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© 2009 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 28:439-448 • 0278-4297

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

Wen Luo, MD, Kazushi Numata, MD, Masaaki Kondo, MD, Manabu Morimoto, MD, Kazuya Sugimori, MD, Kingo Hirasawa, MD, Akito Nozaki, MD, Xiaodong Zhou, MD and Katsuaki Tanaka, MD

Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan (W.L., K.N., M.K., M.M., K.S., K.H., A.N., K.T.); and Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi’an, China (W.L., X.Z.).

Address correspondence to Kazushi Numata, MD, Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan. E-mail: kz-numa{at}urahp.yokohama-cu.ac.jp

Objective. The purpose of this study was to evaluate the enhancement patterns of focal liver tumors in the late phase of Sonazoid-enhanced ultrasonography by intermittent imaging with a high mechanical index (MI). Methods. A total of 142 patients with 208 lesions, including 109 hepatocellular carcinomas (HCCs), 61 metastases, 30 hemangiomas, and 8 focal nodular hyperplasias (FNHs), were enrolled in this prospective study. Contrast-enhanced ultrasonography with intermittent scanning at 2 frames per second (MI, 0.7–1.2) was conducted in the late phase (>5 minutes after bolus intravenous injection of the perflubutane-based contrast agent Sonazoid; Daiichi Sankyo, Tokyo, Japan). Two blinded readers classified the enhancement patterns of the lesions. The sensitivity, specificity, and positive predictive value (PPV) of the dominant enhancement patterns and inter-reader agreement were assessed. Results. A combination of diffuse enhancement with intratumoral vessels and intratumoral vessels alone yielded sensitivity of 85% (average of both readers), specificity of 88%, and a PPV of 88% for HCC. For metastasis, a combination of peripheral ringlike enhancement with peritumoral vessels and peripheral ringlike enhancement with intratumoral vessels yielded sensitivity of 79%, specificity of 95%, and a PPV of 85%. For hemangiomas, a combination of peripheral nodular enhancement with peritumoral vessels and peripheral nodular enhancement without peritumoral vessels yielded sensitivity of 75%, specificity of 99%, and a PPV of 92%. Diffuse enhancement with spoked wheel arteries yielded sensitivity of 82%, specificity of 100%, and a PPV of 87% for FNHs. Good inter-reader agreement was achieved. Conclusions. Sonazoid-enhanced ultrasonography using intermittent imaging with a high MI can potentially be used for evaluating the enhancement patterns of focal liver tumors in the late phase.

Key Words: contrast-enhanced ultrasonography • liver neoplasms • Sonazoid

Abbreviations: CEUS, contrast-enhanced ultrasonography • CT, computed tomography • FNH, focal nodular hyperplasia • HCC, hepatocellular carcinoma • MI, mechanical index • MRI, magnetic resonance imaging • PPV, positive predictive value

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Copyright © 2009 by the American Institute of Ultrasound in Medicine.