Findings of Fat Containing Hepatocellular Carcinoma on Contrast-enhanced Ultrasound with Sonazoid: A Case Report

doi:10.37015/AUDT.2021.200003

Abstract

Abstract:

Contrast-enhanced ultrasound (CEUS) has become more recognized in the diagnosis of hepatocellular carcinoma (HCC). Fat containing HCC often presents as hyper-echoic in gray scale ultrasound and confuses the diagnosis. Here we showed a case of fat containing HCC which was diagnosed by CEUS with Sonazoid, and its histopathologic features, immunohistochemical profile, surgical treatment, patient’s follow up information were also presented.

Key words: Hepatocellular carcinoma; Sonazoid; Contrast agent; Fat-containing

Mengna He, MD, PHD, Lu Zhu, MD, Tianan Jiang, MD, PHD. Findings of Fat Containing Hepatocellular Carcinoma on Contrast-enhanced Ultrasound with Sonazoid: A Case Report. Advanced Ultrasound in Diagnosis and Therapy, 2021, 5(2): 98-101.

References

[1]	Ronot M, Purcell Y, Vilgrain V. Hepatocellular carcinoma: current imaging modalities for diagnosis and prognosis. Dig Dis Sci 2019; 64:934-950.
[2]	European Association For The Study Of The Liver; European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepato 2012; 56:908-43.
[3]	Suzuki K, Okuda Y, Ota M, Kojima F, Horimoto M. Diagnosis of hepatocellular carcinoma nodules in patients with chronic liver disease using contrast-enhanced sonography: usefulness of the combination of arterial- and kupffer-phase enhancement patterns. J Ultrasound Med 2015; 34:423-33.
[4]	Choi JY, Lee JM, Sirlin CB. CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part II. Extracellular agents, hepatobiliary agents, and ancillary imaging features. Radiology 2014; 273:30-50.
[5]	Tekath M, Klotz T, Montoriol PF, Joubert-Zakeyh J, Garcier JM, Da Ines D. Fat-containing lesions of the liver: a pictorial essay. Diagn Interv Imaging 2015; 96:201-11.
[6]	Kutami R, Nakashima Y, Nakashima O, Shiota K, Kojiro M. Pathomorphologic study on the mechanism of fatty change in small hepatocellular carcinoma of humans. J Hepato 2000; 33:282-9.
[7]	Yang WY, Park HS, Kim YJ, Yu MH, Jung SI, Jeon HJ. Visibility of focal liver lesions: Comparison between kupffer phase of CEUS with sonazoid and hepatobiliary phase of gadoxetic acid-enhanced MRI. J Clin Ultrasound 2017; 45:542-550.
[8]	Lee J, Jeong WK, Lim HK, Kim AY. Focal Nodular Hyperplasia of the Liver: Contrast-Enhanced Ultrasonographic Features With Sonazoid. J Ultrasound Med 2018; 37:1473-1480.
[9]	Tochio H, Tamaki E, Imai Y, Iwasaki N, Minowa K, Chung H, Suginoshita Y, Inokuma T, Kudo M. CD68-Positive Cells in Hepatic Angiomyolipoma. Oncology 2017; 92:35-39.

[1]	Liu Taixia, Wang Hanxiang, Wang Dan, Zhang Yuke, Guo Yunyun, Liu Shuo, Zhang Minfeng, Nie Hongming, Shen Rui. The Role of Sonazoid-contrast-enhanced Ultrasound In Precision Diagnosis and Guidance for Radiofrequency Ablation Therapy of Hepatocellular Carcinoma: a Literature Review [J]. Advanced Ultrasound in Diagnosis and Therapy, 2026, 10(1): 20-28.
[2]	Guan Xin, Hu Xinyuan, Han Hong, Zhang Dezhi, Xu Huixiong. The Evolving Application of Ultrasound in the Precision Management of Small Hepatocellular Carcinoma [J]. Advanced Ultrasound in Diagnosis and Therapy, 2025, 9(4): 375-387.
[3]	Yu Xiao jie, Song Zheng lai, Chang Xue yong, Yu Jie, Liang Ping. Artificial Intelligence in Ultrasound Diagnosis of Liver Nodules: A Comprehensive Review of B-Mode and Contrast-enhanced Applications [J]. Advanced Ultrasound in Diagnosis and Therapy, 2025, 9(4): 326-346.
[4]	Xu Junmei, Tahmasebi Aylin, Mohammed Amr, Pour Bahareh Kian, Liu Ji-Bin, Eisenbrey John R.. Contrast-enhanced Ultrasound LI-RADS for Nonradiation Treatment Response Assessment in Liver Tumor: A Pictorial Review Based on LR-TR v2024 [J]. Advanced Ultrasound in Diagnosis and Therapy, 2025, 9(4): 357-374.
[5]	Yue Tian, MB, Yanan Zhao, MD, Yiran Huang, MB. The Diagnostic Value of Real-time Shear Wave Ultrasound Elastography in the Differentiation of Hepatic Hemangioma and Hepatocellular Carcinoma [J]. Advanced Ultrasound in Diagnosis and Therapy, 2024, 8(3): 124-129.
[6]	Osama Mahmoud, BS, Ajay Makkena, BS, Corinne E. Wessner, MS, MBA, RDMS, Ji-Bin Liu, MD, John R. Eisenbrey, PhD, Andrej Lyshchik, MD, PhD. Contrast-Enhanced Ultrasound LI-RADS: A Pictorial Review [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(4): 321-332.
[7]	Priscilla Machado, MD, Ji-Bin Liu, MD, Flemming Forsberg, PhD. Sentinel Lymph Node Identification Using Contrast Lymphosonography: A Systematic Review [J]. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(1): 1-7.
[8]	Esika Savsani, Mohamed Tantawi, MD, Corinne E. Wessner, MBA, RDMS, RVT, Philip Lee, MD, Andrej Lyshchik, MD, PhD, Kevin Anton, MD, PhD, Colette M. Shaw, MD, Ji-Bin Liu, MD, John R. Eisenbrey, PhD. Contrast-enhanced Ultrasound Assessment of Treatment Response in a Patient with Multifocal Hepatocellular Carcinoma Treated with Transarterial Chemo and Radioembolization [J]. Advanced Ultrasound in Diagnosis and Therapy, 2021, 5(3): 254-257.
[9]	Ying Fu, MD, Shi Tan, MD, LiGang Cui, MD, Fang Mei, MD. Contrast-enhanced Ultrasound Improves Technical Sufficiency of Fine-needle Aspiration in Suspicious Thyroid Nodules [J]. Advanced Ultrasound in Diagnosis and Therapy, 2021, 5(3): 219-225.
[10]	Yan Zhou, Jianmin Ding, Fengmei Wang, Zhengyi Qin, Yandong Wang, Hongyu Zhou, Xiang Jing. The Effects of Liver Function Damage after Thermal Ablation on the Prognosis of HCC Patients and Its Prediction [J]. Advanced Ultrasound in Diagnosis and Therapy, 2021, 5(2): 80-86.
[11]	Xiaohui Sun, MD, Jing Ma, MD, Xifeng Ge, MD, Ligang Cui, MD. Diagnosis of Acute Suppurative Thyroiditis Secondary to Pyriform Sinus Fistula by Local Injection of Ultrasound Contrast Agent [J]. Advanced Ultrasound in Diagnosis and Therapy, 2021, 5(1): 47-50.
[12]	Writing Group of the Gastroenterology Group of China Medical Education Association Ultrasound Committee , Tingting Li, MD, Xiaoyan Li, MD, Man Lu, MD, Ji-Bin Liu, MD, Wenming Lu, MD, Lixue Yin, MD, Changjun Wu, MD, Zhiqing Cai, MD, Guangxia Wang, MD, Liying Miao, MD, Jingyu Wang, MD, Dong Xu, MD, Jianqiang Mao, MD, Jin Yan, MD, Kang Wang, MD, Zhi Ding, MD, Ling Guan, MD, Lina Tang, MD, Shengjun Ma, MD, Yinrong Cheng, MD, Kairong Lei, MD, Yanfang Zhou, MD, Xingxing Duan, MD, Xuemei He, MD, Xiaoxia Dou, MD, Yuan Li, MD, Lu Wang, MD. Chinese Expert Consensus and Guidelines on Oral Contrast Gastric Ultrasonography for Scanning Technique and Imaging Acquisition [J]. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(4): 357-365.
[13]	Yaqiong Li, PhD, Ruiqing Liu, MD, Shaobo Duan, MD, Lianzhong Zhang, MD. Advances in Targeted Tumor Diagnosis and Therapy Based on Ultrasound-Responsive Nanodroplets [J]. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(4): 273-283.
[14]	Mengna He, MD, PhD, Lei Xu, MD, Tian’an Jiang, MD, PhD. Time-intensity Curve Analysis of Hepatocellular Carcinoma using Two Contrast-enhanced Ultrasound Methods: Contrast Pulse Sequencing and Contrast Harmonic Imaging [J]. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(3): 217-222.
[15]	Ping Wang, MD, Lihong Sun, PhD, Suhui Sun, MD, Menghong Xu, MD, Lulu Zhang, MD, Jinxia Zhang, MD, Liquan Gao, PhD, Qingfeng Chen, PhD, Xiaolong Liang, PhD. Research Advances in Ultrasound Imaging for Tumor in Situ [J]. Advanced Ultrasound in Diagnosis and Therapy, 2020, 4(3): 169-175.