Caroline Taylor

Duplex Doppler ultrasound (US) was used in 68 consecutive patients with focal liver lesions, including 12 hepatocellular carcinomas, one cholangiocarcinoma, 37 metastases, 15 hemangiomas, one hemangioendothelioma, and two focal nodular hyperplasias. Of the hepatocellular carcinomas, six were diffusely hyperechoic, two were hypoechoic, two were single hyperechoic lesions, and two were multifocal and hyperechoic. All ten tumors with Doppler shifts of 5 kHz or above proved to be hepatocellular carcinomas. The other two hepatocellular carcinomas showed Doppler shifts of 3 kHz. In contrast, no hemangioma showed shifts above 0.7 kHz, and ten of the 15 gave no detectable signal. Of the metastases, 20 gave no signal and 17 had signals of up to 4 kHz. Three-kilohertz signals were also obtained from a cholangiocarcinoma, a hemangioendothelioma, and focal nodular hyperplasia. Correlation with angiographic findings suggested that the high-velocity Doppler signals were associated with large pressure gradients due to arteriovenous shunting. Duplex Doppler US can therefore aid in the differential diagnosis of diffuse and focal liver lesions.

OBJECTIVE: The purpose of this study was to determine the value of duplex Doppler sonography in the characterization of focal hepatic lesions. SUBJECTS AND METHODS: Duplex Doppler sonography with a 3-MHz transducer was performed prospectively on 198 patients with focal hepatic lesions. One hundred thirty-two patients had pathologically proved diagnoses, confirming 46 hepatomas and 86 metastatic lesions. Twenty-three hemangiomas were confirmed either with tissue, tagged RBC study, MR imaging, or hemangioma CT protocol. Forty-three patients with no history of cancer had benign lesions that were established on the basis of follow-up imaging and at least a 2-year clinical history with no evidence of cancer. RESULTS: Thirty-two hepatomas and four metastatic lesions had Doppler shifts of 4.5 kHz or more, giving a 70% sensitivity, 95% specificity, and 89% positive predictive value in distinguishing hepatomas from metastatic lesions. Forty-three hepatomas, 47 metastatic lesions, one hemangioma, and three benign lesions had Doppler shifts of 1.75 kHz or more, giving a 68% sensitivity, 94% specificity, and 96% positive predictive value in distinguishing malignant from benign lesions. Doppler shifts (mean +/- SD) were as follows: hepatomas, 4.72 +/- 1.72 kHz; metastases, 1.99 +/- 1.63 kHz; and hemangiomas, 0.53 +/- 0.75 kHz. These differences in mean Doppler shifts were statistically significant (p < .0001). CONCLUSION: Duplex Doppler sonography aids in distinguishing hepatomas from metastases and malignant from benign hepatic lesions with a high degree of specificity but low sensitivity.