title: Contrast-enhanced ultrasound in the characterization of complex cystic focal liver lesions.
abstract: Complex cystic focal liver lesions (FLLs) found at non-contrast ultrasound (US) may turn out to be malignant. In this prospective, monocentric study we investigated the value of contrast-enhanced US (CEUS) in the differential diagnosis of complex cystic FLLs. In the past 3 years, all patients with complex cystic FLLs unclassifiable at US underwent CEUS with low-transmit insonation power. We evaluated 36 consecutive patients with 61 FLLs (1-6/patient, mean = 2). The diameter of the lesions ranged from 1.1 to 7.9 cm (mean = 3.9 cm). Sixteen patients had an extrahepatic malignancy. There were 42 malignant lesions and 19 benign lesions. No lesion had a certain diagnosis at conventional US, whereas 16 FLLs were classified as probable (benign or malignant) and 45 as uncertain. CEUS correctly categorized 95% of the malignant cases. CEUS was not able to differentiate the biliary cystadenoma from its malignant counterpart and misdiagnosed two abscesses. Complete non-enhancement throughout three phases or sustained enhancement in the portal/late phase was exhibited in most benign complex cystic FLLs, except for 1 (of the 3) cystadenomas and in 2 (of the 4) abscesses. On the other hand, all malignant lesions presented a contrast washout with a hypo-enhancing appearance. CEUS may provide added diagnostic value in all complex cystic FLLs found uncertain at conventional US, potentially avoiding the use of more invasive and expensive imaging modalities.
authors: Department of Radiology and Institute of Biostructures, University Federico II, Naples, Italy; First Department of Radiology, National Cancer Institute, Fondazione Pascale, Naples, Italy. Electronic address: An.cor@hotmail.it.
authors: A
authors: A
authors: Corvino
authors: First Department of Radiology, National Cancer Institute, Fondazione Pascale, Naples, Italy.
authors: O
authors: O
authors: Catalano
authors: First Department of Radiology, National Cancer Institute, Fondazione Pascale, Naples, Italy.
authors: S V
authors: SV
authors: Setola
authors: First Department of Radiology, National Cancer Institute, Fondazione Pascale, Naples, Italy.
authors: F
authors: F
authors: Sandomenico
authors: Department of Radiology and Institute of Biostructures, University Federico II, Naples, Italy.
authors: F
authors: F
authors: Corvino
authors: First Department of Radiology, National Cancer Institute, Fondazione Pascale, Naples, Italy.
authors: A
authors: A
authors: Petrillo
mesh_terms: D003287:Contrast Media / Q000008:administration & dosage; D003560:Cysts / Q000000981:diagnostic imaging*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D010743:Phospholipids / Q000008:administration & dosage*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride / Q000008:administration & dosage*; D014463:Ultrasonography / Q000379:methods*
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: Contrast agent; Cystic lesions; Liver; Microbubbles; Ultrasound