Skip to main content

Advertisement

SpringerLink
Log in

Morphological and dynamic evaluation of complex cystic focal liver lesions by contrast-enhanced ultrasound: current state of the art

  • Review
  • Published:
Journal of Ultrasound Aims and scope Submit manuscript

Abstract

Complex cystic and cystic-like focal liver lesions (FLLs) encompass a spectrum of disorders ranging from non-neoplastic conditions to benign and malignant tumors. In this prospective, the possibility of non-invasive differentiation of these lesions is extremely important, because the clinical implications and therapeutic strategies vary considerably. Because of its advantageous cost/benefit ratio, widespread availability and easy execution, ultrasound (US) is the first-line imaging modality in most countries for the initial liver survey and represents the imaging technique that usually detects a complex liver cyst. However, US showed poor efficacy in the differential diagnosis of complex cystic FLLs. Thus, for years, computed tomography (CT) and magnetic resonance (MR) imaging have been used for further assessment of these lesions. Recently, the development of low mechanical index real-time contrast-enhanced ultrasound (CEUS) technique performed with the second generation of US contrast agents has led to an accurate depiction of macrovasculature and microvasculature. The technique yields information about contrast enhancement of the liver and FLLs almost as CT and MRI do, but in real time and without the use of ionizing radiation. To date, there is only a small amount of evidence about the role of CEUS in the less common setting of complex liver cysts. The aim of this review is to offer an up-to-date overview on the state of the art of CEUS in the study of the most common complex cystic focal liver lesions. To our knowledge, there are no literature comprehensive reviews on this topic.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Lin MX, Xu HX, Lu MD et al (2009) Diagnostic performance of contrast-enhanced ultrasound for complex cystic focal liver lesions: blinded reader study. Eur Radiol 19(2):358–369

    Article  Google Scholar 

  2. Vachha B, Sun MR, Siewert B et al (2011) Cystic lesions of the liver. Am J Roentgenol 196(4):W355–W366

    Article  Google Scholar 

  3. Qian LJ, Zhu J, Zhuang ZG, Xia Q, Liu Q, Xu JR (2013) Spectrum of multilocular cystic hepatic lesions: CT and MR imaging findings with pathologic correlation. Radiographics 33(5):1419–1433. https://doi.org/10.1148/rg.335125063

    Article  PubMed  Google Scholar 

  4. Mortelé KJ, Peters HE (2009) Multimodality imaging of common and uncommon cystic focal liver lesions. Semin Ultrasound CT MR 30(5):368–386

    Article  Google Scholar 

  5. Mortelé KJ, Ros PR (2001) Cystic focal liver lesions in the adult: differential CT and MR imaging features. Radiographics 21(4):895–910

    Article  Google Scholar 

  6. Lantinga MA, Gevers TJ, Drenth JP (2013) Evaluation of hepatic cystic lesions. World J Gastroenterol 19(23):3543–3554

    Article  Google Scholar 

  7. Bakoyiannis A, Delis S, Triantopoulou C et al (2013) Rare cystic liver lesions: a diagnostic and managing challenge. World J Gastroenterol 19(43):7603–7619

    Article  Google Scholar 

  8. Corvino A, Sandomenico F, Corvino F, Campanino MR, Verde F, Giurazza F, Catalano O (2019) Utility of gel stand-off pad in the detection of Doppler signal on focal nodular lesions of the skin. J Ultrasound. https://doi.org/10.1007/s40477-019-00376-3 (Epub ahead of print)

    Article  PubMed  Google Scholar 

  9. Corvino A, Catalano O, Corvino F, Sandomenico F, Petrillo A (2017) Diagnostic performance and confidence of contrast-enhanced ultrasound in the differential diagnosis of cystic and cystic-like liver lesions. Am J Roentgenol 209(3):W119–W127. https://doi.org/10.2214/AJR.16.17062 (Epub 2017 Jun 22)

    Article  Google Scholar 

  10. Corvino A, Catalano O, Corvino F, Petrillo A (2015) Rectal melanoma presenting as a solitary complex cystic liver lesion: role of contrast-specific low-MI real-time ultrasound imaging. J Ultrasound 19(2):135–139. https://doi.org/10.1007/s40477-015-0182-1 (eCollection 2016)

    Article  PubMed  PubMed Central  Google Scholar 

  11. Guarino B, Catalano O, Corvino A, Corvino F, Amore A, Petrillo A (2015) Hepatic inflammatory pseudotumor: educational value of an incorrect diagnosis at contrast-enhanced ultrasound. J Med Ultrason 42(4):547–552. https://doi.org/10.1007/s10396-015-0624-6 (Epub 2015 Mar 27)

    Article  Google Scholar 

  12. Nino-Murcia M, Ralls PW, Jeffrey RB, Johnson M (1992) Color flow Doppler characterization of focal hepatic lesions. AJR 159:1195–1197

    Article  CAS  Google Scholar 

  13. Wilson SR, Jang HJ, Kim TK, Burns PN (2007) Diagnosis of focal liver masses on ultrasonography: comparison of unenhanced and contrast-enhanced scans. J Ultrasound Med 26:775–787

    Article  Google Scholar 

  14. Liu LP, Dong BW, Yu XL, Liang P, Zhang DK, An LC (2009) Focal hypoechoic tumors of fatty liver: characterization of conventional and contrast-enhanced ultrasonography. J Ultrasound Med 28:1133–1142

    Article  Google Scholar 

  15. Corvino F, Giurazza F, Cangiano G, Silvestre M, Cavaglià E, de Magistris G, Amodio F, Corvino A, Niola R (2019) Endovascular treatment of peripheral vascular blowout syndrome in end-stage malignancies. Ann Vasc Surg. https://doi.org/10.1016/j.avsg.2018.10.051 (Epub ahead of print)

    Article  PubMed  Google Scholar 

  16. Bartolotta TV, Taibbi A, Midiri M, Lagalla R (2009) Focal liver lesions: contrast-enhanced ultrasound. Abdom Imaging 34:193–209

    Article  Google Scholar 

  17. Piscaglia F, Lencioni R, Sagrini E et al (2010) Characterization of focal liver lesions with contrast-enhanced ultrasound. Ultrasound Med Biol 36:531–550

    Article  Google Scholar 

  18. Corvino F, Giurazza F, Cangiano G, Cavaglià E, Amodio F, De Magistris G, Corvino A, Niola R (2018) Safety and effectiveness of transcatheter embolization in the treatment of internal mammary artery injuries. Radiol Med 123(5):369–377. https://doi.org/10.1007/s11547-017-0844-5 (Epub 2017 Dec 18)

    Article  PubMed  Google Scholar 

  19. Corvino A, Catalano O, Corvino F, Sandomenico F, Setola SV, Petrillo A (2016) Superficial temporal artery pseudoaneurysm: what is the role of ultrasound? J Ultrasound 19(3):197–201. https://doi.org/10.1007/s40477-016-0211-8 (eCollection 2016 Sep)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Corvino A, Corvino F, Radice L, Catalano O (2015) Synchronous mucinous colonic adenocarcinoma and multiple small intestinal adenocarcinomas: report of a case and review of literature. Clin Imaging 39(3):538–542. https://doi.org/10.1016/j.clinimag.2014.12.019 (Epub 2015 Jan 7)

    Article  PubMed  Google Scholar 

  21. Corvino F, Centore L, Soreca E, Corvino A, Farbo V, Bencivenga A (2016) Percutaneous “Y” biliary stent placement in palliative treatment of type 4 malignant hilar stricture. J Gastrointest Oncol 7(2):255–261. https://doi.org/10.3978/j.issn.2078-6891.2015.069

    Article  PubMed  PubMed Central  Google Scholar 

  22. Borhani AA, Wiant A, Heller MT (2014) Cystic hepatic lesions: a review and an algorithmic approach. Am J Roentgenol 203(6):1192–1204. https://doi.org/10.2214/AJR.13.12386

    Article  Google Scholar 

  23. Mavilia MG, Pakala T, Molina M, Wu GY (2018) Differentiating cystic liver lesions: a review of imaging modalities, diagnosis and management. J Clin Transl Hepatol 6(2):208–216. https://doi.org/10.14218/JCTH.2017.00069 (Epub 2018 Jan 5)

    Article  PubMed  PubMed Central  Google Scholar 

  24. D’Onofrio M, Crosara S, De Robertis R, Canestrini S, Mucelli RP (2015) Contrast-enhanced ultrasound of focal liver lesions. Am J Roentgenol 205(1):W56–W66. https://doi.org/10.2214/AJR.14.14203

    Article  Google Scholar 

  25. Chiorean L, Cantisani V, Jenssen C, Sidhu PS, Baum U, Dietrich CF (2015) Focal masses in a non-cirrhotic liver: the additional benefit of CEUS over baseline imaging. Eur J Radiol 84(9):1636–1643. https://doi.org/10.1016/j.ejrad.2015.05.007 (Epub 2015 May 22)

    Article  CAS  PubMed  Google Scholar 

  26. Ascenti G, Mazziotti S, Zimbaro G, Settineri N, Magno C, Melloni D, Caruso R, Scribano E (2007) Complex cystic renal masses: characterization with contrast-enhanced US. Radiology 243:158–165

    Article  Google Scholar 

  27. Sidhu PS, Cantisani V, Dietrich CF, Gilja OH, Saftoiu A, Bartels E, Bertolotto M, Calliada F, Clevert DA, Cosgrove D, Deganello A, D’Onofrio M, Drudi FM, Freeman S, Harvey C, Jenssen C, Jung EM, Klauser AS, Lassau N, Meloni MF, Leen E, Nicolau C, Nolsoe C, Piscaglia F, Prada F, Prosch H, Radzina M, Savelli L, Weskott HP, The Wijkstra H, Guidelines EFSUMB (2018) Recommendations for the clinical practice of contrast-enhanced ultrasound (CEU) in non-hepatic applications: update 2017 (short version). Ultraschall Med 39(2):154–180. https://doi.org/10.1055/s-0044-101254 (Epub 2018 Mar 6)

    Article  PubMed  Google Scholar 

  28. Corvino A, Catalano O, Setola SV, Sandomenico F, Corvino F, Petrillo A (2015) Contrast-enhanced ultrasound in the characterization of complex cystic focal liver lesions. Ultrasound Med Biol 41(5):1301–1310. https://doi.org/10.1016/j.ultrasmedbio.2014.12.667 (Epub 2015 Feb 7)

    Article  CAS  PubMed  Google Scholar 

  29. Akiyama T, Inamori M, Saito S et al (2008) Levovist ultrasonography imaging in intracystic hemorrhage of simple liver cyst. World J Gastroenterol 14(5):805–807

    Article  Google Scholar 

  30. Naganuma H, Funaoka M, Fujimori S, Ishida H, Komatsuda T, Yamada M, Furukawa K (2006) Hepatic cyst with intracystic bleeding: contrast-enhanced sonographic findings. J Med Ultrason 33(2):105–107. https://doi.org/10.1007/s10396-005-0084-5

    Article  Google Scholar 

  31. Liu GJ, Lu MD, Xie XY et al (2008) Real-time contrast-enhanced ultrasound imaging of infected focal liver lesions. J Ultrasound Med 27(4):657–666

    Article  Google Scholar 

  32. Kim KW, Choi BI, Park SH et al (2004) Pyogenic hepatic abscesses: distinctive features from hypovascular hepatic malignancies on contrast-enhanced ultrasound with SH U 508A; early experience. Ultrasound Med Biol 30(6):725–733

    Article  Google Scholar 

  33. Claudon M, Dietrich CF, Choi BI et al (2013) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver—update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol 39(2):187–210

    Article  Google Scholar 

  34. Tao S, Qin Z, Hao W et al (2011) Usefulness of gray-scale contrast-enhanced ultrasonography (SonoVue®) in diagnosing hepatic alveolar echinococcosis. Ultrasound Med Biol 37(7):1024–1028

    Article  Google Scholar 

  35. Ehrhardt AR, Reuter S, Buck AK et al (2007) Assessment of disease activity in alveolar echinococcosis: a comparison of contrast enhanced ultrasound, three-phase helical CT and [(18)F] fluorodeoxyglucose positron emission tomography. Abdom Imaging 32(6):730–736

    Article  Google Scholar 

  36. Cha EY, Kim KW, Choi YJ et al (2008) Multicystic cavernous haemangioma of the liver: ultrasonography, CT, MR appearances and pathological correlation. Br J Radiol 81(962):e37–e39

    Article  Google Scholar 

  37. Brogna A, Ferrara R, Bucceri AM et al (2009) An atypical case of hepatic cavernous hemangioma. Cases J 2:181

    Article  Google Scholar 

  38. Hanazaki K, Koide N, Kajikawa S et al (2001) Cavernous hemangioma of the liver with giant cyst formation: degeneration by apoptosis? J Gastroenterol Hepatol 16(3):352–355

    Article  CAS  Google Scholar 

  39. 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(1):59–64

    Article  CAS  Google Scholar 

  40. 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(4):685–693

    Article  Google Scholar 

  41. Xu HX, Lu MD, Liu LN et al (2012) Imaging features of intrahepatic biliary cystadenoma and cystadenocarcinoma on B-mode and contrast-enhanced ultrasound. Ultraschall Med 33(7):E241–E249

    Article  Google Scholar 

  42. Buetow PC, Buck JL, Pantongrag-Brown L et al (1995) Biliary cystadenoma and cystadenocarcinoma: clinical-imaging-pathologic correlations with emphasis on the importance of ovarian stroma. Radiology 196(3):805–810

    Article  CAS  Google Scholar 

  43. Korobkin M, Stephens DH, Lee JK et al (1989) Biliary cystadenoma and cystadenocarcinoma: CT and sonographic findings. Am J Roentgenol 153(3):507–511

    Article  CAS  Google Scholar 

  44. Ren XL, Yan RL, Yu XH et al (2010) Biliary cystadenocarcinoma diagnosed with real-time contrast-enhanced ultrasonography: report of a case with diagnostic features. World J Gastroenterol 16(1):131–135

    PubMed  PubMed Central  Google Scholar 

  45. Hohmann J, Albrecht T, Oldenburg A et al (2004) Liver metastases in cancer: detection with contrast-enhanced ultrasonography. Abdom Imaging 29(6):669–681

    Article  CAS  Google Scholar 

  46. Dănilă M, Popescu A, Sirli R et al (2010) Contrast enhanced ultrasound (CEUS) in the evaluation of liver metastases. Med Ultrason 12(3):233–237

    PubMed  Google Scholar 

  47. Larsen LP (2010) Role of contrast enhanced ultrasonography in the assessment of hepatic metastases: a review. World J Hepatol 2(1):8–15

    Article  Google Scholar 

  48. Albrecht T, Oldenburg A, Hohmann J et al (2003) Imaging of liver metastases with contrast-specific low-MI real-time ultrasound and SonoVue. Eur Radiol 13(Suppl 3):N79–N86

    Article  Google Scholar 

  49. Cantisani V, Grazhdani H, Fioravanti C, Rosignuolo M, Calliada F, Messineo D, Bernieri MG, Redler A, Catalano C, D’Ambrosio F (2014) Liver metastases: contrast-enhanced ultrasound compared with computed tomography and magnetic resonance. World J Gastroenterol 20(29):9998–10007. https://doi.org/10.3748/wjg.v20.i29.9998

    Article  PubMed  PubMed Central  Google Scholar 

  50. Lencioni R, Pinto F, Armillotta N et al (1996) Assessment of tumor vascularity in hepatocellular carcinoma: comparison of power Doppler US and color Doppler US. Radiology 201(2):353–358

    Article  CAS  Google Scholar 

  51. Kim TK, Lee KH, Khalili K et al (2011) Hepatocellular nodules in liver cirrhosis: contrast-enhanced ultrasound. Abdom Imaging 36(3):244–263

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Motor Science and Wellness Department, University of Naples “Parthenope”, VIA F. Acton 38, 80133, Naples, Italy

    Antonio Corvino & Domenico Tafuri

  2. Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), Via S. Pansini 5, 80131, Naples, Italy

    Antonio Corvino

  3. Radiology Department, National Cancer Institute Pascale Foundation, Via M. Semmola 53, 80131, Naples, Italy

    Fabio Sandomenico & Sergio Venanzio Setola

  4. Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy

    Fabio Corvino

  5. Radiology Unit, Istituto Diagnostico Varelli, Via Cornelia Dei Gracchi 65, 80126, Naples, Italy

    Orlando Catalano

  6. via Croce no. 82, 81033, Casal di Principe, CE, Italy

    Antonio Corvino

Authors
  1. Antonio Corvino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabio Sandomenico
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sergio Venanzio Setola
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fabio Corvino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Domenico Tafuri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Orlando Catalano
    View author publications

    You can also search for this author in PubMed Google Scholar

Ethics declarations

Conflict of interest

We confirm that this work is original and has not been published elsewhere nor is it currently under consideration for publication elsewhere. Publication is approved by all authors and by the responsible authorities where the work was carried out. Each author has participated sufficiently in any submission to take public responsibility for its content. The authors have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all patients, and the study was approved by the ethics committee of the institution.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Corvino, A., Sandomenico, F., Setola, S.V. et al. Morphological and dynamic evaluation of complex cystic focal liver lesions by contrast-enhanced ultrasound: current state of the art. J Ultrasound 22, 251–259 (2019). https://doi.org/10.1007/s40477-019-00385-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40477-019-00385-2

Keywords

Search

Navigation