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Characterisation of focal liver lesions undetermined at grey-scale US: contrast-enhanced US versus 64-row MDCT and MRI with liver-specific contrast agent

Caratterizzazione delle lesioni focali epatiche indeterminate all’ecografia in scala di grigi: ecografia con mezzo di contrasto versus TC multidetettore (64 strati) e RM con mezzo di contrasto epatospecifico

  • Abdominal Radiology / Radiologia Addominale
  • Published:
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Abstract

Purpose

The aim of this study was to assess the role of contrast-enhanced ultrasonography (CEUS) in the characterisation of focal liver lesions in comparison with multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) with liver-specific contrast agent.

Materials and methods

One hundred and eighty-seven focal liver lesions, 91 malignant and 96 benign (mean size 3.2 cm) — proved by biopsy (n=12), histology (n=4), MDCT (n=108), MRI (n=44) MDCT/MRI (n=19) — in 159 patients were studied by CEUS. Two expert radiologists consensually evaluated the contrast-enhancement patterns at CEUS. For each lesion, they assessed: (a) nature (benign, malignant, not assessable), (b) specific diagnosis and (c) need for further radiological evaluation. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of CEUS were calculated.

Results

A total of 167/187 (89.3%) lesions were correctly assessed as benign or malignant at CEUS, whereas 14/187 (7.5%) lesions remained undetermined and 6/187 (3.2%) were incorrectly assessed. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of CEUS were, respectively, 89%, 89.6%, 89%, 89.6% and 89.3%. The need for further radiological evaluation decreased to 46/187 (24.6%) lesions after CEUS (p<0.001).

Conclusions

In selected cases, CEUS can be considered an effective alternative to MDCT and MRI and reduce the need for further radiological workup.

Riassunto

Obiettivo

Scopo del nostro studio è stato valutare il ruolo dell’ecocontrastografia nella caratterizzazione delle lesioni focali epatiche confrontandola con apparecchiature di tomografia computerizzata multidetettore (TCMD) e risonanza magnetica (RM) con mezzo di contrasto (MdC) epatospecifico.

Materiali e metodi

Centottantasette lesioni focali epatiche, 91 maligne e 96 benigne (diametro medio: 3,2 cm), in 159 pazienti, confermate mediante biopsia (n=12), istologia (n=4) TCMD, (n=108), RM (n=44) TCMD e RM (n=19), sono state studiate con ecocontrastografia, TCMD e/o RM. Due radiologi hanno valutato in consenso gli aspetti ecocontrastografici, indicando per ciascuna lesione: a) diagnosi di natura (benigna, indeterminata, maligna); b) diagnosi specifica; c) necessità di ulteriori indagini radiologiche. Sono stati calcolati sensibilità, specificità, valori predittivo positivo e negativo, nonché l’accuratezza diagnostica dell’ecocontrastografia.

Risultati

L’ecocontrastografia ha consentito una corretta diagnosi (benigne vs maligne) in 167/187 (89,3%) casi. Quattordici/187 (7,5%) lesioni sono rimaste indeterminate e 6/187 (3,2%) non sono state correttamente caratterizzate dopo ecocontrastografia, con valori di sensibilità, specificità, valore predittivo positivo, negativo e accuratezza diagnostica pari, rispettivamente, all’89%, all’89,6%, all’89%, all’89,6% e all’89,3%. Dopo ecocontrastografia, la necessità di ricorrere a ulteriori indagini radiologiche si è ridotta a 46/187 casi (24,6%) (p<0,001).

Conclusioni

L’ecocontrastografia può essere considerata, in casi selezionati, una valida alternativa alla TCMD ed alla RM, riducendo il ricorso ad ulteriori indagini radiologiche.

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Authors and Affiliations

  1. Dipartimento di Biotecnologie Mediche e Medicina Legale, Sezione di Diagnostica per Immagini, Policlinico Universitario, Via del Vespro 127, 90127, Palermo, Italy

    T. V. Bartolotta, A. Taibbi, M. Midiri, L. La Grutta, M. De Maria & R. Lagalla

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  1. T. V. Bartolotta
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  2. A. Taibbi
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  3. M. Midiri
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  4. L. La Grutta
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  5. M. De Maria
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  6. R. Lagalla
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Correspondence to T. V. Bartolotta.

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Bartolotta, T.V., Taibbi, A., Midiri, M. et al. Characterisation of focal liver lesions undetermined at grey-scale US: contrast-enhanced US versus 64-row MDCT and MRI with liver-specific contrast agent. Radiol med 115, 714–731 (2010). https://doi.org/10.1007/s11547-010-0506-3

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  • DOI: https://doi.org/10.1007/s11547-010-0506-3

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