Original Articles
Copyright ©2009 The WJG Press and Baishideng.
World J Gastroenterol. Aug 14, 2009; 15(30): 3748-3756
Published online Aug 14, 2009. doi: 10.3748/wjg.15.3748
Table 1 US equipment and contrast-specific modes
Equipment manufacturerScanning modeNo. of patients scannedTransducerMechanical index
Elegra, SiemensEnsemble contrast imaging (ECI)25Convex array0.10-0.30
3.5C40H
Aplio, ToshibaContrast tissue discrimination (CTD)24Convex array0.1
PVT375AT
HDI 5000, PhilipsPulse inversion harmonic contrast imaging (PI)18Convex array0.04-0.12
C5-2
Technos MPX, EsaoteContrast tuned imaging (CnTI)18Convex array0.09-0.10
CA430
Logic 9, GECoded phase inversion (PI)16Convex array0.09-0.17
3.5C
SSD-5500, AlokaExtended pure harmonic detection (E-PHD)16Convex array0.09-0.20
UST 9126
Sequoia, SiemensCadence contrast pulse sequencing (CPS)7Convex array0.15-0.24
4C1-S
IU 22, PhilipsPulse inversion (PI)3Convex array0.06-0.07
C5-2
Table 2 Classification and diagnostic criteria for the assessment of focal liver lesions
Lesion typeArterial phasePortal venous phaseSinusoidal phase
Malignant lesions
Hepatocellular carcinoma (HCC)Hyperenhanced, often with prominent delineation of feeding vessels around and inside of the lesion, however in well differentiated tumors sometimes only weak arterial enhancementIso- or hypoenhanced, usually rapid contrast wash-outMostly hypoenhanced, however in well differentiated tumors some portal venous enhancement may be present
Cholangiocarcinoma (CCC)Moderately hyperenhancedIso- or hypoenhancedMostly hypoenhanced
Hypervascular metastases (MET)Hyperenhanced, often restricted to the margin of the lesionIso- or hypoenhancedAlways hypoenhanced (black spots)
Hypovascular metastases (MET)Not enhanced or only few isolated spots inside of the lesionHypoenhancedAlways hypoenhanced (black spots)
Other malignant
Benign lesions
Hemangioma (typical)Peripheral nodular enhancement, sharp margin in high-flow hemangiomas: complete filling of the lesion during arterial phaseSlow centripetal progression of the enhancement (‘iris diaphragm sign’), leading to an iso- or hyperenhancedappearance; fill-in can be very slowly (lasting minutes) or rather fast (lasting less than a minute)More or less complete enhancement, prolonged compared to surrounding liver tissue and therefore hyperenhanced at later time points; enhancement may be incomplete in case of (partial) thrombosis
Hemangioma (atypical)Peripheral nodular enhancement, sharp margin or no enhancement (complete thrombosis) or complete enhancement (high flow hemangioma)Slow centripetal progression of the enhancement (‘iris diaphragm sign’), leading to an iso- or hyperenhanced appearance; fill-in can be very slowly (lasting minutes) or rather fast (lasting less than a minute)More or less complete enhancement, prolonged compared to surrounding liver tissue and therefore hyperenhanced at later time points; enhancement may be incomplete in case of (partial) thrombosis
Focal nodular hyperplasia (FNH)Hyperenhanced, with fast centrifugal filling of the lesion; usually a central vessel and radial vascular branches can be delineated, especially in larger lesions (‘spoke and wheel sign’)Iso- or hyperenhancedIso- or hyperenhanced, central scar may become visible
Hepatic adenomaHyperenhanced, frequently with fast centrifugal filling and rapid contrast wash-out; no radial vascular structures visibleIso- or hyperenhanced; hypoenhanced areas in case of central bleeding or scarIso- or hyperenhanced; hypoenhanced areas in case of central bleeding or scar; no central scar or radial intralesional structures
Large regenerating or dysplastic nodulesIsoenhancedIsoenhancedIsoenhanced
Focal fatty accumulationIsoenhancedIsoenhancedIsoenhanced
Focal fatty sparingIsoenhancedIsoenhancedIsoenhanced
CystNo enhancementNo enhancementNo enhancement
Other benign
Table 3 Lesion character of target lesion: SonoVue®-enhanced sonography vs other imaging modalities and final reference diagnosis n (%)
Unenhanced sonographySonoVue®-enhanced sonographyCT and/or MRIHistologyFinal reference diagnosis
n 127127115 31127
Benign25 (19.7)61 (48.0)41 (35.7)8 (25.8)68 (53.5)
Hemangioma (typical)10 (40.0)11 (18.0)12 (29.3)1 (12.5)10 (14.7)
Hemangioma (atypical)5 (20.0)16 (26.2)12 (29.3)1 (12.5)19 (27.9)
Focal nodular hyperplasia6 (24.0)20 (32.8)9 (22.0)3 (37.5)24 (35.3)
Hepatic adenoma02 (3.3)2 (4.9)2 (25.0)3 (4.4)
Regenerating or dysplastic nodules1 (4.0)2 (3.3)1 (2.4) 02 (2.9)
Focal fatty accumulation 02 (3.3)1 (2.4) 02 (2.9)
Focal fatty sparing2 (8.0)3 (5.0)1 (2.4) 03 (4.4)
Cyst 0 00 00
Other benign1 (4.0)5 (8.2)3 (7.3)1 (12.5)5 (7.4)
Malignant25 (19.7)57 (44.9)38 (33.0)21 (67.7)55 (43.3)
Hepatocellular carcinoma14 (56.0)34 (59.7)21 (55.3)13 (61.9)33 (60.0)
Cholangiocarcinoma 0 001 (4.8)1 (1.8)
Hypervascular metastasis2 (8.0)9 (15.8)4 (10.5)2 (9.5)7 (12.7)
Hypovascular metastasis9 (36.0)10 (17.5)10 (26.3)3 (14.3)10 (18.2)
Other malignant lesion 04 (7.0)3 (7.9)2 (9.5)4 (7.3)
Indeterminate77 (60.6)9 (7.1)34 (29.6)2 (6.5)4 (3.2)