Original Article
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. May 7, 2010; 16(17): 2109-2119
Published online May 7, 2010. doi: 10.3748/wjg.v16.i17.2109
Differentiation of focal liver lesions using three-dimensional ultrasonography: Retrospective and prospective studies
Wen Luo, Kazushi Numata, Manabu Morimoto, Akito Nozaki, Michio Ueda, Masaaki Kondo, Satoshi Morita, Katsuaki Tanaka
Wen Luo, Kazushi Numata, Manabu Morimoto, Akito Nozaki, Michio Ueda, Masaaki Kondo, Katsuaki Tanaka, Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
Wen Luo, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, 15th Changle Xi Road, Xi’an 710032, Shaanxi Province, China
Satoshi Morita, Department of Biostatistics and Epidemiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
Author contributions: Luo W and Numata K designed the research; Numata K and Morimoto M performed the research; Luo W, Nozaki A, Kondo M and Tanaka K contributed analytic tools; Luo W, Numata K, Ueda M and Morita S analyzed the data; Luo W and Numata K wrote the paper.
Correspondence to: Kazushi Numata, MD, Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan. kz-numa@urahp.yokohama-cu.ac.jp
Telephone: +81-45-2615656 Fax: +81-45-2619492
Received: November 24, 2009
Revised: January 6, 2010
Accepted: January 13, 2010
Published online: May 7, 2010
Abstract

AIM: To differentiate focal liver lesions based on enhancement patterns using three-dimensional ultrasonography (3D US) with perflubutane-based contrast agent.

METHODS: Two hundred and eighty two patients with focal liver lesions, including 168 hepatocellular carcinomas (HCCs), 63 metastases, 40 hemangiomas and 11 focal nodular hyperplasias (FNHs), were examined by 3D US with perflubutane-based contrast agent. Tomographic ultrasound images and sonographic angiograms were reconstructed. Among 282 lesions, enhancement patterns of 163 lesions between January 2007 and October 2007 were analyzed retrospectively. Then from November 2007 to May 2008, compared with contrast-enhanced (CE) 2D US, CE 3D US was performed on 119 lesions for prospective differential diagnosis. Sensitivity, specificity, area under receiver operating characteristic curve (Az) and inter-reader agreement were assessed.

RESULTS: With the tridimensional view, dominant enhancement patterns were revealed as diffuse enhancement or peripheral ring-like enhancement, followed with washout change for HCCs or metastases, respectively, and peripheral nodular enhancement or diffuse enhancement with spoke-wheel arteries, followed by persistent enhancement for hemangiomas or FNHs, respectively. At CE 3D US, the prospective differentiation of lesions showed sensitivity 92% (mean for two readers), specificity 91% and Az value 0.95 for HCCs, 84%, 97%, and 0.95 for metastases, 91%, 98%, and 0.98 for hemangiomas and 80%, 99%, and 0.99 for FNHs, respectively, while good to excellent inter-reader agreement was achieved. No significant difference exists between prospective diagnosis accuracy at CE 3D US and that at CE 2D US.

CONCLUSION: CE 3D US provides a spatial perspective for liver tumor enhancement, and could help in differentiating focal liver lesions.

Keywords: Three-dimensional, Ultrasonography, Contrast agent, Liver, Neoplasms