Abstract
Most sonographists have probably encountered cases of liver tumor in which vascular images were distorted or poorly defined when the scanning plane included a tumor in front of a vessel. This phenomenon was thought to results from sound refraction through the tumor. We analyzed this phenomenon first by using the results of clinical studies, then by using the results of basic studies with microcomputer simulation models. Results of clinical studies showed (1) a small notch in vessel walls (29/83, 34.9%) and poor definition of vessels (29/83, 34.9%) appearing behind the tumors, as well as (2) poor vessel definition, predominantly behind heterogenous tumors (28/29, 96.6%). Basic studies showed that vessels appearing behind tumors with homogenous internal structure has a smooth rotation, and that these vessels were visualized as combinations of multiple small fragments behind tumors with heterogeneous internal structure. Refraction of the US beam passing through a tumor, especially one with a heterogeneous internal structure, results in distortion of the US image of vessels located behind such tumors. Familiarity with the pattern of artifactually distorted vessel images can help in preventing misinterpretation of these findings as true pathologic vascular changes. This limitation of sonography necessitates the use of other diagnostic modalities for accurate observation of a vessel situated behind a tumor.
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