Differentiation of atypical hepatic hemangioma from liver metastases: Diagnostic performance of a novel type of color contrast enhanced ultrasound

Table 1 Comparison of routine contrast enhanced ultrasound features between atypical hemangioma and liver metastasis

CEUS	Staff			Resident
	H (n = 20)	M (n = 22)	P value	H (n = 20)	M (n = 22)	P value
Peripheral nodular	10 (50)	2 (9.1)	0.003	8 (40)	3 (13.6)	0.052
Peripheral rim-like	6 (30)	5 (22.7)	0.592	8 (40)	4 (18.2)	0.118
Homogenous hyper	2 (10)	6 (27.3)	0.135	3 (15)	9 (40.9)	0.063
Heterogeneous hyper	2 (10)	9 (40.9)	0.023	1 (5)	6 (27.3)	0.096
Feeding artery	6 (30)	10 (45.5)	0.303	5 (25)	8 (36.4)	0.426

Numbers in parentheses are percentages. The difference between peripheral nodular enhancement and heterogeneous enhancement of contrast enhanced ultrasound patterns were observed (P = 0.003, P = 0.023) in staff group. CEUS: Contrast enhanced ultrasound; H: Hemangioma; M: Metastasis.

Table 2 Comparison of color parametric imaging features between atypical hemangioma and liver metastasis

CPI	Staff			Resident
	H (n = 20)	M (n = 22)	P value	H (n = 20)	M (n = 22)	P value
Peripheral nodular1	14 (70.0)	1 (4.5)	< 0.001	13 (65.0)	3 (13.6)	0.001
Peripheral rim-like	2 (10.0)	6 (27.3)	0.152	3 (15.0)	4 (18.2)	0.556
Concentric circles1	3 (15.0)	0 (0)	0.099	2 (10.0)	1 (4.5)	0.463
Mosaic/ chaotic.	1 (5.0)	15 (68.2)	< 0.001	2 (10.0)	14 (63.6)	< 0.001
Feeding artery	4 (20)	13 (59.1)	0.010	4 (20)	12 (54.5)	0.021

Numbers in parentheses are percentages.

¹The difference between peripheral nodular,Mosaic/chaotic enhancement and feeding artery of CPI patterns were observed (P < 0.001, P < 0.001, P = 0.010) in staff group and (P = 0.001, P < 0.001, P = 0.021) in resident group. CPI: Color parametric imaging; H: Hemangioma; M: Metastasis.

Table 3 Inter-reader agreement of contrast enhancement ultrasound and color parametric imaging feature between staff and resident radiologists

Feature	Kappa value
CEUS
Peripheral nodular enhancement	0.602 ± 0.142
Peripheral Rim-like enhancement	0.692 ± 0.127
Homogenous hyper-enhancement	0.835 ± 0.064
Heterogeneous enhancement	0.804 ± 0.132
CPI
Peripheral nodular enhancement	0.885 ± 0.079
Peripheral rim-like enhancement	0.713 ± 0.177
Concentric circles enhancement	0.760 ± 0.112
Mosaic enhancement	0.803 ± 0.134

Data are mean ± SD. CEUS: Contrast enhancement ultrasound; CPI: Color parametric imaging.

Table 4 Diagnostic performance of contrast enhancement ultrasound and color parametric imaging by staff and resident radiologists (%)

Criteria	Sensitivity	P value	Specificity	P value	Accuracy	P value	AUC	P value
Resident
CEUS	55.0 (11/20)	0.456	45.5 (10/22)	0.030	50.0 (21/42)	0.006	0.757	0.036
CEUS+CPI	80.0 (16/20)		77.3 (17/22)		78.6 (33/42)		0.803
Staff
CEUS	65.0 (13/20)	0.144	54.5 (12/22)	0.112	54.8 (23/42)	0.010	0.825	0.013
CEUS+CPI	85.0 (17/20)		77.3 (17/22)		81.0 (34/42)		0.890

CEUS: Contrast enhancement ultrasound; CPI: Color parametric imaging; AUC: Area under curve.