Contrast-Enhanced Ultrasound (CEUS) For The Evaluation Of Focal Liver Lesions – A Prospective Multicenter Study Of Its Usefulness In Clinical Practice

Abstract

Purpose: To assess the value of contrast-enhanced ultrasound (CEUS) for differentiating malignant from benign focal liver lesions (FLLs) and for diagnosing different FLL types.

Material and Methods: CEUS performed in 14 Romanian centers was prospectively collected between February 2011 and June 2012. The inclusion criteria were: age > 18 years; patients diagnosed with 1 – 3 de novo FLLs on B-mode ultrasound; reference method (computed tomography (CT), magnetic resonance imaging (MRI) or biopsy) available; patient’s informed consent. FLL lesions were characterized during CEUS according to the European Federation of Societies for Ultrasound in Medicine and Biology guidelines. For statistical analysis, indeterminate FLLs at CEUS were rated as false classifications.

Results: A total number of 536 cases were included in the final analysis, 344 malignant lesions (64.2 %) and 192 benign lesions (35.8 %). The reference method was: CT/MRI – 379 cases (70.7 %), pathological exam – 150 cases (27.9 %) and aspiration of liver abscesses – 7 cases (1.4 %). CEUS was conclusive in 89.3 % and inconclusive in 10.7 % of cases. To differentiate between malignant and benign FLLs, CEUS had 85.7 % sensitivity, 85.9 % specificity, 91.6 % positive predictive value, 77.1 % negative predictive value and 85.8 % accuracy. The CEUS accuracy for differentiation between malignant and benign liver lesions was similar in tumors with diameter ≤ 2 cm and those with diameter > 2 cm.

Conclusion: CEUS represents a useful method in clinical practice for differentiating between malignant and benign FLLs detected on standard ultrasonography, and the results of this study are in concordance with previous multicenter studies: DEGUM (Germany) and STIC (France).

Zusammenfassung

Ziel: Bewertung des kontrastverstärkten Ultraschalls (CEUS) zur Differenzierung zwischen malignen und gutartigen fokalen Leberläsionen (FLL) und bei der Diagnose verschiedener FLL-Typen.

Material und Methoden: CEUS wurde in 14 rumänischen Zentren von Februar 2011 bis Juni prospektiv durchgeführt und erfasst. Die Einschlusskriterien waren: Alter > 18 Jahre; Diagnose von 1 – 3 FLL de novo im B-Bild; verfügbare Referenzmethode (Computertomografie – CT, Magnetresonanz-Tomografie – MRT oder Biopsie); Einverständniserklärung des Patienten („informed consent“). Die FLL-Läsionen wurden während des CEUS gemäß den Richtlinien der „European Federation of Societies for Ultrasound in Medicine and Biology“ charakterisiert. Für die statistische Auswertung wurden durch CEUS nicht bestimmbare FLLs als falsche Klassifizierungen gewertet.

Ergebnisse: Insgesamt wurden 536 Fälle in die Endanalyse eingeschlossen, 344 maligne (64,2 %) und 192 benigne Läsionen (35,8 %). Die Referenzmethoden waren: CT/MRT – 379 Fälle (70,7 %), pathologische Untersuchung – 150 Fälle (27,9 %) und Aspiration von Leberabszessen – 7 Fälle (1,4 %). In 89,3 % der Fälle war CEUS eindeutig und in 10,7 % nicht eindeutig. Bei der Differenzierung zwischen malignen und gutartigen FLLs betrug die Sensitivität des CEUS 85,7 %, die Spezifität 85,9 %, der positive Vorhersagewert 91,6 %, der negative Vorhersagewert 77,1 % und die Genauigkeit 85,8 %. Die Genauigkeit des CEUS bei der Differenzierung zwischen malignen und benignen Leberläsionen war bei Tumoren mit einem Durchmesser von < 2 cm und > 2 cm Durchmesser gleich.

Schlussfolgerung: CEUS ist in der klinischen Praxis eine nützlich, um maligne und benigne FLL, die in einer Standard-US-Untersuchung entdeckt wurden, zu differenzieren. Die Ergebnisse dieser Studie stimmen mit früheren Multizenter-Studien aus Deutschland (DEGUM) und Frankreich (STIC) überein.

Key words

contrast-enhanced ultrasound - focal liver lesions - liver tumor

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