Hepatocellular carcinoma Echocardiography or Ultrasound: Difference between revisions
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==Overview== | ==Overview== | ||
On ultrasonography, changes in the liver contour and increased nodularity may be evident. The echo texture may appear coarse along with an increase in | On [[ultrasonography]], changes in the [[liver]] contour and increased nodularity may be evident. The echo texture may appear coarse along with an increase in [[echogenicity]] from focal fatty changes and irregular appearing areas with [[fibrosis]], fatty change, or [[Calcification|calcifications]]. | ||
==Echocardiography== | ==Echocardiography== | ||
*[[Echocardiography|Echocardiograms]] may be helpful in the measurement of [[ejection fraction]] and identification of [[ischemia|ischemic]] and [[Hypokinesia|hypokinetic]] areas of the [[ventricle (heart)|ventricles]]. This is useful in establishing a diagnosis of [[congestive cardiac failure]]because of the underlying cause of liver cirrhosis. | *[[Echocardiography|Echocardiograms]] may be helpful in the measurement of [[ejection fraction]] and identification of [[ischemia|ischemic]] and [[Hypokinesia|hypokinetic]] areas of the [[ventricle (heart)|ventricles]]. This is useful in establishing a diagnosis of [[Congestive heart failure|congestive cardiac failure]] because of the underlying cause of [[liver cirrhosis]]. | ||
*[[Radiocontrast|Contrast]] [[echocardiography]] is a useful diagnostic test for [[hepatopulmonary syndrome]]: | *[[Radiocontrast|Contrast]] [[echocardiography]] is a useful diagnostic test for [[hepatopulmonary syndrome]]: | ||
**Intravenous microbubbles (> 10 micrometers in diameter) from agitated [[normal saline]] that are normally obstructed by [[Lung|pulmonary]] [[Capillary|capillaries]] (normally <8 to 15 micrometers) rapidly transit the [[lung]] and appear in the [[left atrium]] of the heart within 7 heart beats. | **[[Intravenous]] microbubbles (> 10 micrometers in diameter) from agitated [[normal saline]] that are normally obstructed by [[Lung|pulmonary]] [[Capillary|capillaries]] (normally <8 to 15 micrometers) rapidly transit the [[lung]] and appear in the [[left atrium]] of the [[heart]] within 7 heart beats. | ||
**Intravenous [[technetium]]-99m–labeled [[albumin]] may transit the [[Lung|lungs]] and appear in the [[kidney]] and [[brain]]. | **[[Intravenous]] [[technetium]]-99m–labeled [[albumin]] may transit the [[Lung|lungs]] and appear in the [[kidney]] and [[brain]]. | ||
==Ultrasound Findings== | ==Ultrasound Findings== | ||
*Ultrasound may be helpful in the diagnosis of hepatocellular carcinoma. | *[[Ultrasound]] may be helpful in the [[diagnosis]] of hepatocellular carcinoma. Findings on an [[ultrasound]] suggestive of hepatocellular carcinoma include:<ref name="pmid25444099">{{cite journal |vauthors=Malhi H, Grant EG, Duddalwar V |title=Contrast-enhanced ultrasound of the liver and kidney |journal=Radiol. Clin. North Am. |volume=52 |issue=6 |pages=1177–90 |year=2014 |pmid=25444099 |doi=10.1016/j.rcl.2014.07.005 |url=}}</ref><ref name="urlHepatocellular Carcinoma - W. Y. Lau - Google Books">{{cite web |url=https://books.google.com/books?vid=ISBN9812707999&hl=en |title=Hepatocellular Carcinoma - W. Y. Lau - Google Books |format= |work= |accessdate=}}</ref> | ||
**Small hypoechoic [[lesion]] with poorly defined margins and coarse irregular internal echoes. | **Small hypoechoic [[lesion]] with poorly defined margins and coarse irregular internal echoes. | ||
**When the tumor increases in size it appears heterogeneous with [[fibrosis]], fatty change, or [[Calcification|calcifications]]. | **When the [[tumor]] increases in size it appears heterogeneous with [[fibrosis]], fatty change, or [[Calcification|calcifications]]. | ||
**Infiltrative HCC may be difficult to differentiate from background [[cirrhosis]]. | **Infiltrative HCC may be difficult to differentiate from background [[cirrhosis]]. | ||
==Contrast | ==Contrast Enhanced Ultrasound== | ||
The following phases are noted on the contrast enhanced ultrasonography of hepatocellular carcinoma:<ref name="pmid254440992">{{cite journal |vauthors=Malhi H, Grant EG, Duddalwar V |title=Contrast-enhanced ultrasound of the liver and kidney |journal=Radiol. Clin. North Am. |volume=52 |issue=6 |pages=1177–90 |year=2014 |pmid=25444099 |doi=10.1016/j.rcl.2014.07.005 |url=}}</ref> | [[Contrast-enhanced ultrasound]] is being adapted for [[Screening (medicine)|screening]] and enhancing minimally invasive diagnostic studies. The following phases are noted on the contrast enhanced [[ultrasonography]] of hepatocellular carcinoma:<ref name="pmid254440992">{{cite journal |vauthors=Malhi H, Grant EG, Duddalwar V |title=Contrast-enhanced ultrasound of the liver and kidney |journal=Radiol. Clin. North Am. |volume=52 |issue=6 |pages=1177–90 |year=2014 |pmid=25444099 |doi=10.1016/j.rcl.2014.07.005 |url=}}</ref><ref name="TerziSalvatore2015">{{cite journal|last1=Terzi|first1=Eleonora|last2=Salvatore|first2=Veronica|last3=Negrini|first3=Giulia|last4=Piscaglia|first4=Fabio|title=Ongoing challenges in the diagnosis of hepatocellular carcinoma|journal=Expert Review of Gastroenterology & Hepatology|volume=10|issue=4|year=2015|pages=451–463|issn=1747-4124|doi=10.1586/17474124.2016.1124758}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
!Phases | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Phases | ||
!Findings | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Findings | ||
|- | |- | ||
|Arterial | |Arterial phase | ||
|Enhanced arteries due to neovascularity | | | ||
* Enhanced [[arteries]] due to neovascularity | |||
|- | |- | ||
|Portal | |Portal venous phase | ||
|Weak echogenicity relative to the background liver is noted after the washout | | | ||
Tumor thrombus may be visible | * Weak [[echogenicity]] relative to the background [[liver]] is noted after the washout | ||
* [[Tumor]] [[thrombus]] may be visible | |||
|} | |} | ||
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Latest revision as of 22:08, 29 July 2020
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Hepatocellular carcinoma Microchapters |
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Differentiating Hepatocellular carcinoma from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]
Overview
On ultrasonography, changes in the liver contour and increased nodularity may be evident. The echo texture may appear coarse along with an increase in echogenicity from focal fatty changes and irregular appearing areas with fibrosis, fatty change, or calcifications.
Echocardiography
- Echocardiograms may be helpful in the measurement of ejection fraction and identification of ischemic and hypokinetic areas of the ventricles. This is useful in establishing a diagnosis of congestive cardiac failure because of the underlying cause of liver cirrhosis.
- Contrast echocardiography is a useful diagnostic test for hepatopulmonary syndrome:
- Intravenous microbubbles (> 10 micrometers in diameter) from agitated normal saline that are normally obstructed by pulmonary capillaries (normally <8 to 15 micrometers) rapidly transit the lung and appear in the left atrium of the heart within 7 heart beats.
- Intravenous technetium-99m–labeled albumin may transit the lungs and appear in the kidney and brain.
Ultrasound Findings
- Ultrasound may be helpful in the diagnosis of hepatocellular carcinoma. Findings on an ultrasound suggestive of hepatocellular carcinoma include:[1][2]
- Small hypoechoic lesion with poorly defined margins and coarse irregular internal echoes.
- When the tumor increases in size it appears heterogeneous with fibrosis, fatty change, or calcifications.
- Infiltrative HCC may be difficult to differentiate from background cirrhosis.
Contrast Enhanced Ultrasound
Contrast-enhanced ultrasound is being adapted for screening and enhancing minimally invasive diagnostic studies. The following phases are noted on the contrast enhanced ultrasonography of hepatocellular carcinoma:[3][4]
| Phases | Findings |
|---|---|
| Arterial phase |
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| Portal venous phase |
|
References
- ↑ Malhi H, Grant EG, Duddalwar V (2014). "Contrast-enhanced ultrasound of the liver and kidney". Radiol. Clin. North Am. 52 (6): 1177–90. doi:10.1016/j.rcl.2014.07.005. PMID 25444099.
- ↑ "Hepatocellular Carcinoma - W. Y. Lau - Google Books".
- ↑ Malhi H, Grant EG, Duddalwar V (2014). "Contrast-enhanced ultrasound of the liver and kidney". Radiol. Clin. North Am. 52 (6): 1177–90. doi:10.1016/j.rcl.2014.07.005. PMID 25444099.
- ↑ Terzi, Eleonora; Salvatore, Veronica; Negrini, Giulia; Piscaglia, Fabio (2015). "Ongoing challenges in the diagnosis of hepatocellular carcinoma". Expert Review of Gastroenterology & Hepatology. 10 (4): 451–463. doi:10.1586/17474124.2016.1124758. ISSN 1747-4124.