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Gastrointestinal Imaging |
1 From the Third Department of Internal Medicine (T.I., T. Kiba, K.H., M.M., T.S., H. Sekihara), Clinical Laboratory (K.N.), and Second Department of Surgery (T. Kubota, H. Shimada), Yokohama City University School of Medicine, Japan; Department of Medicine, Kanagawa Dental College, Yokosuka, Japan (T.M.); and Gastroenterological Center, Yokohama City University Medical Center, Japan (K.T.). Received July 11, 2002; revision requested September 5; final revision received May 2, 2003; accepted May 8. Address correspondence to K.N., Gastroenterological Center, Yokohama City University Medical Center, 4–57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan (e-mail: kz-numa@zero.ad.jp).
PURPOSE: To assess the accuracy of pattern-based classification of contrast material–enhanced wideband harmonic gray-scale ultrasonographic (US) images in the differential diagnosis of hepatic tumors.
MATERIALS AND METHODS: A total of 183 hepatic lesions in 183 patients were studied; lesions included 116 hepatocellular carcinomas, 42 liver metastases, and 25 liver hemangiomas. After injection of a galactose–palmitic acid contrast agent, lesions were scanned with contrast-enhanced wideband harmonic gray-scale US in the arterial, portal venous, and late venous phases. The enhancement patterns were classified, and multiple logistic regression analysis was used to identify diagnostic patterns that enabled differentiation between hepatic tumors.
RESULTS: Five enhancement patterns were found to be significant in predicting different hepatic tumors. In hepatocellular carcinomas, the presence of intratumoral vessels in the arterial phase and homogeneous or heterogeneous enhancement in the portal phase were the most typical patterns. In metastases, the absence of intratumoral vessels in the arterial phase and ring enhancement or a perfusion defect in the portal phase were the most typical patterns. In hemangiomas, the absence of intratumoral vessels in the arterial phase and peripheral nodular enhancement in the portal phase were the most typical patterns. The sensitivity, specificity, and accuracy of diagnosis based on combinations of enhancement patterns were, respectively, 94.8%, 94.0%, and 94.5% for hepatocellular carcinoma; 90.5%, 94.3%, and 93.4% for metastasis; and 88.0%, 99.4%, and 97.8% for hemangioma.
CONCLUSION: Contrast-enhanced wideband harmonic gray-scale US is a useful tool for differentiating among the hepatic tumors studied.
© RSNA, 2003
Index terms: Liver neoplasms, diagnosis, 761.3194, 761.323, 761.332 • Liver neoplasms, US, 761.12988 • Microbubbles • Ultrasound (US), harmonic study
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