Characterization of Indeterminate Liver Lesions on CT and MRI With Contrast-Enhanced Ultrasound: What Is the Evidence?

AJR Am J Roentgenol. 2020 Jun;214(6):1295-1304. doi: 10.2214/AJR.19.21498. Epub 2020 Mar 17.

Abstract

OBJECTIVE. CT or MRI is most commonly used for characterizing focal hepatic lesions. However, findings on CT and MRI are occasionally indeterminate. Contrast-enhanced ultrasound (CEUS), with its unique characteristics as a purely intravascular contrast agent and real-time evaluation of enhancement, is a useful next step. The purpose of this article is to review the evidence for performing CEUS in the assessment of indeterminate hepatic lesions seen on CT and MRI. CONCLUSION. CEUS is a useful problem-solving tool in the evaluation of liver lesions that are indeterminate on CT and MRI. Uses include detection of arterial phase hyperenhancement; differentiation between hepatocellular carcinoma and intrahepatic cholangiocarcinoma; determination of benign versus malignant tumor thrombus, benign versus neoplastic cystic hepatic lesions, and hepatocellular adenoma versus focal nodular hyperplasia; and monitoring for recurrence in postablative therapies. CEUS can help establish a confident diagnosis and determine the need for further invasive diagnosis or treatment.

Keywords: CT; MRI; contrast-enhanced ultrasound; diagnosis; liver neoplasms.

Publication types

  • Review

MeSH terms

  • Adenoma, Liver Cell / diagnostic imaging
  • Carcinoma, Hepatocellular / diagnostic imaging
  • Cholangiocarcinoma / diagnostic imaging
  • Contrast Media
  • Diagnosis, Differential
  • Focal Nodular Hyperplasia / diagnostic imaging
  • Humans
  • Liver Neoplasms / diagnostic imaging*
  • Magnetic Resonance Imaging / methods*
  • Tomography, X-Ray Computed / methods*
  • Ultrasonography / methods*

Substances

  • Contrast Media