Improved detection of hepatic metastases of adrenocortical cancer by contrast-enhanced ultrasound

Adrenocortical carcinoma (ACC) is a rare and heterogeneous malignancy whose pathogenesis and poor prognosis is poorly understood. Computerized tomography (CT) and magnetic resonance imaging (MRI) are routinely performed for the imaging of the adrenal mass and for standard staging of the chest and abdomen as the lung and liver are the primary organs for metastasis in ACC. Contrast-enhanced ultrasound has been shown to have a high sensitivity and specifity for the differentiation of hepatic and neuroendocrine tumors. Twelve patients (7 women and 5 men; aged 24-74 years) with ACC were treated in our centre from 2004 to 2006. The patients received staging with a contrast-enhanced multislice spiral computed tomography (MSCT) as well as with a conventional and an echo-enhanced ultrasound of the liver. Contrast-enhanced ultrasound demonstrated liver metastases in 8 out of 12 patients (67%) and MSCT in 6 out of 12 patients (50%). In 2 out of 8 patients (25%) MSCT did not detect the liver metastases. Even in retrospective analysis with knowledge of the ultrasound results, the hepatic lesions were not recognized by the MSCT, but became detectable by MSCT at a later time point. All hepatic lesions diagnosed by MSCT were also seen by ultrasound. The detection of liver metastases by ultra-sound resulted in a change of therapy in two patients. The contrast-enhanced ultrasound has a high sensitivity in detecting the highly-vascularized liver metastases of ACC and should be included in the staging algorithm of ACC.