Ultrasound appearances of hepatic metastases

Last revised by Andrew Murphy on 23 Mar 2023

Citation, DOI, disclosures and article data

Citation:

Gaillard F, Anan R, Knipe H, et al. Ultrasound appearances of hepatic metastases. Reference article, Radiopaedia.org (Accessed on 09 Dec 2023) https://doi.org/10.53347/rID-6933

DOI:

https://doi.org/10.53347/rID-6933

Permalink:

https://radiopaedia.org/articles/6933

rID:

6933

Article created:

27 Aug 2009, Frank Gaillard ◈

Disclosures:

At the time the article was created Frank Gaillard had no recorded disclosures.

View Frank Gaillard's current disclosures

Last revised:

23 Mar 2023, Andrew Murphy ◉

Disclosures:

At the time the article was last revised Andrew Murphy had no financial relationships to ineligible companies to disclose.

View Andrew Murphy's current disclosures

Revisions:

19 times, by 13 contributors - see full revision history and disclosures

Systems:

Hepatobiliary, Oncology

Sections:

Gamuts

Tags:

ultrasound, cases, contrast-enhanced ultrasound

Synonyms:

Ultrasound features of liver metastases
Liver metastases (ultrasound appearances)
US hepatic metastases

Ultrasound appearance of hepatic metastases can have bewildering variation, and the presence of hepatic steatosis can affect the sonographic appearance of liver lesions.

Radiographic features

Ultrasound

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

hypoechoic: most common ~65%
hyperechoic
peripheral halo: a hypoechoic halo is a concerning feature, sometimes called the target or bull's eye lesion/sign
- common in many
- lung cancer
calcified
- mucinous adenocarcinoma
  - gastrointestinal
  - ovarian mucinous adenocarcinoma
cystic
poorly defined (infiltrative)
associated intrahepatic biliary dilation
- colorectal carcinoma (CRC)

Contrast-enhanced ultrasound

Contrast-enhanced ultrasound may be useful to increase the conspicuity of lesions and/or guide biopsy.

The 'hypovascular' and 'hypervascular' terminology refers to metastatic appearance on contrast-enhanced cross-sectional studies as peak arterial enhancement is not necessarily seen on arterial phase. The viable metastases of the liver show at least early peripheral enhancement on contrast-enhanced ultrasound even if the central aspect would remain unenhanced (necrotic). The extension of the central necrotic area often correlates the tumor size, hence small gastrointestinal metastases may enhance avidly and homogeneously in arterial phase.

arterial phase: variable depending on primary
- hypovascular: gastrointestinal, ovarian, pancreatic adenocarcinoma
- hypervascular: neuroendocrine, melanoma, renal
portal venous and late phase
- "wash out" (decreased echogenicity relative to background liver due to the lack of enhancement); may be the most useful phase for detection as all of the liver metastases show this phenomenon