Department of Diagnostic and Interventional Radiology and Center for Clinical Epidemiology, Institute for Social and Preventive Medicine, University Hospital Lausanne, Switzerland.
Radiology. 2011 Oct;261(1):300-10. doi: 10.1148/radiol.11101866. Epub 2011 Jul 11.
To evaluate whether parametric imaging with contrast material-enhanced ultrasonography (US) is superior to visual assessment for the differential diagnosis of focal liver lesions (FLLs).
This study had institutional review board approval, and verbal patient informed consent was obtained. Between August 2005 and October 2008, 146 FLLs in 145 patients (63 women, 82 men; mean age, 62.5 years; age range, 22-89 years) were imaged with real-time low-mechanical-index contrast-enhanced US after a bolus injection of 2.4 mL of a second-generation contrast agent. Clips showing contrast agent uptake kinetics (including arterial, portal, and late phases) were recorded and subsequently analyzed off-line with dedicated image processing software. Analysis of the dynamic vascular patterns (DVPs) of lesions with respect to adjacent parenchyma allowed mapping DVP signatures on a single parametric image. Cine loops of contrast-enhanced US and results from parametric imaging of DVP were assessed separately by three independent off-site readers who classified each lesion as benign, malignant, or indeterminate. Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated for both techniques. Interobserver agreement (κ statistics) was determined.
Sensitivities for visual interpretation of cine loops for the three readers were 85.0%, 77.9%, and 87.6%, which improved significantly to 96.5%, 97.3%, and 96.5% for parametric imaging, respectively (P < .05, McNemar test), while retaining high specificity (90.9% for all three readers). Accuracy scores of parametric imaging were higher than those of conventional contrast-enhanced US for all three readers (P < .001, McNemar test). Interobserver agreement increased with DVP parametric imaging compared with conventional contrast-enhanced US (change of κ from 0.54 to 0.99).
Parametric imaging of DVP improves diagnostic performance of contrast-enhanced US in the differentiation between malignant and benign FLLs; it also provides excellent interobserver agreement.
评估对比增强超声（CEUS）参数成像是否优于视觉评估，用于鉴别局灶性肝病变（FLL）。
本研究获得了机构审查委员会的批准，并获得了患者的口头知情同意。在 2005 年 8 月至 2008 年 10 月期间，对 145 例患者的 146 个 FLL 进行了实时低机械指数对比增强超声检查，这些患者在静脉注射 2.4 毫升第二代造影剂后进行了检查。记录显示造影剂摄取动力学（包括动脉期、门静脉期和晚期）的图像，随后使用专用图像处理软件离线进行分析。通过分析病变与相邻实质之间的动态血管模式（DVP），可以在单个参数图像上绘制 DVP 特征图。三位独立的远程读者分别评估对比增强超声的电影循环和 DVP 参数成像的结果，他们将每个病变分类为良性、恶性或不确定。计算了两种技术的敏感性、特异性、准确性、阳性预测值和阴性预测值。确定了观察者间的一致性（κ 统计）。
三位读者对电影循环的视觉解释的敏感性分别为 85.0%、77.9%和 87.6%，而参数成像的敏感性分别显著提高至 96.5%、97.3%和 96.5%（P<.05，McNemar 检验），同时保持了高特异性（所有三位读者均为 90.9%）。对于所有三位读者，参数成像的准确性评分均高于传统 CEUS（P<.001，McNemar 检验）。与传统 CEUS 相比，DVP 参数成像增加了观察者间的一致性（κ 值从 0.54 变为 0.99）。
DVP 参数成像改善了 CEUS 在鉴别恶性和良性 FLL 中的诊断性能；它还提供了极好的观察者间一致性。
