Contrast-Enhanced Ultrasound (CEUS) for the Characterization of Focal Liver Lesions in Clinical Practice (DEGUM Multicenter Trial): CEUS vs. MRI – a Prospective Comparison in 269 Patients

Zusammenfassung

Ziel: In der prospektiven Studie wurde der diagnostische Stellenwert der CEUS bei neu festgestellten fokalen Leberläsionen im klinischen Routinebetrieb evaluiert. Ein wichtiger Aspekt ist der Vergleich mit der Kernspintomografie (MRI). Material und Methoden: 1349 Patienten mit im fundamentalen Ultraschall neu entdeckten fokalen Leberläsionen wurden von 05 / 2004 bis 12 / 2006 prospektiv mit einer standardisierten CEUS untersucht. Ziel war die Bestimmung der Tumordignität und -entität. 269 Patienten wurden nach der CEUS standardisiert mit MRI untersucht. Die definitive Diagnose stützte sich bei typischem Leberhämangiom und Fokal Nodulärer Hyperplasie (FNH) auf die MRI als „diagnostischen Goldstandard”, auf beweisende klinische Befunde, zusätzliches Follow-up (Subgruppe A) oder die Histologie (Subgruppe B). 262 Patienten erfüllten den festgelegten diagnostischen Standard. Ergebnisse: Im Subkollektiv (n = 262) wurde die Tumordignität mit CEUS und MRI 225-mal (85,9 %) und die -entität 204-mal (77,9 %) konkordant beurteilt. In Subgruppe A (n = 180) war die Tumordignität in 169 (93,2 %) und die -entität in 160 Fällen (88,9 %) konkordant, hier dominierten Leberhämangiome (n = 122) und FNH (n = 43). Die Subgruppe B (n = 82) beinhaltete überwiegend maligne Läsionen (n = 55), nur wenige Hämangiome (n = 8) und FNH (n = 5). Die Tumordignität war konkordant in 56 (68,3 %), die -entität in 44 Fällen (53,7 %). CEUS und MRI ließen keine statistisch gesicherten Unterschiede erkennen. Schlussfolgerung: CEUS und MRI sind in der klinischen Routine zur Charakterisierung und Differenzierung neu entdeckter Lebertumoren gleichwertig. Sie unterscheiden sehr zuverlässig benigne und maligne Läsionen und erkennen Leberhämangiome und FNH sicher. Auch Metastasen und HCC werden mit hoher Sicherheit erkannt.

Abstract

Purpose: The aim of this prospective multicenter study was to assess the diagnostic role of CEUS in the diagnosis of newly discovered focal liver lesions in clinical practice. One important aspect is the comparison of CEUS with magnetic resonance imaging (MRI). Materials and Methods: From 05 / 2004 to 12 / 2006, standardized CEUS was performed prospectively on 1349 patients with focal liver lesions that had been newly detected by fundamental ultrasound in order to determine tumor differentiation and tumor entity. 269 patients had a standardized MRI after CEUS. In typical liver hemangioma and focal nodular hyperplasia (FNH), the definitive diagnosis was based on the MRI as the ”diagnostic gold standard” and on clinical evidence and additional follow-up (subgroup A) or on histology (subgroup B). 262 patients met the diagnostic standard that had been set. Results: In the subcollective (n = 262), the tumor differentiation (malignant or benign) of CEUS and MRI was concordant in 225 cases (85.9 %), and the assessment of tumor entity in 204 cases (77.9 %). In subgroup A (n = 180), concordant results for tumor differentiation were obtained in 169 (93.2 %) and for tumor entity in 160 (88.9 %) cases. Liver hemangiomas (n = 122) and FNH (n = 43) were most frequent. Subgroup B (n = 82) comprised mainly malignant liver lesions (n = 55), with only a few of hemangiomas (n = 8) or FNH (n = 5). Tumor differentiation was concordant in 56 (68.3 %) and tumor entity in 44 cases (53.7 %). There were no statistically proven differences between CEUS and MRI. Conclusion: CEUS and MRI are of equal value for the differentiation and specification of newly discovered liver tumors in clinical practice. CEUS and MRI are extremely reliable for the differentiation of benign and malignant lesions, the diagnosis of liver hemangiomas and FNH. The characterization of metastases and HCC is also very reliable.

Key words

liver tumor - focal liver lesion - contrast-enhanced ultrasound (CEUS) - MRI - tumor characterization

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