Contrast-enhanced ultrasound for the assessment of focal nodular hyperplasia – results of a multicentre study

Roxana Şirli, Ioan Sporea, Alina Popescu, Mirela Dănilă, Daniela Larisa Săndulescu, Adrian Săftoiu, Tudor Moga, Zeno Spârchez, Cristina Cijevschi, Cătălina Mihai, Simona Ioanițescu, Dana Nedelcu, Nicoleta Iacob, Grațian Miclăuș, Ciprian Brisc, Radu Badea


Aim: Contrast-enhanced ultrasound (CEUS) has become a relevant imaging method for the evaluation of focal liver le-sions (FLL). The aim of this study was to evaluate the performance of CEUS for the assessment of focal nodular hyperplasia (FNH) in a large study group.

Material and methods: We performed a multicentre prospective observational study, which included successive CEUS examinations from fourteen Romanian centres. CEUS examinations were performed in de novo FLL, using low mechanical index ultrasound, following an intravenous bolus of 2.4 ml SonoVue. CEUS was considered conclusive for FNH if a typical pattern was present following contrast (rapid “spoke-wheel” enhancement during the arterial phase, hyperenhanced lesion during venous phase, hyper- or isoenhanced in the late phase). In all cases a reference method was available (contrast enhanced CT or MRI or biopsy). The trial was registered in (Identifier NCT01329458).

Results: During the 6 years study, 2062 “de novo” FLL were evaluated by CEUS. From this cohort, 94/2062 (4.5%) had a typical enhancing pattern for FNH as described in the EFSUMB guidelines. Contrast enhanced CT/MRI and biopsy diagnosed additional 15 FNH. From the 94 cases diagnosed as FNH by CEUS, in nine the final diagnosis was different (five of them adenomas). CEUS had 85% sensitivity, 99.5% specificity, 90.4% positive predictive value, 99.2% negative predictive value and 98.8% diagnostic accuracy for the diagnosis of FNH.

Conclusions: CEUS is a sensitive and very specific method for the diagnosis of FNH.


Contrast Enhanced Ultrasound; focal liver lesions; focal nodular hyperplasia; multicentre studyDOI: 10.11152/mu-2912

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