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Ultrasonography |
1 From the Department of Medical Imaging, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4 (M.J.D.M., K.K., S.R.W.); and the Department of Medical Biophysics, Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ontario, Canada (P.N.B.). Received December 6, 2000; revision requested January 17, 2001; revision received May 30; accepted July 5. Supported by the Terry Fox Programme of the National Cancer Institute of Canada, the Medical Research Council of Canada, and Berlex Canada. Address correspondence to S.R.W. (e-mail: stephanie.wilson@uhn.on.ca).
PURPOSE: To evaluate the role of SH U 508A–enhanced ultrasonography (US) in the differentiation of focal hepatic masses.
MATERIALS AND METHODS: Contrast material–enhanced pulse inversion US was performed on 58 unknown hepatic lesions: 23 hepatocellular carcinomas, 10 focal nodular hyperplasias, 16 hemangiomas, and nine metastases. Selected images were sequentially reviewed by readers blinded to the final diagnosis. On a baseline image, they determined lesion echogenicity, and on a vascular image, the presence or absence of distinct vascularity. On an arterial phase interval-delay flash image and a postvascular image, they assessed enhancement of the lesion and liver. Responses were compared with confirmed diagnoses.
RESULTS: Focal nodular hyperplasia was characterized by detectable vascularity and positive enhancement on interval-delay and postvascular scans (sensitivity, 83% [eight of 10 lesions]; specificity, 98% [40 of 41 lesions]). Hepatocellular carcinoma also showed detectable vascularity and positive enhancement on interval-delay images but no postvascular enhancement (sensitivity, 68% [14 of 20 lesions]; specificity, 74% [23 of 31 lesions]). Vascular imaging with SH U 508A did not contribute to the diagnosis of metastasis or hemangioma. However, no or weak enhancement during the arterial phase flash without postvascular enhancement produced a sensitivity of 83% (seven of eight lesions) and sensitivity of 77% (33 of 43 lesions) for metastasis. Peripheral nodular enhancement on arterial phase flash images was highly specific (98% [37 of 38 lesions]) but not sensitive (44% [six of 13 lesions]) for hemangioma.
CONCLUSION: SH U 508A-enhanced pulse-inversion interval-delay flash and postvascular phase imaging are helpful in differential diagnosis of focal hepatic lesions.
Index terms: Angioma, gastrointestinal tract, 761.3194 • Liver, focal nodular hyperplasia, 761.3198 • Liver neoplasms, diagnosis, 761.12985, 761.12988, 761.12989 • Liver neoplasms, secondary, 761.33 • Liver neoplasms, US, 761.12985, 761.12988, 761.12989
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