By Luigi Bolondi
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Extra resources for Advances in Diagnostic Imaging The Value of Contrast-Enhanced Ultrasound for Liver
The ablated area seemed homogeneous without residual tumor (e). However,a careful review of the cineloop during the arterial phase revealed the persistence of a rim of strongly enhancing tissues (f, arrow). g CT confirmed the presence of a small enhancing area (arrow). The ablation should be considered as incomplete. However, no additional ablation was considered, and further treatment consisted in chemoembolization a b c d e f g 59 60 Jean-Michel Correas et al. by a second imaging modality. Compared to the conventional algorithm, this approach will reduce the delay for treatment.
Fig. 19. Hypervascular liver metastases from ovarian cancer (a), carcinoid (b), renal cell carcinoma (central hypoxia/necrosis) (c), liposarcoma (3-D) (d) a b c d The Role of Contrast-Enhanced Ultrasound (CEUS) in Identifying Focal Liver Lesions 41 Most metastases are hypovascular, with only a short time interval in which an uptake of contrast material – often in the periphery – is seen (rim enhancement) (Fig. 21). It has been reported in the CT literature that, in some primary tumors that are typically hypervascular, metastases have an atypical behavior: one-third of carcinoid metastases are hypoenhancing during arterial phase .
The quick rise in signal intensity on the timeintensity curve (TIC) demonstrates the arterial character of the supplying peripheral vessels. a Arterial phase (12s),b PV phase (65s),c Late phase (144s), d TIC Fig. 7. Typical contrast kinetics of a 6-cm hemangioma. Even during late phase, the center is not completely enhanced. a Baseline, b Arterial phase (15s), c PV phase (62s), d Late phase (121s) Hans Peter Weskott a b c d a b c d The Role of Contrast-Enhanced Ultrasound (CEUS) in Identifying Focal Liver Lesions a b c d 29 Fig.