Small focal nodular hyperplasia (CEUS)

Case contributed by Akos Jaray
Diagnosis certain


Under investigation for abdominal bloating and raised ALT. Incidental left lobe liver lesion on ultrasound.

Patient Data

Age: 50 years
Gender: Female

9 mm, hypoechoic, slightly ill-defined intrahepatic lesion in the periphery of segment 3 on B-mode ultrasound.

Doppler images demonstrate a feeding artery reaching the lesion from the dorsal aspect.

The intralesional vessels show ramification from one point (slightly extcentric to the dorsal aspect).

No artifacts on pre-contrast image (split screen).

Centrifugal filling is well-visualized scrolling through the cine-loop of the early arterial phase. Contrast arrival time at 18 sec.

Even a small non-enhancing area is seen in the center in the late phase (210 sec).


Case Discussion

Focal nodular hyperplasia can be diagnosed by contrast-enhanced ultrasound with high specificity.

B-mode ultrasound alone can not confirm the diagnosis, but sensitive color Doppler parameters can greatly increase the specificity:

  • decrease the field-of-view and depth if possible
  • apply zoom
  • decrease the pulse repetition frequency (scale)
  • look for tortuous feeding artery
  • assess the vascular pattern (typically spoke-wheel)

Contrast-enhanced ultrasound provides excellent spatial and temporal resolution. Early arterial centrifugal filling is seen fully completed by portal venous phase. There is sustained hyper-enhancement or iso-enhancement during portal venous phase. No wash-out in late phase. The central scar is often visualized by the late phase.

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