Characterization of focal liver lesions: Comparison of pulse-inversion harmonic contrast-enhanced sonography with contrast-enhanced CT

Purpose. To compare the efficacy of contrast-enhanced pulse-inversion harmonic sonography for the characterization of focal liver lesions with that of contrast-enhanced helical CT. Methods. Real-time contrast-enhanced sonography (CEUS) using Sonovue and contrast-enhanced CT (CECT) were performed on 109 patients with focal liver lesions, including 61 hepatocellular carcinomas, 15 liver metastases, 5 cholangiocellular carcinomas, 12 hemangiomas, 5 regenerative nodules, 3 adenomas, 3 focal nodular hyperplasias, 4 focal necroses, and 1 angiomyolipoma prior to surgery or percutaneous needle biopsy. The diagnostic performance was assessed by using histopathological results as reference standards. Results. Three cases were missed on CEUS, and 7 cases were missed on CECT. These 10 missed cases were excluded from paired statistical comparison. Ten cases were misdiagnosed on CEUS and 17 cases were misdiagnosed on CECT. The overall accuracy was 89.9% (89/99) for CEUS and 82.8% (82/99) for CECT. The difference between CEUS and CECT was not statistically significant. Concordance between CEUS and CECT was observed in 90.9% (90/99) cases. Conclusion. Real-time pulse-inversion harmonic CEUS with Sonovue is comparable with CECT in the characterization of focal liver lesions. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2007