PMC6335587_01
Axial (a, b) and coronal (c) CT and CEUS (d, e, f) images in a 49-year-old man with rectal bleeding and left pelvic pain. CT exam shows a mass-like thickening of the sigmoid colon wall (a) with isolated diverticula (white arrow in c) and multiple hypodense nodules of the liver (b, c). These findings were suggestive for a colon cancer with liver metastases. CEUS images shows several hyperechoic nodules in both liver lobes (d) and a vein entering the nodule was noted on the Doppler-US (e). After the intravenous contrast administration, the nodules appeared isoechoic in all vascular phases (f) to the surrounding liver and a diagnosis of multinodular steatosis was made.
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Multiple hypodense focal lesions of the liver with a maximum diameter of 2.5 cm were also noticed in both hepatic lobes (Fig. 1a-c). Ultrasound System, Philips Medical System, Best, the Netherlands) was performed 1 month later. US images showed several hyperechoic nodules in both liver lobes (Fig. 1d). The Doppler-US revealed a vein entering the lesion (Fig. 1e). After the i.v. administration of 2.4 ml of contrast medium (SonoVue, Bracco, Milan, Italy) the nodules showed the same hemodinamic behavior of the surrounding liver in the arterial, portal and delayed phases appearing isoechoic to the liver (Fig. 1f, Video 1).
PMC6335587_02
Contrast-enhanced MRI (a-e, g, h) and CEUS (f, i) images in a 66-year-old woman with a breast cancer treated with hormone therapy.. Opposed-phase T1-weighted images (b) showed diffuse reduction in signal compared to in-phase T1-weighted images (a), due to "patchy" liver steatosis. Moreover, in both liver lobes, multiple slightly hyperintense nodules (white asterisks in b) with a peripheral signal drop (Fig. 1 f, g) were detected. The same nodules appeared isointense to the surrounding liver in the delayed hepatobiliary phase (e) and slightly hypoechoic with hyperechoic peripheral halo (right white short arrows in f) on US. On CEUS, they were homogeneously iso-enhancing to liver parenchyma in all vascular phases (left white asterisk in f). A diagnosis of multinodular fatty sparing was made.. In the VI liver segment a one-centimeter diameter hypovascular nodule in the portal-venous phase (white arrow in g, white arrow in i) that appeared hypointense in hepatobiliary phase (white arrow in h) was interpreted as metastasis. A cyst was detected in between the III and IV liver segments (c).
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A consensus meeting between radiologists and oncologists led to further investigate the liver lesion with a CEUS (iU22 Ultrasound System, Philips Medical System, Best, the Netherlands) (Fig. 2f, i, Videos 2.1 and 2.2). In order to support the CEUS findings and investigate the presence of any other potentially unseen liver metastasis, the patient was further investigated with an MRI (Fig. 2a-e, g, h).