Department of Medical Ultrasound, Laboratory of Novel Optoacoustic (Ultrasonic) Imaging, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Department of Ultrasound, Laboratory of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China.
Eur Radiol. 2024 Jun;34(6):3795-3812. doi: 10.1007/s00330-023-10371-2. Epub 2023 Nov 22.
The recognition of arterial phase hyperenhancement (APHE) and washout during the late phase is key for correct diagnosis of hepatocellular carcinoma (HCC) with contrast-enhanced ultrasound (CEUS). This meta-analysis was conducted to compare SonoVue®-enhanced and Sonazoid®-enhanced ultrasound in the assessment of HCC enhancement and diagnosis.
Studies were included in the analysis if they reported data for HCC enhancement in the arterial phase and late phase for SonoVue® or in the arterial phase and Kupffer phase (KP) for Sonazoid®. Forty-two studies (7502 patients) with use of SonoVue® and 30 studies (2391 patients) with use of Sonazoid® were identified. In a pooled analysis, the comparison between SonoVue® and Sonazoid® CEUS was performed using chi-square test. An inverse variance weighted random-effect model was used to estimate proportion, sensitivity, and specificity along with 95% confidence interval (CI).
In the meta-analysis, the proportion of HCC showing APHE with SonoVue®, 93% (95% CI 91-95%), was significantly higher than the proportion of HCC showing APHE with Sonazoid®, 77% (71-83%) (p < 0.0001); similarly, the proportion of HCC showing washout at late phase/KP was significantly higher with SonoVue®, 86% (83-89%), than with Sonazoid®, 76% (70-82%) (p < 0.0001). The sensitivity and specificity for the detection of APHE plus late-phase/KP washout detection in HCC were also higher with SonoVue® than with Sonazoid® (sensitivity 80% vs 52%; specificity 80% vs 73% in studies within unselected patient populations).
APHE and late washout in HCC are more frequently observed with SonoVue® than with Sonazoid®. This may affect the diagnostic performance of CEUS in the diagnosis of HCCs.
Meta-analysis data show the presence of key enhancement features for diagnosis of hepatocellular carcinoma is different between ultrasound contrast agents, and arterial hyperenhancement and late washout are more frequently observed at contrast-enhanced ultrasound with SonoVue® than with Sonazoid®.
• Dynamic enhancement features are key for imaging-based diagnosis of HCC. • Arterial hyperenhancement and late washout are more often observed in HCCs using SonoVue®-enhanced US than with Sonazoid®. • The existing evidence for contrast-enhanced US may need to be considered being specific to the individual contrast agent.
动脉期增强（APHE）和晚期廓清的识别是使用对比增强超声（CEUS）正确诊断肝细胞癌（HCC）的关键。本荟萃分析旨在比较 SonoVue®和 Sonazoid®增强超声在 HCC 增强和诊断评估中的应用。
如果研究报告了 SonoVue®的动脉期和晚期以及 Sonazoid®的动脉期和库普弗期（KP）的 HCC 增强数据，则将其纳入分析。共纳入 42 项使用 SonoVue®的研究（7502 例患者）和 30 项使用 Sonazoid®的研究（2391 例患者）。在汇总分析中，使用卡方检验比较 SonoVue®和 Sonazoid®CEUS。采用逆方差加权随机效应模型估计比例、敏感性和特异性，并计算 95%置信区间（CI）。
荟萃分析显示，SonoVue®显示 HCC 存在 APHE 的比例为 93%（95%CI 91-95%），显著高于 Sonazoid®显示 HCC 存在 APHE 的比例 77%（71-83%）（p<0.0001）；同样，SonoVue®显示 HCC 晚期/KP 廓清的比例为 86%（83-89%），显著高于 Sonazoid®的 76%（70-82%）（p<0.0001）。在未选择患者人群的研究中，SonoVue®检测 HCC 的 APHE 加晚期/KP 廓清的敏感性和特异性也高于 Sonazoid®（敏感性 80% vs 52%；特异性 80% vs 73%）。
与 Sonazoid®相比，SonoVue®更常观察到 HCC 的 APHE 和晚期廓清。这可能会影响 CEUS 在 HCC 诊断中的诊断性能。
荟萃分析数据显示，两种超声造影剂诊断肝细胞癌的关键增强特征不同，SonoVue®增强超声检测动脉期高增强和晚期廓清的频率高于 Sonazoid®。
动态增强特征是基于影像的 HCC 诊断的关键。
使用 SonoVue®增强超声观察到 HCC 的动脉期高增强和晚期廓清比 Sonazoid®更常见。
现有关于对比增强超声的证据可能需要考虑到特定于个体造影剂。
