Ultraschall Med 2010; 31(5): 492-499
DOI: 10.1055/s-0029-1245591
Originalarbeiten/Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Contrast-Enhanced Ultrasound (CEUS) for the Characterization of Focal Liver Lesions in Clinical Practice (DEGUM Multicenter Trial): CEUS vs. MRI – a Prospective Comparison in 269 Patients

Kontrastverstärkte Sonografie (CEUS) zur Charakterisierung fokaler Leberläsionen in der klinischen Routine (DEGUM-Multicenterstudie): CEUS vs. MRI – ein prospektiver Vergleich bei 269 PatientenK. Seitz1 , T. Bernatik2 , D. Strobel2 , W. Blank3 , M. Friedrich-Rust4 , H. Strunk5 , C. Greis6 , W. Kratzer7 , A. Schuler8
  • 1Department of Internal Medicine, District Hospital Sigmaringen
  • 2Department of Medicine I, University of Erlangen
  • 3Department of Internal Medicine, Klinikum am Steinenberg Reutlingen
  • 4Department of Internal Medicine 1, J-W-Goethe-University Hospital Frankfurt
  • 5Department of Radiology, University Hospital Bonn
  • 6Braccon Research, Konstanz
  • 7Department of Internal Medicine I, University of Ulm
  • 8Department of Internal Medicine, Helfenstein Klinik, Geislingen
Further Information

Publication History

received: 3.3.2010

accepted: 27.6.2010

Publication Date:
22 July 2010 (online)

Zusammenfassung

Ziel: In der prospektiven Studie wurde der diagnostische Stellenwert der CEUS bei neu festgestellten fokalen Leberläsionen im klinischen Routinebetrieb evaluiert. Ein wichtiger Aspekt ist der Vergleich mit der Kernspintomografie (MRI). Material und Methoden: 1349 Patienten mit im fundamentalen Ultraschall neu entdeckten fokalen Leberläsionen wurden von 05 / 2004 bis 12 / 2006 prospektiv mit einer standardisierten CEUS untersucht. Ziel war die Bestimmung der Tumordignität und -entität. 269 Patienten wurden nach der CEUS standardisiert mit MRI untersucht. Die definitive Diagnose stützte sich bei typischem Leberhämangiom und Fokal Nodulärer Hyperplasie (FNH) auf die MRI als „diagnostischen Goldstandard”, auf beweisende klinische Befunde, zusätzliches Follow-up (Subgruppe A) oder die Histologie (Subgruppe B). 262 Patienten erfüllten den festgelegten diagnostischen Standard. Ergebnisse: Im Subkollektiv (n = 262) wurde die Tumordignität mit CEUS und MRI 225-mal (85,9 %) und die -entität 204-mal (77,9 %) konkordant beurteilt. In Subgruppe A (n = 180) war die Tumordignität in 169 (93,2 %) und die -entität in 160 Fällen (88,9 %) konkordant, hier dominierten Leberhämangiome (n = 122) und FNH (n = 43). Die Subgruppe B (n = 82) beinhaltete überwiegend maligne Läsionen (n = 55), nur wenige Hämangiome (n = 8) und FNH (n = 5). Die Tumordignität war konkordant in 56 (68,3 %), die -entität in 44 Fällen (53,7 %). CEUS und MRI ließen keine statistisch gesicherten Unterschiede erkennen. Schlussfolgerung: CEUS und MRI sind in der klinischen Routine zur Charakterisierung und Differenzierung neu entdeckter Lebertumoren gleichwertig. Sie unterscheiden sehr zuverlässig benigne und maligne Läsionen und erkennen Leberhämangiome und FNH sicher. Auch Metastasen und HCC werden mit hoher Sicherheit erkannt.

Abstract

Purpose: The aim of this prospective multicenter study was to assess the diagnostic role of CEUS in the diagnosis of newly discovered focal liver lesions in clinical practice. One important aspect is the comparison of CEUS with magnetic resonance imaging (MRI). Materials and Methods: From 05 / 2004 to 12 / 2006, standardized CEUS was performed prospectively on 1349 patients with focal liver lesions that had been newly detected by fundamental ultrasound in order to determine tumor differentiation and tumor entity. 269 patients had a standardized MRI after CEUS. In typical liver hemangioma and focal nodular hyperplasia (FNH), the definitive diagnosis was based on the MRI as the ”diagnostic gold standard” and on clinical evidence and additional follow-up (subgroup A) or on histology (subgroup B). 262 patients met the diagnostic standard that had been set. Results: In the subcollective (n = 262), the tumor differentiation (malignant or benign) of CEUS and MRI was concordant in 225 cases (85.9 %), and the assessment of tumor entity in 204 cases (77.9 %). In subgroup A (n = 180), concordant results for tumor differentiation were obtained in 169 (93.2 %) and for tumor entity in 160 (88.9 %) cases. Liver hemangiomas (n = 122) and FNH (n = 43) were most frequent. Subgroup B (n = 82) comprised mainly malignant liver lesions (n = 55), with only a few of hemangiomas (n = 8) or FNH (n = 5). Tumor differentiation was concordant in 56 (68.3 %) and tumor entity in 44 cases (53.7 %). There were no statistically proven differences between CEUS and MRI. Conclusion: CEUS and MRI are of equal value for the differentiation and specification of newly discovered liver tumors in clinical practice. CEUS and MRI are extremely reliable for the differentiation of benign and malignant lesions, the diagnosis of liver hemangiomas and FNH. The characterization of metastases and HCC is also very reliable.

References

  • 1 Seitz K, Schuler A, Rettenmaier G. Klinische Sonographie und Differenzialdiagnose. 2nd ed. Stuttgart: Thieme Verlag; 2007
  • 2 Albrecht T, Blomley M, Bolondi L et al. Guidelines for the use of ultrasound. January 2004.  Ultraschall in Med. 2004;  25 249-256
  • 3 Claudon M, Cosgrove D, Albrecht T et al. Guidelines and good clinical practice recommendations for contrast-enhanced ultrasound (CEUS) – update 2008.  Ultraschall in Med. 2008;  29 28-44
  • 4 Wermke W. Sonographische Differenzialdiagnose: Leberkrankheiten. Köln: Deutscher Ärzte Verlag; 2007
  • 5 Braun B. Focal Liver Processes: ”Better is the Enemy of Good”: CEUS in the Fast Lane.  Ultraschall in Med. 2009;  30 329-332
  • 6 Seitz K. CEUS for Liver Tumors: Facts, Studies, Relevance and Reality in the Clinical Routine.  Ultraschall in Med. 2008;  29 485-487
  • 7 Wilson S R, Greenbaum L D, Goldberg B B. Contrast-enhanced ultrasound: what is the evidence and what are the obstacles?.  AJR. 2009;  153 55-60
  • 8 Albrecht T. Contrast-Enhanced Ultrasound has come of Age.  Ultraschall in Med. 2008;  29 S4, S 187
  • 9 Strobel D, Seitz K, Blank W et al. Contrast-enhanced Ultrasound for the Characterization of Focal Liver Lesions – Diagnostic Accuracy in Cinical practice (DEGUM multicenter trial).  Ultraschall in Med. 2008;  29 499-505
  • 10 Seitz K, Strobel D, Bernatik T et al. Contrast-Enhanced Ultrasound for the Characterization of focal Liver Lesions – Prospective Comparison in Clinical Practice: CEUS vs. CT (DEGUM Multicenter Trial).  Ultraschall in Med. 2009;  30 383-389
  • 11 Strobel D, Seitz K, Blank W et al. Tumor-Specific Vascularization Pattern of Liver Metastasis, Hepatocellular Carcinoma, Hemangioma, Focal Nodular Hyperplasia in the Differential Diagnosis of 1349 Liver Lesions in Contrast-Enhanced Ultrasound (CEUS).  Ultraschall in Med. 2009;  30 376-382
  • 12 Greis C. Technical Overview: SonoVue (Bracco, Milan).  Eur Radiol. 2004;  14 P11-P15
  • 13 Vogl T J. Magnetic Resonance Imaging in Liver Disease. Stuttgart: Thieme Verlag; 2003
  • 14 Hamm B, Krestin G P, Laniado M, et al, (eds) MRI von Abdomen und Becken. Stuttgart: Thieme Verlag; 2003
  • 15 Oldenburg A, Albrecht T. Sonografische Leberdiagnostik bei Tumorpatienten ohne und mit Kontrastmittel.  Ultraschall in Med. 2008;  29 488-498
  • 16 Quaia E, Calliada F, Bertolotto M et al. Characterization of focal liver lesions with contrast-specific US modes and a sulphur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence.  Radiology. 2004;  232 420-430
  • 17 Bleuzen A, Huang C, Olar M et al. Diagnostic Accuracy of Contrast-Enhanced Ultrasound in Focal Lesions of the Liver Using Cadence Contrast pulse Sequencing.  Ultraschall in Med. 2006;  27 40-48
  • 18 Wilson S R, Jang H J, Kim T K et al. Diagnosis of focal liver masses on ultrasonography: comparison of unenhanced and contrast-enhanced scans.  Am J Roentgenol. 2007;  189 W7-W12
  • 19 Xu H X, Liu G J, Lu M D et al. Characterization of small focal liver lesions using real-time contrast-enhanced. Diagnostic performance analysis in 200 patients.  J Ultrasound Med. 2006;  25 349-361
  • 20 Celli N, Gaiani S, Piscaglia F et al. Characterization of liver lesions by real-time contrast-enhanced ultrasonography.  Eur J Gastroenterol Hepatol. 2007;  19 3-14
  • 21 Piscaglia F, Venturi A, Mancini M et al. Diagnostic Features of Real-Time Contrast-Enhanced Ultrasound in Focal Nodular Hyperplasia of the Liver.  Ultraschall in Med. 2010;  31 274-282
  • 22 Dietrich C F, Mertens J C, Braden B et al. Contrast-Enhanced Ultrasound of Histologically Proven Liver Hemangiomas.  Hepatology. 2007;  45 1139-1145
  • 23 Strobel D, Kleinecke C, Hänsler J et al. Contrast-Enhanced Sonography of Hepatocellular Carcinomas – Correlation with Histological Differentiation.  Ultraschall in Med. 2005;  26 270-276
  • 24 Bauditz J, Schade T, Wermke W. Sonografische Diagnostik des hilären cholangiozellulären Karzinoms mittels Echosignalverstärker.  Ultraschall in Med. 2007;  28 161-167
  • 25 Dörffel Y, Wermke W. Neuroendocrine Tumors: Characterization with Contrast-Enhanced Ultrasonography.  Ultraschall in Med. 2008;  29 506-524
  • 26 Nicolau C, Vilana R, Catala V et al. Importance of evaluating all vascular phases on contrast-enhanced sonography in the differentiation of benign from malignant focal liver lesions.  Am J Roentgenol. 2006;  186 158-167
  • 27 Dietrich C F. Update on Contrast Enhanced Ultrasound in Abdominal and Vascular Imaging.  Ultraschall in Med. 2008;  29 (S4) S 188-202
  • 28 Konopke R, Bunk A, Kersting S. Contrast-Enhanced Ultrasonography in Patients with Colorectal Liver Metastases after Chemotherapy.  Ultraschall in Med. 2008;  29 S4, S 1203-209
  • 29 Albrecht T, Hoffmann C, Schmitz S et al. Detection of liver Metastases: comparison of contrast-enhanced phase inversion ultrasound and dual phase spiral CT with intraoperative sonographic correlation.  Radiology. 2000;  207 459
  • 30 Catala V, Nicolau C, Vilana R et al. Characterization of focal liver lesions: comparative study of contrast-enhanced ultrasound versus spiral computer tomography.  Eur Radiol. 2007;  17 1066-1073
  • 31 Quaia E, D’Onofrio M, Palumba E et al. Comparison of contrast-enhanced ultrasound and contrast-enhanced computer tomography in metastatic disease of the liver: diagnostic performance and confidence.  Eur Radiol. 2006;  16 1599-1609
  • 32 Liu G J, XU H X, Lu M D et al. Enhancement pattern of hepatocellular carcinoma: comparison of real-time contrast-ultrasound and contrast-enhanced computed tomography.  Clin Imaging. 2006;  30 315-321
  • 33 Moriyasu F, Itoh K. Efficacy of Perflubutane Microbubble-Enhanced Ultrasound in the Characterization and Detection of Focal Liver Lesions: Phase 3 Multicenter Clinical Trial.  AJR. 2009;  193 86-95
  • 34 Romanini L, Passamonti M, Aiani L et al. Economic assessment of contrast-enhanced ultrasonongraphy for evaluation of focal liver lesions: a multicentre Italian experience.  Eur Radiol. 2007;  17 F99-106
  • 35 Tranquart F, Correas J M, Ladam Marcus V et al. Real-time contrast-enhanced ultrasound in the evaluation of focal liver lesions: diagnostic efficacy and economical issues from a French multicentric study.  J Radiol. 2009;  90 109-122
  • 36 Burns P, Wilson S. Focal Liver Masses: Enhancement patterns of contrast-enhanced images – concordance of US scans with CT scans and MR images.  Radiology. 2007;  242 162-174
  • 37 Dietrich C F, Kratzer W, Strobel D et al. Assessment of metastatic liver disease in patients with primary extrahepatic tumors by contrast-enhanced sonography versus CT and MRI.  World J Gastroenterol. 2006;  12 1699-1705
  • 38 Leen E, Ceccotti P, Kalogeropoulou C et al. Prospective multicenter trial evaluating a novel method of charaterizing focal liver lesions using contrast-enhanced sonography.  Eur RadiolL. 2007;  17 1066-1073
  • 39 Trillaud H, Bruel J M, Valette P J et al. Characterization of focal liver lesions with SonoVue-enhanced sonography: international multicenter-study in comparison to CT and MTI.  World J Gastroenterol. 2009;  30 3748-3756
  • 40 Giorgio A, Stefano G, Coppola C et al. Contrast-enhanced sonography in the characterization of small hepatocellular carcinomas in cirrhotic patients: comparison with contrast-enhanced ultrafast magnetic resonance imaging.  Anticancer Res. 2007;  27 4263-4269
  • 41 Forner A, Vilana R, Ayuso C et al. Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: Prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma.  Hepatology. 2008;  47 97-104
  • 42 Cosgrove D O. A revolution in liver ultrasound.  Eur J Gastroenterol Hepatol. 2007;  19 1-2
  • 43 Piscaglia F, Bolondi L. Italian Society for Ultrasound in Medicine and Biology (SIUMB) Study Group on Ultrasound Contrast Agents. The Safety of Sonovue in abdominal applications: retrospective analysis of 23 188 investigations.  Ultrasound Med Biol. 2006;  32 1369-1375
  • 44 ter Haar G. Bubble Trouble?.  Ultraschall in Med. 2008;  29 550-551
  • 45 Cowper S E, Robin H S, Steinberg S M et al. Scleromyxoedema-like cutaneous disease in renal dialysis patients.  Lancet. 2000;  356 1000-1001
  • 46 US Food and Drug Administration .Gadolinium-containing contrast agents for magnetic resonance imaging (MRI): Omniscan, OmniMARK, Magnevist, ProHance, and MultiHance. FDA Alert; 2006

Dr. Karlheinz Seitz

Department of Internal Medicine, District Hospital Sigmaringen

Hohenzollernstr. 40

72488 Sigmaringen

Germany

Phone: ++ 49/75 71/1 00 22 91

Fax: ++ 49/75 71/1 00 22 83

Email: k.seitz@klksig.de