title: Diagnostic accuracy and interobserver variability of Dynamic Vascular Pattern (DVP) in primary liver malignancies - A simple semiquantitative tool for the analysis of contrast enhancement patterns.
abstract: BACKGROUND
  Contrast-enhanced ultrasound (CEUS) is a valuable tool in the diagnostic approach of focal liver lesions, but occasionally subjective and observer-dependent. Semiquantitative evaluation of dynamic CEUS (DCEUS) with standardised software programmes such as Dynamic Vascular Pattern (DVP) could help to improve diagnostic accuracy and objectivity in liver tumour assessment.
  
  
  OBJECTIVE
  The present study aimed at evaluation of diagnostic accuracy of DVP in a clinical setting.
  
  
  METHODS
  DVP images of 52 focal liver lesions [30 hepatocellular carcinomas (HCCs), 15 intrahepatic cholangiocellular carcinomas (ICCs), 7 focal nodular hyperplasias (FNHs)] were analysed by four blinded observers with different levels of CEUS-experience. Diagnostic accuracies for the assessment of dignity and entity were evaluated.
  
  
  RESULTS
  Mean sensitivity, specificity, positive and negative predictive value for detection of malignancy with DVP were 48.4% /67.8% /92.7% and 29.3%, respectively. Total diagnostic accuracies for dignity/entity were 63.9% /38.5% (HCC: 58.3% /25.8%; ICC: 73.3% /50%; FNH: 67.9% /67.9%). Interreader-agreement was moderate (κ= 0.42-0.58). Differential diagnosis between ICC and HCC was most challenging.
  
  
  CONCLUSIONS
  Although developed to improve diagnostic accuracy and objectivity in the assessment of focal liver lesions, DVP alone seems insufficient for differential diagnosis of HCC, ICC and FNH and cannot replace the skills of an experienced observer.
authors.affiliation: Department of Internal Medicine 1, Erlangen University Hospital, FAU University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Schellhaas
authors.affiliation: Department of Internal Medicine 1, Erlangen University Hospital, FAU University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: M J
authors.initials: MJ
authors.lastname: Waldner
authors.affiliation: Department of Internal Medicine 1, Erlangen University Hospital, FAU University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: R S
authors.initials: RS
authors.lastname: Görtz
authors.affiliation: Department of Internal Medicine 1, Erlangen University Hospital, FAU University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Vitali
authors.affiliation: Department of Internal Medicine 1, Erlangen University Hospital, FAU University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Ch
authors.initials: C
authors.lastname: Kielisch
authors.affiliation: Department of Internal Medicine 1, Erlangen University Hospital, FAU University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Pfeifer
authors.affiliation: Department of Internal Medicine 1, Erlangen University Hospital, FAU University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Strobel
authors.affiliation: Department of Radiology, Erlangen University Hospital, FAU University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Janka
authors.affiliation: Department of Internal Medicine 1, Erlangen University Hospital, FAU University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: M F
authors.initials: MF
authors.lastname: Neurath
authors.affiliation: Department of Internal Medicine 1, Erlangen University Hospital, FAU University of Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Wildner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003287:Contrast Media / Q000627:therapeutic use*; D020518:Focal Nodular Hyperplasia / Q000175:diagnosis; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008875:Middle Aged; D015588:Observer Variation; D014463:Ultrasonography / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: Dynamic Vascular Pattern (DVP); Liver malignancy; contrast-enhancedultrasound (CEUS); diagnostic accuracy; dynamic contrast-enhanced ultrasound (DCEUS); hepatocellular carcinoma; interobserver-agreement; intrahepatic cholangiocellular carcinoma; semiquantitative analysis; vascularisation pattern