Prospective study of differential diagnosis of hepatic tumors by pattern-based classification of contrast-enhanced sonography

Table 1 Retrospective study of enhancement patterns of hepatic tumors

	Hepatocellular carcinoman =178	M etastasisn =56	Hemangioman =69
Arterial phase
A1	95% (169/178)	9% (5/56)	0% (0/69)
A2	1% (1/178)	27% (15/56)	1% (1/69)
A3	0% (0/178)	55% (31/56)	0% (0/69)
A4	1% (2/178)	0% (0/56)	61% (42/69)
A5	3% (6/178)	9% (5/56)	38% (26/69)
Portal phase
P1	93% (166/178)	16% (9/56)	46% (32/69)
P2	4% (8/178)	14% (8/56)	0% (0/69)
P3	1% (2/178)	66% (37/56)	1% (1/69)
P4	1% (2/178)	4% (2/56)	52% (36/69)
Late Phase
L1	8% (14/178)	0% (0/56)	20% (14/69)
L2	92% (164/178)	100% (56/56)	80% (55/69)

A1: Intratumoral vessels with homogeneous or heterogeneous enhancement; A2: Intratumoral vessels without homogeneous or heterogeneous enhancement; A3: Peritumoral vessels; A4: Peripheral nodular enhancement without tumor vessels; A5: No enhancement and no tumor vessels; P1: Homogeneous or heterogeneous enhancement; P2: Perfusion defect; P3: Ring enhancement; P4: Peripheral nodular enhancement; L1: Iso-echoic; L2: Hypo-echoic.

Table 2 Logistic regression analyses for the diagnosis of hepatocellular carcinoma, metastasis, and hemangioma

	Odds ratio	95% CI	P
Hepatocellular carcinoma
A1	189.665	25.716-1398.871	< 0.01
P1	38.993	4.616-329.381	< 0.01
Metastases
A3	73.139	7.19-743.997	< 0.01
P2	27.973	5.202-150.421	< 0.01
P3	137.385	27.064-697.421	< 0.01
Hemangioma
A4	102.175	15.567-670.619	< 0.01
P4	695.141	110.903-4357.157	< 0.01

A1: Intratumoral vessels with homogeneous or heterogeneous enhancement; A3: Peritumoral vessels; A4: Peripheral nodular enhancement without tumor vessels; P1: Homogeneous or heterogeneous enhancement; P2: Perfusion defect; P3: Ring enhancement; P4: Peripheral nodular enhancement.

Table 3 Enhancement pattern-based classification of contrast-enhanced harmonic gray-scale sonography images and positive predictive value for differentiating hepatic tumors

Enhancement pattern			Positive predictive value (No. of lesions)			Diagnosis1
Pattern combi- nation	Arterialphase	Portalphase	HCC(n = 178)	Metastasis(n = 56)	Hemangioma(n = 69)
1	A1	P1	0.996 (165)	0.004 (2)	0 (0)	HCC
2	A1	P2	1 (2)	0 (0)	0 (0)	HCC
3	A1	P3	0 (0)	1 (3)	0 (0)	Metastasis
4	A1	P4	1 (2)	0 (0)	0 (0)	HCC
5	A3	P1	0 (0)	1 (4)	0 (0)	Metastasis
6	A3	P2	0 (0)	1 (3)	0 (0)	Metastasis
7	A3	P3	0 (0)	1 (24)	0 (0)	Metastasis
8	A4	P1	0 (0)	0 (0)	1 (25)	Hemangioma
9	A4	P3	0.84 (2)	0 (0)	0.16 (1)	HCC
10	A4	P4	0 (0)	0 (0)	1 (16)	Hemangioma
11	others2	P1	0.20 (1)	0.19 (3)	0.61(8)	Hemangioma
12	others2	P2	0.79 (6)	0.21 (5)	0 (0)	HCC
13	others2	P3	0 (0)	1 (11)	0 (0)	Metastasis
14	others2	P4	0 (0)	0.04 (1)	0.96 (19)	Hemangioma

A1: Intratumoral vessels with homogeneous or heterogeneous enhancement; A3: Peritumoral vessels; A4: Peripheral nodular enhancement without tumor vessels; P1: homogeneous or heterogeneous enhancement; P2: Perfusion defect; P3: Ring enhancement; P4: Peripheral nodular enhancement.

¹Diagnosis was made on the basis of the largest positive predictive value for each of the three kinds of tumors in each combination of enhancement patterns.

²Others mean A2 or A5 as shown in Table 1.

Table 4 Prospective study of pattern combination-based classification of contrast-enhanced harmonic gray-scale sonography images for differentiating hepatic tumors

Enhancement pattern			No. of lesions			Diagnosis1
Patterncombi- nation	Arterial phase	Portalphase	HCC(n = 205)	Metastasis(n = 33)	Hemangioma(n = 45)2
1	A1	P1	183	3	0	HCC
2	A1	P2	0	0	0	HCC
3	A1	P3	0	5	0	Metastasis
4	A1	P4	0	0	0	HCC
5	A3	P1	0	1	1	Metastasis
6	A3	P2	0	1	0	Metastasis
7	A3	P3	0	14	0	Metastasis
8	A4	P1	0	0	16	Hemangioma
9	A4	P3	0	0	0	HCC
10	A4	P4	0	0	7	Hemangioma
11	Others3	P1	14	1	2	Hemangioma
12	Others3	P2	8	0	0	HCC
13	Others3	P3	0	8	0	Metastasis
14	Others3	P4	0	0	18	Hemangioma

A1: Intratumoral vessels with homogeneous or heterogeneous enhancement; A3: Peritumoral vessels; A4: Peripheral nodular enhancement without tumor vessels; P1: Homogeneous or heterogeneous enhancement; P2: Perfusion defect; P3: Ring enhancement; P4: Peripheral nodular enhancement.

¹Diagnosis was made on the basis of the largest positive predictive value for each of the three kinds of tumors in each combination of enhancement patterns in the retrospective study.

²One case of hemangioma was not diagnosed because the pattern combination did not exist in Table 3.

³Others mean A2 or A5 as shown in Table 1.