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Background: In prospective multicenter trials with high volume contrast-enhanced-ultrasound (CEUS), accuracy of CEUS for differentiation focal liver lesions (FLL) is comparable to CT and MRI (1,2). CEUS is cost-effective and severe adverse effects are very uncommon (0,06 – 0,4%) (3, 4). Our aim was to assess whether CEUS in everyday clinical routine is practicable with adequate accuracy in terms of tumor dignity.
Methods: We analyzed all CEUS for FLL between 1/2011 – 3/2013 performed by one examinator (level II of training according to European Federation Society for Ultrasound on
only one ultrasound device (Acuson Sequoia 512R, Siemens) to avoid interobserver variation. All patients were examined according the international guidelines (5) with SonoVueR (Bracco). Group A included all patients with histology as gold standard, if not available (e.g. benigne FLL) convergent CEUS with multislice CT or MRI (with intravenous contrast application) results or follow up (mean 15 months) were gold standard. Group B contains only histology as gold standard.
Results: In 112 patients (age 16-86 years, n=25 cirrhotics) no complications occurred after CEUS. The 37 malignant FLL included 18 HCC and 17 patients with metastasis, one cholangiocarcinoma and one primary B-cell lymphoma. The 75 benign FLL included 20 hemangioma, 9 FNH, 9 cystic lesions and 6 regenerative nodules. CEUS performance in groups A and B are demonstrated in tables 1 & 2. CEUS failed to diagnose only one HCC (MRI and histology positive) as malignant FLL. All other malignant FLL were classified correctly by CEUS showing excellent sensitivity (96-97%) and negative predictive value (npV: 94-98%). In contrast (MRT n=4/CT n=2) failed to identify 4 metastasis, one HCC and
one primary lymphoma in the liver (6 false negative results with lower npV: 79-90%). Benign FLL were diagnosed slightly more accurate by MRI/CT (respectively slightly better specificity (94%) and positive predictive value (ppV: 89-94%). In 75 benign FLL CEUS demonstrated 4 false positive results and 3 lesions remained undetermined (specificity 83-90% and ppV 84-89%)
Conclusions: In our setting CEUS is practicable with no adverse effects and good accuracy for differentiation of malignant or benign FLL. CEUS is not inferior to MRI/CT and can avoid false negative results (figure 3-5). CT/MRI can avoid false positive results by CEUS and improved specificity. Therefore CEUS should be used complementary with MRI/CT.