Focal liver lesions: clinical usefulness of contrast-enhanced ultrasound in the selection of surgical patients

Purpose: to evaluate the role of contrast-enhanced ultrasound (CEUS) in the characterization of focal liver lesions (FLLs) for surgical patients selection. Materials and Methods: 135 consecutive patients (71 women, 64 men) with 165 FLLs (mean size: 3.1 cm) - 89 benign (10 simple cysts, 26 hemangiomas, 29 focal nodular hyperplasia (FNH), 2 hepatocellular adenomas, 11 focal fatty sparing, 3 focal fatty areas, 5 regenerative nodules, 2 hydatid cysts, 1 abscess) and 76 malignant - 47 metastases, 26 hepatocellular carcinomas and 3 peripheral cholangiocarcinomas - underwent CEUS after the administration of SonoVue®. Two readers reviewed in consensus baseline US and CEUS scans obtained 25-30 s (arterial phase), 55-80 s (portal-venous phase), and 235-260 s (late phase) after the beginning of SonoVue® injection respectively. The readers classified each lesion as malignant or benign by means of definite diagnostic criteria. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated. Results: CEUS correctly ha characterized 156/165 (94,5%) FLLs, 85 benign and 71 malignant. 5/165 (3%) FLLs, 3 hemangiomas e 2 HCCs, remained undetermined after CEUS and 4/165 (2,4%) FLLs, 3 HCCs and 1 abscess were misdiagnosed. CEUS showed sensitivity, specificity, and diagnostic accuracy values of 93,4%, 95,5% e 94,7% respectively. positive predictive value and negative predictive values were 94,7% e 94,4%.