title: Activity-based cost analysis of contrast-enhanced ultrasonography (CEUS) related to the diagnostic impact in focal liver lesion characterisation.
abstract: OBJECTIVE
  This study was done to assess the clinical-diagnostic impact and cost of contrast-enhanced ultrasound (CEUS) versus computed tomography (CT) and magnetic resonance (MR) imaging in the characterisation of focal liver lesions.
  
  
  METHODS
  CEUS with sulphur hexafluoride-filled microbubbles (SonoVue bolus 2.4 ml) was performed in 157 patients with 160 focal liver lesions identified by other diagnostic techniques. CEUS images were obtained during the arterial (15 to 35 s from contrast injection), portal venous (40 to 70 s) and late phase (up to 300 s from microbubble injection). Contrast-enhanced CT was performed with a 64-row multidetector CT. MRI was performed before and after administration of the liver-specific contrast agent gadobenate dimeglumine (Gd-BOPTA). A patient-by-patient activity-based cost analysis was performed.
  
  
  RESULTS
  CEUS led to a change in the diagnostic workup in 131/157 patients (83.4 %) and in the therapeutic workup in 93/157 patients (59.2 %). CEUS allowed for the final diagnosis to be established in 133/157 patients (84.7 %). The full cost of CEUS was lower than that of contrast-enhanced CT and MR imaging.
  
  
  CONCLUSIONS
  CEUS determined a change in the diagnostic and therapeutic workup in the characterisation of focal liver lesions and reduced the full costs of the diagnostic process.
  
  
  CONCLUSIONS
  • CEUS allows a correct diagnosis in more than 80 % of focal liver lesions. • CEUS has a significant impact on the diagnosis of focal liver lesions. • CEUS examination of focal liver lesions reduces total costs. • Dynamic MR with hepato-specific contrast medium remains the reference standard for lesion characterisation. • CEUS is low-cost, versatile and accurate in the characterisation of focal liver lesions.
authors.affiliation: U.C.O. di Radiologia, Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Azienda Ospedaliero - Universitaria AOUTS, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy.
authors.forename: Arianna
authors.initials: A
authors.lastname: Lorusso
authors.forename: Emilio
authors.initials: E
authors.lastname: Quaia
authors.forename: Gabriele
authors.initials: G
authors.lastname: Poillucci
authors.forename: Fulvio
authors.initials: F
authors.lastname: Stacul
authors.forename: Guido
authors.initials: G
authors.lastname: Grisi
authors.forename: Maria Assunta
authors.initials: MA
authors.lastname: Cova