title: Indeterminate solid hepatic lesions identified on non-diagnostic contrast-enhanced computed tomography: assessment of the additional diagnostic value of contrast-enhanced ultrasound in the non-cirrhotic liver.
abstract: OBJECTIVE
  To assess the additional diagnostic value of contrast-enhanced ultrasound (CEUS) in the characterization of indeterminate solid hepatic lesions identified on non-diagnostic contrast-enhanced computed tomography (CT).
  
  
  METHODS
  Fifty-five solid hepatic lesions (1-4 cm in diameter) in 46 non-cirrhotic patients (26 female, 20 male; age±SD, 55±10 years) underwent CEUS after being detected on contrast-enhanced CT which was considered as non-diagnostic after on-site analysis. Two blinded independent readers assessed CT and CEUS scans and were asked to classify retrospectively each lesion as a malignant or benign based on reference diagnostic criteria for the different hepatic lesion histotypes. Diagnostic accuracy and confidence (area--Az--under ROC curve) were assessed by using gadobenate dimeglumine-enhanced magnetic resonance (MR) imaging (n=30 lesions), histology (n=7 lesions), or US follow-up (n=18 lesions) as the reference standards.
  
  
  RESULTS
  Final diagnoses included 29 hemangiomas, 3 focal nodular hyperplasias, 1 hepatocellular adenoma, and 22 metastases. The additional review of CEUS after CT images improved significantly (P<.05) the diagnostic accuracy (before vs after CEUS review=49% [20/55] vs 89% [49/55]--reader 1 and 43% [24/55] vs 92% [51/55]--reader 2) and confidence (Az, 95% Confidence Intervals before vs after CEUS review=.773 [.652-.895] vs .997 [.987-1]--reader 1 and .831 [.724-.938] vs .998 [.992-1]--reader 2).
  
  
  CONCLUSIONS
  CEUS improved the characterization of indeterminate solid hepatic lesions identified on non-diagnostic contrast-enhanced CT by identifying some specific contrast enhancement patterns.
authors.affiliation: Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy. Electronic address: quaia@units.it.
authors.forename: Emilio
authors.initials: E
authors.lastname: Quaia
authors.affiliation: Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: De Paoli
authors.affiliation: Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Angileri
authors.affiliation: Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
authors.forename: Biagio
authors.initials: B
authors.lastname: Cabibbo
authors.affiliation: Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy.
authors.forename: Maria Assunta
authors.initials: MA
authors.lastname: Cova
mesh_terms: D003287:Contrast Media; D005260:Female; D006801:Humans; D007455:Iodine; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D007455:Iodine; D013459:Sulfur Hexafluoride
keywords: CT; Liver; Microbubbles; Ultrasound