OBJECTIVE:The aims of this study were to assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) in the characterization of atypical cystic and cysticlike focal liver lesions in comparison with conventional US and to determine whether the use of CEUS can reduce the need for further diagnostic workup. SUBJECTS AND METHODS:In a 3-year period 48 patients with 50 atypical cystic and cysticlike lesions found at conventional US underwent CEUS. Diagnostic confirmation was obtained in cytohistopathologic examinations, with other imaging modalities, and in follow-up. Overall, there were 24 cystic lesions and 26 cysticlike solid lesions, specifically 32 benign and 18 malignant lesions. The conventional US and CEUS images and cine loops were reviewed by two blinded readers independently. Sensitivity, specificity, area under the ROC curve (Az), and interobserver agreement were calculated. RESULTS:Diagnostic performance improved after review of CEUS examinations by both readers (conventional US Az = 0.781 vs 0.972; CEUS Az = 0.734 vs 0.957). Interreader agreement increased, although slightly (conventional US weighted κ = 0.894; CEUS weighted κ = 0.953). In terms of differential diagnosis, the occurrence of correctly characterized lesions increased after CEUS for both readers (reader 1, 62% to 98%; reader 2, 56% to 96%). CONCLUSION:The development of low-acoustic-power CEUS has made it possible to identify several imaging features of cystic and cysticlike focal liver lesions that, in association with history and clinical findings, may help to correctly characterize them. Our data indicate the usefulness of CEUS in the evaluation of patients with these lesions.

译文

目的:本研究的目的是评估与常规超声检查相比,超声造影(CEUS)在表征非典型性囊性和囊性样局灶性肝病中的诊断性能,并确定使用CEUS是否可以减少对超声造影的需求。进一步的诊断工作。
研究对象和方法:在3年的时间里,对48例常规美国超声检查中发现的50例非典型囊性和囊样病变患者进行了CEUS。在细胞组织病理学检查,其他影像学检查和随访中获得了诊断确认。总体上,有24个囊性病变和26个囊样实性病变,特别是32个良性病变和18个恶性病变。两个盲人分别对常规的US和CEUS图像以及电影放映机进行了审查。计算灵敏度,特异性,ROC曲线下面积(Az)和观察者之间的一致性。
结果:两位读者对CEUS进行检查后,诊断性能均得到改善(常规US Az = 0.781 vs 0.972; CEUS Az = 0.734 vs 0.957)。阅读器之间的一致性有所提高,尽管有所提高(常规美国加权κ= 0.894; CEUS加权κ= 0.953)。在鉴别诊断方面,两种阅读器在CEUS后正确表征病变的发生率均增加(阅读器1、62%至98%;阅读器2、56%至96%)。
结论:低声功率CEUS的发展使得鉴别囊性和囊样性局灶性肝病的几种影像学特征与历史和临床发现相关联,可能有助于正确地表征它们。我们的数据表明CEUS在评估这些病变患者中的有用性。

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