Liver mass echocardiography and ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Ultrasound is the initial method of choice for the evaluation of liver mass. On ultrasound, characteristic findings of liver mass, may include: fluid-filled spaces without clear walls, posterior acoustic enhancement, anechoic, hypoechoic, or hyperechoic lesions. The evaluation of liver mass will mainly depend on the echogenicity. Further evaluation with ultrasound should include Doppler examination to determine vascular pattern.

Ultrasound

Ultrasound is the initial method of choice for the evaluation of liver mass. The evaluation of liver mass will mainly depend on echogenicity.

• On ultrasound, characteristic findings of liver mass may include:
  • Fluid-filled spaces without clear walls
  • Posterior acoustic enhancement
  • Anechoic, hypoechoic, or hyperechoic lesions

Methods

Evaluation with ultrasound should include the following techniques:

• Doppler examination
• Contrast-enhanced ultrasound

Type	Ultrasound	Enhanced ultrasound
Benign liver mass	Homogeneous hyperechogenicity Hypoechogenicity with hyperechoic ring Posterior sonic enhancement	Wash out during portal venous phase regardless of arterial vascularity
Malignant liver mass	Hypoechoic halo Target appearance	No wash-out during portal phase
Central scar: large central artery is usually present with spoke-wheel like centrifugal flow Sonographic halo sign: hypoechoic halo sign in liver metastases: used in hepatobiliary imaging, is a concerning feature for malignant lesion if the lesion is a hyperechoic liver lesion

The table below summarizes the characteristic ultrasound findings of common benign and malignant liver masses.

Ultrasound findings of common liver masses
Common liver masses	Ultrasound finding
Hepatic hemangioma	Well-demarcated Homogeneous Hyperechoic mass May be hypoechoic in patients with fatty infiltration
Focal nodular hyperplasia	Detectable lesions Central scar with displacement of peripheral vasculature (Doppler examination)
Hepatic adenoma	Large Right lobe of the liver Central hypoechoic region
Idiopathic noncirrhotic portal hypertension	Isoechoic lesions
Hepatocellular carcinoma	Poorly-defined margins Coarse, irregular internal echoes
Cholangiocarcinoma	Hypo-, iso-, or hyperechoic Homogenous or heterogenous
Metastases	Metastases from adenocarcinoma Multiple and hypoechoic in comparison with the surrounding liver parenchyma