Evaluation Of Non-uniform Fatty Liver And Differentiation Of Focal Liver Lesions With Contrast-enhanced Ultrasound

ObjectiveTo study the hemodynamic change and flowing display of Non-uniform fatty liver with contrast-enhanced ultrasound: Focal fatty sparing and focal fatty infiltration. To investigate the ability of Contrast-enhanced ultrasound to reveal differences of focal heptia lesions, hypoecho lesions in fatty livers, and hyperecho lesions in livers.MethodsEvaluation of Non-uniform fatty liver with Contrast-enhanced ultrasound:Fatty liver of 12 patients and normal liver of 12 healthy people were examined with contrast-enhanced ultrasound. Time to peak intensity, Peak signal intensity were measured using low mechanical index contrast gray-scale imaging and Wash-in/ Wash-out time intensity curve software.Sixty-three focal fatty sparing in 52 patients and twenty-five focal fatty infiltration in 20 patients were examined using contrast pulse sequences(CPS), micro-vessel display(MVD), and color Doppler flow imaging(CDFI). Differentiation of Focal liver lesion with Contrast-enhanced ultrasoundWith low mechanical index contrast gray-scale imaging, Two hundred ninety-eight lesions in 238 patients with focal hepatic lesions, one hundred forty-three hypoecho lesions in fatty livers of 113 patients, and eighty-four hyperechoheptic lesions in 66 patients detected by conventional ultrasound were examined in a prospective study.ResultsEvaluation of Non-uniform fatty liver with Contrast-enhanced ultrasound:Compared with nomal liver parenchyma, The lower the peak signal intensity in the anterior and middle field of fatty liver, the enhancement time were later in middle field of fatty liver.Compared with adjacent fatty liver parenchyma, the peak signal intensity of focal fatty sparing is higher. After SonoVue administration, 30s, 60s, 120s, focal fatty sparing showed a statistically significant increase of echogenicity in comparison with fatty liver. Degree of fatty liver is correlation with echogenicity classify of artery phase in focal fatty sparing.Compared with adjacent liver parenchyma, the peak signal intensity of focal fatty infiltration is lower. After SonoVue administration, 25s, 30s, focal fatty infiltration showed a statistically significant increase of echogenicity in comparison with fatty livers. After SonoVue administration, 60s, 120s, focal fatty infiltration, showed no significant change in comparison with fatty livers Flowing display of Non-uniform fatty liverContrast-enhanced ultrasound advanced vessel demonstration. Focal spared area of porta hepatic in fatty liver associated with aberrant venous. Fatty sparing adjacent to the gallbladder fossa associated with aberrant blood flow. Focal fatty infiltration of porta hepatic associated with aberrant venous. Differentiation of Focal liver lesion with Contrast-enhanced ultrasound (1) Differentiation between Benign and Maligant lesions.Two hundred ninety- eight focal hepatic lesions: For the discrimination of malignant versus benign liver lesions, SonoVue-enhanced sonography improved sensitivity from 68.6% to 97.5% and specificity from 79.4% to 98.3% compared with baseline sonography. Receiver operating characteristic analysis revealed asignificant improvement in this discrimination (area under the receiver operating characteristic curve) 0.880±0.021 [SD] at baseline sonography, 0.999±0.001 with SonoVue-enhanced sonography(P<0.0001). Baseline sonography and SonoVue-enhanced sonography both are significative methods in the discrimination of malignant versus benign liver lesions.Eighty-four hyperecho heptic lesions: For the discrimination of malignant versus benign hyperecho heptic lesions, Receiver operating characteristic analysis revealed a significant improvement in this discrimination (area under the receiver operating characteristic curve, 0.867±0.045 [SD] at baseline sonography, 0.997±0.003 with SonoVue-enhanced sonography(P<0.0001). Baseline sonography and SonoVue-enhanced sonography both are significative methods in the discrimination of malignant versus benign hyperecho heptic lesions.One hundred forty-three hypoecho lesions in fatty livers: For the discrimination of malignant versus benign hypoecho lesions in fatty livers, receiver operating characteristic analysis revealed a significant improvement in this discrimination (area under the receiver operating characteristic curve) 0.800±0.050 [SD] at baseline sonography, 1.000±0.0000 with SonoVue-enhanced sonography (PO.0001). Baseline sonography and SonoVue-enhanced sonography both are significative methods in the discrimination of malignant versus benign hypoecho lesions in fatty livers.Malignant versus benign hypoecho lesions in fatty livers, showing artery vessel, distinct margins, posterior echo enhancement have significantly differently. Specific Lesions in fatty livers showing artery vessel, posterior echo enhancement and homogeneneous have significantly differently. (2)Identification of Specific Lesion:Two hundred ninety- eight focal hepatic lesions: Contrast-enhanced ultrasound improved correctly diagnosing specific lesion types from 53.4% to 93.6%, compared with basedline sonography.Eighty-four hyperecho heptic lesions: Contrast-enhanced ultrasound improvedcorrectly diagnosing hyperecho lesion types from 64.3% to 92.9% compared with basedline sonography. For the discrimination of focal fatty infiltrations, SonoVue-enhanced sonography improved sensitivity from 44% to 100%.One hundred forty-three hypoecho lesions in fatty livers: Compared with basedline sonography Contrast-enhanced ultrasound improved correctly diagnosing lesion types in fatty livers from 43.4% to 95.1%(P<0.00001). With baseline ultrasound, correctly diagnosing rate(43.4%) of 143 hypoecho lesions in fatty livers is lower than correctly diagnosing rate(53.4%) of 298 hepitic lesions (P=0.49). Correctly diagnosing rate(43.4%)of hypoecho lesions in fatty livers is lower than correctly diagnosing rate(64.3%) of hyperecho liver lesions.Enhancement features of FSA: Indistinct margins in three phase. In arterial phase, hyper-enhancing 58.7%(37/63), iso-enhancing 38.1%(24/63), hypo-enhancing 3.2%(2/63). In portal phase, hyper-enhancing 15.9%(10/63), iso-enhancing 82.5%(52/63), hypo- enhancingl.6%(l/63). In late vascular phase, hyper-enhancing 19.1%(12/63), iso-enhancing 79.4%(50/63), hypo-enhancing 1.6% (1/63).Enhancement features of focal fatty infiltration: Indistinct margins in three phase. In arterial phase, hyper-enhancing 12%(3/25), iso-enhancing 44%( 11/25), hypo-enhancing 44%(11/25). In portal phase and in late vascular phase, iso-enhancing.Conclusions(1) Signal intensity in fatty liver are lower than nomal fatty in contrast enhanced ultrasound.(2) Signal intensity may be different between focal fatty sparing and adjacent liver parenchyma, focal fatty infiltration and adjacent liver parenchyma in contrast enhanced ultrasound.(3) Focal fatty sparing or fatty infiltration of porta hepatic is correlation with aberrant venous. Fatty sparing adjacent to the gallbladder fossa associatedwith aberrant blood flow .(4) Degree of fatty liver is correlation with echogenicity classify of artery phase in focal fatty sparing. 58.7% lesions of FSA are higher blood perfusion. 44.0% lesions of fatty infiltration are higher blood perfusion.(5) Hypoecho lesions in fatty livers are difficult diagnosis with conventional ultrasound.(6) SonoVue-enhanced sonography has greater ability than baseline sonography for the differentiation of benign and malignant liver lesions. SonoVue-enhanced sonography improve correctly diagnosing liver lesion types.