title: Contrast-enhanced ultrasound (CEUS) for the evaluation of focal liver lesions - a prospective multicenter study of its usefulness in clinical practice.
abstract: OBJECTIVE
  To assess the value of contrast-enhanced ultrasound (CEUS) for differentiating malignant from benign focal liver lesions (FLLs) and for diagnosing different FLL types.
  
  
  METHODS
  CEUS performed in 14 Romanian centers was prospectively collected between February 2011 and June 2012. The inclusion criteria were: age > 18 years; patients diagnosed with 1 - 3 de novo FLLs on B-mode ultrasound; reference method (computed tomography (CT), magnetic resonance imaging (MRI) or biopsy) available; patient's informed consent. FLL lesions were characterized during CEUS according to the European Federation of Societies for Ultrasound in Medicine and Biology guidelines. For statistical analysis, indeterminate FLLs at CEUS were rated as false classifications.
  
  
  RESULTS
  A total number of 536 cases were included in the final analysis, 344 malignant lesions (64.2 %) and 192 benign lesions (35.8 %). The reference method was: CT/MRI - 379 cases (70.7 %), pathological exam - 150 cases (27.9 %) and aspiration of liver abscesses - 7 cases (1.4 %). CEUS was conclusive in 89.3 % and inconclusive in 10.7 % of cases. To differentiate between malignant and benign FLLs, CEUS had 85.7 % sensitivity, 85.9 % specificity, 91.6 % positive predictive value, 77.1 % negative predictive value and 85.8 % accuracy. The CEUS accuracy for differentiation between malignant and benign liver lesions was similar in tumors with diameter ≤ 2 cm and those with diameter > 2 cm.
  
  
  CONCLUSIONS
  CEUS represents a useful method in clinical practice for differentiating between malignant and benign FLLs detected on standard ultrasonography, and the results of this study are in concordance with previous multicenter studies: DEGUM (Germany) and STIC (France).
authors.affiliation: Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babeş" Timişoara, Romania.
authors.forename: I
authors.initials: I
authors.lastname: Sporea
authors.affiliation: Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, Romania.
authors.forename: R
authors.initials: R
authors.lastname: Badea
authors.affiliation: Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babeş" Timişoara, Romania.
authors.forename: A
authors.initials: A
authors.lastname: Popescu
authors.affiliation: Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, Romania.
authors.forename: Z
authors.initials: Z
authors.lastname: Spârchez
authors.affiliation: Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babeş" Timişoara, Romania.
authors.forename: R L
authors.initials: RL
authors.lastname: Sirli
authors.affiliation: Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babeş" Timişoara, Romania.
authors.forename: M
authors.initials: M
authors.lastname: Dănilă
authors.affiliation: Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania.
authors.forename: L
authors.initials: L
authors.lastname: Săndulescu
authors.affiliation: Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babeş" Timişoara, Romania.
authors.forename: S
authors.initials: S
authors.lastname: Bota
authors.affiliation: Department of Gastroenterology, Emergency Hospital Floreasca, Bucharest, Romania.
authors.forename: D P
authors.initials: DP
authors.lastname: Calescu
authors.affiliation: Delta Promedical Hospital, Bucharest, Romania.
authors.forename: D
authors.initials: D
authors.lastname: Nedelcu
authors.affiliation: Department of Gastroenterology, University of Oradea, Romania.
authors.forename: C
authors.initials: C
authors.lastname: Brisc
authors.affiliation: 1st Medical Department, Central Military Emergency University Hospital "Dr. Carol Davila", Bucharest, Romania.
authors.forename: L
authors.initials: L
authors.lastname: Ciobâca
authors.affiliation: IIIrd Department of Gastroenterology and Hepatology, Clinical Institute Fundeni, Bucharest, Romania.
authors.forename: L
authors.initials: L
authors.lastname: Gheorghe
authors.affiliation: Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, Romania.
authors.forename: M
authors.initials: M
authors.lastname: Socaciu
authors.affiliation: Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babeş" Timişoara, Romania.
authors.forename: A
authors.initials: A
authors.lastname: Martie
authors.affiliation: Center of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: S
authors.initials: S
authors.lastname: Ioaniţescu
authors.affiliation: Department of Anatomy and Embriology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, Romania.
authors.forename: A
authors.initials: A
authors.lastname: Tamas
authors.affiliation: Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania.
authors.forename: C T
authors.initials: CT
authors.lastname: Streba
authors.affiliation: 1st Medical Department, Central Military Emergency University Hospital "Dr. Carol Davila", Bucharest, Romania.
authors.forename: M
authors.initials: M
authors.lastname: Iordache
authors.affiliation: IIIrd Department of Gastroenterology and Hepatology, Clinical Institute Fundeni, Bucharest, Romania.
authors.forename: I
authors.initials: I
authors.lastname: Simionov
authors.affiliation: 1st Medical Department, Central Military Emergency University Hospital "Dr. Carol Davila", Bucharest, Romania.
authors.forename: M
authors.initials: M
authors.lastname: Jinga
authors.affiliation: 1st Medical Department, Central Military Emergency University Hospital "Dr. Carol Davila", Bucharest, Romania.
authors.forename: A
authors.initials: A
authors.lastname: Anghel
authors.affiliation: Institute of Gastroenterology and Hepatology, "Grigore T. Popa" University of Medicine and Pharmacy Iaşi, Romania.
authors.forename: C
authors.initials: C
authors.lastname: Cijevschi Prelipcean
authors.affiliation: Institute of Gastroenterology and Hepatology, "Grigore T. Popa" University of Medicine and Pharmacy Iaşi, Romania.
authors.forename: C
authors.initials: C
authors.lastname: Mihai
authors.affiliation: 1st Medical Department, Central Military Emergency University Hospital "Dr. Carol Davila", Bucharest, Romania.
authors.forename: S M
authors.initials: SM
authors.lastname: Stanciu
authors.affiliation: 1st Medical Department, Central Military Emergency University Hospital "Dr. Carol Davila", Bucharest, Romania.
authors.forename: D
authors.initials: D
authors.lastname: Stoicescu
authors.affiliation: Department of Gastroenterology, University of Constanta, Romania.
authors.forename: E
authors.initials: E
authors.lastname: Dumitru
authors.affiliation: IIIrd Department of Gastroenterology and Hepatology, Clinical Institute Fundeni, Bucharest, Romania.
authors.forename: C
authors.initials: C
authors.lastname: Pietrareanu
authors.affiliation: Department of Internal Medicine and Gastroenterology, Emergency Hospital Floreasca, Bucharest, Romania.
authors.forename: D
authors.initials: D
authors.lastname: Bartos
authors.affiliation: Ist, Medical Clinic, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Cluj Napoca, Romania.
authors.forename: R
authors.initials: R
authors.lastname: Manzat Saplacan
authors.affiliation: IIIrd Department of Gastroenterology and Hepatology, Clinical Institute Fundeni, Bucharest, Romania.
authors.forename: I
authors.initials: I
authors.lastname: Pârvulescu
authors.affiliation: IIIrd Department of Gastroenterology and Hepatology, Clinical Institute Fundeni, Bucharest, Romania.
authors.forename: R
authors.initials: R
authors.lastname: Vădan
authors.affiliation: IIIrd Department of Gastroenterology and Hepatology, Clinical Institute Fundeni, Bucharest, Romania.
authors.forename: G
authors.initials: G
authors.lastname: Smira
authors.affiliation: Department of Gastroenterology, University of Constanta, Romania.
authors.forename: L
authors.initials: L
authors.lastname: Tuţă
authors.affiliation: Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania.
authors.forename: A
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authors.lastname: Săftoiu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008100:Liver Abscess / Q000000981:diagnostic imaging / Q000473:pathology; D008107:Liver Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000556:secondary; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012016:Reference Values; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D003287:Contrast Media