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© 2009 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 28:1133-1142 • 0278-4297

Focal Hypoechoic Tumors of Fatty Liver

Characterization of Conventional and Contrast-Enhanced Ultrasonography

Li-Ping Liu, MD, Bao-Wei Dong, MD, Xiao-Ling Yu, MD, Ping Liang, MD, Da-Kun Zhang, MD and Li-Chun An, MD

Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, China. (L.-P.L.); and Department of Ultrasound, Chinese People’s Liberation Army General Hospital, Beijing, China (B.-W.D., X.-L.Y., P.L., D.-K.Z., L.-C.A.).

Address correspondence to Xiao-Ling Yu, MD, Department of Ultrasound, Chinese People’s Liberation Army General Hospital, 28 Fuxing Rd, 100853 Beijing, China. E-mail: dyuxl301{at}yahoo.com.cn, liuliping1600{at}sina.com

Objective. The purpose of this study was to investigate the characteristics of focal hypoechoic tumors of fatty liver using conventional ultrasonography and contrast-enhanced ultrasonography (CEUS). Methods. Sixty-four hypoechoic tumors of fatty liver in 52 patients were examined by both conventional ultrasonography and CEUS. Contrast pulse sequencing and a sulfur hexafluoride contrast agent were used for CEUS. The enhancement patterns were evaluated in real time. Results. Hypoechoic tumors of fatty liver showed posterior echo enhancement, including 71.4% (25 of 35) of hemangiomas, 73.3% (11 of 15) of metastases, and 50.0% (3 of 6) of hepatocellular carcinomas (HCCs) on conventional ultrasonography. During the early arterial phase, 62.5% (5 of 8) of focal nodular hyperplasia lesions showed a central spoked wheel enhancement pattern, whereas the remaining 37.5% (3 of 8) showed eccentric spoked wheel enhancement. During the arterial phase, 97.1% (34 of 35) of hemangiomas showed peripheral enhancement and centripetal fill-in, including ringlike peripheral enhancement (12 of 35), small nodular peripheral enhancement (19 of 35), and massive irregular peripheral enhancement (3 of 35). In total, 76.5% (26 of 34) of hemangiomas were completely filled in. All HCCs showed complete enhancement from 9 to 24 seconds during the arterial phase and began to wash out from 21 to 114 seconds. During the arterial phase, 40.0% (6 of 15) of metastases showed ringlike enhancement; 26.7% (4 of 15) showed slight hyperenhancement; 13.3% (2 of 15) showed hyperenhancement quickly; and the remaining 20.0% (3 of 15) showed heterogeneous hyperenhancement. All metastatic tumors began to wash out from 25 to 40 seconds. In total, 92.2% (59 of 64) of focal hypoechoic tumors of fatty liver were diagnosed as the correct pathologic type with CEUS. Conclusions. With CEUS, characterization of hypoechoic tumors of fatty liver is greatly improved.

Key Words: contrast agent • fatty liver • hypoechoic liver tumor • ultrasonography

Abbreviations: CEUS, contrast-enhanced ultrasonography • CPS, contrast pulse sequencing • CT, computed tomography • FNH, focal nodular hyperplasia • HCC, hepatocellular carcinoma • MI, mechanical index • MRI, magnetic resonance imaging • NAFLD, nonalcoholic fatty liver disease

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Copyright © 2009 by the American Institute of Ultrasound in Medicine.