Liver mass Ultrasound: Difference between revisions

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==Ultrasound==
==Ultrasound==
Ultrasound is the initial  method of choice for the evaluation of liver mass. The evaluation of liver mass will mainly depend on echogenecity
*On ultrasound, characteristic findings of liver mass, may include:
**Fuid-filled spaces without clear walls
**Posterior acoustic enhancement
**Anechoic, hypohechoic, or hyperechoic lesions


*Ultrasound is the initial  method of choice for the evaluation of liver mass
==== Types: ====
*On ultrasound, characteristic findings of liver mass, may include:
:Evaluation with ultrasound should include the following techniques<ref name="pmid17526609" />
:*Fuid-filled spaces without clear walls
:*Posterior acoustic enhancement
:*Anechoic, hypohechoic, or hyperechoic lesions
*Ultrasound is the most useful diagnostic test for simple cysts
*Further evaluation with ultrasound should include the following techniques:<ref name="pmid17526609">{{cite journal |vauthors=Wilson SR, Jang HJ, Kim TK, Burns PN |title=Diagnosis of focal liver masses on ultrasonography: comparison of unenhanced and contrast-enhanced scans |journal=J Ultrasound Med |volume=26 |issue=6 |pages=775–87; quiz 788–90 |year=2007 |pmid=17526609 |doi= |url=}}</ref>
:*Doppler examination  
:*Doppler examination  
:*Contrast-enhanced ultrasound
:*Contrast-enhanced ultrasound
 
{| class="wikitable"
*The evaluation of liver mass will mainly depend on echogenecity
!
*On ultrasound, characteristic findings of benign liver mass, include:<ref name="pmid17526609">{{cite journal |vauthors=Wilson SR, Jang HJ, Kim TK, Burns PN |title=Diagnosis of focal liver masses on ultrasonography: comparison of unenhanced and contrast-enhanced scans |journal=J Ultrasound Med |volume=26 |issue=6 |pages=775–87; quiz 788–90 |year=2007 |pmid=17526609 |doi= |url=}}</ref>
!Ultrasound
:*Homogeneous hyperechogenicity
!Enhanced ultrasound
:*Hypoechogenicity with hyperechoic rind
|-
:*Posterior sonic enhancement  
|Benign liver mass
*On enhanced ultrasound, characteristic findings of benign liver mass, include:
|
:*Wash out during portal venous phase regardless of arterial vascularity
*Homogeneous hyperechogenicity
 
*Hypoechogenicity with hyperechoic rind
*On ultrasound, characteristic findings of malignant liver mass, include:<ref name="pmid17526609">{{cite journal |vauthors=Wilson SR, Jang HJ, Kim TK, Burns PN |title=Diagnosis of focal liver masses on ultrasonography: comparison of unenhanced and contrast-enhanced scans |journal=J Ultrasound Med |volume=26 |issue=6 |pages=775–87; quiz 788–90 |year=2007 |pmid=17526609 |doi= |url=}}</ref>
*Posterior sonic enhancement  
:*Hypoechoic halo
|
:*Target appearance
* Wash out during portal venous phase regardless of arterial vascularity
:*Hypoechoic
|-
*On enhanced ultrasound, characteristic findings of malignant liver mass, include:<ref name="pmid17526609">{{cite journal |vauthors=Wilson SR, Jang HJ, Kim TK, Burns PN |title=Diagnosis of focal liver masses on ultrasonography: comparison of unenhanced and contrast-enhanced scans |journal=J Ultrasound Med |volume=26 |issue=6 |pages=775–87; quiz 788–90 |year=2007 |pmid=17526609 |doi= |url=}}</ref>
|Malignant liver mass
:*No wash-out during portal phase
|
 
*Hypoechoic halo
*On ultrasound, radiological signs of liver mass, include:<ref name="pmid17526609">{{cite journal |vauthors=Wilson SR, Jang HJ, Kim TK, Burns PN |title=Diagnosis of focal liver masses on ultrasonography: comparison of unenhanced and contrast-enhanced scans |journal=J Ultrasound Med |volume=26 |issue=6 |pages=775–87; quiz 788–90 |year=2007 |pmid=17526609 |doi= |url=}}</ref>
*Target appearance
:*'''Central scar''':  large central artery is usually present with spoke-wheel like centrifugal flow
|
:*'''Sonographic halo sign''': hypoechoic halo sign in liver metastases: used in hepatobiliary imaging, is a concerning feature for malignant lesion if the lesion is a hyperechoic liver lesion  
* No wash-out during portal phase
 
|-
*The table below summarizes the characteristic ultrasound findings of common benign and malignant liver masses.  
| colspan="3" |
 
*'''Central scar''':  large central artery is usually present with spoke-wheel like centrifugal flow
{|style="border: 5px; font-size: 90%; margin: 5px; width: 1000px" align=center
*'''Sonographic halo sign''': hypoechoic halo sign in liver metastases: used in hepatobiliary imaging, is a concerning feature for malignant lesion if the lesion is a hyperechoic liver lesion  
!style="padding: 5px 5px; background: #4479BA; font-weight: bold; text-align:center;" colspan="2"|{{fontcolor|#FFF|'''Ultrasound findings of common liver masses'''}}
|}
|valign=top|
'''The table below summarizes the characteristic ultrasound findings of common benign and malignant liver masses.'''
{| style="border: 5px; font-size: 90%; margin: 5px; width: 1000px" align="center"
! colspan="2" style="padding: 5px 5px; background: #4479BA; font-weight: bold; text-align:center;" |{{fontcolor|#FFF|'''Ultrasound findings of common liver masses'''}}
| valign="top" |
|+
|+
!style="background: #4479BA; width: 300px; text-align:center;" | {{fontcolor|#FFF|'''Common liver masses'''}}
! style="background: #4479BA; width: 300px; text-align:center;" | {{fontcolor|#FFF|'''Common liver masses'''}}
!style="background: #4479BA; width: 300px; text-align:center;" | {{fontcolor|#FFF|'''Ultrasound finding'''}}
! style="background: #4479BA; width: 300px; text-align:center;" | {{fontcolor|#FFF|'''Ultrasound finding'''}}
|-
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Hepatic hemangioma
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Hepatic hemangioma
|style="padding: 5px 5px; background: #F5F5F5;"|  
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Well-demarcated
*Well-demarcated
*Homogeneous  
*Homogeneous  
Line 54: Line 57:
*May be hypoechoic in patients with fatty infiltration
*May be hypoechoic in patients with fatty infiltration
|-
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Focal nodular hyperplasia
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Focal nodular hyperplasia
|style="padding: 5px 5px; background: #F5F5F5;"|   
| style="padding: 5px 5px; background: #F5F5F5;" |   
*Detectable lesions  
*Detectable lesions  
*Central scar with displacement of peripheral vasculature (Doppler examination)
*Central scar with displacement of peripheral vasculature (Doppler examination)
|-
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Hepatic adenoma
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Hepatic adenoma
|style="padding: 5px 5px; background: #F5F5F5;"|  
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Large  
*Large  
*Right lobe of the liver
*Right lobe of the liver
*Central hypoechoic region
*Central hypoechoic region
|-
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Idiopathic noncirrhotic portal hypertension
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Idiopathic noncirrhotic portal hypertension
|style="padding: 5px 5px; background: #F5F5F5;"|   
| style="padding: 5px 5px; background: #F5F5F5;" |   
*Isoechoic lesions
*Isoechoic lesions
|-
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Hepatocellular carcinoma
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Hepatocellular carcinoma
|style="padding: 5px 5px; background: #F5F5F5;"|   
| style="padding: 5px 5px; background: #F5F5F5;" |   
*Poorly-defined margins  
*Poorly-defined margins  
*Coarse, irregular internal echoes
*Coarse, irregular internal echoes
|-
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Cholangiocarcinoma
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Cholangiocarcinoma
|style="padding: 5px 5px; background: #F5F5F5;"|  
| style="padding: 5px 5px; background: #F5F5F5;" |  
*Hypo-, iso-, or hyperechoic
*Hypo-, iso-, or hyperechoic
*Homogenous or heterogenous
*Homogenous or heterogenous
|-
|-
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Metastases
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Metastases
|style="padding: 5px 5px; background: #F5F5F5;"|   
| style="padding: 5px 5px; background: #F5F5F5;" |   
*Metastases from adenocarcinoma  
*Metastases from adenocarcinoma  
:*Multiple and hypoechoic in comparison with the surrounding liver parenchyma
:*Multiple and hypoechoic in comparison with the surrounding liver parenchyma
|}
|}


 
[[Image: Focal-nodular-hyperplasia-6.jpg|400px|center|thumb|'''Central scar''':  This image shows the presence of focal nodular hyperplasia.  Detectable lesions characteristically will demonstrate a central scar with displacement of peripheral vasculature on color Doppler examination]][[Image: Halosign livermassus.jpeg|400px|center|thumb|'''Sonographic halo sign''': hypoechoic halo sign in liver metastases: used in hepatobiliary imaging, is a concerning feature for malignant lesion if the lesion is a hyperechoic liver lesion]]
 
 
 
==Gallery==
 
<div align="left">
<gallery heights="175" widths="175">
Image: Focal-nodular-hyperplasia-6.jpg|'''Central scar''':  This image shows the presence of focal nodular hyperplasia.  Detectable lesions characteristically will demonstrate a central scar with displacement of peripheral vasculature on color Doppler examination
Image: Halosign livermassus.jpeg|'''Sonographic halo sign''': hypoechoic halo sign in liver metastases: used in hepatobiliary imaging, is a concerning feature for malignant lesion if the lesion is a hyperechoic liver lesion
</gallery>


==References==
==References==

Latest revision as of 16:59, 31 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

Ultrasound is the initial method of choice for the evaluation of liver mass. On ultrasound, characteristic findings of liver mass, may include: fluid-filled spaces without clear walls, posterior acoustic enhancement, anechoic, hypohechoic, or hyperechoic lesions. The evaluation of liver mass will mainly depend on the echogenecity. Further evaluation with ultrasound should include Doppler examination to determine vascular pattern.[1][2]

Ultrasound

Ultrasound is the initial method of choice for the evaluation of liver mass. The evaluation of liver mass will mainly depend on echogenecity

  • On ultrasound, characteristic findings of liver mass, may include:
    • Fuid-filled spaces without clear walls
    • Posterior acoustic enhancement
    • Anechoic, hypohechoic, or hyperechoic lesions

Types:

Evaluation with ultrasound should include the following techniques[2]
  • Doppler examination
  • Contrast-enhanced ultrasound
Ultrasound Enhanced ultrasound
Benign liver mass
  • Homogeneous hyperechogenicity
  • Hypoechogenicity with hyperechoic rind
  • Posterior sonic enhancement
  • Wash out during portal venous phase regardless of arterial vascularity
Malignant liver mass
  • Hypoechoic halo
  • Target appearance
  • No wash-out during portal phase
  • Central scar: large central artery is usually present with spoke-wheel like centrifugal flow
  • Sonographic halo sign: hypoechoic halo sign in liver metastases: used in hepatobiliary imaging, is a concerning feature for malignant lesion if the lesion is a hyperechoic liver lesion

The table below summarizes the characteristic ultrasound findings of common benign and malignant liver masses.

Ultrasound findings of common liver masses
Common liver masses Ultrasound finding
Hepatic hemangioma
  • Well-demarcated
  • Homogeneous
  • Hyperechoic mass
  • May be hypoechoic in patients with fatty infiltration
Focal nodular hyperplasia
  • Detectable lesions
  • Central scar with displacement of peripheral vasculature (Doppler examination)
Hepatic adenoma
  • Large
  • Right lobe of the liver
  • Central hypoechoic region
Idiopathic noncirrhotic portal hypertension
  • Isoechoic lesions
Hepatocellular carcinoma
  • Poorly-defined margins
  • Coarse, irregular internal echoes
Cholangiocarcinoma
  • Hypo-, iso-, or hyperechoic
  • Homogenous or heterogenous
Metastases
  • Metastases from adenocarcinoma
  • Multiple and hypoechoic in comparison with the surrounding liver parenchyma
Central scar: This image shows the presence of focal nodular hyperplasia. Detectable lesions characteristically will demonstrate a central scar with displacement of peripheral vasculature on color Doppler examination
Sonographic halo sign: hypoechoic halo sign in liver metastases: used in hepatobiliary imaging, is a concerning feature for malignant lesion if the lesion is a hyperechoic liver lesion

References

  1. ↑ Bonder A, Afdhal N (2012). "Evaluation of liver lesions". Clin Liver Dis. 16 (2): 271–83. doi:10.1016/j.cld.2012.03.001. PMID 22541698.
  2. ↑ 2.0 2.1 Wilson SR, Jang HJ, Kim TK, Burns PN (2007). "Diagnosis of focal liver masses on ultrasonography: comparison of unenhanced and contrast-enhanced scans". J Ultrasound Med. 26 (6): 775–87, quiz 788–90. PMID 17526609.
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