Characterization of Focal Liver Lesions using CEUS and MRI with Liver-Specific Contrast Media: Experience of a Single Radiologic Center

Abstract

Aim The purpose of this study was to compare contrast-enhanced ultrasound (CEUS), magnetic resonance imaging (MRI) using liver-specific contrast agent and a combination of both for the characterization of focal liver lesions (FLL).

Methods 83 patients with both benign and malignant liver lesions were examined using CEUS and MRI after the intravenous administration of liver-specific contrast media. All patients had inconclusive results from prior imaging examinations. Histopathological specimens could be obtained in 53 patients. Ultrasound was performed using a multi-frequency curved probe (1 – 6 MHz) after the injection of 1 – 2.4 ml ultrasound contrast media. The sensitivity, specificity, positive predictive value and negative predictive value of CEUS, MRI and a combination of both (CEUS + MRI) were compared.

Results The sensitivity, specificity, positive and negative predictive values regarding lesion classification were 90.9 %, 70.6 %, 92.3 % and 66.6 %, respectively, for CEUS; 90.9 %, 82.4 %, 95.2 % and 70.0 %, respectively, for MRI; and 96.9 %, 70.6 %, 92.7 % and 85.7 % respectively, for CEUS + MRI. There were no statistically significant differences. 6 malignant lesions were missed using CEUS or MRI alone (false negatives). The use of both modalities combined reduced the false-negative results to 2.

Conclusion CEUS and MRI with liver-specific contrast media are very reliable and of equal informative value in the characterization of focal liver lesions. The number of false-negative results can be decreased using a combination of the two methods.

Zusammenfassung

Ziel Vergleich der Aussagekraft von CEUS und MRT mit leberspezifischem Kontrastmittel sowie einer Kombination aus beiden Modalitäten zur Charakterisierung fokaler Leberläsionen (FLL).

Methoden Insgesamt wurden 83 Patienten mit benignen und malignen Leberläsionen mittels CEUS und MRT mit leberspezifischem Kontrastmittel untersucht, nach vorangegangener Schnittbilddiagnostik ohne eindeutiges Ergebnis. Eine histo-pathologische Sicherung der Läsionen erfolgte bei 53 Patienten. Die Sensitivität und Spezifität sowie der positiv und negativ prädiktive Wert von CEUS, MRT mit leberspezifischem Kontrastmittel und der Kombination aus beiden Bildgebungen (CEUS + MRT) wurden verglichen. Die Ultraschalluntersuchungen wurden mit einer Multifrequenz Konvexsonde (1 – 6 MHz) nach Applikation von 1 – 2,4 ml Ultraschallkontrastmittel durchgeführt.

Ergebnisse Die Sensitivität, die Spezifität, der positiv und der negativ prädiktive Wert bezogen auf die Dignität der untersuchten Läsionen waren für CEUS 90,9 %, 70,6 %, 92,3 % und 66,6 %, für MRT 90,9 %, 82,4 %, 95,2 % und 70,0 % und für CEUS + MRT 96,9 %, 70,6 %, 92,7 % und 85,7 %. Die Unterschiede waren nicht statistisch signifikant. Bei Beschränkung auf nur eine bildgebende Modalität (CEUS oder MRT) wurden jeweils 6 maligne Läsionen nicht erkannt (falsch negativ). Eine Kombination aus beiden Bildgebungen (CEUS + MRT) konnte die Anzahl der falsch negativen Ergebnisse auf 2 reduzieren.

Zusammenfassung Sowohl CEUS als auch MRT mit leberspezifischem Kontrastmittel haben bei der Charakterisierung von fokalen Leberläsionen einen hohen diagnostischen Stellenwert. Die Kombination aus beiden Bildgebungen führt zu einer Verringerung falsch negativer Ergebnisse.

Key words

CEUS - MRI - HCC - liver-specific contrast media - focal liver lesions

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