Liver hemangioma – CEUS in 3D. possible applications, usefulness and limitations of the method

Aims: Presentation of application of 3D CEUS techniques on the examples of liver hemangiomas, shortcomings and usefulness of the method.

Materials and methods: We examined 37 patients with former diagnosis or suspicion for liver hemangioma. Final diagnosis was established for 78 lesions.

All patients underwent classical US examination immediately followed by CEUS examination for each lesion and 3D CEUS examination as one of the follow-up examination within 6–18 months. Reference modalities were: CECT=36, CEMR=5, SPECT=4, biopsy=4. For CEUS examination we used Esaote Technos with C2–5MHz probe, Acuson Sequoia with 1C4 probe and Voluson 730 Expert GE with 2–5MHz RAB 3D probe for 3D examination.

SonoVue with single dose of 2.4ml or 4.8ml served as ultrasound contrast agent for 3D examination. Volume acquisition was done in each vascular phase (not repeated when failed).

In the 3D mode we evaluated lesions in following modes: Sectional Planes, Tomographic Ultrasound Imaging.

Results: In comparison to final diagnosis based on reference methods sensitivity of CEUS was 97.4%, specificity 92.3%, CEUS 3D sensitivity was 93.5%, specificity 76.9%.

Classical CEUS versus 3D CEUS sensitivity was 96% and specificity 83.3%.

Possible applications of the method and its limitations will be discussed in the presentation.

Conclusions: 3D CEUS has lower sensitivity and specificity in comparison to the classical CEUS and moreover to the other reference diagnostic imaging modalities. However it seems that most of the shortcomings can be reduced in the near future and still nowadays in some diagnostic cases it should be considered as a very helpful method.