Burns Peter N, Wilson Stephanie R
Department of Medical Biophysics, University of Toronto, and Toronto General Hospital, Ontario, Canada.
Radiology. 2007 Jan;242(1):162-74. doi: 10.1148/radiol.2421051006. Epub 2006 Nov 7.
To assess prospectively the concordance of enhancement patterns of focal liver masses on contrast material-enhanced ultrasonographic (US) scans with patterns on contrast-enhanced computed tomographic (CT) scans or magnetic resonance (MR) images.
This study was approved by the institutional review board; patients gave informed consent. Contrast-enhanced US and contrast-enhanced CT or MR imaging were performed in 135 patients (62 men, 73 women; mean age, 51 years) with 144 confirmed liver masses. Masses included 49 hepatocellular carcinomas, 13 metastases, 30 hemangiomas, 41 lesions of focal nodular hyperplasia, and 11 others. Randomized image sets from each modality were shown independently to three blinded readers, who answered identical questions about enhancement of the lesion and liver in the arterial and portal venous phases and changes with time. Concordance for modalities was calculated from answers of readers and consensus answers between readers, with 95% confidence intervals (CIs). The kappa values were calculated for interreader agreement.
Features of arterial phase enhancement showed concordance of more than 76% for modalities. The highest concordance of 92% (132 of 144), with 95% CI of 86% and 95% (kappa>0.84), was for the presence of peripheral pools and centripetal progression. Concordance in the portal venous phase was lower, with agreement for predominant enhancement of the lesion in 61% (86 of 142), with 95% CI of 52% and 68% (kappa>0.83). Portal venous phase washout occurred in 75% (106 of 142), with 95% CI of 67% and 81% (kappa>0.81). The majority of discordances were for malignancies for which only US depicted no sustained enhancement in the portal venous phase.
US shows high concordance with CT or MR imaging, especially for the arterial phase. Discordance in the portal venous phase may reflect the tendency of CT and MR contrast agents, unlike microbubbles, to diffuse into interstitium.
前瞻性评估对比剂增强超声（US）扫描中肝脏局灶性肿块的强化模式与对比增强计算机断层扫描（CT）或磁共振（MR）图像上的强化模式的一致性。
本研究经机构审查委员会批准；患者均签署知情同意书。对135例（男62例，女73例；平均年龄51岁）确诊有144个肝脏肿块的患者进行了对比增强超声和对比增强CT或MR成像检查。肿块包括49例肝细胞癌、13例转移瘤、30例血管瘤、41例局灶性结节性增生病变和11例其他病变。来自每种检查方式的随机图像集分别独立展示给三位不知情的阅片者，他们回答关于病变和肝脏在动脉期和门静脉期的强化以及随时间变化的相同问题。根据阅片者的回答以及阅片者之间的共识答案计算检查方式之间的一致性，并给出95%置信区间（CI）。计算阅片者间一致性的kappa值。
动脉期强化特征显示各检查方式之间的一致性超过76%。外周池和向心性强化的一致性最高，为92%（144个中的132个），95%CI为86%至95%（kappa>0.84）。门静脉期的一致性较低，病变主要强化的一致性为61%（142个中的86个），95%CI为52%至68%（kappa>0.83）。门静脉期廓清见于75%（142个中的106个），95%CI为67%至81%（kappa>0.81）。大多数不一致情况见于恶性肿瘤，即只有超声显示门静脉期无持续强化。
超声与CT或MR成像显示出高度一致性，尤其是在动脉期。门静脉期的不一致可能反映了CT和MR对比剂与微泡不同，有向间质扩散的倾向。
