Sonazoid-enhanced ultrasound images of multiacinar cirrhotic nodules showing a “donut-like” hyperintense appearance on Gd-EOB-MRI: a case report

Excerpt

A 70 year-old man with alcohol-related cirrhosis was referred to our hospital for a detailed examination of approximately 20 liver nodules 7–38 mm in size, detected with gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI). All the nodules had the following findings: the nodules were depicted as hyperintense lesions in the portal venous and transitional phases. In the hepatobiliary phase, they appeared hyperintense with a central hypointense area, a so-called “donut-like” hyperintense appearance (Fig. 1a). Several of the liver nodules were detectable on unenhanced ultrasound; they were depicted as poorly demarcated, slightly hypoechoic liver nodules. Sonazoid-enhanced ultrasound (SEUS) was performed for detectable nodules. In the arterial phase, the nodules were poorly enhanced; in the portal venous phase, they were gradually enhanced from their central to peripheral portions (wheel-spoke-like spread of portal branches from the nodules’ centers to their peripheral portions); and in the Kupffer phase, the echo levels of the nodules were similar to those of the surrounding liver parenchyma (Fig. 1b). The pathological findings of an ultrasound-guided biopsy specimen were compatible with multiacinar cirrhotic nodule, a subtype of cirrhotic nodule defined by an International Working Party (Fig. 1c) [1].

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