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Late-Phase Pulse-Inversion Sonography Using the Contrast Agent Levovist: Differentiation Between Benign and Malignant Focal Lesions of the Liver

Alexandra von Herbay1, Christoph Vogt and Dieter Häussinger

1 All authors: Department of Medicine and Department of Hepatology, Gastroenterology and Infectious Diseases, University of Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany.



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  		Fig. 1. —Receiver operating characteristic curve. Graph shows differentiation of malignant from benign lesions using contrast-enhanced sonography in late phase of contrast enhancement. We set cutoff value at 3. Broken line represents baseline sonography; solid line represents contrast-enhanced sonography. Sensitivity and specificity of contrast-enhanced sonography for differentiation between benign and malignant lesions were significantly higher than those of B-mode sonography.

 


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  		Fig. 2A. —60-year-old man with focal hyposteatosis. Native B-mode sonogram shows hypoechoic lesion (arrow) ventral to portal vein.

 


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  		Fig. 2B. —60-year-old man with focal hyposteatosis. Contrast-enhanced late-phase pulse-inversion sonogram shows homogeneous enhancement in focal lesion and surrounding liver parenchyma.

 


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  		Fig. 3A. —30-year-old woman with focal nodular hyperplasia. Native B-mode sonogram shows hypoechoic inhomogeneous lesion (arrows) with hypoechoic rim.

 


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  		Fig. 3B. —30-year-old woman with focal nodular hyperplasia. Contrast-enhanced late-phase pulse-inversion sonogram shows homogeneous enhancement in focal lesion and surrounding liver parenchyma.

 


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  		Fig. 4A. —42-year-old woman with benign adenoma of liver. Native B-mode sonogram shows two hypoechoic lesions (arrows) in right lobe of liver.

 


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  		Fig. 4B. —42-year-old woman with benign adenoma of liver. Contrast-enhanced late-phase pulse-inversion sonogram shows homogeneous enhancement in both focal lesions and surrounding liver parenchyma.

 


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  		Fig. 5A. —78-year-old man with metastatic liver disease. Native B-mode sonogram shows inhomogeneous parenchyma of liver, suggestive of focal liver lesions.

 


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  		Fig. 5B. —78-year-old man with metastatic liver disease. Contrast-enhanced late-phase pulse-inversion sonogram shows clear demarcation of multiple focal lesions without enhancement surrounded by enhanced liver parenchyma. Liver biopsy revealed metastatic liver disease by adenocarcinoma. Diffuse infiltration of liver was confirmed on CT.

 


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  		Fig. 6A. —59-year-old woman with cholangiocellular carcinoma. Native B-mode sonogram shows hypoechoic area (arrows) in right lobe of liver.

 


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  		Fig. 6B. —59-year-old woman with cholangiocellular carcinoma. Contrast-enhanced late-phase pulse-inversion sonogram shows clear demarcation of area involved by cholangiocellular carcinoma (arrow).

 


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  		Fig. 7A. —77-year-old man with hepatocellular carcinoma. Native B-mode sonogram shows inhomogeneous lesion in right lobe of liver.

 


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  		Fig. 7B. —77-year-old man with hepatocellular carcinoma. Contrast-enhanced late-phase pulse-inversion sonogram shows clear demarcation of focal lesion (arrows) without contrast enhancement surrounded by enhanced liver parenchyma.

 

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