CEUS of Liver Lesions
Dr. Alison Harris
Dr. Alison Harris.
Conventional ultrasound is widely used in the initial assessment of both focal liver masses and diffuse liver disease and, as a supplement to CT and MR imaging of the abdomen. Characterization of focal liver lesions with ultrasound can be done by assessing whether typical sonographic features are present. Additional information can be gained with colour and spectral Doppler. Although Doppler can provide information regarding direction of flow and presence of flow in large vessels, its ability to detect flow at the perfusion level is limited. Contrast enhanced ultrasound (CEUS) with microbubble contrast agents and specialized ultrasound imaging techniques can be used to assess perfusion and thus provide valuable information for lesion characterization. The pattern of perfusion in the arterial, portal venous and delayed phases serves to predict the diagnosis of focal liver lesions, thereby enabling ultrasound to play a competitive role relative to CT and MRI. CEUS has the additional advantage that it can be used in patients with impaired renal function as the microbubble agents are not nephrotoxic. In addition, there is no associated ionizing radiation, which is frequently a concern.
CEUS is also valuable in the setting of interventional radiology where it can be used to target lesions for treatment with radiofrequency ablation (RFA) and assess response to treatment. The use of CEUS in the characterization of focal liver lesions is discussed with examples and with reference to CT and MR imaging.
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