Detection of liver metastases in cancer patients with geographic fatty infiltration of the liver: the added value of contrast-enhanced sonography

Abstract

PurposeThe aim of this study is to assess the role of contrast-enhanced ultrasonography (CEUS) in the detection of liver metastases in cancer patients with geographic liver fatty deposition on greyscale ultrasonography (US).MethodsThirty-seven consecutive cancer patients (24 women and 13 men; age, 33 to 80 years; mean, 58.1 years) with geographic liver fatty deposition, but without any detectable focal liver lesion on greyscale US, underwent sulphur hexafluoride-enhanced US. Two readers reported by consensus the presence, size, and location of any detected lesion. All patients underwent magnetic resonance imaging (MRI) as a confirmatory study. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy were calculated.ResultsSeven focal liver lesions (size, 4 to 10 mm; mean, 6.1 mm) were detected in 4/37 patients (10.8%): four metastases (size, 5 to 10 mm; mean, 6.7 mm) were detected both by CEUS and MRI, with one hemangioma and two cysts (size range, 4 to 6 mm; mean, 5.3 mm) detected by MRI only. In 1/37 patients (2.7%), CEUS misdiagnosed geographic fatty change as three metastases. In 32/37 patients (86.5%), no lesions were detected. Sensitivity, specificity, PPV, NPV, and accuracy of CEUS were 100% (95% confidence Interval [CI], 1.000 to 1.000), 97.1% (95% CI, 0.914 to 1.027), 75%, 100%, and 97.3%, respectively. No statistically significant differences were found between CEUS and MRI in the detection of focal liver lesions (P=0.480), whereas both of them performed better than baseline US (P<0.001).ConclusionCEUS improves the detection of liver metastases in cancer patients with geographic liver fatty deposition on greyscale US.

Complicated Sonographic View of Diffuse Hepatic Steatosis

“…Fatty change of the liver, often occurring in cancer patients, that underwent chemotherapy and presenting with different patterns of deposition, may further hamper the proper assessment by means of US [1,6,9]. As Rafaelsen et al [10] and Tommaso V et al [11] suggest in their studies, CEUS has proved to have an important role as a first line tool for ruling out the presence of metastases in cancer patients, inconclusive in US, but with a fatty infiltration of the liver.…”

“…Diffuse and focal liver fatty infiltration (hepatic steatosis) has been described in association with chemotherapy, alcohol abuse, diabetes mellitus, obesity, exogenous steroids, iv hyperalimentation [1][2][3][4][5][6][7][8][9][10][11][12][13]. Focal hepatic steatosis can be misinterpreted for other hepatic lesions: metastases, infiltrative primary liver neoplasms, abscesses and cysts [14].…”

The visualisation of focal liver lesions on ultrasound: A review of 300 liver ultrasounds with CT or MRI correlation

“…The case of MLD that was missed involved a patient with NASH cirrhosis. The visualisation of liver metastases in patients with fatty liver is known to be problematic . CEUS has been shown to significantly improve lesion visualisation in patients with fatty livers to a level comparable with contrast‐enhanced CT or MRI …”

“…Sonographers, radiologists, and clinicians should be aware of the limitations of conventional US and exercise a low threshold for the use of additional imaging methods for the detection and characterisation of FLL. For FLLs identified on conventional US and requiring characterisation, CEUS has been proposed as the modality of choice because of its unique combination of favourable characteristics including accuracy, accessibility, ease of implementation, low cost, and proven ability to improve the detection of FLLs . CEUS can also be used to survey the selected patients at risk of malignancy .…”

“…The visualisation of liver metastases in patients with fatty liver is known to be problematic. 17 CEUS can also be used to survey the selected patients at risk of malignancy. 22 However, CEUS is considered a problem-solving tool and is not currently advocated for routine survey of the liver in patients with a low risk of malignancy.…”