Francois Tranquart MD, Presenter: Research Consultant, Bracco Group Research Consultant, Theraclion

Jean Michel Correas MD, Abstract Co-Author: Advisory Board, Koninklijke Philips Electronics NV Speaker, Bracco Group Consultant, bioMérieux SA

Viviane Jeanne Ladam-Marcus MD, Abstract Co-Author: Nothing to Disclose

Philippe Manzoni MD, Abstract Co-Author: Nothing to Disclose

Amelie Le Gouge, Abstract Co-Author: Nothing to Disclose

Valerie Vilgrain MD, Abstract Co-Author: Nothing to Disclose

To assess the medico-economical value of SonoVue® enhanced ultrasonography for characterization of liver lesions not fully characterized by conventional sonography or CT-scan.

In this multicenter study, unenhanced US and SonoVue®-enhanced US were performed at baseline; reference examinations (CT or MRI) within 30 days. CEUS examinations were centrally reviewed. The diagnosis made by CEUS (two independent blinded readers) was compared to that obtained by reference exam (one expert) on the basis of expert review. Final diagnosis was based on histology when performed, or CT/MRI imaging findings obtained within 6 months from baseline evaluations. For each imaging technique, on the basis of reported costs, the machine costs, the duration of the examination, the volume of contrast media required, the time spent by medical staff (physician and technician) were evaluated.

A total of 1034 nodules in 874 patients (sex ratio: 1) were assessed. 245 subjects (28%) had cirrhosis. Medical History was uneventful in 51% of cases; 17% of subjects had history of allergy and 5% of iodine allergy; 5% of the patients had renal failure. The mean lesion diameter was of 2.97cm (+/- 2.07 SD). The mean injected volume was of 3.1 mL (+/- 1.2SD). Diagnostic confidence was expressed in 62.4% of cases based on unenhanced US and in 86.1% of cases based on CE-US. Overall CEUS showed a high diagnostic accuracy with, on average, a 79.4% sensitivity and a 88.1% specificity. The sensitivity ranged from 69.8% for HCC diagnosis up to 85.4% for the diagnosis of hemangioma with a specificity greater than 90% for each detailed diagnosis. The concordance rate between on site and off site blinded diagnoses was higher with CE-US than with reference imaging techniques (90.2% Vs 83.4%). The concordance rate of diagnosis achieved based on CE-US Vs biopsy was similar to that of reference imaging techniques (63% Vs 67.6%) The cost for one exam for contrast ultrasound, CT-scan and MRI was equal to respectively 144.86, 178.97 and 219.56€.  

Those results demonstrate that CE-US has a high accuracy in characterization of FLL , with a sensitivity of approximately 80% and a greater than 90% specificity. Reproducibility of CE-US is higher than that of reference techniques at lower costs.

These results support the diagnostic and economical values of CEUS for characterization of liver lesions.

Tranquart, F, Correas, J, Ladam-Marcus, V, Manzoni, P, Le Gouge, A, Vilgrain, V, Medico-Economical Value of CEUS in FLL: Results from a Large Multicenter Clinical Trial.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6017311.html