Sonography of Liver Masses

Radiology Video - radiology made esay・2 minutes read

Professor Bill Middleton delivers a lecture on six types of liver lesions, with a focus on the most common, liver cysts, and the importance of sonography in characterizing them and other liver masses in cancer patients. The lecture also covers the various appearances of liver metastases, the need for imaging in detection, and the use of ultrasound-guided liver biopsies for successful diagnosis.

Insights

  • Sonography is a valuable tool for detecting and characterizing liver lesions, with a high accuracy rate for identifying cysts, solid metastases, and hemangiomas.
  • Liver metastases, common in cancer patients, can present with various sonographic appearances, including target lesions, hypoechoic masses, hyper-echoic tumors, calcified lesions, and cystic metastases, making their detection crucial due to unreliable liver function tests.

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Recent questions

  • What are the common types of liver lesions?

    Liver lesions include cysts, hemangiomas, metastases, lymphoma, hepatocellular cancer, and hepatic adenomas.

  • How can liver cysts be detected?

    Liver cysts are typically detected through sonography, displaying anechoic characteristics, posterior acoustic enhancement, and strong reflection from the back wall.

  • What is the significance of sonography in detecting liver metastases?

    Sonography plays a crucial role in detecting liver metastases in cancer patients due to its ability to identify various sonographic appearances of metastatic lesions.

  • What are the characteristics of hepatocellular cancer?

    Hepatocellular cancer is associated with chronic liver diseases, can present as focal, multifocal, or diffusely infiltrating lesions, and often exhibits hyper vascularity detectable by Doppler imaging.

  • How are hepatic adenomas associated with certain risk factors?

    Hepatic adenomas, rare benign liver tumors, are more common in women and linked to factors like birth control pills and anabolic steroids.

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Summary

00:00

Sonography of Liver Lesions: Types and Detection

  • Professor Bill Middleton from the Mallinckrodt Institute of Radiology at Washington University School of Medicine in St. Louis delivers a lecture on sonography of liver masses.
  • The lecture focuses on six types of liver lesions, starting with cysts, which are the most common and easily detectable liver masses.
  • Liver cysts typically display anechoic, posterior acoustic enhancement, and strong reflection from the back wall.
  • A study showed that sonography can detect 48% of lesions under 15mm, increasing to 66% with a CT reference, and 83% for lesions over 5mm with CT comparison.
  • Sonography is crucial for characterizing small indeterminate lesions in cancer patients, with a high accuracy rate for cysts, solid metastases, and hemangiomas.
  • Hemangiomas are solid liver lesions filled with blood, often presenting as homogeneous, echo-genic masses with slow blood flow.
  • Hemangiomas can change appearance over time, with some turning hypoechoic, and may rarely mimic malignant target lesions.
  • Follow-up for hemangiomas is generally unnecessary for low-risk patients, while high-risk patients, like those with liver disease or prior malignancies, may require MRI follow-up.
  • Liver metastases are common in cancer patients, often multiple and involving both liver lobes, with imaging crucial for detection due to unreliable liver function tests.
  • Liver metastases can present with various sonographic appearances, including the common target appearance, hypoechoic solid masses, hyper-echoic tumors from GI sources, calcified lesions, and cystic metastases.

18:03

Identifying Liver Metastasis: Challenges and Solutions

  • Diffuse heterogeneous pattern in liver metastasis can be challenging to identify discreet focal lesions.
  • High-resolution linear array can help focus on the near portion of the liver to detect multiple focal hypoechoic lesions.
  • Confirm liver metastasis diagnosis with an ultrasound survey looking for primary sites like pancreas, colon, stomach, and kidney.
  • Most patients with suspected liver metastasis will undergo a CT scan of the chest and abdomen for staging and identifying primaries.
  • Ultrasound-guided liver biopsies are successful in diagnosing metastases, even for lesions less than 1.5 centimeters.
  • Lymphoma can mimic metastatic disease in the liver but is typically hypoechoic, target-like, or diffused.
  • Hepatocellular cancer is associated with chronic liver diseases like cirrhosis and hepatitis B and C.
  • Hepatocellular cancer can present as focal, multifocal, or diffusely infiltrating lesions, often hyper vascular.
  • Doppler can detect hyper vascularity in hepatocellular cancer, aiding in diagnosis.
  • Hepatic adenomas, rare benign tumors, are more common in women and associated with birth control pills and anabolic steroids.
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