[Value of combined conventional and contrast enhanced sonography in the evaluation of hepatic disorders]

J Radiol. 2004 Jun;85(6 Pt 1):755-62. doi: 10.1016/s0221-0363(04)97678-0.
[Article in French]


Purpose: To assess the value of combined conventional and contrast-material enhanced sonography for the characterization of focal liver lesions.

Materials and methods: Simultaneous imaging with grey scale and contrast enhanced US was performed in 90 patients following Levovist injection (Schering, Berlin, Germany) using the "Agent Detection Imaging" method (ADI, Siemens-Acuson, Mountain View, USA). US scanning was performed at least 4 minutes after contrast injection with review of both grayscale and contrast enhanced modes. Results for detection and characterization of lesions were compared to the selected gold standard imaging modality (CT or MRI).

Results: Final diagnoses included: 20 normal examinations, 41 patients with metastases, 6 patients with hepatocellular carcinoma, 13 patients with hemangioma, 6 patients with other benign lesions, 4 patients with cysts and 6 patients with two types of lesions. Delayed phase contrast enhanced US allowed diagnosis of all lesions except for one metastasis and all hepatocellular carcinomas. While the diagnosis of hepatoma could not be confirmed, the features suggested a malignant etiology. For 7 patients with metastases, more lesions were detected at ADI (4.9 lesions) than at conventional US (1.1 lesion). For 3 patients, CT showed more lesions than ADI US (3.3 versus 1.6 lesions). The accuracy of ADI US for differentiating between benign and malignant lesions was 98.7% compared to 49.6% for conventional US (p<0.001). The total number of lesions detected at ADI US was higher (p<0.01) than at conventional US and not significantly different from that obtained by the gold standard reference methods. Complete characterization was achieved in 92.2% of cases with ADI US compared to 59.2% with conventional US (p<0.001).

Conclusion: Contrast-material enhanced US combined with conventional US markedly improves the diagnostic accuracy of US in terms of lesion detection and characterization.

Publication types

  • Comparative Study
  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Hepatocellular / diagnostic imaging
  • Carcinoma, Hepatocellular / secondary
  • Contrast Media*
  • Cysts / diagnostic imaging
  • Diagnosis, Differential
  • Female
  • Hemangioma / diagnostic imaging
  • Humans
  • Image Enhancement / instrumentation
  • Image Enhancement / methods*
  • Image Enhancement / standards
  • Liver Diseases / diagnostic imaging*
  • Liver Neoplasms / diagnostic imaging*
  • Liver Neoplasms / secondary
  • Magnetic Resonance Imaging / standards
  • Male
  • Middle Aged
  • Polysaccharides*
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / standards
  • Ultrasonography, Doppler / instrumentation
  • Ultrasonography, Doppler / methods*
  • Ultrasonography, Doppler / standards
  • Ultrasonography, Doppler, Color / instrumentation
  • Ultrasonography, Doppler, Color / methods*
  • Ultrasonography, Doppler, Color / standards


  • Contrast Media
  • Polysaccharides
  • SHU 508