Diagnosis of Focal Liver Lesions in Cirrhotic Patients: Comparison of Contrast-Enhanced Ultrasound using Sulphur Hexafluoride (SF6) Microbubbles and MRI Using Gd-EOB-DTPA

Aim: The diagnostic accuracies of contrast-enhanced sonography and hepatobiliary contrast-enhanced MRI of the liver in evaluating focal liver lesions in patients with liver cirrhosis were compared. Material and Methods: In 33 patients (25 men, 8 women, mean age 63.2 +/- 11.2 years) MRI of the liver using Gd-EOB-DTPA (Primovist, Bayer Schering Pharma, Berlin) was performed. Axial T-2-weighted, unenhanced T-1-weighted and enhanced T-1-weighted scans during arterial, portal venous and late phases were acquired, followed by coronary T-1-weighted and axial fat-suppressed T-1-weighted scans 15 minutes post contrast application. In all patients within 4 weeks contrast-enhanced sonography using sulfur hexafluoride microbubbles (SonoVue, Nycomed, Germany) was obtained. Results: Cirrhosis of the liver was related to viral infection in 45.4% and to alcoholism in 39.4%. All hepatic lesions were confirmed by histologic examination. Sensitivity and specificity of MRI were 90.2% and 83.3%, compared to contrast-enhanced sonography with 92.7% and 50%, respectively. Positive and negative predictive values were 97.4% and 55.5% for MRI and 90.5% and 50% for contrast-enhanced sonography, respectively. Discussion: In this retrospective study MRI using Gd-EOB-DTPA as well as contrast-enhanced sonography using sulfur hexafluoride microbubbles gave excellent results in detecting HCC in patients suffering from liver cirrhosis. Although the specificity was higher for MRI, the accuracy showed no significant difference between these two imaging techniques.