Hepatocellular carcinoma Echocardiography or Ultrasound

On ultrasonography, changes in the liver contour and increased nodularity may be evident. The echo texture may appear coarse along with an increase in echogenicity from focal fatty changes and irregular appearing areas with fibrosis, fatty change, or calcifications.

• Echocardiograms may be helpful in the measurement of ejection fraction and identification of ischemic and hypokinetic areas of the ventricles. This is useful in establishing a diagnosis of congestive cardiac failure because of the underlying cause of liver cirrhosis.
• Contrast echocardiography is a useful diagnostic test for hepatopulmonary syndrome:
  • Intravenous microbubbles (> 10 micrometers in diameter) from agitated normal saline that are normally obstructed by pulmonary capillaries (normally <8 to 15 micrometers) rapidly transit the lung and appear in the left atrium of the heart within 7 heart beats.
  • Intravenous technetium-99m–labeled albumin may transit the lungs and appear in the kidney and brain.

• Ultrasound may be helpful in the diagnosis of hepatocellular carcinoma. Findings on an ultrasound suggestive of hepatocellular carcinoma include:^[1][2]
  • Small hypoechoic lesion with poorly defined margins and coarse irregular internal echoes.
  • When the tumor increases in size it appears heterogeneous with fibrosis, fatty change, or calcifications.
  • Infiltrative HCC may be difficult to differentiate from background cirrhosis.

Contrast-enhanced ultrasound is being adapted for screening and enhancing minimally invasive diagnostic studies. The following phases are noted on the contrast enhanced ultrasonography of hepatocellular carcinoma:^[3][4]

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