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

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.

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.

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.

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.

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.

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