Contrast-enhanced ultrasound for the assessment of focal nodular hyperplasia – results of a multicentre study

Abstract

Aim: Contrast-enhanced ultrasound (CEUS) has become a relevant imaging method for the evaluation of focal liver le-sions (FLL). The aim of this study was to evaluate the performance of CEUS for the assessment of focal nodular hyperplasia (FNH) in a large study group. Material and methods: We performed a multicentre prospective observational study, which included successive CEUS examinations from fourteen Romanian centres. CEUS examinations were performed in de novo FLL, using low mechanical index ultrasound, following an intravenous bolus of 2.4 ml SonoVue. CEUS was considered conclusive for FNH if a typical pattern was present following contrast (rapid “spoke-wheel” enhancement during the arterial phase, hyperenhanced lesion during venous phase, hyper- or isoenhanced in the late phase). In all cases a reference method was available (contrast enhanced CT or MRI or biopsy). The trial was registered in clinicaltrials.gov (Identifier NCT01329458). Results: During the 6 years study, 2062 “de novo” FLL were evaluated by CEUS. From this cohort, 94/2062 (4.5%) had a typical enhancing pattern for FNH as described in the EFSUMB guidelines. Contrast enhanced CT/MRI and biopsy diagnosed additional 15 FNH. From the 94 cases diagnosed as FNH by CEUS, in nine the final diagnosis was different (five of them adenomas). CEUS had 85% sensitivity, 99.5% specificity, 90.4% positive predictive value, 99.2% negative predictive value and 98.8% diagnostic accuracy for the diagnosis of FNH. Conclusions: CEUS is a sensitive and very specific method for the diagnosis of FNH.

History of contrast enhanced ultrasound (CEUS)

“…Subanalyses have been published as well [15][16][17][18]. Similar studies have been published by French [19] and Romanian authors of the respective societies [20].…”

Color Mapping using Ultrasound System-integrated Perfusion Software for Evaluation of Focal Liver Lesions: A Possible First Step for More Independent Reading

“…Despite ongoing progress in the identification of benign and malignant liver lesions with the aid of contrast-enhanced ultrasonography (CEUS), the significance of the results crucially depends on the experience of the examiner, examination conditions, and image quality [1], which limits the clinical applications and interpretation. The high diagnostic significance of CEUS for characterization of liver tumors has previously been demonstrated in numerous studies, including multicenter studies of the German Society for Ultrasound in Medicine (DEGUM) [2][3][4][5]. Depending on the tumor size and tumor entity, a high diagnostic certainty > 90% can be achieved [6].…”

When Benign Behaves Badly

“…Hemangiomas are the most common benign liver tumor with a reported prevalence ranging from 2% to 20% 1,2 . The etiology of hemangiomas is not well understood; however, they are considered to be hamartomas or vascular malformations of congenital origin 3 .…”

“…H emangiomas are the most common benign liver tumor with a reported prevalence ranging from 2% to 20%. 1,2 The etiology of hemangiomas is not well understood; however, they are considered to be hamartomas or vascular malformations of congenital origin. 3 Histologically, hemangioma is a mesenchymal lesion made up of blood-filled vascular cavities of varying size, surrounded by flat endothelial cells, and supported by fibrous connective tissue.…”

“…Fang et al 7 found that CEUS was equivalent to contrast-enhanced MRI in the diagnosis of hemangioma. A large multicenter trial in Romania including 1153 CEUS examinations found a 90.4% sensitivity, 98.8% specificity, 95.4% positive predictive value, and 97.4% negative predictive value, resulting in a 96.9% diagnostic accuracy for the diagnosis of hemangiomas 2 . A large study of 1034 FLLs in oncologic or cirrhotic patients compared CEUS findings with contrast-enhanced CT, MRI, and liver biopsy and found an 85.4% sensitivity and 93.7% specificity for the diagnosis of hemangiomas, showing high accuracy even in this high-risk group 8 …”