Purpose: To determine the usefulness of CEUS in the characterisation of lesions discovered in patients with chronic hepatitis or cirrhosis.
Methods and Materials: 59 lesions in 53 patients with chronic viral liver disease (38 cirrhosis, 15 chronic hepatitis) were detected during B-mode screeening ultrasonography. Mean lesion size was 2.8cm (range 1.5-6cm). All lesions were therefore examined with CEUS by using continuous real-time low MI scanning (CCI:Acuson-Siemens) and a second generation ultrasound contrast agent (SonoVue: Bracco, Milan, Italy). The standard dose of 2.4ml was administered i.v. followed by a 10ml saline flush. Enhancement patterns of lesions were assessed during arterial,portal and equilibrium phase. Findings were compared with multiphasic spiral CT performed in all patients; 35/53 patients had liver biopsy.
Results: Final diagnoses were hepatocellular carcinomas (n=49), hemangiomas (n=5), regenerative nodules (n=5). CEUS showed a strong enhancement during arterial phase in 47/49 HCCs and a rapid wash-out during portal venous phase. The five regenerative nodules were isoechoic to the surrounding liver during all phases. All hemangiomas showed a typical globular enhancement with progressive fill-in. 3/5 of these lesions were hypoechoic in B-mode imaging mimicking HCC. 4/49 HCCs were hyperechoic mimicking hemangiomas. CEUS characterised correctly 57/59 lesions. No arterial enhancement was depicted in 2 HCC with CEUS. CT confirmed this pattern and considered these lesions as hypovascular HCC; final diagnosis was obtained with liver biopsy.
Conclusion: CEUS is an effective tool in the characterisation of focal liver lesion in the surveillance screening of patients with chronic hepatitis and cirrhosis. Although the majority of lesions discovered in these patients are malignant, the differential diagnosis with benign lesions is mandatory to avoid misdiagnosis
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