Focal liver masses: differential diagnosis with pulsed Doppler US.

Abstract

Duplex Doppler ultrasound (US) was used in 68 consecutive patients with focal liver lesions, including 12 hepatocellular carcinomas, one cholangiocarcinoma, 37 metastases, 15 hemangiomas, one hemangioendothelioma, and two focal nodular hyperplasias. Of the hepatocellular carcinomas, six were diffusely hyperechoic, two were hypoechoic, two were single hyperechoic lesions, and two were multifocal and hyperechoic. All ten tumors with Doppler shifts of 5 kHz or above proved to be hepatocellular carcinomas. The other two hepatocellular carcinomas showed Doppler shifts of 3 kHz. In contrast, no hemangioma showed shifts above 0.7 kHz, and ten of the 15 gave no detectable signal. Of the metastases, 20 gave no signal and 17 had signals of up to 4 kHz. Three-kilohertz signals were also obtained from a cholangiocarcinoma, a hemangioendothelioma, and focal nodular hyperplasia. Correlation with angiographic findings suggested that the high-velocity Doppler signals were associated with large pressure gradients due to arteriovenous shunting. Duplex Doppler US can therefore aid in the differential diagnosis of diffuse and focal liver lesions.

Contrast-enhanced ultrasound of histologically proven liver hemangiomas

“…[30][31][32][33] However, arterioportal shunts have been observed in hepatic hemangiomas not only through use of CEUS 25 but also through use of multiphase helical CT and MRI in a significant percentage of hemangiomas (19%-26%), [34][35][36][37][38][39] which is in the range reported in our study. One possible explanation for rapidly enhancing small hemangiomas is a hyperdynamic status with large arterial inflow, rapid tumoral enhancement, and consequently, large and rapid outflow, which seems to result in early opacification of the draining portal vein via shunts 39 (Fig.…”

Differentiation of a pancreatic metastasis of a renal cell carcinoma from a primary pancreatic carcinoma by echo-enhanced power doppler sonography

“…As demonstrated earlier in liver tumours, examination of the tumour vascularization with Doppler imaging can contribute to their differential diagnosis [6,[8][9][10]. These results correlate well with those of angiographic and histological examinations [11,12].…”

Sonographic and Doppler features of infantile hepatic hemangiomas with pathologic correlation.

“…Additionall~ although found in only 60% (three of five) of our patients with hemangiomas, Doppler flow throughout the lesion has not been reported in metastatic neuroblastoma or hepatoblastoma and was not seen at all in our evaluation, although Doppler flow has been seen in some malignant adult hepatic neoplasms as well as peripheral to three cases of hepatoblastoma. 10 -u Color-flow Doppler is helpful in that it is technically easier to perform and much faster than duplex Doppler. Lesions with demonstrable flow on color Doppler (patients 3 and 4) also showed flow on duplex Doppler.…”