Indeterminate focal liver lesions incidentally discovered at gray-scale US: Role of contrast-enhanced sonography

Tommaso Vincenzo Bartolotta, Adele Taibbi, Massimo Midiri, Domenica Matranga, Luigi Solbiati, Roberto Lagalla

Research output: Contribution to journalArticle

Abstract

Objectives: To assess the role of contrast-enhanced ultrasound (CEUS) in the characterization of focal liver lesions (FLLs) incidentally discovered but indeterminate at gray-scale ultrasound (US). Materials and Methods: One hundred forty-two consecutive patients with 174 FLLs (169 benign and 5 malignant) incidentally discovered but indeterminate at gray-scale US, underwent CEUS after the administration of SonoVue. Two readers independently reviewed CEUS scans and: (1) classified each lesion as malignant or benign on a 5-point scale of confidence by means of definite diagnostic criteria; (2) provided if possible a specific diagnosis; (3) were requested if further imaging was needed for lesion characterization. Sensitivity, specificity, and areas under the receiver-operating characteristic curve (Az) as well as interobserver agreement were calculated. Results: At CEUS, both readers correctly differentiated benign from malignant lesions in 168 of 174 (96.5%) cases (P <0.0001). A specific correct diagnosis was provided in 123 of 174 (70.7%) and 127 of 174 (72.9%) cases for reader 1 and 2, respectively (P <0.0001). A further imaging study to characterize the lesion after CEUS was requested in 67 cases (38.5%) for reader 1 (P <0.001) and 46 cases (26.4%) for reader 2 (P <0.001). Receiver-operating characteristic analysis after CEUS revealed Az value of 1 for both readers and sensitivity and specificity values of 100% and 97.04% for reader 1 and 100% and 96.45 for reader 2 respectively (P <0.0001). Inter-reader agreement at CEUS was good (weighted k ≤ 0.779). Conclusion: CEUS improves the diagnostic performance of radiologists in the characterization of indeterminate FLLs incidentally discovered at US and reduces the need for further radiologic work-up.

Original languageEnglish
Pages (from-to)106-115
Number of pages10
JournalInvestigative Radiology
Volume46
Issue number2
DOIs
Publication statusPublished - Feb 2011

Keywords

  • contrast media
  • diagnosis
  • liver
  • neoplasms
  • ultrasound (US)

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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