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Improved Detection of Hepatic Metastases with Pulse-Inversion US during the Liver-specific Phase of SHU 508A: Multicenter Study¹

¹ From the Dept of Radiology and Nuclear Medicine, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Hindenburgdamm 30, D-12200 Berlin, Germany (T.A., C.W.H.); Dept of Imaging, Hammersmith Hosp, Imperial College, London, England (M.J.K.B., C.J.H., D.O.C.); Sunnybrook Imaging Research, Univ of Toronto, Ontario, Canada (P.N.B.); Dept of Ultrasound, Toronto General Hosp-Univ Health Network, Ontario, Canada (S.W.); Dept of Radiology, Royal Infirmary, Glasgow, Scotland (E.L.); Dept of Radiology, CHU Nancy-Brabois, Nancy-Vandoeuvre, France (M.C., F.L.); Ospedale Maggiore di Lodi, Italy (F.C.); Dept of Adult Radiology, Centre Hosp Necker, Paris, France (J.M.C.); Hosp Saint-Luc, Montreal, Quebec, Canada (M.L.); and Dept of Radiology, IRCCS Policlinico S. Matteo, Univ of Pavia, Italy (R.C.). From the 1999 RSNA scientific assembly. Received Nov 15, 2001; revision requested Feb 1, 2002; revision received Jun 28; accepted Aug 27. Supported by a grant from Philips Ultrasound, Bothell, Wash. C.J.H. supported by a grant from the Medical Research Council, United Kingdom. M.J.K.B. supported by a grant from Schering, Berlin, Germany. P.N.B. supported by the National Cancer Institute of Canada. Address correspondence to T.A. (e-mail: thomas.albrecht@medizin.fu-berlin.de).

View larger version (123K): [in a new window]   Figure 1a. Sagittal US images of the left lobe of the liver in a patient with multiple CT-confirmed hepatic metastases from a carcinoid tumor. (a) Conventional US image shows a single lesion (arrow) in an otherwise heterogeneous liver. (b) Contrast-enhanced US image of the same area shows marked increase of the conspicuity of the metastasis with a characteristic thin hyperechoic rim (arrow), as well as several additional metastases (arrowheads).

View larger version (119K): [in a new window]   Figure 1b. Sagittal US images of the left lobe of the liver in a patient with multiple CT-confirmed hepatic metastases from a carcinoid tumor. (a) Conventional US image shows a single lesion (arrow) in an otherwise heterogeneous liver. (b) Contrast-enhanced US image of the same area shows marked increase of the conspicuity of the metastasis with a characteristic thin hyperechoic rim (arrow), as well as several additional metastases (arrowheads).

View larger version (114K): [in a new window]   Figure 2a. Transverse images in a patient with adenocarcinoma of unknown origin. (a) Conventional US image obtained in the right lobe of the liver shows heterogeneous liver parenchyma but no lesion with identifiable borders. (b) Contrast-enhanced US image obtained in the same region shows a large lobulated metastasis (arrow). (c) Contrast-enhanced spiral CT image in the portal venous phase confirms the presence of the metastasis (arrow).

View larger version (119K): [in a new window]   Figure 2b. Transverse images in a patient with adenocarcinoma of unknown origin. (a) Conventional US image obtained in the right lobe of the liver shows heterogeneous liver parenchyma but no lesion with identifiable borders. (b) Contrast-enhanced US image obtained in the same region shows a large lobulated metastasis (arrow). (c) Contrast-enhanced spiral CT image in the portal venous phase confirms the presence of the metastasis (arrow).

View larger version (154K): [in a new window]   Figure 2c. Transverse images in a patient with adenocarcinoma of unknown origin. (a) Conventional US image obtained in the right lobe of the liver shows heterogeneous liver parenchyma but no lesion with identifiable borders. (b) Contrast-enhanced US image obtained in the same region shows a large lobulated metastasis (arrow). (c) Contrast-enhanced spiral CT image in the portal venous phase confirms the presence of the metastasis (arrow).

View larger version (137K): [in a new window]   Figure 3a. Images in a patient with carcinoma of the stomach. (a) Conventional US image (longitudinal section of the left lobe) shows only one metastasis (arrow) in segment 2. (b) Conspicuity of the metastasis (arrow) in segment 2 is markedly increased after contrast material administration (same imaging plane as in a). (c) Transverse contrast-enhanced US scan of the right lobe shows an additional metastasis (arrow) 4 mm in diameter in segment 6. (d) Transverse contrast-enhanced spiral CT image in the portal venous phase confirms the additional metastasis (arrow).

View larger version (132K): [in a new window]   Figure 3b. Images in a patient with carcinoma of the stomach. (a) Conventional US image (longitudinal section of the left lobe) shows only one metastasis (arrow) in segment 2. (b) Conspicuity of the metastasis (arrow) in segment 2 is markedly increased after contrast material administration (same imaging plane as in a). (c) Transverse contrast-enhanced US scan of the right lobe shows an additional metastasis (arrow) 4 mm in diameter in segment 6. (d) Transverse contrast-enhanced spiral CT image in the portal venous phase confirms the additional metastasis (arrow).

View larger version (143K): [in a new window]   Figure 3c. Images in a patient with carcinoma of the stomach. (a) Conventional US image (longitudinal section of the left lobe) shows only one metastasis (arrow) in segment 2. (b) Conspicuity of the metastasis (arrow) in segment 2 is markedly increased after contrast material administration (same imaging plane as in a). (c) Transverse contrast-enhanced US scan of the right lobe shows an additional metastasis (arrow) 4 mm in diameter in segment 6. (d) Transverse contrast-enhanced spiral CT image in the portal venous phase confirms the additional metastasis (arrow).

View larger version (135K): [in a new window]   Figure 3d. Images in a patient with carcinoma of the stomach. (a) Conventional US image (longitudinal section of the left lobe) shows only one metastasis (arrow) in segment 2. (b) Conspicuity of the metastasis (arrow) in segment 2 is markedly increased after contrast material administration (same imaging plane as in a). (c) Transverse contrast-enhanced US scan of the right lobe shows an additional metastasis (arrow) 4 mm in diameter in segment 6. (d) Transverse contrast-enhanced spiral CT image in the portal venous phase confirms the additional metastasis (arrow).

View larger version (31K): [in a new window]   Figure 4. Graph shows frequency of additional metastases seen at contrast-enhanced US in relation to the number of metastases seen at unenhanced US. "Extra metastases not proven at CT" includes all additional metastases not shown at CT, independent of whether these were confirmed with use of an independent reference (MR imaging, intraoperative US, pathologic findings).

View larger version (123K): [in a new window]   Figure 5a. Images in a patient with colorectal carcinoma. (a) Transverse contrast-enhanced US image shows a metastasis (arrow) smaller than 1 cm that is located centrally in the right lobe of the liver. (b) Transverse contrast-enhanced spiral CT image obtained in the portal venous phase does not show this lesion. (c) Transverse T2-weighted MR image obtained after injection of superparamagnetic iron oxide particles confirmed the metastasis (arrow) in segment 5. Note that the position of the lesion appears somewhat different at MR imaging and US because of caudocranial angulation of the US imaging plane. The lesion is almost the same size, however, and the distance from the lateral margin of the liver is almost identical (this distance is much less influenced by craniocaudal angulation of the imaging plane). No other lesions were seen at US or MR imaging in this patient.

View larger version (137K): [in a new window]   Figure 5b. Images in a patient with colorectal carcinoma. (a) Transverse contrast-enhanced US image shows a metastasis (arrow) smaller than 1 cm that is located centrally in the right lobe of the liver. (b) Transverse contrast-enhanced spiral CT image obtained in the portal venous phase does not show this lesion. (c) Transverse T2-weighted MR image obtained after injection of superparamagnetic iron oxide particles confirmed the metastasis (arrow) in segment 5. Note that the position of the lesion appears somewhat different at MR imaging and US because of caudocranial angulation of the US imaging plane. The lesion is almost the same size, however, and the distance from the lateral margin of the liver is almost identical (this distance is much less influenced by craniocaudal angulation of the imaging plane). No other lesions were seen at US or MR imaging in this patient.

View larger version (126K): [in a new window]   Figure 5c. Images in a patient with colorectal carcinoma. (a) Transverse contrast-enhanced US image shows a metastasis (arrow) smaller than 1 cm that is located centrally in the right lobe of the liver. (b) Transverse contrast-enhanced spiral CT image obtained in the portal venous phase does not show this lesion. (c) Transverse T2-weighted MR image obtained after injection of superparamagnetic iron oxide particles confirmed the metastasis (arrow) in segment 5. Note that the position of the lesion appears somewhat different at MR imaging and US because of caudocranial angulation of the US imaging plane. The lesion is almost the same size, however, and the distance from the lateral margin of the liver is almost identical (this distance is much less influenced by craniocaudal angulation of the imaging plane). No other lesions were seen at US or MR imaging in this patient.