Abstract
Background: To evaluate the diagnostic accuracy of quantitative perfusion parameters in contrast-enhanced ultrasound to differentiate malignant from benign liver lesions. Methods: In this retrospective study 134 patients with a total of 139 focal liver lesions were included who underwent contrast enhanced ultrasound (CEUS) between 2008 and 2018. All examinations were performed by a single radiologist with more than 15 years of experience using a second-generation blood pool contrast agent. The standard of reference was histopathology (n = 60), MRI or CT (n = 75) or long-term CEUS follow up (n = 4). For post processing regions of interests were drawn both inside of target lesions and the liver background. Time–intensity curves were fitted to the CEUS DICOM dataset and the rise time (RT) of contrast enhancement until peak enhancement, and a late-phase ratio (LPR) of signal intensities within the lesion and the background tissue, were calculated and compared between malignant and benign liver lesion using Student’s t-test. Quantitative parameters were evaluated with respect to their diagnostic accuracy using receiver operator characteristic curves. Both features were then combined in a logistic regression model and the cumulated accuracy was assessed. Results: RT of benign lesions (14.8 ± 13.8 s, p = 0.005), and in a subgroup analysis, particular hemangiomas (23.4 ± 16.2 s, p < 0.001) differed significantly to malignant lesions (9.3 ± 3.8 s). The LPR was significantly different between benign (1.59 ± 1.59, p < 0.001) and malignant lesions (0.38 ± 0.23). Logistic regression analysis with RT and LPR combined showed a high diagnostic accuracy of quantitative CEUS parameters with areas under the curve of 0.923 (benign vs. malignant) and 0.929 (hemangioma vs. malignant. Conclusions: Quantified CEUS parameters are helpful to differentiate malignant from benign liver lesions, in particular in case of atypical hemangiomas.
Highlights
Focal liver lesions (FLL) are common and can be found in about 5% of the European population [1]
A focal liver lesion found in conventional ultrasound can in many cases be diagnosed immediately via Contrast-enhanced ultrasound (CEUS) without another appointment at computed tomography (CT) or magnetic resonance imaging (MRI), sparing patients psychical stress and, in case of CT, radiation exposure
In order to evaluate CEUS perfusion quantification parameters in a larger cohort and to evaluate which parameters are best suited to differentiate malignant from benign liver lesions we retrospectively evaluated 139 CEUS examinations with histopathology, MRI or long-term follow-up as the standard of reference
Summary
Focal liver lesions (FLL) are common and can be found in about 5% of the European population [1]. Contrast-enhanced ultrasound (CEUS) can be performed within the same investigation as B-mode and Doppler ultrasound and provides additional information about the vascularization and contrast dynamics of FLL with a good diagnostic performance comparable to CT and MRI [3,4,5]. A focal liver lesion found in conventional ultrasound can in many cases be diagnosed immediately via CEUS without another appointment at CT or MRI, sparing patients psychical stress and, in case of CT, radiation exposure. To evaluate the diagnostic accuracy of quantitative perfusion parameters in contrast-enhanced ultrasound to differentiate malignant from benign liver lesions. Methods: In this retrospective study 134 patients with a total of 139 focal liver lesions were included who underwent contrast enhanced ultrasound (CEUS) between 2008 and 2018. Time–intensity curves were fitted to the CEUS DICOM dataset and the rise time (RT) of contrast enhancement until peak enhancement, and a late-phase ratio (LPR)
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