Focal Liver Lesions: Real‐time 3‐Dimensional Contrast‐Enhanced Ultrasonography Compared With 2‐Dimensional Contrast‐Enhanced Ultrasonography and Magnetic Resonance Imaging

Objectives This study sought to evaluate the application of real‐time 3‐dimensional (3D) contrast‐enhanced ultrasonography (US) to diagnose focal liver lesions and to compare these results with those from 2‐dimensional (2D) contrast‐enhanced US and contrast‐enhanced magnetic resonance imaging (MRI). Methods Patients with focal liver lesions were examined by 2D contrast‐enhanced US, 3D contrast‐enhanced US, and contrast‐enhanced MRI for lesion characterization, and biopsies and comprehensive clinical diagnoses served as reference standards. The sensitivity, specificity, area under the receiver operating characteristic curve, and intermodality agreement were assessed. The number of contrast agent injections and lesions observed per injection were calculated for 3D and 2D contrast‐enhanced US. The number and display quality of the feeding arteries observed with 3D and 2D contrast‐enhanced US were assessed. Results A total of 117 patients with 151 focal liver lesions were enrolled, including 67 cases of hepatocellular carcinoma, 51 cases of liver metastasis, and 33 cases of benign liver lesions. No significant differences were found among the modalities. The sensitivity values for 3D contrast‐enhanced US, 2D contrast‐enhanced US, and contrast‐enhanced MRI were 96%, 95%, and 93%, respectively; the specificity values were 87%, 84%, and 89%; and the area under the receiver operating characteristic curve values were 0.92, 0.90, and 0.92. The intermodality agreement was excellent (κ > 0.77). Fewer contrast agent injections were needed, and more lesions and feeding arteries were more clearly displayed on 3D than 2D contrast‐enhanced US (P