Contrast-Enhanced Ultrasound (CEUS) in Hepatic Lymphoma: Retrospective Evaluation in 38 Cases

Abstract

Purpose: Description of contrast-enhanced ultrasound (CEUS) patterns of hepatic lymphoma.

Materials and Methods: Over a period of 6 years and 1 month from January 2006 to January 2012, n = 38 patients with histological or clinically apparent hepatic lymphoma were studied by means of CEUS prior to B-mode imaging.

Results: Using B-mode imaging, lesions were hypoechoic in n = 37 (97.4 %) cases, while a focal lymphoma lesion was echo-rich in 1 case (2.6 %). For comparison, with CEUS, a hyperenhanced signal during the arterial phase was observed in n = 9 (23.7 %), an isoenhanced signal in n = 17 (44.7 %) and a hypoenhanced signal in n = 12 (31.6 %) cases. During the portal phase n = 2 (5.3 %) lesions were isoenhanced and n = 36 (94.7 %) were hypoenhanced followed by a hypoenhancement in n = 38 (100 %) cases in the late phase.

Conclusion: Lymphomas of the liver can cause different contrast accumulation in the arterial phase of CEUS. Furthermore, a clear differentiation from other malignant liver lesions such as metastases is crucial as different contrast accumulation in the arterial phase of CEUS is observed. In the late phase, hepatic lymphomas lead to a hypoenhancement in CEUS, also known as a “wash-out” phenomenon. In conclusion, CEUS is helpful to differentiate hepatic lesions by means of evaluating the malignancy or benignancy. In this regard, the application of CEUS can help to find the right diagnosis. A final discrimination between malignant liver lesions, such as liver lymphomas, metastasis or HCC, remains impossible.

Zusammenfassung

Ziel: Beschreibung des Kontrastmittelverhaltens von Leberlymphomen in der kontrastmittelunterstützten Sonographie (KMUS).

Material und Methoden: Im Zeitraum von Januar 2006 bis Januar 2012 wurden n = 38 Patienten mit histologisch oder klinisch gesichertem Lymphombefall der Leber B-Bild- sonographisch und mit kontrastmittelunterstützter Sonografie (KMUS) untersucht.

Ergebnisse: B-Bild-sonograhisch stellten sich n = 37 (97,4 %) der Leberlymphomläsionen echoarm und n = 1 (2,6 %) echoreich dar. In der KMUS zeigten n = 9 (23,7 %) Lymphomherde in der arteriellen Phase ein hyperechogenes, n = 17 (44,7 %), ein isoechogenes und n = 12 (31,6 %) ein hypoechogens Enhancement im Vergleich zum Enhancement des umgebenden Lebergewebe. In der portalvenösen Phase wiesen die Läsionen bei n = 2 (5,3 %) Patienten ein isoechogenes und n = 36 Patienten (94,7 %) ein hypoechogenes Enhancement auf. In n = 38 Fällen (100 %) präsentierten sich die Lymphomläsionen in der Spätphase mit einem hypoechogenem Enhancement.

Schlussfolgerung: Leberlymphome zeigten in der arteriellen Phase der KMUS kein einheitliches Kontrastmittelverhalten. In der Spätphase der KMUS wiesen Leberlymphome ein für maligne Läsionen charakteristisches hypoechogenes Enhancement („wash-out-Phänomen“) auf. Die kontrastmittelunterstützte Sonografie ist hilfreich in der Malignitätsbeurteilung der Läsion und somit richtunggebend in der Diagnosestellung des nodulären Lymphombefalls der Leber.  Eine sichere Abgrenzung zu anderen malignen Leberläsionen, wie Metastasen oder dem HCC, ist nicht möglich.

Key words

CEUS - liver - lymphoma - oncology

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