Hyun-Jung Jang MD, Presenter: Nothing to Disclose

Tae Kyoung Kim MD, Abstract Co-Author: Nothing to Disclose

Stephanie Ruth Wilson MD, Abstract Co-Author: Nothing to Disclose

To determine the added benefit of contrast-enhanced ultrasound (CEUS) in characterizing hepatic nodules in patients at high-risk for HCC.

Over a 9-month period, 106 hepatic nodules in 80 patients at high-risk for HCC were evaluated with CEUS. Indications include new nodules at surveillance US (n37) and characterization of indeterminate lesions on CT/MR (n69). CEUS was performed with low-MI continuous scanning after repeated injections of Definity (Bristol-Myers Squibb). Dynamic scanning, focused on identified nodules, was followed by liver survey in the portal phase. Nodules were diagnosed as HCC, dysplastic/ regenerative nodule (DN/RN), hemangioma, pseudomass, or indeterminate based on familiar enhancement patterns.

Diagnoses on CEUS were HCC (n46), DN/RN (n31), hemangioma (n16), pseudomass (n8), and indeterminate (n5). Of 37 new nodules at surveillance US, 21/37 were benign, diagnosed as hemangioma (n8) or DN/RN (n13), and continued routine surveillance was recommended obviating immediate CT/MR scan. To our knowledge, none of these patients has HCC. 15/37 were confirmed HCCs and prompted proper work-up. The remaining 1/37 nodule was diagnosed as a pseudomass, confirmed by subsequent CT. Of 69 indeterminate lesions on CT/MR, 64/69 were diagnosed on CEUS as HCC (n30), DN/RN (n19), hemangioma (n7), or pseudomass (n8), allowing entry to proper management or follow-up protocol. 4/19 DN/RNs have subsequently been diagnosed as HCC. The remaining 5/69 were indeterminate on CEUS and warranted close follow-up including CT/MR. Multiple arterial enhancing foci seen on CT in 10 patients of this group were further clarified as pseudomasses on CEUS, in addition to the characterization of their dominant mass as documented above.

CEUS is a valuable addition to CT/MR for imaging the liver at risk for HCC. Immediate diagnosis of benign disease removes the necessity of referral for CT/MR scan. Continuous real time imaging minimizes problems related to timing on CT/MR scan and clarification of hypervascular pseudolesions is invaluable. Weaknesses of CEUS include those related to scanning the small and abnormal liver where not all lesions are visible within a nodular parenchyma.

Jang, H, Kim, T, Wilson, S, Characterization of Hepatic Nodules in Patients at High Risk for Hepatocellular Carcinoma with Contrast-enhanced Ultrasound.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4406134.html