Enhancement Pattern of Liver Metastasis on Contrast Enhanced Ultrasound Examination - Monocentric Experience

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To evaluate the enhancement pattern of liver metastasis on contrast enhanced ultrasound (CEUS) examination. We performed a retrospective study, which included 496 patients with liver metastasis admitted in the Department of Gastroenterology and Hepatology of Emergency County Hospital of Timisoara between January 2010-December 2016, respectively 496 patients [303 men (61.1%) and 193 women (38.9%)], mean age 64.1 ± 10.7years. CEUS evaluation started from the suspicion of liver metastasis in the context of a neoplasia with single or multiple liver lesions or from the suspicion in standard ultrasound of liver metastasis. We analyzed the cause of liver metastasis, the enhancement pattern on CEUS (hypo- or hypervascular metastasis) and the relationship between primary tumor / behavior in CEUS. The most common cause of liver metastasis was colon cancer (in 28% of cases - 139), followed by pancreatic cancer (62 cases – 12.6%) and gastric cancer (50 cases - 10%). Other causes were: breast cancer (6.4% - 32 cases), oesophageal cancer (3% - 15 cases), ovary, uterus, pharynx, small intestine, kidney, prostate, melanoma, etc (22.6%). In 17.4% cases the primary tumor was not identified. After CEUS examination in 258/496 (52.1%) cases the metastasis were hypervascular and in 238/496 (47.9%) cases were hypovascular. All liver metastates showed washout in the portal and late phase. A correlation was found only between gastric cancer and hypervascular appearance - 30/50 hypervascular metastasis vs. 20/50 hypovascular metastasis (p = 0.042). The vascularity of liver metastasis on CEUS was not correlated with the primary tumor. CEUS is a good imaging method for the detection and characterization for liver metastasis. In the arterial phase in 258/496 (52.1% ) cases hyperenhancing pattern was observed (hypervascular metastasis) and hypoenhancing pattern (hypovascular metastasis) in 238/496 (47.9%) cases. In our study, we found no significant correlation between the primary tumor and The vascularity of liver metastasis, excepting gastric cancer which seemed to correlate with hypervascular metastasis.