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Differentiation Between Benign and Malignant Hepatic Lesions

Utility of Color Stimulated Acoustic Emission With the Microbubble Contrast Agent Levovist

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. This study was undertaken to determine whether the examination of color stimulated acoustic emission in the late phase of Levovist (SH U 508A; Schering AG, Berlin, Germany) enhancement is helpful in the discrimination between benign and malignant liver lesions. Methods. Fifty-six patients with focal hepatic lesions were examined. Diagnosis of the lesions was confirmed by liver biopsy, computed tomography, or scintigraphy. Thirty-one patients had malignant liver lesions: hepatocellular carcinoma (n = 14), cholangiocellular carcinoma (n = 1), metastasis (n = 14), and lymphoma (n = 2). Twenty-five patients had benign lesions: focal nodular hyperplasia (n = 8), hepatic adenoma (n = 1), focal hyposteatosis or hypersteatosis (n = 6), hemangioma (n = 7), and regenerative cirrhotic nodules (n = 3). After a delay of 5 to 10 minutes without scanning, the liver was examined by color stimulated acoustic emission with a fast sweep of 1 to 3 seconds. Results. All patients with homogeneous color stimulated acoustic emission in the late phase of Levovist enhancement had benign liver lesions (P < .001; specificity, 100%; sensitivity, 68%; positive predictive value, 100%; and negative predictive value, 79%). Eighty-one percent of the patients with nonenhancing lesions in the late phase surrounded by enhanced liver parenchyma had malignant liver lesions (P < .001; specificity, 72%; sensitivity, 94%; positive predictive value, 81%; and negative predictive value, 90%). Interobserver agreement (weighted value) improved from 0.570 ± 0.038 for baseline sonography to 0.918 ± 0.028 for color stimulated acoustic emission sonography. The area under the receiver operating characteristic curves for color stimulated acoustic emission sonography (0.927) was significantly higher than for baseline sonography (0.739; P < .05). Conclusions. Color stimulated acoustic emission in the late phase of Levovist enhancement has a high specificity and sensitivity for differentiation between benign and malignant focal liver lesions.

Key Words: adenoma • contrast agent • focal nodular hyperplasia • hepatocellular carcinoma • liver • oncology • sonography • stimulated acoustic emission

Abbreviations: A_z, area under the fitted curve • CT, computed tomography • FNH, focal nodular hyperplasia • HCC, hepatocellular carcinoma • LABMRMC, Laboratory—Multiple Readers—Multiple Cases • MI, mechanical index • ROC, receiver operating characteristic • SAE, stimulated acoustic emission

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