Case of the Day: The Importance of the addition of CEUS.

Teaching Point:

Greyscale ultrasound is excellent and has superior resolution for the identification of masses within the liver. However, it is nonspecific and further information about blood flow is required for a definitive diagnosis.

Teaching Point:

Color doppler adds excellent information about blood flow especially when it comes to big blood vessels and fast moving flow. The mass is vascular but its exact classification is unknown it remains indeterminate.

Teaching Point:

In the Arterial Phase the mass shows Avid globular enhancement. However, complete vascular assessment requires, additionally, evaluation and the portal venous and late phase.

Teaching Point:

Using a Microbubble contrast agent, the liver mass can be assessed in all 3 phases. Showing Globular Enhancement in the Arterial Phase, Sustained enhancement at 1minute and late weak washout in the late phase at 5mins. With the use of CEUS, the greyscale finding can now be confirmed as HCC. These enhancement features in conjunction with a high risk liver have 96% specificity for HCC.