This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by von Herbay, A. Articles by Häussinger, D. Search for Related Content PubMed PubMed Citation Articles by von Herbay, A. Articles by Häussinger, D.

Real-time Imaging With the Sonographic Contrast Agent SonoVue

Differentiation Between Benign and Malignant Hepatic Lesions

Department of Medicine, University of Tübingen, Tübingen, Germany (A.v.H.); and Department of Medicine (A.v.H., C.V., D.H.) and Computer Center (R.W.), University of Düsseldorf, Düsseldorf, Germany.

Address correspondence and reprint requests to Alexandra von Herbay, MD, Department of Gastroenterology, Hepatology, and Infectiology, Clinic of Internal Medicine 1, University of Tübingen, Otfried-Müller-Strasse 10, D-72076 Tübingen, Germany.

Objective. We investigated the ability of contrast-enhanced sonography with SonoVue (Altana Pharma, Konstanz, Germany), a sulfur hexafluoride microbubble contrast agent, to reveal differences between benign and malignant focal hepatic lesions. Methods. One hundred twenty-six lesions in 124 patients with focal hepatic lesions detected by B-mode sonography (hepatocellular carcinoma, n = 36; metastasis, n = 25; cholangiocellular carcinoma, n = 1; lymphoma, n = 2; focal nodular hyperplasia, n = 9; adenoma, n = 4; regenerative cirrhotic nodule, n = 13; hemangioma, n = 29; and focal hyposteatosis, n = 7) were examined in a prospective study. After intravenous injection of 2.4 mL of SonoVue, the liver was examined continuously for 3 minutes by low–mechanical index pulse inversion sonography. Results. For the discrimination of malignant versus benign liver lesions, SonoVue-enhanced sonography improved sensitivity from 78% to 100% and specificity from 23% to 92% compared with baseline sonography. Receiver operating characteristic analysis revealed a significant improvement in this discrimination (area under the receiver operating characteristic curve, 0.510 ± 0.054 [SD] at baseline sonography, 0.998 ± 0.003 with SonoVue-enhanced sonography; P < .001). The following flow patterns in the early phase were diagnosis specific: early central starlike pattern for focal nodular hyperplasia, peripheral globular-nodular pattern for hemangioma, and diffuse arterial enhancement for malignant lesions. Homogeneous enhancement in the late phase was predictive for benign lesions (P < .001). Conversely, 93% of patients without contrast enhancement in the late phase had malignant lesions (P < .001). Conclusions. SonoVue-enhanced sonography has greater specificity and sensitivity than baseline sonography for the differentiation of benign and malignant liver lesions.

Key Words: contrast media • hemangioma • hepatocellular carcinoma • liver • metastasis • sonography • SonoVue

Abbreviations: A_z, area under the receiver operating characteristic curve • CT, computed tomography • FNH, focal nodular hyperplasia • HCC, hepatocellular carcinoma • MI, mechanical index • MR, magnetic resonance • ROC, receiver operating characteristic

This article has been cited by other articles:

				H. Maruyama, H. Ishibashi, M. Takahashi, F. Imazeki, and O. Yokosuka Effect of Signal Intensity from the Accumulated Microbubbles in the Liver for Differentiation of Idiopathic Portal Hypertension from Liver Cirrhosis Radiology, August 1, 2009; 252(2): 587 - 594. [Abstract] [Full Text] [PDF]

				A. von Herbay, A.-P. Barreiros, A. Ignee, J. Westendorff, M. Gregor, P. R. Galle, and C. Dietrich Contrast-Enhanced Ultrasonography With SonoVue: Differentiation Between Benign and Malignant Lesions of the Spleen J. Ultrasound Med., April 1, 2009; 28(4): 421 - 434. [Abstract] [Full Text] [PDF]

				W. Luo, K. Numata, M. Kondo, M. Morimoto, K. Sugimori, K. Hirasawa, A. Nozaki, X. Zhou, and K. Tanaka Sonazoid-Enhanced Ultrasonography for Evaluation of the Enhancement Patterns of Focal Liver Tumors in the Late Phase by Intermittent Imaging With a High Mechanical Index J. Ultrasound Med., April 1, 2009; 28(4): 439 - 448. [Abstract] [Full Text] [PDF]

				G.-J. Liu, M.-D. Lu, X.-Y. Xie, H.-X. Xu, Z.-F. Xu, Y.-L. Zheng, J.-Y. Liang, and W. Wang Real-time Contrast-Enhanced Ultrasound Imaging of Infected Focal Liver Lesions J. Ultrasound Med., April 1, 2008; 27(4): 657 - 666. [Abstract] [Full Text] [PDF]

				H.-X. Xu, X.-Y. Xie, M.-D. Lu, G.-J. Liu, Z.-F. Xu, J.-Y. Liang, and L.-D. Chen Unusual Benign Focal Liver Lesions: Findings on Real-time Contrast-Enhanced Sonography J. Ultrasound Med., February 1, 2008; 27(2): 243 - 254. [Abstract] [Full Text] [PDF]

				M.-H. Chen, W. Wu, W. Yang, Y. Dai, W. Gao, S.-S. Yin, and K. Yan The Use of Contrast-Enhanced Ultrasonography in the Selection of Patients With Hepatocellular Carcinoma for Radio Frequency Ablation Therapy J. Ultrasound Med., August 1, 2007; 26(8): 1055 - 1063. [Abstract] [Full Text] [PDF]

				K. Numata, H. Oka, M. Morimoto, K. Sugimori, R. Kunisaki, H. Nihonmatsu, K. Matsuo, Y. Nagano, A. Nozawa, and K. Tanaka Differential Diagnosis of Gallbladder Diseases With Contrast-Enhanced Harmonic Gray Scale Ultrasonography J. Ultrasound Med., June 1, 2007; 26(6): 763 - 774. [Abstract] [Full Text] [PDF]

				H.-X. Xu, G.-J. Liu, M.-D. Lu, X.-Y. Xie, Z.-F. Xu, Y.-L. Zheng, and J.-Y. Liang Characterization of Small Focal Liver Lesions Using Real-time Contrast-Enhanced Sonography: Diagnostic Performance Analysis in 200 Patients. J. Ultrasound Med., March 1, 2006; 25(3): 349 - 361. [Abstract] [Full Text] [PDF]

				C. Gorg and T. Bert Second-generation sonographic contrast agent for differential diagnosis of perisplenic lesions. Am. J. Roentgenol., March 1, 2006; 186(3): 621 - 626. [Abstract] [Full Text] [PDF]

				H.-X. Xu, M.-D. Lu, G.-J. Liu, X.-Y. Xie, Z.-F. Xu, Y.-L. Zheng, and J.-Y. Liang Imaging of Peripheral Cholangiocarcinoma With Low-Mechanical Index Contrast-Enhanced Sonography and SonoVue: Initial Experience J. Ultrasound Med., January 1, 2006; 25(1): 23 - 33. [Abstract] [Full Text] [PDF]

				C. Gorg, T. Bert, and R. Kring Contrast-Enhanced Sonography of the Lung for Differential Diagnosis of Atelectasis J. Ultrasound Med., January 1, 2006; 25(1): 35 - 39. [Abstract] [Full Text] [PDF]

				C. Gorg, T. Bert, and K. Gorg Contrast-Enhanced Sonography for Differential Diagnosis of Pleurisy and Focal Pleural Lesions of Unknown Cause Chest, December 1, 2005; 128(6): 3894 - 3899. [Abstract] [Full Text] [PDF]