Contrast Enhanced Ultrasound in Diagnosis and Characterization of Focal Hepatic Lesions
Riham Tohamy Abd Elsattar;
Abstract
1. CEUS can be used routinely for FHL found incidentally on conventional US and to clarify obscure lesions detected on CT or MRI.
2. Benign and malignant lesions can be differentiated in the late phase. Malignancy manifests as hypovascularity in this phase, which is the most specific finding, while benign liver lesions show isoechogenicity or even hyperechogenicity relative to the surrounding liver parenchyma.
3. The typical CEUS finding of liver hemangiomas is peripheral nodular enhancement in the arterial phase and complete or incomplete centripetal filling in the PV and late phases.
4. Typical CEUS findings of FNH include strong hyperperfusion from a large tortuous feeding artery in the arterial phase, from the center to outwards, producing a spoke-wheel appearance. The perfusion pattern in the late phase is mostly hyper or isoechoic.
5. The enhancement patterns of an adenoma can be confusingly variable and suggest malignancy. A basic rule is that its diagnosis should be considered whenever a vascular Focal hepatic lesion with late-phase enhancement is found.
6. Arterial-phase hypervascularity is the most reliable characteristic for detecting HCC. The typical vascular pattern in HCC is a high and rapid enhancement in the arterial phase, followed by rapid washout with a hypoechoic appearance in the PV and late phases. However, in a small subset of HCC cases the enhancement pattern differs with the degree of cellular differentiation.
7. Metastatic liver cancer and CCA usually show characteristic enhancement patterns during the arterial phase, and this rim enhancement can be used to differentiate FHL. Hypervascular liver metastases and hypervascular CCA often appear with the same enhancement features as HCC during the arterial phase; however, very early washout is a critical consideration in the diagnosis of metastases or CCA.
8. In addition to the diagnosis of FHL, CEUS can be used in the primary guidance and assessment of treatment responses for HCC biopsies, radiofrequency ablation, and TACE.
9. Definitive CEUS enhancement patterns are usually difficult to obtain from FHL that are not clearly demarcated in conventional US.
Operators need appropriate training and discussion with other examiners in order to ensure that the various enhancement patterns seen during CEUS of these lesions will result in the same correct diagnosis.
2. Benign and malignant lesions can be differentiated in the late phase. Malignancy manifests as hypovascularity in this phase, which is the most specific finding, while benign liver lesions show isoechogenicity or even hyperechogenicity relative to the surrounding liver parenchyma.
3. The typical CEUS finding of liver hemangiomas is peripheral nodular enhancement in the arterial phase and complete or incomplete centripetal filling in the PV and late phases.
4. Typical CEUS findings of FNH include strong hyperperfusion from a large tortuous feeding artery in the arterial phase, from the center to outwards, producing a spoke-wheel appearance. The perfusion pattern in the late phase is mostly hyper or isoechoic.
5. The enhancement patterns of an adenoma can be confusingly variable and suggest malignancy. A basic rule is that its diagnosis should be considered whenever a vascular Focal hepatic lesion with late-phase enhancement is found.
6. Arterial-phase hypervascularity is the most reliable characteristic for detecting HCC. The typical vascular pattern in HCC is a high and rapid enhancement in the arterial phase, followed by rapid washout with a hypoechoic appearance in the PV and late phases. However, in a small subset of HCC cases the enhancement pattern differs with the degree of cellular differentiation.
7. Metastatic liver cancer and CCA usually show characteristic enhancement patterns during the arterial phase, and this rim enhancement can be used to differentiate FHL. Hypervascular liver metastases and hypervascular CCA often appear with the same enhancement features as HCC during the arterial phase; however, very early washout is a critical consideration in the diagnosis of metastases or CCA.
8. In addition to the diagnosis of FHL, CEUS can be used in the primary guidance and assessment of treatment responses for HCC biopsies, radiofrequency ablation, and TACE.
9. Definitive CEUS enhancement patterns are usually difficult to obtain from FHL that are not clearly demarcated in conventional US.
Operators need appropriate training and discussion with other examiners in order to ensure that the various enhancement patterns seen during CEUS of these lesions will result in the same correct diagnosis.
Other data
| Title | Contrast Enhanced Ultrasound in Diagnosis and Characterization of Focal Hepatic Lesions | Other Titles | الموجات فوق صوتيه مع إستخدام الصبغات الملونه فى تشخيص وتوصيف البؤر الكبديه المرضيه | Authors | Riham Tohamy Abd Elsattar | Issue Date | 2014 |
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