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Liver Metastasis (with CEUS imaging)

Technical: Contrast Agent: Sonovue® (Bracco, Milan)

Presentation: A 58 y.o. male with history of rhino-pharynx cancer treated by radio-chemotherapy presents for CEUS characterization of a known liver lesion.

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Caption: Sagittal liver and right kidney
Description: A complex, irregularly shaped predominantly hyperechoic mass with central hypoechoic areas is seen in the right lobe of the liver.  There is enhanced through transition beneath the mass, suggesting central necrosis or fluid content, and there is a thick slightly hypoechoic "halo" surrounding the mass, suggesting invasion or inflammatory response.

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Caption: Sagittal of the mass with color Doppler
Description: Color Doppler reveals blood flow within the mass compatible with a neoplastic lesion

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Caption: Baseline pre contrast administration
Description: Side by side gray-scale optimized and contrast optimized images.

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Caption: 18s post injection
Description: Following contrast injection the lesion enhances during the arterial phase.

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Caption: 25s post injection

DescriptionThere is distinct rim enhancement.

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Caption: 30s post injection

Description: Wash-out begins to appear in the lesion.

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Caption: 33s Post injection
Description: Washout is rapid and marked.

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Caption: 3 min 23s post injection
Description: Contrast washout is nearly complete and rim enhancement has disappeared.

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Caption: MRI of the lesion.
Description: The MRI examination confirms the CEUS exam findings.

Caption: Video
Description: After SonoVue injection the lesion enhances during the arterial phase and shows rim enhancement followed by quick and marked wash-out.


Final: metastasis

Follow up: Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) - Update 2008. EFSUMB Study Group et al.. Ultraschall in Med 2008; 29: 28-44   Role of contrast enhanced ultrasonography in the assessment of hepatic metastases: A review. Lars Peter Skovgaard Larsen. World J Hepatol. 2010 January 27; 2(1): 815.