CT.
authors: Gastroenterology and Hepatology Unit, Gugliemo da Saliceto Hospital, via Taverna 49, 29100 Piacenza, Italy.
authors: F
authors: F
authors: Giangregorio
authors: G
authors: G
authors: Comparato
authors: M G
authors: MG
authors: Marinone
authors: M
authors: M
authors: Di Stasi
authors: G
authors: G
authors: Sbolli
authors: G
authors: G
authors: Aragona
authors: P
authors: P
authors: Tansini
authors: F
authors: F
authors: Fornari
keywords: Contrast-enhanced ultrasound; Detection; Hepatocellular carcinoma; Liver; SonoVue; Spiral CT; Three-dimensional ultrasound
references: Liver Int. 2006 Dec;26(10):1241-7
references: 17105590
references: J Ultrasound Med. 2005 Jan;24(1):49-57
references: 15615928
references: J Vasc Interv Radiol. 2000 May;11(5):611-21
references: 10834493
references: J Ultrasound Med. 2003 Nov;22(11):1239-47
references: 14620896
references: Invest Radiol. 2008 Jan;43(1):33-9
references: 18097275
references: Ann Surg. 2007 Aug;246(2):288-94
references: 17667508
references: Radiographics. 2005 Sep-Oct;25(5):1299-320
references: 16160113
references: Ultraschall Med. 2008 Feb;29(1):28-44
references: 18270887
references: Radiology. 2005 Oct;237(1):170-80
references: 16126930
references: Eur J Radiol. 2005 Feb;53(2):312-7
references: 15664297
references: Eur J Surg Oncol. 2008 Apr;34(4):456-61
references: 17765451
references: Br J Surg. 2007 Jul;94(7):866-75
references: 17380480
references: Hepatology. 2005 Nov;42(5):1208-36
references: 16250051
references: J Hepatol. 2001 Sep;35(3):421-30
references: 11592607
references: Hepatology. 2003 Oct;38(4):1034-42
references: 14512891
references: J Ultrasound Med. 2003 Feb;22(2):215-20
references: 12562126
references: J Vasc Interv Radiol. 2002 Mar;13(3):267-73
references: 11875086
references: Rev Esp Enferm Dig. 2005 Feb;97(2):125-34
references: 15801888
references: J Vasc Interv Radiol. 2001 Apr;12(4):507-15
references: 11287540
references: Korean J Radiol. 2006 Jan-Mar;7(1):28-34
references: 16549953
references: Semin Liver Dis. 1999;19(3):329-38
references: 10518312
references: Surg Endosc. 2003 Jun;17(6):933-8
references: 12632127
references: AJR Am J Roentgenol. 2006 May;186(5 Suppl):S255-60
references: 16632685
references: Int J Clin Oncol. 2006 Aug;11(4):268-77
references: 16937300
references: Invest Radiol. 1996 Jan;31(1):26-9
references: 8850362
references: Radiology. 2000 May;215(2):365-72
references: 10796909