Today's Veterinary Practice

JUL-AUG 2011

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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| TODAY’S VETERINARY RESEARCH UÊ/hiÃiÊ«>ÌÌiÀnÃÊÜiÀiÊ`ivviÀinÌÊ Ìh>nÊ ÌhoÃiÊovÊ «Àim>ÀÞÊ nio«l>ÃÌiVÊ liÃionÃ]ÊÜhiVhÊ iÝhiLiÌi`Ê no ring enhancement or hyperechogenicity during the arterial phase. UÊ nÊ £Ê `o}ÊÜiÌhÊ >Ê Vom«liÝÊ hi«>ÌiVÊm>ÃÃÊ `ÕiÊ to metastatic hepatocellular carcinoma on hiÃÌo«>Ìholo}Þ]ÊÌhiÊhi«>ÌiVÊno`ÕliÃÊ>««i>Ài`Ê homogenous to the surrounding liver paren- chyma in both arterial and portal venous phases and were not visualized after contrast >`miniÃÌÀ>Ìion]ÊÀiÃÕlÌin}ÊinÊLiin}Ê`i>}noÃi`Ê as benign by CEUS. DISCUSSION By increasing the intensity of the signal from Lloo`]Ê inÌÀ>Û>ÃVÕl>ÀÊ VonÌÀ>ÃÌÊmi`i>Êhil«Ê`iël>ÞÊ the morphology and shape distortions of tumor Û>ÃVÕl>ÌÕÀi]Ê ÜhiVhÊ >lloÜÃÊ m>««in}Ê >n`Ê >ÃÃiÃÃ- ment of the characteristics of vessel flow.11 The main difference between benign and malig- nant lesions is: UÊ ini}nÊliÃionÃ]ÊiÝVi«ÌÊVÞÃÌÃÊ>n`ÊÌhÀomLoÃi`Ê EVERYDAY APPLICATION 5IJT TUVEZ TIPXT UIF JNQPSUBODF PG VMUSBTPVOE JNBHF JOUFSQSFUBUJPO PG MJWFS OPEVMFT JO HFOFSBM QSBDUJDF )FQBUJD OPEVMFT BSF B WFSZ DPNNPO GJOEJOH FTQFDJBMMZ JO PMEFS DBOJOF QBUJFOUT #FDBVTF OPU BMM PG UIFN BSF NBMJHOBOU UJTTVF TBNQMJOH XJUI '/" PS 5SV DVU CJPQTZ JT OFDFTTBSZ BOE HFOFSBMMZ TBGF "MUFSOBUJWFMZ $&64 JT B TBGF BOE OPOJOWBTJWF QSPDFEVSF )PXFWFS JU EPFT SFRVJSF TQFDJBMJ[FE FRVJQNFOU BOE VMUSBTPVOE QSPCFT BT XFMM BT DPOUSBTU NFEJVN him>n}iom>Ã]Ê iÝhiLiÌÊ iÃo-inh>nViminÌÊ oÀÊ slight hyperenhancement compared to sur- rounding liver tissue during the portal phase. UÊ >li}n>nÌÊ liÛiÀÊ no`ÕliÃÊ iÝhiLiÌÊ hÞ«o«iÀvÕ- sion or early wash-out in the portal phase because the vascular supply of malignant tumors is provided exclusively by arterial ves- sels and there is no portal venous supply.1 Patterns of contrast-enhancement during ultra- sound for specific hepatic lesions have not been extensively described in veterinary medicine. Two previous studies in dogs with hepatocellular car- cinoma described contrast-enhancement patterns Ãimil>ÀÊ ÌoÊ Ìh>ÌÊ voÕn`Ê inÊ ÌhiÃÊ ÃÌÕ`Þ]ÊÜiÌhÊ liÃionÃÊ remaining hypoechoic compared to liver paren- VhÞm>Ê`ÕÀin}Ê ÌhiÊ«oÀÌ>lÊ«h>Ãi]ÊÜhiVhÊm>Àki`lÞÊ increased the conspicuity of these lesions.{]È One ÀiVinÌÊ ÃÌÕ`Þ]ÊÜhiVhÊÕÃi`Ê >ÊniÜÊ VonÌÀ>ÃÌÊ >}inÌ]Ê described a rim pattern of enhancement with malignant histiocytosis.9 This study described the enhancement patterns ovÊ ÎÊ `ivviÀinÌÊmiÌ>ÃÌ>ÌiVÊ ÌÕmoÀÃ°Ê llÊ iÝhiLiÌi`Ê hÞ«iÀiVho}iniViÌÞÊ`ÕÀin}ÊÌhiÊ>ÀÌiÀi>lÊ«h>Ãi]ÊÜiÌhÊ 2 (histiocytic sarcoma and insulinoma) showing Àin}Ê inh>nViminÌ]Ê >n`Ê >llÊÜiÀiÊ hÞ«o«iÀvÕÃi`Ê Vom«>Ài`ÊÌoÊliÛiÀÊ«>ÀinVhÞm>ÊinÊÌhiÊ«oÀÌ>lÊ«h>Ãi]Ê a pattern previously described for metastasis in humans and dogs.{]È]£Ó Limitations This study’s limitations were: UÊ/hiÊVliniV>lÊ`i>}noÃiÃÊÜ>ÃÊL>Ãi`ÊonÊVÞÌolo}ÞÊ in most cases. The use of cytology may be problematic if more than 1 condition is pres- ent in the liver or an individual nodule. For iÝ>m«li]Ê ÌhiÊVÞÌolo}iVÊ`i>}noÃiÃÊovÊniVÀoÃiÃÊ does not exclude the possibility that malig- nant neoplasia is also present. UÊ/hiÊnÕmLiÀÊovÊ`o}ÃÊÜiÌhÊi>VhÊëiViviVÊÌÕmoÀÊ type was small. Future studies that include a larger number of dogs with primary tumors and metastasis from tumors other than hepatocellular carcinoma are needed to (1) better assess the pattern of enhance- ment of specific tumor types and (2) assess whether primary lesions can be differentiated from meta- static lesions based on CEUS. Conclusion Using enhancement patterns and vascular mor- «holo}Þ]Ê 1-Ê ÜiÌhÊ «iÀvlÕoÀo«Ào«>niÊ VonÌÀ>ÃÌÊ medium can be used to differentiate malignant from benign hepatic nodules seen on gray-scale ultrasound. ■ $&64 DPOUSBTU FOIBODFE VMUSBTPOPHSBQIZ '/" GJOF OFFEMF BTQJSBUJPO 1"$4 QJDUVSF BSDIJWF DPNNVOJDBUJPO TZTUFN 60 Today’s Veterinary Practice July/August 2011

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