Characterization of Focal Liver Lesions with Contrast-specific US Modes and a Sulfur Hexafluoride–filled Microbubble Contrast Agent: Diagnostic Performance and Confidence

TLDR

The study aimed to determine whether sulfur hexafluoride microbubble contrast‑enhanced ultrasound improves characterization of solid focal liver lesions compared with baseline ultrasound. The authors evaluated 452 indeterminate solid liver lesions with sulfur hexafluoride microbubble contrast‑enhanced ultrasound across arterial, portal venous, and late phases, having two readers independently classify lesions as malignant or benign and computing diagnostic metrics against histology or CT follow‑up. Contrast‑enhanced ultrasound revealed distinct late‑phase patterns—benign lesions were hyper‑ or isoechoic, malignant hypoechoic—and improved diagnostic accuracy from ~50 % to ~85–88 % and AUC from ~0.82–0.83 to ~0.97–0.98, confirming that sulfur hexafluoride contrast‑enhanced modes enhance solid liver lesion characterization. © RSNA, 2004.

Abstract

PURPOSE: To assess whether characterization of solid focal liver lesions could be improved by using ultrasonographic (US) contrast-specific modes after sulfur hexafluoride–filled microbubble contrast agent injection, as compared with lesion characterization achieved with preliminary baseline US. MATERIALS AND METHODS: Four hundred fifty-two solid focal hepatic lesions that were considered indeterminate at baseline gray-scale and color Doppler US were examined after microbubble contrast agent injection performed by using low-acoustic-power contrast-specific modes during the arterial (10–40 seconds after injection), portal venous (50–90 seconds after injection), and late (100–300 seconds after injection) phases. Two readers independently and retrospectively reviewed baseline and contrast material–enhanced US scans and classified each depicted lesion as malignant or benign according to standard diagnostic criteria. Sensitivity, specificity, accuracy, and positive and negative predictive values and areas under the receiver operating characteristic curve (Az) were calculated by considering histologic analysis (317 patients) or contrast-enhanced helical computed tomography followed by serial US 3–6 months apart (135 patients) as the reference standards. RESULTS: Different contrast enhancement patterns were observed according to lesion characteristics. During the late phase, benign lesions were predominantly hyper- or isoechoic relative to the adjacent liver parenchyma, whereas malignant lesions were predominantly hypoechoic. Review of the contrast-enhanced US scans after baseline image review yielded significantly improved diagnostic performance (P < .05). Overall diagnostic accuracy was 49% before versus 85% after review of the contrast-enhanced scan for reader 1 and 51% before versus 88% after review of the contrast-enhanced scan for reader 2. Diagnostic confidence—that is, the Az—was 0.820 before versus 0.968 after review of the contrast-enhanced scan for reader 1 and 0.831 before versus 0.978 after review of the contrast-enhanced scan for reader 2. CONCLUSION: The use of contrast-specific modes with a sulfur hexafluoride contrast agent led to improved characterization of solid focal liver lesions. © RSNA, 2004