Sonazoid-Enhanced Ultrasonography and Ga-EOB-DTPA-Enhanced MRI of Hepatic Inflammatory Pseudotumor: A Case Report

Abstract

A liver neoplasm was found in a 63-year-old man with alcoholic liver disease. Sonazoid-enhanced ultrasonography (US) showed that the neoplasm was isoechoic at the early vascular phase and hypoechoic at the post-vascular phase. Gadolinium ethoxybenzyl-diethylenetriamine-enhanced magnetic resonance imaging (MRI) showed that the neoplasm was hypointense at the hepatobiliary phase. We suspected that it was a malignant tumor. By needle biopsy, however, the neoplasm was diagnosed as an inflammatory pseudotumor (IPT). We encountered a rare case of hepatic IPT, the differential diagnosis of which was difficult to distinguish from malignant tumor. Here, we report new US and MRI findings of hepatic IPT.

The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid

“…Inflammatory pseudotumor is a rare disease whose definitive diagnosis is usually made at surgery and biopsy. Sonazoid CEUS shows isoenhancement in the early vascular phase and hypoenhancement in the postvascular phase, which is difficult to distinguish from malignant tumors [97].…”

A Liver Inflammatory Pseudotumor Misdiagnosed as Liver Cancer Using Noninvasive Diagnostic Methods

“…Research has shown a high rate of diagnosis of liver cancer by using Gd-EOB-DTPA-enhanced MRI [16,17]. Nonetheless, MDCT and Gd-EOB-DTPA-enhanced MRI could not accurately distinguish between malignant liver tumors and IPT [18,19]. This patient underwent 3 additional image examinations including Gd-EOB-DTPA-enhanced MRI, MDCT, and ultrasound, which indicated liver malignancy.…”

“…A small number of patients (about 9%) may be asymptomatic [12]. The IPT on Gd-EOB-DTPA-enhanced MRI appeared hypointense on T1 and T2 weighted images, and completely hypointense on Gd-EOB-DTPAenhanced images [14].…”

The AFSUMB consensus statements and recommendations for the clinical practice of contrast-enhanced ultrasound using sonazoid

“…Sonazoid CEUS shows isoenhancement in the early vascular phase and hypoenhancement in the postvascular phase, which is difficult to distinguish from malignant tumors. [ 97 ]…”