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Pulse Inversion Sonography in the Early Phase of the Sonographic Contrast Agent Levovist

Differentiation Between Benign and Malignant Focal Liver Lesions

Department of Medicine and Department of Hepatology, Gastroenterology, and Infectiology, University of Düsseldorf, Düsseldorf, Germany.

Address correspondence and reprint requests to Alexandra von Herbay, MD, Department of Medicine and Department of Hepatology, Gastroenterology, and Infectiology, University of Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany.

Objective. To determine whether examination of focal liver lesions by pulse inversion sonography in the early perfusion phase of the contrast agent Levovist (SH U 508A; Schering AG, Berlin, Germany) enables distinction between benign and malignant lesions. Methods. Seventy-two patients were examined. The cause of the lesion was confirmed by liver biopsy, computed tomography, or both or by hepatic iminodiacetic acid–enhanced scintigraphy. Forty-two patients had malignant liver lesions, and 30 had benign liver lesions. After injection of 2 g of Levovist intravenously, analysis of Levovist arrival was performed by the interval delay imaging technique for 60 seconds. Results. The early arrival of Levovist less than 30 seconds after injection was used as an indicator for malignancy and had specificity of 67% and sensitivity of 60% (P < .05). The central starlike fill-in as a sign for focal nodular hyperplasia had specificity of 100% and sensitivity of 67% (P < .001). The rimlike pattern followed by centripetal fill-in as a sign for hemangioma had specificity of 100% and sensitivity of 18% (P < .01). In contrast, the early diffuse stippled arrival pattern was found in 60% of malignant lesions and also in 33% of cases of focal nodular hyperplasia and in 1 patient with an adenoma. Conclusions. Analysis of Levovist arrival time cannot distinguish between a malignant or benign lesion in individual cases. However, the central starlike arrival pattern is characteristic of focal nodular hyperplasia.

Key Words: contrast agent • focal nodular hyperplasia • hepatocellular carcinoma • Levovist • liver • metastasis • sonography

Abbreviations: CCC, cholangiocellular carcinoma • CT, computed tomography • FNH, focal nodular hyperplasia • HCC, hepatocellular carcinoma • HIDA, hepatic iminodiacetic acid

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