RSNA 2014 

Abstract Archives of the RSNA, 2014


SSJ07-05

Contrast-enhanced Sonography (CEUS) Assessment of Dirty, Cystic-like Focal Liver Lesions (FLLs)

Scientific Papers

Presented on December 2, 2014
Presented as part of SSJ07: Gastrointestinal (Liver Masses)

Participants

Orlando Catalano MD, Abstract Co-Author: Nothing to Disclose
Pietro Paolo Saturnino MD, Presenter: Nothing to Disclose
Antonio Nunziata MD, Abstract Co-Author: Nothing to Disclose
Sergio Venanzio Setola MD, Abstract Co-Author: Nothing to Disclose
Fabio Sandomenico MD, Abstract Co-Author: Nothing to Disclose
Antonella Petrillo MD, Abstract Co-Author: Nothing to Disclose

PURPOSE

Dirty liver cysts at US represent a challenge, since true cysts can mimic a solid FLL while solid FLLs may be confused with cysts. Our single-cancer centre study analyses the additional value of microbubbles contrast injection in cancer patients with “dirty” cysts at baseline US.

METHOD AND MATERIALS

In a 7-year period we identified 48 patients with 50 “dirty” cysts (hypoechoic content in 24 lesions, lack of posterior enhancement in 10 lesions, both findings in 16 lesions) at US. These subjects were imaged for cancer staging/follow-up and had no previous study for comparison. They prospective underwent sulphur hexafluoride-based contrast medium injection. Diagnosis was confirmed by further imaging in 30 lesions, follow-up in 18, and biopsy in 2.

RESULTS

US was indeterminate, by definition, in all lesions (9-39 mm, mean 20). The liver echotexture was fatty in 37 patients and normal in the others. An inhomogeneous content was more predictive for solid nature than lack of dorsal enhancement did. CEUS correctly diagnosed all 24 true cysts (100%) in 24 patients and 25/26 solid lesions (96%, 18 metastases and 7 hemangiomas) in the remaining 24. One deeply located metastasis was incorrectly diagnosed as cyst by CEUS.

CONCLUSION

CEUS allows achieving a definitive diagnosis in patients with US findings of “dirty” liver cyst. CEUS allows ruling out a solid FLL and characterizing truly solid FLLs. This is of special value in countries where US is regarded as the first modality for liver survey.

CLINICAL RELEVANCE/APPLICATION

It is not uncommon that liver cysts show an atypical appearance at US. In these cases CEUS allows to solve the diagnostic pitfall avoiding further imaging with more expensive and invasive modalities.

Cite This Abstract

Catalano, O, Saturnino, P, Nunziata, A, Setola, S, Sandomenico, F, Petrillo, A, Contrast-enhanced Sonography (CEUS) Assessment of Dirty, Cystic-like Focal Liver Lesions (FLLs).  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011661.html