Advertisement

Applicazione dei mezzi di contrasto ecografici nelle lesioni focali del fegato steatosico, nelle lesioni epatiche rare e nelle pseudolesioni del fegato

  • Tommaso Vincenzo Bartolotta
  • Adele Taibbi
  • Emilio Quaia
  • Massimo Midiri

Estratto

Nonostante i continui progressi tecnologici, l’ecografia convenzionale in scala di grigi non presenta elevata specificità nella caratterizzazione delle lesioni focali epatiche [1]. Inoltre, nella pratica clinica, il non infrequente riscontro di alterazioni diffuse del parenchima epatico, come la steatosi, può rendere ancora più difficoltosa una corretta diagnosi [2]. In particolare l’infiltrazione adiposa del fegato,dovuta all’accumulo di trigliceridi sotto forma di vacuoli di differenti dimensioni all’interno degli epatociti, la cui incidenza, secondo alcuni studi autoptici, varia dal 6 all’11%, è responsabile di un’ alterazione diffusa dell’ecogenicità del parenchima epatico che assume un aspetto definito “ brillante”, nel contesto del quale le lesioni epatiche presentano, indipendentemente dalla loro natura, un aspetto prevalentemente ipoecogeno [3, 4]. Inoltre la steatosi può interessare in maniera focale solo alcune aree del parenchima epatico e, per converso, in un fegato diffusamente steatosico possono esistere le cosiddette “aree di risparmio”, con il risultato di creare pseudolesioni che, specialmente nei pazienti oncologici sottoposti a chemioterapia che spesso sviluppano una steatosi epatica, possono porre problemi di diagnosi differenziale con le metastasi.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Bibliografia

  1. 1.
    Harvey CJ, Albrecht T (2001) Ultrasound of focal liver lesions. Eur Radiol 11:1578–1593PubMedCrossRefGoogle Scholar
  2. 2.
    Konno K, Ishida H, Sato M et al (2001) Liver tumors in fatty liver: difficulty in ultrasonographic interpretation. Abdom Imaging 26:487–491PubMedCrossRefGoogle Scholar
  3. 3.
    Valls C, Iannaccone R, Alba E et al (2006) Fat in the liver:diagnosis and characterization. Eur Radiol 16:2292–2308PubMedCrossRefGoogle Scholar
  4. 4.
    Selzner M, Clavien PA (2001) Fatty liver in liver transplantation and surgery. Semin Liver Dis 21(1):105–113PubMedCrossRefGoogle Scholar
  5. 5.
    Kim SH, Lee JM, Lee JY et al (2005) Value of contrastenhanced sonography for the characterization of focal hepatic lesions in patients with diffuse liver disease:receiver operating characteristic analysis. AJR Am J Roentgenol 184:1077–1084PubMedGoogle Scholar
  6. 6.
    Scatarige JC, Scott WW, Donovan PJ et al (1984) Fatty infiltration of the liver: ultrasonographic and computed tomographic correlation. J Ultrasound Med 3:9–14PubMedGoogle Scholar
  7. 7.
    Mattrey RF, Kono Y (1999) Parenchymal enhancement on gray-scale in normal and pathologic tissues. Eur Radiol 9[Suppl 3]:359–363CrossRefGoogle Scholar
  8. 8.
    Bartolotta TV, Midiri M, Scialpi M et al (2004) Focal nodular hyperplasia in normal and fatty liver: a qualitative and quantitative evaluation with contrast-enhanced ultrasound. Eur Radiol 14:583–591PubMedCrossRefGoogle Scholar
  9. 9.
    Bartolotta TV, Midiri M, Galia M et al (2003) Atypical liver hemangiomas: contrast-enhancement patterns with SH U 508A and pulse-inversion US. Radiol Med 106:320–328Google Scholar
  10. 10.
    Quaia E, Bartolotta TV, Midiri M et al (2006) Analysis of different contrast enhancement patterns after microbubble-based contrast agent injection in liver hemangiomas with atypical appearance on baseline scan. Abdom Imaging 31:59–64PubMedCrossRefGoogle Scholar
  11. 11.
    Jang HJ, Kim TK, Lim HK et al (2003) Hepatic hemangioma:atypical appearances on CT, MR imaging, and sonography. AJR Am J Roentgenol 80:135–141Google Scholar
  12. 12.
    Bartolotta TV, Midiri M, Quaia E et al (2005) Liver haemangiomas undetermined at grey-scale ultrasound: contrast-enhancement patterns with SonoVue and pulse-inversion US. Eur Radiol 15:685–693PubMedCrossRefGoogle Scholar
  13. 13.
    Quaia E, Bertolotto M, Dalla Palma L (2002) Characterization of liver hemangiomas with pulse inversion harmonic imaging. Eur Radiol 12:537–544PubMedGoogle Scholar
  14. 14.
    Quaia E, Calliada F, Bertolotto M et al (2004) Characterization of focal liver lesions with contrast-specific US modes and sulphur hexafluoride-filled microbubble contrast agent: diagnostic performance and confidence. Radiology 232:420–430PubMedCrossRefGoogle Scholar
  15. 15.
    Bartolotta TV, Midiri M, Quaia E et al (2005) Benign focal liver lesions: spectrum of findings on SonoVue-enhanced pulse-inversion ultrasonography. Eur Radiol 15:1643–1649PubMedCrossRefGoogle Scholar
  16. 16.
    Bartolozzi C, Lencioni R, Paolicchi A (1997) Differentiation of hepatocellular adenoma and focal nodular hyperplasia of the liver: comparison of power Doppler imaging and conventional color Doppler sonography. Eur Radiol 7:1410–1415PubMedCrossRefGoogle Scholar
  17. 17.
    Von Herbay A, Vogt C, Haussinger D (2002) Pulse Inversion sonography in the early phase of the sonographic contrast agent Levovist: differentiation between benign and malignant focal liver lesions. J Ultrasound Med 21:1191–2000Google Scholar
  18. 18.
    Bartolotta TV, Midiri M, Galia M et al (2007) Characterization of benign hepatic tumors arising in fatty liver with SonoVue and pulse inversion US. Abdom Imaging 32:84–91PubMedCrossRefGoogle Scholar
  19. 19.
    Dietrich CF, Schuessler G, Trojan J et al (2005) Differentiation of focal nodular hyperplasia and hepatocellular adenoma by contrast-enhanced ultrasound. Br J Radiol 78:704–707PubMedCrossRefGoogle Scholar
  20. 20.
    Prasad SR, Saini S, Sumner JE et al (2003) Radiological measurement of breast cancer metastases to lung and liver:comparison between WHO (bidimensional) and RECIST (unidimensional) guidelines. J Comput Assist Tomogr 27:380–384PubMedCrossRefGoogle Scholar
  21. 21.
    Della Vigna P, Cernigliaro F, Monfardini L et al (2007) Contrast-enhanced ultrasonography in the follow up of patients with hepatic metastases from breast carcinoma. Radiol Med 112:47–55CrossRefGoogle Scholar
  22. 22.
    Kroncke TJ, Taupitz M, Kivelitz D et al (2000) Multifocal nodular fatty infiltration of the liver mimicking metastatic disease on CT: imaging findings and diagnosis using MR imaging. Eur Radiol 10:1095–1100PubMedCrossRefGoogle Scholar
  23. 23.
    Quaia E, Bertolotto M, Calderan L (2003) US characterization of focal hepatic lesions with intermittent highacoustic-power mode and contrast material. Acad Radiol 10:739–50PubMedCrossRefGoogle Scholar
  24. 24.
    Nicolau C, Catala V, Bru C (2003) Characterization of focal liver lesions with contrast-enhanced ultrasound. Eur Radiol 13[Suppl 3]:70–78CrossRefGoogle Scholar
  25. 25.
    Apecella PL, Mirowitz SA, Weinreb JC (1994) Extension of vessels through hepatic neoplasms: MR and CT findings. Radiology 191:135–140Google Scholar
  26. 26.
    Matsui O, Kadoya M, Takahashi S et al (1995) Focal sparing of segment IV in fatty livers shown by sonography and CT:correlation with aberrant gastric venous drainage. AJR Am J Roentgenol 164:1137–1140PubMedGoogle Scholar
  27. 27.
    Grossholz M, Terrier F, Rubbia L et al (1998) Focal sparing in the fatty liver as a sign of an adjacent space-occupying lesion. AJR Am J Roentgenol 171:1391–1395PubMedGoogle Scholar
  28. 28.
    Midiri M, Bartolotta TV, Lagalla R (2002) Diffuse liver disease. Evaluation with CT and MR imaging. Radiol Med 103:171–187Google Scholar
  29. 29.
    Locke JE, Choti MA, Torbenson MS et al (2005) Inflammatory pseudotumor of the liver. J Hepatobiliary Pancreat Surg 12:314–326PubMedCrossRefGoogle Scholar
  30. 30.
    Yoon KH, Ha HK, Lee JS et al (1999) Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation. Radiology 211:373–379PubMedGoogle Scholar
  31. 31.
    Park KS, Jang BK, Chung W et al (2006) Inflammatory pseudotumor of liver: a clinical review of 15 cases. Korean J Hepatol 12:429–438PubMedGoogle Scholar
  32. 32.
    Schuessler G, Fellbaum C, Fauth F et al (2006) The infammatory pseudotumour-an unusual liver tumour. Ultraschall Med 27:273–279PubMedCrossRefGoogle Scholar
  33. 33.
    Ding H, Wang WP, Huang BJ et al (2005) Imaging of focal liver lesions: low-mechanical-index real-time ultrasonography with SonoVue. J Ultrasound Med 24:285–297PubMedGoogle Scholar
  34. 34.
    Lim JH, Lee JH (1995) Inflammatory pseudotumor of the liver. Ultrasound and CT features. Clin Imaging 19:43–46PubMedCrossRefGoogle Scholar
  35. 35.
    De Luca M, Luigi B, Formisano C et al (2000) Solitary necrotic nodule of the liver misinterpreted as malignant lesion: considerations on two cases. J Surg Oncol 74:219–22PubMedCrossRefGoogle Scholar
  36. 36.
    Imura S, Miyake K, Ikemoto T et al (2006) Rapid-growing solitary necrotic nodule of the liver. J Med Invest 53:325–329PubMedCrossRefGoogle Scholar
  37. 37.
    Colagrande S, Politi LS, Messerini L et al (2003) Solitary necrotic nodule of the liver: imaging and correlation with pathologic features. Abdom Imaging 28:41–44PubMedCrossRefGoogle Scholar
  38. 38.
    Nonomura A, Enomoto Y, Takeda M et al (2006) Invasive growth of hepatic angiomyolipoma; a hitherto unreported ominous histological feature. Histopathology 48:831–835PubMedCrossRefGoogle Scholar
  39. 39.
    Zhong DR, Ji XL (2000) Hepatic angiomyolipoma-misdiagnosis as hepatocellular carcinoma: a report of 14 cases. World J Gastroenterol 6:608–612PubMedGoogle Scholar
  40. 40.
    Guidi G, Catalano O, Rotondo A (1997) Spontaneous rupture of a hepatic angiomyolipoma: CT findings and literature review. Eur Radiol 7:335–337PubMedCrossRefGoogle Scholar
  41. 41.
    Bartolotta TV, Runza G, Minervini M et al (2003) Hepatic angiomyolipoma: contrast-enhanced pulse inversion US in a case. Radiol Med 105:514–518Google Scholar
  42. 42.
    Flor N, Sardanelli F, Serantoni S et al (2006) Low-fat angiomyolipoma of the liver studied with contrast-enhanced ultrasound and multidetector computed tomography. Acta Radiol 47:543–546PubMedCrossRefGoogle Scholar
  43. 43.
    Khan A, Sherlock DJ, Wilson G et al (2001) Sonographic appearance of primary liver liposarcoma. J Clin Ultrasound 29:44–47PubMedCrossRefGoogle Scholar
  44. 44.
    Vilanova JC, Barcelo J, Smirniotopoulos JG et al (2004) Hemangioma from head to toe: MR imaging with pathologic correlation. Radiographics 24:367–385PubMedCrossRefGoogle Scholar
  45. 45.
    Kruskal JB, Kane RA (2002) Paraneoplastic hypoglycemia associated with a hepatic hemangiopericytoma. J Ultrasound Med 21:927–932PubMedGoogle Scholar
  46. 46.
    Aytac S, Fitoz S, Akyar S et al (1999) Focal intrahepatic extramedullary hematopoiesis:color Doppler US and CT findings. Abdom Imaging 24:366–368PubMedCrossRefGoogle Scholar
  47. 47.
    Gupta P, Naran A, Auh YH et al (2004) Focal intrahepatic extramedullary hematopoiesis presenting as fatty lesions. AJR Am J Roentgenol 182:1031–1032PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Tommaso Vincenzo Bartolotta
    • 1
  • Adele Taibbi
    • 1
  • Emilio Quaia
    • 2
  • Massimo Midiri
    • 1
  1. 1.Diagnostica per Immagini e RadioterapiaUniversità degli Studi di PalermoPalermo
  2. 2.Unità Clinica Operativa di Radiologia, Dipartimento di Scienze Cliniche, Morfologiche e TecnologicheUniversità di Trieste, Ospedale di CattinaraTrieste

Personalised recommendations