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Benefits of Contrast-Enhanced Sonography for the Detection of Liver Lesions: Comparison with Histologic Findings

¹ Department of Medical Imaging, Institut Gustave Roussy, 39 rue Camille Desmoulins, Villejuif 94805, France.
² Department of Gastroenterology, Institut Gustave Roussy, Villejuif 94805, France.
³ Department of Surgery, Institut Gustave Roussy, Villejuif 94805, France.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Unknown liver metastasis in 57-year-old man with colonic adenocarcinoma. Image obtained during portal venous phase in vascular recognition imaging (VRI) mode shows nodular enhancement defect (arrow) in right lobe of liver (hypoechoic area).

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Unknown liver metastasis in 57-year-old man with colonic adenocarcinoma. Same lesion (arrow, B) as that shown in A was detected on image obtained using pulse subtraction imaging (PSI) mode (B) but was not visible on corresponding gray-scale image (C) or contrast-enhanced CT scan (D). It was metastasis at histologic analysis.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Unknown liver metastasis in 57-year-old man with colonic adenocarcinoma. Same lesion (arrow, B) as that shown in A was detected on image obtained using pulse subtraction imaging (PSI) mode (B) but was not visible on corresponding gray-scale image (C) or contrast-enhanced CT scan (D). It was metastasis at histologic analysis.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Unknown liver metastasis in 57-year-old man with colonic adenocarcinoma. Same lesion (arrow, B) as that shown in A was detected on image obtained using pulse subtraction imaging (PSI) mode (B) but was not visible on corresponding gray-scale image (C) or contrast-enhanced CT scan (D). It was metastasis at histologic analysis.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Small unknown liver metastasis in 48-year-old man with colonic adenocarcinoma. Contrast-enhanced delayed phase (85 seconds) sonography image obtained in pulse subtraction imaging (PSI) mode (A) and corresponding baseline sonography image (B) of right lobe of liver show subcentimeter lesion (arrow, A) detected as nodular enhancement defect (hypoechoic area) that was not visible on baseline sonography.

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Small unknown liver metastasis in 48-year-old man with colonic adenocarcinoma. Contrast-enhanced delayed phase (85 seconds) sonography image obtained in pulse subtraction imaging (PSI) mode (A) and corresponding baseline sonography image (B) of right lobe of liver show subcentimeter lesion (arrow, A) detected as nodular enhancement defect (hypoechoic area) that was not visible on baseline sonography.

View larger version (79K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Single hypervascular liver metastasis from colorectal carcinoma not depicted on baseline sonography in 45-year-old woman. Contrast-enhanced CT image (A) and corresponding contrast-enhanced arterial (B) and portal venous (C) phase sonography images show hypervascular lesion (arrows) with washout during portal venous phase. Lesion was not visible on gray-scale sonogram (not shown).

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Single hypervascular liver metastasis from colorectal carcinoma not depicted on baseline sonography in 45-year-old woman. Contrast-enhanced CT image (A) and corresponding contrast-enhanced arterial (B) and portal venous (C) phase sonography images show hypervascular lesion (arrows) with washout during portal venous phase. Lesion was not visible on gray-scale sonogram (not shown).

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Single hypervascular liver metastasis from colorectal carcinoma not depicted on baseline sonography in 45-year-old woman. Contrast-enhanced CT image (A) and corresponding contrast-enhanced arterial (B) and portal venous (C) phase sonography images show hypervascular lesion (arrows) with washout during portal venous phase. Lesion was not visible on gray-scale sonogram (not shown).

View larger version (133K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Atypical hemangioma in 53-year-old woman seen on conventional sonography and after contrast injection. Conventional sonography image shows single lesion between cursors in upper right lobe as hypoechoic nodule in otherwise hyperechoic liver. A = 19 mm.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Atypical hemangioma in 53-year-old woman seen on conventional sonography and after contrast injection. Contrast-enhanced images obtained in pulse subtraction imaging (PSI) mode show partial filling of lesion with central hypoechoic area during portal venous phase.

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