Ultrasound-Arterioportography (US-AP): A new technical approach to perform detection of liver lesions
Issue title: Selected Papers from the 28th Congress on Clinical Hemorheology and Microcirculation of the German Society, Munich, Germany, 20–21 November 2009
Affiliations: Department of Radiology, Regensburg University School of Medicine, Regensburg, Germany | Department of Internal Medicine, University Hospital Regensburg, Regensburg, Germany
Note: [] Corresponding author: Janine Rennert, MD, Department of Radiology, Regensburg University School of Medicine, Franz-Josef-Strauss-Allee 11, D-93053 Regensburg, Germany. Tel.: +49 941 944 7401; Fax: +49 941 944 7402; E-mail: jarennert@yahoo.de
Abstract: Purpose: To show the feasibility of a combination of the advantages of modern contrast enhanced ultrasound (CEUS) with the technique of arterioportography to achieve the highest sensitivity of all different modalities. Material and methods: Ten patients (9 m, 1 f, age 52–73 years) with suspected hepatocellular carcinoma (HCC) in liver cirrhosis (8 ethyl toxic, 2 hepatitis) were included before transarterial chemo-embolization (TACE). In all patients during a 6-week period a double enhanced MRI (Gd-DTPA and SPIO) was performed. Before TACE a bolus <2 mL ultrasound contrast agent (SonoVue®, Bracco, Milan, Italy) was injected over a selectively placed catheter in the superior mesenteric artery (SMA) and ultrasound of the liver (2.5–4 MHz, LOGIQ 9; GE Healthcare) was performed in arterioportographic phase (US-AP). Two independent readers evaluate number, size and localisation of detected lesion in MRI and US-AP. Additional diagnostic quality of both modalities was determined using a 4-point scale (1: excellent–4: not diagnostic). Differences were analysed for significance using a t-test. Interobserver variability was calculated (κ-value). Result: In all 10 patients (100 %) US-AP was feasible. Diagnostic quality was in all cases between 1–2 for both modalities and readers (MRI standard deviation (SD) −0.51, Sono-AP SD −0.421). US-AP detected with 33.5 vs. 24.5 lesions, significant more lesions than double enhanced MRI (p < 0.022). The interobserver variability was κ −0.965 for MRI and κ −0.898 for US-AP. Conclusion: US-AP for detection of liver lesions is feasible. Using this technique significantly more lesions in patients with hepatocellular carcinoma could be detected in comparison to MRI with liver-specific contrast agent.
