Prolonged Heterogeneous Liver Enhancement on Contrast-Enhanced Ultrasound

Abstract

Introduction: Prolonged heterogeneous liver enhancement (PHLE) is a rare phenomenon that is similar to the ultrasound findings of portal venous gas. The purpose of this report is to describe the phenomenon of PHLE after the injection of the ultrasound contrast agent SonoVue^®.

Patients and Methods: From 2000 to 2013, 13 patients with PHLE (“cloudy”, “wool-like”) after bolus injection of SonoVue^® were observed. The height, weight, and body mass index (BMI) of the patients, and the number of injections were analyzed. In addition, the literature was reviewed.

Results: The phenomenon occurred as early as 2 minutes after bolus contrast administration and lasted up to 5 hours on both B-mode and contrast-specific ultrasound. 8/13 (62 %) patients received two or more boluses. None of the patients experienced SonoVue^®-related side effects or health problems. The phenomenon was not reproducible in 3 patients who received a second SonoVue^® injection 24 hours after receiving the first.

Conclusion: This phenomenon is more likely to occur in patients who receive high-dose (or multiple) injections of UCA. It may occur as early as 2 minutes after contrast administration, and therefore, may affect the evaluation of focal liver lesions in the late phase. This phenomenon should not be misdiagnosed as a pathological finding of the liver.

Zusammenfassung

Einleitung: Die langanhaltende heterogene Leberanreicherung (PHLE) entspricht einem seltenen Phänomen portalvenöser Gaseinlagerung durch Kontrastmittelsonografie. Die vorliegende Studie beschreibt das Phänomen nach Injektion des Ultraschallkontrastmittels SonoVue^® und diskutiert mögliche zugrundeliegende Hypothesen.

Patienten und Methode: Von 2000 bis 2013 wurden 13 Patienten mit einer heterogenen (wolkigen) Leberanreicherung nach Bolusinjektion von SonoVue^® beobachtet. Die Größe, das Gewicht und der Body Mass Index (BMI) der Patienten und die Anzahl der Injektionen wurden erfasst. Zusätzlich wurde eine Literaturrecherche zum Thema durchgeführt.

Ergebnis: Das Phänomen wurde frühestens zirka 2 Minuten nach Kontrastmittelinjektion beobachtet und war bis zu 5 Stunden im B-Bild und kontrastspezifischer Einstellung nachweisbar. Das Phänomen wurde gehäuft (aber nicht ausschließlich) bei jungen untergewichtigen Frauen beobachtet. 8 von 13 Patienten (62 %) erhielten 2 und mehr Kontrastmittelinjektionen. Keiner der beobachteten Patienten zeigte Nebenwirkungen oder gesundheitliche Probleme. Das Phänomen konnte bei 3 von 13 Patienten nicht reproduziert werden.

Zusammenfassung: Das an sich harmlose Phänomen kann gehäuft bei jungen untergewichtigen Frauen nach mehrfacher Kontrastinjektion beobachtet werden. Es entwickelt sich nach ca. 2 Minuten und kann somit die Beurteilung der späteren Kontrastphasen beeinflussen und sollte nicht als Leberpathologie fehl diagnostiziert werden.

Key words

ultrasound - microbubbles - liver - heterogeneous enhancement

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