Emilio Quaia MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: To determine if analysis of contrast enhancement after SonoVue (Bracco, Italy) injection may improve diagnostic performance of baseline US/color Doppler US (US/CDUS) in focal liver lesions characterization. Methods and Materials: Eighty focal liver lesions (17 hepatocellular carcinomas -HCCs-, 20 metastases, 21 hemangiomas and 22 non-hemangiomatous benign lesions, comprising 7 focal nodular hyperplasias -FNHs-, 6 macroregenerative nodules -RNNs-, 9 focal fatty sparing/focal fatty changes -FFS/FFCs-), in 80 consecutive patients were scanned by baseline US/CDUS and contrast specific modes (CSMs) using low acoustic power mode, after bolus (2.4-4.8 ml) SonoVue injection during arterial -AP- (20-50 secs), portal -PP- (60-90 secs) and late phase -LP- (100-180 secs). Lesions were characterized by biopsy (n=39) or serial/multimodality imaging (n=41). Contrast enhancement patterns were assessed subjectively by 2 blinded readers in consensus. Contrast enhancement intensity was assessed objectively by measuring lesion and adjacent liver mean gray scale value (0-256), to calculate the objective contrast enhancement score - OCES = (Post - Pre)lesion/(Post - Pre)liver, Pre=precontrast, Post=postcontrast -. Results: On the basis of receiver operating characteristic analysis, diagnostic performance improved significantly with CSMs (Az reader 1/reader 2: 0.857/0.887 for baseline US-CDUS, 0.913/0.974 for US/CDUS/CSMs). HCCs revealed intense (n=14) or dotted (n=3) contrast enhancement and progressive contrast washout. Metastases revealed dotted (n=14) or rim-like (n=6) enhancement. Hemangiomas revealed globular peripheral (n=13), persistent dotted (n=5) enhancement or rapid fill-in (n=3). FNHs showed intense homogeneous contrast enhancement with persistent hyper/isoechogenicity to adjacent liver, while RNNs and FFS/FFCs revealed persistent dotted enhancement. During AP, OCES values of HCCs (OCES range 0.4-3, median OCES 2.05) and FNHs (OCES range 1.5-3, median OCES 2.7) differed significantly (p<.05; ANOVA) from the other diagnostic categories (OCES range 0.05-1.9, median OCES 0.57). During PP and LP, OCES values of HCCs (PP: OCES range 0.5-1.5; median OCES 1.17; LP: 0.4-1.5; 1) and FNHs (PP: OCES range 1.2 - 2, median OCES 1.4; LP: 1.2-1.5, 1.35) differed significantly (p<.05; ANOVA) only from metastases (PP: OCES range 0.1-1.2, median OCES 0.6; LP: 0.05-1, 0.23). Conclusion: Assessment of contrast enhancement improved diagnostic performance of baseline US/CDUS in focal liver lesions characterization.       Questions about this event email: quaia@univ.trieste.it

Quaia MD, E, Subjective and Objective Analysis of Contrast-enhancement in Focal Liver Lesions Scanned by Low Acoustic Power US after SonoVue Injection.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3103233.html