Ultraschall Med 2013; 34 - WS_SL24_06
DOI: 10.1055/s-0033-1354958

Early wash-out (< 60 seconds) at contrast-enhanced ultrasonography in liver nodules in cirrhosis is highly suggestive for non-hepatocellular carcinoma malignancy

A Funaro 1, LM Vitale 1, M Niosi 1, R Meucci 1, C de Sio 1, L Romano 1, C Loguercio 1, M Romano 1, I de Sio 1
  • 1Second University of Naples, Departement of Clinical and Experimental Medicine 'Magrassi-Lanzara', Naples, Italy

Purpose: Contrast-Enhanced Ultrasonography (CEUS) was recommended for detection and characterization of liver nodules, with same diagnostic accuracy as contrast computed tomography (CT) scan and dynamic magnetic resonance imaging (MRI). However, this procedure has been dropped from the diagnostic algorithm of liver malignancy in the update American Association for the Study of Liver Diseases guidelines 2011, because of false positive hepatocellular carcinoma (HCC) diagnosis in patients with cholangiocarcinoma. The present study aimed to assess the role of CEUS in diagnosis of liver non-HCC malignancy.

Material and methods: We enrolled 282 cirrhosis patients with liver nodules who underwent ultrasound (US)-guided percutaneous biopsy from 2008 to 2012. We preliminarly performed CEUS in all patients and evaluated wash-out during portal phase of contrast distribution. CEUS-based diagnosis was compared with histological evaluation of specimens obtained through US-guided percutaneous biopsy.

Results: Final histological diagnosis was the following: HCC in 230 cases, non-HCC malignancy in 18 cases, regenerative nodules in 25 cases and borderline lesions in 9 cases. Non-HCC malignant lesions included: metastasis in 8 cases, cholangiocarcinoma in 5 cases and non-Hodgkin lymphoma in 5 cases. At CEUS we observed early wash-out (< 60 seconds) in all cases of non-HCC malignancy and in only 7 of 230 cases of HCC. Sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value of early wash-out at CEUS for diagnosis of non-HCC malignant lesions in cirrhosis were respectively 100%, 97%, 97%, 72% and 100%.

Conclusion: Early wash-out (< 60 seconds) of liver nodules in cirrhosis at CEUS has excellent diagnostic accuracy for non-HCC malignancy. We postulate that liver nodules with early wash out (< 60 seconds) at CEUS should undergo liver biopsy in order to confirm diagnosis and suggest that CEUS should be reintroduced in diagnostic flow chart of liver malignancy in cirrhosis.