Malignant spread of neoplasm to hepatic parenchyma

Grayscale ultrasound

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  Hypoechoic metastasis: Usually from hypovascular tumors

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  Hyperechoic metastasis: Hypervascular metastasis

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  “Bull’s-eye” or “target” metastatic lesions: Solid mass with hypoechoic rim or halo

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  Cystic/necrotic metastases: Mural nodules, thick walls, fluid-fluid levels, internal septa/debris

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  Calcified metastases: Mucinous or ossific primaries

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  Infiltrative/diffuse metastases: Lung or breast primary; may mimic cirrhosis, especially treated breast cancer, which can have pseudocirrhosis appearance

Color Doppler ultrasound

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  Metastatic lesions follow vascularity of primary tumor

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  Contrast-enhanced ultrasound increases detectability of hepatic metastases

Cysts (vs. hypoechoic or cystic metastases)

Abscesses (vs. hypoechoic metastases)

Hemangiomas (vs. hyperechoic metastases)

Multifocal hepatocellular carcinomas or cholangiocarcinomas (vs. “target” lesion)

Steatosis (vs. hypo-/hyperechoic metastasis)

Hepatic adenomatosis

Most common malignant tumor of liver

Rule out other other causes of multiple liver lesions, e.g., hepatic cysts, abscesses, or hemangiomas

Always correlate with clinical history and look for evidence of primary tumor