Ultraschall Med 2016; 37 - SL20_3
DOI: 10.1055/s-0036-1587812

Performance of Contrast Enhanced Ultrasound (CEUS) in the diagnostic of focal liver lesions – monocentric experience

R Sirli 1, SC Ivascu 1, T Moga 1, A Popescu 1, M Danila 1, I Sporea 1
  • 1University of Medicine and Pharmacy, Gastreoenterology and Hepatology, Timisoara, Romania

Background and aims: To evaluate the diagnostic performance of contrast enhanced ultrasound (CEUS) in assessing focal liver lesions (FLLs) in a large monocentric experience.

Methods: The study included 721 patients (57.8% male, mean age 59.6 ± 13.1 years) with 874 FLLs (mean diameter of 4.5 ± 3.1 cm), which were first characterized by CEUS and then were finally evaluated by a ‘gold-standard’ method (contrast enhanced CT, contrast enhanced MRI or histology). The CEUS diagnosis was based on the FLLs' enhancement pattern following contrast bolus, according to the European Guidelines for the use of CEUS. Using the “gold-standard” methods, we calculated the sensitivity (Se), Specificity (Sp), and accuracy (Ac) of CEUS for the diagnostic of FLLs.

Results: From de 874 FLLs, CEUS was conclusive for the benign vs. malignant nature of the lesions in 776 (88.8%) cases. Using CT, MRI or histology, we established the final diagnostic of the lesions as follows: 246 (28.1%) hepatocellular carcinomas (HCC), 223 (25.5%) liver metastasis, 124 (14.2%) hemangiomas, 30 (3.4%) adenomas, 37 (4.2%) hepatic abscesses, 16 (1.9%) cholangiocarcinomas, 55 (6.3%) focal nodular hyperplasias (FNH), 36 (4.1%) regenerative nodules, 3.3% (29) focal fatty liver alterations (FFLA), 15 (1.8%) liver cysts, 38 (4.3%) other benign lesions, 25 (2.9%) other malignant lesions.

For benign liver lesions, CEUS had 78.3% Se, 94.8% Sp, and 87.4% Ac. For the diagnostic of malignant lesions, CEUS had 82.9%Se, 86.4% Sp, and 84.2% Ac. For HCC, CEUS had a 65%Se, 91.4%Sp, and 81.8%Ac. For the diagnostic of liver metastases, CEUS had 74.4%Se, 93.2%Sp, and 86.7%Ac. For liver hemangiomas, CEUS achieved 73.3%Se, 95.6%Sp and 91.1% Ac. For FNH CEUS had 72.7%Se, a 97.3%Sp and a diagnostic Ac of 95%.

Conclusions: CEUS is a reliable diagnostic, being able to differentiate between malignant and benign lesions in 88.8% cases. The best accuracy was observed for diagnosing hemangiomas and FNHs (91 and 95%, respectively), and the lowest for HCCs (approximately 82%).