In ultrasonic diagnosis of abdominal organs very common find are small “spots” in the liver. Some hearths may be represented by benign vascular haemangioma formations that require periodic observation, some of the hearths can be represented by benign formations developed from hepatocytes (liver cells). For this reason they require closer observation. But more often focal liver formations are malignant tumours which are either secondary (metastases) or primary.
Tactics of treatment and observation of patients with different formations in the liver are completely different, but the method of ultrasound diagnosis in the vast majority of cases only suggests the nature of education. For accurate diagnosis, a more informative method of research is needed, such as multi-layered spiral computed tomography (MST) and magnetic resonance imaging (MRI), which allows to view small pockets in the liver up to sizes of several millimetres.
In order to determine the nature of the hearths in the liver, MSCT and liver MRI should be performed with intravenous contrast. At the same time, the contrast drug should be administered with an automatic syringe, and the volume of contrast matter at ICAC should be at least 100 ml. Introduction of a contrast drug with post-contrast scanning in several phases allows you to see the blood supply of each hearth in the liver, assess the rate of inflow and outflow of the contrasting drug and on this basis draw conclusions about the nature of formations and avoid invasive research with a biopsy.
If the patient is proven to have a haemangioma, further observation can be carried out by ultrasound or non-contrast MRI. The presence of focal nodular hyperplasia (focal nodular hyperplasia) requires periodic control examinations on MRI (possibly non-contrast study) or on ICST (with a painful contrast).
When malignancies are detected in the liver, the correct scan on MRI or MSCT with pain contrast and multiphase scanning allows assessment of the condition of unmodified liver tissue, to assess the ratio of tumours with veins, arteries and bile ducts of the liver, which, in the end, allows surgeons to plan surgical treatment. Multi-ochgic liver damage in the presence of metastases also requires the full implementation of the study. The most detailed information on the volume of liver damage in patients with metastases allows to obtain MRI with the use of a specialized hepatospecific contrasting drug, which makes it possible to detect pockets of size from 2.5 mm. Detailed data on the size and localization of each of the centres are extremely important for planning the operation or to monitor the effectiveness of chemotherapy.
The choice of the method used – MRI or MSCT – depends on the patient’s contraindications to this or that method: metal implants, rhythm drivers, heart valves, fear of enclosed space, contraception to the introduction of iodine-containing drugs, etc.