Liver Spleen Scan There is no relevant literature to support the use of a Tc-99m sulfur colloid scan in this clinical scenario. US Abdomen with Contrast For patients with a lesion on grayscale US, addition of CEUS reduces the number of indeterminate diagnoses from 57% to 6%, and the sensitivity and specificity improve from 49% and 25% at baseline US to 93% and 75% with CEUS, respectively [29]. Furthermore, CEUS can reach a specific diagnosis in 77% to 93% and distinguish benign versus malignant lesions in 89% to 97% of indeterminate liver lesions discovered on grayscale US [9,30-32]. Of the complex cystic lesions found on grayscale US, CEUS correctly categorizes 95% of the malignant cases [33]. CEUS is comparable to CT for establishing a diagnosis for lesions detected on grayscale US, with sensitivity of 94% to 96%, specificity of 75% to 83%, PPV of 92%, NPV of 88%, and accuracy of 88% to 90% [13,14,29]. CEUS can definitively characterize an additional 41% of hemangiomas that are deemed indeterminate on a grayscale US [34]. For specific diagnoses, CEUS correctly characterizes 89% of areas of focal fat, 80% to 90% of hemangiomas, 87% of complex cysts, 78% of hepatic adenomas, 84% to 94% of FNHs, 86% of abscesses, and 60% of hematomas [14,30,35]. Typical pattern of enhancement on CEUS (eg, centripetal fill in during the arterial phase, hyper- enhanced lesion during venous and late phases) has 88% to 90% sensitivity, 99% specificity, 94% to 95% PPV, 97% to 98% NPV, and 97% accuracy for the diagnosis of hemangiomas [18,36]. In noncirrhotic patients, the hypoechoic pattern in portal and sinusoidal phase (rapid wash-out) or the markedly hypoechoic or anechoic pattern in sinusoidal phase (marked late wash-out) showed a sensitivity, specificity, and accuracy of 97%, 100% and 98%, respectively, for the diagnosis of malignancy [37].
Liver Lesion Initial Characterization. Liver Spleen Scan There is no relevant literature to support the use of a Tc-99m sulfur colloid scan in this clinical scenario. US Abdomen with Contrast For patients with a lesion on grayscale US, addition of CEUS reduces the number of indeterminate diagnoses from 57% to 6%, and the sensitivity and specificity improve from 49% and 25% at baseline US to 93% and 75% with CEUS, respectively [29]. Furthermore, CEUS can reach a specific diagnosis in 77% to 93% and distinguish benign versus malignant lesions in 89% to 97% of indeterminate liver lesions discovered on grayscale US [9,30-32]. Of the complex cystic lesions found on grayscale US, CEUS correctly categorizes 95% of the malignant cases [33]. CEUS is comparable to CT for establishing a diagnosis for lesions detected on grayscale US, with sensitivity of 94% to 96%, specificity of 75% to 83%, PPV of 92%, NPV of 88%, and accuracy of 88% to 90% [13,14,29]. CEUS can definitively characterize an additional 41% of hemangiomas that are deemed indeterminate on a grayscale US [34]. For specific diagnoses, CEUS correctly characterizes 89% of areas of focal fat, 80% to 90% of hemangiomas, 87% of complex cysts, 78% of hepatic adenomas, 84% to 94% of FNHs, 86% of abscesses, and 60% of hematomas [14,30,35]. Typical pattern of enhancement on CEUS (eg, centripetal fill in during the arterial phase, hyper- enhanced lesion during venous and late phases) has 88% to 90% sensitivity, 99% specificity, 94% to 95% PPV, 97% to 98% NPV, and 97% accuracy for the diagnosis of hemangiomas [18,36]. In noncirrhotic patients, the hypoechoic pattern in portal and sinusoidal phase (rapid wash-out) or the markedly hypoechoic or anechoic pattern in sinusoidal phase (marked late wash-out) showed a sensitivity, specificity, and accuracy of 97%, 100% and 98%, respectively, for the diagnosis of malignancy [37].