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Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2020 March;179(3):167-76

DOI: 10.23736/S0393-3660.19.04120-2


language: Italian

Complex cystic lesions of the liver: diagnostic and differential contrast-enhanced ultrasound findings

Antonio CORVINO 1, 2 , Fabio SANDOMENICO 3, Sergio V. SETOLA 3, Fabio CORVINO 4, Domenico TAFURI 1, Orlando CATALANO 5

1 Department of Sport and Wellness Sciences, University of Naples “Parthenope”, Naples, Italy; 2 Department of Morphological and Functional Diagnostic, Radiotherapy and Legal Medicine, Federico II University Hospital, Naples, Italy; 3 Unit of Radiology, Istituto Nazionale Tumori “Fondazione Pascale”, Naples, Italy; 4 Unit of Vascular and Interventional Radiology, AORN “A. Cardarelli”, Naples, Italy; 5 Varelli Diagnosis Institute, Naples, Italy

Because of the widespread use of ultrasound (US) in routine examinations of the abdomen, cystic focal liver lesions (FLLs) are increasingly found. However, although the US diagnosis of a simple cyst is straightforward, diagnostic controversies arise when the lesion encountered differ sonographically in the following US complex features: wall thickening or irregularity, internal septation, nodularity, calcifications, and hemorrhagic or proteinaceous contents. Furthermore, since complex cystic FLLs at US may turn out to be malignant, the radiologist must carefully assess such US features to determine whether further imaging workup is indicated. Recently, the development of low-mechanical-index real-time contrast-enhanced ultrasound (CEUS) techniques performed with the second generation of US contrast agents has led to 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. This pictorial essay reviews the growing body of evidence that supports the use of modern ultrasound contrast agents and illustrates the enhancement characteristics of commonly encountered complex cystic FLLs. Pathologies discussed include complicated infectious and hemorrhagic cysts, abscesses, hydatid cysts, cystic hemangiomas, biliary cystadenomas and cystadenocarcinomas, cystic metastases and hepatocellular carcinomas.

KEY WORDS: Liver; Ultrasonography; Cysts

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