Role of contrast enhanced ultrasonography in the assessment of hepatic metastases: A review

Table 1 Results of studies comparing CEUS and US in the detection of liver metastases

Study	n	Study group1	Gold standard	Type of analysis	Sensitivity		Specificity
					US	CEUS	US	CEUS
Piscaglia et al[33], 2007	109	UK	CT, FNA, follow up	P-by-P2	0.77	0.95 (23%)3
Konopke et al[23], 2007	100	K	IOUS	P-by-P	0.56	0.84 (50%)	0.93	0.84
Larsen et al[38], 2007	365	UK	FNA, CT, IOUS	P-by-P	0.69	0.80 (16%)	0.98	0.98
Janica et al[40], 2007	51	S or K	CT, FNA, follow up	P-by-P	0.63	0.90 (43%)
Dietrich et al[32]	131	UK	CT, MRI, FNA, follow up	P-by-P	0.81	0.91 (12%)
Quaia et al[31], 2006	253	S or K	FNA, CT, MRI, IOUS	P-by-P	0.40	0.83 (107%)	0.63	0.84
Konopke et al[39], 2005	56	S or K	IOUS, FNA, CT	P-by-P	0.53	0.86 (62%)	0.89	0.89
Oldenburg et al[15], 2005	40	S	CT, MRI	L-by-L4	0.69	0.90 (30%)
Albrecht et al[51], 2003	123	S or K	CT (MRI, IOUS, FNA)	P-by-P	0.94	0.98 (4%)	0.60	0.88
Esteban et al[36], 2002	27	K	CT	L-by-L	Found 9.3 metastases pr. patient	Found 18.8 metastases pr. patient
Solbiati et al[52], 2001	32	K	CT	L-by-L		Found in 21 out of 32 patients 10-94 more metastases than US
Bertanik et al[53], 2001	28	K	CT	L-by-L	0.59	0.97 (64%)
Albrecht et al[22], 2001	62	S or K	CT, MRI, IOUS, FNA	P-by-P	0.92	0.97 (5%)
Harvey et al[37], 2000	11	K	CT	L-by-L	Found 9.0 metastases pr. patient	Found 21.8 metastases pr. patient

¹Included patients with known (K), suspected (S) or unknown (UK) liver metastases;

²Patient-by-patient analysis;

³Figures in brackets are percent changes in sensitivity;

⁴Lesion-by-lesion analysis.

Table 2 Enhancement patterns of liver metastases

Tumor entity	Arterial phase	Portal phase	Delayed phase
Hypovascular metastasis
Typical features	Rim enhancement	Hypo-enhancement	Hypo-/non-enhancement
Additional features	Complete enhancement	Non-enhancement areas
	Non-enhancement areas (necrosis)
Hypervascular metastasis
Typical features	Hyper-enhancement, complete	Hypo-enhancement	Hypo-/non-enhancement
Additional features	Chaotic vessels
Cystic metastasis
Typical features	Hyper-enhancement nodular/rim component	Hypo-enhancement	Hypo-enhancement

Table 3 Sensitivity of CEUS and CT in detecting liver metastases; an overview of studies

Study	n	Study group1	Type of CT	Analysis	Gold standard	Sensitivity		Statistic
						CEUS	CT
Quaia et al[31], 2006	253	K or S	1-slice CT	P-by-P3	CT, FNA, Follow-up, MRI, IOUS	0.83	0.89	NS2
Larsen et al[34] , 2007	365	S	4-slice CT	P-by-P	CT, IOUS, CEUS, FNA, surgery resection, follow-up	0.8	0.89	NS
Dietrich et al[32]	131	UK	Multislice CT in most cases4	P-by-P	CT, MRI, FNA, follow up	0.91	0.89	NS
Piscaglia et al[33], 2007	109	S	1-or 4-slice CT	P-by-P	CT, US, FNA, Follow-up	0.95	0.91	NS
Janica et al[40], 2007	51	K or S	Not described	L-by-L5	FNA, surgical resection, CT and follow-up	0.9	0.78	NS
Konopke et al[39], 2005	56	S or K	1-, 4- or 16-slice CT	P-by-P	IOUS, FNA, CT	0.86	0.76	NS

¹Included patients with known (K), suspected (S) or unknown (UK) liver metastases;

²Not significant;

³Patient-by-patient analysis;

⁴Details not described.

⁵Lesion-by-lesion analysis.