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Colour Doppler flow imaging of focal hepatic lesions
D N Srivastava1, A Mahajan, M Berry
1Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. deep@medinst.ernet.in
Insights
Colour Doppler flow imaging (CDFI) alone is not reliable for differentiating focal liver lesions. Intratumoral flow patterns, when combined with other imaging features, may aid in diagnosis.
Area of Science:
- Radiology
- Medical Imaging
- Hepatology
Background:
- Focal liver lesions require accurate differentiation for effective management.
- Colour Doppler flow imaging (CDFI) is a non-invasive technique to assess blood flow.
Purpose of the Study:
- To evaluate the utility of CDFI in differentiating focal liver lesions based on intratumoral and peritumoral blood flow patterns.
- To assess the diagnostic performance of CDFI in conjunction with CT imaging.
Main Methods:
- Fifty-four patients with focal liver lesions underwent CDFI and CT.
- Intratumoral and peritumoral blood flow were assessed and categorized.
- Flow patterns were correlated with lesion types including primary hepatic malignancies, metastases, haemangiomas, and inflammatory lesions.
Main Results:
- Peritumoral flow showed no significance in differential diagnosis.
- Intratumoral flow varied significantly: marked flow in malignancies and infantile haemangioendothelioma; moderate flow in malignancies and metastases; mild flow in malignancies, metastases, and haemangiomas.
- No intratumoral flow was observed in inflammatory lesions, most haemangiomas, and many metastases.
Conclusions:
- The presence or absence of intratumoral flow on CDFI alone is not a reliable diagnostic feature for focal liver lesions.
- CDFI flow patterns, when integrated with morphological imaging features, can assist in the differential diagnosis of liver lesions.
Abstract:
Fifty-four patients with focal liver lesions were evaluated with colour Doppler flow imaging (CDFI) and CT to assess whether CDFI could be used to differentiate various types of lesions based on the flow pattern in terms of peritumoral and intratumoral blood flow. Peritumoral flow was found to be of no significance in the differential diagnosis of various liver lesions. Intratumoral flow was graded into mild, moderate or marked depending on the relative number of blood vessels demonstrated within the lesion. Marked intratumoral flow on CDFI was seen in 12.5% of primary hepatic malignancies and in infantile haemangioendothelioma, while a moderate flow pattern was seen in 56.2% of primary hepatic malignancies and in 18.7% of metastases. Mild flow was seen in 33.3% of primary malignancies; 18.7% of metastases; and 16.7% of haemangiomas. No intratumoral flow was seen in 100% of inflammatory lesions; 83.3% of haemangiomas; 62.5% of metastases; and only one hepatocellular carcinoma (5.6%). It was therefore concluded that the presence or absence of flow on CDFI is not a reliable feature for differential diagnosis of focal liver lesions when it is used alone. The flow pattern as assessed on CDFI may point to the nature of the lesion and, when used along with other morphological imaging features, can assist in diagnosis or in narrowing the list of different diagnoses in a particular clinical situation.