Activity-based cost analysis of contrast-enhanced ultrasonography (CEUS) related to the diagnostic impact in focal liver lesion characterisation.

Arianna Lorusso,Gabriele Poillucci,Maria Assunta Cova,Guido Grisi,Emilio Quaia,Fulvio Stacul

doi:10.1007/s13244-015-0402-4

Arianna Lorusso, Gabriele Poillucci + Show 4 more

Open Access

https://doi.org/10.1007/s13244-015-0402-4

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Abstract

PurposeThis study was done to assess the clinical-diagnostic impact and cost of contrast-enhanced ultrasound (CEUS) versus computed tomography (CT) and magnetic resonance (MR) imaging in the characterisation of focal liver lesions.Materials and methodsCEUS with sulphur hexafluoride-filled microbubbles (SonoVue bolus 2.4 ml) was performed in 157 patients with 160 focal liver lesions identified by other diagnostic techniques. CEUS images were obtained during the arterial (15 to 35 s from contrast injection), portal venous (40 to 70 s) and late phase (up to 300 s from microbubble injection). Contrast-enhanced CT was performed with a 64-row multidetector CT. MRI was performed before and after administration of the liver-specific contrast agent gadobenate dimeglumine (Gd-BOPTA). A patient-by-patient activity-based cost analysis was performed.ResultsCEUS led to a change in the diagnostic workup in 131/157 patients (83.4 %) and in the therapeutic workup in 93/157 patients (59.2 %). CEUS allowed for the final diagnosis to be established in 133/157 patients (84.7 %). The full cost of CEUS was lower than that of contrast-enhanced CT and MR imaging.ConclusionsCEUS determined a change in the diagnostic and therapeutic workup in the characterisation of focal liver lesions and reduced the full costs of the diagnostic process.Main messages: • CEUS allows a correct diagnosis in more than 80 % of focal liver lesions. • CEUS has a significant impact on the diagnosis of focal liver lesions. • CEUS examination of focal liver lesions reduces total costs. • Dynamic MR with hepato-specific contrast medium remains the reference standard for lesion characterisation. • CEUS is low-cost, versatile and accurate in the characterisation of focal liver lesions.

Highlights

Greyscale ultrasound (US) in the study of the liver is a noninvasive, inexpensive and readily accessible technique
We considered the external costs to the radiology division for each of the imaging techniques being compared: in particular, the costs arising from determination of serum creatinine levels and those arising from antiallergic preparations through the use of corticosteroids associated with anti-H1 and anti-H2
Change in the Change in the examined through imaging diagnostic therapeutic with Contrast-enhanced US (CEUS) modalities other than US workup strategy lesions that were correctly characterised by CEUS were: 46 angiomatous lesions, 20 areas of macrovesicular steatosis, 16 cystic lesions, 7 regenerative nodules, 3 focal areas of altered perfusion, 1 case of focal nodular hyperplasia (FNH), 1 case of wound abscess following cholecystectomy, 14 hepatocellular carcinoma (HCC) and 12 metastases

Summary

Introduction

Greyscale ultrasound (US) in the study of the liver is a noninvasive, inexpensive and readily accessible technique. Contrast-enhanced US (CEUS) is recognised as a highly accurate test in the detection and characterisation of focal hepatic lesions [2, 4,5,6]. (considering the required venous access), repeatable technique that is readily available in the ultrasound suite, has high contrast and temporal resolution, and allows dynamic evaluation of lesions in real time [2,3,4,5,6,7].

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