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Review
. 2015 Jan;2(1):51-62.
doi: 10.2217/hep.14.25. Epub 2015 Jan 12.

Contrast-enhanced ultrasound in liver cancer

Simona Leoni  1 , Ilaria Serio  1 , Anna Pecorelli  1 , Sara Marinelli  1 , Luigi Bolondi  1
Affiliations
Review

Contrast-enhanced ultrasound in liver cancer

Simona Leoni et al. Hepat Oncol. 2015 Jan.

Abstract

Contrast-enhanced ultrasound (CEUS) is a sure, noninvasive, repeatable imaging technique widely used in the characterization of benign and malignant liver lesions. The European Federation of Societies for Ultrasound in Medicine and Biology guidelines suggest the typical CEUS features of liver lesions as criteria for the noninvasive diagnosis in cirrhotic and not-cirrhotic patients. The clinical application of CEUS in the liver study is summarized in this review; the contrast-enhanced patterns of the most frequent liver lesions are described (hepatocellular and cholangiocellular carcinoma, liver metastases, hemangioma, focal nodular hyperplasia, adenoma). The role of this imaging technique in the diagnostic algorithm of liver malignancy is illustrated and the CEUS application in hepatologic and oncological settings is depicted.

Keywords: cholangiocellular carcinoma; contrast agents; hepatocellular carcinoma; liver lesions; liver metastases; ultrasound.

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Conflict of interest statement

Financial & competing interests disclosure L Bolondi receives consulting and speakers fees from Bayer, Bracco and Roche. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.

Figures

<b>Figure 1.</b>
Figure 1.. Contrast-enhanced ultrasound in different vascular phases of hemangioma detected in a patient without liver disease.
(A) Peripheral nodular enhancement in arterial phase; (B) progressive centripetal enhancement; (C) complete enhancement in portal-venous phase; and (D) complete enhancement in late phase.
<b>Figure 2.</b>
Figure 2.. Contrast-enhanced ultrasound in different vascular phases of focal nodular hyperplasia characterized by typical vascular pattern.
(A) Central arterial hyper-enhancement; (B & C) rapid fill-in from the center outwards; (D) iso-enhancement in late phase.
<b>Figure 3.</b>
Figure 3.. Contrast enhanced ultrasound images of hepatocellular adenoma.
The final diagnosis was confirmed after liver resection and pathological examination of focal liver lesion. (A) Peripherical arterial hyper-enhancement; (B & C) rapid centripetal fill-in; and (D) iso-enhancement in late phase.
<b>Figure 4.</b>
Figure 4.. Contrast-enhanced ultrasound images of nodules with final diagnosis of hepatocellular carcinoma.
Contrast-enhanced ultrasound images of noduleswith final diagnosis of hepatocellular carcinoma. A typical vascular pattern of hepatocellular carcinoma (A, B-mode) at contrast-enhanced ultrasound is characterized by hyper-enhancement in arterial phase (B) and wash out at hypo- enhancement in late phase (2 min) (C). An atypical vascular pattern of hepatocellular carcinoma (D, B-mode) at contrast-enhanced ultrasound could be characterized by iso-enhancement in arterial phase (E) followed by iso-enhancement in late phase (absence of washout) (F).
<b>Figure 5.</b>
Figure 5.. Contrast-enhanced ultrasound images of nodules with final diagnosis of cholangiocellular carcinoma.
Contrast-enhanced ultrasound images of nodules with final diagnosis of cholangiocellular carcinoma. A vascular pattern of cholangiocellular carcinoma at contrast-enhanced ultrasound is characterized by inhomogeneous hyper-enhancement in arterial phase (A) followed by marked washout (hypo-enhancement) in late phase (B). A different vascular pattern of cholangiocellular carcinoma could be characterized by mild peripheral rim hyper-enhancement in arterial phase (C) and washout (hypo-enhancement) in late phase (D).
<b>Figure 6.</b>
Figure 6.. Contras- enhanced ultrasound images of nodules with final diagnosis of metastasis.
A typical vascular pattern of metastasis is characterized by marked peripheral rim hyper-enhancement in (A) arterial phase followed by marked washout (hypo-enhancement) in (B) late phase; another typical vascular pattern of metastasis on contrast-enhanced ultrasound is represented by hyper-enhancement in (C) arterial phase and washout at hypo-enhancement in (D) late phase.
See this image and copyright information in PMC

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