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Contrast-Enhanced Agent Detection Imaging

Value in the Characterization of Focal Hepatic Lesions

Department of Radiology, Chonbuk National University Hospital, Jeonju, South Korea (J.H.Y., C.S.K.); and Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.).

Address correspondence and reprint requests to Jeong Min Lee, MD, Department of Radiology, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea. E-mail: leejm{at}radcom.snu.ac.kr.

Objective. To assess the value of SH U 508A-enhanced agent detection imaging in the characterization of focal hepatic lesions. Methods. Contrast-enhanced agent detection imaging was performed on 78 focal hepatic lesions: 34 hepatocellular carcinomas, 22 metastases, 9 hemangiomas, 9 abscesses, 3 cysts, and 1 focal nodular hyperplasia. After administration of SH U 508A, interval delay scanning with agent detection imaging was performed with intervals of approximately 7 seconds (phase I), 30 seconds (phase II), and 90 seconds (phase III) after the first arrival of the contrast agent to the liver. Two observers blinded to the final diagnosis reviewed selected images and assessed the enhancement patterns of the lesions. For quantitative analysis, we calculated the enhancement ratio of the lesions and the difference of enhancement between the lesions and the liver parenchyma. Results. Agent detection imaging showed a distinctive enhancement pattern in focal liver lesions compared with that in the liver. Hepatocellular carcinomas were characterized by early enhancement (phase I) and wash-out (phases II and III; sensitivity, 94.1%; specificity, 93.2%; positive predictive value, 91.4%). Metastases showed peripheral rim or targetlike enhancement (phase I, phase II, or both) and a defect (phase III) and had sensitivity of 77.3%, specificity of 100%, and a positive predictive value of 100%. Hemangiomas showed peripheral nodular or inhomogeneous (phase I, phase II, or both) and gradually centripetal (phase II, phase III, or both) enhancement (sensitivity, 88.9%; specificity, 100%; positive predictive value, 100%). Abscesses were partially enhanced from phase I to phase III (sensitivity, 66.7%; specificity, 95%; positive predictive value, 85.7%). The results of the quantitative analysis of lesion enhancement were compatible with those of the qualitative analysis. Conclusions. SH U 508A-enhanced agent detection imaging may yield distinctive enhancement characteristics in focal liver lesions that would contribute positively to the characterization of these hepatic lesions.

Key Words: agent detection imaging • contrast media • liver • tumors • ultrasonography

Abbreviations: ADI, agent detection imaging • ANOVA, analysis of variance • CT, computed tomography • FNH, focal nodular hyperplasia • HCC, hepatocellular carcinoma • LLE, lesion-to-liver enhancement • MI, mechanical index • MR, magnetic resonance • PIHI, phase inversion harmonic imaging • PPV, positive predictive value • SI, signal intensity

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