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Background: Dual-phase spiral computed tomography (CT) is still the primary imaging technique in the diagnosis of focal liver lesions. Contrast-enhanced ultrasonography (CEUS) is the most sensitive sonographic technique. The purpose of this study was to investigate the efficacy of CEUS in detecting liver metastases compared with CT as the standard of reference., Material/methods: The examined group consisted of 51 patients (24 men and 27 women, age range: 27-84 years, mean: 57.4 years) suspected of liver metastases. The routine diagnostic approach consisted of B-mode US, CEUS, and CT. Final diagnosis was made at cytologic (n=18) or histologic examination (n=14) and in 9 patients by combining information from CT scans, medical history, and clinical and biochemical investigations., Results: Liver cysts and abscesses were detected in 10 patients. They were excluded from the further analyses. In the remaining 41 patients a total of 134 metastases were detected. In 15 patients with metastases, US images of the liver appeared normal. CEUS detected metastases in 36 patients. The sensitivities of the methods per patient were US 63.4% and CEUS 90.2%. Sensitivities of the methods per lesion were US 60.9%, CT 77.6%, and CEUS 90.2%. Application of contrast media (SonoVue) significantly increased diagnosing of liver metastases compared with standard sonography and CT., Conclusions: CEUS increased diagnostic confidence in the detection and characterization of hepatic metastases compared with standard sonography. Real-time contrast-enhanced sonography is particularly advantageous in detecting small metastases.

Background: The purpose of the study was to assess the quality of performance of wideband, phase inversion harmonic power Doppler sonography in the diagnosis of focal nodular., Material/methods: During a period of one year, thirty-one patients with FNH previously confirmed by ultrasound-guided biopsy, surgical resection, dynamic helical computed tomography or magnetic resonance imaging were examined. The study protocol consisted of B-mode gray scale sonography, color Doppler, power Doppler examinations, and helical CT scans. Then PI scans were performed after the injection of 2.5 g of Levovist intravenously., Results: The images obtained by the B-mode gray scale were typical for focal nodular hyperplasia in 13 lesions only (32.5%), and obtained by color, power Doppler sonography in 25 lesions (62%). On the contrary all patients with focal nodular hyperplasia were diagnosed based on the wide-band, phase inversion power Doppler sonography findings. The common enhancement pattern at pulseinversion harmonic US was filling in a central tumor artery with further centrifugal development of contrast. Then during early arterial phase, all typical anatomical features of FNH as 'star sign 'or 'spoke-wheel 'pattern were clearly visible .In 3 cases ,computed tomography and magnetic resonance imaging have failed to disclose pathology while phase inversion sonographic images were completely suggestive which was later confirmed by histologic examination., Conclusions: Our data demonstrates the usefulness of wide-band, phase inversion harmonic power Doppler sonography in the differential diagnosis of hepatic focal nodular hyperplasia by visualizing all characteristic anatomical details.

Background: Early diagnosis of hepatocellular carcinoma (HCC) is extremely important because surgical resection and local ablation therapy are undoubtfully the most effective treatment regiment. Recent advances in sonographic techniques have risen the question ofsonography utility. The scope of this investigation was to assess the detection accuracy of tumor vascularity in HCC by contrast-enhanced, wide-band phase inversion (PI) power Doppler sonography., Material/methods: Twenty-one patients were examined with 21 nodules (16 hypo-, 2 iso-, 3 hyperechoic nodules). The presence of hepatocellular carcinoma was confirmed by fine-needle biopsy results in 16 nodules, and the diagnosis in the remaining tumors was based on imaging findings and tumor markers. All patients, prior to enhanced sonography, had undergone both the native B-mode and tissue harmonic imaging mode sonography, color Doppler, and power Doppler examinations., Results: Three patients were excluded. 18 nodules evaluation by contrast-enhanced, wide-band PI power Doppler US revealed tumor vessels in 100% cases in arterial phase. The characteristic chaotic pattern of lesions vascularity was evidently pronounced. Rapid increase of enhancement during the arterial and slow decrease of enhancement during the portal phase were the special features of HCCs helping in making the final diagnosis. Power Doppler sonography detection rates were 14 cases (77%)., Conclusions: Based on our results we can recommend wide-band, phase inversion power Doppler sonography in the differential diagnosis of HCC by visualizing characteristic behavior of enhancement pattern in the most cases.

Background: Contrast-enhanced, wide-band, phase inversion power Doppler sonography in the depiction of vasculature in hemangioma and focal nodular hyperplasia., Material/methods: Fifty-one patients with liver lesions (40 FNHs,37 hemangiomas) were prospectively evaluated with conventional, color, power Doppler sonography, tissue harmonic, phase-inversion sonography and helical CT. Levovist was the standard contrast agent used and all examinations were performed on Siemens SONOLINE Elegra equipped with Ensemble Contrast Imaging (ECI) software., Results: Color and power Doppler scans were frequently not specific for these highly vasularized lesions. Images were not suggestive in 15 out of 40 FNHs and not positive in all of 37 hemangiomas). If peripheral enhancement in form of puddle enhancement, 'bloo pools' or rimlike followed by a slow centripetal fill-in is regarded as a positive finding for hemangiomas all lesions were depicted confidently with wide-band, phase inversion, contrast enhanced power Doppler scans. Moreover, all typical vascularity features of FNHs confluence firstly the feeding artery then centrifugal spread of contrast later forming wheel like pattern was obvious in all cases of diagnosed FNHs., Conclusions: Contrast-enhanced, wide-band, PI ,power Doppler imaging is useful method for diagnosing the vascularity of FNHs and hemangiomas. Not only it overcomes the low prediction rate which was the main obstacle for routine use of sonography but it is cheap, portable, and free also from contrast media and radiation.