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Diagnosis of Focal Liver Masses on Ultrasonography

Comparison of Unenhanced and Contrast-Enhanced Scans

Department of Medical Imaging, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada (S.R.W., H.-J.J., T.K.K.); and Departments of Medical Biophysics and Medical Imaging, University of Toronto, and Imaging Research, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (P.N.B.).

Address correspondence to Stephanie R. Wilson, MD, Toronto General Hospital, 585 University Ave, Toronto ON M5G 2N2, Canada. E-mail: stephanie.wilson{at}uhn.on.ca

Objective. The purpose of this study was to compare the diagnostic accuracy, confidence level, and recommended management of focal liver masses after contrast-enhanced ultrasonography (CEUS) compared with unenhanced ultrasonography alone. Methods. One hundred sixty-seven patients were referred for CEUS to characterize a focal liver mass. A 2-person blind read determined benignancy or malignancy, comparative diagnosis, and accuracy on both ultrasonography and CEUS. Results were compared with the final diagnoses. Results. The 2 readers could not determine benignancy or malignancy in 77 (46.1%) and 46 (27.5%) of 167 unenhanced scans compared with 2 (1.2%) and 1 (0.6%) of 167 CEUS scans. The confidence level increased from 0 responses in the 2 highest grades (4 and 5) on the unenhanced scans to 135 (81.8%) and 132 (79.5%) of 167 at level 5 for CEUS. Regarding the diagnosis, the confidence level was lowest (grade 1) on the unenhanced scans in 128 (82.1%) and 79 (65.3%) of 167 for the 2 readers and improved to the highest (grade 5) in 110 (65.9%) and 113 (68.1%) of 167. Regarding diagnostic accuracy, the unenhanced scans agreed with the correct diagnosis in 85 (50.9%) and 63 (37.7%) of 167, and CEUS agreed with the correct diagnosis in 133 (79.6%) and 142 (85%) of 167 for readers 1 and 2, respectively. Recommendations for further imaging decreased from 166 (99.4%) and 147 (88%) of 167 on the unenhanced scans to 30 (18%) and 5 (3%) of 167 on CEUS for readers 1 and 2. Conclusions. Contrast-enhanced ultrasonography improves the accuracy and confidence of diagnosis of focal liver lesions and reduces recommendations for further investigations.

Key Words: contrast agents • liver neoplasms • microbubbles • ultrasonography

Abbreviations: CEUS, contrast-enhanced ultrasonography • CT, computed tomographic • FNH, focal nodular hyperplasia • HCC, hepatocellular carcinoma • MI, mechanical index • MR, magnetic resonance

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