Abstract
The objective was to evaluate whether the echogenicity of focal liver lesions (FLLs) on baseline gray-scale ultrasound (US) interferes with the diagnostic performance of contrast-enhanced US (CEUS) for small FLLs. Three-hundred and eighty-eight patients were examined by real-time CEUS using a sulfur hexafluoride-filled microbubble contrast agent. The images of 114 hyperechoic lesions, 30 isoechoic lesions and 244 hypoechoic lesions were reviewed by two blinded independent readers. A five-point confidence level was used to discriminate malignant from benign lesions, and specific diagnoses were made. The diagnostic performances were evaluated by receiver-operating characteristic (ROC) analysis. The diagnostic performances of CEUS on hyperechoic lesions in terms of the areas (Az) under the ROC curve were 0.987 (reader 1) and 0.981 (reader 2), and were 0.987 (reader 1) and 0.984 (reader 2) for iso- and hypoechoic lesions, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 87.0–95.9%, 93.1–100%, 88.6–100%, 70.0–97.1% and 90.0–95.1%, respectively. The echogenicity of FLLs on baseline gray-scale US does not appear to interfere with the diagnostic ability of CEUS for small FLLs.
Similar content being viewed by others
References
Claudon M, Cosgrove D, Albrecht T et al (2008) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS)—Update 2008. Ultraschall Med 29:28–44
Quaia E, Caliada F, Bertolotto M et al (2004) Characterization of focal liver lesions with contrast-specific US modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence. Radiology 232:420–430
von Herbay A, Vogt C, Willers R, Häussinger D (2004) Real-time imaging with the sonographic contrast agent SonoVue: differentiation between benign and malignant hepatic lesions. J Ultrasound Med 23:1557–1568
Ding H, Wang WP, Huang BJ et al (2005) Imaging of focal liver lesions: low-mechanical-index real-time ultrasonography with SonoVue. J Ultrasound Med 24:285–297
Xu HX, Liu GJ, Lu MD et al (2006) Characterization of small focal liver lesions using real-time contrast-enhanced sonography: diagnostic performance analysis in 200 patients. J Ultrasound Med 25:349–361
D’Onofrio M, Rozzanigo U, Masinielli BM et al (2005) Hypoechoic focal liver lesions: characterization with contrast enhanced ultrasonography. J Clin Ultrasound 33:164–172
Solbiati L, Martegani A, Leen E, Correas JM, Burns PN, Becker D (2003) Contrast-enhanced ultrasound of liver diseases. Springer, Milan
Cosgrove DO, Blomley MJ, Eckersley RJ et al (2002) Innovative contrast specific imaging with ultrasound. Electromedica 70:147–150
Wilson SR, Kim TK, Jang HJ, Burns PN (2007) Enhancement patterns of focal liver masses: discordance between contrast-enhanced sonography and contrast-enhanced CT and MRI. AJR Am J Roentgenol 189:W7–W12
Llovet JM, Fuster J, Bruix J, Barcelona-Clinic Liver Cancer Group (2004) The Barcelona approach: diagnosis, staging and treatment of hepatocellular carcinoma. Liver Transpl 10:S115–S120
de Jong N, Bouakaz A, Frinking P (2002) Basic acoustic properties of microbubbles. Echocardiography 19:229–240
Ishak KG, Goodman ZD, Stocker JT (2001) Tumors of the liver and intrahepatic bile ducts. Atlas of Tumor Pathology, Armed Forces Institute of Pathology, Washington D.C.
Choi BI, Takayasu K, Han MC (1993) Small hepatocellular carcinomas and associated nodular lesions of the liver: pathology, pathogenesis, and imaging findings. AJR Am J Roentgenol 160:1177–1187
Liu GJ, Lu MD, Xu HX et al (2008) Real-time contrast-enhanced ultrasound imaging of infected focal liver lesions. J Ultrasound Med 27:657–666
Yoon KH, Ha HK, Lee JS et al (1999) Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation. Radiology 211:373–379
Xu HX, Lu MD, Liu GJ et al (2006) Imaging of peripheral cholangiocarcinoma with low-mechanical index contrast-enhanced sonography and SonoVue: initial experience. J Ultrasound Med 25:23–33
Rode A, Bancel B, Douek P et al (2001) Small nodule detection in cirrhotic livers: evaluation with US, spiral CT, and MRI and correlation with pathologic examination of explanted liver. J Comput Assist Tomogr 25:327–336
Gritzmann N (2003) Small hepatocellular carcinomas in patients with liver cirrhosis: potentials and limitations of contrast-enhanced power Doppler sonography. Eur J Gastroenterol Hepatol 15:881–883
Lim JH, Kim MJ, Park CK, Kang SS, Lee WJ, Lim HK (2004) Dysplastic nodules in liver cirrhosis: detection with triple phase helical dynamic CT. Br J Radiol 77:911–916
Catalano O, Sandomenico F, Raso MM, Siani A (2004) Low mechanical index contrast-enhanced sonographic findings of pyogenic hepatic abscess. AJR Am J Roentgenol 182:447–450
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Liu, GJ., Xu, HX., Xie, XY. et al. Does the echogenicity of focal liver lesions on baseline gray-scale ultrasound interfere with the diagnostic performance of contrast-enhanced ultrasound?. Eur Radiol 19, 1214–1222 (2009). https://doi.org/10.1007/s00330-008-1251-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-008-1251-z