Salama Fady, Thakral Nimish, Leyson Christina Delacruz, Konjeti Venkata, Benrajab Karim, Hawk Gregory, Fouch Harrison, Gedaly Roberto, Khurana Aman
Department of Internal Medicine-Division of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky 40536, USA.
Dr. Bing Zhang Department of Statistics, University of Kentucky, Lexington, Kentucky 40536, USA.
Int J Hepatol. 2024 Oct 24;2024:3879328. doi: 10.1155/2024/3879328. eCollection 2024.
: Focal liver lesions (FLL) are one of the most common indications for hepatology and hepatobiliary surgery consultation. In this retrospective study, we aim to assess if contrast-enhanced ultrasound (CEUS) can address diagnostic dilemmas in the evaluation of indeterminate liver lesions by identifying characteristics of indeterminate FLL on CEUS and correlating these with cross-sectional imaging and pathology findings. : We retrospectively reviewed all patients who underwent CEUS evaluation for liver lesions over a 28-month period (Oct 2020 to Jan 2023) at the University of Kentucky. To assess the relationship between CEUS results and the corresponding CT, MRI, and/or pathologic findings, the McNemar-Bowker tests were performed. : Twenty-nine patients were included (after two exclusions from a total of 31). Mean age was 54 years, 62% were female, and 48% had underlying cirrhosis. Of the 29 patients with initial cross-sectional imaging, the initial results showed malignancy or likely malignant lesion in 6 patients and benign or likely benign lesion in 6 patients. The remaining 17 patients had inconclusive/indeterminate results. CEUS clarified an "indeterminate" CT/MRI result 15 times out of 17 (88.2%), moving the diagnosis to "benign" 11 times while suggesting "malignant" only four times. When aggregating indeterminate cross-sectional results with either benign or malignant categories suggested by CEUS, CEUS never reversed a benign CT/MRI diagnosis but often reversed a malignant CT/MRI diagnosis. : CEUS provided a definitive diagnosis of indeterminate liver lesions in approximately 90% of patients and avoided the need for biopsy in most patients. In cases where the liver lesions were biopsied, CEUS accurately distinguished malignant versus benign lesions as confirmed by biopsy findings. CEUS, therefore, has the potential to provide a precise diagnosis for the majority of indeterminate lesions.
局灶性肝病变（FLL）是肝病学和肝胆外科会诊最常见的指征之一。在这项回顾性研究中，我们旨在通过识别CEUS上不确定FLL的特征，并将这些特征与横断面成像和病理结果相关联，评估对比增强超声（CEUS）能否解决不确定肝病变评估中的诊断难题。我们回顾性分析了肯塔基大学在28个月期间（2020年10月至2023年1月）接受CEUS评估肝病变的所有患者。为了评估CEUS结果与相应CT、MRI和/或病理结果之间的关系，进行了McNemar-Bowker检验。纳入29例患者（总共31例，排除2例）。平均年龄54岁，62%为女性，48%有潜在肝硬化。在29例进行初始横断面成像的患者中，初始结果显示6例为恶性或可能为恶性病变，6例为良性或可能为良性病变。其余17例患者结果不明确/不确定。CEUS在17例中有15例（88.2%）明确了“不确定”的CT/MRI结果，将诊断改为“良性”11次，仅提示“恶性”4次。当将不确定的横断面结果与CEUS提示的良性或恶性类别合并时，CEUS从未推翻良性CT/MRI诊断，但经常推翻恶性CT/MRI诊断。CEUS为约90%的患者提供了不确定肝病变的明确诊断，并避免了大多数患者进行活检的必要性。在对肝病变进行活检的病例中，CEUS如活检结果所证实，准确区分了恶性与良性病变。因此，CEUS有可能为大多数不确定病变提供精确诊断。
