Purpose: To assess whether non-linear ultrasound (US) contrast specific modes (CSMs) with SonoVue (Bracco, Italy) may improve diagnostic performance of baseline US/color Doppler US (US/CDUS) in focal liver lesions characterization.
Methods and Materials: Four hundred forty-eight focal hepatic lesions (diagnostic categories: 231 hepatocellular carcinomas - HCCs-, 7 cholangiocarcinomas - CCCs-, 3 epithelioid hemangioendotheliomas -EEs-, 84 metastases, 53 hemangiomas, 24 focal nodular hyperplasias - FNHs-, 8 adenomas, 29 macroregenerative nodules -RNNs-, 9 focal fatty sparing/focal fatty changes - FFS/FFCs-) indeterminate on baseline US, in 448 consecutive patients, were evaluated by baseline US/CDUS and then by CSMs after SonoVue injection (2.4-4.8 ml) using continuous low acoustic power imaging. Lesions were definitely characterized by fine needle biopsy (343 patients) or multiphase contrast-enhanced helical CT (HCT) followed by serial US examinations 3-6 months apart (106 patients). Prospective lesions analysis by 3 on-site indepenedent sonographers was performed to assess diagnostic performance (sensitivity, specificity, positive and negative predictive values -PPV, NPV-, accuracy and receiver operating characteristic -ROC- curves analysis) of baseline US/CDUS and of baseline US/CDUS with addition of CSMs to classify lesions in different diagnostic categories, while capability in malignancy diagnosis was assessed through retrospective analysis by 2 blinded off-site independent readers.
Results: Baseline US/CDUS suggested a correct diagnosis in FNHs and FFS/FFCs which was confirmed by CSMs allowing also a more confident diagnosis. In HCCs, CCCs, metastases, hemangiomas and RNNs, CSMs improved significantly sensitivity, specificity, PPV, NPV and accuracy (P<.05, chi-squared test) and area under ROC curves -Az- (Az baseline/contrast-enhanced US: reader 1=0.840/0.990, reader 2=0.825/0.985, P<.05, DeLong method; k=0.82-0-86, interobservers agreement) in comparsion to baseline US/CDUS both in prospective and retrospective analysis, by identifing typical enhancement patterns. Lesions with atypical or devoid of typical contrast enhancement pattern (hypoenhancing HCCs - n=5 -, EEEs, diffusely enhancing metastases - n=32 - or diffusely enhancing RNNs - n=3 -), rapid filling hemangiomas (n=7) and hepatocellular adenomas, were not correctly characterized or remained indeterminate.
Conclusion: CSMs with SonoVue improved diagnostic performance in focal liver lesions characterization.
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