Liver tumors in fatty liver: difficulty in ultrasonographic interpretation

Konno, Kunihiko; Ishida, Hideaki; Sato, Makoto; Komatsuda, Tomoya; Ishida, J.; Naganuma, Hiroko; Hamashima, Y.; Watanabe, Sumio

doi:10.1007/s00261-001-0005-z

Cited by 47 publications

(34 citation statements)

References 4 publications

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“…In clinical practice the presence of diffuse liver disease, such as steatosis, may largely alter grey-scale US appearance of hepatic tumours [48]. In a study carried out with a first-generation contrast agent, diffuse liver steatosis masked contrast enhancement of FNH, thus hampering a reliable characterization [19].…”

Section: Discussionmentioning

confidence: 99%

Liver haemangiomas undetermined at grey-scale ultrasound: contrast-enhancement patterns with SonoVue and pulse-inversion US

et al. 2004

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The objective of this study was to describe the spectrum of contrast-enhancement patterns of hepatic haemangiomas undetermined at grey-scale ultrasound (US) on SonoVue-enhanced pulse-inversion (PI) US. Twenty patients (11 women, nine men) with 35 haemangiomas (size range: 1-7 cm; mean: 3.1 cm) undetermined at baseline US underwent PI at low M.I. (0.05-0.08) after i.v. injection of SonoVue. All haemangiomas were confirmed by typical helical computed tomography (CT) and/or magnetic resonance imaging (MRI) findings. US examinations were videotaped and then reviewed by two experienced radiologists blinded to the final diagnosis. Readers evaluated by consensus the baseline echogenicity and the dynamic enhancement pattern of each lesion, in comparison with adjacent liver parenchyma. After administration of SonoVue, 31/35 (88%) haemangiomas showed peripheral hyperechoic nodules in the arterial phase, followed by progressive centripetal fill-in, which was complete in 25/35 cases and incomplete in 6/35 cases. Three out of 35 (9%) haemangiomas showed rapid and complete fill-in in the arterial phase, which persisted in the portal and delayed phases. Finally, 1/35 haemangiomas (3%) showed a rim of arterial contrast enhancement with progressive and complete centripetal fill-in in portal-venous and delayed phases. In conclusion, PI after the administration of SonoVue enabled the depiction of typical contrast-enhancement patterns in haemangiomas undetermined at baseline US.

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Section: Discussionmentioning

confidence: 99%

Liver haemangiomas undetermined at grey-scale ultrasound: contrast-enhancement patterns with SonoVue and pulse-inversion US

et al. 2004

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“…The ultrasonographic diagnosis of fatty liver was established on the basis of these typical ultrasonographic findings: (1) a markedly fine echogenic liver compared with the right kidney and (2) absence of ultrasonographic findings suggestive of chronic hepatic diseases, such as an irregular hepatic surface, a coarse echo texture, and an enlarged caudate or left lobe. 9 In our study, the diagnosis of fatty liver was confirmed by histologic analysis of perilesional hepatic tissue, CT attenuation values, or a difference between the MRI signal intensity on in-and out-of-phase sequences. We excluded all patients with liver fibrosis or cirrhosis and those without a definitive final diagnosis established by means of the reference standards outlined above.…”

Section: Patientsmentioning

confidence: 56%

“…9 For example, when a typical hemangioma is present in the liver, if fatty infiltration of the liver has occurred, its ultrasonographic appearance will be altered. 10 Fatty infiltration of the liver may also cause obscuration of the echogenic border around the tumor.…”

mentioning

confidence: 99%

Focal Hypoechoic Tumors of Fatty Liver

Liu

Dong

et al. 2009

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to investigate the characteristics of focal hypoechoic tumors of fatty liver using conventional ultrasonography and contrast-enhanced ultrasonography (CEUS). Methods. Sixty-four hypoechoic tumors of fatty liver in 52 patients were examined by both conventional ultrasonography and CEUS. Contrast pulse sequencing and a sulfur hexafluoride contrast agent were used for CEUS. The enhancement patterns were evaluated in real time. Results. Hypoechoic tumors of fatty liver showed posterior echo enhancement, including 71.4% (25 of 35) of hemangiomas, 73.3% (11 of 15) of metastases, and 50.0% (3 of 6) of hepatocellular carcinomas (HCCs) on conventional ultrasonography. During the early arterial phase, 62.5% (5 of 8) of focal nodular hyperplasia lesions showed a central spoked wheel enhancement pattern, whereas the remaining 37.5% (3 of 8) showed eccentric spoked wheel enhancement. During the arterial phase, 97.1% (34 of 35) of hemangiomas showed peripheral enhancement and centripetal fill-in, including ringlike peripheral enhancement (12 of 35), small nodular peripheral enhancement (19 of 35), and massive irregular peripheral enhancement (3 of 35). In total, 76.5% (26 of 34) of hemangiomas were completely filled in. All HCCs showed complete enhancement from 9 to 24 seconds during the arterial phase and began to wash out from 21 to 114 seconds. During the arterial phase, 40.0% (6 of 15) of metastases showed ringlike enhancement; 26.7% (4 of 15) showed slight hyperenhancement; 13.3% (2 of 15) showed hyperenhancement quickly; and the remaining 20.0% (3 of 15) showed heterogeneous hyperenhancement. All metastatic tumors began to wash out from 25 to 40 seconds. In total, 92.2% (59 of 64) of focal hypoechoic tumors of fatty liver were diagnosed as the correct pathologic type with CEUS. Conclusions. With CEUS, characterization of hypoechoic tumors of fatty liver is greatly improved.

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“…The ultrasound imaging characteristics of focal liver lesions have been described relative to normal liver parenchyma. However, many patients have diffuse liver disease that can change the background echogenicity (Konno et al 2001 ). For example, a hemangioma in a fatty liver can appear hypoechoic instead of hyperechoic ( Fig.…”

Section: Livermentioning

confidence: 99%