Detection of benign regenerating nodules of liver cirrhosis using contrast enhanced ultrasound (CEUS)

Objectives: Up to now intra-parenchymal benign regenerating nodules of liver cirrhosis are rarely seen on conventional Ultrasound. The aim of our study was to detect benign regenerating nodules of liver cirrhosis using CEUS in clinically chronic hepatitis (CH) patients allowing diagnosis of early cirrhosis.

Methods: Two hundred patients who underwent percutaneous liver biopsy before starting antiviral therapy for their CH were studied.

All chronically infected patients (48 HBV, 18 HBV-HDV, 134 HCV) had no clinical and ultrasound findings of liver cirrhosis. All CEUS exams were performed before liver biopsy by the same physician who was unaware of clinical and laboratories findings. The right lobe was scanned in the subcostal space and CEUS performed at low mechanical index and i.v. injection of 2,4ml of Sonovue (Bracco, Italy). In all patients arterial, portal and sinusoidal phases were studied. All exams were recorded and rewieved to measure diameter of eventually detected benign regenerating nodules.

Results: On CEUS 14 patients showed numerous, small (2–7mm.), hypoechoic nodules during the early arterial phase. These nodules were thought to be benign regenerating nodules. Regenerating nodules were seen in 3 HCV, 5 HBV and 6 HBV-HDV patients respectively. In all cases liver histology showed liver cirrhosis without malignant lesions. At histological examination the nodules were surrounded by complete and incomplete fibrotic septa in 9 and 5 cases respectively.

Conclusions: Our data show that CEUS are able to detect benign regenerating nodules of liver cirrhosis allowing the diagnosis at an early stage and in a non-invasive mode.