Pulsed Doppler US diagnosis of hepatocellular carcinoma and other liver focal lesions

Objective: To assess the role of pulsed Doppler ultrasound in the differential diagnosis of focal liver lesion, based upon the presence of a Doppler signal and its waveform. Methods: The presence of a Doppler signal was accurately investigated in 267 focal liver lesions which had subsequently a definitive diagnosis. Most representative groups included hepatocellular carcinomas (188 cases), metastases (34 cases) and haemangiomas (42 cases). Results: Doppler signals were detected with a significantly higher rate in hepatocellular carcinomas than in metastases ( P = 0.001) and haemangiomas ( P < 0.0001). The detection rate in metastases was significantly higher than in haemangiomas ( P = 0.001). Assuming the detection of a Doppler signal allows to classify a liver lesion as malignant, we obtained sensitivity of 84.9%, specificity of 90.5%, diagnostic accuracy of 85.8%, positive predictive value of 97.9% and negative predictive value of 52.8%. Considering only the presence of a pulsatile wave as a diagnostic sign of malignancy, these figures resulted 80.8%, 100%, 84.2%, 100% and 52.8%, respectively. Conclusions: The detection of Doppler signals from within a liver lesion has a clinical relevance. The finding of a pulsatile waveform makes it possible to differentiate a malignant lesion from haemangioma with high sensitivity and absolute specificity.