Characterization of solid liver lesions with color and pulsed Doppler imaging

Background: To assess the usefulness of color Doppler and duplex sonography in the characterization of solid liver lesions. Methods: We performed color Doppler and duplex sonography on 106 solid hepatic lesions. With color Doppler, we evaluated the aspect and distribution of tumoral vessels. The pulsed Doppler parameters considered were only those showing the highest systolic peak velocity values. Results: Intratumoral color and pulsed Doppler signals were obtained in 81% (59/73) of malignant tumors (p < 0.0001) but only in 18% (6/33) of benign tumors. Ninety-six percent (45/47) of the lesions with arterial intratumoral and peritumoral signals were malignant, whereas 4% were benign (p < 0.0001). Only eight (11%) malignant lesions had intratumoral venous signal vis-a-vis 23 (70%) benign. Twelve cases showing intratumoral venous Doppler signal as a single finding were benign. No statistically:significant differences were observed in the quantitative parameters recorded by pulsed Doppler (Student t test, p > 0.05), there having been a clear overlapping in the values obtained in benign and malignant lesions. Conclusions: (a) The type of signal (arterial or venous) and its distribution detected by color and pulsed Doppler is more helpful than the assessment of the spectral quantitative parameters obtained by pulsed Doppler. (b) The presence of intratumoral venous flow remarkably suggests benignancy. (c) The presence of both intra- and peritumoral arterial flow in the same lesion strongly suggests malignancy.