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Ultrasonography |
1 From the Dept of Radiology and Nuclear Medicine, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Hindenburgdamm 30, D-12200 Berlin, Germany (T.A., C.W.H.); Dept of Imaging, Hammersmith Hosp, Imperial College, London, England (M.J.K.B., C.J.H., D.O.C.); Sunnybrook Imaging Research, Univ of Toronto, Ontario, Canada (P.N.B.); Dept of Ultrasound, Toronto General Hosp-Univ Health Network, Ontario, Canada (S.W.); Dept of Radiology, Royal Infirmary, Glasgow, Scotland (E.L.); Dept of Radiology, CHU Nancy-Brabois, Nancy-Vandoeuvre, France (M.C., F.L.); Ospedale Maggiore di Lodi, Italy (F.C.); Dept of Adult Radiology, Centre Hosp Necker, Paris, France (J.M.C.); Hosp Saint-Luc, Montreal, Quebec, Canada (M.L.); and Dept of Radiology, IRCCS Policlinico S. Matteo, Univ of Pavia, Italy (R.C.). From the 1999 RSNA scientific assembly. Received Nov 15, 2001; revision requested Feb 1, 2002; revision received Jun 28; accepted Aug 27. Supported by a grant from Philips Ultrasound, Bothell, Wash. C.J.H. supported by a grant from the Medical Research Council, United Kingdom. M.J.K.B. supported by a grant from Schering, Berlin, Germany. P.N.B. supported by the National Cancer Institute of Canada. Address correspondence to T.A. (e-mail: thomas.albrecht@medizin.fu-berlin.de).
PURPOSE: To compare conventional B-mode ultrasonography (US) alone with the combination of conventional B-mode US and contrast material–enhanced (SHU 508A) late-phase pulse-inversion US for the detection of hepatic metastases by using dual-phase spiral computed tomography (CT) as the standard of reference.
MATERIALS AND METHODS: One hundred twenty-three patients underwent conventional US, US in the liver-specific phase of SHU 508A, and single-section spiral CT. US and CT images were assessed by blinded readers. Differences in sensitivity, specificity, and the number and smallest size of metastases at conventional and contrast-enhanced US were compared by using CT as the standard of reference. Lesion conspicuity was assessed objectively (quantitatively) and subjectively by one reader before and after contrast material administration.
RESULTS: In 45 of 80 (56%) patients with metastases, more metastases were seen at contrast-enhanced US than at conventional US. In three of these patients, conventional US images appeared normal. The addition of contrast-enhanced US improved sensitivity for the detection of individual metastases from 71% to 87% (P < .001). On a patient basis, sensitivity improved from 94% to 98% (P = .44), and specificity improved from 60% to 88% (P < .01). Contrast enhancement improved the subjective conspicuity of metastases in 66 of 75 (88%) patients and the objective contrast by a mean of 10.8 dB (P < .001). Contrast-enhanced US showed more metastases than did CT in seven patients, and CT showed more than did contrast-enhanced US in one of 22 patients in whom an independent reference (magnetic resonance imaging, intraoperative US, or pathologic findings) was available.
CONCLUSION: Contrast-enhanced US improved sensitivity and specificity in the detection of hepatic metastases.
© RSNA, 2003
Index terms: Liver neoplasms, CT, 761.12115 • Liver neoplasms, metastases, 761.33 • Liver neoplasms, US, 761.1298, 761.12988 • Ultrasound (US), contrast media, 761.12988
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