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Real-Time Harmonic Contrast Material–specific US of Focal Liver Lesions¹

¹ From the Department of Radiology, S. Maria delle Grazie Hospital, Via Domitiana Località La Schiana, Pozzuoli, Italy (O.C., R.L., A.S.); and the Diagnostic Imaging Area, PSI Napoli Est, Naples, Italy (A.N.). Presented as an education exhibit at the 2003 RSNA Scientific Assembly. Received April 7, 2004; revision requested June 30; final revision received November 3; accepted November 3. All authors have no financial relationships to disclose. Address correspondence to O.C., Via Crispi 92, Naples 80121, Italy (e-mail: orlandcat{at}tin.it).

Recent advances in contrast material–enhanced ultrasonography (US) mainly include (a) development of low-acoustic-pressure (low-mechanical-index) harmonic software, capable of obtaining real-time images without disrupting contrast material microbubbles, and (b) commercialization of new contrast media ("second-generation" contrast media), capable of producing intense echo signals in this low-mechanical-index setting. With use of low-mechanical-index continuous-mode contrast-enhanced US, the circulatory kinetic models of various focal liver lesions can be displayed dynamically. Hepatic lesions usually have typical perfusion characteristics and enhancement patterns through the various phases of parenchymal enhancement, which helps characterize lesions and, in most cases, allows definitive diagnosis, even among lesions that exhibit very similar baseline appearances. Because of the use of harmonic technologies at low emission frequencies, there is some loss of spatial resolution and overall image quality, typically resulting in a grainy appearance. In addition, lesion depth affects the detectability of vascularity to some degree in that poor signal arises from deep-seated lesions. Moreover, liver attenuation (eg, in patients with steatosis or chronic liver disease) further reduces the sensitivity of contrast-enhanced US. Nevertheless, with its unique capacity to provide images in real time, low-mechanical-index contrast-enhanced US is the dynamic imaging modality of choice in the differential diagnosis of focal liver lesions.

© RSNA, 2005

Abbreviations: CCC = cholangiocellular carcinoma, FNH = focal nodular hyperplasia, HCC = hepatocellular carcinoma

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