Hypoechoic focal liver lesions: Characterization with contrast enhanced ultrasonography

✍ Scribed by Mirko D'Onofrio; Umberto Rozzanigo; Bianca Maria Masinielli; Sabrina Caffarri; Andrea Zogno; Roberto Malagò; Carlo Procacci

• Publisher: John Wiley and Sons
• Year: 2005
• Tongue: English
• Weight: 506 KB
• Volume: 33
• Category: Article
• ISSN: 0091-2751
• DOI: 10.1002/jcu.20111

✦ Synopsis

Purpose:

To evaluate the late sinusoidal phase of contrast enhancement with a 2nd-generation ultrasound contrast enhanced medium in the characterization of hypoechoic focal liver lesions.

Methods:

We studied 88 hypoechoic liver lesions (diameter range, 1-18 cm; with 18 lesions 2 cm or less) found on conventional grayscale sonography (us) with contrast-enhanced ultrasonography (ceus). final diagnosis was made using contrast enhanced helical ct, contrast enhanced mr, angiography (dsa), and/or histopathic confirmation or clinical imaging follow-up.

Results:

There were 37/88 benign lesions demonstrated: 17 cavernous hemangiomas, 3 capillary hemangiomas, 11 focal nodular hyperplasias (fnh), 3 focal areas of sparing in hepatic steatosis, 2 adenomas, and 1 intrahepatic necrotic area. malignant lesions demonstrated included 51/88: 27 hepatocellular carcinomas (hcc) in cirrhosis, 11 metastatic carcinomas, 10 metastatic endocrine tumors, 2 cholangiocellular carcinomas (ccc) and 1 non-hodgkin's lymphoma (nhl). ceus characterized 30/37 (81%) benign lesions and 45/51 (88%) malignant lesions. on the basis of the results obtained during the sinusoidal contrast enhanced phase of ceus, diagnosis of benignancy was possible in 35/37 (95%) of benign liver lesions and diagnosis of malignancy in 49/51 (96%) of malignant liver lesions. the enhancement pattern of 13 small (< or = 2 cm in diameter) hypervascular liver lesions (3 capillary hemangiomas, 2 fnhs, 4 hccs, 4 metastatic endocrine tumors) was better demonstrated on ceus than on helical ct. in these cases the hyper vascularization of the lesions shown on ceus was not confirmed on ct.

Conclusions:

Ceus distinguished malignant from benign hypoechoic liver lesions with an accuracy of 95%.