title: Contrast-enhanced ultrasound in combination with color Doppler ultrasound can improve the diagnostic performance of focal nodular hyperplasia and hepatocellular adenoma.
abstract: The aim of our study was to evaluate the value of combining color Doppler ultrasound (CDUS) with contrast-enhanced ultrasound (CEUS) in identifying and comparing features of focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA). Thirty-eight patients with FNH (n = 28) or HCA (n = 10), whose diagnoses were later confirmed by pathology, were examined with conventional ultrasonography and CEUS between 2010 and 2013. Two doctors blinded to the pathology results independently reviewed the conventional ultrasound and CEUS images and then reached a consensus through discussion. The following parameters evaluated for all lesions included vascularity pattern on CDUS or CEUS, enhancement characteristics on CEUS and the presence of a central scar. Statistical analysis was performed with the independent sample t-test and Fisher exact test. On CDUS, FNH was characterized by the presence of abundant blood flow signals exhibiting dendritic (53.6%, 15/28) and spoke-wheel (28.6%, 8/28) patterns, whereas blood flow signal of HCA was slightly less than FNH and often showed subcapsular short rod-like (50%, 5/10) appearance. On CEUS, the most common arterial enhancement pattern was centrifugal or homogeneous enhancement in FNH (both, 12/28, 42.9%) and homogeneous enhancement in HCA (6/10, 60%). Spoke-wheel arteries, feeding artery and central scar were detected in 5 (17.9%), 8 (28.6%) and 5 (17.9%) of 28 FNHs. Hypo-echogenic pattern during delayed phase was more common in HCA (60%, 6/10) than in FNH (3/28, 10.7%) (p = 0.010). A total of 25 (25/38, 65.8%) lesions were correctly assessed using CDUS in combination with CEUS, whereas the number decreased to 15 (15/38, 39.5%) when CDUS was used alone (p = 0.038). The areas under the ROC curves before and after CEUS administration were 0.768 and 0.879, respectively. In conclusion, CEUS in combination with CDUS improve the diagnostic performance of FNH and HCA. Blood signal of HCA was less than FNH on CDUS. The differences of enhancement pattern during arterial phase and echogenicity during delayed phase may contribute to the differentiation of these lesions.
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Wen-Tao
authors.initials: WT
authors.lastname: Kong
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: puguang61@126.com.
authors.forename: Wen-Ping
authors.initials: WP
authors.lastname: Wang
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Bei-Jian
authors.initials: BJ
authors.lastname: Huang
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Ding
authors.affiliation: Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Mao
authors.affiliation: Department of Ultrasound, 81st Hospital of Chinese PLA, Nanjing Jiangsu, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Si
mesh_terms: D018248:Adenoma, Liver Cell / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D012372:ROC Curve; D015203:Reproducibility of Results; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: Color Doppler ultrasound; Contrast-enhanced ultrasound; Focal liver lesions; Focal nodular hyperplasia; Hepatocellular adenoma