The Prevalence of Hyperechoic Rim in Solid Focal Liver Lesions and Its Implication

Abstract

Sonography has been globally used for the assessment of the liver, and because of these imaging evaluations, focal liver lesions have been incidentally discovered. The initial identification of a focal liver lesion is usually based on its sonographic characteristics. Typically, the rim at the periphery of focal liver lesions can present as isoechoic, hypoechoic, marked hypoechoic, and/or hyperechoic. The hyperechoic rim of a focal liver lesion has a higher echogenicity than both the internal architecture and the liver parenchyma. Previous reports have indicated that a hyperechoic rim can be noted in a liver hemangioma, regenerative cirrhosis nodule, and hepatocellular carcinoma (HCC). 1-6 However, clinically, it rarely presents with other focal liver lesions, except hepatic cavernous hemangioma. Unfortunately, the distribution of a sonographic hyperechoic rim associated with a focal liver lesion remains unaddressed in the literature. It may be diagnostically helpful to deliberately analyze the sonographic appearance of a hyperechoic rim when assessing solid focal liver lesions and may also help to narrow further investigation. The objective of this study was to investigate the prevalence as well as the implications of a sonographic hyperechoic rim appearance in association with solid focal liver lesions. Materials and Methods Study Population An audit of the archived medical record of patients referred for an inpatient liver sonogram was performed between January 2011 and March 2018. The patients' data and sonographic images were obtained from the Hospital Information Systems and Picture Archiving and Communication Systems (PACS). Two sonologists, who were not responsible for interpretation of the images, collected the cases for review. If a patient received several liver sonograms, the patient was still counted as one case. The inclusion criteria included patients who underwent a 798365J DMXXX10.

Radiologic-Pathologic Correlation of Liver Tumors

“…No central flow is demonstrated using color Doppler; however, peripheral vascularity can be present. A "reverse target" morphology with hyperechoic rim may be seen in a minority, with metastasis or HCC as the diagnosis of exclusion on a background of normal or cirrhotic liver parenchyma, respectively (49). Where CEUS is available, enhancement patterns parallel CT and MRI.…”