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Blood Flow Patterns in Focal Liver Lesions at Microbubble-enhanced US¹

¹ From the Department of Medical Imaging, University of Toronto, Toronto General Hospital, University Health Network, 585 University Ave, Toronto, Ontario, Canada M5G 2N2 (M.B., S.R.W.); and the Department of Medical Biophysics, University of Toronto, Imaging Research, Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ontario, Canada (P.N.B.). Presented as an education exhibit at the 2002 RSNA    scientific assembly. Received July 1, 2003; revision requested July 30 and received September 24; accepted October 28. Supported by grants from   the Canadian Institutes of Health Research and the Terry Fox Program of the National Cancer Institute of Canada. Clinical studies were also supported by Bristol-Myers Squibb Medical Imaging, Berlex Canada, and Mallinckrodt Medical Inc. Address correspondence to S.R.W. (e-mail: stephanie.wilson@uhn.on.ca).

Noninvasive diagnosis of liver lesions is usually performed with contrast material–enhanced computed tomography (CT) and magnetic resonance (MR) imaging and is based on enhancement features of the arterial and portal venous phases. Ultrasonography (US) is often limited in characterizing liver lesions because color and spectral Doppler US provide limited vascular information in large patients and in small or deep lesions. However, microbubble contrast agents, together with specialized US techniques, now allow diagnosis of liver lesions based on morphologic evaluation of lesion vascularity and visualization of specific enhancement features. Microbubble contrast agents are purely intravascular, easy to administer, and well tolerated and allow sensitive real-time evaluation of blood flow in hepatic lesions. During the portal venous phase, benign lesions (eg, hemangioma, focal nodular hyperplasia) typically enhance more than the liver, whereas malignant lesions (eg, hepatocellular carcinoma, metastases) enhance less. Microbubble-enhanced US allows characterization of very small lesions that may not be accurately characterized with CT or MR imaging. Findings from initial studies suggest that microbubble-enhanced US of the liver provides enhancement information comparable to that provided by contrast-enhanced CT and MR imaging, along with real-time morphologic evaluation of lesion vascularity.

© RSNA, 2004

Index Terms: Liver, focal nodular hyperplasia, 761.3198 • Liver neoplasms, 761.3194, 761.3198, 761.323, 761.33 • Liver neoplasms, diagnosis, 761.12988 • Liver neoplasms, US, 761.12988 • Ultrasound (US), contrast media • Ultrasound (US), technology

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