Skip to main content

Advertisement

SpringerLink
Log in

Comparison of contrast-enhanced ultrasonography versus baseline ultrasound and contrast-enhanced computed tomography in metastatic disease of the liver: diagnostic performance and confidence

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Aim: The aim of this study was to compare contrast-enhanced ultrasonography (CEUS) to baseline US and contrast-enhanced computed tomography (CT) in metastatic disease of the liver diagnosed or suspected by US during presurgical staging or postsurgical follow-up for primary malignancies. Materials and methods: Two hundred-fifty-three patients considered suitable for US due to the complete explorability of the liver and with one to five proven or suspected liver metastases at baseline US were included. All patients underwent US before and after microbubble injection, and multiphase contrast-enhanced CT. Independent panels of readers reviewed US and CT scans and recorded liver metastases according to a 5-grade scale of diagnostic confidence. Sensitivity, specificity (diagnostic performance) and area under the receiver operating characteristics (ROC) curve (diagnostic confidence) were calculated. Results: Reference standards revealed no metastases in 57/253, more than five in 59/253, and one to five in 137/253 patients. In patients with one to five metastases, CEUS versus baseline US revealed more metastases in 64/137 and the same number in 73/137 patients while CEUS versus CT revealed more metastases in 10/137, the same number in 99/137, and lower number in 28/137. Sensitivity, specificity, and area under ROC curve of CEUS (83%, 84%, 0.929, respectively) differed from baseline US (40%, 63%, 0.579, respectively; P<0.01) while did not differ from CT (89%, 89%, 0.945, respectively; P>0.05). Conclusion: CEUS improved liver metastases diagnosis in comparison with baseline US while it revealed similar diagnostic performance and confidence to contrast-enhanced CT in patients considered suitable for US and with proven or suspected liver metastases at baseline US.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Hughes K, Scheele J, Sugarbaker PH (1989) Surgery for colorectal cancer metastatic to the liver: optimizing the results of treatment. Surg Clin North Am 69:339–359

    PubMed  CAS  Google Scholar 

  2. Cosgrove DO, Bolondi L (1993) Malignant liver disease. In: Cosgrove D, Meire H, Dewbury K (eds) Abdominal and general ultrasound. Churchill Livingstone, Edinburgh, pp 271–293

    Google Scholar 

  3. Wernecke K, Rummeny E, Bongartz G et al (1991) Detection of hepatic masses in patients with carcinoma: comparative sensitivities of sonography, CT and MR imaging. AJR Am J Roentgenol 157:731–739

    PubMed  CAS  Google Scholar 

  4. Bipat S, van Leeuwen MS, Comans EF et al (2005) Colorectal liver metastases: CT, MR Imaging, and PET for diagnosis—Meta-analysis. Radiology 237:123–131

    Article  PubMed  Google Scholar 

  5. Soyer P, Levesque M, Elias D et al (1992) Detection of liver metastases from colorectal cancer: comparison of intraoperative US and CT during arterial portography. Radiology 183:541–544

    PubMed  CAS  Google Scholar 

  6. Haspigel KD, Neidl KFW, Eichenberger AC et al (1995) Detection of liver metastases. Comparison of superparamagnetic iron oxide-enhanced and unenhanced MR imaging at 1.5 T with dynamic CT, intraoperative US and percutaneous US. Radiology 196:471–478

    PubMed  Google Scholar 

  7. Seneterre E, Taourel P, Bouvier Y et al (1996) Detection of hepatic metastases: ferumoxides-enhanced MR imaging versus unenhanced MR imaging and CT during arterial portography. Radiology 200:785–792

    PubMed  CAS  Google Scholar 

  8. Ward J, Naik KS, Guthrie JA et al (1999) Hepatic lesion detection: comparison of MR imaging after the administration of superparamagnetic iron oxide with dual phase CT by using alternative-free response receiver operating characteristic analysis. Radiology 210:459–466

    PubMed  CAS  Google Scholar 

  9. Bluemke DA, Paulson EK, Choti MA et al (2000) Detection of hepatic lesions in candidates for surgery: comparison of ferumoxides-enhanced MR imaging and dual-phase helical CT. AJR Am J Roentgenol 175:1653–1658

    PubMed  CAS  Google Scholar 

  10. Gehl H, Bourne M, Grazioli L, Moller L, Loderman KP (2001) Off site evaluation of liver lesion detection by Gd-BOPTA-enhanced MR Imaging. Eur Radiol 11:187–192

    Article  PubMed  CAS  Google Scholar 

  11. Blomley MJ, Albrecth TA, Cosgrove DO et al (1999) Improved detection of Liver Metastases with Stimulated Acoustic Emission in late phase of enhancement with the US contrast agent SH U 508: early experience. Radiology 210:409–416

    PubMed  CAS  Google Scholar 

  12. Harvey CJ, Blomley MJ, Eckersley RJ et al (2000) Hepatic malignancies: improved detection with pulse inversion US in late phase of enhancement with SH U 508 A - early experience. Radiology 216:903–908

    PubMed  CAS  Google Scholar 

  13. Quaia E, Bertolotto M, Forgács B, Rimondini A, Locatelli M, Pozzi Mucelli R (2003) Detection of liver metastases by Pulse Inversion Harmonic Imaging during Levovist late phase: comparison to conventional ultrasound and helical CT in 160 patients. Eur Radiol 13:475–483

    PubMed  Google Scholar 

  14. Albrecht T, Blomley MJK, Burns PN et al (2003) Improved detection of hepatic metastases with Pulse-Inversion US during the liver-specific phase of SHU 508A: multicenter study. Radiology 227:361–370

    Article  PubMed  Google Scholar 

  15. Oldenburg A, Hohmann J, Foert E et al (2005) Detection of hepatic metastases with low MI real time contrast enhanced sonography and SonoVue. Ultraschall Med 26(4):277–284

    Article  PubMed  CAS  Google Scholar 

  16. Whittingham T (2005) Contrast-specific imaging techniques: technical perspective. In: Quaia E (ed) Contrast media in ultrasonography: basic principles and clinical applications. Springer, Berlin Heidelberg New York, pp 43–70

    Chapter  Google Scholar 

  17. Harvey CJ, Blomley MJK, Eckersley RJ, Cosgrove DO (2001) Developments in ultrasound contrast media. Eur Radiol 11:675–689

    Article  PubMed  CAS  Google Scholar 

  18. Correas JM, Bridal L, Lesavre A et al (2001) Ultrasound contrast agents: properties, principles of action, tolerance, and artefacts. Eur Radiol 11:1316–1328

    Article  PubMed  CAS  Google Scholar 

  19. Schneider M, Arditi M, Barrau MB et al (1995) BR1: a new ultrasonographic contrast agent based on sulphur hexafluoride-filled microbubbles. Invest Radiol 30:451–457

    Article  PubMed  CAS  Google Scholar 

  20. Morel DR, Schwieger I, Hohn L et al (2000) Human pharmacokinetics and safety evaluation of SonoVue, a new contrast agent for ultrasound imaging. Invest Radiol 35:80–85

    Article  PubMed  CAS  Google Scholar 

  21. Blomley MJK, Albrecht T, Cosgrove DO et al (1998) Stimulated acoustic emission in liver parenchyma with Levovist. Lancet 351:568–569

    Article  PubMed  CAS  Google Scholar 

  22. Bismuth H (1982) Surgical anatomy and anatomical surgery of the liver. World J Surg 6:3–8

    Article  PubMed  CAS  Google Scholar 

  23. Coinaud C (1957) Le foie: etudes anatomiques et chirurgicales. Masson, Paris, pp 9–12

    Google Scholar 

  24. Beck JR, Shultz EK (1986) The use of relative operating characteristic (ROC) curves in test performance evaluation. Arch Pathol Lab Med 110:13–20

    PubMed  CAS  Google Scholar 

  25. Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:443–839

    PubMed  Google Scholar 

  26. Bleuzen A, Tranquart F (2004) Incidental liver lesions: diagnostic value of cadence contrast pulse sequencing (CPS) and SonoVue. Eur Radiol 14(Suppl 8):P53–P62

    Article  PubMed  Google Scholar 

  27. Quaia E, Calliada F, Bertolotto M et al (2004) Characterization of focal liver lesions by contrast-specific US modes and a sulfur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence. Radiology 232:420–430

    Article  PubMed  Google Scholar 

  28. Krix M, Plathow C, Essig M, Herfarth K, Debus J, Kauczor HU, Delorme S (2005) Monitoring of liver metastases after stereotactic radiotherapy using low-MI contrast-enhanced ultrasound—initial results. Eur Radiol 15 (4):677–684

    Article  PubMed  CAS  Google Scholar 

  29. Albrecht T, Blomley M, Bolondi L et al (2004) Guidelines for the use of contrast agents in ultrasound. Ultraschall Med 25:249–256

    Article  PubMed  CAS  Google Scholar 

  30. Semelka RC, Schlund JF, Molina PL et al (1996) Malignant liver lesions: comparison of spiral CT arterial portography and MR imaging for diagnostic accuracy, cost, and effect on patient management. J Magn Reson Imaging 6:39–43

    Article  PubMed  CAS  Google Scholar 

  31. Schmidt J, Strotzer M, Fraunhofer S et al (2000) Intraoperative ultrasonography versus helical computed tomography and computed tomography with arterioportography in diagnosing colorectal liver metastases: lesion-by-lesion analysis. World J Surg 24:43–47

    Article  PubMed  CAS  Google Scholar 

  32. Bluemke DA, Soyer P, Fishman EK (1995) Nontumorous low-attenuation defects in the liver on helical CT during arterial portography: frequency, location, and appearance. AJR Am J Roentgenol 164:1141–1145

    PubMed  CAS  Google Scholar 

  33. Breen DJ, Rutherford EE, Stedman B, Lee-Elliott C, Hacking CN (2004) Intrahepatic arterioportal shunting and anomalous venous drainage: understanding the CT features in the liver. Eur Radiol 14:2249–2260

    Article  PubMed  Google Scholar 

  34. Petersein J, Spinazzi A, Giovagnoni A et al (2000) Focal liver lesions: evaluation of the efficacy of gadobenate dimeglumine in MR imaging-a multicenter phase III clinical study. Radiology 215:727–736

    PubMed  CAS  Google Scholar 

  35. Grazioli L, Morana G, Kirchin MA, Schneider G (2005) Accurate differentiation of focal nodular hyperplasia from hepatic adenoma at gadobenate dimeglumine-enhanced MR imaging: prospective study. Radiology 236:166–177

    Article  PubMed  Google Scholar 

  36. Ward J, Guthrie A, Wilson D et al (2003) Colorectal hepatic metastases: detection with SPIO-enhanced breath-hold MR imaging-comparison of optimized sequences. Radiology 228:709–718

    Article  PubMed  Google Scholar 

  37. Sahani DV, O’Malley ME, Bhat S, Hahn PF, Saini S (2002) Contrast-enhanced MR of the liver with mangafodipir trisodium: imaging technique and results. J Comput Assist Tomogr 26:216–222

    Article  PubMed  Google Scholar 

  38. Kim KW, Kim AY, Kim TK et al (2004) Small ( 2 cm) Hepatic lesions in colorectal cancer patients: detection and characterization on mangafodipir trisodium-enhanced MRI. AJR Am J Roentgenol 182:1233–1240

    PubMed  Google Scholar 

Download references

Acknowledgement

This work was supported by the Philips Research grant from the ECR Research and Education Fund 2000 and 2004.

Author information

Authors and Affiliations

  1. Department of Radiology, Cattinara Hospital, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy

    Emilio Quaia, Alessandro Palumbo, Stefania Rossi, Stefano Bruni & Maria Cova

  2. Department of Radiology, University of Verona, Hospital G.B. Rossi, Piazza L.A. Scuro 10, 37134, Verona, Italy

    Mirko D’Onofrio

Authors
  1. Emilio Quaia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mirko D’Onofrio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessandro Palumbo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefania Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefano Bruni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Cova
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emilio Quaia.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Quaia, E., D’Onofrio, M., Palumbo, A. et al. Comparison of contrast-enhanced ultrasonography versus baseline ultrasound and contrast-enhanced computed tomography in metastatic disease of the liver: diagnostic performance and confidence. Eur Radiol 16, 1599–1609 (2006). https://doi.org/10.1007/s00330-006-0192-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-006-0192-7

Keywords

Search

Navigation