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Il Giornale Italiano di Radiologia Medica 2018 Marzo-Aprile;5(2):178-84

DOI: 10.23736/S2283-8376.18.00050-5


language: Italian

Atypical cystic and cystic-like focal liver lesions: added value of low-mechanic-index contrast-enhanced ultrasound with SonoVue®

Antonio CORVINO 1, 2 , Orlando CATALANO 1, Fabio CORVINO 3, Fabio SANDOMENICO 3, Enrico CAVAGLIÀ 4, Antonella PETRILLO 1

1 Università di Napoli Parthenope, Napoli, Italia; 2 Dipartimento ad Attività Integrata di Diagnostica Morfologica e Funzionale, Radioterapia e Medicina Legale, Azienda Ospedaliera Universitaria Federico II, Napoli, Italia; 3 Dipartimento di Radiologia, Istituto Nazionale Tumori, Fondazione Pascale, Napoli, Italia; 4 Dipartimento di Radiologia Vascolare e Interventistica, A.O.R.N. A. Cardarelli, Napoli, Italia


BACKGROUND: Aim of our study was to assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the characterization of atypical cystic and cystic-like focal liver lesions compared with baseline ultrasound (US).
METHODS: Over a 3-year period, 48 patients with 50 atypical cystic and cystic-like lesions at US underwent to CEUS. We included all lesions that appeared anechoic on US and lacked posterior enhancement, or markedly hypoechoic ones that showed internal echoes with or without posterior enhancement. The US and CEUS images and cineloops were reviewed by two blinded readers independently. Sensitivity, specificity, areas under the receiver operating characteristic (ROC) curve, and interobserver agreement were calculated.
RESULTS: The diagnostic confirmation was obtained by cyto-histopathologic examination, by other imaging modalities, and by follow-up. Overall, there were 24 cystic lesions and 26 cystic-like solid lesions, specifically 32 benign and 18 malignant lesions. We reported that the diagnostic performance improved after reviewing CEUS exams for both readers (Az: 0.781 vs. 0.972 and 0.734 vs. 0.957 at baseline US and CEUS, respectively). Inter-reader agreement increased, although slightly (weighted k=0.894 at baseline US vs. k=0.953 at CEUS). In terms of differential diagnosis, the occurrence of correctly characterized lesions increased after CEUS for both readers (62% vs. 98%, and 56% vs. 96%, respectively).
CONCLUSIONS: The possibility of differentiating non-invasively liver cystic and cystic-like solid lesions is extremely important because the clinical implications and therapeutic strategies vary considerably. Our data indicate the usefulness of CEUS in patients with these lesions. This is an added value in countries where US is regarded as the first-choice modality for liver survey.

KEY WORDS: Ultrasonography - Microbubbles - Contrast media - Liver

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