Liver Cancer
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Mar 21, 2006; 12(11): 1699-1705
Published online Mar 21, 2006. doi: 10.3748/wjg.v12.i11.1699
Assessment of metastatic liver disease in patients with primary extrahepatic tumors by contrast-enhanced sonography versus CT and MRI
Christoph F Dietrich, Wolfgang Kratzer, Deike Strobel, Etienne Danse, Robert Fessl, Alfred Bunk, Udo Vossas, Karlheinz Hauenstein, Wilhelm Koch, Wolfgang Blank, Matthijs Oudkerk, Dietbert Hahn, Christian Greis
Christoph F Dietrich, Department of Internal Medicine II, Johann Wolfgang Goethe University Hospital, 60590 Frankfurt, Germany
Wolfgang Kratzer, Department of Internal Medicine I, University Hospital, Ulm 89070, Germany
Deike Strobel, Medical Clinic I, University Hospital, Erlangen 91054, Germany
Etienne Danse, Department of Radiology, University Hospital St. Luc, Brussels 1200, Belgium
Robert Fessl, Department of Radiology, Central Hospital, Augsburg 86156, Germany
Alfred Bunk, Department for Visceral, Thoracic and Vascular Surgery, University Hospital, Dresden 01307, Germany
Udo Vossas, Department of Radiology, Marien Hospital, Düsseldorf 40479, Germany
Karlheinz Hauenstein, Department of Radiology, University Hospital, Rostock 18055, Germany
Wilhelm Koch, Medical Clinic II, Leopoldina Hospital, Schweinfurt 97422, Germany
Wolfgang Blank, Department of Internal Medicine, Hospital am Steinenberg, Reutlingen 72764, Germany
Matthijs Oudkerk, Department of Radiology, University Hospital, Groningen 9700, Netherlands
Dietbert Hahn, Department of Radiology, University Hospital, Würzburg 97080, Germany
Christian Greis, Clinical Research, Bracco Altana Pharma, Konstanz 78467, Germany
Correspondence to: Prof. Christoph F Dietrich, 2nd Depart-ment of Internal Medicine, Caritas Hospital Bad Mergentheim, Uhlandstr. 7, Bad Mergentheim D-97980, Germany.
Telephone: +49-793-1582201 Fax: +49-793-1582290
Received: October 10, 2005
Revised: October 20, 2005
Accepted: November 10, 2005
Published online: March 21, 2006

AIM: To evaluate contrast-enhanced ultrasonography (CEUS) using SonoVue® in the detection of liver metastases in patients with known extrahepatic primary tumors versus the combined gold standard comprising CT, MRI and clinical/histological data.

METHODS: It is an international multicenter study, and there were 12 centres and 125 patients (64 males, 61 females, aged 59 ± 11 years) involved, with 102 patients per protocol. Primary tumors were colorectal in 35 %, breast in 27 %, pancreatic in 17 % and others in 21 %. CEUS using SonoVue® was employed with a low-mechanical-index technique and contrast-specific software using Siemens Elegra, Philips HDI 5000 and Acuson Sequoia; continuous scanning for at least five minutes.

RESULTS: CEUS with SonoVue® increased significantly the number of focal liver lesions detected versus unenhanced sonography. In 31.4 % of the patients, more lesions were found after contrast enhancement. The total numbers of lesions detected were comparable with CEUS (55), triple-phase spiral CT (61) and MRI with a liver-specific contrast agent (53). Accuracy of detection of metastatic disease (i.e. at least one metastatic lesion) was significantly higher for CEUS (91.2 %) than for unenhanced sonography (81.4 %) and was similar to that of triple-phase spiral CT (89.2 %). In 53 patients whose CEUS examination was negative, a follow-up examination 3-6 mo later confirmed the absence of metastatic lesions in 50 patients (94.4 %).

CONCLUSION: CEUS is proved to be reliable in the detection of liver metastases in patients with known extrahepatic primary tumors and suspected liver lesions.

Keywords: CT, MRI, Metastasis, Detection, SonoVue®