Echo-enhanced ultrasound has a higher sensitivity than high-resolution CT in the detection of hepatic metastasis of adrenocortical carcinoma
Jürgen Bauditz1, Wolfram Wermke1, Dirk Beyersdorff2, Herbert Lochs1, Christian J. Strasburger1 & Marcus Quinkler1
Background: Adrenocortical carcinoma (ACC) is a rare and heterogeneous malignancy with incompletely understood pathogenesis and poor prognosis. Computerized tomography (CT) and magnetic resonance imaging (MRI) are routinely performed for imaging of the adrenal mass and for standard staging of chest and abdomen as lung and liver are the primary organs for metastatic spread in ACC. Contrast ultrasound is a non-invasive procedure which has been shown to have a high sensitivity and specifity for differentiation of hepatic and neuroendocrine tumours.
Methods: patients (7 women, 5 men; aged 24 to 77 years) with ACC were treated in our centre from 2004 to 2006. Patients received staging with HR-CT as well as with contrast ultrasound (Sonovue/Bracco, Acuson Sequoia/Siemens, CPS) of the liver.
Results: Contrast ultrasound demonstrated liver metastases in 8 of 12 patients (67%), HR-CT showed liver metastases in 6 of 12 patients (50%). In 2 of 8 patients (25%) HR-CT missed detection of liver metastases. Even retrospectively and with knowledge of the ultrasound results, the hepatic lesions were not recognized by HR-CT, but were detectable by HR-CT at a later time point. All hepatic lesions diagnosed by HR-CT were also seen by ultrasound. The detection of liver metastases by ultrasound resulted in a change of therapy in the 2 patients.
Conclusions: Contrast ultrasound has a higher sensitivity than HR-CT in detecting highly vascularized liver metastases of ACC and should be included in the staging algorithm of ACC.