Detection of liver metastases with pulse inversion harmonic imaging: Preliminary results

The aim of this study is to evaluate capability of contrast enhanced ultrasonography (US) using pulse inversion harmonic imaging (PIHI) to detect liver metastases in comparison to fundamental B-mode ultrasound and spiral CT. Thirty-six consecutive patients with known malignancies and sonographically proved or suspicious liver metastases have been examined with fundamental B-mode US, with PIHI 2', 4' and 6' after Levovist injection and with four phase spiral-CT. Presence, conspicuity and number of lesions have been evaluated comparing PIHI with fundamental B-mode US and spiral-CT. A strong grey-scale enhancement of the liver parenchyma has been observed 2' and 4' after Levovist injection. The optimum parenchymal enhancement and contrast difference between liver and metastases was observed during the 2' measurements. PIHI revealed more lesions than fundamental B-mode US in 56% of patients, while in 39% and in 5% revealed respectively the same number and fewer lesions. PIHI and spiral-CT were in agreement in 67% of patients, while in 22% and 11% PIHI revealed respectively more and fewer lesions. PIHI accurancy presents restrictions in anterior superficial and in deep liver areas, whereas it may be superior to spiral-CT in studying sub-diaphragmatic liver regions.