Contrast-Enhanced Ultrasound Performance in the Evaluation of Focal Nodular Hyperplasia in a Multicenter Study

Abstract

Contrast-enhanced ultrasound (CEUS) has become the main player in the evaluation of focal liver lesions. The aim of this study was to evaluate the sensitivity, specificity and accuracy of CEUS for focal nodular hyperplasia from a large study group. A multicenter prospective study was performed in fourteen Romanian centers, over a period of 6 years (02.2011-03.2017), that gathered 2062 newly detected focal liver lesions evaluated by CEUS. Each lesion had a contrast CT, MRI or histology as reference method. The lesions have not been previously diagnosed by other imaging technique, and they were considered conclusive if they had an obvious enhancement pattern, as recommended by the guidelines. CEUS performance for the FNH was assessed using OpenEpi software for the statistical analysis. During the 6 years study, 2062 “de novo” focal liver lesions, have been evaluated by CEUS. From this cohort, 94/2062 (4.5%) had a typical FNH enhancing pattern as described in the EFSUMB guidelines. Contrast CT/MRI and biopsy diagnosed additional 15 FNH. From the 94 cases diagnosed as FNH by CEUS, in 9 the final diagnosis was different (5 of them adenomas). CEUS performance for the FNH was: 84% sensitivity, 99.4% specificity, 89.7% positive predictive value, 99.0% negative predictive value and 98.5% diagnostic accuracy for the diagnosis of focal nodular hyperplasia. FNH is a benign liver lesion that can accurately be characterized by CEUS as a first-line imaging method.