Contrast-Enhanced Ultrasound for the differentiation of benign and malignant focal liver lesions: a meta-analysis

Abstract

Background: International guidelines of Ultrasound recommend the performance of contrast-enhanced ultrasound (CEUS) as the first method of choice after conventional ultrasound for the diagnostic work-up of focal liver lesions. However, these recommendations are based on the results of multiple single studies and only few large multicentre studies.

Aims: The rationale of the present systematic review and meta-analysis was to assess the overall sensitivity and specificity of CEUS for the diagnosis of malignant liver lesions.

Methods: Literature databases were searched up to March 2012. Inclusion criteria were evaluation of CEUS, assessment of sensitivity and specificity of CEUS for the diagnosis of malignant liver lesions. The meta-analysis was performed using the random-effects model based on the DerSimonian Laird method. Quality analyses were carried out to assess sources of heterogeneity.

Results: A total of 45 studies with 8147 focal liver lesions were included in the analysis. Overall sensitivity and specificity of CEUS for the diagnosis of malignant liver lesions was 93% (95%-CI: 91-95%) and 90% (95%-CI: 88-92%) respectively. Significant heterogeneity was found between studies. However, subanalysis revealed no significant difference when evaluating studies using histology for all liver lesions, when comparing high-quality and low-quality studies, and blinded vs non-blinded studies.

Conclusion: The results of this meta-analysis support the international recommendations on CEUS for the diagnostic work-up of focal liver lesions selecting patients who need further diagnostics.