What are the ultrasound findings of primary liver cancer?
Sep 23, 2025
Source: Cainiu Health
Dr. Gao Jun
Introduction
Primary liver cancer, a malignant tumor originating from hepatocytes or intrahepatic biliary epithelial cells, typically presents on ultrasound as abnormal echogenicity of liver masses, characteristics of mass margins, internal structural changes of the mass, abnormalities in intrahepatic blood vessels, and alterations in perihilar tissues. Patients are advised to undergo regular follow-up liver ultrasounds to closely monitor lesion changes and strictly adhere to the treatment plan prescribed by their physician.
Generally, primary liver cancer, a malignant tumor originating from hepatocytes or intrahepatic biliary epithelial cells, presents on ultrasound as abnormal echogenicity of liver masses, characteristics of mass margins, internal structural changes of the mass, abnormalities in intrahepatic blood vessels, and alterations in perihilar tissues. The specific findings are as follows:
1. Abnormal mass echogenicity: On ultrasound, primary liver cancer typically appears as a hypoechoic mass. Some lesions may be isoechoic or hyperechoic, while a minority show mixed echogenicity. Hypoechoic masses are commonly seen in early-stage tumors; as the tumor grows and develops necrosis or fibrosis internally, it may evolve into mixed echogenicity.
2. Mass boundary characteristics: Most liver cancer masses have poorly defined, irregular borders. Some lesions may be surrounded by a hypoechoic halo, caused by peritumoral fibrous tissue proliferation or compressed liver parenchyma. A few small, early-stage hepatocellular carcinomas may have relatively clear boundaries and appear nearly round.
3. Internal structural changes of the mass: Larger liver tumors may develop liquefactive necrosis, appearing as anechoic areas on ultrasound. Calcifications may also be present within some lesions, appearing as punctate or patchy hyperechoic foci with posterior acoustic shadowing.
4. Intrahepatic vascular abnormalities: When tumors invade intrahepatic vessels, ultrasound may detect thrombi in the portal or hepatic veins, appearing as hypoechoic or isoechoic intraluminal masses that cause vessel stenosis or occlusion. Additionally, abnormal neovascularization may be observed around some tumors.
5. Perihepatic tissue changes: Advanced liver cancer may invade the liver capsule, causing local elevation or indentation of the capsule. If tumor rupture leads to hemorrhage, ultrasound may reveal fluid-filled dark spaces in the perihepatic regions. Furthermore, some patients may exhibit ultrasound signs of liver cirrhosis, such as an irregular liver surface and coarse, heterogeneous parenchymal echotexture.
Patients are advised to undergo regular follow-up liver ultrasounds to closely monitor lesion changes and strictly adhere to the treatment plan prescribed by their physicians. Maintaining a low-fat diet, avoiding alcohol, and reducing liver burden in daily life can help stabilize the condition.
