Ultrasound appearances of liver metastases

Ultrasound appearance of liver metastases can have bewildering variation.

Patterns do exist between ultrasound appearance of the liver metastases and the likely primary, which is sometimes helpful in directing search for an unknown primary, as well as helping distinguish between benign lesions and metastatic disease from a particular primary:

Contrast-enhanced ultrasound

May be useful to increase conspicuity of lesions and/or guide biopsy

  • arterial phase: variable depending on primary
    • hypovascular:  gastrointestinal, ovarian, pancreatic adenocarcinoma
    • hypervascular: neuroendocrine, melanoma, renal
  • portal venous phase
    • "wash out" (decreased echogenicity relative to background liver); may be the most useful phase for detection

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