Ultrasound-arterioportography (US-AP): A new technical approach to perform detection of liver lesions.

PURPOSE

To show the feasibility of a combination of the advantages of modern contrast enhanced ultrasound (CEUS) with the technique of arterioportography to achieve the highest sensitivity of all different modalities.

MATERIAL AND METHODS

Ten patients (9 m, 1 f, age 52-73 years) with suspected hepatocellular carcinoma (HCC) in liver cirrhosis (8 ethyl toxic, 2 hepatitis) were included before transarterial chemo-embolization (TACE). In all patients during a 6-week period a double enhanced MRI (Gd-DTPA and SPIO) was performed. Before TACE a bolus <2 mL ultrasound contrast agent (SonoVue®, Bracco, Milan, Italy) was injected over a selectively placed catheter in the superior mesenteric artery (SMA) and ultrasound of the liver (2.5-4 MHz, LOGIQ 9; GE Healthcare) was performed in arterioportographic phase (US-AP). Two independent readers evaluate number, size and localisation of detected lesion in MRI and US-AP. Additional diagnostic quality of both modalities was determined using a 4-point scale (1: excellent-4: not diagnostic). Differences were analysed for significance using a t-test. Interobserver variability was calculated (κ-value).

RESULT

In all 10 patients (100 %) US-AP was feasible. Diagnostic quality was in all cases between 1-2 for both modalities and readers (MRI standard deviation (SD) -0.51, Sono-AP SD -0.421). US-AP detected with 33.5 vs. 24.5 lesions, significant more lesions than double enhanced MRI (p < 0.022). The interobserver variability was κ -0.965 for MRI and κ -0.898 for US-AP.

CONCLUSION

US-AP for detection of liver lesions is feasible. Using this technique significantly more lesions in patients with hepatocellular carcinoma could be detected in comparison to MRI with liver-specific contrast agent.