Diagnostic ultrasound ( PDFDrive )

CHAPTER 4 The Liver 111
A
B
C
D
FIG. 4.45 Contrast-Enhanced Ultrasound (CEUS) Images of Increased Conspicuity of Metastases in Two Patients. (A) and (B) are of
historic signiicance. (A) Subtle isoechoic mass in the liver. (B) Postvascular image with contrast agent Levovist showing increased echogenicity
of the liver. The mass now appears black with increased conspicuity. (C) Baseline image showing a hypoechoic region in the liver without good
margination raising the possibility it could be fat sparing. (D) CEUS performed with a perluorocarbon contrast agent shows punched-out washout
of a large metastasis, again increasing the conspicuity. Two additional small masses are shown. More and smaller metastases are detected with
CEUS than on baseline.
recommended to conirm the suspicion of hemangioma: CEUS,
CT, or MRI.
In the arterial phase on CEUS, hemangiomas show peripheral
puddles and pools that are brighter than the adjacent enhanced
liver parenchyma. here are no linear vessels. Over time,
centripetal progression of the enhancement leads to complete
globular ill-in, with sustained enhancement equal to or better
than the liver in the portal venous phase, which may last for
several minutes 148 (Fig. 4.47). his enhancement may occur
rapidly or slowly and may be incomplete, even in the late
portal venous phase (Video 4.6). We have diagnosed almost
100% of hemangiomas with CEUS, including those of small
size, removing the necessity for conirmation with other imaging
modalities.
In a small minority of patients, imaging will not allow deinitive
diagnosis of hemangioma. Percutaneous biopsy of hepatic
hemangiomas has been safely performed. 149,150 Cronan et al. 149
performed biopsies on 15 patients (12 of whom were outpatients)
using a 20-gauge needle. In all patients the histologic sample
was diagnostic and was characterized by large spaces with an
endothelial lining. It is recommended when sampling lesions
that normal liver be interposed between the abdominal wall and
the hemangioma to allow hepatic tamponade of any potential
bleeding.