Myxoid liposarcoma of the spermatic cord: US and MR imaging findings

We report a patient with myxoid liposarcoma of the spermatic cord in whom combined use of both ultrasound (US) and MRI helped to suggest the diagnosis. The lesion was solid at US and vascularized at color Doppler. T1‐weighted MRI did not show fat within it; on T2‐weighted images it had high signal intensity, with a cyst‐like appearance. It is known that fat‐poor myxoid liposarcomas with high water content may mimic a cystic lesion on non‐contrast‐enhanced MR; then, a combination of MRI findings, suggesting a cyst, and of US findings, showing the mass was actually solid and vascularized, allowed preoperatively the diagnosis of fat‐poor myxoid liposarcoma. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :96–99, 2014     

A case of gallbladder perforation detected by sonography after a blunt abdominal trauma

Gallbladder (GB) perforation is a very rare posttraumatic abdominal injury. It is potentially life‐threatening, and good outcome requires early diagnosis. We present a case of isolated posttraumatic GB perforation in which the precise sonographic (US) diagnosis led us to apply proper management. Color Doppler US showed a clear to‐and‐fro flow signal passing through the perforation site, and contrast‐enhanced US confirmed the presence of a small defect in the GB wall. When examining posttraumatic patients, the possibility of GB perforation must be kept in mind. Color Doppler US and contrast‐enhanced US are the examinations of choice to detect the perforation site and show bile movement through the perforation. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :301–304, 2014     

Influence of paramagnetic melanin on the MRI contrast in melanoma: a combined high‐field (11.7 T) MRI and EPR study

Melanoma is the most dangerous form of skin cancer and its incidence is rising each year. Because the current methods of diagnosis based on the visual aspect of the tumor show limitations, several new techniques are emerging to help in this diagnosis, amongst which are magnetic resonance imaging (MRI) and electron paramagnetic resonance (EPR). The origin of the typical contrast pattern observable in melanoma in T₁‐ and T₂‐weighted images remains to be elucidated and is a source of controversy. In addition, melanin could create sufficient magnetic inhomogeneities to allow its visualization on T₂*‐weighted images using high‐field MRI. In order to elucidate the possible role of melanin in the MRI contrast of melanoma, the present study was designed to correlate the paramagnetic content in melanin pigment to the contrast on T₁‐, T₂‐ and T₂*‐weighted images. MR images were obtained in vivo at 11.7 T using four types of experimental tumors with different pigmentations (B16, HBL, LND1 melanomas and KHT sarcomas). The paramagnetic content in melanin pigment was measured by EPR. No significant correlation was observed between the content in melanin and the relaxation times T₁, T₂ and T₂*, emphasizing that the presence of pigment alone has negligible effect on the MRI contrast. Copyright © 2014 John Wiley & Sons, Ltd.     

MRI of recurrent rectosigmoid carcinoma

Background: A prospective study was performed to determine the most reliable MRI criteria to distinguish recurrent rectosigmoid carcinoma from benign postoperative fibrosis. Methods: Twenty-two consecutive patients who were suspected to have recurrent rectosigmoid carcinoma were examined by T2 and precontrast and contrast enhanced T1 weighted images. The prospective interpretations, the presence of high signal on T2 weighted images, the shape of the margins of a mass and the degree of contrast enhancement were correlated with histology and follow up to determine their respective accuracies, sensitivities and specificities. Results: The best criteria for recurrent tumor was the combination of high signal on T2 weighted images, round margins and > 40% contrast enhancement, which had an accuracy of 92%, sensitivity of 100% and specificity of 85%. In patients who were more than one year postoperative the specificity was 100%. Conclusions: The most reliable MRI criteria for distinguishing recurrent rectosigmoid carcinoma from benign postoperative fibrosis are the combination of the signal intensity on T2 weighed images, the shape of the margins of a mass and the presence of greater than 40% contrast enhancement. Received: 6 February 1996/Accepted after revision: 19 June 1996     

Contrast enhancement by lipid‐based MRI contrast agents in mouse atherosclerotic plaques; a longitudinal study

The use of contrast‐enhanced MRI to enable in vivo specific characterization of atherosclerotic plaques is increasing. In this study the intrinsic ability of two differently sized gadolinium‐based contrast agents to enhance atherosclerotic plaques in ApoE^?/? mice was evaluated with MRI. We obtained a kinetic profile for contrast enhancement, as the literature data on optimal imaging time points is scarce, and assessed the longer‐term kinetics. Signal enhancement in the wall of the aortic arch, following intravenous injection of paramagnetic micelles and liposomes, was followed for 1 week. In vivo T₁‐weighted MRI plaque enhancement characteristics were complemented by fluorescence microscopy of NIR₆₆₄ incorporated in the contrast agents and quantification of tissue and blood Gd–DTPA. Both micelles and liposomes enhanced contrast in T₁‐weighted MR images of plaques in the aortic arch. The average contrast‐to‐noise ratio increased after liposome or micelle injection to 260 or 280% respectively, at 24 h after injection, compared with a pre‐scan. A second wave of maximum contrast enhancement was observed around 60–72 h after injection, which only slowly decreased towards the 1 week end‐point. Confocal fluorescence microscopy and whole body fluorescence imaging confirmed MRI‐findings of accumulation of micelles and liposomes. Plaque permeation of contrast agents was not strongly dependent on the contrast agent size in this mouse model. Our results show that intraplaque accumulation over time of both contrast agents leads to good plaque visualization for a long period. This inherent intraplaque accumulation might make it difficult to discriminate passive from targeted accumulation. This implies that, in the development of targeted contrast agents on a lipid‐based backbone, extensive timing studies are required. Copyright © 2012 John Wiley & Sons, Ltd.     

肝内脂肪瘤和血管平滑肌脂肪瘤的CT和MRI诊断

目的 探讨肝内脂肪瘤和血管平滑肌脂肪瘤的CT和MRI表现及其相应病理组织学基础。方法 收集经手术病理证实的肝内脂肪瘤和血管平滑肌脂肪瘤各3例和5例。其中7例作平扫和动、门双期螺旋CT增强扫描，1例只作平扫和平衡期增强CT扫描，2例同时加作MRI平扫和动态增强扫描。影像表现与病理组织学所见进行对照研究。结果 3例肝脂肪瘤CT平扫低密度，CT值-79～-92HU，边界清楚，密度均匀，增强扫描无明显强化。其中1例作MRI扫描，表现为T1、T2均呈均匀高信号；T1脂肪抑制呈低信号。光镜见肿瘤由丰富的脂肪组成。5例肝血管平滑肌脂肪瘤中，4例为单发肝内瘤灶，1例为肝内多发并双肾病灶。肝血管平滑肌脂肪瘤的CT平扫，表现为病灶存在不同程度的脂肪密度和低于肝组织密度的软组织区域，CT值由-83～ 41HU；动、门双期CT扫描，病灶非脂肪密度部分明显强化，高于周围肝组织，延迟期则等于或低于肝实质密度，其中2例见动脉期病灶周围肝静脉“早显”。脂肪密度区域则无明显强化。1例同时作MRI扫描，对应CT脂肪密度部分表现为T1、T2不均匀高信号，用脂肪抑制序列扫描T1高信号变为低信号。光镜见肿瘤由丰富的脂肪、血管和不同程度的平滑肌组织组成。结论 肝脂肪瘤和血管平滑肌脂肪瘤的CT、MRI表现具明显特征性，CT、MRI平扫及动态增强扫描能在术前对其作出准确诊断。     

Tumor vessel destruction resulting from high-intensity focused ultrasound in patients with solid malignancies

The purpose of this study was to explore the sequential imaging and histologic alterations of tumor blood vessels in the patient with solid malignancies after extracorporeal treatment of high-intensity focused ultrasound (HIFU). A total of 164 patients underwent extracorporeal HIFU ablation of malignant solid tumors. After HIFU treatment, enhanced magnetic resonance imaging (MRI), color Doppler ultrasound (US) imaging, dynamic radionuclide scanning, digital subtraction angiography, and histologic study were performed to monitor the response of tumor vessels to HIFU ablation. Compared with tumor images in the patients before HIFU, clinical images showed an abrupt interruption, followed by the cessation of blood flow within the tumor vessels after HIFU treatment. The histologic examination indicated that not only the treated tumor cells showed coagulative necrosis, but also small tumor vessels were severely damaged by the HIFU treatment. The results strongly imply that the damaged tumor vessels might play a critical role in secondary tumor cell death, and then indirectly strengthen the destructive force of focused US beams on tumor tissue. It is concluded that tumor vessel damage can be induced by HIFU, which may be a promising strategy in the treatment of patients with solid malignancies.     

A Method for Assessing the Microvasculature in a Murine Tumor Model Using Contrast‐Enhanced Ultrasonography

Objective. The purpose of this study was to develop a method for assessing tumor vascularity in a preclinical model of breast cancer using contrast‐enhanced ultrasonography. Methods. Eight mice were injected with 67NR breast cancer cells on their hind limbs and imaged with ultrasonography 8 days later. Mice were injected with an ultrasound contrast agent (UCA), and a sequence of images of the resultant backscattered echoes was recorded before and after high‐power “destruction” pulses for each of multiple parallel planes. From these, data maps of the maximum contrast enhancement (within each time course) were constructed for each pixel, which enabled reconstruction of high‐resolution coregistered sections into a 3‐dimensional (3D) volume reflecting tumor vascularity. Additional studies were performed to determine the duration and repeatability of image enhancement, and images were correlated with conventional 3D power Doppler measurements. Results. The lifetime of the UCA in vivo was found to be 4.3 ± 1.09 minutes (mean ± SD). The 3D contrast‐enhanced ultrasonographic technique produced images that correlated well with power Doppler images in specific regions but also depicted additional regions of flow surrounding the power Doppler signal. The mean correlation coefficient between voxel measurements of the central slice for each animal was 0.64 ± 0.07 (P < .01). In addition, sequential studies in each animal were reproducible. Conclusions. A method producing high‐resolution volumetric assessments of tumor vascularity in a preclinical model of breast cancer is shown that correlates with other ultrasonographic measures of blood flow, which may provide greater sensitivity to the microvasculature.     

Small hypervascular hepatocellular carcinoma versus hypervascular pseudolesions: differential diagnosis on MRI

BACKGROUND: We wanted to differentiate small hypervascular hepatocellular carcinoma (HCC) from hypervascular pseudolesion (HPL) on magnetic resonance imaging (MRI). METHODS: We reviewed small hypervascular foci (< or = 2 cm in diameter) on dynamic MRI in patients with chronic liver disease, which were followed-up with serial MRI examinations. RESULTS: Twenty of 34 hypervascular foci were larger at follow-up; 19 of 20 foci had characteristics suggesting HCC; and 14 foci did not grow or disappeared and were judged to be HPLs. There were no differences in the initial sizes and follow-up periods between HCCs and HPLs. On initial MRI, nine of 19 HCCs (47%) and one of 14 HPLs (7%) appeared hyperintense on T2-weighted images. The difference between HCCs and HPLs on T2-weighted images was statistically significant (p = 0.039). CONCLUSION: HPLs are seen frequently as small hypervascular foci on dynamic MRI in patients with chronic liver disease. Hyperintensity of the foci on T2-weighted images differentiates HCCs from HPLs.     

Usefulness of contrast-enhanced ultrasonography in the diagnosis of renal pseudotumors

Background: Within the term “pseudotumors” are grouped some renal anatomic variations that may simulate a focal renal lesion at ultrasonography. Our purpose was to assess the accuracy of contrast-enhanced ultrasonography (CEUS) using a second-generation contrast agent in the diagnosis of renal pseudotumors. Methods: We retrospectively retrieved CEUS examinations performed in 24 patients for characterization of suspected renal pseudotumor, in which conventional and power Doppler US study had been unable to confidently exclude a neoplasm. The considered criterion to define the diagnosis of renal pseudotumor was the demonstration of the same perfusion and reperfusion after microbubble breakage in both pseudotumor and surrounding parenchyma during early and late corticomedullary phase. In all patients, multiphase CT or dynamic MRI was available, representing a standard of reference for this study. In cases of CT or MRI diagnosis of renal lesion, final diagnoses were obtained with percutaneous renal biopsy or with surgery. Results: Contrast-enhanced ultrasonography diagnosis was concordant with MR or CT images in all cases. Conclusion: In our experience CEUS shows complete concordance with CT and MRI in the characterization of all 24 pseudotumors considered dubious at conventional and power Doppler US. The appropriate use of CEUS can reduce the need for contrast-enhanced CT or dynamic MRI in this item.     

Mn‐loaded apoferritin: a highly sensitive MRI imaging probe for the detection and characterization of hepatocarcinoma lesions in a transgenic mouse model

Mn‐Apo is a highly sensitive MRI contrast agent consisting of ca. 1000 manganese atoms entrapped in the inner cavity of apoferritin. Part of the metallic payload is in the form of Mn²⁺ ions that endow the nano‐sized system with a very high relaxivity that can be exploited to detect hepatocellular carcinoma in mice. Cellular studies showed that Mn‐Apo is readily taken up by normal hepatocytes via the ferritin transporting route. Conversely, hepatoma cells (HTC) displayed a markedly reduced ability to entrap Mn‐Apo from the culture medium. The i.v. administration of Mn‐Apo into C57BL/6 J mice resulted in a marked liver tissue hyperintensity in T₁‐weighted MR image 20 min after injection. When injected into HBV‐tg transgenic mice that spontaneously develop hepatocellular carcinoma (HCC), Mn‐Apo allowed a clear delineation of healthy liver tissue and tumor lesions as hyperintense and hypointense T₁‐weighted MR images, respectively. Immunohistochemistry analysis correlated Mn‐Apo cellular uptake to SCARA5 receptor expression. When the MRI contrast induced by Mn‐Apo was compared with that induced by Gd–BOPTA (a commercial contrast agent known to enter mouse hepatocytes through organic anion transporters) it was found that only some of the lesions were detected by both agents while others could only be visualized by one of the two. These results suggest that Mn‐Apo may be useful to detect otherwise invisible lesions and that the extent of its uptake directly reports the expression/regulation of SCARA5 receptors. Mn‐Apo contrast‐enhanced MR images may therefore contribute to improving HCC lesion detection and characterization. Copyright © 2012 John Wiley & Sons, Ltd.     

Ultra‐small gadolinium oxide nanoparticles to image brain cancer cells in vivo with MRI

The majority of contrast agents used in magnetic resonance imaging (MRI) is based on the rare‐earth element gadolinium. Gadolinium‐based nanoparticles could find promising applications in pre‐clinical diagnostic procedures of certain types of cancer, such as glioblastoma multiforme. This is one of the most malignant, lethal and poorly accessible forms of cancer. Recent advances in colloidal nanocrystal synthesis have led to the development of ultra‐small crystals of gadolinium oxide (US‐Gd₂O₃, 2–3 nm diameter). As of today, this is the smallest and the densest of all Gd‐containing nanoparticles. Cancer cells labeled with a sufficient quantity of this compound appear bright in T₁‐weighted MRI images. Here we demonstrate that US‐Gd₂O₃ can be used to label GL‐261 glioblastoma multiforme cells, followed by localization and visualization in vivo using MRI. Very high amounts of Gd are efficiently internalized and retained in cells, as confirmed with TEM and ICP‐MS. Labeled cells were visualized in vivo at 1.5 T using the chicken embryo model. This is one more step toward the development of “positively contrasted” cell tracking procedures with MRI. Copyright © 2010 John Wiley & Sons, Ltd.     

彩色多普勒超声在精索扭转诊断鉴别诊断中的应用研究进展

在泌尿外科中,精索扭转是导致急性阴囊胀痛常见致病因素,在临床中极易出现漏诊及误诊情况。在以往的评估诊断中大多采用常规超声辅助检查,但该项检测不能够对微小血管及低速血流进行准确显示,进而不利于病情准确判定。彩色多普勒超声属于一种新型的超声检查技术,本研究通过对精索扭转患者采用彩色多普勒超声诊断,进而对其应用价值展开综述。     

Diagnosis of advanced hepatocellular carcinoma using contrast-enhanced harmonic gray-scale imaging with enhancement agents (Levovist): Correlation with helical CT and US angiography

We compared contrast-enhanced harmonic gray-scale imaging with helical CT and US angiography to evaluate vascularity in advanced hepatocellular carcinoma (HCC). Contrast-enhanced harmonic gray-scale imaging using Levovist (Nihon Schering, Tanabe) as the contrast agent and enhanced helical CT were performed on 38 patients with 45 lesions (29 men and 9 women aged 41 to 83 years; mean age, 66 years; mean maximum tumor diameter, 30.5±23.0 mm), and angiography was performed to evaluate 37 lesions from 32 of these 38 patients (24 men and 8 women, aged 41 to 79 years; mean age, 65 years; mean maximum tumor diameter, 27.9±17.9 mm). Contrast-enhanced harmonic gray-scale imaging showed hypervascular enhancement in 41 of the 45 lesions; the other 4 lesions were not visualized as hypervascular because 3 of the them could not be detected with non-enhanced US and the remaining lesion was situated deep in the liver and more than 11 cm from the surface of the body. Helical CT showed areas of high attenuation in 40 of the 45 lesions, leaving the other 5 lesions equivocal, while US angiography achieved positive enhancement in 36 of 37 lesions. Intratumoral vessels were visualized with contrast-enhanced harmonic gray-scale imaging in 25 of the 45 lesions; however; intratumoral vessels were seen in only 4 of the 45 lesions examined with helical CT. In evaluating vascularity in advanced HCC, contrast-enhanced harmonic gray-scale imaging with Levovist was as effective as US angiography and more effective than helical CT. Motion artifacts produced by the heart make it difficult to evaluate vascularity in advanced HCC located in the left lobe of the liver with Doppler sonography. Contrast-enhanced harmonic gray-scale imaging can show intratumoral vessels and hypervascular enhancement of the tumor without motion artifacts, however, even when the tumor is located near the heart or large vessels. Contrast-enhanced harmonic gray-scale imaging is useful for evaluating vascularity in advanced HCC when the tumor can be visualized with non-enhanced US.     

Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion.

Objective. The purpose of this study was to prospectively investigate the role of high‐resolution and color Doppler sonography in the differential diagnosis of acute scrotum and testicular torsion in particular. Methods. Patients who underwent sonography for acute scrotum between April 2000 and September 2005 were included in the study. Gray scale and color Doppler sonography of the scrotum was performed. The spermatic cord was studied on longitudinal and transverse scans from the inguinal region up to the testis, and the whirlpool sign was looked for. Results. During this period, 221 patients underwent sonography for acute scrotum. Sixty‐five had epididymo‐orchitis with a straight spermatic cord, a swollen epididymis, testis, or both, an absent focal lesion in the testis, and increased flow on color Doppler studies along with the clinical features of infection. Three had testicular abscesses. Sonography revealed features of torsion of testicular appendages in 23 patients and acute idiopathic scrotal edema in 19. Complete torsion was seen in 61 patients who had the whirlpool sign on gray scale imaging and absent flow distal to the whirlpool. There was incomplete torsion in 4 patients in whom the whirlpool sign was seen on both gray scale and color Doppler imaging. Nine patients had segmental testicular infarction, and 1 had a torsion‐detorsion sequence revealing testicular hyperemia. In 14 patients, the findings were equivocal. There was a complicated hydrocele, mumps orchitis, and vasculitis of Henoch‐Schönlein purpura in 1 patient each. Five patients had normal findings. Fourteen were lost for follow‐up. Conclusions. Sonography of acute scrotum should include study of the spermatic cord. The sonographic real‐time whirlpool sign is the most specific and sensitive sign of torsion, both complete and incomplete. Intermittent testicular torsion is a challenging clinical condition with a spectrum of clinical and sonographic features.     

Dynamic manganese‐enhanced magnetic resonance imaging can detect chronic cryoinjury‐induced infarction in pig hearts in vivo

The purpose was to investigate whether MnCl₂ can serve as an MRI contrast agent to detect chronic cryoinjury infarction in pigs in vivo and whether MnCl₂ causes significant hemodynamic disturbances. Hearts were subjected to a topical 2 min cryothermia to establish myocardial infarction (MI). Thereafter GdDTPA‐enhanced MRI was performed at 0, 1, 2 and 3 weeks using a 3 T scanner. Four weeks post‐cryoinjury the pigs underwent in vivo Mn‐enhanced magnetic resonance imaging (MEMRI). MnCl₂ (70 μmol/kg, 14 min) was infused i.v. intermittently (n = 4) or continuously (n = 5) and T₁‐weighted images were acquired every 2 min simultaneously recording heart rate and arterial blood pressure. Either infusion scheme led to an immediate increment in MR signal intensity (SI) within the left ventricular (LV) blood pool and LV normal and cryoinjured myocardium, which reached a maximum at the end of infusion. No significant difference was observed between the normal and cryoinjured myocardium. After infusion termination, SI decreased faster within the LV blood pool and the MI, as compared with the normal myocardium in either group, resulting in significant contrast between the MI and normal tissue (intermittent: 18 ± 7 vs 49 ± 13%, p = 0.002; continuous: 19 ± 8 vs 36 ± 9%, p = 0.004). Infarction sizes were similar in Mn²⁺‐ and GdDTPA‐enhanced images at 4 and 3 weeks post injury, respectively. Thus, in vivo MEMRI differentiated infarcted from normal myocardium in pig hearts subjected to 4‐week cryoinjury. Compared with intermittent infusion, continuous infusion minimized hemodynamic fluctuations. Copyright © 2011 National Research Council Canada.     

Sonographic appearance of focal fatty infiltration of the pancreas

We report the sonographic, CT, and MRI findings in a case of focal fatty infiltration of the pancreas. Sonography revealed an echogenic mass in pancreas head. On CT, the mass was hypodense. The mass showed same signal intensity to the surrounding normal pancreas on in‐phase T1‐weighted MR images and a loss of signal intensity on opposed‐phase MR images. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010     

Torsion of the spermatic cord: the main gray-scale and doppler sonographic signs

Scrotal ultrasonography (US) is usually the initial imaging modality for evaluating patients who present with acute pathologic conditions of the scrotum. Acute epididymitis, acute epididymo-orchitis, torsion of the spermatic cord (TSC), and other acute scrotal abnormalities may have similar findings at clinical examination. Pain and swelling make the clinical examination difficult, sometimes practically impossible, potentially resulting in management delays. The objective of this review is to summarize the main clinical signs of the TSC and to illustrate and briefly discuss the US features of this entity, including gray-scale imaging, color Doppler with spectral analysis, and power Doppler sonography. Although TSC can occur at any age, it is most common in adolescent boys. The intensity of the symptoms and the US findings vary with the duration of the torsion, number of twists in the spermatic cord (degree of rotation), and how tightly the vessels of the cord are compressed. An enlarged, more spherical, and diffusely hypoechogenic testis without detectable arterial and venous testicular flow at color and power Doppler US is considered diagnostic of acute testicular ischemia. The presence of a color or power Doppler signal in one part of the testis does not exclude TSC. Positive blood flow but significantly diminished, usually near or inside the mediastinum, may be found, mainly in the partial or incomplete TSC. Identification of a large echogenic extratesticular mass distal to the site of the torsion, frequently misinterpreted as a chronic epididymitis, can be the key to the diagnosis of TSC. When a small arterial sign is found a low amplitude waveform is present with an increased resistive index on the affected side due to a diminished, absent, or reversed diastolic flow. Gray-scale imaging, color Doppler, power Doppler and pulsed Doppler with spectral analysis are very effective to make or exclude the diagnosis of TSC.     

Value of Contrast‐Enhanced Ultrasonography in Assessing the Vascularity of Liver Metastases

Objective. The purpose of this study was to compare the capability of contrast‐enhanced ultrasonog‐raphy (CEUS) and contrast‐enhanced computed tomography (CECT) in evaluating the vascularity of liver metastases. Methods. Both CEUS and CECT examinations were performed on 70 patients with liver metastases, which were from colon carcinoma in 31, rectal carcinoma in 17, pancreatic carcinoma in 5, and others in 17. In patients with multiple lesions, the most easily observed lesion was selected as the target lesion for evaluation of vascularity. Results. Peak enhancement of the target lesion during the arterial phase was characterized as hyperenhancement, isoenhancement, hypo‐enhancement, and nonenhancement in 61 (87.1%), 6 (8.6%), 3 (4.3%), and 0 (0%) patients on CEUS, respectively, and in 52 (74.3%), 8 (11.4%), 8 (11.4%), and 2 (2.9%) on CECT. Contrast‐enhanced ultrasonography showed more lesions with hyperenhancement than CECT (P < .01). The enhancement pattern during the arterial phase was homogeneous, inhomogeneous, and rimlike in 30 (42.9%), 16 (22.9%), and 24 (34.2%) patients on CEUS and in 13 (18.6%), 8 (11.4%), and 49 (70%) on CECT. Contrast‐enhanced ultrasonography revealed more lesions with homogeneous enhancement than CECT (P < .01). Contrast‐enhanced ultrasonography showed dysmorphic vessels in 33 patients (47.1%) during the arterial phase, whereas CECT showed dysmorphic vessels in 27 (38.6%; P < .01). Contrast‐enhanced ultrasonography showed hypervascular lesions in 58.6% of patients, whereas CECT showed hypervascular lesions in 12.9% (P < .01). Conclusions. Contrast‐enhanced ultrasonography was superior to CECT in assessing the vascularity of liver metastases.