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Contrast-enhanced ultrasound approach to the diagnosis of focal liver lesions: the importance of washout

Ultrasonography 2019년 38권 4호 p.289 ~ 301
 ( Yang Hyun-Kyung ) - University of Toronto Department of Medical Imaging

 ( Burns Peter N. ) - University of Toronto Sunnybrook Research Institute Department of Medical Biophysics
 ( Jang Hyun-Jung ) - University of Toronto Department of Medical Imaging
 ( Kono Yuko ) - University of California Departments of Medicine and Radiology
 ( Khalili Korosh ) - University of Toronto Department of Medical Imaging
 ( Wilson Stephanie R. ) - University of Calgary Department of Radiology
 ( Kim Tae-Kyoung ) - University of Toronto Department of Medical Imaging

Abstract


Contrast-enhanced ultrasound (CEUS) is a powerful technique for differentiating focal liver lesions (FLLs) without the risks of potential nephrotoxicity or ionizing radiation. In the diagnostic algorithm for FLLs on CEUS, washout is an important feature, as its presence is highly suggestive of malignancy and its characteristics are useful in distinguishing hepatocellular from non-hepatocellular malignancies. Interpreting washout on CEUS requires an understanding that microbubble contrast agents are strictly intravascular, unlike computed tomography or magnetic resonance imaging contrast agents. This review explains the definition and types of washout on CEUS in accordance with the 2017 version of the CEUS Liver Imaging Reporting and Data System and presents their applications to differential diagnosis with illustrative examples. Additionally, we propose potential mechanisms of rapid washout and describe the washout phenomenon in benign entities.

키워드

Carcinoma, hepatocellular; Neoplasm metastasis; Liver; Ultrasonography; Contrast media; Diagnosis, differential
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