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Imaging of Focal Liver Lesions

Low-Mechanical-Index Real-time Ultrasonography With SonoVue

Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China.

Address correspondence and reprint requests to Hong Ding, MD, Department of Ultrasound, Zhongshan Hospital of Fudan University, 180 Fenglin Rd, Shanghai 200032, China. E-mail address: hongding3{at}hotmail.com

Objective. The purpose of this study was to evaluate the usefulness of a contrast-enhanced contrast-specific ultrasonographic technique with a low mechanical index for characterization of focal liver lesions. Methods. Contrast-specific ultrasonography was used to assess 144 patients with 147 focal liver lesions: 87 primary liver carcinomas, 27 hemangiomas, 16 focal nodular hyperplasias, 5 hepatic abscesses, 3 inflammatory pseudotumors of the liver, and 9 metastases. A sulfur hexafluoride gas–based contrast agent was used with a mechanical index of 0.08 to 0.11. Results. On contrast-enhanced ultrasonography, the typical hemodynamic pattern of primary liver carcinoma was the whole-lesion enhancement or mosaic enhancement in the arterial phase with an enhancement defect in the late phase (sensitivity, 92.0%; specificity, 86.7%). The most common enhancement pattern of hemangioma was that enhancement appeared in the periphery first and progressively filled into the lesion center (sensitivity, 96.3%; specificity, 97.5%). The enhancement pattern of focal nodular hyperplasia was that the whole lesion enhanced early and rapidly in the arterial phase with a centrifugal radiating configuration and appeared isoechoic or hyperechoic until the late phase (sensitivity, 87.6%; specificity, 94.5%). The central scar was detected in 31.3% of cases in the late phase. The specific enhancement of a hepatic abscess was the honeycomblike enhancement in all phases (sensitivity, 80.0%; specificity, 100%). No enhancement of a lesion in all phases was specific for an inflammatory pseudotumor of the liver. Conclusions. Contrast-enhanced real-time ultrasonography is a promising approach in the noninvasive characterization of focal liver lesions and can be useful as a first-line imaging technique clinically when a focal liver lesion is detectable on ultrasonography.

Key Words: contrast media • liver neoplasms • low mechanical index • microbubbles • ultrasonography

Abbreviations: CT, computed tomography • MI, mechanical index • MRI, magnetic resonance imaging

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