The visualisation of focal liver lesions on ultrasound: A review of 300 liver ultrasounds with CT or MRI correlation

IntroductionConventional ultrasound (US) is the most common imaging investigation of the liver. The ability of US to visualise focal liver lesions (FLLs) can be limited by technical factors, patient characteristics, and operator experience. The aim of this study was to determine the percentage and types of FLLs that were visualised on conventional US when compared with CT or MRI. MethodologyThree hundred patients who received a US followed by CT or MRI within 10 days were retrospectively reviewed. The final outcome of all liver lesions was determined by the best available evidence. ResultsIn noncirrhotic livers, 168 FLLs were visualised ranging from 2 to 62 mm in size. The most common lesions were cysts (n = 107, 64%), indeterminate FLLs (n = 20, 12%), haemangiomas (n = 11, 7%), other benign FLLs (n = 10, 6%), and metastases (n = 9, 5%). US visualised 39 (23%) FLLs and failed to visualise 129 (77%). The visualisation of FLL increased with increasing lesion size. FLLs less than 10 mm were seldom visualised, whereas FLLs greater than 15 mm were visualised two-thirds of the time. In cirrhotic livers, US failed to visualise malignant lesions in two patients. Disseminated metastatic liver disease was visualised on US in 94% of cases. ConclusionConventional US continues to play a major role in the screening for focal liver disease. US practitioners and clinicians should be aware that the ability of US to visualise FLLs is size dependent and may be limited in some patients.