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Contrast-enhanced ultrasound trumps CT and MR for liver, kidney tumors: two studies

por John R. Fischer, Senior Reporter | February 28, 2023
CT MRI Ultrasound
Two new studies show that contrast-enhanced ultrasound is better for assessing liver and kidney tumors.
Providers are better off using contrast-enhanced ultrasound than other imaging modalities to assess certain liver and kidney nodules.

That’s according to two new studies from Canada and the U.S. that were presented at the International Contrast Ultrasound Society (ICUS).

CEUS administers ultrasound contrast agents intravenously to enhance images to observe abnormal microvascular blood flow patterns in real time. It can identify cancers, heart and vascular disease, chronic gastro-intestinal diseases and monitor therapy.
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The principal investigator of the Canadian research was Dr. Stephanie Wilson, a clinical professor of radiology and gastroenterology at the University of Calgary and co-president of ICUS. She and her colleagues assessed 196 patients, finding its sensitivity to be superior to MR, at 81% to 64% when diagnosing malignancy.

It also did not compromise specificity (92% vs. 93%) and was more likely to reproduce and characterize nodules found on screening (97% vs. 78.5%). Wilson and her colleagues said CEUS found malignant or premalignant diagnoses that would most likely have been missed or delayed.

“CEUS quickly and reliably identified benign lesions and pseudo-lesions, sparing these patients the costs and risks associated with unnecessary downstream testing and procedures,” she said in a statement.

Following her study, Wilson called for the American Association for the Study of Liver Diseases (AASLD) to include CEUS in its liver imaging guidelines, along with MR and CT. She says it proves that CEUS scans may at least be equivalent, if not superior, to MR imaging for evaluating liver lesions, making it a first choice for investigating nodules found on surveillance for liver cancer.

But she cautions that MR is necessary for managing and staging malignant tumors prior to treatment.

On the U.S. side, an Ohio team compared CEUS to CT, with data from over 10 years to evaluate its accuracy for diagnosing benign kidney nodules in 341 patients. None of the CEUS diagnoses changed in the blinded analysis.

Lead author Dr. Richard Barr, a radiology professor at the Northeast Ohio Medical University and treasurer of ICUS, says it is safe, accurate, low-cost and radiation-free and can help avoid additional, unnecessary testing and surgery.

“Due to radiation exposure associated with CT, we believe CT should not be used as the first-line imaging modality for assessing cystic lesions that are most probably benign in character,” he said.

Both studies were published in the Journal of Ultrasound in Medicine (JUM).

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