Assessment of metastatic liver disease in patients with primary extrahepatic tumors by contrast-enhanced sonography versus CT and MRI

Figure 1 Demonstration of a focal (multicystic) lesion in a patient with cervix carcinoma using contrast-enhanced ultrasound (CEUS). A: The lesions can be delineated in the portal-venous phase as ‘black spots’ lacking portal-venous enhancement within normally enhanced liver tissue. B: An additional small lesion next to the diaphragm (not visible in native B-mode) was detected by CEUS but not with CT. Biopsy confirmed metastatic disease.

Figure 2 Detection of metastases in a patient with colorectal carcinoma. A: Native B-mode sonography revealed 3 metastases (segment 6/7) in agreement with CT, MRI revealed 4 metastases (segment 6/7 and 4). B: Contrast-enhanced sonography identified diffuse metastatic disease in both liver lobes. The metastatic lesions are clearly delineated in the portal-venous phase as ‘black spots’, due to the lack of portal-venous blood supply.

Figure 3 Detection of multiple metastatic lesions in the liver of a patient with sarcoma. A: In contrast-enhanced sonography, the lesions show a periperal enhancement in the arterial phase (“rim sign”), indicating the arterial blood supply to the peripheral proliferation zone of this metastatic lesions from a hypervascular tumor. B: During portal-venous phase, the lesions show lack of portal-venous enhancement (‘black spot’), indication the absence of portal-venous blood flow typical for malignant liver lesions.