Détection des lésions hépatiques malignes en échographie de contraste

Dynamic contrast enhanced ultrasound (DCE-US) is a new imaging tool giving rise to increasing interest in liver imaging. Numerous clinical studies have focused on its usefulness in characterizing liver lesions. Real time imaging provides a better comprehension of the pattern of blood supply to tumors so that the hypoechogenic feature of liver lesions (due to wash out) at portal-late venous phase is currently a well established criterion of malignancy. This feature has been used in several clinical trials on tumor detection using DCE-US liver imaging. Recently, our institution conducted a study to compare DCE-US and baseline US preoperatively. Histological specimens were used as the gold standard. DCE-US exhibited improved sensitivity and specificity compared to baseline (from 58.8 to 68.7% and from 58.7 to 67% respectively). The use of contrast injection provided a benefit in 13.7% of all analyzed nodules by detecting more malignant lesions and by characterizing as benign some undetermined nodules. Nevertheless the role of DCE-US in detecting malignant liver lesions is not yet well established in regard to conventional slice imaging modalities (CT, MRI). Technical aspects, advantages, limitations of DCE-US are discussed in the following article on the basis of our clinical study and literature data.