types of benign liver tumors. variable, generally imprecise delineation, may have a very pronounced circulatory signal Most authors accept the carcinogenesis process as a progressive Hypervascular metastases are less common and are seen in renal cell carcinoma, insulinomas, carcinoid, sarcomas, melanoma and breast cancer. Asked for Male, 58 Years. The specification of these data is important for staging liver tumors and prognosis. [citation needed], However, it is able to detect the appearance of new lesions and to assess the occurrence of CEUS allows guidance in areas of viable tissue The nodule's response to treatment. This pattern suggests aggressive behavior and is seen in bronchogenic, breast and colon carcinoma, . 2 A distended or enlarged organ. Inconclusive ultrasound results warranted a CT scan of the chest, abdomen and pelvis with contrast, which showed a heterogeneous low-density lesion within the right lobe of the liver that extended to the left lobe (Figure 5). In some cases this accumulation can Thus, for a nodule with a size of less than 10mm the patient will be reevaluated by During the portal venous phase there is a specific "wash out" of ultrasound contrast agent (UCA) and the tumor appears hypoechoic during the late phase. They are very common and are seen in up to 50% of patients with cirrhosis. First look at the images on the left and try to find good descriptive terms for what you see. The biliary route is often the result of biliary manipulation as in ERCP. CEUS. A high content of fat in the liver is indicative of fatty liver disease. CEUS examination is This includes lesions developed on liver In the arterial phase there is enhancement, but not as dense as the bloodpool. of hemangioma, ultimately prove to be hepatocellular carcinoma. It is usually central in location and then spreads out. guided biopsy; at a size over 20mm one single dynamic imaging technique with One should always keep in mind the risk of false positive results for HCC in case of It can be associated with other uncertain results or are contraindicated. Calcification can be seen in metastases of colon, stomach, breast, endocrine pancreatic ca, leiomyosarcoma, osteosarcoma and melanoma. As per ultrasound scan report of today, it has been observed that "heterogeneous echotexture of liver with irregular nodular surface of concern for chronic liver parenchymal disease" and "mild ascites". large sizes), are quite elastic and do not invade liver vessels. reasons contrast imaging (CT or CEUS) control should be performed one month after HCC diagnosis with a predictability of 89.5%. In uncertain cases The exact risk of malignant transformation is unknown. The most common tumor that causes retraction besides cholangiocarcinoma is metastatic breast cancer. appetite and anemia with cancer). tissue must be higher than the initial tumor volume. Using CEUS examination to detect metastases a sensitivity of 8095% is obtained, similar to or chronic inflammatory diseases. Currently, local response to treatment is focused on tumor necrosis diagnosed by contrast establish a differential diagnosis with hepatocellular carcinoma. In sepsis the spread will be via the arterial system as in patients with endocarditis and there will be multiple abscesses spread out through the periphery of the liver. slow flow speed. late or even very late "wash out" while poorly differentiated HCC has an accelerated wash A heterogeneous liver appears to have different masses or structures inside it when imaged via ultrasound. [citation needed], These lesions have various patterns (hypo or hyperechoic) with at least 1cm diameter. normal liver parenchyma. Nevertheless, chronic Budd-Chiari syndrome may be difficult to differentiate from cirrhosis ( 8 ). techniques, CEUS is the one that brought a significant benefit not only by increasing the You see it on the NECT and you could say it is hypodens compared to the liver. Computed tomography angiography revealed that this large vessel was a spontaneous extrahepatic portocaval shunt draining portal flow to the iliac veins through the inferior epigastric veins ( Fig. [1], Tumor detection is based on the performance of the method and should include morphometric information (three axes dimensions, volume) and topographic information (number, location specifying liver segment and lobe/lobes). The enhancement pattern is characterized by sequential contrast opacification beginning at the periphery as one or more nodular areas of enhancement. Patients with glycogen storage disease, hemochromatosis, acromegaly, or males on anabolic steroids also are more prone to developing hepatic adenomas. Occasionally, well-differentiated HCC foci can arterial phase, with portal and late wash-out. NAFLD is now recognized as the hepatic manifestation of the metabolic syndrome and is a major cause of liver-related morbidity and mortality. 4 An abdominal aortic . arterial phase followed by wash out during portal venous and late phase. CT sensitivity 24 hours post-therapy is reported to be even lower than with the medical history, the patient's clinical and functional (biochemical and Arterial Some cholangiocarcinomas have a glandular stroma. In the portal venous phase the lesion is again isodense to the surrounding liver parenchyma and you can't see it. This behavior of intratumoral They are single or multiple (especially metastases), have a clinical suspicion of abscess. Cirrhotic liver monitoring, Early hepatocellular carcinoma (Early HCC), Techniques for evaluating the efficiency of therapy, Ultrasound monitoring ablative therapies (alcoholization PEI, radiofrequency ablation RFA), Ultrasound monitoring of TACE therapy (transarterial chemoembolization), Ultrasound monitoring of systemic therapies, "[Sonographic diagnostics of liver tumors]", "Contrast-enhanced ultrasonography parameters in neural network diagnosis of liver tumors", https://en.wikipedia.org/w/index.php?title=Ultrasonography_of_liver_tumors&oldid=1076573293, detection and characterization of hepatic tumors, This page was last edited on 11 March 2022, at 20:00. [citation needed], On CEUS examination, early HCC has an iso- or hypervascular appearance during the The size varies from a few millimeters to more than 10 cm (giant hemangiomas). degree of tumor necrosis is not correlated with tumor diameter, therefore simple efficiency is currently made by indirect assessing Lipiodol binding to the tumor using nonenhanced So we have a HCC in the right lobe on the upper images and a hemangioma in the left lobe on the lower images. If a patient is known to have a fatty liver, it is better to do an MRI or ultrasound for the detection of livermetastases. neovascularization is enhanced in a chaotic and explosive way, while normal, arterial and (well differentiated HCC) or increased RI (moderately or poorly differentiated HCC). therapeutic efficacy. Similar observation was made in ultrasound scan earlier this month but doctors told it is fatty liver and nothing to . 3 Abnormal function of the liver. However when you look carefully you will notice the lamellar and heterogenous structure of FLC compared to the homogeneous appearance of FNH. arterial phase, with washout during the portal venous phase and hypoechoic pattern determined by two observations not less than 4 weeks apart; It is the antonym for homogeneous, meaning a structure with similar components. They consist of sheets of hepatocytes without bile ducts or portal areas. Finally there is a direct route as in penetrating injury or direct spread of cholecystitis into the liver. but it is an expensive method and still difficult to reach. Had a ultrasound, results said liver is 13.4cm and that there is somewhat heterogeneous appearance but with no definite abnormality r focal finding? Adenomas are prone to central necrosis and hemorrhage because the vascular supply is limited to the surface of the tumor. distinguished. lobar or generalized. Always look how they present in the other phases and compare with the bloodpool and remember that rim enhancement is never hemangioma. have distinct delineation (hydatid cyst), lack of vascularization or show a characteristic Adenomas may rupture and bleed, causing right upper quadrant pain. Over the years, different criteria for assessing the effectiveness of attenuation which make US examination more difficult. Peritumoral edema makes lesions appear larger on T2WI and is very suggestive of a malignant mass. [citation needed], Spectral Doppler characteristics of early HCC overlap those of the dysplastic nodule, as they Calcified liver metastases are uncommon. If you look at the images on the left and just would consider the T2W-images, what could be the cause of the central area of high signal? remaining liver parenchyma has a dual vascular intake, predominantly portal. In this situation a pronounced hepatomegaly occurs. However, this pattern is not specific for metastases as it can also be seen in primary malignant liver neoplasms (eg, HCC) and benign liver neoplasms (eg, adenoma in glycogen storage disease). An ultrasound, CT scan and MRI can show liver damage. melanoma, sarcomas, renal, breast or thyroid tumors) with hyperechoic appearance during Correlate . to the analysis of the circulatory bed. and avoids intratumoral necrotic areas. Hepatobiliary and Pancreatic Radiology: Imaging and Intervention. Clinical correlation in such cases is most helpful. showing that the wash out process is directly correlated with the size and features of The cirrhotic liver has a coarse, heterogeneous echotexture with reduced pulsatility of the hepatic venous waveform Ultrasound is approximately 80% sensitive in the detection of HCC. The size varies from a few millimeters to more than 10 cm (giant hemangiomas). normal liver (metastases). useful to exclude an active lesion at the moment of exploration but does not have absolute The lesion is hyperdense in the equilibrium phase indicating dens fibrous tissue. They are applied in order to obtain a full short time intervals. So this is fibrotic tissue and the diagnosis is FNH. (Claudon et al., 2008). anti-angiogenic molecules by quantifying intratumoral perfusion based on the statistical 3. 2D ultrasound appearance is uncharacteristic solid mass All these areas of enhancement must have the same density as the bloodpool. During the arterial phase, the signal is weak or <2cm (from <5% in the 90s in Europe to > 30% today in Japan) with curative therapy 68F, referred for ultrasound due to recurrent upper abdominal pain. Your mildly heterogeneous pancreas can be as a result of a fatty liver, or chronic pancreatitis. [citation needed], Ablative therapies are considered curative treatments for HCC together with surgical tumor enhanced areas, reflecting total tumor necrosis) and absence of other new lesions When increasing, they can result in central necrosis. hyperemia, presence of intratumoral air, ultrasound limitations (too deep lesion or the Currently, CEUS and MRI are It is composed of multiple vascular channels lined by endothelial cells. therapeutic efficacy as early as possible. above described behavior can occur in arterialized hemangiomas or those containing The key is to look at all the phases. No metastases were seen, but on an ultrasound of the same region multiple metastases were detected. However if we look at the NECT on the right, we'll notice, that it is not enhancement that we're looking at. Whenever you see a small cyst-like lesion in a patient who recently underwent an ERCP, be very carefull to assume it is just a simple cyst. complementary dynamic imaging techniques or biopsy should be performed. Barbara Beuscher-Willems (Contributor), M. W. Max Brandt (Contributor), Christian Goerg (Contributor). These results prove that for a correct characterization of 80% of adenomas are solitary and 20% are multiple. Echogenity is variable. identification (small sizes, small number) is important to establish an optimal course of tumor may appear more evident. On the other hand a fatty liver can also obscure metastases. Early HCC needs to be differentiated from other hypervascular lesions, that will be hyperdense in the arterial phase. Sometimes there is rim enhancement and you might mistake them for a hemangioma. During this phase the center of the lesion becomes hypoechoic, enhancing the tumor and hypoechoic appearance during late phase. It is important to separate the early appearance from the late appearance of HCC. The described changes have diagnostic value in liver nodules larger than 2cm. asymptomatic but also can be associated with pain complaints or cytopenia and/or Abstract Purpose: To assess the value of contrast-enhanced ultrasound (CEUS) for differentiating malignant from benign focal liver lesions (FLLs . especially in smaller tumors. characteristic of moderate/poorly differentiated HCC, with low or absent fatty changes. Ultrasound of her liver showed patchy echogenic liver parenchyma. and requires other imaging procedures, follow up and measurements of the tumor at to bloating, in cancer patients post-therapy steatosis occurs, which prevent deep visibility. have a heterogeneous structure in case of intratumoral hemorrhage. 4. HCC and Portal Vein thrombosis vasculature changes progressively, correlated with the degree of malignancy, and it is It captures live images of your organs using high frequency sound waves. It Heterogeneous Liver on Research Ultrasound Identifies Children with Cystic Fibrosis at High Risk of Advanced Liver Disease: Interim Results of a Prospective Observational Case-Controlled Study Marilyn J. Siegel MD 1 , A. Jay Freeman MD 2 , Wen Ye PhD 3 , Joseph J. Palermo MD 4 , Jean P. Molleston MD 5 , Shruti M. Paranjape MD 6 , Janis Stoll MD 7 , The lower images show a lesion that is visible on all images. The bacteria will fall down into the dependent portion of the right lobe. Local response to treatment is defined as:[citation needed] A heterogeneous liver appears to have different masses or structures inside it when imaged via ultrasound. be identified in high-grade dysplastic nodules (appearance called "nodule in nodule") internal bleeding. All the normal constituents of the liver are present but in an abnormally organized pattern. To accurately assess the effectiveness of treatment it is mandatory to An echogenic liver is defined as increased echogenicity of the liver parenchyma compared with the renal cortex. Poorly differentiated tumors may have a stronger wash out leading to an isoechoic appearance to the liver parenchyma during portal venous phase. In 65% there are satellite nodules and in some cases punctate calcifications are seen. investigations with other diagnostic procedures; at a size between 10 20mm two portal vasculature continues to decline. These lesions need to be differentiated from other lesions with a scar like FLC, FNH and Cholangiocarcinoma. [citation needed], After curative therapies (surgical resection, local ablative therapies) continuing ultrasound dynamic imaging techniques and recognized by the presence of intratumoral non-enhanced [citation needed], Given that TACE is indicated only for hyperenhanced lesions during arterial phase, CEUS The lesion on the left has the folowing characteristics: The finding of an infiltrating mass with capsular retraction and delayed persistent enhancement is very typical for a cholangiocarcinoma. [citation needed], It develops on non cirrhotic liver. normal parenchyma in a shining liver. detect liver metastases is recommended when conventional US examination is not its ability to enhance intra-lesion microcirculation, has proved its utility in monitoring The lesion definitely has some features of a hemangioma like nodular enhancement in the arterial phase and progressive fill in in the portal venous and equilibrium phase. Characteristic elements of malignant Heterogeneous steatosis MRI Definition Steatosis is defined as the accumulation of fatty acids in the form of triglycerides in the cytoplasm of hepatocytes. This can be caused by mild fibrosis of fatty liver disease. mass. characteristic appearance is enough for positive diagnostic. CE-MRI as complementary methods. measurement of the tumor diameter (RECIST criteria) is not enough for therapy assessment. located in contact with the diaphragm, a "mirror image" phenomenon can be seen. enhancement is slow, during several minutes, depending on the size of hemangioma and Diffuse heterogeneous enlargement of the liver can be seen as a specific pattern in . Hypoechoic appearance is acoustic enhancement phenomenon is seen, which strengthens the suspicion of fluid During the late phase the tumor remains isoechoic to the liver, which strengthens the In Part II the imaging features of the most common hepatic tumors are presented. The risk of significant bleeding from the tumor is as high as 30%. Microcirculation investigation allows for discrimination between benign and malignant tumors. tool in the evaluation of liver enzyme abnormalities is abdominal ultrasound (US), with more in-depth evalua-tion by computed tomography (CT), magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatog-raphy (MRCP), or cholescintigraphy as detailed later. prognostic value; therefore the patient should be periodically examined at short intervals. characterization of liver nodules. 4 Finally, the nodular pattern is thought to represent changes related to hepatic fibrosis; it is present in approximately 10% of CFLD patients. Typically HCC invades liver vessels, primarily the portal veins but also the hepatic veins . by complete tumor necrosis with a safety margin around the tumor. In histological terms, this usually appears as macrovacuolar steatosis, with large intracytoplasmic vacuoles displacing the nucleus to the periphery of the cells. Then continue. examination. Characteristic 2D ultrasound appearance is that of a very well defined lesion, with sizes of 2-3 cm or less, showing increased echogenity and, when located in contact with the diaphragm, a "mirror image" phenomenon can be seen. The role of US is curative or palliative therapies have been considered. phase. transformation of DN from low-grade to high-grade and into HCC. [citation needed], In the first days after RFA both CEUS and spiral CT have low sensitivity in assessing (2002) ISBN: 1588901017. The efficiency of 2D ultrasound is low in assessing the effects of HCC or metastasis therapy, artery with gelfoam, alcohol or metal rings. tumors larger than 1cm, and specificity can reach 90%. nodule as a characteristic feature of dysplastic nodules and early HCC (Minami & Kudo, AJR 2003; ISO: 1007-1014. It displays a mix of densities due to various factors including alcohol damage and obesity. and the tumor diameter is unchanged. Metastases in fatty liver contrast enhancement of a nodule within 12cm developed on a cirrhotic liver is sufficient They typically displace normal liver vessels but no vascular or biliary invasion Fibrolamellar carcinoma (FLC) has a dark scar on T2WI and FNH has a brigth scar on T2WI in 80% of the cases. The presence of membranes, abundant sediment associating "wash out" during portal and late CEUS phases. phase there is a centripetal and inhomogeneous enhancement. When an ultrasound states it is minimally heterogeneous.it means its surface has a different echotexture.this could be that it is developing a more coarse appearance which means possible liver disease that has no known cause. In both cases ultrasound examination identifies a ultrasound every 3 months, as the growth trend is an indication for completion of On CEUS examination both RN and DN may have quite a variable enhancement pattern. They are best seen in the late arterial phase at 35 sec after contrast injection. single, solid consistency with inhomogeneous structure. Also they are Then continue. 1).Features include increased echogenicity of the liver parenchyma, poor or non-visualisation of the diaphragm, intrahepatic vessels and posterior part of the right hepatic lobe. This suggested underlying liver fibrosis, although the liver contour was smooth. In 60% of cases more than one hemangioma is present. HCC consists of abnormal hepatocytes arranged in a typical trabecular pattern. Liver ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI) are the primary imaging modalities to diagnose liver lesions. At conventional B-mode ultrasound, diffuse fatty infiltration results in increased echogenicity of the liver when compared to other organs such as the renal cortex (Fig. This can occur due to a number of reasons which include: conditions that cause hepatic fibrosis 1 cirrhosis hemochromatosis various types of hepatitis 3 particularly chronic hepatitis conditions that cause cholestasis Differential Diagnosis in Ultrasound: A Teaching Atlas. change the therapeutic behavior . metastases, hepatocellular carcinoma and hemangioma and the confusion between Mortel K, Segatto E, Ros P. The Infected Liver: Radiologic-Pathologic Correlation. is therefore mandatory to analyze all these three phases of CEUS examination for a proper Liver cirrhosis was confirmed in 111 participants; therefore, ultrasound had a 94% sensitivity and 49% specificity for the detection of liver cirrhosis [ 41 ]. In most cases, a finding of heterogeneous liver is followed by further medical testing to determine the cause of the heterogeneity. This can occur due to a number of reasons which include: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. related to US penetration (pronounced fatty liver disease, deep lesion, excessive obesity) and hepatic artery and injection of chemotherapeutic agents (usually adriamycin, but other Given the CEUS limitations, currently some authors consider CT conditions, using the available procedures discussed above for each of them. totally "filled" with CA, hemangioma appears isoechoic to the liver. The case on the left demonstrates how difficult the detection of ta cholangiocarcinoma can be. The liver is the most common site of metastases. UCAs injection. On dynamic contrast-enhanced MRi the characteristics of metastases are the same as for CECT. This is the hallmark of fatty liver. On ultrasound? Fat deposition within adenomas is identified on CT in only approximately 7% of patients and is better depicted on MRI. Cholangiocarcinoma usually presents as a mass of 5-20cm. 1).Features include increased echogenicity of the liver parenchyma, poor or non-visualisation of the diaphragm, intrahepatic vessels and posterior part of the right hepatic lobe. It is the antonym for homogeneous, meaning a structure with similar components. Checking a tissue sample. Larger HCC lesions typically have a mosaic appearance due to hemorrhage and fibrosis. resection) but welcomed. Ultrasound findings A similar appearance has been described with liver abscesses.Calcified metastases may shadow when they are densely echogenic (figure). By looking at the other phases to see if the enhancing areas match the bloodpool, it is usually possible to differentiate these lesions. At US, metastases may appear cystic,hypoechoic, isoechoic or hyperechoic. the lesions it is necessary to extend the examination time to 5 minutes or even longer. Imaging features of FLC overlap with those of other scar-producing lesions including FNH, HCC, Hemangioma and Cholangiocarcinoma. [citation needed], It is a benign tumor made up of normal or atypical hepatocytes. : this is a common ultrasound finding, echogenic or heterogenous liver - meaning not all of liver tissue looks exactly the same. reverberations backwards. Dysplastic nodules are hypovascular in the arterial phase. Limitations of the method are those You'll need to see a gastroenterologist, who hopefully specialises in the pancreas, who can . HCC becomes isodense or hypodense to liver in the portal venous phase due to fast wash-out. 3 Left untreated, continued fibrotic changes can lead to multilobular cirrhosis. The spatial distribution of the vessels is irregular, disordered. So progressive fill in is a non-specific feature, that can be seen in many other lesions like metastases or primary liver tumors like cholangiocarcinoma. Small HCC and hypervascular metastases may mimic small hemangiomas because they all show homogeneous enhancement in the arterial phase. This is however also a feature of HCC and large hemangiomas. sensitivity and specificity of ultrasound in detecting liver metastases, but also by assessing limited in the first few days after the procedure, and refers only to its complications, due to therapies initially after one month then after every 3 months post-TACE. However, if HA or HCC remains in the differential diagnosis, surgery usually is indicated. If you take a cohort of patients with hepatitis C and you follow them for 10 years, 50% of them will have end stage liver disease and 25% will have HCC. This is the fibrous component of the tumor. transarterial embolization but without chemotherapeutic agents injection, used in the is high only for lesions who are hyperenhanced during arterial phase. It means that the liver isn't homogeneous. Postcontrast imaging can help distinguish lesions depending on their degree of vascularity and composition. Sometimes, especially for HCC treated by During late phase the appearance is isoechoic or Brancatelli G., Baron RL, Peterson MS, Marsh W. Helical CT screening for HCC in patients with Cirrhosis: Frequency and causes of False-Positive interpretation. They can crowd resulting in large pseudo tumors. the presence of arterio-arterial and arterio-venous shunts, lack or incompetence of arterial focal nodular hyperplasia) or absent, with posterior acoustic enhancement effect (cysts), 1 ). On T2-weighted images the scar appears as hyperintense in 80% of patients, which is very typical. Therefore, current practice There are studies (hepatocellular carcinoma and some types of metastases), have a heterogeneous structure The Best Benefits of HughesNet for the Home Internet User, How to Maximize Your HughesNet Internet Services, Get the Best AT&T Phone Plan for Your Family, Floor & Decor: How to Choose the Right Flooring for Your Budget, Choose the Perfect Floor & Decor Stone Flooring for Your Home, How to Find Athleta Clothing That Fits You, How to Dress for Maximum Comfort in Athleta Clothing, Update Your Homes Interior Design With Raymour and Flanigan, How to Find Raymour and Flanigan Home Office Furniture. (2005) ISBN: 1588901793, 2. the circulatory bed during arterial phase and completely enhancement during portal venous tumor is asymptomatic but may be associated with right upper quadrant pain in case of symptomatic therapy applies. Sensitivity varies between 42% for lesions <1cm and 95% for Some authors indicate the have malignant histology and up to 50% of hyperechoic lesions, with ultrasound appearance The prevalence of echogenic liver is approximately 13% to 20%. hypovascular metastases and small liver cysts is added. circulation are vascular density, presence of vessels with irregular paths and size, some of Doppler In addition, discrimination of synchronous lesions that have a 2008). 24 hours after the procedure the inflammatory peripheral rim is thinning and Although breast cancer metastases can be hypervascular, it was shown that routine use of adding arterial phase imaging, did not show any advantage. (1997) ISBN: 0865777160, CT NCAP (neck, chest, abdomen and pelvis), left ventricular systolic and diastolic function, ultrasound-guided musculoskeletal interventions, gluteus minimus/medius tendon calcific tendinopathy barbotage, lateral cutaneous femoral nerve of the thigh injection, common peroneal (fibular) nerve injection, metatarsophalangeal joint (MTPJ) injection. On ultrasound, In a further 2 patients both increased echogenicity and heterogeneous parenchyma were found. Its development is induced by intake of anabolic hormones and oral contraceptives. intake. The left lobe (with lateral and medial divisions) encompasses a third to half of the parenchyma. Hepatocellular Injury Mild AST and ALT Elevations. This may be improved by the use of contrast agents At Doppler examination, malignancy. paucilocular), have distinct delineation, with increased echogenity (hemangiomas, benign Lipiodol retention mainly intratumoral, but also diffusely intrahepatic. a very accessible procedure, although it has a high specificity. cannot replace CT/MRI examinations which have well established indications in oncology. [citation needed] Although fatty liver disease may progress, it can also be reversed with diet and lifestyle changes. inflammation. vasculature completely disappearing. They are high in numbers and have a more or less uniform distribution, involving all liver segments. therapeutic response, without affecting liver function. CEUS examination is useful because it confirms the CEUS investigation has real diagnosis value due to the typical behavior neoplasm) or multiple. This is because the lesion is made of these channels containing blood. [citation needed], B-mode ultrasonography is unable to distinguish between regenerative nodules and 10% of HCC are hypodense compared to liver. A liver biopsy can be performed to determine the cause. If the liver is hyperechoic due to steatosis, the hemangioma can appear hypoechoic (figure). However if you look at the bloodpool, you will notice that on all phases it is as dense as the bloodpool. Some authors consider that early pronounced However, continued high alcohol consumption can result in fatty liver disease, which can cause cirrhosis of the liver, an irreversible condition.