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Quantitative dynamic contrast-enhanced sonography of hepatic tumors

  • Hepatobiliary-pancreas
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Abstract

Liver tumors are defined using quantitative dynamic contrast-enhanced ultrasound compared to histological diagnosis, respectively, long-term follow-ups. Forty-two focal liver lesions in 39 patients were examined by contrast harmonic imaging over a period of 2 min after bolus injection of 10-ml galactose-based contrast agent. Vascular enhancement was quantified by using a dedicated software that allowed us to place representative regions of interest (ROI) in the center of the lesion, in the complete lesion, in regular liver parenchyma and in representative liver vessels (artery, vein and portal vein). Peak enhancement was judged to be either in the arterial, portal venous or in the late phase of liver perfusion. The lesion was described as hypovascular, isovascular and hypervascular compared to liver parenchyma. Contrast uptake was described as centrifugal or centripetal and peripheral or homogenous, respectively. Characterization of the lesions was performed unenhanced and after contrast by four independent specialists unaware of histology. Diagnosis of malignancy was evaluated by using a receiver operating characteristic (ROC) analysis, also overall accuracy, average sensitivity, specificity and negative and positive predictive values were calculated. Interobserver agreement was defined by the Kappa statistics. Histologic examination revealed 29 malignant [hepatocellular carcinoma (HCC), n=11; cholangiocellular carcinoma (CCC), n=1; lymphoma, n=1; metastases, n=16)] and 7 benign [hemangioma, n=1; focal nodular hyperplasia (FNH), n=4, adenoma, n=2)] lesions. Six benign lesions (hemangioma n=1; FNH n=5) were proved by long-term follow-up. ROC analysis regarding the diagnosis of malignancy showed values from 0.43 to 0.62 (mean 0.57) before and from 0.70 to 0.80 (mean 0.75) after contrast agent, respectively. The average values for sensitivity, specificity, accuracy and negative and positive predictive values were 66, 26, 62, 45 and 73% unenhanced and 83, 49, 73, 65 and 82% after contrast, respectively. The interobserver agreement was 0.54 and 0.65 for unenhanced and enhanced examinations, respectively. Quantitative dynamic contrast-enhanced sonography improves the diagnosis of malignancy in liver lesions.

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References

  1. Bartolozzi C, Lencioni R (1997) Differentiation of hepatocellular adenoma and focal nodular hyperplasia of the liver: comparison of power Doppler imaging and conventional color Doppler sonography. Eur Radiol 7:1410–1415

    CAS  PubMed  Google Scholar 

  2. Wang LY, Wang JH (1997) Hepatic focal nodular hyperplasia: findings on color Doppler ultrasound. Abdom Imaging 22:178–181

    Article  CAS  PubMed  Google Scholar 

  3. Learch TJ, Ralls PW (1993) Hepatic focal nodular hyperplasia: findings with color Doppler sonography. J Ultrasound Med 12:541–544

    CAS  PubMed  Google Scholar 

  4. Gaiani S, Casali A (2000) Assessment of vascular patterns of small liver mass lesions: value and limitation of the different Doppler ultrasound modalities. Am J Gastroenterol 12:3537–3546

    Google Scholar 

  5. Hosten N, Puls R (1999) Contrast-enhanced power Doppler sonography: Improved detection of characteristic flow patterns in focal liver lesions. J Clin Ultrasound 27:107–115

    Article  CAS  PubMed  Google Scholar 

  6. Maruyama M, Matsutani S (2000) Enhanced color flow images in small hepatocellular carcinoma. Abdom Imaging 25:164–171

    Article  CAS  PubMed  Google Scholar 

  7. Pennisi F, Farina R (1998) Hepatic focal lesions: role of color Doppler ultrasonography with contrast media. Radiol Med 96:579–587

    CAS  Google Scholar 

  8. Maresca G, Barbaro B (1994) Color Dopler ultrasonography in the differential diagnosis of focal hepatic lesions. The SH U 508 A (Levovist) experience. Radiol Med 5:41–49

    Google Scholar 

  9. Bertolotto M, Dalla Palma L (2000) Characterization of unifocal liver lesions with pulse inversion harmonic imaging after Levovist injection: preliminary results. Eur Radiol 9:1369–1376

    Article  Google Scholar 

  10. Uggowitzer M, Kugler C (1998) Sonographic evaluation of focal nodular hyperplasias (FNH) of the liver with a transpulmonary galactose-based contrast agent (Levovist). Br J Radiol 71:1026–1032

    CAS  PubMed  Google Scholar 

  11. Wermke W (1998) Tumordiagnostik der Leber mit Echosignalverstärkern. Springer, Berlin Heidelberg New York

  12. Dietrich CH (2000) Signalverstärkte Farbdopplersonographie des Abdomens. Schnetztor, Konstanz

  13. Blomley MJK, Sidhu PS (2001) Do different types of liver lesions differ in their uptake of the microbubble contrast agent SHU-508 A in the late liver phase? Early experience. Radiology 220:661–667

    CAS  PubMed  Google Scholar 

  14. Quaia E, Bertolotto M (2002) Characterization of liver hemangiomas with pulse inversion harmonic imaging. Eur Radiol 12:537–544

    PubMed  Google Scholar 

  15. Dill-Macky M, Burns P (2002) Focal hepatic masses: enhancement patterns with SHU-508 A and pulse-inversion US. Radiology 222:95–102

    PubMed  Google Scholar 

  16. Wilson SR, Burns PN (2000) Harmonic hepatic ultrasound with microbubble contrast agent: initial experience showing improved characterization of hemangioma, hepatocellular carcinoma and metastasis. Radiology 215:153–161

    CAS  Google Scholar 

  17. Frinking P, Bouakaz A (2000) Ultrasound contrast imaging: current and new potential methods. Ultrasound Med Biol 26:965–975

    CAS  PubMed  Google Scholar 

  18. Jang HJ, Lim H (2000) Ultrasonographic evaluation of focal hepatic lesions: comparison of pulse inversion harmonic, tissue harmonic, and conventional imaging techniques. J Ultrasound Med 19:293–299

    CAS  PubMed  Google Scholar 

  19. Harvey C, Blomley M (2000) Pulse-inversion mode imaging of liver specific microbubbles: improved detection of subcentimetre metastases. Lancet 355:807

    CAS  PubMed  Google Scholar 

  20. Albrecht T, Hoffmann C (2001) Phase-inversion sonography during the liver-specific late phase of contrast enhancement: improved detection of liver metastases. Am J Roentgenol 176:1191–1198

    CAS  PubMed  Google Scholar 

  21. Kim TK, Choi BI (2000) Improved imaging of hepatic metastases with delayed pulse inversion harmonic imaging using a contrast agent SHU 508 A: preliminary study. Ultrasound Med Biol 26:1439–1444

    Article  CAS  PubMed  Google Scholar 

  22. Tanaka S, Ioka T (2001) Dynamic sonography of hepatic tumors. Am J Roentgenol 177:799–805

    Google Scholar 

  23. Strobel D, Krodel U (2000) Clinical evaluation of contrast-enhanced color doppler sonography in the differential diagnosis of liver tumors. J Clin Ultrasound 28:1–13

    CAS  PubMed  Google Scholar 

  24. Oestmann J, Galanski M (1989) ROC: A method to compare the diagnostic performance of imaging systems. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 151:89–92

    CAS  PubMed  Google Scholar 

  25. Hanley J, McNeil B (1882) The meaning and the use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–38

    Google Scholar 

  26. Nino-Murcia M, Olcott EW (2000) Focal liver lesions: pattern based classification scheme for enhancement at arterial phase CT. Radiology 215:746–751

    CAS  PubMed  Google Scholar 

  27. King L, Burkill G (2002) MnDPDP enhanced magnetic resonance imaging of focal liver lesions. Clin Radiol 57:1047–1057

    CAS  PubMed  Google Scholar 

  28. Op de Beeck B, Luypaert R (1999) Benign liver lesions: differentiation by magnetic resonance. Eur J Radiol 32:52–60

    Article  PubMed  Google Scholar 

  29. Tanaka S, Kitamra T (1990) Color Doppler flow imaging of liver tumors. Am J Roentgenol 154:509

    CAS  Google Scholar 

  30. Cosgrove D (1996) Ultrasound contrast enhancement of tumors. Clin Radiol 51:44

    PubMed  Google Scholar 

  31. Leen E, McArdle CS (1996) Ultrasound contrast agents in liver imaging. Clin Radiol 51:35

    Google Scholar 

  32. Schlief R (1996) Developments in echo-enhancing agents. Clin Radiol 51:5

    PubMed  Google Scholar 

  33. Tanaka S, Kitamara T (1995) Effectiveness of galactose-based intravenous contrast medium on color Doppler sonography of deeply located hepatocellular carcinoma. Ultrasound Med Biol 21:157

    Article  CAS  PubMed  Google Scholar 

  34. Ramnarine K, Kyriakopoulou K (2000) Improved characterisation of focal liver tumours: dynamic power Doppler imaging using NC100100 echo-enhancer. Eur J Ultrasound 11:95–104

    Article  CAS  PubMed  Google Scholar 

  35. Martínez-Noguera A, Montserrat E (2002) Ultrasound imaging of hepatic cirrhosis and chronic hepatitis. Med Imaging Int 12–16

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Authors and Affiliations

  1. Institut für Röntgendiagnostik, Universität Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany

    Detlef Klein, Manfred Jenett, Jörn Sandstede & Dietbert Hahn

  2. Chirurgische Klinik, Universität Würzburg, Josef-Schneider-Straße 2, 97080, Würzburg, Germany

    Heinz-Jochen Gassel

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  1. Detlef Klein
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  2. Manfred Jenett
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  3. Heinz-Jochen Gassel
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  4. Jörn Sandstede
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  5. Dietbert Hahn
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Correspondence to Detlef Klein.

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Klein, D., Jenett, M., Gassel, HJ. et al. Quantitative dynamic contrast-enhanced sonography of hepatic tumors. Eur Radiol 14, 1082–1091 (2004). https://doi.org/10.1007/s00330-004-2299-z

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