Dania Cioni MD, Abstract Co-Author: Nothing to Disclose

Riccardo Antonio Lencioni MD, Abstract Co-Author: Nothing to Disclose

Clotilde Della Pina, Presenter: Nothing to Disclose

Laura Crocetti MD, Abstract Co-Author: Nothing to Disclose

Jacopo Lera, Abstract Co-Author: Nothing to Disclose

Carlo Bartolozzi MD, Abstract Co-Author: Nothing to Disclose

To evaluate the value of contrast-enhanced ultrasound (US) in differentiating focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA) in patients with inconclusive contrast-enhanced spiral CT.

Fifty-seven patients with neither history of malignancy nor chronic liver disease in whom a previous contrast-enhanced spiral CT revealed 69 focal liver lesions 1.5-9 cm in diameter suspected for either FNH or HCA, were enrolled in a prospective clinical trial. All focal liver lesions were examined with contrast-enhanced US by using low mechanical index mechanical index (0.01-0.04) scanning (Contrast Tuned Imaging; Technos MPX, Esaote Biomedica, Genoa, Italy) after bolus injection of 2.4 ml of a second generation contrast agent (SonoVue; Bracco, Milan, Italy). Final diagnoses were obtained with MR imaging by using a bolus injectable superparamagnetic contrast agent (Resovist; Schering AG, Berlin, Germany) in 60 lesions and with US-guided biopsy in nine lesions. Three blinded readers reviewed videotapes of contrast-enhanced US studies.

Final diagnoses included FNH in 48 cases, HCA in 12 cases, and hemangioma in 9 cases. At contrast-enhanced US, 47/49 (98%) FNHs showed strong homogeneous enhancement in the arterial phase with isoechoic or slighly hyperechoic appearance in the portal-venous phase and isoechoic appearance in the delayed phase Central radiating intratumoral vessels were detected in 39/48 (81%)FNHs. Nine of 12 (75%)HCAs showed homogeneous enhancement in the arterial phase followed by isoechogenicity in the portal-venous and delayed phases, while 3/9 (25%) HCAs showed inhomogeneous enhancement in the arterial phase followed by hypoechogenicity in the portal-venous and delayed phases. No HCA showed radiating intratumoral vesseles. Correct lesion characterization was obtained in 48/60 (80%) hepatocellular lesions.

Contrast-enhanced US is useful for differentiating FNH from HCA in patients in whom contrast-enhanced spiral CT findings are not conclusive.

Cioni, D, Lencioni, R, Della Pina, C, Crocetti, L, Lera, J, Bartolozzi, C, Value of Contrast-enhanced Ultrasound in Differentiating Focal Nodular Hyperplasia from Hepatocellular Adenoma in Patients with Inconclusive Spiral CT Findings.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4414857.html