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Importance of Evaluating All Vascular Phases on Contrast-Enhanced Sonography in the Differentiation of Benign from Malignant Focal Liver Lesions

¹ All authors: Diagnosis Imaging Center, Hospital Clinic, Villarroel 170, Barcelona 08036, Spain.

View larger version (154K): [in a new window]   Fig. 1A —Dynamic contrast-enhanced sonographic images of liver of 66-year-old man with segment IV hepatic metastasis (diameter, 15 mm) originating from colon carcinoma. Baseline sonographic image shows well-defined hypoechoic lesion in left lobe.

View larger version (132K): [in a new window]   Fig. 1B —Dynamic contrast-enhanced sonographic images of liver of 66-year-old man with segment IV hepatic metastasis (diameter, 15 mm) originating from colon carcinoma. Arterial phase image shows peritumoral vessels (arrows) and only scarce intranodular vessels.

View larger version (149K): [in a new window]   Fig. 1C —Dynamic contrast-enhanced sonographic images of liver of 66-year-old man with segment IV hepatic metastasis (diameter, 15 mm) originating from colon carcinoma. Portal phase image obtained at 60 sec shows that tumor is hypoechoic with respect to surrounding liver, suggesting malignancy.

View larger version (159K): [in a new window]   Fig. 2A —Dynamic contrast-enhanced sonographic images of liver of 77-year-old man with focal nodular hyperplasia in right anterior segment of liver. Arrows point to margins of tumor. Arterial phase image obtained 7 sec after injection of contrast agent shows enhancement that is almost entirely central.

View larger version (167K): [in a new window]   Fig. 2B —Dynamic contrast-enhanced sonographic images of liver of 77-year-old man with focal nodular hyperplasia in right anterior segment of liver. Arrows point to margins of tumor. One second later, spider web morphology of arterial enhancement can be seen clearly.

View larger version (176K): [in a new window]   Fig. 2C —Dynamic contrast-enhanced sonographic images of liver of 77-year-old man with focal nodular hyperplasia in right anterior segment of liver. Arrows point to margins of tumor. Late phase shows that lesion remains slightly hyperechoic with respect to surrounding liver.

View larger version (129K): [in a new window]   Fig. 3A —Dynamic contrast-enhanced sonographic images of liver of 70-year-old man with segment V hepatocellular carcinoma (diameter, 2.3 cm). Arrows point to margins of tumor. Baseline sonographic image shows focal hypoechoic hepatocellular carcinoma in right hepatic lobe.

View larger version (144K): [in a new window]   Fig. 3B —Dynamic contrast-enhanced sonographic images of liver of 70-year-old man with segment V hepatocellular carcinoma (diameter, 2.3 cm). Arrows point to margins of tumor. Arterial phase image shows homogeneous enhancement of lesion.

View larger version (105K): [in a new window]   Fig. 3C —Dynamic contrast-enhanced sonographic images of liver of 70-year-old man with segment V hepatocellular carcinoma (diameter, 2.3 cm). Arrows point to margins of tumor. Late portal phase image obtained at 180 sec shows that hepatocellular carcinoma is clearly hypoechoic with respect to surrounding liver.

View larger version (145K): [in a new window]   Fig. 4A —Dynamic contrast-enhanced sonographic images of liver of 58-year-old man with well-differentiated hepatocellular carcinoma (diameter, 2.2 cm) in lateral segment of left lobe. Tumor was misdiagnosed as benign when we evaluated only late phase. Arrows point to margins of tumor (suspected margins in late phase). Baseline sonographic image shows hypoechoic hepatocellular carcinoma in lateral segment of left hepatic lobe.

View larger version (178K): [in a new window]   Fig. 4B —Dynamic contrast-enhanced sonographic images of liver of 58-year-old man with well-differentiated hepatocellular carcinoma (diameter, 2.2 cm) in lateral segment of left lobe. Tumor was misdiagnosed as benign when we evaluated only late phase. Arrows point to margins of tumor (suspected margins in late phase). Arterial phase image obtained at 25 sec shows marked intratumoral enhancement of lesion.

View larger version (173K): [in a new window]   Fig. 4C —Dynamic contrast-enhanced sonographic images of liver of 58-year-old man with well-differentiated hepatocellular carcinoma (diameter, 2.2 cm) in lateral segment of left lobe. Tumor was misdiagnosed as benign when we evaluated only late phase. Arrows point to margins of tumor (suspected margins in late phase). Late phase image obtained at 180 sec shows that hepatocellular carcinoma is isoechoic with respect to surrounding liver.

View larger version (169K): [in a new window]   Fig. 5A —Dynamic contrast-enhanced sonographic and MR images of 44-year-old man with hepatic hemangioma (diameter, 2.9 cm) in lateral segment of left lobe. Tumor was misdiagnosed as malignant when we evaluated only late phase. Baseline sonographic image shows slightly heterogeneous but predominantly hyperechoic focal liver lesion.

View larger version (123K): [in a new window]   Fig. 5B —Dynamic contrast-enhanced sonographic and MR images of 44-year-old man with hepatic hemangioma (diameter, 2.9 cm) in lateral segment of left lobe. Tumor was misdiagnosed as malignant when we evaluated only late phase. Arterial phase image obtained at 20 sec shows only small peripheral nodular enhancement (arrows).

View larger version (178K): [in a new window]   Fig. 5C —Dynamic contrast-enhanced sonographic and MR images of 44-year-old man with hepatic hemangioma (diameter, 2.9 cm) in lateral segment of left lobe. Tumor was misdiagnosed as malignant when we evaluated only late phase. Late phase image obtained at 180 sec shows only slight, partial filling of lesion.

View larger version (137K): [in a new window]   Fig. 5D —Dynamic contrast-enhanced sonographic and MR images of 44-year-old man with hepatic hemangioma (diameter, 2.9 cm) in lateral segment of left lobe. Tumor was misdiagnosed as malignant when we evaluated only late phase. Contrast-enhanced T1-weighted image obtained at 2 min shows partial filling of lesion. Hemangioma showed almost complete filling on delayed T1-weighted image obtained at 7 min (not shown).

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