Changes in spectral Doppler measurement of V-max after administration of an ultrasound contrast agent - A possible new variable for the differential diagnosis of breast lesions

Background: To analyze the effect of the ultrasound agent Levovist(R) on th e spectral Doppler measurement of V-max in the hope of obtaining a new vari able for differential diagnosis of breast lesions. Methods: Ultrasound exam inations were pre-operatively conducted on 41 female patients with breast l esions. After a standardized adjustment of the Doppler, Levovist(R) (300 mg /ml) was administered intravenously as a bolus. The difference in maximum s ystolic flow velocity (V-max) before and after administration of Levovist(R ) was determined and the sensitivity, specificity, positive and negative pr edictive values (npv, ppv), and odds-ratio for the detection of breast canc er based on the difference in V-max were calculated. Results: The improved measurement of V-max after administration of Levovist(R) resulted suited in a significant increase in the range of its measured value for malignant le sions (pre-Levovist(R) median 11.9 cm/s, range 7.5-18.2 cm/s; post-Levovist (R) median 11.9 cm/s, range 9.7-23.7 cm/s). The sensitivity of using the di fference, between pre- and post-contrast V-max measurements for detecting b reast cancer was 65.7% for a difference greater than or equal to 0.0 cm/s; the specificity was 20%, the ppv 74.2%, the npv 14.3%, and the odds-ratio 0 .5. For a V-max difference greater than or equal to 3 cm/s the sensitivity was 37.1%, the specificity 100%, the ppv 100%, the npv 31.2%, and the odds- ratio infinity. Conclusion: The present experimental study suggests that th e difference in V-max pre- and post-contrast medium administration might pr ove to be of value as an additional parameter in the differential diagnosis of focal findings of the breast.