Presentation
Right liver lobe extended segmentectomy and multiple TACE treatments due to to HCC a few years earlier. Control abdominal CT raised the possibility of recurrence.
Patient Data
Multiple hypoechogenic solid masses are visible in the liver using B-mode ultrasound. The lesions show increased internal vascularity when interrogated using superb microvascular imaging.
After administration of iv. ultrasound contrast agent (SonoVue) the largest lesion is monitored throughout the arterial phase. The mass again shows internal vascularity with slightly delayed enhancement, followed by washout in the portal venous and delayed phases. Findings are in line with multifocal recurrence of the HCC.
The liver shows signs of earlier extended right lobe segmentectomy and multiple TACE treatments. Multiple solid lesions showing subtle hyperenhancement are visible in the arterial phase, due to which CEUS was recommended. The picture is in sharp contrast with the very obvious abnormalities found later with noncontrast and contrast enhanced US.
Case Discussion
CEUS appearance of recurrent HCC is somewhat variable in the arterial phase, here we see profound arterial vascularity with somewhat delayed enhancement. The late phase washout is however pathognomic. The value of superb microvascular imaging is also demonstrated as it depicts the increased arterial supply and neoangiogenesis in the mass with great detail. The case also demonstrates the limitations and pitfalls of CT owing to its inferior temporal and spatial resolution.
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