Impact of contrast-enhanced ultrasonography in a tertiary clinical practice

The purpose of this study was to assess the impact of contrast-enhanced ultrasonography (CEUS) of the liver in a tertiary clinical practice.

One thousand forty consecutive CEUS examinations performed over 30 months for mass characterization were reviewed to determine their source, accuracy, and clinical impact.

Two hundred seventy-five (26.4%) of 1040 examinations were motivated by incidental detection of a mass at routine ultrasonography; 765 (73.6%) were clinical referrals, most often for characterization of a mass in a high-risk patient scanned for hepatoma surveillance or characterization of an indeterminate mass after prior imaging. Clinician referrals increased from 57 in the first 6 months after CEUS introduction to 158 in the last 6 months of the study. Surveillance scans yielded 78 confirmed hepatocellular carcinomas characterized on CEUS at the time of identification. Contrast-enhanced ultrasonography was accurate in 233 (89.2%) of 261 with histologic proof, including 208 malignant lesions. Clinical impact included reduced referrals for other imaging in 226 (21.7%) of 1040 patients, decreased time to diagnosis in 390 (37.5%), and successful guidance for ablation therapy in 26 (2.5%). A positive change in management occurred in 182 (17.5%) of 1040, including alteration of a previous diagnosis, a diagnosis made by CEUS after indeterminate prior imaging, and a diagnosis upstaged by CEUS. Negative impacts included delayed management in 8 (0.8%) small hepatocellular carcinomas misdiagnosed as benign lesions and wrong management of a solitary sclerotic hemangioma, in a high-risk patient for hepatoma, misdiagnosed as a malignant tumor on CEUS, computed tomography, and magnetic resonance imaging, leading to its surgical removal.

Contrast-enhanced ultrasonography has a positive impact on clinical management, providing rapid, accurate diagnosis of incidentally detected masses and resolving nodules on surveillance scans and indeterminate masses on other imaging.