Liver metastases: Sulphur hexafluoride-enhanced ultrasonography for lesion detection: a systematic review

This is a systematic review to evaluate the accuracy of contrast-enhanced ultrasonography (CEUS) performed with "SonoVue" (sulphur hexafluoride) in the detection of hepatic metastases. The MEDLINE, EMBASE and COCHRANE Databases were searched, regardless of language, for relevant articles published before December 2009. Two reviewers independently assessed study eligibility using a standardized form and methodological quality using the quality assessment of diagnostic accuracy studies (QUADAS) Checklist. Sensitivity estimates were calculated on a per-patient and/or per-lesion basis. The search for published articles yielded 718 potentially relevant abstracts. Of these, 14 papers were eligible but only three articles fulfilled the inclusion criteria, which comprised a total of 450 patients (patient sample number: range 12 to 365; cancer prevalence: 14.8 to 71.2%). Estimated per-patient sensitivity ranged from 79-100%. Although the quality assessment of diagnostic accuracy studies checklist showed the papers were of good quality, a meta-analysis was not applicable because of the lack of eligible studies. In conclusion, CEUS seems to be promising in the detection of liver metastases; however, there have not been enough studies to conduct meta-analysis. Further studies are required before this promising method can be widely used.