Verbesserte detektion von leberläsionen durch ultraschall- kontrastmittel der zweiten generation im vergleich zur konventionellen sonografie

Aim: Aim of this first prospective international multicentre phaseIIIb study was the comparison of unenhanced (US) and contrast enhanced ultrasound (CEUS) with contrast enhanced spiral computed tomography (CT) and/or contrast enhanced magnetic resonance imaging (MRI) in the detec-tion of focal liver lesions. Methods: 77patients (73per protocol) with liver lesions (primary or secondary liver lesions) were enrolled. After conventional ultrasound examination up to 3injections of 2.4 or 4.8mL SonoVue were injected. Scans were repeated using contrast-specific imaging. Detection of lesions before and after contrast medium injection was com-pared using MRI and/or CT as the standard of reference. Results: US detected 106/160 reference con-firmed liver lesions (sensitivity and positive predictive value (PPV) of 66% and 77%, respectively). CEUS detected 127/160 reference confirmed liver lesions (sensitivity and PPV of 79% and 83%, re-spectively). Five lesions were only detected using conventional unenhanced B-mode ultrasound, 26lesions were only detected with CEUS. 27/154lesions in 73patients (17.5%) detected by CEUS could not be confirmed by the reference method and thus were considered false positive. No adverse events were reported. Discussion: CEUS with SonoVue improves the ability of ultrasound to detect liver lesions. The high rate of lesions detected with CEUS and not by the reference methods (false positive) is actually a general bias in detection studies, in which no absolute non-invasive gold standard is available. Therefore, the true PPV of CEUS may be higher than that reported in this study.