Ultrasonographic study of calcified hepatic metastases: A report of 13 cases

Abstract

Thirteen cases of calcified metastases were discovered by u l t r a s o n o g r a p h y in cancer patients undergoing chemotherapy. Plain films revealed calcifications in only 9 of these 13 cases; CT scans confirmed the u l t r a s o n o g r a p h i c findings in the remaining 4 cases. A l t h o u g h calcification of a metastasis corresponds to at least partial involution, it is always associated with a polymetastatic hepatic condition, and detection of a calcified metastasis therefore does not affect the prognosis.Key words: Hepatic metastases -U l t r a s o n o g r a p h y -Liver calcification C o m p u t e d t o m o g r a p h y .A l t h o u g h liver metastases constitute the most frequent type of liver tumors, they are only rarely calcified. Various publications have dealt with the radiologic aspects as seen on X-rays of the a b d o m e n without p r e p a r a t i o n [1-4], but we found only one p u b l i c ation, limited to 3 cases, concerning the echographic aspects o f calcified metastases [5]. In 1979 Bernardino and Green [6] discussed the surveillance of hepatic metastases during chemotherapy, but they did not mention the possibility of calcifications. We therefore felt it interesting to present our 13 personal observations of calcified liver metastases. Material and MethodsOf a population of 800 patients with hepatic metastases, 300 on chemotherapy were entered in our study. Ultrasonography revealed calcifications in one or more hepatic metastases in 13 cases (8 men, 5 women). These patients' primary cancers included adenocarcinoma of the colon (10), breast cancer (1), Ewing's tumor (1), and thyroid cancer (1). Real-time echography was followed by contact Address reprint requests to: J.N. Bruneton, M.D., Department of Radiology, Centre A. Lacassagne, 36 Voie Romain 06054 Nice Cedex, France scanning using 2.25-5 MHz transducers, depending on the patient's morphotype.In all instances where sonographic findings pointed toward calcifications, a plain film was taken. When radiologic films proved negative, a CT scan was obtained (4 cases). Existence of hepatic metastases was demonstrated anatomically in all 13 cases. Except for 1 case, all patients were followed up by echography, and all had undergone at least 2 other echographic examinations prior to discovery of calcifications within metastases. All patients were on chemotherapy. ResultsThe hepatic calcifications in all 13 cases showed as a large, highly echoic zone with an acoustic shadow behind (Figs.1 3). Other metastatic lesions were found in all patients (hyperechoic in 12 cases, hypoechoic in 1 case). Necrotic metastases in another area o f the liver were also noted in 5 patients.Plain films revealed occasionally hard-to-see heterogenic images o f calcification in only 9 cases (Fig. 4). In the 4 cases in which radiologic films were Fig. 1. Sagittal scan of the liver : hyperechoic pattern with acoustic shadow. Note a bull's-eye metastasis in the inferior part of the right lobe 0364-2356/82/0007-0061 $01.00 9 1982 Springer-Verlag New Y o r k Inc.62 J....

Ultrasonography Appearances of Hepatic Metastases from Female Breast Cancer in Patients in Central Sudan

“…Our study showed that breast cancer liver metastases could have a variety of ultrasonography echogenic appearances; hypoechoic (70% of cases), hyperechoic (21.7% of cases), mixed (hypo and hyperechoic; 5.7% of cases), and isoechoic (3.8% of cases). These findings are in accordance with a study by Bruneton et al who found that about 70% of liver metastases had a hypoechoic appearance on ultrasonography [27]. The most common hypoechoic liver metastases were from breast, lung, esophagus, stomach, and pancreatic cancer and non-Hodgkin lymphoma.…”