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© 2007 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 26:337-345 • 0278-4297

Transient Hepatic Echogenicity Difference on Contrast-Enhanced Ultrasonography

Sonographic Sign and Pitfall

Orlando Catalano, MD, Fabio Sandomenico, MD, Antonio Nunziata, MD, Mauro Mattace Raso, MD, Paolo Vallone, MD and Alfredo Siani, MD

Department of Radiology, National Cancer Institute, "Fondazione G. Pascale," Naples, Italy (O.C., F.S., M.M.R., P.V., A.S.); and Department of Radiology, Presidio "Stefania Bellone," Azienda Sanitaria Locale Napoli 1, Naples, Italy (A.N.).

Address correspondence to Orlando Catalano, MD, Via F. Crispi 92, I-80121 Naples, Italy. E-mail: orlandcat{at}tin.it

Objective. The purpose of this study was to report and analyze a new contrast-enhanced ultrasonographic (CEUS) imaging finding, the transient hepatic echogenicity difference due to perfusion changes, using computed tomography (CT) as a reference standard. Methods. We retrospectively investigated the records of patients evaluated in a 2-year period, selecting those who had undergone both CT and CEUS within 15 days, who had CT evidence of a perfusion abnormality, and who had had a CEUS study that included the malperfused parenchymal area. Results. There were 30 patients with 44 hepatic perfusion changes on CT scans (28 around liver focal lesions and 16 unrelated to focal lesions). Retrospectively, CEUS allowed recognition of 21 of 28 perifocal transient hepatic attenuation differences (THADs), 6 of 10 subsegmental THADs, 2 of 3 segmental THADs, and 1 of 3 lobar THADs. Only some of these abnormalities had been identified at the original CEUS examinations: 0 of 3 lobar THADs, 1 of 3 segmental THADs, 2 of 10 subsegmental THADs, and 16 of 28 perifocal THADs. Conclusions. Contrast-enhanced ultrasonography can show hepatic perfusion abnormalities similar to those well known from CT literature, although with a lower sensitivity. Knowledge of this transient hepatic echogenicity difference phenomenon may be relevant for avoiding incorrect image interpretation or incorrect tumor size measurement and for eventually identifying occult vascular disorders such as venous thrombosis or fistulas.

Key Words: contrast-enhanced ultrasonography, liver • liver, focal lesions • liver, perfusion • liver, vascular abnormalities

Abbreviations: CEUS, contrast-enhanced ultrasonography • CT, computed tomography • HCC, hepatocellular carcinoma • MRI, magnetic resonance imaging • THAD, transient hepatic attenuation difference • THED, transient hepatic echogenicity difference




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Terminology for Contrast-Enhanced Sonography: A Practical Glossary
J. Ultrasound Med., June 1, 2007; 26(6): 717 - 730.
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Copyright © 2007 by the American Institute of Ultrasound in Medicine.