Ultraschall Med 2005; 26 - OP004
DOI: 10.1055/s-2005-917285

KLINISCHER NUTZEN DER KONTRASTMITTELSONOGRAPHIE IN DER DIFFERENTIALDIAGNOSE VON LEBERRAUMFORDERUNGEN – ZWISCHENANALYSE DER MULTIZENTERSTUDIE DER DEUTSCHEN GESELLSCHAFT FÜR ULTRASCHALL IN DER MEDIZIN

D Strobel 1, W Blank 2, A Schuler 3, A Von Herbay 4, FW Albert 5, P Samaras 6, W Kratzer 7, K Seitz 8, K Dirks 9, J Kunz 10, T Bernatik 11
  • 1Department of Medicine I, University of Erlangen, Erlangen
  • 2Innere Medizin, Kreiskliniken Reutlingen, Reutlingen
  • 3Innere Medizin, Helfenstein-Klinik, Geislingen
  • 4Innere Medizin I, Uniklinikum Tübingen, Tübingen
  • 5Med. Klinik III, Westpfalzklinikum, Kaiserslautern
  • 6Med. Klinik II, Uniklinikum Homburg/Saar, Homburg/Saar
  • 7Innere Medizin I, Universitätsklinikum Ulm, Ulm
  • 8Innere Medizin, Kreiskrankenhaus Sigmaringen, Sigmaringen
  • 9Innere Medizin I, Klinikum Bayreuth, Bayreuth
  • 10Medizinische Klinik, Fürst-Sirum Bruchsal, Bruchsal
  • 11Medizinische Klinik I, Universität Erlangen, Erlangen, Germany

Purpose: This ongoing german multicenter trial was initiated by the german society of ultrasound in medicine (DEGUM) to evaluate the clinical utility of contrast-enhanced sonography in the differential diagnosis of liver tumors, which remain unclear in conventional B-scan sonography and color/power Doppler sonography.

Methods and Materials: This study was started in February 2004. Up to time of abstract submission 362 focal liver lesions were included in the study by ten study centers.Contrast-enhanced sonography was performed according to a standardized protocol using a low-mechanical techniques like phase- or pulse inversion imaging and 2.4–4.8ml intravenous bolus injection of Sonovue for contrast enhancement. Tumor vascularisation pattern based on contrast enhancement in the early arterial phase, arterial phase, portalvenous phase and late phase (>2 minutes) were assessed. The tumor diagnosis in contrast-enhanced sonography was compared to the final tumor diagnosis based on the goldstandard histology with th exception of hemangiomas and focal nodular hyperplasia, where CT or NMR were also accepted as diagnostic standards.

Results: The final tumor diagnosis was confirmed by histology in 77% of 362 liver tumors. Contrast-enhanced sonography provided in more than 80% of the benigne liver lesions a correct diagnosis: in hemangiomas (n=66) 80.3%, in focal nodular hyperplasia (n=51) 84,3%, Hämangiome (n=66) 80,3%, liver adenoma (n=6)83.3%. In malignant liver lesions contrast-enhanced sonography provided a correct diagnosis in more than 90%: liver metastases (n=98) 90.8%, hepatocellular carcinomas(n=80) 85%

Conclusions: This interim-analysis of the german multicenter trail on contrast-enhanced sonography clearly underlines the clinity utility of contrast-enhanced sonography in the differential diagnosis of liver tumors. The high diagnostic accuracy in benigne liver lesions indicates that contrast application in sonography in liver lesion like focal nodular hyperplasia and hemangiomas indicate that further timely and costly imaging procedures will be spared. This high diagnostic accuracy in malignant liver lesions may not substitute imaging techniques (which will be necessary for tumor staging), but contrast-enhanced sonography may optimize and accelerate patient management.