Emilio Quaia MD, Presenter: Nothing to Disclose

Mirko D'Onofrio MD, Abstract Co-Author: Nothing to Disclose

Sabrina Caffarri, Abstract Co-Author: Nothing to Disclose

Francesca Degobbis MD, Abstract Co-Author: Nothing to Disclose

Alessandro Palumbo, Abstract Co-Author: Nothing to Disclose

Roberto Pozzi Mucelli, Abstract Co-Author: Nothing to Disclose

Each focal liver lesion identified in a patient with chronic liver disease should be considered an hepatocellular carcinoma (HCC) till otherwise proved. The aim of this study was to assess whether contrast enhancement patterns after sulphur hexafluoride-filled microbubbles injection may allow differentiation of HCCs from other lesions histotypes of possible identification in patients with chronic liver disease.

This series comprised 111 HCCs, 35 macroregenerative nodules, 40 liver hemangiomas, 4 fibrous nodular hyperplasias and 1 hepatocellular adenoma, identified in 191 consecutive patients with chronic diffuse liver disease due to chronic hepatitis, B or C virus–related ± cirrhois, and scanned after SonoVue (Bracco, Italy) bolus (4.8 mL) injection at low acoustic power insonation during arterial (10-35 secs), portal (35-90 secs) and late (90-300 secs from injection) phase. Multiple logistic regression was employed to identify independent variables (enhancement pattern at arterial phase and appearance at late phase) associated with the dependent variable (HCC histotype). The significant independent variables were employed to calculate positive predictive values.Secondly, 2 blinded readers performed off-site retrospective assessment of contrast-enhanced US scan and expressed HCC (=1) or not HCC (=0) diagnosis according to the combination of independent variables which revealed the highest positive predictive value. Overall diagnostic accuracy was calculated.

HCCs showed diffuse homogeneous (n=40) or heterogeneous (n=56), dotted (n=10) or absent (n=5) contrast enhancement at arterial phase and hypo (n=71) or isoechoic (n=40) appearance to adjacent liver at late phase. The highest positive predictive value for HCCs was obtained by combining diffuse heterogeneous enhancement at arterial phase with hypoechoic appearance at late phase (Odds Ratio=15-17). This combination provided a positive predictive value for HCC diagnosis of 94% and overall accuracy in HCC characterization of 92%.

Contrast-enhanced US allowed a reliable differentiation of HCCs from other focal liver lesions histotypes which may be identified in patients with chronic liver disease.

Quaia, E, D'Onofrio, M, Caffarri, S, Degobbis, F, Palumbo, A, Pozzi Mucelli, R, Contrast Enhancement Patterns Analysis in Hepatocellular Carcinomas after Sulphur Hexafluoride-filled Microbubble Injection and Low Acoustic Power Insonation: Is it Useful for Differentiation from Other Lesions in Patients with Chronic Liver Disease.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4403502.html