title: Detection of liver metastases in cancer patients with geographic fatty infiltration of the liver: the added value of contrast-enhanced sonography.
abstract: OBJECTIVE
  The aim of this study is to assess the role of contrast-enhanced ultrasonography (CEUS) in the detection of liver metastases in cancer patients with geographic liver fatty deposition on greyscale ultrasonography (US).
  
  
  METHODS
  Thirty-seven consecutive cancer patients (24 women and 13 men; age, 33 to 80 years; mean, 58.1 years) with geographic liver fatty deposition, but without any detectable focal liver lesion on greyscale US, underwent sulphur hexafluoride-enhanced US. Two readers reported by consensus the presence, size, and location of any detected lesion. All patients underwent magnetic resonance imaging (MRI) as a confirmatory study. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy were calculated.
  
  
  RESULTS
  Seven focal liver lesions (size, 4 to 10 mm; mean, 6.1 mm) were detected in 4/37 patients (10.8%): four metastases (size, 5 to 10 mm; mean, 6.7 mm) were detected both by CEUS and MRI, with one hemangioma and two cysts (size range, 4 to 6 mm; mean, 5.3 mm) detected by MRI only. In 1/37 patients (2.7%), CEUS misdiagnosed geographic fatty change as three metastases. In 32/37 patients (86.5%), no lesions were detected. Sensitivity, specificity, PPV, NPV, and accuracy of CEUS were 100% (95% confidence Interval [CI], 1.000 to 1.000), 97.1% (95% CI, 0.914 to 1.027), 75%, 100%, and 97.3%, respectively. No statistically significant differences were found between CEUS and MRI in the detection of focal liver lesions (P=0.480), whereas both of them performed better than baseline US (P<0.001).
  
  
  CONCLUSIONS
  CEUS improves the detection of liver metastases in cancer patients with geographic liver fatty deposition on greyscale US.
authors.affiliation: Department of Radiology-Di.Bi.Med., University of Palermo, Palermo, Italy.
authors.forename: Tommaso Vincenzo
authors.identifier: 0000-0002-8808-379X
authors.initials: TV
authors.lastname: Bartolotta
authors.affiliation: Department of Radiology-Di.Bi.Med., University of Palermo, Palermo, Italy.
authors.forename: Adele
authors.initials: A
authors.lastname: Taibbi
authors.affiliation: Department of Radiology-Di.Bi.Med., University of Palermo, Palermo, Italy.
authors.forename: Dario
authors.identifier: 0000-0001-6719-7969
authors.initials: D
authors.lastname: Picone
authors.affiliation: Department of Radiology-Di.Bi.Med., University of Palermo, Palermo, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Anastasi
authors.affiliation: Department of Radiology-Di.Bi.Med., University of Palermo, Palermo, Italy.
authors.forename: Massimo
authors.identifier: 0000-0003-1824-7549
authors.initials: M
authors.lastname: Midiri
authors.affiliation: Department of Radiology-Di.Bi.Med., University of Palermo, Palermo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lagalla
keywords: Contrast media; Fatty liver; Liver diseases; Liver neoplasms; Neoplasm metastasis; Ultrasonography